Tertiary Care Hospital In South India Research Articles

CYP2C9 polymorphisms are associated with phenytoin toxicity in South-Indian epileptic patients

Background and Aims: The contribution of CYP2C9 in phenytoin metabolism is generally modest, but it increases with increasing serum phenytoin concentration. In the current study, we sought to study the association of CYP2C9*2 and CYP2C9*3 polymorphism with clinical and biochemical phenytoin toxicity in epileptic patients presenting to a tertiary care hospital in South-India. Methods: In total, 50 patients on phenytoin therapy and clinically diagnosed with phenytoin toxicity in neurology outpatient department/casualty/intensive care unit and medicine wards were considered as cases. A total of 50 patients on phenytoin therapy without any evidence of toxicity were considered as controls. CYP2C9*2 (exon-3) and CYP2C9*3 (exon-7) gene polymorphisms were studied using the allele specific PCR method. Results: Out of 100 patients, CYP2C9*2 polymorphism was seen in 8 (8%) patients in which 6 (12%) were cases and 2 (4%) were controls. CYP2C9*3 polymorphism was seen in 23 (23%) patients out of which 17 (34%) were cases and 6 (12%) were controls. Mean serum phenytoin level in cases was 24.23 ± 1.3 μg/ml, whereas in controls, it was 17.10 ± 0.6 μg/ml and the difference was statistically significant with P value Conclusion: Our findings conclude that the presence of CYP2C9*2 and CYP2C9*3 polymorphisms are associated with increased serum phenytoin levels and increased risk of clinical toxicity with phenytoin.

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Surveillance of adverse drug reactions and drug-drug interactions with pediatric oncology patients in a south Indian tertiary care hospital.

The present study was conducted to evaluate the pattern of occurrence of adverse drug reactions and drug-drug interaction in a pediatric oncology unit of a tertiary care hospital. A prospective, observational study was conducted in the Department of Pediatric Oncology, Sri Ramachandra Medical College and Hospital, India. Patients were monitored actively for the occurrences of any adverse drug reaction during the study period. Patient's demographic details, clinical, and treatment data were collected for drug-drug interaction analysis. The detected adverse drug reaction was assessed for causality, severity, and preventability. Drug-drug interaction identified was rated based on their level of urgency and the nature of actions necessary to respond to an interaction. Of 176 patients, 118 were detected for the occurrence of various adverse drug reaction. The majority of the cases were suffering with acute lymphocytic leukemia (67.9%). Vincristine was noted for a maximum number of adverse drug reaction in cytotoxic drugs. Rash is the most frequently occurred reaction. Assessment of causality showed that the majority of cases are "probable" (60.16%). In evaluating the severity of adverse drug reactions, 57.6% reactions were moderately severe and 74.5% of the reactions were preventable. Upon assessing the drug-drug interaction, 38.13% of the prescription needs to be monitored and 10 drug-drug interactions were under the risk category of "X." The majority of the adverse drug reaction was moderately severe in nature and those were preventable. Since pediatrics are vulnerable population, they must have a thorough surveillance system for adverse drug reaction and drug-drug interaction; thereby, a positive impact on the medication-use system and improved patient care can be achieved.

Incidence of complications following umbilical vein catheterisation in neonates

Background: Umbilical vein catheter (UVC) insertion in newborns has life threatening complications like Catheter related bloodstream infections (CRBSI), Portal vein thrombosis (PVT) and other mild complications. This study has been done to assess the incidence and risk factors of complications in neonates with umbilical vein catheterisation.Methods: A prospective observational study was carried out in neonates admitted to a South Indian tertiary care hospital between January 2017- June 2018.Results: Umbilical vein catheterisation was done for 65 neonates, of them 46 completed the study. One neonate (2%) developed CRBSI and none of them developed PVT in both baseline and follow up scans. Minor complications noted were repositioning in 26%, umbilical site leak in 23%, reattempts in 19%, catheter block in 13%, periumbilical erythema in 6% and umbilical site bleed in 2%. There was no statistical significance between minor complications and baseline study characteristics.Conclusions: Although UVC is a common and easy vascular access, it is not without complications. Incidence of serious complications following umbilical vein catheterisation is low when proper technique and sterile precautions are followed. However, the occurrence of mild complications following UVC insertion is high.

Assessment of medication adherence and risk factors for hypothyroidism in South Indian Tertiary care hospital: a cross–sectional study

Assessment of medication adherence and risk factors for hypothyroidism in South Indian Tertiary care hospital: a cross–sectional study

A Prospective Study on Clinically Significant Drug – Drug Interactions by Systematic Review of Case files in a South Indian Tertiary Care Hospital

<p style="text-align: justify;"><strong>Objectives:</strong> The main objective of the study was to recognize potential drug-drug interactions, thus reducing their potential risk and improving pharmaceutical care by minimizing problems that may arise out of improper medication. <strong>Methodology:</strong> A prospective interventional study of a duration of 6 months was conducted in three phases (Pre interventional, Interventional and Post interventional) among 200 inpatients (in the age group of 18 years and above) of Pulmonology, Nephrology, Gastroenterology and General Medicine Departments of a tertiary care referral hospital. <strong>Results:</strong> Out of a total of 495 interactions, 368 (74.34%) interactions occurred in the Pre interventional phase and 127 (25.65%) interactions in Post interventional phase. There was a statistically significant reduction in drug-drug interactions occurring in the Post interventional phase (<em>P</em> value &lt;0.05) which suggests encouraging the intervention of clinical pharmacists in assessing and controlling potential drug-drug interactions.<strong> Conclusion:</strong> Among the conclusions of this study are that a wide number of DDIs exist within a hospital environment. Further, that a majority of the DDIs may be reduced by a significant amount via means of contact programs with both physicians as well as subjects. This may include distributing information letters to physicians concerned and providing bedside patient counseling as was carried out in this study. In conclusion, our study suggests that a clinical pharmacist could make statistically provable improvements in minimizing harmful outcomes of DDIs by means of calculated study and information disbursal of the given medical scenario. <p style="text-align: justify;"><strong> Key words:</strong> Drug drug interactions, Drug Interaction probability scale, Lexicomp, Pharmacodynamic , Pharmacokinetic.

Assessment of medication adherence, quality of life and risk factors among patients with tuberculosis in a South Indian tertiary care hospital: a cross-sectional study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The main objective of the current study was to assess the level of medication adherence, quality of life, risk factors for better treatment outcomes and to improve patient quality of life by giving TB education.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective observational study was conducted on 278 patients (139 tubercular patients and 139 health volunteers). A data collection form of various socio-demographic factors, lifestyle factors, and co-morbid conditions for tuberculosis were collected. The quality of life (QOL) was assessed by interviewing the subjects using WHO-QOL BREF questionnaire. Morisky – 8 item medication Adherence Questionnaire was used for assessing adherence. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In a total of 139 TB patients, high adherence (60.06%), medium adherence (20.86%) and low adherence (10.07%) are reported. WHOQOL-BREF mean domain scores were physical health (54.10±12.33), psychological health (51.73±16.24), social health (62.04±15.35) and environmental health (57.14±16.90) respectively. In present study male (67.63%) are higher than females (32.37%). Risk factors observed in study were statistically significant and discussed in present study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study showed that the MMAS-8 had good reliability and validity for measuring adherence levels in rural TB patients. There was a high level of adherence to anti-TB treatment was seen in study area. WHO-QOL BREF questionnaire had good reliability and validity for measuring quality of life and Improved quality of life observed in patients with high adherence to anti tubercular drugs. Risk factors such as age, education, locality, food habits, income, smoking and alcoholism are independently associated with Tuberculosis.&lt;/p&gt;

Incidence of Medication Errors in a Tertiary Care Hospital in South-India

Incidence of Medication Errors in a Tertiary Care Hospital in South-India

Hypermucoviscous uropathogenic strains of Klebsiella pneumoniae producing extended spectrum beta-lactamase: An experience in South Indian tertiary care hospital

Klebsiela pneumoniae (K. pneumoniae), belongs to Enterobacteriaceae family and is the most pathogenic species that is prominently reasons for infections such as septicaemia, pneumonia and also urinary tract infections (UTIs). The UTIs is due to Gram negative bacteria and could be both nosocomial and also community acquired which are very difficult to treat as a consequence of antibiotics resistance. The increased incidence of antibiotic resistance among these healthcare associated uropathogenic strains of K. pneumoniae leads to increase in mortality, morbidity rates makes the treatment of UTIs less cost effective. Increase in multidrug-resistance and production of extended spectrum Beta- lactamases (ESBLs) by uropathogenic K. pneumoniae strains which are of a greater public health concern. This study was conducted to know the occurrence of hypermucoviscosity and ESBL production in K. pneumoniae isolates from urine samples in a tertiary care medical college hospital in Dakshina Kannada, Mangalore, Karnataka, India. K. pneumoniae isolates were characterized from urinary tract samples by using standard microbiological procedures showing hypermucoviscosity which were screened to test antibiotic sensitivity by using Kirby Bauer disc diffusion and also by double disk synergy test (DDST) for presumptive ESBL production. In our study we found, among 80 samples of uropathogenic K. pneumoniae isolates, 78(97.5%) were hypermucoviscous or hypervirulent, 19(23.7%) isolates were found to be ESBL producers. This shows that ESBL producing K. pneumoniae isolates had a greater capacity to produce hypermucoviscosity (100%) than non-ESBL producing K. pneumoniae isolates (96.7%). Keywords: Klebsiella pneumoniae, Hypermucoviscous, Uropathogenic, Hypervirulent, ESBL production.

Revisit of efficiency of blood usage – Need for continuous audit

Background: The most common indices assessing blood usage are crossmatch-to-transfusion (C/T) ratio, transfusion probability (%T), Transfusion Index (TI), nonusage probability (NUP), and wastage as percentage of issue (WAPI). This study, in a South Indian tertiary care hospital, audits blood utilization efficiency and revisits it after implementing corrective measures for deficiencies identified by the first audit highlighting the importance of continuous surveillance and proper measures in efficient blood utilization. Materials and Methods: Blood utilization over 6 months, assessed by C/T ratio, TI, %T, and NUP indicated inefficient blood usage (high C/T ratio). After initiating appropriate measures, reaudit over 1 month assessed effect on blood usage. The total duration was from December 2017 to November 2018. Request forms packed red blood cells provided patient demographics, number of units requested, and indication. Blood bank records provided number of units crossmatched and issued against each request. Results: Initial audit: total requests- 4450, C:T ratio-3.6, TI-0.5, %T- 32% and NUP- 72%. Reaudit: Total requests-948 (medical 52%, surgical 48%), Overall monthly WAPI- 0.1%, C:T ratio-2.4 (medical 1.3, surgical 3.5), %T-63.5%(medical 84%, surgical 43%), TI-1 (medical 1.4, surgical 0.6), NUP- 24% (medical- 11%, surgical 37%) C/T ratio – no subspecialty crossed the highest acceptable value (2.5) except gynecology and obstetrics (4.1) and pediatric surgery (2.75). All departments met the lowest acceptable %T (30%) except G&O (25.2%). All departments met minimum TI (0.5) except G&O (0.3), pediatric surgery (0.47), and surgical super specialties (0.3). Conclusion: Initial audit showed inefficient blood utilization. Appropriate steps taken to improve this included the establishment of standard protocols. Reaudit showed efficient blood utilization in medical departments and the need for further revision in practices for surgical departments. Hence, continuous monitoring is vital in ensuring effective blood usage.

Scrub typhus-associated acute kidney injury: A study from a South Indian Tertiary Care Hospital.

Infections including scrub typhus contribute to a significant proportion of community-acquired acute kidney injury (AKI) in the tropics. Scrub typhus infection now requires global attention since disease outbreaks are being reported across continents. We intended to study the clinical profile, renal involvement, and parameters predicting renal involvement in scrub typhus infection. This is a retrospective study. The medical records of all patients who were admitted and treated for scrub typhus infection for a study period of two years (from September 2015 to August 2017) were analyzed, and salient clinical features and laboratory results were collected from the hospital data. Statistical analysis was done from the collected data. Our study had 272 patients including 81 children. Adults constituted 70.96% (n = 193) and the remaining 29.04% (n = 81) were pediatric population. Among adults, females constituted 62.7% (n = 121) and males 37.3% (n = 72). The mean age of the adult population was 45.7 ± 15 years and that of pediatric patients was 8.56 ±5.1 years. 18.7% of adult cases and 3.70% of pediatric cases had AKI. Renal replacement therapy was required in 3.67% of adult cases. Mortality was 4.14% in adults and 1.23% in children. Hypotension, pulmonary involvement, central nervous system involvement, multiorgan dysfunction syndrome, increased total counts, elevated aspartate transaminase levels, and hypoalbuminemia predicted AKI in our adult population. Scrub typhus should be considered as a differential in cases presenting with fever and AKI. Outcomes of scrub typhus infection in terms of mortality seem to be improving in this region.

Study of Prescribing Pattern, Identification of Drug Related Problems and Therapeutic Intervention in Cardio Vascular Diseases (CVD) Patients

Cardiovascular disease (CVD) is a disorder of heart and blood vessels. CVD is one of the major causes of deaths in India, which contributed around 30 to 40%. The aim of the study was to study the prescribing pattern of drugs, identification of drug related problems and therapeutic intervention in CVD patients. A hospital based prospective and observational study was carried out for a period of nine months in a south Indian tertiary care hospital. Among 120 selected patients, 79 were male (65.83%) and 41 were female (34.16%), more number of patients (35) were between the age group of 55-64 (29.16%) of which 27 were males &amp; 8 were females, and very less number of patients (6) were between the age group 85-94 (5%) of which all the 6 were male. Hypertension is the most commonest and dominant disorder, which affected 47(39.16%) patients, in which 30 were male (25%) and 17 were female (14.16%). Most common risk factor is HTN followed with smoking and diabetes of 45 patients (37.5%). The most often prescribed pattern adopted in CVD is Dual therapy, it is most frequently used therapy 50 (41.66%) and quadruple therapy is less frequently 6(6.5%) used. The diuretics and calcium channel blocker combination were maximally prescribed class of drugs as a dual therapy. A total of 47 drug-drug interactions were found, among 12 were major, 15 were moderate and 20 were minor interactions. Clinical pharmacist has intervened with the help of other health care professionals in order to reduce the risk factor and minimise the drug-drug interactions. The study provides the benefits of presence of clinical pharmacist in a hospital setting, in order to prevent the medication related errors and provide the expertise pharmacotherapy opinion in CVD patients, which improves the patient compliance. Hence study justifies a need of active collaboration between clinical pharmacist, physician and other health care professionals for the better management of CVD patients.&#x0D; Keywords: Prescribing Pattern; Cardio Vascular Diseases; Drug Related Problems; Therapeutic Intervention.

Drug-Related Problems in South Indian Tertiary Care Hospital

Drug-Related Problems in South Indian Tertiary Care Hospital

Assessment of pattern and outcomes of pesticides poisoning in a tertiary care hospital.

To assess the socio-demographic profile, pattern and treatment outcomes of pesticides poisoning. A prospective observational study was conducted at the department of emergency medicine of a South Indian tertiary care hospital for 1.5 years to study the pattern and outcomes of poisoning cases due to pesticides. Level of significance (P) <0.05 was considered as statistically significant. A total of 375 poisoning victims with intentional/accidental exposure to pesticides were followed up and documented. The male-female ratio was 1:0.32; mean age was 31.65 ± 13.10 years. 72% of cases were rural residents. Organophosphorus compounds were the most implicated pesticides. Mean Glasgow Comatose Score (GCS) of the patients was 12.22 ± 3.86. 80.3% of patients recovered while 6.4% died. About 13.3% patients were lost to follow-up as they were discharged against medical advice (DAMA). There was a statistical significance seen in the implication of pesticides for intentional poisoning with age, route of administration, area of residence and occupation of the victims. However, there was a strong association of the outcomes of poisoning with the toxic agent implicated for the poisoning.

Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital

PurposeDiabetic foot infections (DFIs) are major public health concerns. In the view of the ever increasing burden of multidrug-resistant (MDR) organisms, improving the use of antimicrobial agents (AMAs) is a national priority. Objective of the study was to determine antimicrobial susceptibility (AMS) pattern of aerobes in DFIs. MethodsA cross-sectional study was conducted for a period of 3 years at Department of Surgery, Kasturba hospital, Manipal, India during which, 260 diabetic foot ulcer (DFU) patients admitted in the general surgery wards were enrolled for the study. These patients’ culture specimens were observed as Gram-stained smears and cultured aerobically on blood agar and MacConkey agar plates. AMS test was performed by disc diffusion technique according to Clinical and Laboratory Standards Institute (CLSI) guidelines. ResultsA total of 354 microbes were isolated from the ulcer wounds of 213 diabetic foot patients, with an average of 1.7 organisms per lesion. Monomicrobial infections were less common (n=81; 31.2%) than polymicrobial infections (n=132; 50.7%). Gram-negative bacteria were the most common among the isolates (n=192; 54.2%). Aerobic Gram-positive Cocci accounted for 162 (45.8%) of all isolates. On the other hand, Staphylococcus aureus was the most frequently isolated aerobe (n=106; 29.9%) followed by Pseudomonas aeruginosa (n=91; 25.7%). ConclusionAMS data from our study recommends that doxycycline would be the appropriate choice as single drug for empirical coverage for Gram-positive organisms. The most appropriate antibiotic for Gram-negative organisms is meropenem. One of the critical observations is the presence of Acinetobacter, an MDR isolated from DFIs, which is either relatively or totally resistant to all the AMAs tested.

Incidence and Factors Associated with Drug Related Hospital Admissions in a South Indian Tertiary Care Hospital

Incidence and Factors Associated with Drug Related Hospital Admissions in a South Indian Tertiary Care Hospital

Pattern of growth and neurodevelopmental outcome of preterm babies born ≤34 weeks of gestation in a South Indian tertiary care hospital

Background: Advances in neonatal care since the early days have led to an increase of survival in preterm infants. Developmental sequelae, however are still a major problem mostly because babies who would previously have been expected to die are now surviving due to neonatal intensive care. There is scarcity of data regarding the outcome of prematurity from low and middle-income countries like India in literature.Methods: 140 preterm babies born at or before 34 weeks of gestation were enrolled and followed up for 1 year. All babies were screened for retinopathy of prematurity and hearing impairment. Anthropometric measurements were taken at 40 weeks, 3 months, 6 months, 9 months and 12 months of corrected age. Neurodevelopmental assessment was done using the Bayley scales of infant and toddler development III at 1 year of age.Results: Among 140 preterm babies, 6 babies expired before 1 year. Majority had catch up growth by 1 year of age. Growth and neurodevelopment were inversely proportional to birth weight and gestational age. Incidence of severe ROP requiring intervention was 8.6% and hearing aid was needed in 4%. At 1 year 24% had cognitive delay, 27% had language delay and 29% had motor delay. Intraventricular hemorrhage, culture proven sepsis, shock and DIC in newborn period were strong predictors of neurodevelopmental impairment.Conclusions: Majority of preterm babies showed catch up growth and had good neuro developmental outcome at 1 year of corrected age.

Incidence of Adverse Drug Reactions in a South Indian Tertiary Care Hospital

Incidence of Adverse Drug Reactions in a South Indian Tertiary Care Hospital

Assessment of Medication Adherence to JNC-7 Guidelines and Risk Factors for Hypertension in a South Indian Tertiary Care Hospital

Assessment of Medication Adherence to JNC-7 Guidelines and Risk Factors for Hypertension in a South Indian Tertiary Care Hospital

Epidemiology of major limb amputations: a cross sectional study from a South Indian tertiary care hospital

Background: Limb loss to amputation is a major problem especially in developing countries where majority of the cases are preventable. It is a burden, not just for the patient, but also for their care givers which imposes tremendous financial and psychological burden upon them. The aim was to outline the patterns, indications and short term complications of major limb among patients attending Government Medical College, Kozhikode, Kerala, India which is a tertiary care centre.Methods: This was a prospective, observational study that was conducted at Govt. Medical College, Kozhikode, for a period of 18 months. 81 patients underwent major limb amputations in our hospital during the study period.Results: The age ranged between 23 to 90 years (mean 59.23±14.79). Males outnumber females by a ratio of 4:1. Above knee (transtibial) amputations were the most common. Diabetes mellitus was the most common cause (39.5%) followed by chronic NDMVI (33.3%). Younger individuals who underwent amputation were mostly due to trauma. Most common post op complication was surgical site infection (21%) and the most common organism cultured from the wound was Pseudomonas (50%). The most common additional procedure done was wound debridement. Themortality rate was 10% and mean duration of hospital stay was 23 days. Conclusions: Complications of diabetic foot ulcers and chronic vascular disease were the most common indications for major limb amputation in our environment. Trauma was the most common indication in younger individuals. The majority of these amputations are preventable by provision of health education, early presentation and appropriate management of the common indications.