Tertiary Care Hospital In South India Research Articles

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.

Prevalence and Antifungal Susceptibilities of Candida spp from a South Indian Tertiary Care Hospital

Introduction: Candida sp. is increasingly being implicated as the cause of both community acquired and Nosocomial infections. With development of new resistance patterns versus the inherent resistance present in some of the species isolated from critical care areas, the complications resulting from long term antibiotics, surgical and medical interventions and environmental colonization by the Candida sp. is becoming more prevalent. Method: Prevalence of different species and their antifungal susceptibilities grown from various samples received in 20 months were studied using semi-automated MiniAPI kits. Results of tests done on 356 isolates were collated and analysed retrospectively. Results: Of the 356 samples, C. tropicalis showed prevalence of 37.07% as compared to C.albicans 31.1%, C guilliermondii (11.8) and C parapsilosis (6.74%). Candida sp were found to sensitive to 5-Flucytocine and Amphotericin B. Resistance to Itraconazole was noted more than to Fluconazole. Conclusions: Infections with Candida spp are usually of low virulence and are associated with a few well-defined risk factors as immunocompromised state, Malignancy and steroid therapy. Understanding these risk factors, identifying the species with changing trends in antifungal resistance, instituting infection control practices to reduce morbidity and mortality in critical care areas can improve outcomes.

Epidemiological, demographic and risk factor profile in patients harbouring various types of gallbladder calculi: a cross sectional study from a south Indian tertiary care hospital

Background: Gallstone disease is one of the most common digestive system diseases next to GERD and accepted treatment involves laparoscopic or open cholecystectomy making it one of the costly diseases. with increasing westernisation of Indian lifestyle and food and also recent studies pointing out its association with cardiovascular disease and cancer mortality its need of the time to undertake an extensive study on epidemiology, demography and risk factors of gallstone disease. The aim was to study the epidemiological, demographic and risk factor profile in patients harbouring various types of gallbladder calculi.Methods: A cross sectional prospective study was conducted. 100 cholelithiasis patients were undergoing operative procedure at our department.Results: Showed that females had higher incidence of gallstone disease with a ratio of 2:1, mixed gallstone was the predominant type (53%), mean BMI of the study population was 28.03 with SD of 3.61.Conclusions: Women are twice as likely as men to form gallstones. Most common gallstone type found is mixed type and least is cholesterol type. Age group most commonly affected is between 31-50 years. There is a statistically significant association between high BMI and occurrence of gallstone. There is a statistically significant association between diabetes and occurrence of gallstone.

Drug information center as referral service in a South Indian tertiary care hospital

Objective:The objective of this study is to assess the various aspects of drug information services (DISs) provided in the DI center of a tertiary care hospital.Materials and Methods:DI queries received from various departments from April 2013 to May 2017 were included in the study. Various aspects such as year- and department-wise distribution, reason for sending the queries, mode of receipt and reply, time taken for reply, number of visit for bedside examination of patients, and number of references given per query were analyzed. All the results are expressed in numbers and percentages.Results:Fifty-five DI queries were received during the study period. Most of the queries were received from Department of Orthopedics (26, 47.27%), followed by Neurology (4, 7.27%). Most common mode of receipt of queries (41, 74.55%) was by Cross-reference form not case record form followed by phone calls (8, 14.55%) and outpatient department (OPD) case sheet (6, 10.9%). CRF with attached opinion was the most common mode of reply (41, 74.55%) followed by phone calls (7, 12.73%), and OPD case sheets (6, 10.9%). The most common reason for sending queries was antimicrobials-related problem (25, 45.46%), followed by the use of anticoagulants (13, 23.63%). Most of the queries were replied within 24 h (31, 56.36%), followed by 48 h (14, 25.45%). Out of 41 CRF received for in-patients, bedside examination was requested in 23 (56.09%) CRF. There was an increasing trend in the number of queries received every year with more queries received during 2016 (23, 41.82%).Conclusions:DIS if utilized properly can be used as a referral service such as other specialties in a tertiary care hospital.

Clinical, laboratory profile and outcome of dengue fever at a south Indian tertiary care hospital

Clinical, laboratory profile and outcome of dengue fever at a south Indian tertiary care hospital

Nutritional Intake in Low Body Mass Index (BMI) Males with Type 1 Diabetes and Fibrocalcific Pancreatic Diabetes: What are the Unmet Needs? A Cross-Sectional Study from a South Indian Tertiary Care Hospital

Nutritional Intake in Low Body Mass Index (BMI) Males with Type 1 Diabetes and Fibrocalcific Pancreatic Diabetes: What are the Unmet Needs? A Cross-Sectional Study from a South Indian Tertiary Care Hospital

Psychological Impact of Cancer Diagnosis in Newly Diagnosed Breast Cancer Patients

Aim: The aim of the study was to examine the impact of cancer diagnosis on the psychological status of women with breast cancer, focusing on anxiety and psychological distress experienced by breast cancer patients. Materials and Method: A descriptive, cross-sectional study was conducted among 80 breast cancer patients after an initial cancer diagnosis by using purposive sampling. The study was conducted in a tertiary care hospital in South India. Data was collected by using Demographic and Clinical proforma, State-Trait Anxiety Inventory and Impact of Event Scale. Sample characteristics were analyzed using descriptive statistics, the influence of anxiety on psychological distress was tested with correlation and a chi-square test was used to test the association between anxiety and distress with demographic and disease-related variables. Results: The sample consisted of 80 women with a mean age of 48.1 years. 96% were married, and 90% of them were housewives. Half of the subjects were educatedupto primary school. 80% were in stage II of cancer with a duration of diagnosis of 2-4 weeks.48% of the subjects were suffering from a moderate range of distress and 16% had severe psychological distress. Similarly, 80% of subjects had moderate to high level of anxiety. Anxiety did not have any influence on psychological distress. And only duration of diagnosis was associated with psychological distress. Conclusion: Results of the study suggest that cancer diagnosis can cause moderate to severe distress in breast cancer patients. Recognizing distress and intervening it on time is pivotal to improve treatment outcomes of women with breast cancer.

Fever, thrombocytopenia, and AKI-A profile of malaria, dengue, and leptospirosis with renal failure in a South Indian tertiary-care hospital.

In the tropics, the triad of fever, thrombocytopenia, and AKI portends a grim prognosis with high mortality and a severe strain on already-stretched resources. Malaria, dengue, and leptospirosis account for most cases. We undertook a review of cases to determine factors accounting for adverse prognosis. All patients presenting to the emergency room (ER) with a history of fever, thrombocytopenia, and renal failure were included in the study. Patients were followed until discharge or death, and end points looked at were 1-week and 30-day mortality, and renal function upon discharge. Parameters like liver function test (LFT), renal function, and platelet count upon discharge were also documented. A total of 43 patients was included in the study. Mean age was 42.5 years with 86% males. Mean APACHE and SOFA scores on admission were 23.89 and 15.42, respectively. Mean admission platelet counts were 41,000. Mean serum creatinine was 4.1, and bilirubin was 9.94. A platelet count of <34,000, serum creatinine of >4, albumin of >2.3, SOFA score of >20, and APACHE score of >32.2 were significantly predictive of 1week mortality. Need for mechanical ventilation, oliguria on admission, and need for dialysis all were highly predictive of 30-day mortality. In addition, a serum bicarbonate of <12, INR of >1.5, hemoglobin of <9.5 were highly predictive of higher 30 day mortality. Overall, 1-week mortality was 16.3%, of which 48% was accounted for by patients with leptospirosis. Factors like low platelet count, oliguria, need for dialysis, high APACHE and SOFA scores on admission, need for mechanical ventilation, and low serum albumin portend a grave prognosis. There is need for randomized control trials (RCT) to further determine adverse prognostic factors in this subsect of patients.

A Prospective study on the assessment of risk factors for type 2 diabetes mellitus in outpatients department of a south Indian tertiary care hospital: A case-control study

Background: Type 2 diabetes mellitus (T2DM) is the most general type of diabetes. In India, the risk factors (modifiable and nonmodifiable) for diabetes are seen more frequently and there is lack of perception about this problem.Objective: The objective of the study was to assess the incidence and risk factors for T2DM in a south Indian tertiary care hospital.Materials and Methods: A prospective study was conducted on 1161 subjects (with or without T2DM) from November 2014 to April 2015 in general medicine department of Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Andhra Pradesh, south India. Chi-square test was used to evaluate the incidence of T2DM and odds ratios were calculated in univariate logistic regression analysis for risk factors.Results: T2DM was significantly higher in the subjects of age above 41 years (86.3%, P&lt;0.0001), married (95.4%, P=0.002), educators (degree and above, 13.2%, P&lt;0.0001), known family history (50.8%, P&lt;0.0001), BMI (&gt;25 kg/m2,58.7%; P&lt;0.0001), Govt. job holders (5.5%, P&lt;0.0001), business people (12%, P&lt;0.0001), house wives (38.3%, P&lt;0.0001), high economic status (34.9%, P&lt;0.0004), preexisting hypertension (40.2%, P&lt;0.0001), urban residence (50.4%, P&lt;0.0001), physical inactivity (45.3%, P&lt;0.001), stress (61.0%, P=0.01), consumption of tea and coffee (daily thrice or more, 6.3%, P=0.0003), soft drinks (weekly thrice or more, 4%, P=0.0008) and junk foods (weekly thrice or more 2.6%, P=0.025) than non-diabetic subjects. Univariate logistic regression analysis showed that the age (above 41 years), marital status, education, family history, BMI (&gt;25 kg/m2), high economic status, co-morbidities (hypertension and thyroid disorders) urban residence, physical inactivity, stress, consumption of tea and coffee (daily thrice or more), soft drinks (weekly thrice or more) and junk foods are the significantly risk factors for T2DM.Conclusion: The present study results suggested that beware of hypertension, thyroids disorders, physical inactivity, stress, soft drinks and junk foods, which are major risk factors of T2DM.

PHP125 - A Comparison of National Guidelines for Network Meta Analysis

To determine the prevalence and the occurrence of ADR To determine the patients economic impact on ADRs treatment The study was carried out at South Indian tertiary care hospital, for a period of 6 months. All the necessary and relevant data were collected from patient case notes, treatment charts, laboratory data reports, ADR notification forms, patient interview and reporter interview. Patients of either sex of any age who developed ADR within the hospital were included in the study. If any doubts/disagreements of the occurrence of ADRs (Allergic reactions due to pollen, dust and insect are excluded from the study).Patients who developed ADR outside of the hospital were excluded from the study. ADR documentation form was validated using CDSCO ADR form. Causality assessment was done using Naranjos assessment scale. Hartwig scale was used to analyze severity of ADRs. Among 22203 patients admitted to the hospitals during the 6 months period, a total of 32 suspected ADRs were reported and evaluated. The prevalence of ADR was found to be 0.14%, males were affected more, Type B reactions were more predominant, most ADRs reported were mild to moderate using Hartwig's scale most ADRs were found to be probable using Naranjos scale. Most of the ADRs were associated with Antibiotics (cephalosporins) prescribed from Hematology and Neurology department and mainly caused dermatological reactions. Patient economic expenditure was studied and most ADRs occurred during the disease treatment period (between the admission and discharge time). ADRs are a common occurrence, but are often not recognized. Even if they are recognized they are under-reported as many physicians are unaware that clinically important ADRs should be reported to ADRs monitoring centers.

Assessment of prescription adherence to the AACE guidelines and risk factors for type 2 diabetes in a South Indian tertiary care hospital

Genetic, environmental, and metabolic risk factors are interrelated and contributed to the development of type 2 diabetes mellitus (T2DM). The American Association of Clinical Endocrinologists (AACE) guidelines are gold standard for the management of T2DM. The objective of the study was to assess the prescription adherence to AACE treatment guidelines and risk factors for T2DM in a South Indian tertiary care hospital. A cross-sectional study was carried out in 950 subjects (with or without T2DM), and prescription adherence was assessed by comparing with the AACE guidelines. Odds ratios were calculated in univariate logistic regression analysis for risk factors. T2DM was significantly higher in the subjects of age above 40 years, females, married, BMI, urban residence, higher socioeconomic class, hypertension as comorbidity, physical inactivity, smokers, alcoholics, and stress. Metformin was the most widely prescribed drug followed by α-glucosidase inhibitors in monotherapy. The overall rate of prescription adherence was 88.0 % (when HbA1c 9 %, P 25 kg/m2), urban residence, body weight (above 50 kg), high economic class, hypertension, past alcoholic, physical inactivity, and stress are the significantly risk factors for T2DM. The present study results suggested that prescription adherence to AACE guidelines was optimal. Female gender, age (above 50 years), hypertension, stress, physical inactivity, urban residence, body weight, BMI, and high socioeconomic status are the major risk factors for T2DM.

A Comparative Study of Thrombolytics Used for The Treatment of STEMI in a South Indian Tertiary Care Hospital

Background: ST segment elevated myocardial infarction is the most common cause of mortality and morbidity in worldwide; it occurs when thrombus formation results in complete occlusion of major epicardial vessel, thrombolytics was the first choice of treatment for STEMI along with other supporting therapies. Objective: To compare safety and efficacy of thrombolytics Streptokinase, Tenecteplase and Reteplase for the treatment of STEMI. Methodology: This is a prospective observational study conducted for a period of 6 months (November 2014 to May 2015) in RMMCH, Chidambaram. A total of 90 cases were collected. Study consist of three groups, group-1 (receiving streptokinase), group-2 (receiving Reteplase) and group 3 (receiving tenecteplase). Relevant data was obtained from case sheets before and after lysis and analyzed. Result: The study identified all three fibrinolytic drugs to be efficacious in causing &gt; 50% resolution in ST segment, symptoms relief. Safety parameters were found to be fair in Reteplase group where no side effect was observed. Hypotension and cardiovascular arrest was observed in Streptokinase and Tenecteplase respectively. Efficacy was found to be high in Reteplase group with 93% of STEMI resolution and 93% of symptomatic relief where 83 % and 90% in tenecteplase and 83% and 86% in streptokinase groups. One death was reported in streptokinase and tenecteplase group respectively. Conclusion: Reteplase was found to be most safest and efficacious drug followed by tenecteplase and streptokinase.

Incidence of Intravenous Medication Errors in a South Indian Tertiary Care Hospital

Background: The use of medications in the hospital is a complex process which is dependent on the successful interaction of the health care professionals. Intravenous medication errors are one such which compromise patient confidence in the health-care system, increase health-care costs and has high incidence but limited evidence. Objective: The study reports the incidence of intravenous errors in preparation and administration. Specifically, the study was done to explore and measure the frequency of IV medication errors by direct observation and identify clues to their causes. Methodology: The study design is a prospective observational study which enrolls patients given intravenous therapy in the department of general medicine and ICUs in a tertiary care hospital. Error categories were categorized and error rate of drug classes was measured. Results: In a period of 6 months, 161 (N) samples were observed. Five error types (improper aseptic conditions, wrong diluents, improper mixing, wrong dose/volume, and wrong time) accounted for 78.88% of errors. Improper aseptic conditions were the most frequent and accounted for 39.13%. The least type of errors was wrong dose errors-7.45%. The other categories wrong diluents, improper mixing and wrong time accounted for 9.93%.10.55% 13.04% respectively. Conclusion: This study found a high rate of intravenous medication errors of moderate significance. Changes in practice should be considered to make intravenous therapy safer for patients. The findings of this study suggest that it is necessary to engage pharmacists in IV dose preparation and administration.

Study of clinical, laboratory abnormalities and outcome in patients with scrub typhus at a south Indian tertiary care hospital

Study of clinical, laboratory abnormalities and outcome in patients with scrub typhus at a south Indian tertiary care hospital

Clinical, laboratory profile and outcome of patients with dengue viral infection at a South Indian tertiary care hospital

Clinical, laboratory profile and outcome of patients with dengue viral infection at a South Indian tertiary care hospital

Molecular characterization and clinical significance of extraintestinal pathogenic Escherichia coli recovered from a south Indian tertiary care hospital

• We Correlated extraintestinal E. coli with clinical outcome of mortality, recovery and relapse.