Super Specialty Hospital Research Articles

Study on Front Office Total Service Quality at Super- Speciality Hospitals in India - A Diagnostic Study

Total Service Quality (TSQ) at the front office is a critical element in every super-specialty hospital-integral to the hospital's administrative function. The backbone of its operations is a well-coordinated team of front-office executives responsible for planning, supervising, and efficiently managing hospital operations while maintaining daily coordination with all departments. As the initial point of contact for patients, these executives require continuous training and development to enhance patient happiness. Aligning training programs with high-quality service delivery is essential for improving productivity across-both the front and back ends of-the hospital, crucial for maintaining service standards. In this context, the primary aim of the study is to measure the overall service quality of the administration staff and its impact on patient satisfaction in super-specialty hospitals. The primary data was collected by an ordered random sampling without replacement method [ORSWRM] gathered from 100 respondents in Bengaluru city. The findings of the study highlights factors such as timely service delivery, adherence to prescribed treatments, complaint resolution, patient attention, and staff's communication skills are vital in realizing the hospital's vision, mission, goals, and objectives making TSQ a tangible reality.

Gestational Diabetes Mellitus Prevalence and Risk Factors - A Study from a Tertiary Care Centre in North India

Introduction: Type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) pose significant global health challenges. The increasing global prevalence of GDM and its associated complications underscores the need for proactive screening and management. The study aimed to evaluate the prevalence of GDM and its associated risk factors in a tertiary care hospital in North India Methodology: A prospective cross-sectional study conducted at Max Super Speciality Hospital, New Delhi, during 2016-2017, enrolled 900 pregnant women (aged 18-50 years) from the antenatal outpatient department (OPD). Primary objective: To assess impaired oral glucose tolerance prevalence (IADPSG criteria) at 24th-28th weeks. The data covered demographic, socioeconomic, obstetric, and medical details. Descriptive statistics were used to summarize the variables. Chi-square or Fisher's tests were applied to categorical data, while continuous data were analysed using independent t-tests. Multiple regression analysis was conducted to identify risk factors. Results: GDM was diagnosed in 7.4% of participants. Prevalence was highest in the age group >35 years (36.2%, p=0.000), and a significant association was found between increasing body mass index (BMI) and GDM (p=0.04). Adverse obstetric history, including previous abortions and GDM in prior pregnancies, increased the risk of GDM. Complications during pregnancy, such as macrosomia (present in 1 patient with GDM and none in non-GDM), foetal distress (9.09% in GDM), and preeclampsia (4.7% in GDM), were higher in women with GDM. Vaginal delivery prevalence was higher in non-GDM, while GDM had a higher rate of caesarean section delivery (p<0.005). Conclusion: The study discloses a 7.4% GDM prevalence in North Indian tertiary care, accentuating rising diabetes trends. Identified risk factors inform antenatal screening, highlighting the need for early GDM management to mitigate complications and prevent future diabetes. Single-centre limitations emphasise the necessity for broader population studies for accurate prevalence rates.

Analysis of Infection Prevention Control Management of Central Sterile Supply Department (CSSD) Staff

Background: The Central Sterilization Supply Department’s (CSSD) main function is to clean, disinfect and provide sterile items for subsequent use by healthcare professionals in various hospital departments, including the ambulance. Materials and Methods: A survey of infection prevention control (IPC) knowledge, practice, and infrastructure adherence was conducted in a selected government super-speciality hospital's central sterilisation supply department (CSSD). The data were analysed, and a report with recommendations was presented to the institution's head. Results: The overall response showed good knowledge and practices with hospital environmental adherence to infection prevention control protocol with few infrastructure modifications facilitating the unidirectional flow pattern. Conclusion: This study was able to bring insights into the staff knowledge and practice towards IPC adherence

Adverse Drug Reactions and Safety Profiles in Cardiovascular Drug Therapy: A Pharmacovigilance Analysis

Aims: The purpose of the study is to identify adverse drug reactions (ADRs) and evaluate patient knowledge of the disease using the Knowledge Assessment Questionnaire (KAQ). This study was designed to compare adverse effects on Cardiovascular Drug Therapy. Adverse drug reaction (ADRs) is a major cause of mortality worldwide. The objective of the present study were a) to find out the prevalence of adverse drug reaction (ADRs) in the hospitalized patient by active surveillance, b) to study the profile of ADRs detected. (3) This study was done in superspecialty hospital Netaji Subhash Chandra Bose medical college & Hospital, Jabalpur, for three month study. Methodology: This study was Pharmacovigilance group, belonging to department of cardiology at Netajisubhash Chandra bose medical college, Jabalpur M.P. (5) Total number of patients taken for study was 90 in number. Results and Conclusion: Total 90 subjects were recruited in the study. Drug used for their co morbidities to find out ADRs in which maximum ADRs found in chronic rheumatoid heart diseases, for this diseases patient took in two combination mainly Digoxin with Clopidogrel (47.36%) and another were with atorvastatin, spironolactone and warfarin (47.30% ADRs Adverse drug reactions on particular body system were mostly observed on CNS (32.14% ADRs). According to Naranjonaranjo causality assessment scale applied to this study illustrates that the maximum possible and probable adverse drug reaction were shown on Furosemide as well as for Digoxin and Spironolactone.

Incidence and Prognostic Significance of Arrhythmia in Acute Myocardial Infarction Presentation: An Observational Study.

Background Arrhythmias are well-recognized complications of acute myocardial infarction (AMI) and are an important risk factor for mortality in both men and women across a wide age range. Aim This study aims to analyze the incidence of arrhythmia in patients with AMI with respect to age, gender distribution, and location of AMI and also to evaluate the prognostic factors of mortality in patients with AMI. Methods This prospective, observational, and cross-sectional study included 300 patients admitted within an hour of the presentation of AMI at a Super Speciality Hospital, MGMMC (Mahatma Gandhi Memorial Medical College), Indore, after fulfilling the inclusion criteria. Clinical features, elevated cardiac biomarkers, and an electrocardiogram guided the diagnosis of AMI and arrhythmia. Results Of the total of 300 patients, the majority were male, 280 (93.4%), with a mean age of 57.48 ± 13.48 years. Prevalent risk factors included obesity, 195 (65%); diabetes mellitus, 185 (61.66%); hypertension, 181 (60.33%); smoking, 114 (38%); alcohol consumption, 123 (41%); and hypercholesterolemia, 207 (69%). Among 152 patients with arrhythmia, obesity, ischemic heart disease, diabetes, hypertension, smoking, and alcohol were more prevalent compared to those without arrhythmia. The arrhythmia incidence was higher in 143 (51.07%) male patients. Out of 37 mortality cases, 29 were associated with arrhythmia. Mortality was highest in extensive anterior wallacute myocardial infarction (EAWMI), 14 (37.24%), and inferior wall myocardial infarction (IWMI), 13 (35.14%). Conclusion In conclusion, arrhythmia was prevalent in the age group of 45-54 years and among patients with EAWMI. Mortality was significantly associated with arrhythmia and was highest in elderly patients with EAWMI and IWMI. These findings underscore the importance of risk stratification and targeted management strategies.

A Study to Assess the Effectiveness of Video Assisted Teaching Programme on Knowledge, Attitude and Practice Regarding Renal Rehabilitation among Patients with Chronic Kidney Disease Who are Admitted in the Mamata General and Super Specialty Hospital, at Khammam, Telanagana

ABSTRACT Background: Kidneys are one of the vital organs in the human body. Kidneys perform vital functions like excretion of waste products, maintenance of water balance, thus maintaining the homeostasis. In addition, kidneys perform many other functions such as role in Homeostasis, Production of Erythrocyte, Endocrine function, Regulation of Blood Sugar and regulation of Blood Calcium level. Because the kidney performs a wide variety of functions, the effects of loss of renal function not only in kidney but also in other organ systems.Hemo dilaysis is used for clients with acute or irreversible renal failure and fluid and electrolyte imbalances. It is usually the treatment of choice when toxic agents, such as barbiturates after an over dose need to be removed quickly. The availability of the treatment for clients with end stage renal failure (ESRF) has become more prevalent. The population receiving hemo dilaysis now represents a wide cross-section of age rehabilitative potential of socio-economic status. Materials and Methods: For the present study, quantitative Evaluative Approach ,Pre – Experimental research design, one group pretest and one group post test design.The study was conducted in the Mamata General and super specialty Hospital at Khammam, Telangana. Results: The above table shows that the pre test mean knowledge score is 10.05 and standard deviation is 3.77 where as post test mean score is 18.02 and standard deviation is 3.36 and mean difference is 7.97, the paired ‘t’ test calculated value is 14.89, which is greater than table value with df value of 79at (p<0.05) level. Conclusion: The main study was conducted in Mamata general and super specialty hospital, at Khammam, Telanagana . The sample sizes 30. The sample was selected by using non probability of convenient sampling technique among those fulfill the criteria.

Role of lymphocyte-to-monocyte ratio as a predictive marker for diabetic coronary artery disease: A cross-sectional study.

The lymphocyte to monocyte ratio (LMR) is considered a marker of systemic inflammation in cardiovascular disease and acts as predictor of mortality in coronary artery disease. To investigate the predictive role of LMR in diabetic coronary artery disease patients. This cross-sectional study was conducted at tertiary care super-specialty hospital at New Delhi, India. A total of 200 angiography-proven coronary artery disease (CAD) patients were enrolled and grouped into two categories: Group I [CAD patients with type 2 diabetes mellitus (T2DM) and glycated hemoglobin (HbA1c) levels ≥ 6.5%], and Group II (CAD patients without T2DM and HbA1c levels < 6.5%). Serum lipoproteins, HbA1c, and complete blood count of enrolled patients were analyzed using fully automatic analyzers. The logistic regression analysis showed an odds ratio of 1.48 (95%CI: 1.28-1.72, P < 0.05) for diabetic coronary artery disease patients (Group I) in unadjusted model. After adjusting for age, gender, diet, smoking, and hypertension history, the odds ratio increased to 1.49 (95%CI: 1.29-1.74, P < 0.01) in close association with LMR. Further adjustment for high cholesterol and triglycerides yielded the same odds ratio of 1.49 (95%CI: 1.27-1.75, P < 0.01). Receiver operating characteristic curve analysis revealed 74% sensitivity, 64% specificity, and 0.74 area under the curve (95%CI: 0.67-0.80, P < 0.001), suggesting moderate predictive accuracy for diabetic CAD patients. LMR showed positive association with diabetic coronary artery disease, with moderate predictive accuracy. These findings have implications for improving CAD management in diabetics, necessitating further research and targeted interventions.

Effect of aerobic exercise program on neuropathic pain and quality of life in person with paraplegia: study protocol for a randomized controlled trial

BackgroundIndividuals with spinal cord injury (SCI) often suffer from neuropathic pain which is often disabling and negatively affects function, participation, and quality of life (QoL). Pharmacological treatments lack efficacy in neuropathic pain reduction hence studying alternatives to drug treatment is necessary. Preclinical evidence of various aerobic exercises has shown positive effects on neuropathic pain but scientific studies investigating its effect in the SCI human population are limited.MethodologyThis study is a double-blind, parallel, two-group, randomized controlled trial with an interventional study design that aims to evaluate the effectiveness of aerobic exercise program on neuropathic pain and quality of life (QoL) in individuals with chronic paraplegia. Thirty individuals with chronic paraplegia with the neurological level of injury from T2 to L2 will be recruited from the rehabilitation department at a super specialty hospital based on the inclusion criteria. Using a 1:1 allocation ratio, the participants will be randomly assigned to one of the two groups. The intervention group will perform high-intensity interval training (HIIT) aerobic exercise using an arm ergometer based on their peak heart rate, and the control group will perform free-hand arm aerobic exercise. In both groups, the intervention will be delivered as 30-min sessions, four times a week for 6 weeks.Outcome measuresInternational Spinal Cord Injury Pain Basic Data Set Version 3.0 will be used for diagnosing and assessing neuropathic pain and its interference with day-to-day activities, mood, and sleep. The International Spinal Cord Society (ISCoS) QoL basic data set will be used to assess QoL, and 6-min push test distance will be used to assess peak heart rate and aerobic capacity.DiscussionThe effectiveness of the aerobic exercise program will be assessed based on the changes in neuropathic pain score and its interference with day-to-day activities, mood, sleep, QoL, and aerobic capacity after 3 weeks mid-intervention and after 6 weeks post-intervention. The trial will provide new knowledge about the effectiveness of the aerobic exercise program in improving neuropathic pain and QoL in individuals with chronic paraplegia.Trial registrationClinical Trials Registry-India CTRI/2023/08/056257. Registered on 8 August 2023.

A Prospective and Observational Study on the Impact of Patient Counselling on Medication Adherence and Quality of Life in Stroke Patients

PURPOSE: The study goals are to improve medication adherence and high-quality lifestyles in stroke patients through effective patient counselling. BACKGROUND: Stroke is one of the most common neurological disorders and the second most common purpose of dying worldwide. Stroke is likewise called cerebral infarction or cerebrovascular twist of fate. It occurs when blood flow to the brain is reduced due to permanent or temporary blockage of an artery that carries blood to the brain, or rupture of an artery in the brain because of high blood pressure The primary danger elements of Stroke encountered are high blood pressure, age, diabetes mellitus, obesity, smoking, and alcohol. the burden of stroke is gigantic and recurrence of stroke is a first-rate risk issue for growing the weight of stroke. medications play an crucial position in stopping stroke recurrence. Adherence can be summarized as ‘The extent to which someone’s behaviour taking medicinal drug, following a diet, and/or executing life-style modifications – corresponds with agreed tips from a health care provider”. current estimates are that only one-sixth of all sufferers come close to perfect adherence to their medicine regimen. the issue is gaining importance because of an increase in the prevalence of chronic diseases and an ageing population. common reasons of medicine nonadherence include complicated remedy regimens and patients’ lack of belief within the treatment. Healthcare specialists play an crucial position in remedy adherence amongst stroke survivors. They should deal with the boundaries and facilitate remedy adherence behaviours. METHODOLOGY: It is a prospective observational study conducted in Lalitha Super specialities Hospital, Guntur over 6 months duration study in the neurology department, a total of 200 patients of age groups between 25-85 of both genders with comorbidities like hypertension, diabetes, and affected with stroke were enrolled in the study. RESULTS &amp; DISCUSSIONS: The outcomes were obtained after 6 months duration observe within the neurology branch of tertiary care hospital a total of 200 patients enrolled in the study. The study of the effect of patient counselling on medication adherence and quality of life in stroke patients is a prospective observational take a look at in which facts is amassed in Lalitha super speciality hospital with a random representative sampling method explaining the qualitative &amp; quantitative evaluation. We accrued 200 instances of these tormented by ischemic, hemorrhagic, and transient ischemic stroke, and affected person counselling was given and followed up after discharge. Out of 2 hundred samples, 67% of patients are suffering from ischemic stroke, 22.5% from hemorrhagic &amp; 10.5% from TIA. males (60.5%) are greater stricken by stroke than females (39.5%) and the age group between 46-55 is more affected by stroke (32%). The patients who are with both hypertension and diabetes were extra affected by stroke (45.5%) than the ones having single co-morbidities, high blood pressure (28%) and DM (13.5%). in the collected samples males are more effecting by hypertension (33.88%) and females with diabetes (15.18%) and both high blood pressure &amp; diabetes (49.36%). medication adherence in stroke patients is the primary goal of the observe, figure no 5 indicates that out of 200 sufferers, 129 (sixty four.5%) have highly adhered to medicine, 61 patients (30.5%) are mild, and, 10 patients (5.0%) low adherence to remedy after counselling to the patients. quality of lifestyles is the main objective of this study. figure no 6 suggests the quality of life of 200 stroke patients earlier than and after patient counselling. The exceptional of lifestyles had been measured using a modified ranking SCALE (mRS). After the 6-month observe up the quality of life had improved in patients. A quantitative analysis was done using the chi-square test the end result of x squared value is 35.1 with Df 6 at a significance level of 0.05, and the P value is &lt;0.05. CONCLUSION: The main aim of this study is to provide better patient counselling to improve medication adherence and the quality of life in stroke patients was achieved successfully. In this study 200 stroke patients were enrolled and patient counseling was provided and followed up through face-to-face interviews and phone calls. Among 200 patients, 129 patients (64.5%) were highly adherence to the medication and 61 patients (30.50%) were moderately. 10 patients (5%) were low adherence to medication. The quality of life of stroke patients increased after the counselling compared to before counselling. The medication adherence and quality of life were measured using MMAS-8 QUESTIONS and a modified ranking scale (mRS) respectively. It is also evident from the study that pharmacist intervention is effective in improving medication adherence and its associated effect on the management of patients receiving stroke therapy.

Beyond Numbers: How Biochemical Parameters Can Predict Outcomes in Chronic Kidney Disease Patients on Maintenance Hemodialysis.

Introduction The treatment and management of patients undergoing maintenance hemodialysis (MHD) requires constant evaluation through the assessment of biochemical markers. This is necessary for treatment, to prevent progression to complications such as mineral bone disease, and to improve quality of life. We aimed to study the biochemical profile of patients with chronic kidney disease (CKD) grades4 and 5 onMHD, identify markers altered due to different etiologies, duration of illness, and duration of hemodialysis, and create a panel of markers that can be useful in planning better management. Methods All consecutive patients attending the dialysis unit of ESIC Super Speciality Hospital with CKD grade 4 or grade 5 on MHD between 2019 and 2020 were recruited. A detailed clinical history and demographic profile were taken, and blood samples were collected from the patients during follow-up visits in plain and EDTA (ethylenediaminetetraacetic acid) tubes for analysis. Results A total of 312 patients (22.1% females and 77.9% males.) with a mean age of 49.74 ± 11.49 years were recruited. In the study population, diabetic nephropathy (DN) (17%) and hypertensive nephropathy (48.7%) were the two most prevalent causes of CKD. The majority (64%) of the patients were on MHD three times a week. The range of estimated glomerular filtration rate (eGFR) (ml/min/1.73 m2) at the time of initiation of MHD was 2.9-26.8 according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. The mean duration of MHD was 51.58 months, with a mortality rate of 5.9% during the follow-up period (3-108 months). Conclusion Optimal selection and combination of biochemical tests will help in ascertaining the adequacy of management, progress of disease, or complications in MHD patients. This in turn will help guide the clinicians in effectively using these markers in their day-to-day practice.

A Prospective Study on the Assessment of Complications in Pregnancy at an Indian Super Specialty Hospital

The main of this study is to estimate the prevalence of complications in pregnancy at an Indian superspeciality hospital. We considered all age groups of pregnant with more than 12 weeks of gestational age as inclusion criteria whereas the pregnant with other co-morbid conditions were considered as exclusion criteria with a prospective way of approach. Among the 325 pregnant, 74 (22.7%) were observed with complications during their pregnancy. Most of the pregnant women with complications were observed in the 26-30 years age group (43.2%) and the majority were observed with the complication hypothyroidism (71.6%) followed by gestational diabetes (13.5%). Most of the pregnant women were observed with complications in the first trimester (78.4%) followed by the second trimester (20.3%). Clinical pharmacists along with obstetricians should create awareness regarding the complications during pregnancy in order to prevent them in the early stage. Counselling sessions during the different trimesters will definitely show a positive impact in maintaining the overall health of pregnant women.

Clinical Outcomes of Arthroscopic Adhesiolysis: A Case Series of 40 Patients With Postoperative Knee Stiffness.

Introduction Restricted range of motion over the knee joint is a known complication following the surgical procedure. Aggressive rehabilitation protocols can initially manage knee stiffness due to arthrofibrosis. If conservative management fails, surgical (open or arthroscopic) release is the preferred modality of management. We present a series of 40 patients with postoperativeknee stiffness who were treated with arthroscopic adhesiolysis. Material and methods This is a retrospective study conducted at Phoenix Orthopedic Superspeciality Hospital, Nagpur, India, from 2017 to 2021. Our study included 40 patients with postoperative knee joint stiffness, of whom 27 were males and 13 were females. The study considered the duration of stiffness, which ranged from six months to five years. All patients underwent arthroscopic knee release. A rigorously supervised physical therapy program followed this procedure. Patients were examined at three months, six months, and one year to assess improvement in knee range of movement. Results Out of 40 patients, six were classified as Shelbourne type 4, and the remaining were Shelbourne type 3. Twenty-three of 40 patients developed arthrofibrosis following intra-articular or peri-articular fracture fixation surgery; 11 patients were operated on arthroscopically for anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) reconstruction. Three patients developed stiffness following total knee replacement, one following patellectomy, and three following infection after fracture fixation. The mean pre-op knee range of motion (ROM) was 48.875 degrees. Following arthroscopic release, the mean improvement in ROM was 60 degrees intra-operatively. The average postoperative range was 108.25 degrees. Conclusion Arthroscopic adhesiolysis and quadriceps release are reliable methods for dealing with postoperative knee stiffness. It prevents wound complications and increases the chances of surgical site infection due to smaller incisions. Postoperatively, we achieved an average increase of 60 degrees in ROM over the knee joint.

Study on Universal Health Coverage Scheme in India – The Stumper to Private Hospitals

Background Many governments have introduced health insurance schemes for the poor sections of society to save them from catastrophic health expenditure. Private hospitals play a key role in India, as they are in significant number in secondary and tertiary care services. Private hospitals have to fund their infrastructure, staff salaries from the revenue of previous year. In this study, we compared money received by a private medical college hospital bed through government insurance scheme patient and private paying patient. Methods Observational study, comparing money reimbursed for top ten procedures treated in private medical college hospitals by Ayushman Bharat (AB) fund and the price offered by a paying patient in similar bed. Results On average 600 patients received medical care through the AB scheme per month at our tertiary care super-specialty hospital. Highest numbers were seen in specialties like cardiovascular, and cancer treatments and infectious diseases under general medicine specialty. The costs considered were surgeon’s cost, medicines, devices, and hospitalization costs. The laparoscopic procedures were incurring a loss of 130%, knee replacements about 50%, coronary bypass grafting thankfully due to controlling of prices by central government is incurring a loss of 10%. The package amount offered accounts to 26–52% only of the costs incurred by the private hospitals. Conclusion The private academic hospitals need 25% to 50% more than current prices offered, across various procedures.

Unveiling acute myocardial infarction in young adults of rural India: Exploring demographic, clinical, and angiographic profiles

ABSTRACT Introduction: Cardiovascular disease, particularly myocardial infarction (MI), remains a leading cause of mortality globally and in India. The prevalence of coronary artery disease (CAD) among young adults in India presents unique challenges, marked by earlier onset and distinct risk factor profiles. However, comprehensive data on young MI patients in rural areas are scarce, necessitating an investigation into their demographics, clinical characteristics, and outcomes. Materials and Methods: This institution-based, cross-sectional study was conducted at the Department of Cardiology, NIMS Super Specialty Hospital, Jaipur, focused on individuals under 45 years old admitted with MI. Data encompassing demographic, clinical, echocardiographic, and angiographic profiles were collected and analyzed. The study spanned from December 2022 to December 2023. Results: Among 45 young MI patients studied, males constituted a substantial majority (86.67%). Lower socioeconomic status (SES) was prevalent (71.11%), and risk factors such as smoking (51.11%) and hypertension (35.56%) were notable. Troponin-T/CPK MB levels were significantly elevated in 57.78% of cases, indicating myocardial damage. Angiographic assessments revealed predominance in left anterior descending (LAD) artery abnormalities (55.56%) and a significant proportion underwent primary percutaneous transluminal coronary angioplasty (PTCA) (46.67%). Conclusion: The study highlights the concerning prevalence of MI among young adults in rural areas of India, with a predominance of males and a high prevalence of traditional risk factors such as smoking and hypertension, as well as the notable influence of low SES (P = 0.0046). Contrary to previous studies that linked higher SES and sedentary lifestyles to an increased risk of CAD, this study underscores the significant burden of CAD among young individuals from lower socioeconomic groups. The elevated levels of troponin-T and CPK-MB, along with the predominance of LAD artery abnormalities, emphasize the severity and distinct coronary involvement patterns in this demographic. These findings highlight the urgent need for targeted preventive strategies and improved access to health-care services for young adults in lower socioeconomic groups in rural areas.

Precision Medicine for COVID-19 Based on the Inflammatory Response

Background The threat due to the global pandemic of the coronavirus disease 2019 (COVID-19) demands a search for effective treatments to combat the severity of the infections and their associated morbidity and mortality in vulnerable populations. One of the medications with putative antiviral, anti-inflammatory, and immunomodulatory effects is fluvoxamine, a selective serotonin reuptake inhibitor and σ-1 receptor agonist. A few studies have reported doses of 100–300 mg/day to be effective. Aim This retrospective study evaluates the outcomes of an individually tailored dosing strategy for fluvoxamine, based on measurements of inflammatory status, in treating COVID-19-positive individuals in India. Methods This study included patients with severe acute respiratory syndrome coronavirus 2 infection visiting the outpatient department of a super speciality hospital in India from February to July 2021. Fluvoxamine was initiated at 50 mg or 100 mg twice daily based on their individual C-reactive protein (CRP) and D-dimer status. By day five, patients with rising or static levels of CRP and D-dimer were up-titrated. Results In a population of 104 individuals infected with COVID-19, 10 required up-titration of dose, and 94 patients did not need up-titration. Overall, there was very low mortality (N = 1) and hospitalization rate (8.7%). Those individuals who required an up-titration on day five had significantly elevated CRP and D-dimer levels compared to those who were maintained at the initial dose of 50 mg twice daily. In such patients, up-titration of the dose on day 5 appeared to offer better treatment benefits and outcomes. In our study population, there was only one mortality during the course of COVID-19. Conclusions Given the individual variability in the host immune response to severe acute respiratory syndrome coronavirus 2 infection, tailoring the dose of a drug such as fluvoxamine based on the inflammatory status of the individual may be beneficial. Individually tailored dosing could combat disease progression while reducing side effects.

Health situation analysis of cervical cancer in Delhi

The capital city of India, Delhi is endowed with a plethora of multi- and super-specialty hospitals, both private and government, for treating various diseases. Patients from around the globe seek medical care in Delhi. The primary healthcare system is robust, with a network of newly established Mohalla and polyclinics. However, when it comes to a sensitive disease, ‘cervical cancer’, all glorious claims mentioned above seem to be inadequate. Cervical cancer is the 2nd most common cancer among Delhi's females. Delhi was 1st state to launch HPV vaccination as a public health program in 2016 despite resistance from civil societies. A situation analysis from literature reveals that cervical cancer screening services at the primary and secondary levels are on the backburner in Delhi, which is also evident from the poor screening habits of Delhi's females (0.7%) according to NFHS-5. This prompts questions regarding organization of the cervical cancer prevention program (NP-NCD) and the delivery of screening services in Delhi. In this review we have tried to illuminate the contemporary landscape of cervical cancer burden, screening, and treatment, while also identifying opportunities for enhancing cervical cancer management in Delhi. The study finds that implementation research targeted at finding barriers in program organization and service delivery would help strengthen the capacity of Delhi’s health system.

A study on complications and outcome of hypospadias repair at tertiary care hospital

Background: The surgical procedure used to treat hypospadias varies widely in clinical practice due to several considerations. In light of this, we assessed the risks and results of many surgical techniques for correcting hypospadias. Methods: It was a prospective hospital-based study done for a period of 1 year. All patients with age greater than 12 months who underwent hypospadias repair in the surgery department of PMSSY super speciality hospital (KIMS, Hubballi) from January 2022 to December 2023 were included in the study. Approval from institutional ethical committee was taken before initiation of the study. Written informed consent was taken from the parents of the study participants. Total 42 patients with hypospadias were included in the present study. Results: The most common type of hypospadias was distal seen in 67% of patients among distal the most common site of urethral opening was distal penile in 43% followed by mild penile in 40%. Proximal type was second most common type seen in 24% and 7% were granular. TPIF repair was the most common choice of operation among surgeons in distal and proximal hypospadias due to ease of application and less complications and it was statistically significant followed by Snodgrass repair mostly seen in distal hypospadias. Conclusions: In this study, distal type hypospadias was the most prevalent form. Roughly one-third of the patients received TPIF surgery, whereas the same percentage had Snodgrass repair for their hypospadias.

Clinical Profile of Male Patients Presenting with Breast Cancer in Kashmir Valley

Abstract Introduction Breast cancer is a rare disease in males with unknown etiology and variable rate of incidence among different ethnic and geographical groups. Objectives This article studies the clinical profile of male breast cancer in Kashmir Valley of India Materials and Methods This study was a retrospective study conducted at a superspecialty hospital (Government Medical College Srinagar) in the department of medical oncology over a period of 4 years from January 2017 to October 2021. All male patients who presented with a histopathology-proven diagnosis of breast cancer were included and studied. Results A total of 8 male patients with breast cancer were studied. The median age at diagnosis was 55 years. Most of the patients were from rural background. The most common presenting symptom was breast lump followed by ulceration. The most common location of the tumor was retroareolar. Infiltrating ductal carcinoma (100%) was the only subtype present in our patients. Locally advanced disease accounted for most of the cases. Among stage IV patients two had bone as the metastatic site and one patient had in addition lung metastasis. Immunohistochemistry analysis revealed that all patients (100%) were hormone receptor positive with only one patient being triple positive (12.5%). None of the patients had triple negative disease in our study. In our study 6 patients were treated with multimodalities (surgery, chemo, radiation, and targeted agents). Conclusion Male breast cancer is a well-recognized entity and the gender gap of disease need to be abolished. Awareness among masses and training of general practitioners is needed to pick cases at early stage.

MRI Insights in Chiari Malformation Type 1 and Variations With Hydrosyringomyelia.

Chiari malformation (CM) type 1 is a complex neurological disorder characterized by the displacement of the cerebellar tonsils into the upper spinal canal. Hydrosyringomyelia (HSM), which frequently coexists with this condition, presents diagnostic and treatment problems due to its broad spectrum of symptoms. There are various forms of CMs, with CM type 1 (CM1) being the most common type. Magnetic resonance imaging (MRI) is the best imaging technique to properly identifyand diagnose CM1 and HSM. Important imaging findings include downward displacement of the cerebellar tonsils across the foramen magnum, the appearance of the syrinx in the spinal cord, and the alteration of the flow dynamics of the cerebrospinal fluid. This study was conducted at Datta Meghe Medical College, Nagpur, and Government Medical College & Super Speciality Hospital, Nagpur, India. It focuses on the diagnostic use of MRI in CM1 and its variations associated with HSM. Individuals who are asymptomatic may not need any treatment; however, those who are symptomatic or have HSM may require surgical decompression and restoration of the flow. We discuss the findings of MRI of six cases of CM1 and its variants with HSMand search for possible underlying causes. We conclude that magnetic resonance imaging is an imaging modality for the identification and evaluation of CM1 in cases of HSM.

To Evaluate the Efficacy and Safety of Mifepristone in Reducing the Size & Symptoms of Uterine Leiomyoma/Fibroids.

Uterine leiomyomas, or fibroids, are prevalent benign gynecological tumors affecting many women during their reproductive years. While surgical excision has long been the gold standard for fibroid treatment, the pharmacological management, including progesterone receptor modulators like mifepristone (RU 486), has garnered attention due to the reduced surgical approaches. However, there is a notable paucity of research on the effectiveness of mifepristone, on the same. This study seeks to evaluate the safety and efficacy of mifepristone in reducing uterine leiomyoma size and alleviating associated symptoms. Conducted prospectively, the study enrolled 20 pre-menopausal women, aged 18years or older, from Nanavati Max Super Speciality Hospital Mumbai, Maharashtra, India. Participants were selected based on specific inclusion criteria, including the presence of at least one uterine myoma with a minimum diameter of 2.5cm as confirmed by ultrasound. Participants had an average age of 39.75years and an average BMI of 27.58kg/m2. The study found that mifepristone significantly reduced uterine volume by 75%, with hemoglobin levels substantially improving from 9 gm/dL initially to 12.51 gm/dL after six months. Pain intensity, assessed using the Visual Analog Scale (VAS) score, gradually decreased from baseline to three-month, with all 20 patients reporting the complete absence of pelvic pain by six months. This prospective study highlights mifepristone's promise as a non-surgical approach to effectively reduce uterine fibroid volume, improve hemoglobin levels, and mitigate uterine blood loss in patients.