Teaching Hospital In India Research Articles

Comprehensive evaluation of bone health among kidney transplant recipients – A prospective, single center, observational cohort study from India

Background: There is a paucity of studies describing trabecular bone score (TBS) and bone mineral density (BMD) in kidney transplant (KT) recipients from developing countries. Study setting: This prospective observational study, from a tertiary teaching hospital in India assessed clinical, biochemical parameters including bone turnover markers and dual-energy X-ray absorptiometry (DXA) for BMD/TBS, hip structural analysis (HSA) and vertebral fracture assessment (VFA) at pre-KT, 3 months and 12 months post-KT. Results: A total of 53 KT recipients (90.6% living related) were recruited from August 2019 to March 2020 and followed till 1-year post-KT. The mean age was 33.9±10.4 years, 71.7% were males, and 11.5% had a history of pre-KT steroid use. Baseline fractures pre-KT as assessed by VFA were seen in 4 patients (7.5%). Mean BMD at spine and femoral neck and HSA variables at narrow neck and femoral shaft continued to decline till 3 months, but stabilised and reached pre-KT values 12 months post-KT. However, TBS and bone turn over markers continued to decline till 12 months post-KT (p value <0.001). New onset vertebral fractures were seen in 2(3.7%) and 1 patient (2.3%) at 3- and 12-months post-KT respectively. Pre-KT BMD significantly influenced bone health at 12 months post-KT, with patients in each quartile maintaining a similar trajectory over the follow up period (p < 0.001). Conclusion: Despite significant improvement in kidney function following transplant, TBS and BMD of the spine significantly decreased mainly in the early post-KT period suggesting the effect of immunosuppressants on the bone. Strategies to improve bone health in KT patients are warranted.

Study of Gaming Disorder and Its Association with Depressive Disorder and Anxiety among Medical Students in India

Abstract Context: Internet gaming disorder (IGD) was included in the 5th edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Addiction to Internet gaming is prevalent among Indian medical students. This study aims to measure the severity and pattern of gaming behavior along with the impact and association of IGD on different psychological conditions such as depression and anxiety. Methods: A cross-sectional study was conducted through an online survey among 845 medical students at a tertiary care teaching hospital in India. The Internet GD Scale-Short Form (IGDS9-SF) was used to assess the intensity of gaming disorders, while patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder assessment (GAD-7) were used to assess the severity of depression and anxiety, respectively. Results: A total of 194 students were identified as current gamers, out of which 36 had gaming disorders based on DSM-5 diagnostic criteria for IGD from the current study sample. Multiple regression was calculated for the following age (B = 0.85, P = 0.002), weight (B = 0.07, P = 0.02), average time spent on gaming/day in hours (B = 1.01, P &lt; 0.0001), PHQ-9 scores (B = 0.35, P ≤ 0.0001), GAD-7 scores (B = −0.24, P = 0.01) - Model R 2 = 0.35, F = 19.41, P &lt; 0.0001. Conclusions: Potentially problematic gaming was found to be associated with psychological symptoms, negative affectivity, and a preference for solitude. There is a need for other studies that can help in creating awareness about the prevalence of gaming disorders in medical students.

Hepatitis B: A Pilot study on awareness and attitude among staff nurses and students of a teaching hospital in India.

Hepatitis B is a serious public health concern and health care professionals especially nurses are at higher risk of acquiring this infection. Basic knowledge, awareness and a positive attitude are required to prevent this disease. The present pilot study was conducted to assess awareness and attitude regarding hepatitis B among staff nurses and nursing students of a teaching hospital in north India. A total of 205 subjects who gave consent to participate were included in this descriptive study. A self-structured pre-tested close ended questionnaire comprising of two parts was used to collect information from the study subjects. First part collected information on demographic details of the study subject and second part assessed subjects' awareness and attitude on various aspects of hepatitis B infection including vaccination. Chi-square test and multiple linear regression analysis was used for statistical analysis. The mean age of the study subjects was 25.8±5.6 years. Awareness regarding HBV infection was present among 92.6% (190) of subjects. Long-term effects of hepatitis B were known to 58.4% (119) of subjects and 79.1% (162) of subjects reported taking universal precautions. Half of the subjects (105), were getting regularly tested for hepatitis B antigen.The odds of getting regularly tested for hepatitis B antigen were 3.26 times greater in female subjects and 3.45 times greater in subjects who were GNMs. Low awareness levels were reported regarding some important aspects of hepatitis B among study subjects though more than 90% were aware of it. There is an urgent need for education and training programs for nurses designed to increase their knowledge about HBV infection.

Impact of Educational Intervention on Knowledge, Attitude &amp; Practice About Pharmacovigilance in Nursing Students in A Tertiary Care Teaching Hospital in India: A Cross-Sectional Study

Background: It is crucial for healthcare professionals to know how to report adverse drug reactions (ADRs). To improve reporting rates, it is essential to improve knowledge, attitude and practice (KAP) of healthcare professionals regarding Pharmacovigilance (PV) and adverse drug reactions (ADR) reporting. According to previous studies, there has been a lack of knowledge in nursing students regarding Pharmacovigilance (PV) and reporting of adverse drug reactions (ADR). Hence, this study was planned to assess the impact of educational intervention on nursing students' knowledge, attitude, and practice of pharmacovigilance at a tertiary care teaching hospital in India. Materials and Methods: This was an interventional study conducted among 93 BSc nursing students at a tertiary care teaching hospital, India. Each participant was explained the purpose of study and asked to fill in a questionnaire about their knowledge, attitude and practice of pharmacovigilance. The post-KAP questionnaire was re-circulated among participants at the end of the intervention and data was analyzed using Chi square test. Results: The study involved 93 BSc nursing students aged 21.52 ± 1.11 years, with a male to female ratio of 1:2. All statistical calculations were performed using Graph Pad prism v10.1.0. Results showed significant differences in understanding pharmacovigilance between pre-intervention and post-intervention, and a significant change in attitudes towards pharmacovigilance due to the educational intervention. A statistically greater proportion of students learned about Pharmacovigilance and ADR reporting forms. Conclusion: The Continuing Medical Education (CME) and group discussions significantly enhanced the knowledge and attitude of nursing students regarding pharmacovigilance.

Burning Bright or Burning Out: A Cross-sectional Study on Burnout among Postgraduate Residents in an Eastern Indian Teaching Hospital

Introduction: Burnout is a concerning clinical syndrome comprising excessive stress, lack of satisfaction, and a feeling of being overworked. In India, postgraduate residents who shoulder the entire burden of patient care, are prone to suffer from burnout. Only a few Indian studies have been carried out to estimate the prevalence of burnout among postgraduate resident doctors. Our study, the first of its kind from eastern India, aims to address this lacuna. Materials and Methods: This was a single-institution cross-sectional observational study carried out using an online semi-structured form comprising demographic data and the Maslach Burnout Inventory. Appropriate statistical tests were carried out to analyze the data obtained. Results: The study received a response rate of 79.2%. Of the participants, 44.1% were females, 54.9% were males, and 1% identified as other gender. The mean age (standard deviation) of the participants was 28.02 (3.67) years. Overall, 75% of the participants experienced burnout. Younger participants, females, clinical residents, those in a relationship, and 2nd year of residency reported higher emotional exhaustion. Depersonalization was associated with lower age, being in a relationship, metropolitan upbringing, and 2nd year of residency. The lower personal accomplishment was seen in those coming from metropolitan and rural backgrounds. Conclusion: Burnout has serious implications on psychological and physical health of the residents. Interventions for effective management will greatly improve the overall mental health and work performance of the junior doctors.

Knowledge and attitude on childhood cancer survivorship among healthcare trainees: a multicentre study from India

BackgroundThe proportion of childhood cancer survivors (CCS) in low/middle-income countries (LMICs) is rising. CCS often develop several physical and psycho-social long-term adverse effects, with unique healthcare needs. Primary healthcare providers...

Pattern and clinical profile of patients with ocular trauma presenting to the emergency department of a teaching hospital in India: A prospective observational study.

One major contributor to avoidable ocular morbidity is ocular trauma (OT). The study aimed to document the epidemiological factors, pattern of injury, and outcome among patients with OT presenting to the emergency department (ED). This was a prospective observational study conducted in the ED of a tertiary care teaching hospital in Eastern India after due approval from the institutional ethics committee. The data were collected during the period from March 2021 to February 2022. Data pertaining to age, sex, type of injury, mechanism of injury, time and place of injury, details of tissue involvement, visual acuity, any prior history of injury, initial diagnosis, and management were noted. To estimate the severity of the injury and the probable visual outcome, we calculated through OT score (OTS), including one raw score and OTS. Statistical analysis was performed using the R, version 4.6.1. A total of 180 patient's data were included for final analysis. The median (interquartile range) age of the patients was 32 (24-45) years. The majority were males (n = 147 [81.6%]) with a male-female ratio of 4.5:1. Road traffic accidents (RTA) were the common cause of injury (n = 122 [67.7%]). Unilateral eye involvement was the most common (n = 147 [81.6%]). In the pattern of injury, most of the patients sustained closed globe injuries (CGIs) (n = 158 [87.7%]). Among the CGIs, injury to the ocular adnexa and conjunctiva (n = 141 and 127, respectively) was the most common. Injury to the retina and choroids occurred in 20 (11%) patients. The vision was not affected in most of the cases (n = 125 [69.4%]) with a visual acuity of > 6/18. The majority (n = 120 [67%]) of the patients had an OTS of grade-4, followed by grade-2 (n = 22 [12%]). Most of the patients required only medical management (n = 100 [56%]), whereas 77 (43%) patients required surgical interventions. OT was a common presentation in the ED. Male patients with monocular injuries involved in RTAs were mostly affected. The vision was preserved in most of the cases.

Learner’s perspectives and outcomes of peer role play as a teaching learning method for prescription communication skills in second year medical students at a tertiary teaching hospital in India

Background: Medical education in India is experiencing a positive shift from traditional curriculum to competency-based medical education. Among the different initiatives, inclusion of role-play with specific aim of improving prescription communication skills in the current curriculum, could lead to beneficial patient- response outcomes. This study aims to evaluate the undergraduate medical student’s perspectives on implementing role-play for learning about prescription communication. Methods: This was a cross-sectional observational study conducted in the department of pharmacology involving second-year medical students of Vydehi institute of medical science and research centre participating for a month-long duration. An internally validated questionnaire was used to assess students’ perspectives on role-play in prescription communication. The outcome was evaluated based on students’ performance in prescription writing and appropriate communication before and after the role-play session. The data obtained was analysed using the SPSS software. Results: The mean score for the overall benefit of role play for prescription communication for all responding participants (n=163) was 4.2 out of 5. In this study, 89.4% of students agreed that role-play in prescription communication should be an essential aspect of their training in the curriculum and is worth taking this additional effort. 84.6% of students found that, the sessions helped to understand and share the pharmacology concepts better. Mean pre and post role play prescription writing assessment scores in students was 7.59 and 9.01 out of 10 respectively. Conclusions: Role-play was well received by the students as a low-cost innovative teaching methodology for better understanding of Pharmacology concepts as mandated by the CBME curriculum. It helps in understanding the importance of teamwork and error-free prescription communication for future clinical practice. Overall, following appropriate demonstration, use of role-play showed significant improvement in student performance in prescription communication.

The Combined Effect of Robot-assisted Therapy and Activities of Daily Living Training on Upper Limb Recovery in Persons With Subacute Stroke: A Randomized Controlled Trial

ObjectivesTo evaluate the effectiveness of robot-assisted therapy (RAT) followed by activities of daily living (ADL) training in comparison with conventional rehabilitation therapy (CRT) and ADL training in individuals with subacute stroke. DesignA single-blind, 2-arm, parallel-group, open-level, randomized controlled trial. SettingA tertiary care teaching hospital in India. ParticipantsForty-four persons (n=44) with first-ever stroke (in subacute stage) were enrolled from August 2021 to July 2023. InterventionParticipants in the RAT group (n=22) received RAT for 30 minutes, followed by ADL training for 30 minutes. In contrast, participants in the CRT group (n=22) received CRT (30 minutes) followed by ADL training (30 minutes). Both groups received allocated interventions for 15 days over 3 weeks (5 days/week, 3 weeks). Main Outcome MeasuresPrimary outcome: Motor domain score of the Fugl-Meyer Assessment scale for upper extremity (FMA-UE). Secondary outcomes: the other domains scores of FMA-UE (UL -sensation, -joint motions, -joint pain); Modified Ashworth Scale (MAS) (spasticity); hand-function (HF) and ADL-domain scores of the stroke impact scale (SIS); WHOQQL-BREF questionnaires (QOL). Participants were assessed at enrolment and follow-up at 3, 6, and 12 weeks. ResultsPersons who received RAT and ADL training reported significant improvement (P<.05) in UL motor function (mean difference [MD]=3.54;(95% confidence interval [CI]: 1.28 to 5.79]), UL passive joint motions (MD=2.54; [95% CI: 1.56 to 3.52]), SIS-HF (MD=6.37;[95% CI: 4.75 to 7.99]), SIS-ADL (MD=7.13 [95% CI: 3.52 to 8.74]), and in all domains of WHOQOL-BREF (except environmental domain) compared with persons who received CRT and ADL training at 12 weeks. ConclusionsThe findings indicate that RAT followed by ADL training is more effective than CRT followed by ADL training in motor improvement, SIS-HF, SIS-ADL, and QOL at 12 weeks.

Predictors of biomedical waste management practices among staff nurses of a tertiary care teaching hospital in India.

Inappropriate handling of biomedical waste (BMW) may pose serious threats to the health of patients and hospital personnel. Among all healthcare workers, staff nurses play a vital role in BMW management (BMWM). Thus, the present study aimed to determine the predictors of BMWM practices among staff nurses of a tertiary care teaching hospital in India. A prospective cross-sectional study was conducted among 150 staff nurses, working at a tertiary care teaching hospital in South India, from July to August 2018. Data were collected using a pretested, semi-structured, and self-administered questionnaire after taking their written informed consent. Regression analysis was carried out to identify the predictors of satisfactory BMWM practice status. Of the total 150 staff nurses, most of them were young females with a work experience of ≤ 5 years. Concerning knowledge scores, most staff nurses (63.3%) belonged to the moderate category, whereas a few (24%) were in the high category. Also, most of them (62.7%) were in the high category of attitude scores. For practice scores, half of the participants were in moderate and high categories, each. Female gender, attended training status, and moderate and high knowledge scores were significantly associated with satisfactory BMWM scores in unadjusted analysis. After adjusting for other independent variables, all these three factors were found significantly associated with satisfactory BMWM practice scores. The present study shows that the female gender, attending training in BMWM, and having a moderate and high knowledge of BMWM were significant predictors of satisfactory BMWM practice among staff nurses. Thus, all hospitals must periodically train their staff nurses to strengthen their BMWM practices. Safe BMWM leads to environmental protection and safeguards the health of patients, hospital personnel, and the public.

Treatment Cost Along With Pattern of Disease and Therapy in the Intensive Care Unit of a Tertiary Care Teaching Hospital in India.

Background The intensive care unit (ICU) represents an important platform for conducting drug utilization analysis using defined daily dose (DDD)/100 bed-days and the financial burden of treatment as patients are seriously ill and are often suffering from chronic critical illnesses. Therefore, in this study, we evaluated the drug utilization patterns and cost of treatment in the ICU. Methods A retrospective observational analysis of the medical records obtained for the medical ICU of an apex tertiary care teaching hospital in central India was conducted for a period of three years from 2017 to 2019. All the patients admitted to the medical ICUduring the study tenure were included in the study. Patients hospitalized in neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), and surgical ICU were excluded from the study. The socio-demographic and clinical data, utilization of different classes of drugs, WHO-Anatomic Therapeutic Chemical(WHO-ATC) classification, DDD/100 bed days, hospital stay, etc. were analyzed.A partial pharmaco-economic analysis of the average cost of admission to patients was done. Results Data from 280 patients was assessed. The mean age was 47 ± 19.18 years and 58% were males. Antibiotics and injections were prescribed to 96% and 97.5% of the patients, respectively, during their ICU stay (median: seven days). Antimicrobial drugs were most frequently prescribed (n=1096, 68%); the most common were beta-lactams and carbapenems, followed by drugs acting on the central nervous system (5%) and cardiovascular system (4.3%). Cefoperazone/sulbactum, ceftriaxone, and piperacillin/tazobactam were the most utilized antibiotics with 8, 16, and 6 DDD/100 bed-days, respectively, while proton pump inhibitors, analgesics, and anti-epileptics were the most frequently prescribed non-antimicrobial drug class. The median cost of treatment per ICU admission was Indian Rupees (INR) 23,347 (IQR 12,552- 65,524). Conclusion Drug utilization assessment provides crucial information for understanding the usage of drugs in the settings of the ICU, and should be conducted regularly to help in the proper planning and implementation of rational drug use. Treatment costs reflect the high economic burden seen in ICU admissions.

High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trial

ObjectivesSympathetic crashing acute pulmonary edema (SCAPE) is a subset of heart failure with a dramatic presentation. The unique physiology of this condition requires a different management strategy from the conventional...

Acquaintance of medical students with the National List of Essential Medicines

Background: Undergraduate medical students are future prescribers of medicines, and they must understand the concept of essential medicines and their importance in healthcare. Regulations on Graduate Medical Education Amendment 2019, has revolutionized Indian medical education by introducing competency-based medical education which states that the major goals for an Indian medical graduate are to acquire the competency of a “clinician who understands and provides preventive, promotive, curative, palliative, and holistic care with compassion.” The National List of Essential Medicines (NLEM) has been included as a core topic in the curriculum of undergraduate medical students. This research attempted to understand the level of knowledge regarding the NLEM among undergraduate medical students. Aim and Objective: To assess the baseline level of knowledge regarding the NLEM among undergraduate medical students. Materials and Methods: A questionnaire-based study was done among medical students of a government tertiary care teaching hospital in India. 1st year students were excluded as they were not taught about Essential Medicines and NLEM. A pre-validated multiple-choice questionnaire was distributed to medical students and information was collected related to knowledge regarding NLEM significance, criteria for inclusion in NLEM, terminologies, and drugs in NLEM that are used for common conditions. Results: Out of 600 students 237 (39.50%) students responded. 98 (41.35%) students were aware of recent NLEM-2022, 91 (38.40%) students were aware of terminologies used in NLEM, and 71 (29.96%) students were aware of the criteria for inclusion of any drug in NLEM. 175 (73.84%) students were unaware of updates in NLEM-2022. 165 (69.62%) students were unaware of the number of medicines added and deleted in NLEM-2022.155 (65.40%) students were not able to answer the questions regarding drugs for anaphylaxis and new antihypertensive drugs included in recent NLEM-2022. Conclusion: Knowledge regarding NLEM is limited among undergraduate medical students. To sensitize medical students to rational drug therapy, there is an urgent need to improve their knowledge related to NLEM via educational interventions.

Knowledge, attitude, and practice regarding COVID-19 vaccine precaution dose among health-care professionals at a tertiary care teaching hospital in India: A cross-sectional study

Background: COVID-19 vaccine precaution dose has emerged as an essential tool to control the spread of COVID-19 infections worldwide. The acceptance of vaccines is influenced by various factors such as knowledge, perception of the likelihood of COVID-19 spread, vaccine safety, logistics, vaccine efficacy, and perceived risk. Aim and Objectives: This study aimed to assess knowledge, attitude, and practice of COVID-19 vaccine precaution dose among health-care professionals (HCPs) at a tertiary care teaching hospital. Materials and Methods: A cross-sectional study was conducted among 147 participants using a self-designed, semi-structured, and pre-validated questionnaire circulated through Google Forms to HCPs. Results: The results showed that all the participants were aware of the COVID-19 vaccine precaution dose. However, only 68.49% of the participants had received the dose. The major source of information was the World Health Organization. About 79.4% of the participants were worried about serious unknown long-term effects of the precautionary dose, but the majority were willing to take it without any hesitation. About 14.3% of the participants experienced side effects, with pain at the injection site being the most common. Conclusion: The study demonstrates that participants had a good understanding of the COVID-19 precaution dose, but their attitudes were slightly lesser compared to their knowledge, and also, there was a lot of hesitation with respect to practicing the COVID-19 vaccine precaution dose.

Management of Biomedical Waste: An Overview of a Tertiary Care Teaching Hospital in India

Abstract Introduction: Waste is an inevitable result of health-care services that may pose a health risk. Health-care waste comprises of general, infectious, and chemical/radioactive waste. Preventing the spread of infection to health-care personnel, patients, attendants, and the community at large is the ultimate objective of biomedical waste management (BMWM). Materials and Methods: It was a descriptive study which explored available resources, considering physical facilities, equipment, and human resources. All the personnel engaged in the management of BMW were included with focus on their training and vaccination status. The workflow process for BMWM was documented. In addition, the quantities of Yellow, Red, Blue, and White Waste generated were recorded. BMW generated per bed per day was calculated for each category and also overall waste collected was calculated. Results: The hospital’s comprehensive waste management plan encompasses seven defined routes, ensuring coverage of the entire facility. The BMW produced during a month range from 32,201 to 44,390 kg with a total of 465,392 kg/year. The mean BMW generated was 38,782.67 kg and the average BMW generated per day was 1271.25 kg. BMW generated per bed per day came out to be 0.33 kg. Conclusion: Every employee involved in the management of BMW was vaccinated for Hepatitis B and Tetanus toxoid. Sixty-eight percent of the workforce involved in BMWM underwent regular BMW refresher training. The remaining 32% received BMW training at the commencement of their roles but did not undergo refresher training. Regularly refresher training sessions on BMWM should be conducted, maintaining accurate and up-to-date records.

Blood lead levels in pregnant women and their newborn infants at an Indian teaching hospital.

With the growth of the world's economy and industrialization, lead (Pb) contamination in the environment has become a major issue on a global scale. Lead is typically linked to unfavorable pregnancy outcomes such as stillbirth, low birth weight preterm, and spontaneous abortion. In this study, we evaluated the blood lead levels of pregnant women and their birth outcomes attending an Indian tertiary care teaching hospital, those who were not exposed to any lead-associated industry or shops. A descriptive study was undertaken to evaluate blood lead estimation in pregnant women and umbilical blood lead levels in a community hospital. Blood samples from 104 mothers during the 1st trimester, 90 mothers during 3rd trimester, and from the umbilical cord were collected. Self-administered questionnaires were used to collect information on demographics, medical history, and concerns linked to pregnancy. Following acid digestion, the levels of lead in whole blood were determined by an atomic absorption spectrometer. The DNA damage in high blood lead-concentrated pregnant women was evaluated by comet assay methods. Among 194 blood samples of pregnant women, 31 (15.98%) samples revealed ≥5 μg/dL blood lead levels. High lead concentration (≥5 µg/dL) in 1st trimester pregnant women, end of 3rd trimester and cord blood were detected 20.19%, 11.11% and 1.11% respectively. The mean blood lead levels in 1st trimester, 3rd trimester, and cord blood were 3.88 ± 3.19, 2.66 ± 1.82, and 1.53 ± 1.06 mg/dL, respectively. The blood lead concentrations were significantly higher in the 1st trimester of pregnancy than in the 3rd trimester of pregnancy (P < 0.0017). A positive correlation between maternal and infant blood lead levels was revealed (P < 0.0001). When the comet assay was used to assess the genotoxic consequences of elevated blood lead levels during pregnancy, higher amounts of DNA damage were found in the samples (P < 0.01). In this descriptive study, there was a significant amount of lead transferred from mother to baby through the placenta. All mothers were not exposed to lead-associated industry and most were housewives. This article may be viewed as an eye-opener for understanding the blood lead concentration during pregnancy to avoid abnormal birth outcomes. To minimize exposure to environmental lead, all possible measures should be undertaken.

Unit Cost of Magnetic Resonance Imaging Scan at a Tertiary Care Teaching Hospital in India

Unit Cost of Magnetic Resonance Imaging Scan at a Tertiary Care Teaching Hospital in India

Surgical Site Infections in Elective and Emergency Abdominal Surgeries: A Prospective Observational Study About Incidence, Risk Factors, Pathogens, and Antibiotic Sensitivity at a Government Tertiary Care Teaching Hospital in India.

Background Surgical site infections (SSIs), the third most common nosocomial infection, endanger hospitals and patients. SSIs must be monitored continuously. This present study examined SSI incidence, risk factors, pathogens, and antibiotic sensitivity in emergency and elective or planned abdominal surgeries. Methods The Dr. S.N. Medical College General Surgery Department in Jodhpur, India, operated on 100 patients. The sample was divided into two 50-person groups. Group A includes emergency surgery patients, while Group B includes elective surgery patients. The samples were aseptically collected and processed according to microbiological methods. Data were processed with IBM SPSS Statistics for Windows, version 20 (released 2011; IBM Corp., Armonk, New York, United States). Results Out of a sample size of 100 patients, 17 individuals experienced SSIs. SSIincidence was 16.66% in male patients and 18.18% in female patients. In addition, the rate of SSIs was 26% in the emergency group and 8% in the planned group. The association was stronger among elderly individuals, diabetics (33.33% in Group A and 12.5% in Group B), and anemics with a history of smoking. The association was higher in those who underwent surgery for more than 60 minutes (34.37% in Group A and 18.8% in Group B). The incidence of SSIs was higher in emergency cases compared to elective surgeries, with rates of 26% and 8%, respectively, but was statistically insignificant. The infection rate in clean cases during planned surgery was 3.70%, while clean contaminated cases during planned surgery had a wound infection rate of approximately 13.04%. In emergency surgery, no clean case was operated on, but the SSI rate in the emergency group was 9.09%, 22.22%, and 47.36% in the clean-contaminated, contaminated, and dirty cases, respectively.In Group A, Escherichia coli was the predominant organism found in SSI wounds, while in Group B, Staphylococcus aureus was the predominant organism, accounting for 46.15% and 50% of infections, respectively. Amikacin and metronidazole exhibited the highest efficacy against E. coli, with amikacin demonstrating the highest sensitivity. Conclusion SSIs are more common in emergencies than planned procedures. Age, gender, diabetes, hypertension, smoking, and prolonged surgery are risk factors for SSIs. Effective antibiotic policy and infection control can greatly prevent SSIs.

E-HEART score: A novel scoring system for undifferentiated chest pain in the emergency department.

Cardiovascular disease is the leading cause of death worldwide. As there is an increase in the global burden of ischemic heart disease, there are multiple scoring systems established in the emergency department (ED) to risk stratify and manage acute coronary syndrome (ACS) in patients with chest pain. The objective of this study was to integrate point-of-care echo into the existing history, electrocardiogram, age, risk factors, and troponin (HEART) score and evaluate a novel scoring system, the echo HEART (E-HEART) score in risk stratification of patients presenting with undifferentiated chest pain to the ED. The E-HEART Score was also compared with existing traditional scoring systems for risk-stratifying acute chest pain. A diagnostic accuracy study involving 250 patients with chest pain at the ED of a single tertiary care teaching hospital in India was conducted. The emergency physicians assessed the E-HEART score after integrating their point-of-care echo/focused echo findings into the conventional HEART score on presentation. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) within 4 weeks of initial presentation. The accuracy of the E-HEART score was compared with other conventional risk stratification scoring systems such as the thrombolysis in myocardial infarction (TIMI), history, electrocardiogram, age, and risk factors, Troponin Only Manchester ACS (T-MACS), and HEART scores. A total of 250 patients with a median age of 53 years (42.25-63.00) were part of the study. Low E-HEART scores (values 0-3) were calculated in 121 patients with no occurrence of MACE in this category. Eighty-one patients with moderate E-HEART scores (4-6) were found to have 30.9% MACE. In 48 patients with high E-HEART scores (values 7-11), MACE occurred in 97.9%. The area under receiver operating characteristics (AUROC) of E-HEART score is 0.992 (95% confidence interval: 0.98-0.99), which is significantly higher than AUROC values for HEART (0.978), TIMI (0.889), T-MACS (0.959), and HEAR (0.861), respectively (P < 0.0001). At a cutoff of E-HEART score >6, it accurately predicted ACS with a sensitivity of 92% and a specificity of 99% with a diagnostic accuracy of 97%. The E-HEART score gives the clinician a quick and accurate forecast of outcomes in undifferentiated chest pain presenting to the ED. Low E-HEART scores (0-3) have an extremely low probability for short-term MACE and may aid in faster disposition from the ED. The elevated risk of MACE in patients with high E-HEART scores (7-11) may facilitate more aggressive workup measures and avoid disposition errors. E-HEART is an easily adaptable scoring system with improved accuracy compared to conventional scoring systems.

Effectiveness of Gentamicin Wound Irrigation in Preventing Surgical Site Infection During Lumbar Spine Surgery: A Retrospective Study at a Rural Teaching Hospital in India.

Surgical site infections (SSIs) are an opposing result of surgery and account for the majority of healthcare-related infections worldwide. It is one of the most common complications associated with open-spine surgery and is associated with high rates of mortality and high demand for healthcare resources. Surgical site infections are the result of a variety of reasons, which is why a range of prevention strategies have been proposed. Intraoperative wound irrigation (IOWI) is a simple procedure that involves moving a solution through an open wound to help hydrate the tissue. It is a type of prophylactic wound irrigation. It removes and dilutes bodily fluids, bacteria, and cellular debris. It may also act as a bactericidal agent when used with antibiotics and antiseptics. To evaluate the incidence of SSIin lumbar spine surgeries by comparing IOWI with normal saline containing gentamicin (NS-G) and normal saline (NS) alone. A hospital-based retrospective study was conducted among 40 patients who underwent elective lumbar spine surgery at the Department of Orthopaedics, RL Jalappa Hospital Centre, Kolar, Karnataka, India. Out of the total participants enrolled, 60% were males and 40% were females. There was no statistically significant difference found between mean age, mean BMI, mean hemoglobin level, mean WBC counts, and mean fasting blood sugar (FBS) levels among both groups. The overall prevalence of SSI among patients was 25%. In Group A (NS-G), the prevalence of SSI was 15%, and in Group B (NS), it was 35%. In total, 17.5% of study participants had superficial SSI, while 7.5% had deep SSI. Gentamicin, an aminoglycoside antibiotic, is bactericidal and efficient against gram-positive organisms likeStaphylococcus, the most frequent pathogen causing SSI in spine surgery. During lumbar spine surgery, IOWI with saline and gentamicin before closure is more effective in preventing SSI than simple saline irrigation.