Teaching Hospital In New Delhi Research Articles

How well are we prescribing medications to our children?

Introduction: Prescription errors are common and every step in the process of writing a prescription has the potential for error. These errors can be broadly attributed to the lack of knowledge or lack of skill. Poor legibility, inaccuracy in writing, incomplete prescriptions, omissions, and use of abbreviations are the most common type of errors. Objectives: The primary objective of our study was to assess the completeness and legibility of the prescriptions. This is to estimate the rates of skill-based errors. Secondary objective of this study was to assess the appropriateness of the prescriptions using the pediatrics: Omission of Prescriptions and Inappropriate prescriptions (POPI) tool. Methods: This was a cross-sectional study, conducted in the pediatric outpatient department of a tertiary teaching hospital in New Delhi, India. Prescriptions received by outpatients attending both the general and special pediatric clinics were collected and evaluated using the World Health Organization Guide to Good Prescribing and the Medical Council of India guidelines. Results: A total of 343 prescriptions were assessed, in which 753 drugs were prescribed. A total of 1709 errors were uncovered pertaining to the completeness of the prescription. A majority of the prescriptions were written by postgraduates trainees (206), followed by senior residents (61), consultants (42), and junior residents (20). Abbreviations were used while mentioning the drug names in 53.64% prescriptions. The mean legibility score of all prescriptions was 3.35. Forty (11.66%) prescriptions were found inappropriate as per the International POPI tool. Conclusion: The legibility and completeness are largely overlooked yet crucial to the “Art of Prescription Writing.” They deserve as much awareness and education as the appropriateness of the drugs prescribed. The international POPI tool is a promising tool to analyze the appropriateness of pediatric prescriptions.

Virological profile of upper respiratory tract infections in children under 5 years of age- a cross sectional study in a tertiary care hospital in North India

Objective: To study the virological profile of URI among children under 5 years of age. Since, it is very difficult to distinguish between various viral etiologies solely on the basis of symptoms, this study was attempted to generate evidence that majority of URI are caused due to viral illness and no antibiotics should be prescribed in the management of the same. Methods: This observational study was conducted over a period of one year (June 2021–May 2022) in a tertiary care teaching hospital in New Delhi. A total of 180 children between the age of 0–5 years with symptoms of URI were included. Nasopharyngeal swabs were taken and processed for detection of viruses using multiplex RT PCR. Results: Presence of viruses were detected in 136 (75.6%) samples. A single virus was identified in 113 samples, whereas 21 were found to harbour two viruses and 2 were carrying three viruses. The most common virus isolated was Human Rhinovirus (HRV- 55.8%) followed by Respiratory Syncytial Virus (RSV- 23.5%). In samples showing coinfection with two viruses, most common was Human Corona Virus (HCoV)- NL63, 229E, OC43, HKU1. None of the patients were given antibiotics. None of the patients required any hospital admission for severe respiratory illness. Conclusions: Viruses are a major cause of URI in children under five years of age, with the most prevalent organisms being HRV and RSV. Antibiotic prescriptions in URI are not warranted.

OCCURENCE OF ADVERSE PREGNANCY OUTCOMES AND ITS RELATION TO LIPID PROFILE IN EARLY PREGNANCY IN WOMEN ATTENDING IN TERTIARY CARE CENTRE

Background: Maternal dyslipidemia has been linked to adverse perinatal outcomes. Hypercholesterolemia and elevated triglycerides in early pregnancy have been associated with an increased risk for gestational hypertension and adverse perinatal outcomes. The present study aimed to know the occurrence of adverse pregnancy outcomes among dyslipidemic pregnant females in rst trimester and the relationship between maternal lipid prole in early pregnancy and birth outcomes. Material and methods: Serum lipid levels of total 124 pregnant females were taken in rst trimester in a large tertiary care teaching hospital in New Delhi and they were followed up for their pregnancy and perinatal outcomes. The outcomes were stratied by normal and elevated lipid levels. Results: 41.9% pregnant females were found to be dyslipidemic. The common morbidities were gestational Hypertension (10.5)% and gestational diabetes (16.1%). The overweight females (BMI, 25-30 kg/m2) in hyperlipidemia group (61.5%) were more than normal lipid group (36.1%). (p<0.01). Babies with birth weight between 3.5- 4 kg were all born to mothers having hyperlipidemia during rst trimester (N=8). (p <0.01). Babies with birth weight falling under large for gestation (LGA) category were signicantly more in hyperlipidemia group (15.4%) compared to normal lipid group (2.8 %) (p<0.05). Mean serum total cholesterol and triglyceride was signicantly higher in women >30 years compared to women less than 30 years. Conclusion: Risk of gestational hypertension, preeclampsia and gestational diabetes was higher in females with hyperlipidemia in rst trimester. Hyperlipidemia and gestational diabetes were responsible for large for gestation birth weights

Willingness of medical students to volunteer during the Covid-19 pandemic: Assessment at a tertiary care hospital in India.

Background The involvement of medical students in strategies to control Covid-19 might be considered to cope with the shortage of healthcare workers. We assessed the knowledge about Covid-19, willingness to volunteer, potential areas of involvement and reasons for hesitation among medical students towards volunteering. Methods We did this cross-sectional study among undergraduate students at a tertiary care teaching hospital in New Delhi. We used a web-based questionnaire to elicit demographic information, knowledge of Covid-19, willingness to volunteer and reasons deterring them from working during the Covid-19 pandemic, and self-declared knowledge in six domains. Results A total of 292 students participated in the study with a mean (SD) age of 19.9 (3.1) years. The mean (SD) knowledge score of Covid-19 was 6.9 (1.1) (maximum score 10). Knowledge score was significantly different among preclinical (6.5), paraclinical (7.18) and clinical groups (7.03). Almost three-fourth (75.3%) participants were willing to volunteer in the Covid-19 pandemic, though 67.8% had not received any training in emergency medicine or public health crisis management. Willingness to work was maximum in areas of social work and indirect patient care (62.3% each). Lack of personal protective equipment was cited as a highly deterring factor for volunteering (62.7%) followed by fear of transmitting the infection to family members (45.9%), fear of causing harm to the patient (34.2%) and the absence of available treatment (22.2%). Conclusions A majority of the students were willing to volunteer even though they had not received adequate training. Students may serve as an auxiliary force during the pandemic, especially in non-clinical settings.

Effectiveness of Tibolone in Relieving Postmenopausal Symptoms for a Short-Term Period in Indian Women.

Tibolone is an alternative to conventional estrogen and progesterone in relieving post-menopausal symptoms in Indian women. A prospective short-term observational study was done at a tertiary care teaching hospital in New Delhi from November 2019 to September 2021. Fifty-three women, less than 60years of age, presenting with moderate to severe intensity of menopausal symptoms as assessed by measuring menopausal rating score (MRS > 8) were enrolled and given Tibolone 2.5mg daily for 3months. Improvements in symptoms were seen at 1month and 3months. Side effects were also noted. Marked improvement was seen as reduction in scores of psychological, somatic and genitourinary symptoms was noted. The psychological symptoms reduced from 8.92 ± 1.959 to 2.905 ± 1.042, the somatic symptoms decreased from 8.33 ± 2.299 to 3.4 ± 1.167, and genitourinary symptoms decreased from 3.64 ± 1.42 to 2.150 ± 0.948 after 3months of treatment with Tibolone. Only 3 patients (5.6%) experienced vaginal spotting with no major side effects. Tibolone is a highly effective and well accepted drug to reduce moderate to severe menopausal symptoms, especially psychological symptoms including depression.

Effects of RME on Hearing in UCLP Patients: A Pilot Study.

To assess the changes in hearing after rapid maxillary expansion (RME) and at the end of 6 months retention period in complete unilateral cleft lip and palate (UCLP) patients using pure tone audiometry and tympanometry test. Prospective pilot study. Tertiary health care teaching hospital in New Delhi. This study was conducted on 6 UCLP patients in the age range of 6-14 years with normal ear anatomy. All 6 patients had undergone primary repair of cleft lip and palate and required no more than 5 mm expansion in the intermolar region. RME was done using a Hyrax expander with daily activation of one-quarter turn per day for a period of 15-20 days (0.25 mm per day). Audiometry and tympanometry readings at the baseline as compared to the post expansion and at the end of 6 months retention period. There were no significant changes in the hearing levels on the audiometry test after RME on the cleft side (p-value -0.51) and the noncleft side ear (p-value -0.26). No significant changes were observed in the middle ear volume on the tympanometry test after RME on the cleft side (p-value -0.09) and the noncleft side ear (p-value -0.28). There was no improvement or deterioration in the hearing levels after RME and at the end of 6 months retention period in UCLP patients as evaluated using pure tone audiometry and tympanometry test. Hence RME may be undertaken in UCLP patients safely in terms of hearing is concerned.

Preparation of operating room for COVID-19 suspects at a tertiary care teaching hospital in New Delhi, India

The continuous rise in the number of cases of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), generated an urgent need to transform the facilities of our existing operating rooms (OR) to cater for emergency surgeries for patients with suspected COVID-19. The aim was to minimise the spread of infection and to achieve the lowest risk for patients and staff while caring for COVID-19 suspects undergoing surgery. We devised a protocol in our hospital to prepare OR for patients suspected to be suffering from COVID-19 but in whom the surgical intervention could not be deferred until the result of the COVID-19 test was obtained. The key consideration was that we cater to suspected and confirmed COVID-19 patients who required emergency surgery while adhering to strict infection control measures. The study was undertaken as a pilot exercise in consultation with treating surgeons, hospital infection control committee members, hospital administrators, and engineers, along with a literature review, to transform the design and functioning of existing facilities to prepare for emergency surgeries of COVID-19 suspects at the beginning of the pandemic. While this required significant planning on paper and onsite by members of the OR staff, hospital infection control committee, administration, and engineers, the creation of a safe operating environment was possible within a 48-h period with minimal structural alterations.

Study of the client experience and continuation rate of postpartum intrauterine Copper-T device in semi-urban population in India

Background: Postpartum intrauterine copper device (PPIUCD) is a reliable and efficient method of contraception for women. In spite of its ease of administration, its acceptance is very low owing to a number of factors. The current study was undertaken to analyze the continuation rates and problems among women accepting PPIUCD as contraceptive method. Methods: The present study was undertaken in the family planning department of a teaching hospital in New Delhi. It was an ambispective, observational study in which 880 beneficiaries of PPIUCD were telephonically contacted and interviewed. A pro forma containing demographic profile, obstetric history of the women, date and timing of insertion of PPIUCD, source of information about PPIUCD, side effects encountered, willingness to continue, and reasons of discontinuation, if applicable, was filled and the data, collected thus, were analyzed. Results: Most of the women enrolled in the study had a mean age of 26.5 (±4.1) years; the average parity was two. The timing of insertion of PPIUCD was postplacental in majority of women (91.7%). Most of the women received information about PPIUCD from health-care workers (90.1%). It was found that 86.7% of women were using PPIUCD at the time of interview and 73.3% were satisfied with it and willing to continue further. The predominant side effect observed was pain abdomen (15%), followed by menstrual irregularity. Conclusion: The present study revealed a high continuation rate of PPIUCD. Health-care professionals were the foremost source of information for PPIUCD. It is a highly effective method which needs to be popularized among the masses by the active participation of media and other agencies as it has the potential to bridge the gaps in existing family planning services.

Trends in Practices of Self-Medication with Antibiotics among Medical Undergraduates in India.

Background:Self-medication with antibiotics (SMA) without the consultation of a professional is a serious health concern and can lead to serious health hazard. This study was designed to evaluate the trends in SMA behavior and risk factors in medical undergraduates to further explore the association between SMA practices and adverse drug events (ADEs).Materials and Methods:This cross-sectional questionnaire-based study was carried out among 360 volunteering medical undergraduates at a tertiary care teaching hospital in New Delhi.Results:67.78% of students (244/360) gave a history of SMA practice with females dominating (54.09%). Out of 244 students giving a positive history of SMA, 182 (74.59%) experienced ADE, reflecting a strong positive association between the two. Convenience (86.07%) was observed to be the main reason of practicing SMA in this study. Over-the-counter sale of prescription-only drugs, namely antibiotics by the community pharmacies, is as high as 90.16%, leading to the main source of acquiring antibiotics for self-medication. Fever (47.54%) and respiratory infections (39.34%) emerged as the major indications for SMA. Extended-spectrum penicillins (60.66%) were the most commonly used class of antibiotics for SMA.Conclusion:Our findings endorse high SMA prevalence among Indian medical students. Strict regulations on antibiotic sales and public education reinforced by strong antibiotic stewardship program at all levels are highly recommended.

Comparison of High-Flow Nasal Cannula and Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure Due to Severe COVID-19 Pneumonia.

Efficacy of high-flow nasal cannula (HFNC) over noninvasive ventilation (NIV) in severe coronavirus disease 2019 (COVID-19) pneumonia is not known. We aimed to assess the incidence of invasive mechanical ventilation in patients with acute hypoxemic respiratory failure due to COVID-19 treated with either HFNC or NIV. This was a single-center randomized controlled trial performed in the COVID-19 ICU of a tertiary care teaching hospital in New Delhi, India. One hundred and nine subjects with severe COVID-19 pneumonia presenting with acute hypoxemic respiratory failure were recruited and allocated to either HFNC (n = 55) or NIV (n = 54) arm. Primary outcome was intubation by 48 h. Secondary outcomes were improvement in oxygenation by 48 h, intubation rate at day 7, and in-hospital mortality. Baseline characteristics and [Formula: see text]/[Formula: see text] ratio were similar in both the groups. Intubation rate at 48 h was similar between the groups (33% NIV vs 20% HFNC, relative risk 0.6, 95% CI 0.31-1.15, P = .12). Intubation rate at day 7 was lower in the HFNC (27.27%) compared to the NIV group (46.29%) (relative risk 0.59, 95% CI 0.35-0.99, P = .045), and this difference remained significant after adjustment for the incidence of chronic kidney disease and the arterial pH (adjusted OR 0.40, 95% CI 0.17-0.93, P = .03). Hospital mortality was similar between HFNC (29.1%) and NIV (46.2%) group (relative risk 0.6, 95% CI 0.38-1.04, P = .06). We were not able to demonstrate a statistically significant improvement of oxygenation parameters nor of the intubation rate at 48 h between NIV and HFNC. These findings should be further tested in a larger randomized controlled trial. The study was registered at the Clinical Trials Registry of India (www.ctri.nic.in; reference number: CTRI/2020/07/026835) on July 27, 2020.

Psychosocial profile of cases of gender dysphoria attending a tertiary care hospital in Delhi

AbstractThere is a dearth of scientific data from India on gender dysphoria (GD), and only few published research articles, mainly in the form of case reports or case series, are present. The aim of this work is to study the socio‐demographic profile, parental/family support, comorbid psychiatric illness, and other characteristics (cross‐dressing, sexual orientation, pattern of referral) related to GD. It was a descriptive case study of 20 cases of GD (diagnosed as per DSM‐5) registered from May 2012 to February 2019 at the psychiatry Out Patient Department (OPD) of a tertiary care multispecialty teaching hospital in New Delhi. The subject's socio‐clinical profile was assessed. Descriptive statistical analysis was carried out in this study. Out of the total 20 cases (n = 20), 12 cases (60%) were transgender women, rest (40%) were transgender men, with a male:female sex ratio of 3:2. The mean age of sample was 23.5 ± 6.43 years, age range being 15–41 years. In majority of cases (60%), the age of realization of their problem was in early or middle childhood. Parents of 11 cases (55%) were against the gender affirming treatments and procedures. Cross‐dressing in routine and public life was present in 12 (60%) cases; 20% of the cases had comorbid psychiatric illness. Individuals with this condition are coming forward, seeking help which shows that the awareness about availability of treatment facility especially in the government sector is increasing.

Strengthening sepsis care at a tertiary care teaching hospital in New Delhi, India

IntroductionFailure of early identification of sepsis in the emergency department (ED) leads to significant delays in antibiotic administration which adversely affects patient outcomes.AimThe primary objective of our Quality Improvement (QI)...

Seroprevalence of antibodies to SARS-CoV-2 and predictors of seropositivity among employees of a teaching hospital in New Delhi, India.

ObjectivesHealthcare workers (HCWs) are at a high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to the increased likelihood of clinical exposure during patient management. The study objective was to determine the seroprevalence of antibodies to SARS-CoV-2 and its predictors among hospital employees.MethodsThe cross-sectional study was conducted at a teaching hospital from August 2020 to September 2020 among 1,401 employees, including 1,217 HCWs, in New Delhi, India. The serum samples were examined for immunoglobulin G (IgG) antibodies to SARS-CoV-2 using the COVID Kavach-Anti-SARS-CoV-2 IgG Antibody Detection enzyme-linked immunosorbent assay kit. Data were collected electronically using the EpiCollect mobile platform. A p < 0.05 was considered to indicate statistical significance.ResultsA total of 169 participants (12.1%) had detectable IgG antibodies to SARS-CoV-2. The highest seropositivity rate was observed in the administrative staff (20.1%), while it was lowest among medical doctors (5.5%, p < 0.001). Male sex and ever having lived in a containment zone were independently associated with past infection with SARS-CoV-2.ConclusionThe seroprevalence of SARS-CoV-2 infection in health workers may be lower than in the general population in New Delhi. However, nonpharmaceutical interventions were not associated with a reduction in the risk of acquisition of SARS-CoV-2.

Factors Affecting High Caries Risk in Children With and Without Cleft Lip and/or Palate: A Cross-Sectional Study.

The aim of the study was to analyze the caries protective factors, salivary parameters, and microbial counts in high caries risk children with cleft lip and/or palate (CL/P). This was a cross-sectional study. This study was conducted in a tertiary health care teaching hospital in New Delhi, India. The study was conducted in 40 children, 20 with CL/P and 20 without aged between 5 and 12 years. Children with 2 or more caries lesions in both groups were included in this study. Demographic details, dental caries of affected teeth (World Health Organization criteria for Decayed Missing Filled Teeth [WHO-DMFT] and International Caries Detection and Assessment System [ICDAS II]), caries protective factors, salivary parameters, and microbial counts were recorded by one calibrated investigator. Caries protective factors, salivary parameters, and microbial profile. The Chi-square (χ2) test and Pearson correlation were used for statistical analysis. All the children participating in the study brushed their teeth only once in a day and consumed sweets more than twice a day. None of the children had ever received fluoride varnish. Resting saliva had a low buffering capacity in 80% of children with CL/P and 95% of children without CL/P. Microbial assessment of stimulated saliva showed that with the increases in the numbers (DMFT scores ≥4) and severity (ICDAS codes from 1-2 to 5-6) of caries lesions, both Streptococci and Lactobacilli counts were ≥105 colony-forming units/mL of saliva in the both groups. Children with CL/P showed limited access to caries protective measures and low buffering capacity in resting saliva, along with elevated levels of salivary Streptococci and Lactobacilli in stimulated saliva.

Surgical Site Infection in a 1000-Bed Tertiary-Care Teaching Hospital in New Delhi, India

Background: Surgical site infection (SSI) includes infections occurring after 48 hours of any surgery and accounts for most of the healthcare-associated infections (HAIs) in surgical centers. Surgical site infections can result in pain, discomfort, prolonged hospital stay, increased exposure to antimicrobials, and consequentially, increased healthcare costs. Objectives: The study intended to characterize the incidence, etiology, and emerging resistance of SSI in a 1000-bed tertiary-care teaching hospital in New Delhi. Methods: The ambispective study was conducted in a 1000-bed tertiary-care teaching hospital in New Delhi. Clinical, laboratory, and environmental surveillance and screening of health care providers (HCPs) were conducted using the National Healthcare Safety Network (NHSN) definitions and methods given by the US Centers for Disease Control and Prevention (CDC). Results: With 3,541 patients admitted to the Gynecology and Obstetrics Ward and General Surgical Ward of the hospital, the total episodes of SSI were 80 (2.26%). The mean rates of superficial, deep, and organ space SSI were 46.25%, 47.5%, and 6.25%, respectively. The most common organisms isolated were Acinetobacter baumannii (23.75%), Pseudomonas aeruginosa (17.5%), Escherichia coli (15%), and Staphylococcus aureus (12.5%). Conclusions: The rate of SSI in our study was comparable to the unadjusted rates in India, lower-middle, upper-middle, and high-income countries worldwide. Patients with pre-existing medical illness, prolonged operation time, and wound contamination are strongly predisposed to surgical site infection.

Evaluation of Gasless Laparoscopy as a Tool for Minimal Access Surgery in Low-to Middle-Income Countries: A Phase II Noninferiority Randomized Controlled Study

BackgroundMinimal access surgery is not available to most people in rural areas of low-to middle-income countries. This leads to an increase in morbidity and economic loss to the poor and marginalized. Gasless laparoscopic (GAL) procedures are possible in rural areas because they can be performed under spinal anesthesia. In most cases, it does not require the logistics of providing gases for pneumoperitoneum and general anesthesia. The current study compares GAL with conventional laparoscopic (COL) operations for general surgical procedures.MethodsA single-center, nonblinded randomized controlled trial was conducted to evaluate noninferiority of GAL vs COL at a teaching hospital in New Delhi, India. Patients were allocated into 3 groups and underwent minimal access surgery (cholecystectomies and appendectomies). The procedures were performed by 2 surgeons choosing randomly between GAL and COL. The data were collected by postgraduates and analyzed by a biostatistician.ResultsOne hundred patients who met the inclusion criteria were allocated into 2 groups. No significant difference was observed in the mean operating time between the GAL group (52.9 minutes) and the COL group (55 minutes) (p = 0.3). Intraoperative vital signs were better in the GAL group (p < 0.05). The postoperative pain score was slightly higher in the GAL group (p = 0.01); however, it did not require additional analgesics.ConclusionsNo significant differences were found between the 2 groups. GAL can be considered as noninferior compared with COL and has the potential to be adopted in low-resource settings.

Patterns of concomitant use of Ayurveda and conventional anti-diabetic formulations - Experiences at a tertiary care Ayurveda hospital, India.

Background:Majority of the population relies on traditional medicines for many of their health related problems. Particularly individuals with chronic illness like diabetes mellitus (DM) are more likely to simultaneously use herbal medicines. Many of such users believe that traditional medicines are natural and therefore safe, but this is a dangerous over simplification. Some herbal medicines may be associated with adverse effects, which include interactions with prescribed drugs. Information on such concomitant use of anti-diabetic drugs along with Ayurveda medicines is limited in Indian scenario.Aims and objectives:To survey the patterns of concomitant use of Ayurveda and conventional anti-diabetic drugs by diabetic patients attending an out-patient department of a tertiary care teaching hospital in New Delhi, India through a validated questionnaire.Materials and methods:This is a questionnaire-based survey, carried out after the approval of the Institutional Ethics Committee, subsequently registered at CTRI. A questionnaire to assess the pattern of concomitant use was developed; content was validated and pre-tested by a pilot study in 40 patients, further refined and used in the survey. The data was analyzed to evaluate the patterns of concomitant use of Ayurvedic and conventional anti-diabetic drugs.Results:About 95.9% of diabetic patients were taking herbo-mineral formulations concomitantly with conventional anti-diabetic drugs. Although 45.3% of diabetics were using Ayurveda interventions under the supervision of qualified AYUSH physicians, remaining involved in procuring the drugs over the counter (OTC) or from the local vendors. In majority of these instances, the use of Ayurveda formulations was not communicated with their physicians.Conclusion:The observations reveal that a majority of the diabetics (95.9%) were taking one or the other form of herbal preparations along with their conventional anti-diabetic drugs and about 44% among them were using these concomitantly. Thus, generating awareness on good practices of drug use seems to be essential.

Epidemiological & clinical characteristics & early outcome of COVID-19 patients in a tertiary care teaching hospital in India: A preliminary analysis.

Background & objectives:In this study we describe the epidemiological data, comorbidities, clinical symptoms, severity of illness and early outcome of patients with coronavirus disease 2019 (COVID-19) from a tertiary care teaching hospital in New Delhi, India.Methods:In this preliminary analysis of a prospective observational study, all adult patients admitted to the screening intensive care unit (ICU) of the institute who fulfilled the WHO case definition of COVID-19 and confirmed to have SARS-CoV-2 infection by reverse transcription-polymerase chain reaction were included. Demographics, clinical data and 24 h outcome were assessed.Results:The preliminary analysis of 235 patients revealed that the mean age was 50.7±15.1 yr and 68.1 per cent were male. Fever (68.1%), cough (59.6%) and shortness of breath (71.9%) were the most common presenting symptoms. Hypertension (28.1%) and diabetes mellitus (23.3%) were the most common associated comorbid illnesses. Patients with mild, moderate, severe and critical illness were 18.3, 32.3, 31.1 and 18.3 per cent, respectively, at the time of ICU admission. The proportions (95% confidence interval) of patients requiring any form of oxygen therapy, oxygen therapy by high-flow nasal cannula and invasive mechanical ventilation were 77, 21.7 and 25.5 per cent, respectively, within 24 h of hospital admission. The 24 h ICU mortality was 8.5 per cent, and non-survivors had higher respiratory rate (P<0.01, n=198) and lower baseline oxyhaemoglobin saturation (P<0.001, n=198) at presentation and higher baseline serum lactate (P<0.01, n=122), total leucocyte count (P<0.001, n=186), absolute neutrophil count (P<0.001, n=132), prothrombin time (P<0.05, n=54) and INR (P<0.05, n=54) compared to survivors.Interpretation & conclusions:Nearly half of the patients presented with severe and critical disease and required high-flow nasal oxygen or invasive mechanical ventilation at admission. Severity of the presenting respiratory illness, haematological parameters and lactate rather than age or presence of comorbidity predicted early death within 24 h.

Patients Knowledge of Prescribed Medications and Factors Affecting it in a Tertiary Care, Public, Teaching Hospital in New Delhi, India

Objectives: To study patients’ knowledge about their prescribed medication and factors affecting it. Patients and Methods: An observational, cross-sectional study was conducted in 500 outpatients in the Medicine department of a tertiary care teaching hospital. The patients were interviewed about prescribed medicines using a structured questionnaire. The average consultation time and average dispensing time was also recorded for 100 interactions each. Results: Among 500 patients interviewed, 55% were females. Hindi was the primary language in 99.6% of the patients and majority of the patients 75.2% could not read English. The mean total score for patients’ medication knowledge was 38.87 ± 10.42 (maximum 60). 95% of participants had ‘Adequate to Good Knowledge’, and 5% had ‘Poor Knowledge’. Only 1.8% of the patients surveyed had complete knowledge of their prescribed medications. Various factors like age > 60 years, female gender, illiteracy, inability to read English, the doctor informing the patient only in writing and the pharmacist not explaining the medication information were associated with lower scores. The average consultation time was 284.6 ± 172.87 seconds and the average dispensing time was 60.45 ± 22.3 seconds. Conclusion: Overall the patients appear to have an adequate basic knowledge of their prescribed medications despite inability to understand the language and less time given for doctor patient pharmacist interaction. Interventions are required to improve health care providers understanding of what is required to educate the patients about the same. This is especially so for patients with risk factors contributing to their low knowledge about prescribed treatment.

Multidrug resistance in tubercular mediastinal adenopathy diagnosed by endobronchial ultrasound-transbronchial needle aspiration.

Background:Drug resistance in tuberculosis (TB) is a major public health problem. It is easy to assess for drug resistance in pulmonary samples, but the resistance pattern of TB in the mediastinal nodes has not been studied. The aim of this study is to assess the incidence of multidrug resistance in tubercular mediastinal adenopathy with the help of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration.Materials and Methods:This was a prospective study at a tertiary care teaching hospital in New Delhi where 102 patients with positive mycobacterial cultures from mediastinal lymph node aspirates taken with the help of EBUS were enrolled over 24 months and their drug sensitivity to the first-line antitubercular drugs analyzed.Results:There were 30 cases of drug resistance of 102 culture-positive cases. Of them, 8 patients had multidrug resistant TB (MDR-TB), 16 cases had only single drug resistance, and the remaining 6 cases had more than one drug resistance pattern but not MDR. In our study, the overall incidence of MDR-TB is 7.8% (8/102), although the incidence of MDR-TB in new and re-treatment cases is 2.2% (2/89) and 46.1% (6/13), respectively.Conclusion:Such a high percentage of drug-resistant patients is common in tertiary care hospitals; however, similar percentages may be found in other settings as well. Therefore, all efforts should be made to take samples for Mycobacterium tuberculosis culture from the involved nodes before commencing therapy to avoid treatment failures.