Teaching Hospital In South India Research Articles

Reasons Behind Patients Defaulting from Elective Pediatric Urology Procedures at a Tertiary Private Teaching Hospital in South India.

The aims of the study are to audit the default rate of the provisional date of elective surgery in pediatric urology private practice and to study the factors involved in the postponement of elective operation dates by patients. The audit involved analysis of reasons behind patients defaulting from elective pediatric urology procedures between January 2019 and December 2019 at a tertiary private teaching hospital in South India. The details were obtained from the outpatient register kept for elective booking. The details of actual procedures performed were obtained from OT records. From the defaulters, the reasons for postponement were obtained through personal/telephonic interview. A total of 289 patients were given dates for elective procedures. Among this, 72 (24.9%) defaulted, leaving 217 patients who underwent elective surgery. Among those who underwent surgery, 90 (41%) were elective day case (DC) procedures, whereas 127 (59%) were inpatient (IP) procedures. The default rate was 26/116 (22.4%) for DC procedures, whereas 46/173 (26.6%) for IP procedures, with no significant difference between them (P = 0.64). Among the 72 defaulters, the reasons for cancellation were as follows: financial factors (FFs) 22 (30.6%), lack of family support 19 (26.4%), function/grievance in house 10 (13.9%), respiratory illness 14 (19.4%), and treatment at a different center 7 (9.7%). FF (insurance denial) was significantly higher (P = 0.001) in crucial IP procedures at 19/46 (41%) compared to DC procedures at 3/26 (12%). The various diagnoses denied insurance were UPJO (7), VUR (6), hypospadias (4), UDT (3), and PUV (2). FFs were mainly responsible for parents postponing their children's elective pediatric urology procedures in India. Universal insurance coverage for congenital anomalies might help overcome this most important cause of cancellations.

Correlates of atherosclerotic vascular disease in stable postrenal transplant patients from South India

Introduction: Renal transplant recipients (RTRs) show increased mortality after 1st year of undergoing renal transplantation. Cardiovascular disease (CVD) is the major cause of mortality in these patients. Oxidative stress (OS), inflammation, and endothelial dysfunction (ED) represent a key triad for the onset and progression of atherosclerosis. The present study was undertaken to assess OS, inflammatory biomarkers, and ED as a surrogate marker of atherosclerosis in stable RTRs. Materials and Methods: Thirty stable post-RTRs along with 30 healthy individuals as controls were included in the study conducted at a tertiary care teaching hospital in south India. Lipid profile; OS markers; malondialdehyde (MDA), ischemia-modified albumin (IMA), and ferric reducing ability of plasma (FRAP); inflammatory marker high-sensitivity C-reactive protein and interleukin 6 (IL-6); ED markers nitric oxide (NO) and P-selectin were estimated using standard methods. Lipid indices were calculated. Carotid intima-media thickness, two-dimensional echocardiogram, and renal Doppler scans were done. Results: No difference in lipid profile was observed between the RTRs and the control groups. RTRs had significantly higher oxidant markers (MDA and IMA), inflammatory marker (IL-6), marker of ED (NO), and lower antioxidant marker (FRAP) (P < 0.05) compared to the control group. RTRs had significantly more number of carotid plaques compared to the control group. A positive correlation was observed between number of carotid plaque and OS, ED, and inflammatory markers. Conclusion: RTRs have increased CVD risk despite undergoing renal replacement therapy. This can be attributed to the increased OS and inflammation which is seen in these patients.

Risk Factor for Health Care Workers Developing Hypertension: A Nested Case-Control Study

Background and Objectives: The study was aimed to evaluate the role of stress, lifestyle as well as traditional risk factors in the development of hypertension among health-care workers (HCWs). Methods: This nested case–control study was done at a tertiary care university teaching hospital in South India. Cases were hospital employees diagnosed with hypertension and who were taking antihypertensive medications. Controls were age- and sex-matched HCWs who were not diagnosed with hypertension. They were identified preferably in the same department where its case was presently working. One hundred and twenty-eight cases and 128 controls were enrolled. We collected data on risk factors for hypertension, physical activity, diet, and stress. Those significant on the bivariate analysis were entered into a logistic regression analysis. Results and Interpretation: In the logistic regression, we found that living in a joint family (2 siblings and their families), family history of hypertension, family history of diabetes mellitus, and family history of ischemic heart disease were independently predictive of hypertension developing in the study HCWs. Occasional or regular walking/cycling to work and milk consumption were independent factors that protected against the development of hypertension. Extra added salt to food and stress more than normal in any domain tested were not associated with the development of hypertension in our cohort. Conclusions: HCWs have some novel and other similar risk factors to general population for developing hypertension. Simple preventive measures seem effective. Neither stress nor self-reported salt consumption seemed to play a role in the development of hypertension.

Histopathological gamut of fallopian tube lesions: A 5-year retrospective descriptive study in a tertiary care teaching hospital in South India

Histopathological gamut of fallopian tube lesions: A 5-year retrospective descriptive study in a tertiary care teaching hospital in South India

Serum Uric Acid Levels In Patients With Diabetes Mellitus And Its Correlation With Glomerular Filtration Rate

Context: Serum uric acid is a potential risk factor for development of type 2 Diabetes Mellitus. Hyperuricemia is frequently found in persons with metabolic syndrome. Aim: To compare the serum uric acid in the normal population and in those with diabetes mellitus. Settings and Design: A comparative study was conducted in a tertiary-care teaching hospital in South India, with 100 patients with type 2 diabetes mellitus and 100 healthy controls. Methods and Material: Serum uric acid levels were compared in patients with diabetes and the controls. The serum uric acid levels of the cases and controls were correlated with GFR. Association with factors such as age, gender, BMI, duration of diabetes, proteinuria and hypertension were looked for. Statistical analysis used: Appropriate test of significance such as Student t test, one-way ANOVA test and Pearson’s correlation were used. A p-value of less than 0.05 was considered significant. Results: The mean GFR in cases were 82.6 and in controls were 116.76. The mean serum uric acid levels were significantly higher among cases as compared to controls (4.8 v/s 3.7 mg/dl. A weak negative correlation was obtained between serum uric acid levels and GFR, both in diabetics as well as healthy controls. Conclusions: Serum uric acid levels were higher in patients with diabetes mellitus than in the normal population. Those with elevated serum uric acid levels were found to have reduced GFR.

Risk factors for primary drug resistance among newly detected pulmonary tuberculosis patients presenting to a tertiary care teaching hospital in South India

Risk factors for primary drug resistance among newly detected pulmonary tuberculosis patients presenting to a tertiary care teaching hospital in South India

A comparative assessment of empathy in medical undergraduates: First-year medical undergraduates versus final-year medical undergraduates in a tertiary care teaching hospital in South India

A comparative assessment of empathy in medical undergraduates: First-year medical undergraduates versus final-year medical undergraduates in a tertiary care teaching hospital in South India

Global and sectoral retinal nerve fiber layer thickness in glaucoma suspects and primary open-angle glaucoma patients attending a tertiary care center in South India

ABSTRACT Background: Spectral-domain optical coherence tomography (OCT) can identify the presence of localized glaucomatous structural damage. The peripapillary retinal nerve fiber layer (RNFL) thickness is a popular OCT parameter used for glaucoma diagnosis and monitoring progression. Aim: To measure the peripapillary RNFL thickness, the pattern of RNFL defect, and association of RNFL with the severity of glaucoma using Spectralis Spectral Domain – OCT in patients with primary open-angle glaucoma (POAG) at a glaucoma clinic in a tertiary care teaching hospital in south India. Methods: Cross-sectional study design. Peripapillary RNFL thickness of 109 glaucomatous eyes of 56 patients aged 40–75 years having POAG, ocular hypertension, or suspected to have glaucoma but without visual field (VF) defects were included in the study. The cross-sectional thickness of RNFL using a 3.46 mm circle centered around the disc in 6 segments were measured and defects in the RNFL were identified by comparing measurements from each patient with the normative database. Results: The study included 109 eyes with 51 (46.79%) preperimetric eyes and 58 (53.21%) POAG eyes (with field defects). The average global thickness in the study population was 91.31 ± 12.81 µm for preperimetric eyes and 67.76 ± 17.33 µm for eyes with glaucoma. There was significant thinning in all segments between eyes with POAG and normal eyes with the mean difference highest in the inferotemporal segment (mean difference of 73.05) and the superotemporal segment (mean difference of 55.85). The global RNFL thickness had a coefficient of − 0.015 (standard error [SE] 0.003, 95% confidence interval [CI]: 0.02–0.009, R2 = 0.29) for mild glaucoma, −0.010 (SE 0.004, 95% CI: 0.02–0.003, R2 = 0.12) for moderate and − 0.18 (SE: 0.001, 95% CI: 0.022–0.014, R2 = 0.60) for severe glaucoma compared to preperimetric eyes in a linear regression model that adjusted for age and gender. Global and sector-wise RNFL thickness also had a significant area under Receiver Operator Characteristic (0.84, 95% CI: 0.78. 0.91) that showed the ability to discriminate between preperimetric and glaucomatous eyes. Possible “floor effect” of RNFL thickness was shown by 7 eyes with advanced glaucoma cases. Conclusion: RNFL thinning can be used as a parameter to assess glaucomatous structural loss that can aid in early diagnosis and monitoring of disease progression, to grade the severity of the disease in primary open-angle glaucoma, and when VFs cannot be done.

An observational study on the effectiveness of tolvaptan in patients with euvolemic and hypervolemic hyponatremia admitted to a tertiary care center

Background: Hyponatremia is a common electrolyte abnormality encountered in hospital wards. Even mild hyponatremia can result in significant morbidity and mortality especially in elderly. Treatment of the condition depends on the volume status of the patient, duration and severity of hyponatremia, and clinical condition of the patient. Aims and Objectives: Tolvaptan is an oral vasopressin receptor antagonist approved for use in euvolemic and hypervolemic hyponatremia. The present study aimed to assess the effectiveness and safety of tolvaptan 15 mg daily for 3 days in patients with euvolemic and hypervolemic hyponatremia. Materials and Methods: This study was a prospective observational study conducted on 82 patients with euvolemic and hypervolemic hyponatremia in whom tolvaptan was given in the Department of General Medicine in a tertiary care teaching hospital in south India. History, clinical examination findings, and baseline laboratory values were recorded in the structured proforma. Serum sodium levels were done daily along with other laboratory parameters such as renal function test, serum electrolytes, liver function tests, and random blood sugar. The rise in serum sodium level and the occurrence of overcorrection was noted. Adverse effects developing during treatment were recorded. Results: By day 3, 27% of patients achieved normonatremia and hence tolvaptan was stopped after 2 doses. By day 4, 84% of patients who took tolvaptan achieved normonatremia. Overly rapid correction of hyponatremia was observed in 9.8% of patients. There was a significant correlation between day 1 sodium and day 4 sodium as well as day 1 sodium and total correction. The mean increase in serum sodium with 3 doses of tolvaptan was 18.24 mEq/L with a P &lt; 0.0001. The adverse events during the study period were mild and included increased thirst, dry mouth, and polyuria. There was no significant change in transaminase levels during treatment. Conclusion: Tolvaptan is highly effective in increasing serum sodium level in hyponatremia with minimal adverse effects. The risk of an overly rapid correction is present with its use and is more in severe hyponatremia. This can be minimized by frequent monitoring of sodium level and ensuring adequate fluid intake.

A cross-sectional study on COVID-19-related knowledge, attitudes, and practices among undergraduate medical students in an Indian setting

Background: The coronavirus disease (COVID-19) is a severe acute respiratory disease that emerged with viral pneumonia-like symptoms in Wuhan, China, in December 2019. As the main strategies for dealing with COVID are prevention of transmission rather than medical intervention, the role of the knowledge, attitudes, and practices of the population and medical faculty are of paramount importance in reducing risk and mortality due to COVID-19, especially in Indian setting where population density is very high. Aims and Objectives: The aims and objectives of the study are to assess the knowledge, attitude, and practices among undergraduate medical students regarding COVID-19 in a South Indian teaching hospital. Materials and Methods: A questionnaire-based study was conducted among 150 2nd-year undergraduate students from Mysore Medical College and Research Institute, Mysore, from January 2022 to March 2022. A validated questionnaire consisting of 23 questions divided under 3 sections, knowledge, attitude, and practice, was used. Statistical analysis of data was done using MS-Excel spreadsheet. Results: 98.6% of the respondents had good knowledge regarding COVID-19. With respect to attitude, majority of the students (92%) felt that the COVID pandemic will come under control eventually and 20.7% wanted it to remain private if someone in their family were to get infected with COVID. With regard to their practices, 71.3% changed their daily routines in response to the pandemic. Conclusion: The study shows good knowledge and practices among medical students but lacks in certain social aspects regarding attitude toward COVID-19 such as keeping COVID-19 infections in the family private, which shows scope for improvement.

Learner’s perspectives on competency-based medical education in pharmacology at a tertiary care teaching hospital in South India

Background: Competency based medical education (CBME) was implemented recently in India. The study was conducted to evaluate the perspectives of undergraduate medical students towards CBME curriculum in pharmacology at a tertiary care medical college in South India.Methods: After the completion of the curriculum, feedback was taken in a semi-structured, validated questionnaire. It was based on Kirkpatrik’s level 1 model of evaluation. Majority of the questions were framed on a 5-point Likert's scale (1 being poor to 5 being excellent). Qualitative data was collected by open ended question on additional comments.Results: The response rate was 72.8%. Majority of the participants rated the theory classes, practical classes, small group discussions, self-directed learning, integration, and assessments as good and excellent. More than 80% participants rated role play as an innovative and worthwhile concept towards mastering prescription communication. They felt that role play ignites team work, and provides confidence. Close to 90% of the participants rated the overview on emergency use authorization, orientation on drug regulators, perspectives on hydroxychloroquine prophylaxis as effective and excellent. More than 85% participants felt that AETCOM provided them insight on ethical issues, patient communication, and perspective of doctors as caregivers. 9.8% (16) participants provided comments to open ended question for feedback.Conclusions: The study provided an insight of medical undergraduates towards CBME curriculum. Further studies can be designed to look into the effectiveness of teaching learning methods based on the performance of the students, perspective of faculties with focus faculty development, and role of various stakeholders.

A questionnaire based study to assess knowledge, attitude and practice of pharmacovigilance among exam going second year undergraduate medical students in a South Indian teaching hospital

Background: Pharmacovigilance not only helps in the early detection of adverse drug reactions (ADRs) but also facilitates the identification of both, risk factors and the underlying mechanism. To increase the reporting rate, it is essential to improve the knowledge, attitude, and practices (KAP) of healthcare professionals regarding ADR reporting and pharmacovigilance, especially during undergraduate and postgraduate education. The objective of this study was to assess the KAP about pharmacovigilance among exam-going second-year undergraduate medical students.Methods: A cross-sectional questionnaire-based study was conducted among 150 exam-going second-year undergraduate students from Mysore Medical College and Research Institute, Mysore from April 2022 to June 2022. A validated questionnaire consisting of 22 questions divided into 3 sections; knowledge, attitude, and practice was used. Statistical analysis of data was done using an MS excel spreadsheet.Results: Out of the 150 participants 133 had good knowledge about ADR and pharmacovigilance. Majority of the students agreed that reporting of ADRs is necessary (95.3%), mandatory (95.3%), and should be included in pharmacology practicals (94.7%). Only 29.3% of the students had witnessed an ADR and none of the participants had ever reported an ADR indicating poor practice among the undergraduate students.Conclusions: Students had good knowledge and positive attitude towards ADR reporting and pharmacovigilance. Practice regarding pharmacovigilance was found to be poor, indicating the need for training the undergraduate students in ADR reporting by including ADR recognition and reporting as a part of clinical posting curriculum.

Retrospective Analysis of Mortality in a Tertiary Care Teaching Hospital in South India

Introduction: Mortality data reveals much about the health of the population. Traditionally and universally,most epidemiological studies begin with mortality data. Mortality characteristics and the audit give a myriad ofinformation. This helps to identify trends of mortality. Mortality audit of mortality data is essential to improvehospital services and helps in proper allocation of resources. Hence this study was conducted to identify themortality characteristics of the patients admitted in the year 2021 in the Tertiary care hospital in South India.Material and Methods: This retrospective study was conducted after Institutional ethical clearance with mortalityrecords pertaining to the patients admitted to Hangal Sri Kumareshwar Hospital and Medical Research Center,Bagalkot, Karnataka during the year 2021. The data retrieved included demographic characteristics like ageand sex, place of residence, ward of admission and causes of death classified according to ICD 10th revision andanalysed using percentages and chi-square test and a p value of less than 0.05 was considered as significant in allthe tests.Results: Out of 592 deaths in 2021, 64.19% were males and 35.81% were females. Majority of the deaths (34.46%)occurred between the ages of 41 to 60 years followed by 61 to 80 years (27.20%). Communicable diseases contributedto 54.56% of the total deaths (p= 0.0022).Conclusion: Statistical analysis of causes of death from mortality statistics is the backbone of National healthpolicy and planning of health programs. It monitors the trend in public health issues like infant mortality, maternalmortality, infectious diseases, accidents and suicides.

1763. A study on the effectiveness of a pharmacist led Antifungal stewardship program, in immunocompromised patients of a tertiary care teaching hospital in South-India.

Abstract Background Anti-fungal stewardship (AFS) is a less explored area of an anti-microbial stewardship (AMS) program as the patients prone to fungal infections are mostly immunocompromised, post-chemotherapy or post-transplant. In a Low-and- Middle income country (LMIC) like India, there is a dearth of Infectious Disease (ID) trained physicians and pharmacists. We aimed to study the effectiveness of a pharmacist led AFS program to ensure rational prescribing of antifungals via a post-prescription review and feedback method. Methods In this prospective interrupted time series analysis from June 2021 to November 2021, AFS was done on adult in-patients in the department of Hematology in a tertiary care teaching hospital in South India. The study had a pre-intervention phase and intervention phase of 3 months each. In the pre-intervention phase, patients on anti-fungal therapy &amp;gt; 48 hours were identified and base line data were collected and no recommendations were given. In the intervention phase, in those on antifungals &amp;gt;48 hours, appropriate recommendations were made with regard to modification and discontinuation of the anti-fungals based on patients’ clinical condition under the supervision of an ID physician. Acceptance and impact of the intervention were monitored and recorded. METHOD OF THE STUDY The study was a prospective study with 2 phases : pre-intervention and intervention. In the intervention phase, the appropriateness of the Anti-fungal therapy was analyzed and recommendations were given. Results A total of 193 patients were analyzed over 6 months, of which 107 patients with a mean age of 42.1 ± 14.2 belonged to the pre-intervention phase and 86 patients aged 40.2 ±12.6 years were in the intervention phase. There was no statistically significant difference in the in-hospital mortality [26.16% vs 23. 25% (p = 0.64)] between the two groups. In the intervention phase, 15 (17.44%) prescriptions were found to be inappropriate. Among these 66% of the recommendations were accepted by the treating physician. The days of therapy per 100 patient days were calculated for each individual anti-fungal drug and there was a significant reduction in consumption of Anidulafungin [29.648 Vs 14.28 (p &amp;lt; 0.0007)], Amphotericin B [42.05 Vs 22.18 (p&amp;lt; 0.0001)] and Voriconazole [56.41 Vs 35.77 (p&amp;lt; 0.00001)] in the intervention phase. Outcome measurements Conclusion A pharmacist led AFS program resulted in statistically significant reduction in the consumption of antifungals, without a significant difference in the in-hospital mortality. Disclosures Priscilla Rupali, MD, DTM&amp;H, PFIZER: Grant/Research Support|PFIZER: Grant/Research Support.

AN OVERVIEW OF MEDICO-LEGAL CASES REPORTING TO A TERTIARY CARE HOSPITAL OF SOUTH INDIA

Background: Proper handling of medico-legal cases is an important aspect of a healthcare facility. The spectrum of the medico-legal cases depends upon the cultural and socio-demographic diversity, the policies of law enforcing agencies and the manner of the injury. Therefore, it becomes imperative for the hospital administrators to study the pattern of such cases so that it would help them to deal with such cases promptly and in more appropriate way and improve upon their facilities accordingly. To study the pattern Aim: of Medico-legal cases reporting to a tertiary care hospital of South India. It i Methods: s a record based cross-sectional study conducted in a tertiary care teaching hospital in South India over a period of 1 year from 1st October 2021 to 30th September 2022 where the Medico-legal register and case-sheets of medico-legal cases were thoroughly studied and data pertaining to their demographic prole, date, time and manner of injury were noted. Out of 1561 cases studied, 1146 cases were males and 415 cas Results: es were females and a majority belonged to the age group of 21 to 40 years (46.5%).A total of 828 cases (53%) belonged to the urban areas. The peak hours for reporting of cases was between 12pm to 6pm (39%) while least number of cases had reported past mid-night. A majority of medico-legal cases reported during monsoons (46%). Road Trafc Accidents (58.2%) constituted the majority of cases, followed by poisoning (11.8%) and the manner of injuries were accidental in nature in majority of cases (77%) The study gives an insight about the spectrum of medic Conclusion: o-legal cases reporting to the study hospital. It projects the domains which need to be focused by the government and healthcare policy makers in terms of providing appropriate facilities and implementation of laws for ensuring effective handling/management of the medico-legal cases.

Transcutaneous Bilirubin Measurement as a Predictor of Significant Neonatal Hyperbilirubinemia in Low Birth Weight Neonates

Introduction: Early recognition of neonatal hyperbilirubinemia is essential to prevent bilirubin encephalopathy. Transcutaneous bilirubin (TCB) measurement is a simple and easy method to predict neonatal hyperbilirubinemia. We aimed to study the efficacy of TCB as a predictor of subsequent significant neonatal hyperbilirubinemia in low birth neonates and compared the forehead and sternal sites for TCB measurement. Methods: A prospective study was conducted from August to October 2018 at a teaching hospital in South India including term and late preterm neonates weighing &lt; 2.5 kg. The TCB values were obtained from the forehead (TCB-FH) and sternum (TCB-S) by a non-Invasive Bilirubin Analyser. The average of TCB (TCB- AV) was determined for each baby with TCB-FH and TCB –S values. Neonates were followed up subsequently till discharge for the development of significant hyperbilirubinemia. Receiver operating characteristic (ROC) curve was generated and the best cut-off value for 24-hour TCB as a predictor of significant hyperbilirubinemia was established. Results: The study included 88 neonates, of which 39 (44.3%) were late preterm and 49 (55.7%) term small for gestation age. Mean values of TCB –AV 6.25 ± 1.58, TCB – FH 6.24 ± 1.57391, and TCB – S 6.27 ± 1.56 were noted. The cut off value for TCB – AV was found to be 6.85 as a predictor for subsequent neonatal hyperbilirubinemia. TCB – AV was a better predictor than TCB - FH or TCB – S. Conclusions: TCB measurement is an easy and reliable predictor for subsequent significant hyperbilirubinemia in low birth weight neonates. The average of TCB forehead and sternum was a better predictor of significant hyperbilirubinemia.

Prevalence and Risk Factors of Peripheral Neuropathy in Parkinson's Disease.

A lesser studied aspect of Parkinson's disease (PD) is its associated peripheral sensory-motor neuropathy. Peripheral neuropathy is an intriguing aspect of PD, a problem not given sufficient attention and which if tackled properly could make a difference to the multifaceted sufferings of the PD patient. Studies regarding the prevalence of peripheral neuropathy and its risk factors in patients with PD are scarce from the Indian subcontinent. This prospective observational study was conducted in a tertiary care teaching hospital in South India. Patients diagnosed with idiopathic Parkinson's disease (IPD) were screened and enrolled. All the patients underwent detailed evaluation of symptoms, signs, and electrophysiology (Nerve conduction study, Sympathetic skin response), stimulated skin wrinkling with Eutectic Mixture of Local Anesthetics. Patients found to have large/small fiber neuropathy underwent additional tests to exclude other causes of neuropathy. A total of 154 patients with IPD were enrolled in the study (mean age: 61.96 ± 9.15 years, mean duration of disease was 4.08 ± 3.16 years). The mean Hoehn and Yahr (H and Y) score was 2.3 ± 0.825 and the mean Unified Parkinsons Disease Rating Scale (UPDRS)-3 score in the ON state was 23.07 ± 11.14. The mean cumulative levodopa dose was 482.68 ± 651.76 (median: 292; range: 4728.57) grams. Peripheral neuropathy was found in 49 patients (31.8%), large fiber in 28 (18.2%) and small fiber in 47 (30.5%); an overlap of large and small fiber neuropathy was seen in 26 patients (16.9%). Around 34% of patients had serum homocysteine levels >20 mg/dl. In univariate analysis, duration of disease, levodopa cumulative dose, serum homocysteine level, H and Y score, UPDRS-3 ON score, Toronto Clinical Neuropathy Score (P < 0.001 for all), age at presentation, and rigidity predominant presentation (P = 0.02 for both) were associated with large fiber neuropathy. All of these variables were also associated with the presence of small fiber neuropathy (P = 0.004 for age at presentation and P < 0.001 for rest), except the type of PD presentation. However, in multivariate logistic regression analysis, only duration of disease, levodopa cumulative dose, and H and Y score were associated with the presence of large and small fiber neuropathy. In our cohort, majority of the patients were in early-stage PD and around one-fifth and one-third of patients suffer from large and small fiber polyneuropathy, respectively. Large and small fiber neuropathy in PD is mainly associated with duration of disease, levodopa cumulative dose, and H and Y score.

404P Adolescent & young adult cancers (AYA): Experience from a large rural teaching hospital in South India

Cancers in AYA is being recognized as a disenfranchised niche field with its own unique epidemiology, cancer biology, risk factors, treatment implications & the massive socio-economic impact it bears on this most economically productive age-group. There is a paucity of well-collated published data from developing countries. Our study has tried to compile & analyze the pattern of AYA cancers from a large rural tertiary care teaching-hospital in South India & compare it to the published national data.

A STUDY ON QUANTUM OF BIOMEDICAL WASTE GENERATED IN A TERTIARY CARE TEACHING HOSPITAL OF SOUTH INDIA

Introduction: Management of biomedical waste (BMW) has become a very serious health problem in developing countries. Every day, in the health care hospitals and in various facilities large amount of hazardous and potentially infectious wastes is generated. Inappropriate waste management and chaotic disposal of biomedical waste that occur in hospital cause various types of health effect on society. Objectives: To estimate the quantity of BMW generated by various departments of a hospital and to determine their compliance with BMW norms. Materials and methods: With regards to quantum of BMW generated a retrospective study was conducted for a period of 3 years from January 2019 to December 2021, and with regards to compliance of bio-medical waste management an observational study was conducted for a period of 3 months from July 2021 to September 2021. Selected areas of hospital were included in the study. Area wise waste collected, segregated and disposed off was observed and recorded on checklist designed on existing BMW management rules 2016. Results: The quantum of BMW generated during 3 years is in 20-19-106563 kg/year, 2020-98353 kg/year, and 2021-75951 kg/year. Yellow waste constituted the maximum of all during all 3 years(52%). Overall compliance with BMW rules 2016 was 85%. Conclusions: The quantum of biomedical waste generated is high as per permitted norms by local regulatory body. All the concerned staff should be frequently trained in this regard to avoid excess wastage, in order to bring down biomedical waste generated.

A STUDY ON QUANTUM OF BIOMEDICAL WASTE GENERATED IN A TERTIARY CARE TEACHING HOSPITAL OF SOUTH INDIA

A STUDY ON QUANTUM OF BIOMEDICAL WASTE GENERATED IN A TERTIARY CARE TEACHING HOSPITAL OF SOUTH INDIA