Teaching Hospital In South India Research Articles

An autopsy study of the pattern of unnatural deaths among youth at a tertiary care teaching hospital in south India

Mortality among youth owing to unnatural causes is on the rise. Hence, the present study was undertaken to estimate the number of such deaths, and assess the manner of death and the commonest cause of death. A total of 255 cases of unnatural deaths among youth aged between 15 and 29 years, autopsied at a tertiary care teaching hospital in South India were studied for a duration of 18 months from November 2015 to April 2017. Unnatural deaths among youth constituted 25.91%, l/4th of all medico-legal autopsies. Males outnumbered females. Most of the victims were 24 to 26 years old male and 21 to 23 years old female. Most of the victims were Hindu. Socio-economically, most of the victims belonged to the middle class. Most of them were urban residents belonging to nuclear families. The majority of the victims were secondary school students. Most of the unnatural deaths were suicides; with victims aged 27 to 29 years. Hanging was the most commonly preferred method of committing suicide. The commonest reason was ill-health. Road traffic accidents claimed 43 lives, victims were mostly 24 to 26 years old and died due to head injury. Homicides accounted for 5.49% of unnatural deaths. Most of the homicidal deaths were due to injuries inflicted by sharp weapons, consequently, the majority of victims succumbed to shock and hemorrhage due to multiple injuries.

Evaluation of knowledge, awareness, and practice of antimicrobial stewardship among prescribers of a teaching hospital in South India

Background: The injudicious and indiscriminate use of antimicrobials has led to the development of antimicrobial resistance (AMR), particularly in the low- and middle-income countries. Antimicrobial Stewardship (AMS) is the coordinated intervention to enhance the appropriate use of antimicrobials. Antimicrobial stewardship program (ASP) is a multidisciplinary program with interventions and strategies to encourage AMS to prevent emergence of AMR. Aims and Objectives: This study aimed at evaluating the knowledge, awareness, and practice (KAP) of AMS among prescribers of a teaching hospital in South India. Materials and Methods: A cross-sectional questionnaire based study conducted after obtaining Institutional Ethics Committee approval was conducted among prescribers of a teaching hospital from September 2022 to October 2022. Responses to the questionnaires issued to the prescribers through Google Forms were analyzed by descriptive statistics using Microsoft excel. Results: A total of 230 prescribers submitted the filled in questionnaires. The definition of AMS was known to 62%. The constitution and functioning of ASP was known to 59%. However, only a few (38%) prescribers agreed that antimicrobials are avoided in viral infections. More than 60% had good awareness of AMS. However, only 25% were aware of an ASP program is their hospital. Fifty percent agreed to the practice of reviewing antimicrobial use after 48–72 h and only 38% to the practice of obtaining cultures before prescribing antimicrobials. Conclusions: The prescribers had moderate knowledge and awareness and poor practice of AMS. To address these gaps, educational interventions and capacity building approaches are required.

To Study the Job Satisfaction Among Hospital Staff Working in Government Teaching Hospital of South India

To Study the Job Satisfaction Among Hospital Staff Working in Government Teaching Hospital of South India

Effectiveness and perception of demonstration-observation- assistance-performance (DOAP) versus video-assisted learning (VAL) in training advanced cardiac life support (ACLS) among medical interns - A comparative study.

Demonstration-Observation-Assistance-Performance (DOAP) and Video-Assisted Learning (VAL) are small-group teaching/learning methods (TLM) in medical education. Comparison studies between the two are scanty. There is a gap in knowledge, skills, and attitude among medical interns toward Advanced Cardiac Life Support (ACLS). The author studied the effectiveness of DOAP and VAL in training ACLS using mannequins and automated external defibrillator (AED)-simulators among interns in 2021. This descriptive study was done in the Emergency Department of a tertiary teaching hospital in South India. Out of 80 medical interns, 39 and 41 were allocated to ACLS training by DOAP (Group 1) and VAL (Group 2), respectively, by convenient sampling with random allocation, with the use of mannequins and AED-Simulators (10 interventions in each small group; three-five participants in each session). Pre-validated pre-test and posttest multiple-choice questionnaires (MCQs) and attitude questionnaires, OSCE by two blinded assessors, and perception by Likert-based questionnaire were analyzed with appropriate statistical analysis. The mean pretest and posttest MCQs and Attitude and OSCE scores of DOAP and VAL showed no statistically significant difference between them (MCQ pre-test 44.51 (11.43); 42.54 (6.56); p = 0.350 and MCQ posttest, 78.97 (8.59); 77.22 (11.29); p = 0.438; OSCE 40.51 (2.43) and 40.63 (1.92); p = 0.804; Attitude: 11 (3), 11 (2); p = 0.567; 14 (2), 14 (3); p = 0.095). MCQ post-tests showed improved scores (p < 0.001) in both the methods and the standardized mean difference based on the MCQ scores for the DOAP group was 3.02, and for the VAL group 3, showed the effectiveness of both methods. Perception scores showed learners' interest and positive feedback to both methods and ACLS. Both DOAP and VAL were equally effective TLMs in imparting knowledge, skills, and attitude to medical interns with positive feedback. In DOAP, the learner performs under supervision and clarifies doubts. As repeatable and cost-effective, VAL is useful in resource-limited settings. Both can be used as complementary methods in training ACLS. The attitude of learners towards ACLS improved with training.

Analysis of caesarean section rates according to Robson's ten group classification system at a tertiary care teaching hospital in South India

Background: Robson’s ten-group classification system (RTGCS) is recommended by WHO as an analytical tool for effective monitoring of caesarean section (CS) rates. The overall CS rates are high but seldom, women are classified based on CS.Methods: Data was collected and reviewed retrospectively. All the pregnant women who delivered from January 2016 to December 2017 in the labour ward were classified according to RTGCS.Results: Total of 2951 women delivered- 1598 (54.15%) vaginally and 1353 (45.84%through CS. In this study, Group 5 was the largest contributor (30.08%), group 1 was second (28.15%).Conclusion: Reviewing the definition of failure to progress in labour and changing norms of fetal distress may lower CS rates in groups 1, 2 and5. RTGCS proves to be an effective tool that allows standardized comparison of data, time point and identifies the groups responsible for rising CS rates.

Problematic smart phone use in medical undergraduates in a Tertiary Teaching Hospital in South India during COVID lockdown

Background: The COVID-19 pandemic has influenced all spheres of existence. Medical education, especially undergraduates, had to cope with the changing trends in the delivery of teaching modules. This has substantially influenced smart phone usage in medical students. Aims: The aim of the study is to evaluate the impact of COVID-19 lockdown on smart phone usage in medical students Materials and Methods: Using a cross-sectional online survey design, 556 medical undergraduates in a teaching hospital were included and assessed using questionnaires to measure problematic smart phone use/addiction. Results: Majority of the medical students scored high on problematic mobile phone use questionnaire short version-dependent subscale and SMARTPHONE ADDICTION SCALE-SHORT VERSION scales used to assess smart phone usage. Significant increase in the smart phone use during COVID lockdown was observed when compared to smart phone use before lockdown. Conclusion: COVID-19 pandemic with resulted in nationwide lockdown affected the smart phone usage in medical students. Problematic smart phone use and smart phone addiction is prevalent in medical undergraduates. Smart phone use for recreational use exceeds the smart phone use for academic achievement.

Hepatitis B surface antibody levels among health-care personnel vaccinated against hepatitis B in a teaching hospital in South India

Background:Hepatitis B virus infection is a global health priority, and health-care personnel (HCP) have 10 times higher prevalence than the general population. Seromonitoring identifies those with low titers and vaccine nonresponders with increased risk.Objective:The objective of the study was to assess hepatitis B surface antibody (anti-HBs) titers and associated factors among HCP vaccinated against hepatitis B in a teaching hospital in Kerala.Methods:A cross-sectional study was done among 454 vaccinated HCP, and anti-HBs antibody titers were assessed by enzyme-linked immunosorbent assay method.Results:Participants included 162 (35.7%) doctors, 132 (29.3%) nursing and laboratory personnel, and 160 (35.3%) supporting staff. The mean age was 38.06 ± 11.33 years, and 72% were female. Majority (92.5%, 420) were seroprotected and 78.9% (358) with high (>100 mIU) titers. Moderate (10–100 mIU) and low (<10 mIU) level seroprotection was seen in 13.7% (62) and 7.5% (34), respectively. Incomplete vaccination, >10 years since vaccination, and age >40 years were independent predictors for poor seroprotection, while increasing doses and boosters were positively associated.Conclusions:Majority of vaccinated HCP were seroprotected. Incomplete schedules, older age, and prolonged time since vaccination can lead to decline in titers, and periodical seromonitoring should guide hepatitis B revaccination strategies.

Early clinical exposure on Gout for first year medical undergraduates at a tertiary care teaching hospital in South India- A mixed methods study

Early clinical exposure on Gout for first year medical undergraduates at a tertiary care teaching hospital in South India- A mixed methods study

Clinicoetiological profile of urinary tract infection in pediatric population in a teaching hospital in south India

Background: Urinary tract infection (UTI) is one of the most common bacterial infections seen in children. A wide range of organisms with varying antibiotic sensitivity patterns have been known to cause UTI. The objective of the study was to analyse the clinical presentation of UTI in children between 1-month to15 years of age and to analyse the causative microorganism and their drug susceptibility in UTI in children between 1 month to 15 years of age.Methods: A retrospective study was conducted in a teaching hospital in Kerala, between July 2018 and June 2020 among children 1 month to 15 years of age who presented with symptoms of UTI. Patients who had culture positive UTI were included in the study. Clinical data was obtained from inpatient and outpatient records. Antimicrobial susceptibility was done for positive urine culture by Kirby-Bauer disk diffusion method. Statistical analysis was done using Statistical package for social sciences (SPSS) software version 16.Results: Of the 1057 urine samples analysed, 18.44% had significant bacteuria. 43.07% were children less than one year of age with male predominance. Fever and dysuria were the most common clinical presentation. E. coli was the most prevalent pathogen isolated followed by Klebsiella pneumoniae. Enterococcus faecalis was the only gram-positive bacilli isolated. Highest resistance was shown to ampicillin, third generation cephalosporins and co-trimoxazole. Least resistance was shown to nitrofurantoin, fluoroquinolones, aminoglycosides, piperacillin- tazobactam and carbapenems.Conclusions: Regular surveillance programme is necessary for implementation of guidelines for empiric treatment of UTI.

Group B Streptococcal infections among nonpregnant adults: A cross sectional study from a Tertiary care teaching hospital in South India

To understand the epidemiology of Group B Streptococcal infections among nonpregnant adults and to study the antibiotic susceptibility profile of GBS isolates.: A cross sectional study conducted in the department of microbiology in a tertiary care teaching hospital during December 2018 to May 2020. Group B Streptococcal (GBS) isolates from clinical samples of nonpregnant adults were included in the study. Identification and antibiotic susceptibility testing of GBS isolates were performed according to standard microbiology techniques. Patient’s demographic features and clinical details were collected from medical records. : A total of 58 GBS isolates were obtained from nonpregnant adults during the study period. There was a female (60.3%) predominance among the study group. Mean age of the study subjects was 51.4 years. In our study GBS were commonly isolated from urine 50% (n=29) and wound swabs 46.6% (n=27). One isolate each (1.7%) was obtained from blood culture, urethral swab and high vaginal swab. Common GBS infections noted in this study were Urinary tract infections (50%) and skin and soft tissue infections (46.6%). Diabetes mellitus (58.6%) was the most common risk factor noted in our study. All the isolates were sensitive to Penicillin, Linezolid and Vancomycin. Erythromycin and clindamycin resistance of 13.8% and 6.9% respectively were noted. A shifting trend of GBS infections from pregnant women and neonates to non-pregnant adults was observed in the present study. In patients with diabetes mellitus GBS could be considered as causative agent of skin and soft tissue infections.

Neuropsychiatric Symptoms and Caregiver's Burden in Parkinson's Disease Patients in a Tertiary Care Teaching Hospital in South India

In patients with Parkinson's disease (PD), the occurrence of motor and non-motor symptoms increases with disease progression. The range of neuropsychiatric symptoms (NPS) vary among individuals and can be burdensome for caregivers. Only a few studies have identified the contributing factors of NPS and caregiver burden in India. We aimed to study the clinical profile, disability, and predictive factors of NPS in PD patients and associated caregiver's burden. This was a cross-sectional observational study carried out in PD patients and their respective caregivers attending a movement disorder clinic in a tertiary care teaching hospital in Kerala. A total of 104 patients diagnosed with idiopathic PD receiving levodopa therapy and who had a primary caregiver were enrolled in the study. Structured questionnaires were administered to both patients and caregivers to collect data. Data analysis was done using an independent t-test, linear, and multiple regression analysis. Among 104 patients recruited for the study, 61.5% of patients had shown at least one NPS and 40.44% showed multiple NPS. Results from the study showed that depression is the primary NPS occurring in IPD patients (55.8%) followed by irritability, anxiety, and apathy. On linear regression models, the prime determinant of NPS was the Everyday Abilities Scale for India (EASI). For caregiver burden, the main determinants were the presence of NPS, duration of caregiving, EASI, and RBDSQ score. NPS in PD are highly associated with and are determinants of caregiver burden. Detailed assessment and specific interventions aimed at NPS could alleviate caregiver burden.

Perceptions and Practice of Self-Medication among Undergraduate Medical Students of a Tertiary Care Teaching Hospital in South India

Perceptions and Practice of Self-Medication among Undergraduate Medical Students of a Tertiary Care Teaching Hospital in South India

English

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterised by progressive dyspnoea on exertion and cough. COPD is associated with comorbidities that influence mortality and hospitalizations independently. Metabolic syndrome (MS) consists of central obesity, hypertriglyceridemia, low levels of high-density lipoprotein (HDL), hyperglycaemia and hypertension. Presence of metabolic syndrome in patients with COPD increases the frequency of exacerbations and their duration. This study was done to find out prevalence of metabolic syndrome in COPD patients and its influence on exacerbations. METHODS This prospective observational study was conducted in a tertiary care teaching hospital in South India. 174 patients meeting the inclusion criteria were recruited for this prospective observational study, out of which 13 were excluded due to various reasons. Selected patients underwent detailed clinical examination and investigations including chest X-ray, spirometry, fasting blood sugar, fasting lipid profile, electrocardiogram (ECG) etc. Patients were further grouped in to those with metabolic syndrome and those without. They were followed up for one year with review on every two months for assessing exacerbation of COPD. Data was evaluated at the end of the study, statistical evaluation was done using Statistical Package for Social Sciences (SPSS software version18). RESULTS A total of 174 patients were recruited for the study, among which 13 were excluded. 161 patients were included in the final evaluation, out of which 157 patients were male (97.5 %). 44.7 % were belonging to global initiative for obstructive lung disease (GOLD stage III), 37.3 % stage IV and 18 % stage II. 70 (43.5 %) had metabolic syndrome. 51.6 % had normal body mass index (BMI), 23.6 % over weight and 3.7 % were obese. Mean number of exacerbations were 3.20 in those with metabolic syndrome, whereas 1.52 in those without, during the follow up period. CONCLUSIONS Prevalence of metabolic syndrome among COPD patients was 43.5 % in this study. COPD patients with metabolic syndrome had more mean number of exacerbations than those without metabolic syndrome. KEYWORDS COPD, Exacerbations, Metabolic Syndrome, Co-morbidities

P–301 Intrauterine instillation of autologous platelet rich plasma for thin endometrium improves the outcome of frozen embryo transfer cycles

Abstract Study question How does the intrauterine instillation of autologous platelet rich plasma (PRP) affect the endometrial thickness and live birth rate in frozen embryo transfer cycles? Summary answer Intrauterine instillation of autologous PRP resulted in significant improvement in endometrial thickness. The live birth rates were satisfactory post-PRP instillation. What is known already Autologous Platelet rich plasma (PRP) had resulted in significant improvement in endometrial thickness, when instilled intrauterine in women with thin endometrium in FET cycles. Study design, size, duration A retrospective observational study was performed at a tertiary care university teaching hospital in South India. 35 women who received intrauterine autologous PRP during endometrial preparation for frozen embryo transfer from June 2017 to December 2020, were included. Patients who underwent donor oocyte recipent cycles, those with a history of tubercular endometritis, Asherman syndrome, previous intrauterine manipulations such as manual removal of placenta, and uterine anomalies were excluded. Participants/materials, setting, methods All the women underwent endometrial preparation in artificial cycles by depot GnRH agonist suppression and HRT (Hormone replacement therapy) was initiated by 4–6 mg of estradiol valerate and stepped up as required. Autologous PRP was offered to all women who had endometrial thickness &amp;lt; 7 mm on day 16 of HRT. PRP was prepared by the two-step centrifugation method and administered intrauterine by IUI catheter. The patients underwent repeat evaluation after 5 days post-PRP instillation. Main results and the role of chance Optimal response to PRP was considered as the attainment of an endometrial thickness (ET) ≥ 7mm after 5 days of post-PRP. 25 (71.4%) had an optimal response to PRP. There was a significant improvement in the endometrial thickness(mm) in the study participants following PRP instillation: 6.3 ± 0.6 vs. 7.1 ± 1.2; P = 0.0001.The study participants were divided into two groups based on their response to intrauterine PRP instillation. Those who optimally responded to PRP were categorized as Group A and those who didn’t were categorized as Group B. The study participants of both the groups were comparable by their demographic characteristics such as age, cause of infertility, indications for ART, and the dose of estradiol valerate before PRP. The dose of estradiol valerate (mg) after PRP was significantly higher in Group B compared to Group A: 19.9 ± 4.9 vs. 15.6 ± 3.9; P = 0.014. A total of 26 women underwent embryo transfer and 9 (25.7%) women had cycle cancellation. Of these 22 were from Group A and 4 from Group B. The pregnancy, clinical pregnancy, miscarriage and live birth rates were 36.3%(8/22) and 25% (1/4); 31.8% (7/22) and 25% (1/4); and 31.8% (7/22) and 25% (1/4), respectively. Limitations, reasons for caution As the study was retrospective in nature and the PRP was offered only in patients who had consented, there was a significant bias. Hence the results of the study should be interpreted with caution. Further large prospective RCTs (Randomised controlled trials) are required to confirm our findings. Wider implications of the findings: Autologous PRP may enhance the response to the estrogen preparations. It may produce satisfactory live birth rates and reduce cycle cancellations in a reasonable proportion of patients with thin endometrium in FET cycles. However, these findings should be confirmed by dose finding clinical trials, and studies involving a comparison group. Trial registration number Not applicable

Clinical spectrum and short-term outcomes of multisystem inflammatory syndrome in children in a south Indian hospital.

BackgroundMultisystem inflammatory syndrome in children (MIS-C) is a new hyperinflammatory variant that evolved during the coronavirus disease 2019 pandemic. Although the precise pathophysiology of MIS-C is uncertain, it is thought to be due to immune dysregulation occurring after recovery from acute infection.PurposeOur study aimed to analyze the clinical spectrum, laboratory parameters, imaging characteristics, treatment strategies, and short-term outcomes of children with a diagnosis of MIS-C.MethodsThis retrospective and prospective observational study included children less than 16 years of age who were admitted to the pediatric unit of a tertiary care teaching hospital in south India between August 2020 to January 2021 with a diagnosis of MIS-C according to World Health Organization criteria.ResultsTwenty-one children were included in the analysis; all had fever with variable combinations of other symptoms. The mean age was 6.9 years; 71.4% were male. Gastrointestinal (80.9%) and cardiovascular (80.9%) systems were the most commonly affected. The majority of children had elevated inflammatory markers, and 16 (76.2%) had echocardiographic abnormalities mimicking Kawasaki disease. Eleven children (52.4%) required intensive care admission, 3 (14.3%) required supplemental oxygen, and 4 (19%) required inotropes. Nine (42.9%) were treated with intravenous immunoglobulin alone, 6 (28.6%) with steroids alone, and 3 (14.3%) with steroids and immunoglobulin. The median hospital stay was 6 days; there were no fatalities. Overweight/obesity, elevated ferritin, and mucocutaneous involvement were significantly associated with a prolonged hospital stay (≥7 days). Sixteen children (76.2%) were followed up till now and all of them had no clinical concerns.ConclusionMIS-C is an emerging disease with variable presentation. A high index of suspicion is necessary for its early identification and appropriate management. Further research is essential for developing optimal treatment strategies.

Evaluation of Medication Errors in a Tertiary Care Hospital of a Low- to Middle-Income Country.

IntroductionMedication errors (MEs) are a major public health concern as they are detrimental to patient safety, compromise patients' confidence in the healthcare system, increase healthcare costs, and adversely affect the patient's quality of life. This is especially true in low to middle-income countries where the significance of MEs is largely undervalued. This study aims to investigate the prevalence of MEs and analyze the causes, medicines involved, reporting, and severity of MEs in a tertiary care setting.MethodsA prospective observational study was conducted from March 2020 to February 2021 in a tertiary care teaching hospital in South India. The data was collected after reviewing patient medical records, by interviewing patients and healthcare professionals. National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index was used to evaluate MEs.ResultsA total of 557 MEs were identified from 3798 patients with a prevalence of 14.6%. Prescribing errors were the most commonly observed ME followed by errors related to documentation of medical records, administration-related errors, and dispensing errors. Lack of time for documentation of medication records, shift change and work overload were common causes of MEs. The majority of MEs were category A and B of the NCC MERP severity index.ConclusionAntibiotics and proton pump inhibitors were the most common medicines involved in MEs. Prescribing and documentation errors were most prevalent. Implementation of systems like strict adherence to treatment guidelines, computerized provider order entry (CPOE), barcode medication administration, and closed-loop electronic medication management systems may greatly help reduce MEs. All healthcare institutions should undertake routine audits to determine the prevalence and causes of medication errors.

English

BACKGROUND Endometrial cancer (EC) is also the second most common gynaecologic malignancy in developing countries, with an incidence of 5.9 per 100,000 women. Due to the multiple modifiable factors, a better understanding of the prognostic indicators can lead to early detection and treatment. The purpose of this study was to evaluate the frequency and the distribution of various risk factors, epidemiological factors, and histological patterns of patients diagnosed with endometrial carcinoma in a tertiary teaching hospital in south India and compare them with similar studies. The compiled findings of 60 consecutive cases that presented to our tertiary care teaching hospital in Kerala, south India, over oneand-a-half-year period were studied. METHODS This study was essentially an ex post facto retrospective study done on 60 patients for one and half years. Retrospective data collection and compilation were done with previously prepared structured questionnaires in patients with histologically proven endometrial carcinoma. All cases were subjected to hysterectomy with post-surgical histopathology correlation. A study of the risk factors, general epidemiological characteristics, endometrial biopsy findings, and post-surgical histopathology was done. RESULTS The mean age at presentation was 59.83 years. The mean age of menarche was 13.72 years, and menopause was 49.42 years. The majority of patients were married, multiparous, and presented with bleeding per vaginum (77 %). 61.7 % of the patients had a history of hypertension, 31.7 % had a history of hypothyroidism, and 43.3 % had a history of diabetes mellitus in the study population. The most common histopathological type by endometrial biopsy and histopathological correlation was endometrioid adenocarcinoma (88.3 %). CONCLUSIONS Postmenopausal age group, with early menarche and late menopause, high body mass index (BMI), thickened endometrium on ultrasound, and atrophic uterus were some of the features associated with endometrial carcinoma. The most common histological subtype was found to be endometrioid carcinoma KEYWORDS Endometrial Carcinoma, Risk Factors, Prognostic Indicators

Utility of positron emission tomography-computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation.

Positron emission tomography–computed tomography (PET-CT) has been used as an imaging modality in workup of fever of unknown origin (FUO). The aim of our study is to evaluate the diagnostic utility of PET-CT in FUO workup in a resource-limited setting. We also looked at laboratory parameters as predictors of contributory PET-CT scans and propose an algorithm for evaluation of FUO in resource-limited tropical regions. This retrospective observational study included patients admitted for FUO workup under general medicine in a teaching hospital in South India from June 2013 to May 2016. PET-CT was done when the patient remained undiagnosed after a detailed clinical assessment and first- and second-tier investigations. Among 43 patients included in our study, a definite diagnosis was established in 74% (32). Noninfectious inflammatory diseases, infections, malignancies, and miscellaneous diseases were diagnosed in 37.2% (16/43), 23.3% (10/43), 9.3% (4/43), and 4.7% (2/43), respectively. Tuberculosis was the single most common disease seen in 20.9% (9/43). PET-CT scans were contributory toward establishment of final diagnosis in 90.7% (39/43). High C-reactive protein (CRP) and aspartate aminotransferase (AST) levels were associated with contributory PET-CT scans (P = 0.006 and 0.011, respectively). PET-CT delineating organ/tissue for diagnostic biopsy was associated with final diagnosis of infectious disease (P = 0.001). Sensitivity, specificity, and positive and negative predictive value of PET-CT scans were 76.9% (20/26), 33.3% (2/6), 83% (20/24), and 25% (2/8), respectively. High CRP and AST were predictors of contributory PET-CT scans. PET-CT scans have high sensitivity and positive predictive value when used in evaluation of FUO. Although it is a useful tool in FUO workup, especially in the diagnosis of tropical infections, PET-CT should be done after a comprehensive clinical assessment and basic investigations.

Appropriate use criteria in myocardial perfusion imaging in a tertiary care hospital in South India: An audit.

Myocardial perfusion imaging (MPI) is an important investigative tool in the diagnosis and management of coronary artery disease. This investigation has seen a manifold increase in number in past decades as compared to other investigations such as cardiac magnetic resonance imaging/positron emission tomography or computed tomography. In 2005, “Appropriate use criteria (AUC) in cardiac radionuclide imaging” was formulated by the American College of Cardiology Foundation and the American Society of Nuclear Cardiology for effective use of this investigation, later revised in 2009. We assessed the appropriateness of indications for MPI in patients presenting to the nuclear medicine department of a tertiary care hospital according to the latest AUC for cardiac radionuclide imaging. This is a retrospective analysis of all cardiac perfusion scans performed from June 2019 to January 2020 in a tertiary care teaching hospital in South India. All patients' indications for MPI were assessed for appropriateness using AUC 2009 as appropriate, inappropriate, and uncertain indications by two experienced nuclear medicine physicians blinded for results of the test and hospital stay of the patients. A total of 1015 cardiac scans were performed in the given period, which were analyzed. This included 613 males and 402 females, with most of the patients aged above 60 years (n = 640; males = 385, females = 255). Most of the patients had diabetes mellitus or hypertension or both except in 161 patients (15.8%) which did not have either of the comorbidities. Chest pain and/or shortness of breath were the most common presenting complaints. The appropriate indication for imaging was found in 784 patients (77.2%), inappropriate in 121 patients (12%), and uncertain in 110 patients (10.8%). Our results showed appropriate indication to be 77.2% and inappropriate indications as 12% for MPI referrals in a tertiary care teaching hospital, similar to Western literature but can be improved further by continued teaching and awareness campaigns.

Evaluation of immune response to hepatitis B vaccine among health care workers at a tertiary care hospital in south India: a retrospective record based study

Seroprevalence of hepatitis B virus (HBV) among healthcare workers (HCWs) is two to four times higher than that of the general population due to repeated exposure. To determine the hepatitis B (hep B) vaccination status, non-response rate to (hep B) and its determinants among HCWs at a tertiary care teaching hospital in south India. A secondary analysis of the medical records of a group of HCWs who joined the hospital from 1st January 2015 to 31st December 2016 was done. A total of 451 HCWs received the vaccine at the study hospital. Mean age of the HCWs was 25.3±6.1 years, majority 374 (82.1%) of them were females and joined as staff nurses 213 (47.2%). Only 164 (36.3%) had received all 3 doses of hep B vaccination. Complete vaccination with (hep B) among HCWs was poor. Health education and suitable administrative controls must be instituted to ensure protection.