Tertiary Care Center Research Articles

Impact of post-thrombectomy isolated subarachnoid hemorrhage on neurological outcomes in patients with anterior ischemic stroke - a retrospective single-center observational study.

We aimed to investigate the impact of post-thrombectomy isolated subarachnoid hemorrhage (i-SAH) and other types of intracranial hemorrhage (o-ICH) on patient's neurological outcomes. Stroke data from 2018 to 2022 in a tertiary care center were retrospectively analyzed. Patients with large vessel occlusion from ICA to M2 branch were included. Post-thrombectomy intracranial hemorrhages at 24h were categorized with Heidelberg Bleeding Classification. Neurological impairment of patients was continuously assessed at admission, at 24h, 48h and 72h, and at discharge. Predictors of i-SAH and o-ICH were assessed. 297 patients were included. i-SAH and o-ICH were found in 12.1% (36/297) and 11.4% (34/297) of patients. Overall, NIHSS of i-SAH patients at discharge were comparable to o-ICH patients (median 22 vs. 21, p = 0.889) and were significantly higher than in non-ICH patients (22 vs. 7, p < 0.001). i-SAH often resulted in abrupt deterioration of patient's neurological symptoms at 24h after thrombectomy. Compared to non-ICH patients, the occurrence of i-SAH was frequently associated with worse neurological outcome at discharge (median NIHSS increase of 4 vs. decrease of 4, p < 0.001) and higher in-hospital mortality (41.7% vs. 23.8%, p = 0.022). Regardless of successful reperfusion (TICI 2b/3), the beneficial impact of thrombectomy appeared to be outweighed by the adverse effect of i-SAH. Incomplete reperfusion and shorter time from symptom onset to admission were associated with higher probability of i-SAH, whereas longer procedure time and lower baseline ASPECTS were predictive for o-ICH occurrence. Post-thrombectomy isolated subarachnoid hemorrhage is a common complication with significant negative impact on neurological outcome.

A Study of Obstetric Referral Cases to Tertiary Care Center in Rural Setting of Mahasamund, Chhattisgarh

A Study of Obstetric Referral Cases to Tertiary Care Center in Rural Setting of Mahasamund, Chhattisgarh

Surveillance of Health Care-Associated Violence Using Natural Language Processing.

Patient and family violent outbursts toward staff, caregivers, or through self-harm, have increased during the ongoing behavioral health crisis. These health care-associated violence (HAV) episodes are likely under-reported. We sought to assess the feasibility of using nursing notes to identify under-reported HAV episodes. We extracted nursing notes across inpatient units at 2 hospitals for 2019: a pediatric tertiary care center and a community-based hospital. We used a workflow for narrative data processing using a natural language processing (NLP) assisted manual review process performed by domain experts (a nurse and a physician). We trained the NLP models on the tertiary care center data and validated it on the community hospital data. Finally, we applied these surveillance methods to real-time data for 2022 to assess reporting completeness of new cases. We used 70 981 notes from the tertiary care center for model building and internal validation and 19 332 notes from the community hospital for external validation. The final community hospital model sensitivity was 96.8% (95% CI 90.6% to 100%) and a specificity of 47.1% (39.6% to 54.6%) compared with manual review. We identified 31 HAV episodes in July to December 2022, of which 26 were reportable in accordance with the hospital internal criteria. Only 7 of 26 cases were reported by employees using the self-reporting system, all of which were identified by our surveillance process. NLP-assisted review is a feasible method for surveillance of under-reported HAV episodes, with implementation and usability that can be achieved even at a low information technology-resourced hospital setting.

Psychosocial Correlates of Emotional Eating Among Healthcare Professionals in a Tertiary Care Centre in Mysuru

Abstract Introduction: People’s food preferences and eating habits are heavily influenced by their psychological health. Emotional eating (EE) is not a distinct eating disorder, but rather a subtype within a range of different eating behaviors that are affected by habits, stress, emotions, and personal eating attitudes. Stress and eating are frequently unhealthy companions for those in the medical field. This study proposes to determine the prevalence and psychosocial correlates with EE among health-care professionals. Materials and Methods: A cross-sectional study was done among 320 health-care professionals at JSS Hospital, Mysore, over 6 months using a convenient sampling technique. A pretested, semistructured self-administered questionnaire was used to collect information regarding sociodemographic characteristics, perceived stress (Perceived Stress Scale), EE (Emotional Eaters Questionnaire), and eating and lifestyle habits of participants. Statistical tests such as Chi-square tests and Spearman’s correlation test were used. Results: Among 320 health-care professionals, 82.8% were emotional eaters. Among emotional eaters, 28.8%, 42.5%, and 11.5% were low, emotional, and very emotional eaters, respectively. Among the study subjects, 77.19% had moderate stress and 13.12% had severe stress. There was a statistically significant association between age, perceived stress, and fried food intake with EE. Conclusion: The findings raise concerns over the high prevalence of EE among health-care professionals, calling for close attention from policymakers to address this new health challenge. Enhancing dietary habits, body weight status, exercise, and perceived stress levels could be potential targets for interventions.

Obinutuzumab in Difficult to Treat Phospholipase A2 Receptor Positive Membranous Nephropathy: Our Experience at a Tertiary Care Center in North India

Obinutuzumab is a glycoengineered type II anti-CD20 monoclonal antibody with superior B cell cytotoxicity compared to rituximab. Various case reports suggest that in refractory phospholipase A2 receptor (PLA2R) positive membranous nephropathy (MN) patients, Obinutuzumab led to immunologic remission and improvement in proteinuria. In the present case series, we present six cases of difficult-to-treat PLA2R-associated MN refractory to prednisolone, calcineurin inhibitor (CNI), cyclophosphamide, and rituximab but subsequently responded to Obinutuzumab. Five out of six cases showed partial /complete clinical remission and immunological remission (IR) with normalization of serum albumin and stable renal function. Though this drug’s long-term efficacy and impact remain unclear, it is being increasingly considered for PLA2R-associated MN resistant to standard therapy.

Prevalence of Methicillin Resistant Staphylococcus aureus (MRSA) in different clinical samples in tertiary hospital Piparia, Vadodara, Gujarat.

Background: Methicillin resistant Staphylococcus aureus (MRSA) is constantly occur and is a major trouble for tertiary care centre. Aims of this study are detection prevalence rate and antibiotics sensitivity of MRSA in our tertiary care centre.

Bacteriological Profile and Antibiotics Sensitivity Pattern of Urinary Tract Infection Patient in Tertiary Care Centre

Introduction- The Urinary Tract Infections (UTIs) leading bacterial infection, mostly occur in all the community and hospital setups irrespective with their age and gender . At least half of women get experiences of urinary tracts infection for once in the life , due to anatomical structure of female urogenital system.

Modified D2 Gastrectomy operation in Gastric Cancer Patients and Outcome

Gastric cancer remains the fifth most commonly diagnosed cancer and the third leading cause of cancer-related deaths worldwide. In 2018, there were an estimated 1,033,701 newly diagnosed cases and 782,685 related deaths. The aim of this study was to evaluate outcome of modified D2 gastrectomy operation in gastric cancer patients with or without comorbidities. This prospective observational study was conducted at the Department of Surgical Oncology, National Institute of Cancer Research and Hospital, Mohakhali, Dhaka, from July 2019 to March 2021. A total of 53 patients were included in the study. The outcome of the surgery was assessed by monitoring postoperative complications for a period of 30 days. Statistical analysis was performed using SPSS (Statistical Package for the Social Sciences) version 28. Prior to the commencement of the study, the research protocol was approved by the Research Review Committee of the Department of Surgical Oncology and the Ethical Committee of the National Institute of Cancer Research and Hospital, Dhaka. There was no significant association observed between postoperative complications of modified D2 gastrectomy and patients’ age, gender, or smoking status. Among the 53 patients, the highest proportion (92.45%) experienced anorexia, followed by vomiting (81.13%), and approximately 71.69% had dyspepsia. Among the patients, 52.83% had diabetes mellitus (DM) and 45.28% had hypertension (HTN). Patients with gastric cancer and DM were found to be more susceptible to developing wound infections. Based on the analysis of the study results, it can be concluded that modified D2 gastrectomy is a safe procedure that yields acceptable postoperative outcomes for the treatment of gastric cancer in a tertiary care center. Mugda Med Coll J. 2024; 7(1): 31-35

Psychiatric Morbidity Among Patients Recovered from COVID-19 Pneumonia: A Cross Sectional Telephonic Survey

Background: Mental health issues among COVID-19 survivors can have broader public health implications, including decreased quality of life, impaired functional recovery, increased healthcare utilization, and higher mortality rates. Aims and Objectives: The aim of this study was to evaluate the psychiatric morbidities among the persons treated and recovered from COVID-19. Materials and Methods: A cross sectional telephonic survey was undertaken in hundred patients infected with COVID-19 pneumonia, treated and discharged from a tertiary care centre. Depression, anxiety, PTSD symptoms were assessed using PHQ-2, GAD-2, PTSD screen for DSM-5 respectively. Sleep quality was assessed using single item sleep quality scale. Overall quality of life and health satisfaction was assessed using WHOQOL-BREF. Results: Mean age of study participants is 46.15 years and study sample included 62% of males. Admitted patients had mean CT severity score of 40% lung involvement. On the measures of sleep quality, twelve were having fair range and two participants had poor sleep quality. 24% and 31% of participants had anxiety and depressive symptoms respectively while 14% had symptoms of PTSD. Conclusion: Post covid sequelae is an important concern to be addressed, larger studies are required to assess the psychiatry morbidity accurately. Further sequential assessments would help to delineate the natural course of post covid psychiatric sequalae.

Identification and Antimicrobial Susceptibility Testing of Staphylococcus Aureus from Clinical Samples of Tertiary Care Centre, North India

Staphylococci are contributors of the Micrococcaceae family. Staphylococcus aureus is the most common type of bacteria which causes infections in the humans. They are classically taken into consideration extracellular, pyogenic pathogens due to their capacity to set off abscess formation. The microorganisms are non-motile and generally tend to develop in clusters. They are extraordinarily hardy and may continue to exist for extended durations of time on environmental surfaces. Staphylococci are identified in medical samples with the aid of using Gram stain and their function morphology – Gram positive cocci in grape-like clusters. They shape spherical frequently beta-hemolytic colonies on agar. It is characterized by the presence of the bacteria in different samples collected from different departments and the use of different antibiotic drugs and other medicines have increased the rate of infections. Some of the other risk factors includes the advanced ages and hospitalization. Staphylococcus aureus can be of different types like MRSA, MSSA, VRSA etc. Staphylococcus can cause infections in different ages it can infect child also or adult also. Different types of samples of Staphylococcus aureus can be identified using MALDI-TOF, MICROSCAN and BD PHOENIX and their interpretation of the antimicrobial susceptibility test can be given. Staphylococcus aureus is a major bacterial human pathogen that causes a wide variety of harmful diseases to the clinical manifestations. Infections caused by this bacterium are commonboth in community as well as hospital settings and treatment of the diseases caused by this remains challenging to manage. Because due to the emergence of its multi-drug resistant strainssuch as MRSA. Different drugs were used like Amp/Sulbactam, Ampicilin, Ceftriaxone, Ciprofloxacin, Clindamycin, Daptomycin, Erythomycin, Linezolid, Oxacillin, Rifampin, Synercid, Tetracycline, Teicoplanin, Vancomycin, Penicillin. The antimicrobial susceptibility test was done and their resistance percentage is calculated.

Clinical Outcome Of Children Hospitalized With Community Acquired Pneumonia Treated With Ampicillin In Tertiary Care Center

Clinical Outcome Of Children Hospitalized With Community Acquired Pneumonia Treated With Ampicillin In Tertiary Care Center

A Retrospective Analysis of Diagnostic Breast Imaging Outcomes in Young Women at a Tertiary Care Center.

(1) Purpose: The purpose of this study was to describe the outcomes of diagnostic breast imaging and the incidence of delayed breast cancer diagnosis in the study population. (2) Methods: We collected the outcome data from diagnostic mammograms and/or breast ultrasounds (USs) performed on women between the ages of 30 and 50 with symptomatic breast clinical presentations between 2018 and 2019. (3) Results: Out of 171 eligible patients, 10 patients (5.8%) had BIRADS 0, 90 patients (52.6%) had benign findings (BIRADS 1 and 2), 41 (24.0%) patients had probable benign findings requiring short-term follow-up (BIRADS 3), while 30 (17.5%) patients had findings suspicious of malignancy (BIRADS 4 and 5). In the BIRADS 3 group, 92.7% had recommended follow-up, while in BIRADS 4 and 5, only 83.3% underwent recommended biopsy at a mean time of 1.7 weeks (range 0-22 wks) from their follow-up scan. Ten (6%) patients were diagnosed with breast cancer, all of whom had BIRADS 4 or 5, with a mean time of breast cancer diagnosis from initial diagnostic imaging of 2.2 weeks (range 1-22 wks). No patients had delayed breast cancer diagnosis in our cohort. (4) Conclusions: We conclude that diagnostic mammograms and breast US are appropriate investigations for clinical breast concerns in women aged 30-50 years.

Characteristics of patients with burn injuries managed at a tertiary care centre

IntroductionBurn injuries are becoming a growing burden, negatively impacting both individuals and society. They affect a person’s health and lead to psychosocial and economic problems. This study evaluates the prevalence, characteristics, and short-term outcomes of patients with burn injuries admitted to a tertiary care hospital in Northern Sri Lanka. MethodsThis prospective cross-sectional study was conducted on patients with burn injuries admitted to Tertiary care centre Jaffna over six months in 2023. Ethical clearance was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Jaffna. Baseline characteristics and clinical features during hospitalisation were recorded. Categorical variables were compared using the Chi-square test, with post hoc Tukey tests conducted where applicable. ResultsThis study included 57 patients aged 1 to 88 years, with a mean age of 35.19 ± 21.16 years. Most participants were female (53.4 %), and most had completed secondary education (62.1 %). Approximately 65.5 % were employed in unskilled jobs, with the remainder in skilled professions. Accidental burns were the most common cause (72.4 %), with 84.5 % of injuries occurring at home, though suicide-related burns accounted for 24.1 %. Flame-related burns constituted 50 % of injuries, with first-degree burns being the most common (44.8 %). The availability of first aid significantly influenced outcomes, with 74.1 % receiving assistance, primarily through removing clothing (43.8 %) and using running water (15.8 %). A combined approach of care was received by most patients (52.7 %), while 8.8 % were hospitalised in the plastic and reconstructive surgery department. Many patients had burns covering less than 10 % of their body surface area (46.6 %). ConclusionThe findings of this study on patients with burn injuries underscore the importance of understanding the causes of burns, administering appropriate first aid, recognising different injury types and severities, assessing the total burn surface area, and tailoring patient treatment. These insights are crucial for informing prevention strategies and healthcare planning, aiming to mitigate the impact of burn injuries and improve patient outcomes.

Serum lipid level as a biomarker in depressive disorder: A cross-sectional case control study

Objectives: This study investigates the potential of serum lipids as markers for depression, specifically focusing on symptoms such as suicidal ideation and anhedonia. In the context of advancing psychiatric biomarker research, this study aims to identify lipid-related markers and their underlying biological connections to depression, offering valuable insights for clinical practice and patient outcomes. Material and Methods: This case-control observational study was conducted over 18 months at a tertiary care center. The study enrolled patients aged 18–60 years diagnosed with depression attending outpatient and inpatient departments, totaling 100 subjects, including 100 cases and 100 controls, with gender and body mass index (BMI)-matched controls. Inclusion criteria for cases required depression diagnosis using the International Classification of Diseases-10-Diagnostic Criteria for Research criteria, while controls comprised healthy individuals within the same age range. Exclusion criteria encompassed comorbid psychiatric illnesses, substance use disorders (except tobacco), unstable medical conditions, lipid-lowering agent use, and a BMI over 30. Clinical assessments, including the Hamilton Depression Rating Scale-17 item scale, Modified Scale for Suicidal Ideation, and Snaith-Hamilton Pleasure Scale-Clinician administered, were administered. Serum lipid parameters, including triglycerides (TG), total cholesterol (TC), and high-density lipoprotein (HDL)-cholesterol, were measured. Results: In a cross-sectional case-control study (n = 200), we examined serum lipids as potential depression biomarkers. Cases (n = 100) matched controls in age, BMI, and gender. Cases had lower TC (153.27 mg/dL vs. 171.34 mg/dL, P &lt; 0.01*). Serum TG and low-density lipoprotein also varied significantly with depression severity (P &lt; 0.01*). However, HDL levels remained consistent. No significant associations were found between suicidal ideation and anhedonia, and post hoc analyses revealed significant differences (P ≤ 0.05) in lipid parameters across various depression severity levels. Conclusion: These findings suggest a complex relationship between serum lipids and depression, with potential implications for understanding the biological underpinnings of depression and its severity. However, there was no such relationship that was observed between serum lipids and anhedonia or suicidal ideation. These insights could inform clinical practices and improve patient outcomes in depression management.

Video Otoscopy as a Novel Teaching and Remote Otolaryngology Consultation Tool at an Academic Medical Center.

Assess the use of video otoscopy (VO) as a tool for teaching Emergency Department (ED) residents and remote Otolaryngology consultation. Survey and retrospective chart review. Tertiary care center. Emergency Medicine resident physicians completed an otologic skill self-assessment and pathology followed by an interactive training on VO and postintervention assessment after 9 months of use. Outcomes compared change in pre- to posttraining scores. ED consultations using VO during this time period were reviewed to detect differences between the presumed diagnosis/treatment based only on phone consultation and VO image compared to the final diagnosis/treatment after in-person Otolaryngology consultation. Forty-six (63.1%) ED residents participated. Diagnostic accuracy improved by 20.7% overall. The most improved diagnoses were of a normal ear canal (+75%), tympanosclerosis (+58.4%), and ear canal foreign body (+57.1%); most challenging were external auditory canal cyst (-13.6%), hemotympanum (-11.3%), and cerumen (-1.9%). Cholesteatoma did not improve because all responses were incorrect; neither did tympanic membrane perforation because all were correct. Confidence in the otologic exam and anatomy also increased (P < .01). Thirteen consults used VO and 3 (23.1%) had a change in diagnosis/treatment after in-person Otolaryngology evaluation. Training on the use of VO significantly improves the confidence and diagnostic skills of ED providers for many pathologies. This application suggests the efficacy of an otologic e-consultation model.

Evaluation of Serum Potassium Levels as a Prognostic Marker in Acute Organophosphorus Poisoning in a Tertiary Care Center

Evaluation of Serum Potassium Levels as a Prognostic Marker in Acute Organophosphorus Poisoning in a Tertiary Care Center

Depression and Associated Factors Among Post-Stroke Patients in Tertiary Care Center

Introduction: Stroke is the leading cause of long-term physical and mental disability and causes major individual, social and financial burden. The relationship between depression and stroke is well established. There is substantial evidence that comorbid depression among stroke survivors is associated with a negative impact on recovery, especially on daily functioning, and it also decreases the quality of life. The aim of this study is to find the prevalence of depression and its associated factors among post-stroke patients.Method: A descriptive-prospective study was done among post-stroke patients attending the out-patient and inpatient departments of Internal Medicine at National Medical College from 1st June 2014 to 30 May 2015. Purposive sampling, a type of non-random sampling technique was utilized for the study. Informed consent was taken prior to study. Ethical approval was taken from Institutional Review Board. After proper instructions, self-designed pro-forma was used to collect data, following which, ICD-10 and HAM-D (Hamilton Depression Rating Scale) was applied. Data analysis was done using SPSS 20.Results: Out of 79 stroke patients, 62.02% had an ischemic stroke and 37.97% had a hemorrhagic stroke. Prevalence of depression using Hamilton Depression Rating Scale was 39.24%. Statistically significant association was seen between depression and sex, income and occupation among socio-demographic variables (p &lt; 0.05). Association of depression with age, education, marital status, address, laterality of lesion, duration of illness and type of stroke was not statistically significant. Conclusion: Occurrence of depression in stroke survivors is common. Routine depression screening is recommended in stroke survivors for better management and early recovery.

Following Through: The Impact of Culinary Medicine on Mediterranean Diet Uptake in Inflammatory Bowel Disease.

The Mediterranean diet (MD) is recommended for all patients with inflammatory bowel disease (IBD) unless there is a specific contraindication. Culinary medicine has emerged as a method for improving dietary education. Patients and caregivers are often invested in making dietary changes to improve disease control. Here, we examine the dietary preferences of a group of young people with IBD and apply culinary medicine techniques with an in-person MD-focused cooking class. A survey evaluating dietary attitudes was sent to an IBD email listserv at our tertiary care center (n = 779). A validated questionnaire, the Mediterranean Diet Quality Index for Children and Adolescents was used to assess MD adherence. IBD dietitians customized 2 in-person MD-focused cooking classes, one for children 6 to 12 years of age (arm 1) and one for adolescents 13 to 17 years of age (arm 2). Baseline, 1-month follow-up, and 3-month follow-up surveys were completed. There were 112 survey responses. Participants were 67.0% male with diagnosis of Crohn's disease (50.0%), ulcerative colitis (42.0%), or IBD unclassified (8.0%). Most were managed on advanced therapies (82.0%). Most reported making decisions about diet (82.0%) in order to help with IBD, had met with a dietitian (69.0%), and were interested in learning more about the MD (55.3%). MD scores were primarily in the average (49.5%) and poor (41.1%) diet categories. Only those eating together as a family 3 or more times per week or those who had met with a dietitian scored in the optimal diet category. The median MD score at baseline was 4.5, increasing to 6.0 at 1 month and 7.0 at 3 months postintervention. Almost all (90%) would recommend cooking classes to others. Common barriers to MD uptake included lack of knowledge about which foods to prepare, concern about taste, and time to prepare food. This study showcases high patient and caregiver interest in dietary management of IBD and demonstrates efficacy of education via application of culinary medicine. Classes were well received by families and MD adherence scores increased postintervention. As patients with IBD and their families are often motivated to incorporate dietary therapy into their care, this work highlights the role of culinary medicine and value of future study.

Effect of Seasonal Change on the Admission of Patients with Schizophrenia in a Tertiary Care Center: A Retrospective Cross - Sectional Observational Study

Effect of Seasonal Change on the Admission of Patients with Schizophrenia in a Tertiary Care Center: A Retrospective Cross - Sectional Observational Study

Time to Positive Blood Cultures Among Critically Ill Children Admitted to the PICU.

Our study aimed to assess the time to positivity (TTP) of clinically significant blood cultures in critically ill children admitted to the PICU. Retrospective review of positive blood cultures in patients admitted or transferred to the PICU. Large tertiary-care medical center with over 90 PICU beds. Patients 0-20 years old with bacteremia admitted or transferred to the PICU. None. The primary endpoint was the TTP, defined as time from blood culture draw to initial Gram stain result. Secondary endpoints included percentage of cultures reported by elapsed time, as well as the impact of pathogen and host immune status on TTP. Host immune status was classified as previously healthy, standard risk, or immunocompromised. Linear regression for TTP was performed to account for age, blood volume, and Gram stain. Among 164 episodes of clinically significant bacteremia, the median TTP was 13.3 hours (interquartile range, 10.7-16.8 hr). Enterobacterales, Staphylococcus aureus, Streptococcus agalactiae, and Streptococcus pneumoniae were most commonly identified. By 12, 24, 36, and 48 hours, 37%, 89%, 95%, and 97% of positive cultures had resulted positive, respectively. Median TTP stratified by host immune status was 13.2 hours for previously healthy patients, 14.0 hours for those considered standard risk, and 10.6 hours for immunocompromised patients (p = 0.001). Median TTP was found to be independent of blood volume. No difference was seen in TTP for Gram-negative vs. Gram-positive organisms (12.2 vs. 13.9 hr; p = 0.2). Among critically ill children, 95% of clinically significant blood cultures had an initial positive result within 36 hours, regardless of host immune status. Need for antimicrobial therapy should be frequently reassessed and implementation of a shorter duration of empiric antibiotics should be considered in patients with low suspicion for infection.