Tertiary Care Hospital In Bangalore Research Articles

Lived-in Experience Among Caregivers of Autistic Children: A Qualitative Study from South India

Background: Autism is a developmental disorder that impairs the skills related to behavior, communication, interaction, and learning. This study was undertaken to understand the difficulties faced by caregivers in various aspects of life while taking care of children with autism and their unique life experiences. Methods: After obtaining ethical approval, the study was conducted in a tertiary care hospital in Bangalore, India. An informed consent and a subject information sheet were taken to obtain permission from the subjects. A baseline proforma was prepared for collecting the demographic data for both autistic children and the caregivers. An in-depth, face-to-face, semi-structured interview that consisted of around 10 questions was conducted for 30 minutes. The interview was recorded, later transcribed verbatim, and extracted into specific themes and subthemes. Results: The lived-in experiences throw light on many emotional, social, psychological, and physical distress the caregivers go through on a day-to-day basis. The daily hassles of every caregiver are unique and challenging. Five themes and corresponding subthemes were extracted as follows: emotional meltdown, change in family dynamics, spiritual transition, perceived social burden, and perception of a child’s future. Conclusion: The caregivers of children with autism faced various challenges such as physical and emotional turmoil, financial constraints, and the deprivation of a healthy social life almost every day. Interventional measures such as nurse-led clinics, counseling measure, and planning training sessions for nurses to deal with the various issues faced by the caregivers could be taken up to address the growing concerns of caregivers of children with autism.

Intelligence quotient in children with congenital hypothyroidism on treatment: A cross-sectional study

Introduction: Congenital hypothyroidism (CH) is the most commonly identified endocrine disorder. Early intervention can prevent intellectual deficits. Objective: To determine the intelligence quotient (IQ) and aetiology in children diagnosed with CH undergoing treatment and the associations between the IQ and the age of diagnosis. Method: A cross-sectional study was conducted in a tertiary care hospital in Bangalore, which enrolled 52 children aged 6 months to 15 years diagnosed with CH. Using a pre-designed proforma, we collected demographic data and confirmed CH aetiology. For IQ assessment, children under 3 years underwent the Vineland Social Maturity Scale (VSMS) and developmental screening test (DST), while those over 3 years were evaluated with the VSMS and Binet Kamat test of intelligence (BKT). Results: Among the 52 children with CH, dyshormonogenesis was the predominant aetiology. In the under-3-year age group (n=17), all demonstrated average to above-average intelligence. Among those over 3 years (n=35), 10.9% (95% CI: 6.5% to 17.2%) exhibited low average and borderline intelligence with the VSMS, and 5.7% (95% CI: 2.3% to 12.5%) had extremely low IQ (IQ <70). The BKT scale showed 20% (95% CI: 12.8% to 29.7%) with low average and borderline intelligence, and 2.9% (95% CI: 0.7% to 8.3%) with extremely low IQ (IQ <70). Children diagnosed at a mean age of 4.2 and 4.4 years exhibited intellectual disability on the VSMS and BKT scales, respectively. Conversely, those diagnosed at a mean age of 1.2 and 1.8 years showed average and above-average intelligence on the VSMS (p-value 0.02) and BKT scale (p-value 0.001), respectively. Conclusions: Children diagnosed with CH at mean ages of 4.2 and 4.4 years exhibited intellectual disability on the VSMS and BKT scales, respectively. Conversely, those diagnosed with CH at mean ages of 1.2 and 1.8 years showed average and above-average intelligence on the VSMS (p = 0.02) and BKT scale (p = 0.001), respectively.

A study on appropriate use and stewardship of proton pump inhibitors

Objective: To analyze the prescribing pattern of use of PPI with respect to “FDA-Approved Indications and Doses for PPI Therapy.” Materials and Methods: After obtaining approval from the Institutional Ethics Committee, a cross-sectional study was carried out among 400 inpatients in a tertiary care hospital in Bangalore. The data were collected from the patient case profile and prescriptions and noted in a self-designed data collection form. The statistical analysis of the collected data was performed using SPSS software and Excel. Results: The study, conducted on 400 patients, revealed a male majority (60%) and a female representation of 40%. Proton Pump Inhibitors (PPIs), mainly Pantoprazole (74.70%), were frequently prescribed, notably in General Medicine (220 patients). PPI use was generally appropriate: indication (99%), dose (97%), frequency (92.8%), and duration (91.8%). However, irrational prescriptions were noted: indication (1%), dose (3%), frequency (7.3%), and duration (8.3%). 139 drug interactions were identified, categorized into Major (39.6%), Moderate (46%), and Minor (14.4%). For example, Ondansetron and tramadol exhibited a major interaction. Among PPI combinations, 93.75% could affect CYP2C19 metabolism, and 6.3% had additive/synergistic toxicity potential.

Opportunistic Screening for Hypertension and Obesity among Patients Attending a Tertiary Care Hospital in Bangalore, India

Background: An estimated 1.28 billion adults in the age group of 30–79 years globally have hypertension. Opportunistic screening would be one method to screen all patients attending health care facility for hypertension and Cardiovascular risk factors. Objectives of this study was to assess the magnitude of the undiagnosed hypertension and obesity by opportunistic screening among the study participants and also to study the factors associated. Methods and Material: A cross-sectional study design was carried out in the outpatient department of General Medicine, in a teaching hospital, India. Blood pressure, BMI, waist circumference was measured among patients aged 30 and above. Results: Almost one third of the study participants were screened to be having Hypertension (27.6%). More than half of the study participants belonged to the category of overweight according to BMI (64.4%) and majority of them were obese according to waist circumference (Male-81.3%, Female-74.2%). Conclusions: Opportunistic screening is a simple and yet efficient method for screening patients for Hypertension and Obesity. Management of these two important risk factors at early stage will help in preventing cardiovascular events among the patients in the future Keywords Opportunistic screening, Non communicable disease, Hypertension, Obesity

A cross-sectional study on drug utilization and it’s cost analysis in the urological disorders and other health issues in patients of a tertiary care hospital

To evaluate drug utilization patterns in terms of WHO indicators, urological disorders, and other health issues in patients of a tertiary care hospital.After obtaining approval from the Institutional Ethics Committee, a cross-sectional study was carried out among 200 inpatients in a tertiary care hospital in Bangalore. The data were collected from the patient case profile and prescriptions and noted in a self-designed data collection form. The statistical analysis of the collected data was performed using SPSS software and Excel. In a study of 200 patients with urological disorders (129 males and 67 females), common co-morbidities included diabetes, hypertension, and hypothyroidism. Benign Prostate Hyperplasia (BPH) and Urinary Tract Infections (UTI) were the prevalent diagnoses. Prescribed drugs included analgesics, antipyretics (26.7%), antibiotics (18.1%), proton pump inhibitors (18.0%), anti-hypertensives (8.7%), anti-emetics (7.9%), anti-hyperlipidemic (7.6%), vaccines (7.5%), and loop diuretics (5.5%). Average drugs per prescription were 6.94, with 23.79% prescribed generically. Antibiotics accounted for 48% of encounters, and injectables were used in 52% of cases. All the drugs came from the essential list. Polypharmacy affected 58% of patients over 50 years, with 32 major interactions and observed adverse drug reactions. The current research provides valuable insights into the overall pattern of drugs used in urological disorders. Physicians should be encouraged to increase generic prescribing to reduce medication cost burdens as well as to avoid unessential drugs, which may lead to polypharmacy and may result in other medication-related problems.

Clinical Profile and Outcome of Children Using Mechanical Insufflation Exsufflation Device (Cough Assist) at a Tertiary Care Hospital in Bangalore, India

Abstract Background and Objective: Children with neuromuscular disorders (NMDs) face a higher risk of recurrent pneumonias. Mechanical insufflation–exsufflation (MI-E) is a technique designed to enhance cough effectiveness, improve mucus clearance, and ultimately enhance lung health by boosting expiratory airflow and cough peak flow in coordination with a cough. We assessed the safety and adverse effects of MI-E in our cohort. Materials and Methods: This retrospective study was conducted over a period of 1.5 years at a tertiary care hospital in Bangalore, South India. Children between 1 and 18 years of age were included in the study. The demographic details of each child were collected from hospital records, along with the indication for starting MI-E and the duration of usage of MI-E. Results: Thirty-three children (18 boys) were started on MI-E. The most common indication was spinomuscular atrophy. Before the start of MI-E, 30 children were on noninvasive ventilation and 13 had a tracheostomy. The median insufflation and exsufflation pressures used were in the range of +15 to 25 cm H2O and −15 to −25 cm H20, respectively. Auto mode was used in all the cases, and 28 children used it on a long-term basis. There was a decrease in the frequency of hospitalization (especially in children with NMD). Adherence was very good without any evidence of barotrauma or any other complications. Conclusions: We found that the MI-E device is a valuable tool for aiding airway clearance in children with NMDs. Its use not only prevents intensive care unit admissions, reducing hospital stay duration but many times mitigates the need for hospital admissions altogether.

Phenomenological Study on Professional Role Transition of New Graduate Nurses

Background Transition from a newly graduated nurse to an expert nurse may involve personal professional intellectual and emotional changes along with skill and role changes. As the global shortage of nurses remains an important issue to be solved it is important to ensure that novice nurses have a safe and smooth professional role transition.Aim The study aimed to address the professional role transition of new graduate nurses during their initial years of practice.Methods A phenomenological research approach was used among the ten nurses who were working as staff nurses at a tertiary care hospital in Bangalore. An interview technique was used to collect the data in two phases Focused group interview and Individual interview.Results The collected data was categorized into three stages based on Judy Boychuk Duchscherrsquos transition theory. During the initial 3-4 months Doing stage the nurses were excited but soon realized that they were not prepared enough to manage the workload and responsibility of their role as staff nurses. The themes that emerged were ldquoBeing scared and stressedrdquo ldquoReality is differentrdquo and ldquoNeed to learnrdquo. Subjects felt scared and stressed and realized that the reality is different and understood the need to learn. During the next 9-12 months Being Stage their competency skill and confidence levels improved. ldquoGaining confidence and Trustworthinessrdquo were the themes that emerged during this phase. From 12 months and above Knowing phase the subjects experienced less stress gained confidence and improved their individual capacity to cope and the themes unfolded were ldquoYes I know and to be empoweredrdquo.Conclusion The study revealed the complexity in the transition from student to registered nurse. In the current scenario with an acute shortage of staff nurses it is vital to address this issue and to plan necessary reforms for strengthening the profession.

Serodiagnosis of Brucellosis in Patients with Fever of Unknown Origin at a Tertiary Care Hospital in Bangalore: A Cross-sectional Study

Introduction: Brucellosis is a zoonotic disease caused by bacteria of the genus Brucella. Although it is not commonly transmitted between humans, it can be transmitted through direct handling of cattle or their products, such as raw milk, unevenly heated milk, clotted cream, and cheese, for varying periods. Brucellosis is considered as one of the neglected zoonotic diseases worldwide, as it can cause debilitating acute infections and later become chronic with numerous complications. Aim: To determine the prevalence of brucellosis among patients with Pyrexia of Unknown Origin (PUO). Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology at Ramaiah Medical College and Teaching Hospital in Bangalore, Karnataka, India, over a period of two years, from December 2019 to December 2021. The study included patients who visited the Outpatient Department (OPD) and those admitted to the hospital with fever persisting for more than 5-7 days and Fever of Unknown Origin (FUO). The total sample size was 180, and 5-10 ml of blood was collected from each patient under aseptic precautions from the median cubital vein for serological tests. The blood samples were stored at 2-8°C for the Rose Bengal Test (RBT) assay and Enzyme-Linked Immunosorbent Assay (ELISA). The demographic parameters considered included clinical history, age, gender, residency, and history of animal exposure. Data analysis was performed using the statistical software Statistical Package for the Social Sciences (SPSS) version 18.0, employing the Chi-Square test, Fisher’s-Exact test, and descriptive statistics. The significance level employed was set at p-value <0.05. Results: Among 180 samples, six (i.e., 3.3%) were positive for the Brucella RBT (BRBT), while 11 (i.e., 6.1%) were positive for the (ELISA IgM), and 17 (i.e., 9.4%) were positive for the (ELISA IgG). Additionally, 22 samples (i.e., 12.22%) tested positive for either ELISA of IgG or IgM (ELISA IgG/IgM). Conclusion: The present study identified 22 patients (12.22%) with Brucella-positive cases who presented with various clinical signs and symptoms, originating from different geographical locations and regardless of gender. These findings suggest that all cases of FUO presented to a clinician should be evaluated for Brucella infection.

Clinical and Epidemiological Characteristics of Elderly Patients with Coronavirus Disease-19 at a Tertiary Care Center in South India

Objective: To evaluate the clinical features and laboratory profile of elderly patients with Coronavirus Disease-19 (COVID-19) at a tertiary care centre in South India. Material and Methods: A hospital-based retrospective study was conducted in 1,744 elderly patients by collecting the clinical and laboratory data from COVID-19 confirmed patients from May 2020 to June 2021 in a tertiary care hospital in Bangalore, India. The clinical features, comorbidities, serum biochemical parameters and inflammatory markers were recorded and collated with disease outcomes. The clinical presentation, inflammatory markers were studied and compared between survivors and non-survivors. P-value less than 0.05 set as statistical significance. Results: The mean age of the patients was 69.7±7.4 years and the male: female ratio was 1.65:1. The most common comorbidity reported in elderly patients with COVID-19 was type 2 diabetes mellitus (46.8%), followed by hypertension (35.7%), chronic kidney disease (10.7%), and ischemic heart disease (6.47%). 41.9% of the patients did not have any co-morbidities. Out of the 1,744 elderly patients, 164 (9.4%) died and mortality was highest in the COVID-19 patients with severe disease (103 patients, 62.8%). Inflammatory markers of neutrophil/lymphocyte ratio (N/L ratio), lactate dehydrogenase (LDH), ferritin, C-reactive protein (CRP), D-Dimers and interleukin-6 were significantly elevated among the patients who did not survive. Conclusion: Mortality was highest in elderly COVID-19 patients with severe disease and most of the patients who died had one or more comorbidities. Neutrophilia, lymphopenia, eosinopenia along with elevated N/L ratio, LDH, ferritin, D-dimer, IL-6 and CRP were significantly associated with adverse disease outcomes.

A study to assess utility of diabetes anxiety depression scale in diabetic patients and to correlate its scores with glycaemic control

Background: According to the International Diabetes Federation “diabetes is one of the largest global health emergencies of the 21st century”. Depression and anxiety have been identified as frequent co-morbid condition in Type 2 diabetes, which is itself associated with worse outcomes including increased mortality. People with diabetes are 2 to 3 times more likely to have depression than people without diabetes. Only 25% to 50% of people with diabetes who have depression get diagnosed and treated. The diabetes anxiety depression scale (DADS) is a potentially useful instrument in screening for anxious depression in people with type 2 diabetes in clinical practice. Methods: The study was a prospective observational study done on 100 Diabetic patients in a tertiary care hospital in Bangalore during the period of 2 months from November 2022 to December 2022. Results: Among the subjects studied,57% were Male and 43% were female. The maximum number of subjects i.e., 31% were in the age group of 51-60 years. Then mean duration of Type 2 DM in the study subjects was 12.34 years. 53% were found to have poor glycaemic control which is a HbA1C value of more than equal to 8%. 31% of them scored 18-39. Score of 18-39 was suggestive of major anxious depression. Conclusions: Anxious depression was prevalent across all categories of glycemic variability. There was no statistically significant difference among glycemic variability across the anxious depression spectrum. DADS score had a positive correlation with increasing age. Male diabetic patients had more anxious depression than female patients. Female diabetic patients had poorer diabetic control over prolonged periods of time. The present study findings have potential clinical implications but also have certain limitations in terms of sample size.

DRUG THERAPY OF HYPOPIGMENTARY DISORDERS OF THE SKIN: A HOSPITAL-BASED STUDY

Objective: To determine the pattern of drug use, adverse events (AEs), and quality of life (QOL) in hypopigmentary disorders of the skin. Methods: A prospective, observational study was conducted on 48 newly diagnosed and untreated participants with hypopigmentary disorders who attended the dermatology outpatient department (OPD) of a tertiary care hospital in Bangalore, India. The pattern of drug therapy and AEs to the therapy were analyzed using descriptive statistics. The dermatology life quality index (DLQI) score for QOL was assessed before and after treatment using analysis of variance (ANOVA). The participants were monitored every 30 d for three months to study the appropriateness and changes in prescription patterns, AEs, and QOL. Results: Male participants had a mean age of 36.69±15.58, while female participants had a mean age of 40.96±11.88. The different classes of drugs used were calcineurin inhibitors, growth factors, melanizing agents, glucocorticoids (GCs), antifungals, and anti-lepra drugs. QOL improved after treatment. The most common AEs include gastritis (16.6%) and acneiform eruption (10.41%). Conclusion: This study has helped in determining the different patterns of drugs used in hypopigmentary disorders and their positive impact on QOL. The individualized prescribing pattern could improve the clinical and psychosocial outcome of the disease in the future.

Profile of injury cases before, during and after lockdown of COVID-19 pandemic: a hospital based study

Background: Injuries show a significant burden of morbidity, disability and mortality throughout world, especially in lower-middle income nations. Injuries result from road traffic crashes, falls, burns, and acts of violence against oneself or others, among other causes. Road Traffic Accidents are especially dominant among injuries, which are unintentional. The lockdown has resulted in dramatic changes in service provision from emergency departments and hospitals. And the pattern of the injuries has differed because of different reasons being reduced mobility, isolation at home, boredom and so on. The aim of this study was to assess the type of injury cases reaching a tertiary care hospital in Bangalore before, during and after lockdown of the COVID-19 pandemic and its profile. Methods: The data was collected from the hospital records of all inpatients of selected tertiary care hospitals. Results: Incidence of RTA and Assaults are observed to be high constituting 52.5% and 31.4% respectively. The change in trend of injuries indicated a dropdown in injury cases during lockdown and the increase of cases after lockdown relaxations. Conclusions: Road traffic accidents was the most common cause of injury observed in this study, with specifically 2-wheeled vehicles were most involved. The development of trauma registries all over the country containing minimum epidemiologically desired data is the need of the time for India. The data in the hospital records should be standardized and centralized.

Unnatural Death Among Covid-19 Tested Positive Individuals: A Retrospective Study

Introducction:- Covid 19 started out as a fast-spreading viral disease, in Wuhan in 2019. Soon, it spread acrossthe globe and WHO declared it a Pandemic. Various countries took various measures to control its spread andtransmission. By the time, countries recovered from it, a new wave would come along with different expressionsand pathophysiology.When Covid 19 began, various health agencies in India started making protocols and standard ooperatingprocedures including conducting autopsies in COVID-19 infected bodies.Aims and Objectives:- Aim of our study is to analyze cause of death among all covid 19 positive cases broughtfor medicolegal autopsies from the time of lockdown for a period of one year. Our aim is to see if there were anyfactors which could have prevented these deaths.Materials and methods: A retrospective study of 1 year conducted from 25th March 2020 to 24th March 2021,(1st wave of Covid 19) was done in a tertiary care hospital in Bangalore. (Bowring and Lady Curzon hospital)Results: 39 Covid-19-positive unnatural deaths were handled with the youngest being 18 years old and the oldestbeings 83. The majority turned out to be suicides (51.28%), then RTAs, falls, and natural death. The commonestmethod of suicide was hanging (35.89%), followed by poison consumption, and falling from a height.Conclusion: COVID -19 is a viral infection with variable clinical signs and variable fatality rates. There is much tolearn about it. However, suicides in COVID -19 cases might not have ended death if some care, timely diagnosis,and treatment were provided.

Pattern of Donor Adverse Reactions in Blood Donation in a Tertiary Care Hospital in Bangalore, India

Pattern of Donor Adverse Reactions in Blood Donation in a Tertiary Care Hospital in Bangalore, India

A Retrospective Cross-sectional Study of Paediatric Dermatoses during the COVID-19 Pandemic in a Tertiary Care Hospital in Bengaluru, Karnataka, India

Introduction: Dermatologic conditions constitute at least 30% of all outpatient visits to paediatricians and 30% of all visits to dermatologists involve children. Skin conditions that manifest themselves during childhood and adolescence are referred as paediatric dermatoses and make up their own unique category of skin conditions. Aim: To identify the dermatological conditions which were prevalent during the Coronavirus Disease 2019 (COVID-19) pandemic in a tertiary care hospital in Bangalore. Materials and Methods: This retrospective cross-sectional study was conducted by reviewing records of Outpatient Department (OPD) of Dermatology and Paediatrics in our tertiary care center, Bengaluru from February 2020 to February 2022. The demographic details and diagnosis are recorded. The diagnosis was made according to ICD-10 (International Classification of Diseases 10th Revision) and the prevalence of different dermatoses was calculated. Mean and standard deviation was calculated for descriptive statistics. Data were statistically evaluated with IBM Social Package for Statistical Analysis (SPSS) Statistics for Windows version 26.0., IBM Corp., Chicago, IL. Results: The total number of paediatric cases attended dermatology OPD during the two year pandemic was 558. The prevalence of paediatric dermatoses in the present study was 193 (34.58%). There were 283 girls and 275 boys with Male : Female is 1:1.02. There is a female preponderance of 50.7% against 49.28%. The majority was infectious lesions 153 (27.41%), congenital dermatoses 9 (1.61%), Papulosquamous disorders 23 (4.12%), Pilosebaceous disorders 111 (19.89%), dermatitis 193 (34.58%) followed by Miscellaneous 69 (12.36%). Conclusion: This study was conducted during COVID-19 pandemic which in comparison to the other studies shows a similar distribution of dermatoses. But there was a significant shift of age group affected which can be well explained by the lockdown and social isolation.

Abstract 13541: A Digital Health Ecosystem for Coronary Artery Bypass Graft and Percutaneous Coronary Angiography Facilitates Recovery for Patients in Their Homes

Introduction: The transition from hospital to home disrupts the continuum of patient care, adversely impacting readmissions and patient engagement. Our study objective is to develop and assess a Digital Health Ecosystem (DHE) intervention to mitigate CABG and PTCA readmissions and improve patient satisfaction with minimal clinician burden. Methods We developed and assessed a DHE combining evidence-based personalized content; web-based clinician dashboards; patient caregiver mobile apps; and nurse care plans and escalation protocols (figure). A tertiary-care hospital in Bangalore, India deployed the DHE to address post-discharge challenges of CABG and PTCA. India is attractive for testing digital health due to its large population, large mobile phone penetration, large out of pocket healthcare costs and positive telehealth attitudes. In an IRB-approved retrospective study, Jan-Dec 2019, we assessed patient outcomes and satisfaction for 799 patients (CABG=325; PTCA=474). We used an all-comers real-world approach without exclusions to assess feasibility. Results Escalations of care (n=7665), were greater in CABG (n=4772; 15 per patient) compared with PTCA (n=2893; 6 per patient). The figure shows 101 higher level escalations from 82 patients (48 CABG, 34 PTCA) with 41 resolved via virtual care and 60 resulting in 35 ED visits and 17 hospitalizations. Net Promoter Score (NPS) indicated patients were loyal and likely to recommend the DHE. The hospital NPS increased by 60%, from hospital reported baseline of 47 to 75. Conclusions Only 10.3% of patients after discharge had serious complaints. There were relatively few ED visits (4.4% of patients) and even fewer readmissions (1.9%). This contrasts with Indian studies showing 10-20% readmission after CABG. We demonstrated a DHE that provides improved post-discharge patient care and satisfaction and can be implemented alongside traditional healthcare. Moreover, this DHE may significantly reduce readmissions.

Reducing hospital-acquired infections and improving the rational use of antibiotics in a tertiary care hospital in Bangalore

Prevention of hospital-acquired infections (HAI) is central to providing safe and high quality healthcare. Transmission of infection between patients by health workers, and the irrational use of antibiotics have been identified as preventable aetiological factors for HAIs. Few studies have addressed this in developing countries.To assess the effectiveness of a multifaceted infection control and antibiotic stewardship programme on HAIs and antibiotic use. A retrospective study was conducted for a study period of 11months (June 2021-April 2022) in Vydehi Hospital, Bangalore. All patients admitted to the intensive care unit and wards were included in the study. Intervention period was 6 months (June 2021-Nov 2021) and post-intervention period was 5 months (Dec 2021- April 2022). Assessment of HAIs was made based on the criteria from the Centers for Disease Control and Prevention. The multifaceted intervention consisted of hand hygiene campaign, isolation of multidrug resistance organism’s patients, water and air quality analysis, training of health care workers in infection control practices, and antibiotic stewardship. Data was collected using an identical method in the intervention and post intervention periods.We observed a major reduction in HAIs, from 89% (198/222 patients) in the intervention period to 10.8% (24/222 patients) in the post intervention period (relative risk (RR) (95% CI) 0.48 (0.31 to 0.56). Antibiotic use in ICUs declined from 58% (780/1347) to 44% (442/995) (RR 0.44 (0.40 to 0.55). Overall, hand hygiene compliance among the health- care workers was maintained at 100% during both the periods. Multifaceted infection control interventions are effective in reducing HAI rates, improving the rational use of antibiotics, increasing hand hygiene compliance, and may reduce mortality in hospitalised patients in developing countries.

Work-related Musculoskeletal Disorders and Quality of Life Among Staff Nurses in a Tertiary Care Hospital of Bangalore

Work-related musculoskeletal disorder (WMSD) is a collective and descriptive term used for the symptoms caused or aggravated by work. Significant WMSDs can affect the productivity and Quality of Life (QOL) of nurses. This study was undertaken to estimate the prevalence of WMSDs, identify their risk factors, and find the association, if any. This study also assessed the quality of life of nurses and its association with WMSDs. This cross-sectional study was conducted among 207 staff nurses at a tertiary care hospital in Bangalore for a period of 7 months (June-2018 to Dec-2018). The nurses were stratified based on their parent department into three broad categories - Medical, Surgical, and Operation Theatre. Stratified random sampling was followed to obtain the required number of nurses from each stratum. Data was collected using a pre-tested semi-structured questionnaire, Nordic Musculoskeletal Questionnaire (NMQ), clinical examination tests, and WHOQOL-BREF. The annual prevalence of WMSDs among the study subjects using NMQ was 168 (81.2%). The prevalence of WMSDs based on clinical examination tests was 67 (32.4%). Repetitive movements at work (OR 9.3, 95% CI 3.4-25.7), working in abnormal postures for prolonged periods (OR 4.7, 95% CI 1.7-12.9), and working even when sick (OR 5.3, 95% CI 2.0-14.1) were the risk factors for WMSDs (P < 0.05). No significant association was found between reported WMSDs (according to NMQ) and QOL. Our study found that the prevalence of WMSDs was high among the staff nurses and it did not affect their QOL significantly. Workshops and training sessions on ergonomics should be regularly conducted at the workplace to prevent WMSDs.

Role of Laparoscopy in Complicated Appendicitis in Children

Background: Appendicitis is one of the most common surgical emergencies among children. Approximately 30% of children present to the hospital with complicated appendicitis, which is associated with higher morbidity than simple appendicitis. Controversy exists in the treatment of complicated appendicitis in the pediatric age group. The goal of this study was to review the results of laparoscopic surgery in complicated appendicitis in terms of safety, efficacy, and complicationsMaterials and Methods: A retrospective observational study was conducted in a tertiary care hospital in Bangalore from 2015 to 2020 over a period of 5 years. All children who underwent laparoscopic surgery for complicated appendicitis (perforated, gangrenous, and mass) were included in the study. Thorough history with respect to symptoms and their duration were recorded followed by general and abdominal examination. Routine blood investigation and imaging were done before surgery. Intraoperative data regarding the type of complication, presence or absence of fecolith, and position of appendix were documented. Postoperatively duration of stay and complications were analyzed. Results: Sixty cases were included in the study. The mean age of presentation was 10.11 ± 0.855 years. Of 60 children, 53 were males and 7 were females. The mean operative time was 55.8333 ± 4.806 min. The rate of conversion from the laparoscopy to open surgery was 11.5%. The mean time of duration of intravenous antibiotics was 4.2778 ± 0.446 days. The mean time for starting of oral feeding was 2.8333 ± 0.307 days. The mean duration of hospital stay was 5.11 ± 0.545 days. Wound infection in the immediate postoperative period was seen in 6.6% of the children. No long-term complications were noted. Conclusion: Laparoscopic appendectomy (LA) for complicated appendicitis is safe and effective. Therefore, it should be the first choice for cases of complicated appendicitis in children.

A study to compare fibrinolytic therapy versus primary percutaneous coronary intervention in ST-segment elevation myocardial infarction in a tertiary care hospital

Background: ST-segment elevation myocardial infarction (STEMI) is the most dramatic manifestation of coronary artery disease, acute STEMI is a clinical syndrome defined by characteristic symptoms of myocardial ischemia in association with persistent electrocardiographic ST elevation and subsequent release of biomarkers of myocardial necrosis. Reperfusion with thrombolysis or PCI (percutaneous coronary intervention) is the current standard of care for STEMI. Aims and Objectives: The aim of the study was to compare the effectiveness of fibrinolytic therapy and primary PCI which are the available reperfusion strategies for STEMI. Materials and Methods: This prospective and observational study was conducted at a tertiary care hospital in Bangalore. Patients presenting with STEMI to emergency department were treated with either fibrinolysis or PCI as per protocol. Patients in each arm were followed up to know the differences in outcome at discharge and 30-day follow-up. Results: Patients admitted with STEMI had overall in hospital mortality of 17 (7.1%) patients, of which 9 (7.6%) patients were from fibrinolysis group and 8 (6.6%) patients from PCI group with no statistically significant difference (P = 0.760). There was significant incidence (P = 0.001) of reinfarct in fibrinolysis group (9.3%) when compared to PCI group (0%). Conclusion: There was no statistically significant mortality difference at discharge and at 30 day between fibrinolysis and primary PCI in patients with STEMI in our study, this may be attributed to use of rescue PCI in failed fibrinolysis patients and early tricuspid valve repair in many patients after fibrinolysis.