Tertiary Care Hospital In Karnataka Research Articles

Oral anticoagulation in cerebral venous sinus thrombosis-Experience from a tertiary care hospital in Karnataka, South India

Oral anticoagulation in cerebral venous sinus thrombosis-Experience from a tertiary care hospital in Karnataka, South India - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/j.ijn.2019.016, IP Indian Journal of Neurosciences-IP Indian J Neurosci

Analysis of clinical profile and prescription pattern of malaria in a tertiary care hospital in Karnataka, India

Background: Malaria is one of the leading causes of morbidity and mortality in developing countries like India. Plasmodium falciparum and Plasmodium vivax are the commonest species implicated for an increased incidence of malaria in India. The pattern of disease, signs, and symptoms vary from place to place, region to region due to demographic variations. The current study was undertaken to study the differences in the clinical profile of malaria, particularly signs and symptoms, complications and response to treatment in malaria.Methods: A retrospective, single center, surveillance study was carried out at a tertiary health care center in Mangalore. All patients aged above 18 years diagnosed as malaria by peripheral smear method and rapid diagnostic tests were included in the study. The clinical features, complications, and response to treatment were noted.Results: Fifty eight patients diagnosed as malaria were included in the study. Compared to other studies and nationwide incidences, here P. vivax emerged as the leading cause of malaria. All patients presented with fever varying from 3-20 days. About 30 patients complained of headache and 21 patients presented with malaise. In about 6 patient’s complications were seen. Majority of patients received artemisinin derivatives followed by chloroquine for treatment of malariaConclusions: Previous thinking that complications are only seen with P. falciparum has to be changed. Now many complications, mild as well as severe type are seen in P. vivax malaria. Drug resistance is another global problem which needs to be tackled wisely by systematic usage of antimalarials.

Emergency peripartum hysterectomy: A five year study from a tertiary care hospital in Mysore, South India

Emergency peripartum hysterectomy: A five year study from a tertiary care hospital in Mysore, South India

Onsite mentoring of special newborn care unit to improve the quality of newborn care.

It has been possible to set up special newborn care units (SNCUs) and to improve the survival of newborns in India. However, several challenges remain affecting their effective functioning. Different approaches have been attempted and several policies have also been implemented to address this issue. To evaluate the feasibility of implementing best practices in neonatal care by onsite mentoring in an SNCU over 4 months. The mentoring team was from a tertiary care hospital in Karnataka. The SNCU was functioning at the district hospital, catering to approximately 3500 live births per year. Onsite mentoring was carried out from August 2016 to November 2016. This was a prospective implementation research. Framework focused on infection control, preterm care, care at birth, advocacy for infrastructure and resources, and facility-based refresher training. A total of 16 visits were done by the mentoring team and 2 weeks of in-house residency. There were improvements in hand hygiene compliance from 0% to 87.5%, in cleaner IV site (from 50% to 100%), decreased unnecessary oxygen administration (from 75% to 33.3%), decreased antibiotic usage (from 70.5% to 35.5%), decrease in the number of babies receiving >5 days of antibiotics (from 41.6% to 0%), and increased kangaroo mother care initiation rate from 0% to 41.6%. The facility got level IIA accreditation by the end of the intervention period. Onsite mentorship program of SNCU is feasible and planning should be contextual. With the problems being uniform across most facilities, the model could be replicated across the country.

ASSESSMENT OF ADVERSE DRUG REACTIONS OCCURRING AT DEPARTMENT OF NEUROLOGY OF A TERTIARY CARE HOSPITAL IN INDIA

Objective: The purpose of this study was to assess the incidence and pattern of adverse drug reactions (ADRs) reported from the department of neurology of a tertiary care hospital in Karnataka, India.Methods: It is a hospital-based prospective, observational study, conducted among the inpatients of all age groups of either sex for a period of 6 months. ADRs were reported by the clinical pharmacists and physicians of this hospital. ADRs obtained were categorized based on its causality, severity, preventability, predictability, and outcomes. Binary logistic regression was carried out to identify the predictors of ADR and Kaplan–Meier analysis was performed for survival analysis.Results: A total of 250 patients were enrolled for the study in which 108 (43%) patients were presented with at least one ADR and a total of 212 ADRs were observed. The highest rate of ADRs was observed with antiepileptics 61 (29.5%). The most commonly reported that ADRs were skin reactions 23 (10.8%). Causality was assessed using three different scales which showed that most of the ADRs were probable. Severity, preventability, and predictability were assessed, of which 125 (59%) ADRs were moderate, 192 (90.6%) ADRs were probably preventable, and 156 (73.6%) ADRs were predictable, respectively. The outcomes showed that 150 (70.1%) patients recovered from the reactions. Predictors such as polypharmacy and duration of stay were found to be significant.Conclusion: The study concluded that the prevalence of ADRs in the department of neurology is high. Thus, early detection and management of ADRs are essential to avoid further complications of the reaction.

Development of a Nurse Navigator Programme for the Care of Breast Cancer Patients

Background: Breast cancer incidences in India are rapidly rising, amounting to a significant percentage of all cancers in women. The diagnosis and expenses for treatment make the patient to thrust on a journey that disorganizes their daily function and family roles with much fear and uncertainty. The care of the patients requires a comprehensive individualized care from a pivotal nurse to meet their informational and educational needs, support, and care coordination throughout their illness trajectory. Limited studies have been reported from developing countries on specific nursing roles in cancer care. Therefore, the researcher felt the need for developing a nurse navigation program for the care of breast cancer patients. Aim: The aim of the study was to develop, validate and assess the usefulness of the program in women with breast cancer. Methods: The content of Nurse Navigator Program was prepared by reviewing literature pertaining to nurse/patient navigation programs. The program has been validated by an expert committee consisting of experts from various fields. The program consists of preoperative education on surgery and postmastectomy care, progressive muscle relaxation training, information booklets on post mastectomy care, chemotherapy and radiation therapy, telephonic follow-up sessions and ONN visits. Readability testing of the information booklets was checked online by Flesch reading ease and Flesch Kincaid-Grade level. The educational program and information booklets were translated into Kannada and retranslated into English with help of 2 experts. Researcher had undergone training in progressive muscle relaxation. Finally the usefulness and acceptability of the program was tested in 60 breast cancer patients undergoing surgery followed by chemo/radiation therapy in surgery, chemo and radiotherapy wards of a tertiary care hospital in Karnataka. After obtaining ethical permission from institutional ethical committee written informed consent was obtained from participants before conducting study. Results: The mean ICVI, SCVI/UA and mean expert proportion of the Nurse Navigator Program was found to be −1.00 for each. Flesch reading ease was 77.3 and Flesch Kincaid-Grade level achieved was 4.8. 83.3% of women strongly agreed that information booklets were useful, 80% strongly agreed the user friendliness of this program & 70% of people reported that their emotional needs were taken care seriously and got additional emotional support. 90% strongly agreed navigation services are necessary and would recommend navigation service. Conclusion: The validated Nurse Navigator Program was found acceptable and useful for patients. The whole program may give evidence on the effectiveness of a nurse navigator program for the care of women with breast cancer. If significant effects are detected this program could be implemented in the hospital setting to improve cancer care.

Pattern of upper gastrointestinal diseases: an audit of 1000 cases based on endoscopic findings from a tertiary care hospital in Mysore

Background: Fibreoptic endoscopy is a highly efficient diagnostic tool, which is now increasingly being used in the diagnosis of upper gastrointestinal diseases. This study has been carried out to evaluate the distribution of various upper gastrointestinal diseases based on endoscopic findings in a tertiary care hospital in Mysore.Methods: A cross-sectional study was conducted based on data from endoscopic register of 1000 subjects who underwent endoscopy for various upper gastrointestinal symptoms from 1st January 2017 to 31st December 2017(one year).Results: Mean age of the study population was 50.23 years (SD-15.46). Minimum age was 12 years and maximum was 88 years. About 44.7% of the study subjects belonged to 40-60 age group.61.6% of the study subjects were males. Most common indication was pain abdomen (32.1%) followed by dysphagia (22.2%). Of the 1000 study subjects 18.6% had normal findings. Most common finding was Gastritis / Duodenitis /Gastric erosions (28%). Malignant lesions were noted among 11.1%, of which esophagus and stomach are 5.4% and 4.9% respectively.Conclusions: Endoscopic diagnosis is useful for early detection of UGI diseases and helpful for their management.

Mortality trends in a tertiary care hospital in Mysore

AIM: The aim of this study is to find out the various causes of mortality in a tertiary care hospital over a 1-year period. MATERIALS AND METHODS: All deaths occurring in the study period were retrospectively analyzed by analyzing the hospital records from the Medical Records Department for causes of death and various epidemiological parameters such as age and sex. RESULTS: A total of 1028 deaths were included the study. Deaths were more in males than females. More deaths were observed in the fifth and sixth decades of life. The maximum deaths, i.e., 356 were due to sepsis (34.6%) of which pneumonia was the cause in a majority of sepsis-related deaths (36.51%). Cardiovascular causes of death were 184 (17.89%) of which a majority of 130 (70.65%) were related to ischemic heart disease. The other causes of deaths included 137 (13.3%) from road traffic accidents, 117 (11.3%) due to cerebrovascular accidents, 73 (7.1%) due to gastrointestinal tract-related causes, 58 (5.64%) due to primary renal diseases, 45 (4.37%) from chronic respiratory ailments, 32 (3.11%) due to malignancies, 18 (1.75%) due to poisonings, and 4 (0.38%) deaths due to hematological disorders. CONCLUSION: The most common cause of overall mortality was sepsis followed by cardiac causes. Road traffic accidents also significantly contributed to the overall mortality. Steps are needed to be taken to educate the medical fraternity and the people about the prevalence and preventive strategies for communicable and noncommunicable diseases.

A Comparative Study of Serum Procalcitonin (PCT) and C-Reactive Protein (CRP) at Varied Severity of Organ dysfunction in Sepsis in a Tertiary Care Hospital In Karnataka, India

A Comparative Study of Serum Procalcitonin (PCT) and C-Reactive Protein (CRP) at Varied Severity of Organ dysfunction in Sepsis in a Tertiary Care Hospital In Karnataka, India

Spectrum of biopsy-proven kidney diseases at a tertiary care hospital in South India

Introduction The prevalence of kidney diseases, glomerular and tubulointerstitial, varies with the geographical area, socioeconomic conditions of the people, population demographics, race and ethnicity, access to health care, and also the threshold for doing a renal biopsy. Objective The primary objective was to study the prevalence of biopsy-proven kidney diseases presenting to a tertiary care hospital in Mysore, South India. Patients and methods We have retrospectively analyzed the renal biopsy data from 2005 to 2013. The clinical and laboratory data of patients were collected from biopsy request forms, and histopathology data were recorded. Biopsy specimens were examined by light and immunofluorescence microscopy. As a hospital policy, all biopsies were based on definite indications. A total of 1113 biopsies were considered. Transplant biopsies and those with inadequate specimen were excluded. Results A total of 914 patients had some kind of glomerulopathy. Minimal change disease (n=182/1113) was the commonest histological type among glomerular diseases, followed in order by postinfectious glomerulonephritis, focal segmental glomerular sclerosis, membranous glomerulopathy, and immunoglobulin A nephropathy. Among the secondary glomerular diseases, the commonest was diabetic nephropathy (n=72) followed by lupus nephritis (n= 58) and crescentic glomerulonephritis. Most common indication for renal biopsy was nephrotic syndrome (n=274/1113), chronic kidney disease (n=141), acute glomerulonephritis (n=107), acute kidney injury with unclear etiology or delayed recovery, and rapidly progressive glomerulonephritis. Conclusion Nephrotic syndrome was the commonest indication for renal biopsy, and minimal change nephrotic syndrome (MCNS) was the most common glomerular disease followed by focal segmental glomerular sclerosis. Membranoproliferative glomerulonephritis, the incidence of which has decreased in the developed world, still accounts for a significant number in our population. There is a need for electronic data monitoring in India with nationwide integration for a proper analysis of the changing trends of diseases occurring over an extended time frame.

A Study on Ocular Morbidity among Patients with Psoriasis Visiting a Tertiary Care Hospital in Karnataka, Southern India

ABSTRACTIntroduction: Psoriasis is a chronic immune-mediated disorder with predominantly dermatological manifestations and varying prevalence in different parts of the world. Data on the ocular features of this disease are limited. Hence, we aimed to estimate the burden of ocular disease in psoriatic patients in the Indian population.Materials and methods: An interdisciplinary cross-sectional hospital-based observational study was conducted in South India, wherein an ophthalmological evaluation was performed for the patients with Psoriasis. The ocular features were recorded and compared with the severity of psoriasis using the Psoriasis Area Severity Index (PASI) score.Results: Ocular morbidity was observed in 80% of the patients with psoriasis which increased with increasing duration (p = 0.004) and increasing PASI score (p < 0.001). Blepharitis and dry eye disease were common in our patients with psoriasis.Conclusion: It is important to screen patients with psoriasis for ocular comorbidities so as to prevent sight-threatening complications.

Study on self care and adherence to therapy among diabetic patients at a tertiary care center in Mysore

Background: Adherence to lifestyle modification and self-care are vital elements in the management of diabetes mellitus and the reason for poor adherence and poor self-care could vary from person to person. The study aimed to assess the level of adherence to therapy, the self-care practices and the barriers preventing adherence among diabetic patients attending a tertiary care hospital in Mysore. Methods: A mixed methods study was conducted among an estimated sample of 150 patients attending a tertiary care teaching hospital in Mysore, Karnataka. Diabetes self-care activities was assessed using modified Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. An in depth interview was conducted for 20 subjects for understanding the factors contributing to their level of adherence / non-adherence. The quantitative data was analysed with standard statistical methods and qualitative data through content analysis. Results: The adherence to the drugs was found to be 86.6%.The median number of days during which target diet plan was achieved, at least 30 minutes of physical activity undertaken and foot care was 5.5 and 0 respectively. Lack of awareness and socioeconomic barriers were cited by the patients as the barriers preventing adherence to drug therapy, diet and exercise. Conclusions: Lack of awareness of the disease and cost of the pharmacological therapy are potentially modifiable reasons of poor adherence. Health education is to be provided by the healthcare providers focusing on the importance of adherence to drugs, diet and exercise.

Clinical Perspective of Ectopic Pregnancy in a Tertiary Care Hospital in Karnataka, India

Clinical Perspective of Ectopic Pregnancy in a Tertiary Care Hospital in Karnataka, India

Patient based factors influencing drug compliance in a tertiary care hospital in Mysore..A pilot study

Patient based factors influencing drug compliance in a tertiary care hospital in Mysore..A pilot study

Epidemiological profile of acute respiratory distress syndrome patients: A tertiary care experience.

Background:Acute respiratory distress syndrome (ARDS) is seen in critically ill patients. Its etiological spectrum in India is expected to be different from that seen in western countries due to the high prevalence of tropical infections.Aim:To study the epidemiological profile of ARDS patients.Setting:A tertiary care hospital in Karnataka, India.Materials and Methods:Retrospective analysis of 150 out of the 169 ARDS patients diagnosed during 2010–2012. Data collected included the clinical features and severity scoring parameters.Results:The mean age of the study population was 42.92 ± 13.91 years. The causes of ARDS included pneumonia (n = 35, 23.3%), scrub typhus (n = 33, 22%), leptospirosis (n = 11, 7.3%), malaria (n = 6, 4%), influenza (H1N1) (n = 10, 6.7%), pulmonary tuberculosis (n = 2, 1.3%), dengue (n = 1, 0.7%), abdominal sepsis (n = 16, 10.7%), skin infection (n = 3, 2%), unknown cause of sepsis (n = 18, 12%), and nonseptic causes (n = 15, 10%). A total of 77 (51.3%) patients survived, 66 (44%) expired, and 7 (4.7%) were discharged against medical advice (AMA). Preexisting comorbidities (46) were present in 13 survivors, 19 nonsurvivors, and four discharged AMA. History of surgery prior to the onset of ARDS was present in one survivor, 13 nonsurvivors, and one discharge AMA. Mean Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, and Sequential Organ Failure Assessment scores in survivors were 9.06 ± 4.3, 49.22 ± 14, and 6.43 ± 2.5 and in nonsurvivors 21.11 ± 7, 86.45 ± 23.5, and 10.6 ± 10, respectively.Conclusion:The most common cause of ARDS in our study was pneumonia, but a large percentage of cases were due to the tropical infections. Preexisting comorbidity, surgery prior to the onset of ARDS, higher severity scores, and organ failure scores were more frequently observed among nonsurvivors than survivors.

Prevalence and leukotoxic profile of biofilm forming Staphylococcal strains isolated from a tertiary care hospital in Mysore

Background: Staphylococci causes chronic skin infections, device associated infections, ear infections, bone infections and post-operative infections. It secretes toxins such as Pantone-Valentine Leukocidin which prolongs the infection in hospitalized patients. Aim: To investigate the prevalence of Staphylococcal biofilm associated strains and to understand the correlation between biofilm production, multi-drug resistance and leukotoxicity. Methods: 280 Staphylococcal clinical isolates obtained from biofilm associated infections are collected from a tertiary care hospital in Mysore. They were screened for the production of biofilm, multi-drug resistance and leukotoxicity. They were also screened for icaAB and PVL luk F/S genes by PCR. Correlation between leuktoxicity and biofilm production was established by finding the leukotoxic potential of biofilm positive strains. Findings: Among 280 Staphylococcal clinical isolates, 34.6% showed biofilm production. Out of these isolates, 25% showed the presence of icaAB genes and 29% showed the presence of PVL luk F/S genes. Presence of icaAB gene was found to be higher in isolates obtained from implant associated infections. But the prevalence of PVL luk F/S genes was higher in chronic skin infections. 78% of the isolates displayed multi-drug resistance and methicillin resistant strains were comparitively high in device associated infections (77%). Strong biofilm producing PVL positive isolates from chronic skin infections showed increased leucotoxicity compared to PVL negative, weak and moderate biofilm producers. Conclusion: Statistical analysis revealed that PVL in association with biofilms can promote higher leukotoxicity compared to non biofilm producers. This study foresee the essential role of biofilm production, multi-drug resistance and toxins for the increased Staphylococcal pathogenesis.

Microbiological profile of early-onset neonatal sepsis in a tertiary care hospital in South India

Aims: To identify the microbiological profile of neonatal sepsis and antibiotic sensitivity patterns of various isolates in the Newborn Intensive Care Unit at a Tertiary Care Hospital in Karnataka. Materials and Methods: In this retrospective study, the laboratory data of primary blood culture reports of 240 neonates admitted with clinical suspicion of early-onset sepsis, from April 2014 to March 2016, were analyzed. Results: Total 240 samples were received during the study period, of which 40, (16%) were found to be positive. Out of these, 18 (7.5%), 18 (7.5%), and 4 (1%) had Gram-positive, Gram-negative, and Candida infection, respectively. The most common organism noted among Gram-positive isolates was Staphylococcus aureus (22.5%), followed bycoagulase-negative staphylococci (12.5%) and Enterococcus (10%). Among Gram-negative isolates, Acinetobacter was the most commonly implicated organism (20%), followed by Klebsiella pneumoniae (12.5%), Escherichia coli (7.5%), and Pseudomonas aeruginosa (5%). Conclusion: This study emphasizes the need for close observation to be carried out at regular intervals to describe the various pathogens causing early-onset neonatal sepsis and their ever changing antibiotic sensitivity pattern which will provide useful data to guide practice and policies on rational use of antibiotics.

“Enterococci speciation and antibiogram: an assessment of data at a tertiary care hospital in Karnataka”

Background: Enterococci were known to be less virulent in healthy individuals, but recently have become important opportunistic pathogens, especially in hospitalized patients because of their ability to colonize the gastrointestinal tract for long periods which is a crucial factor in the development of drug resistance and have become a major obstacle for treatment. Objective: 1. To determine the species of Enterococci isolated from various clinical samples. 2. To determine the antimicrobial susceptibility pattern of Enterococci. Material and Methods: A cross sectional study was conducted at a private tertiary care hospital in Shivamogga district of Karnataka, using secondary data of Enterococcal species isolated from various clinical samples such as urine, blood, pus, sputum, sterile body fluids which were maintained in the Microbiology laboratory registers for a period of 1 year from January 2014 to December 2014. Standard protocols were followed for Enterococcus isolation, identification and to assess their antibiotic susceptibility. Analysis was done using MS Excel 2010. Results: Out of 66 enterococcal isolates from various clinical samples majority i.e. 32 (48.48%) were isolated from urine followed by pus 22 (33.33%). Majority of the Enterococcus were isolated from females 34 (51.51%). E. faecalis was the predominant isolate i.e. 56 (84.84%). All the isolates were susceptible to Linezolid and Vancomycin. Maximum resistance was seen against Penicillin i.e. 26 (76.47%). Conclusion: Considering the general scenario of increasing drug resistance and prevalence of wide variety of Enterococcus species there is a need to carry-out regular surveillance of antimicrobial resistance of enterococci to recommend appropriate therapy. Key words: Antimicrobial susceptibility pattern, Clinical samples, Enterococcus species

English

English

Cross sectional analysis of aerobic bacteria and their antibiotic susceptibility pattern among orthopedic wound infections at a tertiary care hospital in Karnataka

Background: Orthopedic wound infections are one of the important causes of morbidity and are difficult to treat. With the development of antimicrobial resistance, the situation has further worsened and it has become difficult to manage them by conservative means leading to further deterioration in health and wellbeing of the patients. To avoid such complications, orthopedic wound infections need to be managed at the earliest by microbial isolation and appropriate antibiotic administration. Objectives: 1. To study the profile of aerobic bacteria affecting the orthopedic wounds. 2. To study the pattern of their antibiotic susceptibility. Methods: A Cross sectional study was conducted using secondary data of orthopedic wound infection cases maintained in the microbiology laboratory registers for a period of 1 year from September 2014 to August 2015. The bacteriological agents were isolated, identified and their antibiotic susceptibility patterns were determined using standard protocols. Analysis was done using MS Excel 2010. Results and interpretation: Our study yielded 249 (56.08%) positive culture cases. Prevalence of Gram positive bacteria was more than Gram negative bacteria. Staphylococcus aureus was the predominant causative agent followed by Pseudomonas aeruginosa. The prevalence of MRSA was 25%. All the Gram positive cocci isolates were sensitive to linezolid and vancomycin. Members of Enterobacteriaceae family showed high sensitivity to Meropenem followed by amikacin. Polymyxin B and piperacillin-tazobactam were the most effective antibiotics among non-fermenters. All the Gram negative bacteria were resistant to penicillin and cephalosporins. Conclusion: Microbial analysis of samples and their antibiogram is recommended for proper management of Orthopaedic wounds. Key words: Antibiogram, Bacterial isolates, Orthopaedic wound infections