Tertiary Care Hospital In Karnataka Research Articles

Trends of lipid abnormalities among newly detected type-2 diabetes mellitus in a tertiary care hospital in Karnataka, India

Background: Diabetes mellitus is a common and a chronic disease with chronic complications and constitutes a substantial burden for both patient and health care system. Insulin resistance and type 2 diabetes are associated with a clustering of interrelated plasma lipid and lipoprotein abnormalities, which include reduced HDL cholesterol, a predominance of small dense LDL particles, and elevated triglyceride levels. Aims and objectives were to study the pattern of lipid abnormalities in newly detected type-2 diabetic patients. Methods: A cross sectional study was conducted at Vijayanagara Institute of Medical Sciences Hospital and College, Bellary from May 2014 to November 2014. A total of 300 newly detected diabetic patients were included in the study. Blood Examination was done to estimate low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides (TG). Results: Out of 300 patients, lipid abnormality was seen in 200/300 (66.67%) of the patients. Increased LDL noted in 152 (50.67%), triglycerides in 112 (40.67%), decreased HDL in 130 (43.34%) of patients. Conclusions: It is clearly evident that dyslipidaemia is very common association of type 2 diabetes mellitus, and culprit of majority diabetic related cardiovascular mortality.

Genotyping of community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) in a tertiary care centre in Mysore, South India: ST2371-SCCmec IV emerges as the major clone

The burden of community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) is on the rise in population and clinical settings on account of the adaptability and virulence traits of this pathogen. We characterized 45 non-duplicate CA-MRSA strains implicated mainly in skin and soft tissue infections (SSTIs) in a tertiary care hospital in Mysore, South India. All the isolates were genotyped by staphylococcal cassette chromosome mec (SCCmec) typing, staphylococcal protein A (spa) typing, accessory gene regulator (agr) typing, and multi-locus sequence typing (MLST). Four sequence types (STs) belonging to three major clonal complexes (CCs) were identified among the isolates: CC22 (ST2371 and ST22), CC1 (ST772) and CC8 (ST8). The majority (53.3%) of the isolates was of the genotype ST2371-t852-SCCmec IV [sequence type-spa type-SCCmec type], followed by ST22-t852-SCCmec IV (22.2%), ST772-t657-SCCmec V (13.3%) and ST8-t008-SCCmec IV (11.1%). ST237I, a single locus variant of ST22 (EMRSA-15 clone), has not been reported previously from any of the Asian countries. Our study also documents for the first time, the appearance of ST8-SCCmec IV (USA300) strains in India. Representative strains of the STs were further analyzed by pulsed field gel electrophoresis (PFGE). agr typing detected type I or II alleles in the majority of the isolates. All the isolates were positive for the leukotoxin gene, pvl (Panton–Valentine leukocidin) and the staphylococcal enterotoxin gene cluster, egc. Interestingly, multidrug resistance (resistance to ⩾3 classes of non-beta-lactam antibiotics) was observed in 77.8% (n=35) of the isolates. The highest (75.5%) resistance was recorded for ciprofloxacin, followed by erythromycin (53.3%), and quinupristin–dalfopristin (51.1%). Inducible clindamycin-resistance was identified in 37.7% of the isolates and it was attributed to the presence of erm(A), erm(C) and a combination of erm(A) and erm(C) genes. Isolates which showed a phenotypic pattern of MR/LS (macrolide-resistance/lincosamide-sensitivity) harbored the msr(A) gene. In conclusion, we report a high rate of multidrug resistance among Indian strains of CA-MRSA and the emergence of the lineages ST2371 and ST8 in India.

Assessment of Medication Adherence in Rheumatoid Arthritis Patients in a Tertiary Care Hospital.

To assess the medication adherence rates and quality of life in Rheumatoid Arthritis (RA) patients. RA patients admitted in the general medicine ward of a tertiary care hospital in Karnataka, India, during August to December 2013 were enrolled in the study. Demographic data of these patients was collected from patients’ medical records, outpatient data and by interviews. Patients (age≥18 years) with RA, irrespective of sex, fulfilling the 2010 ACR/EULAR Classification Criteria, were enrolled in the study. Patient’s assessment of adherence to medication was analyzed by using Medication Adherence Report Scale (MARS) and physical function using the Kannada version of the Stanford Improved Health Assessment Questionnaire (KA-HAQ) was collected. The mean age of 72 RA patients was 46.90 ± 12.88 years and disease durations was 4.27 ± 5.53 years. 86% of the patients were females. Among patients, 15 (21.43%) received methotrexate alone and 28 (40%) received a combination therapy of methotrexate and hydroxychloroquine. The mean KA-HAQ score of RA patients measured by KA-HAQ was 2.70 ± 1.01. Scores on MARS ranged from 26 to 41 with a mean score of 38.65 ± 3.5. The Cronbach's alpha for the MARS was 0.6 and KA-HAQ was 0.92.Using the mean cut-point 44% of 68 patients who completed the MARS were adherent and remaining 64% were not adherent. In our study we found that 64% of the patients were not adherent to the medications which lead to decreased quality of life RA patients. Adherence to the medications is the optimal management for RA.

A study of viral hepatitis e infection in a tertiary care hospital in mysore, South India.

Background. In this study, we aimed to explore the clinical and epidemiological profile of all patients with hepatitis E virus (HEV) who were admitted to a tertiary care hospital in Mysore, India and to further assess various factors that influence the prognosis of these patients.Methods. Two hundred ninety patients with HEV infection were included in the study and interviewed. They were subjected to clinical examination and laboratory investigations, including complete hemogram, renal, and liver function tests. Viral markers for HBV, HAV, HCV, and HEV by hepatitis B surface antigen, anti-HAV, anti-HCV, and anti-HEV antibodies, respectively, were done using the enzyme-linked immunosorbent assay method. Final outcome was recorded in the form of discharge or death.Results. Males had higher (82.8%) incidence of HEV infection. Yellowish discoloration of urine was the most common symptom, and icterus was the most common sign at presentation. Hepatomegaly was most common finding on abdominal examination. Mean duration of hospital stay was higher among diabetics (10 days vs 7.11 ± 3.52 days). Overall, mortality observed was 3.45%. A higher mean age (P = .000) and duration of hospital stay (P = .000) were associated with higher mortality. Mortality was significantly higher among patients with alcohol abuse (25% vs 0%) (P = .004). Higher mean prothrombin time-international normalised ratio (PT-INR) (1.6 ± 0.13 vs 1.21 ± 0.32), total bilirubin (20.3 ± 5.08 vs 11.33 ± 7.26 mg/dL), and direct bilirubin (15.05 ± 3.64 vs 6.35 ± 3.71 mg/dL) were associated with higher mortality, whereas lower mean serum albumin (2.6 ± 0.11 vs 3.41 ± 0.40 gm/dL) was associated with higher mortality. Increase in renal parameters (ie, urea [97 ± 33.48 vs 32.43 ± 18.41 mg/dL] and creatinine [2.9 ± 1.38 vs 1.12 ± 0.64 mg/dL]) and electrolyte imbalances (ie, hyperkalemia [5.95 ± 1.21 vs 4.29 ± 0.51 mmol/L] and hyponatremia [123 ± 3.56 vs 136.04 ± 2.97 mmol/L]) were associated with higher mortality. There were 20-fold increases in mean serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT) values (SGPT: SGOT = 1.148) and a 1-fold increase in mean alkaline phosphatase.Conclusions. Higher mean age, duration of hospital stay, PT-INR, total bilirubin, direct bilirubin, blood urea, serum creatinine, potassium values, alcohol abuse, presence of ascites, and fulminant hepatitis were associated with higher mortality, whereas lower mean serum albumin and sodium values were associated with higher mortality. Diabetics had a higher mean duration of hospital stay.

Chest physiotherapy techniques in neurological intensive care units of India: A survey.

Context:Neurological intensive care units (ICUs) are a rapidly developing sub-specialty of neurosciences. Chest physiotherapy techniques are of great value in neurological ICUs in preventing, halting, or reversing the impairments caused due to neurological disorder and ICU stay. However, chest physiotherapy techniques should be modified to a greater extent in the neurological ICU as compared with general ICUs.Aim:The aim of this study is to obtain data on current chest physiotherapy practices in neurological ICUs of India.Settings and Design:A tertiary care hospital in Karnataka, India, and cross-sectional survey.Subjects and Methods:A questionnaire was formulated and content validated to assess the current chest physiotherapy practices in neurological ICUs of India. The questionnaire was constructed online and a link was distributed via E-mail to 185 physiotherapists working in neurological ICUs across India.Statistical Analysis Used:Descriptive statistics.Results:The response rate was 44.3% (n = 82); 31% of the physiotherapists were specialized in cardiorespiratory physiotherapy and 30% were specialized in neurological physiotherapy. Clapping, vibration, postural drainage, aerosol therapy, humidification, and suctioning were used commonly used airway clearance (AC) techniques by the majority of physiotherapists. However, devices for AC techniques such as Flutter, Acapella, and standard positive expiratory pressure devices were used less frequently for AC. Techniques such as autogenic drainage and active cycle of breathing technique are also frequently used when appropriate for the patients. Lung expansion therapy techniques such as breathing exercises, incentive spirometry exercises, and positioning, proprioceptive neuromuscular facilitation of breathing are used by majority of physiotherapists.Conclusions:Physiotherapists in this study were using conventional chest physiotherapy techniques more frequently in comparison to the devices available for AC.

English

OBJECTIVE: To compare the techniques of single layer closure and conventional layered closure of laparotomy wounds on the basis of operative time and post-operative complications. METHODS: Prospective randomized study of 100 patients who underwent laparotomy in a tertiary care hospital in Karnataka, for abdominal surgical problems needing either emergency or elective surgery. Out of these 100 patients, 50 patients underwent laparotomy wound closure by single layer closure technique and the rest 50 patients by conventional layered closure technique. Time taken for closure of laparotomy wound was noted and patients were followed up post-operatively for any wound complications like seroma, wound infection, wound gaping, burst abdomen and incisional hernia. RESULTS: The mean time taken for closure of laparotomy wounds by single layer closure technique was 19 minutes and by conventional layered closure technique was 27 minutes. There was a difference of 8 minutes which was statistically significant (p=0.001). In the postoperative period, in patients who underwent single layer closure, totally 9 patients (18%) had post operative complications. In that 3 patients (6%) had seroma, 3 patients (6%) had wound infection, 2 patients (4%) had wound gaping, 1 patient (2%) had burst abdomen and none had incisional hernia. In patients who underwent conventional layered closure, totally 15 patients (30%) had post operative complications. In that 5 patients (10%) had seroma, 4 patients (8%) had wound infection, 3 patients (6%) had wound gaping, 2 patients (4%) had burst abdomen and 1 patient (2%) had incisional hernia. CONCLUSION: Laparotomy wound closure with single layer closure technique is better than the conventional layered closure technique in terms of decreased operative time and also decreased postoperative complications.

Evaluation of trends in the profile of gynaecologic malignancies at a tertiary care hospital in Karnataka, South India

Objective: Comprehensive estimates of the incidence of gynecological malignancies reported from India are very limited due to limitation in record maintenance. Auditing of the results on the incidence rates provided by the Population Based Cancer Registries has shown variation in the patterns of gynecologic malignancies. The present study was undertaken to establish the profile of gynecologic malignancies reported in our centre, with reference to incidence, histological subtypes and frequency of involvement at various sites. Another objective was also to compare the procured data with those from other national and international centers. Materials and Methods: In this descriptive study, the records pertaining to all the pathological specimens categorized as ovarian, uterine corpus and uterine cervical cancers from January 2003 to December 2012 at our tertiary center were studied and compared with the available international data. Results: Cervical malignancies were the commonest at our center, as compared to the uterine malignancies, which were commoner as per the data available from Surveillance Epidemiology and End Result (SEER) programme of the United States and the European Union.

Emergency Peripartum Hysterectomy: A Retrospective Study at a Tertiary Care Hospital in Karnataka

Objectives: The main objectives of this study were to determine the incidence, maternal characteristics, indications, the maternal and perinatal outcomes at J.J.M. Medical College, Teaching Hospital, Davangere, Karnataka, India Materials and method: This is a retrospective descriptive study done in the maternity unit of the J.J.M. Medical College Teaching Hospital, Davangere, Karnataka, India. From June 2009 to June 2011. Results: The incidence of peripartum hysterectomy during the study period was 1.0/1000 deliveries. The main indication was uterine atony 15(60%) ,severe uterine bleeding from uterine rupture 8 (32%), placenta accreta 2 (8%) and all patients received blood transfusion. 62.5% of women belonged to the 26-30 year age group and 31% belonged to the 20-25 year age group. There were 4 mortalities (8%) one patient died on 4th post-op day due to acute renal failure and the other died 2 hours after surgery due to cardiac arrest.2 died secondary to DIC. Average hospital stay of the patients was 9 days. Perinatal loss occurred in 14 cases (56%), majority due to pulmonary haemorrhage and prematurity. Conclusions: The incidence of emergency peripartum hysterectomy is high. It is performed for young nulliparous women to elderly grand-multiparous women. The surgery is associated with significant maternal and perinatal morbidity and mortality. Timely expert management in a well resourced centre is advocated.

An evaluation of two health insurance schemes in India

The study aimed to find out the functioning of two community-based health insurance schemes through patients enrolled in them, at a tertiary care hospital in Karnataka, South India. Methodology: It was a cross sectional study, total of 384 patients was randomly selected from the whole lot of patients who were enrolled in the two selected community-based health insurance schemes. The study was carried out using a pretested semi structured questionnaire. About. 98% of the respondents said that they availed services 1–3 times from the scheme in 1 year; 89% of the respondents said that discount provided by the scheme was useful. Satisfaction levels of the card users were analyzed and out of 384 patients, 54.9% patients said that their scheme was good and 51.8 felt that admission and claim process was good. About 49.2% said that quality of treatment was good. It can be concluded that many users are satisfied with the health insurance they have opted and utilisation rate of the card is high.

A profile of dengue cases admitted to a tertiary care hospital in Karnataka, southern India

During the past two decades, epidemics of dengue fever have been causing concern in several South-East Asian countries, including India. A study was conducted in a tertiary care hospital situated in Southern India to determine the trends and outcome of dengue cases. There was a steady rise in number of cases from 2002 to 2007, with the largest number of cases seen in 2007. Most cases were observed in the post-monsoon season in the month of September. Out of a total of 344 cases, 285 (82.8%) patients had dengue fever, 34 (9.8%) had dengue haemorrhagic fever and 25 (7.3%) had dengue shock syndrome. Deaths were reported in nine cases, with the majority of deaths occurring in 2003. The disease control programme should emphasise on vector surveillance, integrated vector control, emergency response, early clinical diagnosis and appropriate management of the cases.

Pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka, India

Background and Objective:Acute poisoning is a medical emergency. It is important to know the nature, severity and outcome of acute poisoning cases in order to take up appropriate planning, prevention and management techniques. This study aimed to assess the pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka.Materials and Methods:This is a retrospective hospital record-based study conducted in a tertiary care hospital attached to a medical institution in Karnataka. The study included 136 cases and data regarding age, sex, time elapsed after intake; circumstances of poisoning, name of the poisonous substance, chemical type, duration of hospitalization, severity and outcome were collected in the prestructured proforma.Results:Incidence was more common among males (75.4%) compared to females (24.3). Most cases of acute poisoning presented among 20- to 29-year age group (31.2%) followed by 12- to 19-year age group (30.2%). A majority of poisoning cases (36.0%) were due to organophosphorus compound (OPC). Total mortality was found to be 15.4%. Mortality rate due to corrosives was significantly high compared with OPC poisoning (χ2 = 4.12, P = 0.04). Of the 56 patients of OPC and carbamate poisoning, 13 patients (23.2%) had respiratory arrest and required respiratory support. Time lapse had a significant role on the mortality in cases of acute poisoning (χ2 = 10.9, P = 0.01).Conclusion:Poisoning is more common in young males. The overall mortality is substantially high, mainly contributed by self-poisoning with insecticides and corrosives. Early care in a tertiary care center may help to reduce mortality in India.