Tertiary Care Hospital In Kashmir Research Articles

Microbiological and quantitative analysis of burn wounds in the burn unit at a tertiary care hospital in Kashmir

Background: The burn wound represents a susceptible site for opportunistic colonization by organisms of endogenous and exogenous origin. The present study was undertaken to analyze the microflora of burn wounds of the burn patients from a tertiary care hospital in Kashmir, India. Materials sand Methods: The study included all patients with acute burns admitted from January 2010 to December 2011 (2 years). The standard techniques, as practiced during collection of microbiological specimens, were used during wound swab/biopsy collection. Results: 74.19% of swab cultures yielded single isolates. On swab culture, Pseudomonas aeruginosa was the commonly isolated organism (46.86%). Staphylococcus aureus was the most common isolate isolated during 1st postburn week (30.86%). 258/288 (89.58%) blood cultures were sterile. 8/58 (13.79%) blood cultures were positive during the second postburn week. S. aureus was the most common organism grown on blood culture (44.44%). P. aeruginosa was mostly sensitive to polymyxin B (86.0%), amikacin (40.0%), and ciprofloxacin (37.3%), respectively. S. aureus was most commonly sensitive to linezolid (85.0%) and vancomycin (78.8%%) whereas Acinetobacter spp. was sensitive to polymyxin B (65.3%), piperacillin/tazobactam (44.9%), and amikacin (38.8%). Patients (27.27%) who showed local signs of burn wound infection and positive blood culture were subjected to burn wound biopsy. 93.33% of patients who had counts >105 colony-forming unit/g of tissue showed significant association with local signs of burn wound infection and positive blood culture for any organism. Conclusion: The microbiological surveillance of burn wounds needs to be continued for a rational antibiotic policy and prevention of emergence of resistant organisms. Burn wound biopsy culture is an effective tool for quantitative analysis of burn wounds; however, subjecting this biopsy to histological examination is more predictable of burn wound infection and its correlation with burn wound sepsis.

Clinical profile of plasma cell leukemia at Tertiary Care Hospital in Kashmir, India

Introduction: Plasma cell dyscrasias represent 1.4–2% of all malignancies and among hematologic malignancies; it constitutes 10% of the tumors. Plasma cell dyscrasias are composed of multiple myeloma (MM), and primary and secondary plasma cell leukemia. Materials and Methods: Primary plasma cell leukemia (pPCL) is a rare and aggressive disease, representing 1–4% of plasma cell dyscrasias. Results: The prognosis of this is very poor with median survival of 8–11 months in different reported series. Discussion: We are reporting a study from our hospital over a period of 8 years and 9 months, in which pPCL was found in 1.8% of MM patients, with slight male predominance and earlier age than MM, and all had high disease burden with high lactate dehydrogenase (LDH), β2-microglobulin, and plasmacytosis. Conclusion: This disease had very aggressive behavior, especially with light chain lambda disease, and all patients succumbed within 8 months of treatment.

Prevalence of fecal carriage of extended-spectrum- and metallo-β-lactamase-producing gram-negative bacteria among neonates born in a hospital setting in central Saudi Arabia.

BACKGROUND AND OBJECTIVECommensal neonatal fecal flora constitute a reservoir of antibiotic resistance. The aim of this study was to characterize the prevalence of fecal carriage of extended spectrum beta-lactamases (ESBLs) and carbapenemase producing gram-negative bacteria among 150 neonates who were born in two hospitals in central Saudi Arabia.PATIENTS AND METHODSFrom June 2012 to Janauary 2013, 150 healthy neonates ≤7 days of age were screened for intestinal enteric bacteria colonization and the influence of age, mode of delivery, body weight and breast feeding of neonates on colonzation rates. The isolates were identified manually and by VITEK 2 and antibiotic susceptibility was tested. Phenotypic tests were performed to seek ESBL and metallo-β-lactamase (MBL) producers in recovered isolates.RESULTSAmong 150 fecal specimens, 188 gram-negative rods were recovered. E coli (n=130; 69.1%) was the commonest organism followed by Klebsiella pneumoniae (n=23; 12.2%), Pseudomonas aeuroginosa (n=14; 7.5%), Acinetobacter baumannii (n=9; 4.8%), Enterobacter spp. (n=9; 4.8%) and Morganella morganii (n=3; 1.6%). E coli colonization during the first day of life was 95.5% (n=43/45), which was relatively higher than in subsequent days. The colonization rate of E coli among low weight babies (≤3 kg) was significantly higher than fully grown neonates (≥4 kg)(P=.03). The prevalence of ESBL and MBL was 15.0% (n=28/188) and 1.6% (n=3/188). The prevalence rates of ESBL in E coli, K pneumoniae, E cloacae, M morganii and E aerogenes were 16.9% (n=22/130), 4.3 % (n=1/23), 60% (n=3/5), 33.3% (n=1/3), and 25% (n=1/4), respectively. All E cloacae with ESBLs and MBLs were resistant to all tested antibiotics including carbapenems.CONCLUSIONWithin the first week of life, the most important determinants of gut enteric bacteria composition in neonates were age in days, body weight, mode of delivery, and type of neonatal feeding. The findings of ESBLs- and MBLs-producing enteric bacteria as neonate-gut colonizers may have wider implication or linkage to prevention of nosocomial and community-acquired infections by these strains.

Sociodemographic profile and pattern of opioid abuse among patients presenting to a de-addiction centre in tertiary care Hospital of Kashmir.

Background:The substances abuse has become one of the major public health problems of present society. Recently there has been an increase in the incidence of substance abuse including that of opioids throughout the world. The proper assessment of the current trends and pattern of opioid abuse can be helpful in more effective intervention of this menace.Materials and Methods:To find out various socio-demographic variables and pattern of opioid abuse, a predevised questionnaire was administered to 200 opioid patients who presented to de-addiction center for treatment.Results:Majority of the participants (75%) were of young age group (20–30 years) and the mean age of subjects was 27.6 years. More than half of participants (55%) were abusing the opioid substances for < 3 years followed by 30% of the abusers who were using the opioids for 4–6 years. Oral route was the most common route(35%)of substance administration followed by chasing(13%) and intravenous(11%) routes. Diverted pharmaceuticals emerged as one of the common substances of abuse, and peer pressure was found to be the main reason to start substance abuse.Conclusion:A comprehensive preventive program targeting young adults needs to be formulated and strict laws against sales of diverted pharmaceuticals to be implemented.

Prevalence and spectrum of congenital heart diseases in children

Background: Congenital heart disease (CHD) is one of the major causes of mortality and morbidity in the pediatric population of both the developing and developed countries. Variability in incidence and prevalence of CHD from various countries of Indian subcontinent and rest of the world could be because of genetic, cultural, and environmental factors. Objective: To find the prevalence and pattern of CHD in a tertiary care hospital in Kashmir (J&K). Materials and Methods: A retrospective analysis of case-records data of 767,921 patients (0-18 years) over 3 years and 10 months period was conducted to ascertain the prevalence and spectrum of CHDs. Results: A total of 877 patients out of 767,921, were found having CHDs measuring a prevalence of 1.12/1000. About 777 (88.5%) were the acyanotics, and 100 (11.5%) were cyanotic heart patients. Among the acyanotic heart diseases ventricular septal defect was the most frequent lesion seen in 241 (31.2%), followed by patent ductus arteriosus in 184 (24.3%) children. Among the cyanotic heart diseases tetralogy of Fallot was the most frequent cyanotic heart disease seen in 48 (48.0%) patients. Conclusion: Prevalence of 1.12/1000 among the hospital attending patients could be an underestimation of the actual disease burden in our community, and heightened awareness among the treating physicians about the cardiac diseases could actually reduce the mortality and morbidity associated with these ailments.

Epidemiology of burn patients in a tertiary care hospital in Kashmir: A prospective study

Background: Burns are a common injury in developing countries creating a major public health problem and are associated with significant morbidity and mortality. Our aim was to study the epidemiology of various demographic characteristics, their outcome and prevention. Materials and Methods: All acute burn cases admitted to the burn unit of Sheri-Kashmir Institute of Medical Sciences, ( tertiary care referral centre in Kashmir, India) over a period of 2 years (2010-2011) were investigated. The registration data regarding various demographic characteristics, mode of burn injury, time of presentation after burn and associated risk factors and illness. Assessment of burn wound was done regarding site, affected body surface area, degree, depth, severity of injury and complications. Data were collected and analyzed statistically. Results: Patient's ages ranged from 1 to 65 years with a mean age of 24.2 ± 7.6 years. The most common class of the population burnt were school going children (32.70%) followed by housewives (19.10%). Eighty percentage of patients belonged to rural areas and 20% to urban areas. Flame burns were more common in females (52.1%), electric burns were more common in males (93.3%) and scalds were more common in children (64.3%). Most of the burns were accidental (96.4%). 64.5% of patients reported within 24 h to hospital. 56.3% of patients had mixed degrees of burns, and 22.7% had third degrees of burns. Mortality was 11.8% and most common causative agent responsible was flame. The outcome was significantly associated with mode of injury, degree, depth, extent, causative agent and gender. Conclusions: This study provides important aspects of burn injuries for medical and nonmedical healthcare workers. The majority of burns are accidental seen in school going children, housewives and linemen of Power Development Department as a result of scalds, flame and electric burns respectively. Measures should be taken regarding awareness and education programs about burn prevention to reduce morbidity and mortality associated with it.

External tube drainage or omentoplasty in the management of residual hepatic hydatid cyst cavity: a prospective randomized controlled study.

Background: Surgical procedures advocated for management of residual hepatic hydatid cyst cavity have been a subject of controversy. The aim of this study was to compare omentoplasty (OP) and external tube drainage (ETD).Material and methods: This was a prospective randomized controlled study conducted on radiologically documented cases of hepatic hydatidosis (n=50) in a tertiary care hospital of Kashmir. Patients were divided into two groups; in one group ETD was performed and in another OP was done.Results: Twenty-eight patients were offered ETD and 22 OP. There was no statistically significant difference in mean operative time. The overall complication rate was higher in ETD (42.86%) as compared to OP (22.73%). In ETD group two patients had bile leak and infection of residual cavity each; whereas no such complication was seen in OP. The mean pain scores were elevated in ETD (p<0.0016).The mean hospital stay was more in ETD as compared to OP (p<0.0031). Also time for resumption of activities of daily life was more in ETD (p<0.0026). The recurrence of disease was seen in three patients in ETD as compared to none in OP. Conclusion: Omentoplasty offers a number of advantages over external tube drainage and should remain the preferred option whenever possible.

Barium Enema in the Diagnosis of Hirschsprung's Disease: A Comparison with Rectal Biopsy

Aim: The aim of the present study was to compare the diagnostic accuracy of a barium enema in Hirschsprung’s disease with respect to a rectal biopsy. Materials And Methods: This study was conducted on 60 consecutive patients of clinically suspected cases of Hirschsprung’s disease admitted to a tertiary care hospital in Kashmir over a period of three and a half years. All the patients were subjected to a barium enema and a full-thickness rectal biopsy. Results: The mean age was 3.5 + 0.5 years. A rectal biopsy revealed absence of ganglion cells in 36 (60%) patients, absence of ganglion cells with nerve hypertrophy in 4 (6.66%) patients and ruled out Hirschsprung’s disease in 20 (33.33%) patients. A barium enema was compatible with Hirschsprung’s disease in 20 (33.33%), suggestive in 14 (23.33%) and unremarkable in 26 (43.33%) patients. A barium enema had a diagnostic accuracy of 76.67% with a positive predictive value of 88.23%, a negative predictive value of 61.53%, specificity of 80% and a sensitivity of 75%, and a rectal biopsy had a diagnostic accuracy of 100% (P value < 0.0001). Conclusion: Barium enema is a valuable diagnostic tool for the diagnosis of patients with Hirschsprung’s disease. We recommend a barium enema as a routine initial workup in the management of patients of suspected Hirschsprung’s disease.

Prevalence, pattern, sensitivity and resistance to antibiotics of different bacteria isolated from port site infection in low risk patients after elective laparoscopic cholecystectomy for symptomatic cholelithiasis at tertiary care hospital of Kashmir.

The aim of this study was to determine specific pattern of port site microbial colonisation, sensitivity and resistance to different antibiotics of bacteria isolated from port site infection (PSI) in low risk patients after elective laparoscopic cholecystectomy in surgical wards at tertiary care hospital of Kashmir. This is a prospective study. The study included 675 consecutive patients of postoperative PSI after elective laparoscopic cholecystectomy for symptomatic cholelithiasis over a period of 12 months. Culture swabs were taken from port sites with signs of PSI and transported to the microbiology laboratory. The positive swab cultures were subjected to antibiotic susceptibility test. The data obtained was analysed by using appropriate statistical analytical tests. The incidence of PSI after elective laparoscopic cholecystectomy is 6·7%. The commonest organism responsible for PSI is pseudomonas, 19 (42·2%) cases. Most of the strains of organisms isolated were resistant to commonly used antibiotics in the hospital,pseudomonas was found 100% resistant to the combination of ampicillin + sulbactum and ceftriaxone and it was sensitive to imipenem, amikacin and vancomycin in 89·47,57 and 52·63% of cases respectively. Our study will be helpful in choosing effective empirical prophylactic antibiotic therapy in cases of elective laparoscopic cholecystectomy and will have a great impact on morbidity and mortality in them because of PSI.

Annual Radiation Exposure to Workers in a Tertiary Care Hospital in Kashmir : A 10-Year Analysis and Comparison with National Levels of exposure

Objective: To assess the radiation exposure amongst radiation workers in Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, a tertiary care 620 bedded superspeciality hospital was carried out.&#x0D; Material and Methods: A 10-year retrospective analysis of the whole body radiation exposure to the radiation workers of SKIMS Srinagar, Two blocks of five years each from 1995 to 1999 &amp; 2002 to 2007 were studied and compared with the national pool of radiation workers for the same period. The average annual dose of radiation workers working in different radiation departments of SKIMS was compared with the workers of the similar department of the national pool.&#x0D; Results &amp; Conclusion: It was observed that in the block of 5 years from 1995 to 1999 the average whole body dose to the radiation works at SKIMS during the latter half showed a rising trend for three years as compared to the national pool. However in the block 2002 to 2005 the average annual dose was mostly similar except for a higher dose to SKIMS workers in 2005. It was observed that the average annual dose received by the workers of Nuclear Medicine department of SKIMS was usually high more so in the five year block of 2000 to 2005.The workers of Radiodiagnosis at SKIMS also received a higher annual dose in 7 of the 10 years of study. J Med Sci 2009;12(2):41-45