Tertiary Care Hospital In Kolkata Research Articles

β-lactamase and Plasmid-mediated Quinolone Resistance Determinants Among Proteus spp. Isolates at a Tertiary-care Hospital in Kolkata, India

Background: Emerging antibiotic resistance (ABR) in Proteus spp., especially to third-generation cephalosporins (3GCc), carbapenems, and fluoroquinolones, challenges the treatment outcome and infection prevention. Limited studies pose a knowledge gap between them and ABR. Methods: We investigated the in vitro efficacy of therapeutic options and prevalence of β-lac-tamase and plasmid-mediated quinolone resistance (PMQR) traits in 3GC- and/or fluoroquino-lone-nonsusceptible Proteus (P.) spp. (n=27) in Kolkata, India, during 2021–2022. P. mirabilis was commonly isolated (>80%) from superficial and urine samples. The majority of the isolates (48-78%) remained susceptible to piperacillin-tazobactam, meropenem, amikacin, cefoperazone-sulbactam, and cefepime. Results: All isolates showed >0.2 multiple-antibiotic resistance index, with >65% being multi-drug and >30% being extensively drug-resistant. blaTEM (n=9), blaNDM (n=9), and qnrA (n=6) were commonly noted with the co-production of β-lactamases and PMQR in ten (37%) isolates. More than 50% of the isolates were devoid of the tested acquired genes. Conclusion: The study concludes that superbugs dominate, with limited occurrence of plasmid-borne markers in this geographic location.

Prominent early adulthood hyperferritinemia in scrub typhus

Background: Scrub typhus is an acute infectious disease, caused by Orientia tsutsugamushi. It is endemic to a geographically distinct region of Japan, Taiwan, China, and South Korea, known as the tsutsugamushi triangle, as well as in Nepal, Pakistan, and Papua New Guinea. In India, the incidence of this disease varies from 4-46% with high morbidity and mortality. Methods: In this cross-sectional study at a tertiary care hospital in Kolkata, India we analysed ferritin blood levels along with different demographic and laboratory test parameters of 60 suspected scrub typhus patients who were also scrub typhus IgM antibody positive during a one-year study period. Results: It was found that serum ferritin levels were unusually high in 21-40 years age group patients along with mildly increased urea and creatinine levels. Other important findings were below 40 years of age males were mostly affected, but above 40 years of age, females were generally affected. Haemoglobin and platelet levels were normal in all age groups. Although WBC count and neutrophils were normal in the 21-40 years age group, in other age groups increased levels were observed. CRP, SGPT, and SGOT levels were uniformly high above 20 years of age. Electrolytes were mildly decreased. Conclusions: It appears that oxidative stress-induced acute kidney injury may be an important reason for the rising ferritin levels in the 21-40 years age group. These important findings may be helpful to clinicians in management of these patients.

A comparative study of clinical symptoms, demographic characteristics and laboratory parameters among primary and secondary dengue cases in a tertiary care hospital in Kolkata

A comparative study of clinical symptoms, demographic characteristics and laboratory parameters among primary and secondary dengue cases in a tertiary care hospital in Kolkata

IJCM_304A: A Study on Stigma-Discrimination and Sense of Grip on Disease Experienced by the PLHIV Visiting ART Centre of a Tertiary Care Hospital of Kolkata

Background: People Living with HIV face not just a health challenge but also the burden of stigma-discrimination. The impact isn’t just physical; it takes a toll on their mental health. Many internalize this stigma, feeling shame about their condition. It Is crucial to address these issues not only for those directly affected but also to build a society that is compassionate and understanding, supporting individuals with HIV/AIDS rather than marginalizing them. Objective: To determine the level of stigma-discrimination faced by PLHIV visiting the ART center of a tertiary care hospital of Kolkata including the factors associated with it. The second objective is to explore their sense of grip on the disease among them. Methodology: This descriptive method study was conducted in November 2023 among 120 PLHIV (Selected by systematic random sampling) visiting the ART center of the School of Tropical Medicine, Kolkata after getting permission from IEC & NACO. Qualitative data was collected via IDI & KII. Quantitative data were analyzed using MS Excel, SPSS v. 16, employing descriptive and inferential statistics. Manual thematic analysis applied for qualitative data. Results: Among 120 participants 45.8% of the participants faced more stigma & discrimination in comparison to others. There was a statistically significant difference in the level of stigma & discrimination based on their age group (p-value 0.033), type of family (p-value 0.014), Addiction status (p-value 0.037), co-morbidities (p-value 0.011), viral load (p-value 0.033). On exploring sense of grip on disease majority of the participants were shown to have a compliant profile. Conclusion: The levels of stigma- discrimination were associated with their behavioral & disease characteristics. Thus, raising awareness is essential to combat stigma and enhance sense of grip on the disease.

IJCM_210A: Assessment of Outdoor Patients Waiting Time and Consultation Time in a Tertiary Care Hospital of Kolkata

Background: Waiting and consultation times affect patient satisfaction and the managerial capacity of the health system. Whereas waiting time is mainly attributed to organizational processes, consultation time is characterized by health demands, concerns, and protocols followed by service providers, which vary between individuals. Therefore, periodic evaluation of the entire process is necessary to achieve continuing health service improvement. Objectives: 1. To measure the waiting time and consultation time for each participant 2. To find out the variation of waiting and consultation time according to the departments visited. Methodology: A descriptive, cross-sectional study was carried out at a tertiary care medical college hospital in Kolkata, between May-June 2023. A systematic sampling design was followed. Data collection was conducted for two weeks for the entire OPD duration (9 AM-3 PM). Waiting Time was defined as the time taken from registration to chamber entry. Consultation Time was defined for the study as the time taken from chamber entry to exit. Timing record was maintained by giving a time-indicated note to the patient at the time of registration. Exit interviews were conducted after completing consultations. Results: Total number of participants was 432, with 74.8% female and mean age of 28.7 years. There were 22% participants who had 10 or more years of schooling and 80.1% resided in rural areas. Mean waiting time was 98.6 minutes (SD 45.4) and the consultation time was 6.5 (SD 13.7) minutes. Waiting time was maximum for general medicine OPD (mean-122 min) and minimum for pediatric medicine OPD (mean 43 min), while consultation time was maximum for surgery OPD (mean 6.8 min). Conclusion: The study shows an imbalance between waiting time and consultation time. Walk-in patients for minor illnesses and unnecessary referrals should be reduced to prevent overcrowding of tertiary institutes and compromising quality of care.

Out-of-pocket Expenditure and its Impact on the Quality of Life among Patients Attending the Anti-retroviral Therapy Centre of a Tertiary Care Hospital in Kolkata

Introduction: Out-of-pocket expenditure (OOPE) has a negative impact on Quality of life (QoL) of People Living with HIV (PLHIV)which can increase the risk of slipping into poverty. Objectives: Primary Objective of this study was to estimate the burden of OOPE in seeking health care among HIV patients attending the Anti-retroviral therapy (ART) centre of a tertiary care hospital; and secondary objectives were to assess their QoL, to identify the association of socio-demographic characteristics with the OOPE & QoL and to find out the correlation between OOPE and QoL. Method: A cross-sectional study was conducted among 232 patients attending ART centre of a tertiary care hospital in Kolkata using a pre-designed, pre-tested, structured schedule. Multivariable binary logistic regression was done to identify the association of their socio-demographic characteristics and clinical profile with the OOPE and QoL. Results: About 41.4% of the study population rated their QoL as neither poor nor good, 18.9% as ‘good’. All the participants reported OOPE; 20.7% in the form of direct health expenditure. Participants belonging to the age group 18-39 years, residing in a joint family, had family member infected with HIV and had associated co-morbidity were statistically significant covariates of direct health expenditure; whereas participants belonging to the age group ≥40 years, living in a joint family, involved in an unskilled occupation, and belonging to middle and lower middle were statistically significant covariates of poor QoL. Conclusion: OOPE was experienced by all participants. As per the study findings Qol was neither poor nor good among participants. With increase in OOPE, the QoL worsened.

A hospital-based cross-sectional study on parental self‑medication among children in a tertiary care hospital in Kolkata

Introduction: Self-medication/self-prescription, the practice of using measures to treat and handle diseases, without consulting appropriate authority, has been significantly inculcated in modern society. Parental self-medication is today a significant paediatric public health problem contributing to global rise of antimicrobial resistance.Objectives: To assess the magnitude and determinants of parental self-medication among children attending a tertiary care hospital in Kolkata. Method: This cross-sectional study was conducted on parents of 105 children attending the paediatric clinic of a tertiary care hospital in Kolkata. Universal sampling was employed. Parents were surveyed by face-to-face interview using a pre-tested semi-structured interview schedule validated by subject experts. Information on pattern, reasons, and perception of parental self-medication were elicited from the schedule. Microsoft Excel and STATA MP16 were used for statistical analysis. Results: Mean ages of the parents and their children were 31.79±5.6 years, and 5.3±2.9 years respectively. Prevalence of parental self-medication was 78.1% (95% CI: 69-85%). Analgesic-antipyretics were the most common type of medicine used during self-medication (77.1%), whereas prior experience in dealing with similar illness was the most common reason (42%) for practising self-medication. Higher educational levelof respondent parent and increased age of child (>3 years) were significantly associated with the practice of self-medication in bivariate analysis.Conclusions: Prevalence of parental self-medication was 78.1%. Analgesic-antipyretics were used during self-medication in 77.1% cases. Prior experience in dealing with similar illness was the reason for practising self-medication in 42% cases. Higher educational level of the respondent parent and increased age of child (>3 years) were significantly associated with the practice of self-medication.

Whole genome sequence-based molecular characterization of blood isolates of carbapenem-resistant Enterobacter cloacae complex from ICU patients in Kolkata, India, during 2017-2022: emergence of phylogenetically heterogeneous Enterobacter hormaechei subsp. xiangfangensis.

Blood-borne infections caused by the carbapenem-resistant Enterobacter cloacae complex (CR-ECC) are major public threats with respect to the challenges encountered during treatment. This study describes the whole genome sequencing-based molecular characteristics of blood isolates (n = 70) of CR-ECC from patients admitted to the intensive care unit of tertiary care hospitals in Kolkata, India, during 2017-2022 with respect to species identification, antimicrobial resistance (AMR) profiling, mechanism of drug resistance, and molecular subtypes. Vitek2 MALDI and species-specific PCR identified Enterobacter hormaechei subsp. xiangfangensis (47.14%) as the emerging CR-ECC subspecies in Kolkata. The predominating carbapenemase and extended-spectrum β-lactamase genes found were blaNDM-1 (51.42%) and blaCTX-M-15 (27%), respectively. Besides, blaNDM-4, blaNDM-5, blaNDM-7, blaCMH-3, blaSFO-1, blaOXA-181, blaOXA-232, blaKPC-3, and blaDHA-7 genes were also detected, which were not previously reported from India. A multitude of Class 1 integrons (including In180, In4874, In4887, and In4888, which were novel) and plasmid replicon types (IncFIB, IncFII, IncX3, IncHI1-HI2, IncC, and IncR) involved in AMR dissemination were identified. Reverse transcription-PCR and western blot revealed that carbapenem resistance in non-carbapenemase-producing CR-ECC isolates was contributed by elevated levels of ampC, overexpression of acrAB, and loss of ompF. A total of 30 distinct sequence types (STs) were ascertained by multi-locus sequence typing; of which, ST2011, ST2018, ST2055, ST2721, and ST2722 were novel STs. Pulsed-field gel electrophoresis analysis showed heterogeneity (69 pulsotypes with a similarity coefficient of 48.40%) among the circulating isolates, suggesting multiple reservoirs of infections in humans. Phylogenetically and genetically diverse CR-ECC with multiple AMR mechanisms mandates close monitoring of nosocomial infections caused by these isolates to forestall the transmission and dissemination of AMR.IMPORTANCEThe emergence and extensive dissemination of the carbapenem-resistant Enterobacter cloacae complex (CR-ECC) have positioned it as a critical nosocomial global pathogen. The dearth of a comprehensive molecular study pertaining to CR-ECC necessitated this study, which is the first of its kind from India. Characterization of blood isolates of CR-ECC over the last 6 years revealed Enterobacter hormaechei subsp. xiangfangensis as the most prevalent subsp., exhibiting resistance to almost all antibiotics currently in use and harboring diverse transmissible carbapenemase genes. Besides the predominating blaNDM-1 and blaCTX-M-15, we document diverse carbapenemase and AmpC genes, such as blaNDM-4, blaNDM-7, blaOXA-181, blaOXA-232, blaKPC-3, blaCMH-3, blaSFO-1, and blaDHA-7, in CR-ECC, which were not previously reported from India. Furthermore, novel integrons and sequence types were identified. Our findings emphasize the need for strengthened vigilance for molecular epidemiological surveillance of CR-ECC due to the presence of epidemic clones with a phylogenetically diverse and wide array of antimicrobial resistance genes in vulnerable populations.

A Cross-sectional Study on Awareness and Utilisation of Government Health Insurance Schemes among Patients at a Tertiary Level Hospital in Kolkata, India

Introduction: Despite the presence of multiple Government Health Insurance (GHI) schemes in West Bengal, the National Family Health Survey report (NFHS-5) has indicated that only 29.3% of households are covered by a health scheme. Awareness of health insurance schemes increases their utilisation. The absence of health insurance coverage results in increased out-of-pocket health expenditures, pushing families into debt. Therefore, there is a need to determine whether this lack of awareness among patients contributes to the issue. Aim: To estimate the awareness level, enrollment in GHI schemes, experiences of their utilisation, and to determine the contributory factors of awareness and enrollment among patients attending the Outdoor Patient Departments (OPDs) at a tertiary care hospital in Kolkata. Materials and Methods: An observational cross-sectional study was conducted from April 2023 to June 2023 at Medical College, Kolkata, West Bengal, India. A total of 390 respondents were chosen using a systematic random sampling technique and were interviewed using a predesigned, pretested, and semistructured questionnaire. Data were analysed using R Studio version 4.3.0. A p-value <0.05 was considered statistically significant. Results: Awareness about Swasthya Sathi was found to be present in 318 (81.54%) patients, but only 109 (34.28%) of them were enrolled. Awareness of Sishu Saathi and Rashtriya Bal Swasthya Karyakram (RBSK) was 12 (3.08%) and 10 (2.57%), respectively, and none were enrolled. The major source of information (11.03%) regarding health insurance among respondents was informal sources such as friends, relatives, and neighbours. The age of the respondents, type of family, occupation, and economic status were found to have a significant association with the right awareness (p=0.008, 0.012, 0.0005, and 0.029, respectively). The patient satisfaction level after utilising Swasthya Sathi was found to have a significant positive correlation with the right awareness (Spearman’s ρ=0.322, p-value <0.01). The determinants of enrollment in Swasthya Sathi were female gender, rural residence, and right awareness (p<0.001). The commonest reason for not enrolling in any GHI among the non subscribers was a lack of awareness (82.56%). Conclusion: Correct awareness was found to be a determinant of enrollment in GHI. In order to bridge the gap between awareness and utilisation of GHI, there is a need to focus on Information, Education, and Communication (IEC) activities involving mass media and frontline health workers.

Knowledge, Attitude, and Practice of COVID-19 in Adolescents Attending Covid Vaccination Center in a Tertiary Care Hospital in Kolkata, India: A Cross-sectional Study

Introduction: This study aimed to assess the knowledge, attitudes, and practices related to coronavirus disease 2019 (COVID-19) among adolescents in India, recognizing the vital role this demographic plays in pandemic control. Materials and Methods: Conducted at the Medical College, Kolkata COVID-19 vaccination center from June to August 2022, this web-based prospective cross-sectional study included individuals aged 13–19 years. Data collection involved a structured questionnaire in multiple languages, ensuring broad accessibility. Ethical standards were upheld with online informed consent and rigorous data confidentiality measures. Results: The study revealed balanced gender representation among participants, with most enrolled in the 10th or 12th standard. Parents’ educational backgrounds varied, but a significant proportion had family members employed in the health-care sector (66.7%). Knowledge about COVID-19 in India was surprisingly limited: only 3.7% knew about oxygen saturation and its utility. 18.75% considered depression as a comorbidity of COVID-19. 73.8% of the participants relied on social media for information about COVID-19. A majority (66.25%) of the participants believed 2 doses of the vaccine would protect them from the disease. Twice as many women believed in the protection offered by vaccines. Conclusion: This research, distinct from conventional scoring-based studies, emphasized uncovering misconceptions and knowledge gaps. Importantly, many adolescents lacked awareness of the true COVID-19 situation in India, potentially undermining the pandemic gravity perception and preventive measures. Although participants showed awareness of common COVID-19 symptoms and preventive measures, knowledge about comorbidities’ influence on mortality rates was limited.

Role of HER2/neu in Colorectal Carcinoma: A Cross-sectional Study from a Tertiary Care Centre in West Bengal, India

Introduction: In many tumours, Human Epidermal Growth Factor Receptor 2 (HER2) expression and HER2 amplification are studied as therapeutic and prognostic factors. The incidence of HER2/neu expression and its consequences in patients with colorectal carcinoma has shown conflicting evidence. Aim: To evaluate the utility of HER2/neu expression in colorectal carcinoma and to find any association between HER2/neu expression, histological grade, and stage of the tumour. Materials and Methods: This cross-sectional study was conducted on 50 cases of colorectal carcinoma. Patients undergoing surgery for colorectal tumours were selected over an 18-month period (January 2020 to June 2021) in a tertiary care hospital in Kolkata, West Bengal, India. Various clinical and demographic parameters were obtained from the patients, and the specimens were subjected to Immunohistochemical (IHC) staining for HER2/neu. The results were analysed using Statistical Package for the Social Sciences (SPSS)software version 25.0 (IBM, Armonk, New York, USA). Results: On HER2/neu IHC examination, 30 cases (60%) showed a 3+ score, 4 cases (8%) showed a 2+ score, 7 cases (14%) showed a 1+ score, and the remaining 9 cases (18%) showed a score of 0. HER2/neu expression was found in 30 cases (60%) of colorectal carcinoma. HER2/neu expression showed a significant association with the histological grade of the tumour (p-value=0.020). HER2/neu expression also showed a significant association (p-value<0.001) with histological subtypes of the tumour. Conclusion: This study revealed a significant association between HER2/neu expression and histological subtypes and grade of the tumour. Moderately differentiated adenocarcinoma showed the highest expression, while mucinous adenocarcinoma and undifferentiated carcinoma showed minimal or absent HER2/ neu expression. Thus, HER2/neu can serve as a prognostic and therapeutic marker in colorectal carcinoma. In conclusion, surgery alone is not curative for patients with colorectal cancer, and additional forms of management may be required to improve patient survival. In such cases, HER2/neu expression can guide new adjuvant therapy.

A comparative analysis of serum phosphorus levels and mineral metabolic markers in non-dialysis and dialysis chronic kidney disease patient: a cross-sectional study

Background: Chronic kidney disease is a major public health problem worldwide. As kidney function declines, it leads to several metabolic abnormalities including dysregulation of mineral metabolism. It is also reported that hyperphosphatemia in patients with advanced kidney disease is associated with an increased risk of mortality and cardiovascular events, and is higher in dialysis-dependent chronic kidney disease (CKD) patients compared to non-dialysis CKD. However, data in the Indian context is limited. Objectives were to evaluate and compare serum phosphorus levels and associated factors in non-dialysis and dialysis CKD patients. Also, the impact of dietary phosphate restriction and the use of phosphate binders on serum phosphorus is analysed. Methods: A cross-sectional study was conducted at a tertiary care hospital in Kolkata, India, with 100 CKD patients: 50 non-dialysis CKD patients and 50 dialysis-dependent CKD patients. Relevant demographic, clinical and laboratory parameters including serum phosphorus, calcium, parathyroid hormone (PTH), alkaline phosphatase, albumin and estimated glomerular filtration rate (eGFR) were collected. Data was analyzed using appropriate statistical tests. Results: Mean serum phosphorus was significantly higher in the dialysis CKD group (6.12±0.34 mg/dl) compared to the non-dialysis CKD group (4.56±0.80 mg/dl). Serum calcium and PTH were also higher while eGFR and albumin were lower in the dialysis CKD group. Serum phosphorus levels increased with advancing CKD stages in the non-dialysis group. Phosphate binder helped phosphorus control in dialysis CKD patients. Conclusions: Our study is in confluence with other reports and dietary phosphate restriction and the use of phosphate binders help optimize phosphorus levels in CKD patients.

Effect of School Closure During COVID-19 Lockdown on ADHD Symptoms Among Students.

Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder among children, with an estimated prevalence of 1.3 per 1000 in India. The nationwide lockdown imposed due to the COVID-19 pandemic has led to the closure of schools for an indefinite period. After the reopening of schools, the lockdown period was feared to have caused a deterioration in symptoms of existing mental health conditions among school-going children. This field study aimed to probe the association of school closures due to lockdown with any change in symptoms of ADHD in aged 6-15 years in the largest tertiary care hospital in Kolkata. A longitudinal observational study was conducted involving 34 prediagnosed ADHD patients attending the Clinical Psychology outpatient department (OPD) of a tertiary hospital for follow-up. Data was collected by face-to-face interviews with the patients' parents using a predesigned, pretested structured study schedule. Conners' Parent Rating Scale (CPRS) was used to assess the ADHD symptoms. Twenty-three (67.65%) patients were observed to have worsened ADHD symptoms after lockdown. Significant worsening was observed in the ADHD indicator and the mood disorder indicator. Significant contributing factors were rural residence, nuclear family, non-attendance at school, and knowledge inadequacy among parents. There was a significant worsening of symptoms of ADHD owing to the school closure due to the lockdown.

Psychological Impact of COVID-19 and Its Influence on Parental Willingness to Vaccinate Children: A Cross-Sectional Study at a Tertiary Care Hospital in Kolkata.

Background COVID-19 has affected the physical and mental health of people globally, and vaccination is seen as a crucial tool in controlling the pandemic. However, the readiness to vaccinate children remains a concern, particularly in India. Aim The study aimed to investigate the association between the psychological impact of COVID-19 and willingness to vaccinate their children among attendees of the COVID-19 vaccination clinic at Nil Ratan Sircar Medical College, Kolkata. Method The study used an observational, cross-sectional design and collected data from 356 participants between August and September 2022. The COVID-19 Perceived Stress Scale-10 was used to assess participants' psychological impact, and willingness to vaccinate was determined using a survey. Results Approximately 64% (n=227) and 71% (n=253) of the participants exhibited a high level of perceived stress and willingness to vaccinate their children. The vaccine acceptance was significantly associated with perceived stress level and other factors such as family type, presence of chronic illness, and history of acquaintances suffering from COVID-19. Conclusion The study highlights the importance of addressing parental stress and anxiety to enhance vaccination rates among children. To achieve this, population-level awareness of vaccine safety measures and benefits should be raised to alleviate stress and increase vaccine uptake.

Endoscopic Endonasal Trans-Sphenoidal Minimally Invasive Pituitary Surgery with Image Guided Navigation System (Igns): Learning Experience of Ent Surgeon: First Author.

During the period of April 2015 to August 2022 a total 104 patients, diagnosed with pituitary adenoma underwent surgery and further followed up in a multidisciplinary team approach in a tertiary care hospital of Kolkata, India. The data obtained were reviewed statistically to satisfy the study objectives. Total 104 operations were done on 98 patients and total cases taken for calculation and analysis was 98, which consist of 11 microadenomas, 81 macroadenomas. Among 35 patients with normal preoperative hormonal assay, one patient developed postoperative hypopituitarism. Among 6 patients with preoperative hypopituitarism 4 patients (66.6%) recovered after surgery. Overall, 85 cases had total disease clearance as detected on post-operative MRI. In functioning pituitary adenoma (FPA) clinical and endocrinological improvement occurred after primary surgery in 85.36% (n = 35) and after revision surgery it was 84.44% (n = 38). Macroadenomas, giant adenomas were found to have statistically significant higher risk of incomplete disease clearance but large adenomas do not have statistically higher risk of incomplete clearance. IGNS requires extra time for setup, but with proper registration of tracker instruments it adds precision to the surgery. IGNS supplements endoscopic visualization with localization of target lesion by real time stereotactic feedback using preset preoperative imaging data, thus increasing accuracy, safety and effectiveness of minimally invasive surgery.

Prevalence of pulmonary arterial hypertension in post-tuberculosis lung fibrosis patients: A cross-sectional observational study

Introduction: Post-tuberculosis (TB) lung fibrosis is an infrequently reported cause of Pulmonary arterial hypertension (PAH). Pulmonary TB still being an important global health problem, especially in developing countries, PAH developing after pulmonary TB deserves attention. This study was undertaken to know the prevalence of PAH among patients with post-TB lung fibrosis. Methods: A cross-sectional observational study was carried out in two tertiary care hospitals in Kolkata over a period of 1 year. Sixty adult post-TB lung fibrosis patients without any cardiovascular or other pulmonary comorbidities were included in this study. Results: Out of the 60 patients with varying degrees of lung fibrosis confirmed radiologically, eight patients were found to have PAH (13.33% of the study population). Among the eight cases, six were males and two were females. Five of the males were smokers with a mean of 17.6 pack years of smoking. Out of the eight diagnosed PAH cases, three were mild PAH, four were moderate, and one case had severe PAH (grading based on 2D echocardiography findings). Pulmonary function test (PFT) revealed obstructive pattern in three cases, restrictive pattern in three cases, and mixed in two cases. On PFT, smokers with PAH exhibited obstructive pattern and mixed pattern, whereas the nonsmoker PAH cases exhibited restrictive pattern. Conclusion: All post-TB lung fibrosis cases must be followed up at regular intervals and screened to rule out PAH. Early diagnosis and prompt treatment of the cases will help to reduce morbidity and mortality of the disease which otherwise has a poor prognosis.

Prospective Study to Evaluate the Effect of Optimal Medical Therapy on Iron Profile in Patients of Chronic Heart Failure in Tertiary Care Hospital in Kolkata

Prospective Study to Evaluate the Effect of Optimal Medical Therapy on Iron Profile in Patients of Chronic Heart Failure in Tertiary Care Hospital in Kolkata

Efficacy and Tolerability of Tenofovir/Lamivudine/Dolutegravir among Antiretroviral Therapy Naive Human Immunodeficiency Virus Infected Patients of a Tertiary Care Center in Eastern India.

Although many drug regimens have been used in the treatment of human immunodeficiency virus (HIV) infection, the National AIDS Control Organization (NACO) of India recommends the use of a fixed-dose combination of tenofovir/lamivudine/dolutegravir (TLD) as a first-line regimen since 2020. In spite of much global data on the use of this combination, experience in the Indian population is still limited. We aim to find out the efficacy and tolerability of this novel regimen, in a tertiary care center of Eastern India. A descriptive observational study, longitudinal in design performed in the antiretroviral therapy (ART) center of a tertiary care hospital in Kolkata, West Bengal, India. All patients who attended the ART center from April 2021 to October 2022 were enrolled in the study following inclusion and exclusion criteria. A detailed history, clinical examination, necessary biochemical tests, and CD4 count of all patients were done at baseline. Subsequently, they were followed up for 6 months with monthly visits when they were enquired about any adverse effects requiring therapy interruptions. At the end of 6 months, CD4 count and viral load were measured. Out of a total sample of 249 patients, the TLD regimen was efficacious in 99.2% (n = 247) in whom viral load was suppressed to <1,000 copies/mL after 6 months of treatment. The regimen had to be temporarily discontinued in 6% of patients (n = 15). The most common cause of treatment interruption was hepatic dysfunction (3.2%) followed by cutaneous manifestation (2.4%). In 14 out of 15 patients, the regimen could be reintroduced and was safely tolerated afterward. Only one patient had to be shifted to an alternative regimen due to tenofovir-induced nephrotoxicity. Thus TLD was tolerated in 99.6% (n = 248) patients. The fixed-dose combination of TLD is a highly efficacious and well-tolerated first-line regimen for ART naïve patients with HIV infection having >95% adherence. How to cite this article: Sengupta D, Ghosh S, Pain S, et al. Efficacy and Tolerability of Tenofovir/Lamivudine/Dolutegravir among Antiretroviral Therapy Naive Human Immunodeficiency Virus Infected Patients of a Tertiary Care Center in Eastern India. J Assoc Physicians India 2023;71(9):72-74.

Satisfaction among caregivers of beneficiaries with the services provided at the well-baby clinic of a tertiary care hospital, Kolkata

Background: Well-baby clinics (WBC) are health facilities for providing primary care, including immunization services to infants and children. Caregivers’ satisfaction is a vital indicator of the quality of healthcare services provided. Aims and Objectives: This study aims to assess the caregivers’ satisfaction with the services provided at the WBC of a tertiary care hospital in Kolkata, West Bengal and to identify the associated sociodemographic factors. Materials and Methods: A descriptive-type of observational study with a cross-sectional design, was conducted from June to July 2022, using a predesigned pretested and structured schedule, among 106 caregivers of beneficiaries attending WBC. Satisfaction was assessed using 24 items answered on a 5-point Likert scale, ranging from “highly satisfied” to “highly dissatisfied.” Data were tabulated in MS Excel 2021 and analyzed using statistical package for the social sciences v25.0. Bivariate Logistic Regression was performed to examine the association of sociodemographic factors with caregivers’ satisfaction. Results: High satisfaction with the services was observed among 52.8% participants. Least number of caregivers were satisfied with the vaccination services. Caregivers’ gender, mothers’ education and beneficiaries’ gender were found to be statistically significant with their satisfaction. Furthermore, the female caregivers had lower odds of statistically significant high satisfaction than the males. Conclusion: Almost half of the caregivers were less satisfied with the services offered at the WBC, while the least number of caregivers were satisfied with the vaccination services. Extensive research is needed to identify the factors contributing to the satisfaction of caregivers with the services, mainly vaccination.

Surgical site infection: Clinico- bacteriological Profile and antibiogram in a tertiary care hospital in Kolkata

Surgical site infections (SSIs) are a major health care associated infections and possess a great challenge to clinicians. It increases duration of hospital stay, associated morbidity and mortality and treatment cost. For prompt and appropriate management, it is necessary to understand the appropriate microbial etiology and its antimicrobial susceptibility pattern. To determine the prevalence of SSI along with its clinico-bacteriological profile and antibiogram and to correlate with the risk factors.A cross-sectional study was conducted in the Department of Microbiology of Nil Ratan Sircar Medical College &amp; Hospital, Kolkata for a period of one year (2020-2021). Post-operative surgical site infections within 30 days after surgery were included in the study. All samples were collected from clinically suspected SSI cases and processed in the lab as per standard laboratory protocol. Vitek®2 compact system (BIOMERIEUX) was used for further identification and antimicrobial susceptibility testing. All Gram negative pathogens resistant to 3rd generation cephalosporins were screened for ESBL and AmpC. Carbapenem resistant isolates were subjected to Carba NP test for carbapenemase production. Out of 6582 surgeries, clinically suspected SSIs were detected in 220 cases. Among these 220 patients, 186 patients were confirmed as SSI in the laboratory, SSI rate being 2.83%. In 62.27% cases, growth was mono-microbial. Growth of gram negative organisms were noted in 58.72% cases and gram positive growth was 38.53%. (57.14%) was the predominant isolates followed by (35.94%). Diabetes mellitus, obesity and using prophylactic antibiotic &amp;#62;2 hours prior to surgery were found to be significantly associated. For gram positive organism, Vancomycin and Linezolid were found to be most susceptible antimicrobials and for gram negative organisms, it was Polymyxin B and Meropenem. Most of the gram negative organisms were ESBL producer (67.97%). Rapidly emerging multi drug resistant organisms are complicating the management of surgical site infection day by day and possessing significant burden to health care system. For implementation of appropriate antimicrobial policy, it is important to identify bacteriological profile and antibiogram in every hospital.