Tertiary Care Hospital In Mumbai Research Articles

Observational study to assess demographic, clinical profile and outcome of acute kidney injury due to acute gastroenteritis during monsoon season

Background: Worldwide incidence and causes of acute kidney injury (AKI) are variable and even more in developed and developing countries. At least 80% of AKI in tropics is community acquired. Acute gastroenteritis (AGE) is a common problem in developing countries. Present study concentrates on AGE as cause of AKI during monsoon period. It presents in epidemic proportion during monsoon and is preventable with timely intervention.Methods: The study was carried out prospectively in tertiary care hospital in Mumbai during monsoon season of 2012 and 2013. AKI was staged as per AKIN criteria. Patients were treated for primary disease and AKI, initially conservatively and dialysis if indicated. Patients were followed during the hospital stay.Results: Two hundred and thirty patients had AKI due to infectious disease during monsoon. Incidence of AKI due to diarrhea was 23%, and affecting males predominantly in 4th decade. Diarrhea and vomiting were the most common presenting complaints. 32% patients required dialysis. Mortality rate was 3.8%.Conclusions: AKI secondary to AGE is common in tropics. Treatment of primary disease and hemodynamic optimization at the earliest helps to prevent AKI. Presents with less severe AKI and has better outcome. Multiorgan involvement and need for supportive lifesaving therapies were risk factors for AKI.

COMPARATIVE OUTCOMES BETWEEN INHALED BUDESONIDE AND ORAL MONTELUKAST IN MILD PERSISTENT CHILDHOOD ASTHMA

Background: Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of recurrent respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation.
 Aim: To compare the clinical efficacy of oral montelukast with inhaled budesonide as controller medication in mild persistent childhood asthma.
 Methods: 54 Children of both genders aged 3 to 12 years, diagnosed as mild persistent childhood asthma in OPD and in pediatric indoor admissions at the tertiary care Hospital in Mumbai were enrolled in this randomized prospective parallel-group comparative study. 28 (51.9%) patients of group A were started on Oral montelukast & 26 (48.1%) of group B were started on inhaled budesonide.
 Results: Amongst patients of Group A, 9 were asymptomatic & 19 were symptomatic at 4 weeks of treatment.10 were asymptomatic & 18 were symptomatic at 3 months of treatment. P-Value was 0.09 suggesting no significant change/improvement in control of asthma symptoms at 3months than at 4 weeks in children treated with oral montelukast. Out of 26 patients of Group B, 6 were asymptomatic & 20 were symptomatic at 4 weeks of treatment. 17 were asymptomatic & 9 were symptomatic at 3 months of treatment. P-Value was 0.046 suggesting a statistically significant improvement in control of asthma symptoms at 3 months than at 4 weeks in children treated with inhaled budesonide.
 Conclusion: More children on inhaled budesonide were controlled on their asthma symptoms, required significantly less reliever medications, had lesser episodes of night awakening due to asthma symptoms and had improvement in their day-time symptoms and activity than those on oral montelukast.

Assessment of medical certificate of cause of death at a tertiary care centre in Mumbai, India

Assessment of medical certificate of cause of death at a tertiary care centre in Mumbai, India - IJFCM- Print ISSN No: - 2394-6768 Online ISSN No:- 2394-6776 Article DOI No:- 10.18231/j.ijfcm.2019.017, Indian Journal of Forensic and Community Medicine-Indian J Forensic Community Med

Implementing antimicrobial stewardship to reduce surgical site infections: Experience and challenges from two tertiary-care hospitals in Mumbai, India.

Surgical site infections (SSIs) contribute significantly to post-surgical morbidity globally. Antimicrobial stewardship programmes (ASPs) are essential to reduce SSI rates and to curb antimicrobial resistance, especially in low-and-middle-income countries. This prospective study aimed to show the reproducibility of ASP implementation and SSI prevention measures in a semi-private institution with high perioperative prophylactic antimicrobial consumption beyond guidelines. The prevalence of SSIs in clean surgeries was analysed in a government hospital adhering to SSI prevention guidelines including antimicrobial prophylaxis (phase 1; n=335) and in a surgical department unit of a semi-private hospital where the same guidelines were subsequently implemented (phase 2; n=235). SSI rates were compared to check the hypothesis that ASPs and infection control policies are reproducible with similar SSI rates. Moreover, antimicrobial prophylaxis costs were compared between units with and without guideline adherence. Among a total of 570 clean surgeries analysed, SSI rates were similar in both phases (6.0% vs. 5.1%; P=0.659). SSI rates were higher in patients aged >50 years in both phases (P=0.0009 and 0.045), whilst there was no difference in SSI rates between diabetics and non-diabetics (P=0.475 and 0.835). The cost of antimicrobial prophylaxis was lower in the guideline-oriented group (US$0.42 vs US$9 per patient; P=0.0042). Implementing SSI prevention guidelines, including proper antimicrobial prophylaxis, is feasible and reproducible among different hospital settings, leading to a significant decrease in prophylaxis costs. SSI rates do not differ following the same international standards.

Use of Continuous Metabolic Syndrome Score in Overweight and Obese Children.

To assess the utility of continuous metabolic syndrome score (cMetS) for predicting metabolic syndrome (MS) and determine the cut-off values in overweight and obese children. This study was conducted among 104 children (7-14 y) attending obesity clinics of a tertiary care hospital in Mumbai, India. The cMetS was computed by standardizing the residuals of waist circumference (WC), mean arterial blood pressure (MAP), high density lipoprotein cholesterol (HDL-C), triglycerides (TG), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) by regressing them according to age and sex and aggregating them. The optimal cut-off of cMetS for predicting MS was determined by the receiver operation characteristic (ROC) curve analysis. The cMetS increased significantly with increase in the number of MS risk factors. It was significantly high in children with MS than those without it (boys: 1.070+1.834 vs. -1.478+2.262; girls: 2.092+1.963 vs. -2.253+2.140; combined children group: 1.572+1.950 vs. -1.907+ 2.374; p < 0.001). The score predicted MS with high accuracy in girls; (AUC of 0.95, 95% CI: 0.90-1.00), moderate accuracy in boys (AUC of 0.79, 95% CI: 0.65-0.92) and in the combined group (AUC of 0.87, 95% CI 0.80-0.94) respectively. The cut-off of cMetS yielding maximal sensitivity and specificity for predicting the MS was -1.009 in boys (sensitivity 93% and specificity 62%); -0.652 in girls (sensitivity 96.4% and specificity 77%) and - 0.6881 in the combined group (sensitivity 91.2% and specificity 70.2%). cMetS predicted MS with moderate to high accuracy. It had high sensitivity and specificity in predicting MS in overweight and obese children.

Prevalence of Extended Spectrum Beta-lactamase (ESBL) producing Enterobacteriaceae from clinical samples in a tertiary care hospital in Mumbai

Prevalence of Extended Spectrum Beta-lactamase (ESBL) producing Enterobacteriaceae from clinical samples in a tertiary care hospital in Mumbai - IJMR- Print ISSN No: - 2394-546X Online ISSN No:- 2394-5478 Article DOI No:- 10.18231/j.ijmr.2019.033, Indian Journal of Microbiology Research-Indian J Microbiol Res

Modeling and Forecasting Indian Malaria Incidence Using Generalized Time Series Models

In this article, time series for generalized linear models (GLMs) is used to fit weekly malaria data collected from the largest tertiary care hospital in Mumbai, India. Since the data are positive counts of malaria, conditional distribution of the disease counts given the past outcomes and the covariates are assumed to be distributed as a Poisson or a negative binomial. The data analysed show a downward trend, with the presence of seasonality and overdispersion. Various time series models for GLMs are compared and the best model is selected for forecasting the malaria counts. Forecasting regions and model fitting statistics are reported.

Microbiological profile and antibiotic susceptibility pattern of Gram-positive isolates at a tertiary care hospital.

OBJECTIVES:Gram-positive infections such as those by Staphylococcus aureus have contributed to the disease burden by increasing the morbidity and mortality rates in India. This study aims to determine the prevalence and the antibiotic susceptibility pattern of Gram-positive pathogens at a tertiary care hospital, Mumbai, Maharashtra, India.MATERIALS AND METHODS:This retrospective cross-sectional study was carried out from January, 2015 to December, 2017, at a tertiary care hospital in Mumbai, India. The clinical isolates were cultured, and identification was done using Vitek 2 culture system. The antibiotic susceptibility testing was done as per the Clinical Laboratory Standard Institute guidelines.RESULTS:Out of 2132 (29%) Gram-positive isolates, S. aureus (49%) was the most common encountered pathogen, followed by Enterococcus spp. (24.5%) and coagulase-negative Staphylococcus (16%). Majority of the S. aureus were observed in patients with skin and soft-tissue infections (61.2%) followed by those suffering from respiratory (41%) and bloodstream infections (35%). Among the infections caused by S. aureus, the prevalence of methicillin resistance was 30%. While the MRSA isolates showed lower sensitivity toward co-trimoxazole (39%), clindamycin (30%), erythromycin (23%), and ciprofloxacin (10%), they showed higher susceptibility to linezolid (98%), vancomycin (98%), and teicoplanin (98%). All the isolates were found to be sensitive to daptomycin and tigecycline. While vancomycin-resistant enterococci (VRE) formed 7.5%, the linezolid-resistant enterococcus species was as high as 4.1%.CONCLUSION:The study showed a high prevalence of MRSA and VRE, thereby emphasizing the increasing antimicrobial resistance pattern of the Gram-positive pathogens. Therefore, there is an urgent need for novel antimicrobial stewardship to restrict the ongoing resistance rate among the isolates.

Exploring the factors associated with lipohypertrophy in insulin-treated type 2 diabetes patients in a tertiary care hospital in Mumbai, India

This exploratory study reports the prevalence of lipohypertrophy (LH) in insulin-treated type 2 diabetes patients attending a private tertiary hospital in Mumbai, India, and explores the factors associated with this condition. A total of 96 patients attending the outpatient department, completed an interviewer-administered questionnaire followed by an examination of insulin injection sites for the presence of LH by a trained diabetes nurse educator. Nearly 68% of the respondents had LH. Most patients (82%) had LH on at least two injection sites, with the frontal areas of the right and left side of the abdomen being the most common sites. Despite a high prevalence of LH, the majority of patients were unaware that they had the condition (77%) and could not identify the causes (74%). Half of the patients reported awareness about the different sites for injecting insulin, injection techniques, and the need for rotating injection sites. Only 26% always rotated injection sites, while 16% changed needles more than half of the time in the week prior to the interview. Bivariate analysis found higher number of years with diabetes and on insulin and a higher insulin dose per day as significant factors (p value < 0.05). Logistic regression showed a strong relationship between the presence of LH and the number of years on insulin (p value < 0.05). The number of years on insulin for patients with and without LH averaged 8.2 and 3.7, respectively. Findings highlight a gap in patients’ knowledge and management of LH, and call for a hospital-wide intervention encompassing patient education and provider sensitization.

Antibiotic Audit in Cases of Septicemia in Medical Intensive Care Unit (MICU) in a Tertiary Care Hospital in Mumbai

Antibiotic Audit in Cases of Septicemia in Medical Intensive Care Unit (MICU) in a Tertiary Care Hospital in Mumbai

Pediatric hematopoietic stem cell transplants - a ray of hope for non-malignant disorders. Experience of a tertiary care hospital in mumbai, india

Pediatric hematopoietic stem cell transplants - a ray of hope for non-malignant disorders. Experience of a tertiary care hospital in mumbai, india

VSICON 2018 Prize Paper Abstracts

VSICON 2018 Prize Paper Abstracts

KNOWLEDGE OF THE DISEASE AMONG TYPE 2 DIABETES PATIENTS IN A TERTIARY CARE HOSPITAL IN MUMBAI, INDIA

Objective: An estimated 72 million in India live with diabetes; the country faces an impending health-care crisis with prevalence and complications of diabetes forecasted to multiply in the next decade. Improving patients’ knowledge about diabetes to manage the disease better is an urgent and important public health goal.Methods: Knowledge about diabetes, its complications, and management was surveyed using a structured questionnaire among 167 Type 2 diabetes patients attending a tertiary care hospital in Mumbai, India.Results: None of the participants had ever received any formal diabetes self-management education previously. Respondents’ mean and median correct knowledge scores were 20 of 32 test items. Although majority answered statements about blood sugar levels and complications, there was lack of knowledge about the causes and management of diabetes. Around 82% stated that medication was more important than dietary intake and physical activity in managing diabetes. A multiple regression model showed that postgraduate or graduate level education, not being married, having two or less children, and visiting a doctor 1–3 times a year (as compared to more than three visits) was independently associated with higher diabetes knowledge scores (*p&lt;0.05) in this sample.Conclusion: An information disparity exists between patients who have higher levels of education versus those with lesser education. Future research will have to examine the mechanisms by which higher education contributes to better knowledge, and facilitate the design of diabetes education programs that bridge information gaps and improve required competencies in patients to better manage their condition.

Histopathological findings in nerve biopsies from patients suspected with pure neural leprosy in two teaching hospitals in Mumbai in the period 2008–2015

Patients presenting with ‘pure neural leprosy’ poses a diagnostic challenge as several other peripheral neuropathies present with similar clinical features. It is common for patients presenting with peripheral neuropathy symptoms to seek treatment at the tertiary care hospitals. We report histopathological findings in 113 referred cutaneous nerve biopsies from patients suspected with ‘Pure neural leprosy’ at two teaching tertiary care hospitals in Mumbai, during the period 2008–2015. Confirmatory evidence of leprosy in histopathology was found in 83 (73.5%) cases and 35 (42.2%) among them scored positive for Acid-Fast Bacilli (AFB). Among the confirmed cases, the entire spectrum of leprosy was seen with predominance of Borderline Leprosy to Lepromatous Leprosy (BL-LLs) lesions (37.3%) followed by Borderline Tuberculoid (BT) (31.3%), Mid Borderline (BB) (15.7%) and Indeterminate type (4.8%). In the remaining 39 cases (34.5%), the nerves showed moderate to severe fibre loss but no specific infiltrating cells or AFB. Thus a conclusive diagnosis of leprosy could not be made. Conclusion: Neural histopathology in almost 35% of suspected ‘pure neural cases’ did not conform to leprosy. The present study underscores the importance of histopathology in establishing a firm diagnosis and classification, and draws attention to appropriate selection of nerve for biopsy.

Postpartum Depression Prevalence in a Tertiary Care Hospital in Mumbai, Maharashtra, India

Postpartum Depression Prevalence in a Tertiary Care Hospital in Mumbai, Maharashtra, India

Health status and health seeking behaviour among urban and rural nursing students of a tertiary care hospital: a comparative study

Background: Nurses play a very essential role as health care providers and taking care of their health is necessary. Nursing students are believed to be healthy and although morbidity and mortality from non-communicable diseases occur in adulthood, exposure to risk factors begin in early life. Early identification of risk factors is essential considering their role as future nurses and in public health interventions.Methods: A cross-sectional study was carried out among 280 nursing students of a tertiary care hospital of Mumbai, Maharashtra after the ethical clearance. Pretested questionnaire was used for collecting data by interview after obtaining informed consent.Results: Out of the total 280 students, 47% missed at least one of their meals. 67.8% were underweight (BMI &lt;18.5). There was no consumption of dry fruits and non-veg food in 54.64% and 23.9% of the students respectively. 36.07% students consumed green leafy vegetables only once a week. Consumption of water was quite low among the students. 56.07%, were anaemic (Hb &lt;12 gm/dl). Under-nutrition and anaemia was found to be more prevalent in students coming from rural areas. The health seeking behaviour was observed to be better among the urban students.Conclusions: Findings of this study demonstrated that there is a need to increase the awareness among the nursing students regarding the healthy lifestyle and to follow specific strategies for their comprehensive management.

PMD33 - Price Ceiling on Coronary Stents: Impact on Utilization and Cost of Percutaneous Coronary Interventions (PCI) in Tertiary Care Hospitals in Mumbai, India

1) To comprehend cardiologists’ rationale behind using Drug Eluting Stents (DES) over Bare Metal Stents (BMS). 2) To gauge the impact of price ceiling (recently commissioned by the National Pharmaceutical Pricing Authority, NPPA) on utilization of coronary stents. A questionnaire-based survey directed towards cardiologists was conducted in 3 multispecialty hospitals. The questions were aimed to study benefits of DES over BMS; and change induced by the price ceiling in number and cost of Percutaneous Coronary Interventions (PCI). 1) DES account for majority of stents placed due to factors like risk minimization, improved patient outcomes and prevention of re-occlusion. However, Dual Antiplatelet Therapy (DAPT) was prescribed for up to 2 years, irrespective of the type of stent(s) used. 2) Of the total cases of Ischemic Heart Disease, 50% were recommended PCI. The cost of the intervention (with 1 stent) ranges from 2,00,000 to 3,00,000 INR. The number and cost of PCIs performed per month saw no significant change. The cost of BMS has been reduced by about 81% (from an average of 45,095 to 7,260 INR) and that of DES by about 76% (from an average of 1,21,000 to 29,600 INR) irrespective of subcategory. Despite this substantial drop, the cost borne by patients remains unchanged. This is likely due to raised auxiliary costs. Although the price ceiling may favor local stent manufacturing companies, it curbs potential for entry of high-end products by making the Indian market less rewarding to innovators. As a result, patient choice is limited. This initiative could be boosted by adopting strategies such as rationalization of trade margins and implementation of systematic differential pricing. Hence, the government, in conjunction with manufacturers, can take a prudent call to revise this policy such that interests of all stakeholders are protected.

Rotavirus in diarrhoeic children under-five attending a tertiary care hospital in Mumbai, India

Background: Diarrhoeal diseases are a leading cause of morbidity and mortality among children requiring hospitalization in developing countries. Rotavirus is the most common cause of acute diarrhoea among under-five children. Etiological diagnosis of diarrhoea would enable appropriate management of patients while limiting the spread of drug resistant pathogens. This study was undertaken to determine presence of rotavirus and other diarrhoeal pathogens in under-five diarrhoeic children attending a tertiary care hospital, and the related clinical presentations.Methods: 120 stool samples of under-five children with acute diarrhoea, attending the OPD and indoor services of a tertiary care hospital, were studied over one year. Rotavirus antigen was detected using enzyme linked immunosorbent assay. Bacterial and parasitic pathogens were detected using standard microbiological techniques.Results: Out of 120 stool samples tested, 36 were positive for Rota virus antigen. Bacterial isolates included E. coli (25), Vibrio cholerae (12) and Aeromonas species (1). Parasites were observed in nine samples and multiple pathogens in nine.Conclusions: Rotavirus continues to be a major cause of childhood diarrhoea. As antibiotics have no role in the management of viral and parasitic diarrhoeas, etiological diagnosis is imperative for proper management of diarrhoea and prevention of indiscriminate use of antibiotics.

Incidence, Epidemiology and Control of Clostridium difficile Infection in a Tertiary Care Private Hospital in India

Purpose:Clostridium difficile infection (CDI) is a serious healthcare-associated infection (HAI) now being increasingly reported from hospitals across India. However, there is a paucity of data on the incidence of and impact of control measures on CDI in India. Materials and Methods: This is a retrospective study conducted at a tertiary care hospital in Mumbai from January 2016 to December 2017. All patients with healthcare-onset diarrhoea were tested for C. difficile by glutamate dehydrogenase (GDH)/toxin assay or nucleic acid amplification test (NAAT). CDI was defined as either GDH and toxin positive or NAAT positive. The incidence of CDI was calculated per 1000 patient days. Demographic features of patients with CDI including age, sex, duration of hospitalisation before onset of CDI, antibiotic use and treatment administered were summarised. Results: A total of 67 patients had CDI in the study period with a mean incidence of 0.2/1000 patient days. A halving of the CDI incidence was seen after intensification of the CDI prevention bundle. The mean age of affected patients was 64 years and CDI occurred at a median duration of 2 weeks after hospitalisation. Eighty-seven per cent of the patients were on antibiotics at the time of diagnosis of CDI. The crude mortality rate was 22%. Conclusions: CDI is an emerging HAI in India. All hospitals need to set up policies for surveillance, testing, treatment and prevention of CDI based on recent international guidelines and local infrastructure/logistics.

Hepatitis C Virus Infection in a Tertiary Care Hospital in Mumbai, India: Identification of a Mixed and Novel Genotype

Purpose: Hepatitis C virus (HCV) is a leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). HCV being a ribonucleic acid virus has considerable sequence variability. Assessment of viral load and genotype is necessary for designing treatment strategies and monitoring for viral resistance among HCV-infected cases. HCC is the most common form of liver cancer, often occurring in people with chronic hepatitis B or C. We undertook this study to observe genotype distribution of the virus in HCV patients from Mumbai. Materials and Methods: Between January 2017 and December 2017, the study was conducted on 120 chronic hepatitis outpatients from a tertiary care hospital, Mumbai, after obtaining ethics approval. All these diagnosed cases of HCV were subjected to molecular diagnosis in a research institute, Mumbai, by real-time polymerase chain reaction-based techniques. Results: Males were more preponderant than females with HCV infection, and the highest number of HCV-infected cases was observed in the age group of 41–50 years. Genotype 3 (n = 70; 58.3%) accounted for the highest number of cases followed by genotypes 1b (n = 29; 24.2%) and then 1a (n = 14; 11.7%). Mixed genotypes 1b + 3 and individual genotype 4 were found in two cases each (1.7%). A total of three samples (2.5%) were found with untypeable genotype. Conclusion: The major HCV genotype observed was 3 which is difficult to treat with direct-acting antivirals, owing to the more rapid progression of liver disease, increased rates of steatosis (non-alcoholic fatty liver disease), a higher risk for cancer (HCC). We believe this study is the first one to address the prevalence of mixed genotypes and untypeable genotype from India.