Tertiary Care Hospital In Mumbai Research Articles

Findings in chest radiographs of patients admitted with novel coronavirus infection at a tertiary care institution in India: A retrospective study

Aim: In the ever-changing understanding of the ongoing COVID 19 pandemic, this study aims to present the spectrum of findings in chest radiographs conducted in serologically proven symptomatic patients of COVID 19 in a tertiary care hospital in Mumbai, India. Methods: The study was a retrospective analysis of 449 chest radiographs(CXRs) obtained from serologically proven symptomatic 312 COVID patients in a tertiary care institute at Mumbai, India. CXRs were conducted as per a hospital approved protocol. The x-rays were analysed by three radiologists for presence of consolidation, ground glass opacities, interstitial opacities and distribution of findings. Results: Out of the total CXRs reviewed, 50.7% were abnormal with 91.7% of them showing the commonest pattern of finding as consolidation. The majority of findings were seen (71.1%) in patients above 50 yrs of age. 84 cases (26.9%) had a serial radiograph follow up mandated by their clinical status. Of these, 75% were abnormal. There were 46 fatal cases, out of which 22 patients (47.82%) underwent CXRs and 10 (21.73%) were followed up. All of these radiographs (100%) showed abnormal findings. Conclusions: Chest radiographs conducted in this retrospective analysis of patients with symptomatic COVID-19 infections showed that a little more than half of the patients with the infection had abnormal findings. The commonest pattern of involvement was a patchy peripheral consolidation with no predilection for any particular side. However, there was a significant basal predominance (85.5%). The progression of findings was seen in 75% of the CXRs with good correlation between clinical & radiological severity. The study shows that CXRs have an important diagnostic and prognostic role in the management of patients with the COVID-19 infection.

Incidence and Etiology of Hemodialysis Catheter Related Blood Stream Infections at a Tertiary Care Hospital in Mumbai: A 5 Year Review.

Incidence and Etiology of Hemodialysis Catheter Related Blood Stream Infections at a Tertiary Care Hospital in Mumbai: A 5 Year Review.

Clinical profile and outcome of children with tuberculosis in a tertiary care hospital in Mumbai, India

Clinical profile and outcome of children with tuberculosis in a tertiary care hospital in Mumbai, India

A hospital based exploratory study to assess the reasons and timings of seeking abortion services in a tertiary care hospital in Mumbai

Background: The adoption of the Medical Termination of Pregnancy (MTP) Act has allowed for abortion on the grounds of medical and social reasons since 1972.The aim of the present study is to establish the demographic of women seeking abortion care services and to determine the role of different factors in the timing of seeking an abortion.Methods: A retrospective hospital record-based study was carried out among pregnant women seeking an MTP in a tertiary care hospital in Mumbai. The records of women seeking MTP over a 5-year period from January 2012 to December 2016 were accessed and data pertaining to their demographic and obstetric history was recorded. Statistical tests of significance and analysis were done.Results: A total of 803 women underwent an MTP from January 2012 to December 2016. The number of deliveries during the same time period was 13735. The most common age group was 25-30 years. Stratification in terms of the educational backgrounds showed that 45.7% had received only secondary school education while 12.7% had no schooling. Majority of the women (74.8%) availed an MTP in the first trimester, out of which, most of them (36.9%) had 2 previous pregnancies. Most women coming in the second trimester (43.6%) hadn’t conceived before.Conclusions: Education didn’t seem to be a significant factor in determining the timing of seeking an MTP. School education did not necessarily include exposure to sexual education. Experience in terms of parity was more relevant in identifying signs of pregnancy and seeking appropriate services in a timely manner.

A randomised trial of 5% minoxidil versus combination of 5% minoxidil and oral spironolactone in treatment of female pattern hair loss

<p class="abstract"><strong>Background:</strong> Female pattern hair loss (FPHL) is a common form of nonscarring hair loss. We compared the usefulness and safety of topical minoxidil alone with combination of oral spironolactone and topical minoxidil in the treatment of FPHL.</p><p class="abstract"><strong>Methods:</strong> This prospective, single-centre, randomised open label study over 100 patients attending tertiary care hospital in Mumbai during period December 2011 to June 2012. The data were entered into SPSS version 21 for analysis. Data collected were coded and described as frequency and percentage for qualitative data and means and standard deviation for quantitative data. Statistical analysis was done using chi-square and student t test. Statistical significance was considered if p value was less than 0.05.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 48 patients in Group I and 46 patients in Group II. At 6 months, significantly higher mean Sinclair grade was observed among Group I patients as compared to Group II patients (2.85±0.68 vs 2.56±0.50, p=0.02). We observed a significant improvement in women’s androgenetic alopecia quality of life questionnaire in Group I patients at 12 months after treatment (26.93±2.25 vs 23.47±2.95, p<0.001). Minoxidil and spironolactone were tolerated well by the patients.</p><p class="abstract"><strong>Conclusions:</strong> Combination therapy of topical minoxidil and oral spironolactone has an additive effect. However, plateau of effectiveness of the combination therapy in normoandrogenic patients at 6 months of therapy was observed. We recommend the combination for 6 months and continuation of therapy with minoxidil only.</p>

Incidence and clinico-demographic characteristics of neonatal meningitis in clinically suspected sepsis: an observational study

Background: Authors objective was to study the incidence and risk factors for meningitis in neonates with clinical suspicion of sepsis in Neonatal Intensive Care Unit (NICU) of tertiary care hospital of Mumbai, India.Methods: This descriptive observational study enrolled Consecutive 92 patients of either sex with suspected neonatal sepsis admitted in NICU of Tertiary Care Hospital. All neonates admitted to NICU with clinical suspicion of sepsis or developing signs of sepsis during NICU stay were included in study. Exclusion criteria were 1.Neonates with hemodynamic instability 2.major congenital malformations 3.contraindication or no willingness for Lumber puncture (LP ) 4.neonates who have received intravenous antibiotics for more than 24 hours elsewhere.Standard data collection form was used to collect all demographic data and clinical characteristics of neonates.Results: Incidence of meningitis in study population was 7.6%. Cases of meningitis in study population had mean birth weight 1.91 kg, 71.43% were preterm, 57.14% vaginaly delivered, 42.86% by LSCS, Premature rupture of membrane (PROM) observed in 28.57% cases. Meconium stained liquor in 42.86% cases and foul smelling liquor in 28.57% cases observed. 42.86% cases required resuscitation and 28.57% received surfactant therapy. Poor feeding (100%), lethargy (85.71%), weak cry (85.71%) and tachypnea (50.58%). Retractions (85.71%), Grunting (57.14%) and Nasal flaring (42.86%) were clinical presentation. Lab findings in a case of meningitis: mean Hemoglobin (Hb) 15.22 gm%, Leukopenia (28.57%), Leukocytosis 28.57%, Absolute Neutrophil count (ANC) <1800 (28.57%), Thrombocytopenia 42.85%, blood culture positive (28.57%) hypoglycemia (28.57%), CSF white cell count (124.57cells/ml.), mean CSF protein level (60 mg/dl.) Mean CSF glucose level (40.86 mg/dl.) CSF culture was positive in two cases of meningitis.Conclusions: Authors study highlights the diagnostic utility of routine lumbar puncture in neonates with clinically suspected sepsis.

The Incidence, Aetiology and Antimicrobial Susceptibility of Central Line-Associated Bloodstream Infections in Intensive Care Unit Patients at a Private Tertiary Care Hospital in Mumbai, India

AbstractBackground: There is a need to generate accurate data on temporal trends in incidence rates, aetiology and antimicrobial susceptibility of central line-associated bloodstream infections (CLABSIs) in the Indian setting. Aim: To study the incidence, aetiology and antimicrobial susceptibility of CLABSI in adult, paediatric and neonatal intensive care units (NICUs) in a tertiary care private hospital in Mumbai, India. Materials and Methods:This is a prospective observational study conducted at the adult, paediatric and NICUs of tertiary care private hospital from 2011 to 2018. CLABSI was defined as per the Centers for Disease Control criteria. Surveillance of CLABSI in the intensive care units (ICUs) was conducted using a form adapted from the International Nosocomial Infection Control Consortium surveillance system. The incidence rates of CLABSI (per 1000 central line days), crude mortality, aetiology and antimicrobial susceptibility were calculated and reported. Results: Six hundred and eighty-six episodes of CLABSI were recorded, and the overall incidence of CLABSI was 5/1000 catheter days, 4.1 in the adult ICU, 5 in the paediatric ICU and 9 in the newborn ICU. Crude mortality in patients with CLABSI in the adult, paediatric and NICUs was 45%, 30% and 7%, respectively. Of the 752 isolates, 80% were Gram negative, 10% Gram positive and 10% yeast. The prevalence of extended-spectrum beta-lactamase producers was 80%, and rates of carbapenem resistance were on an average 50%. Conclusions: The CLABSI rates at a well-equipped tertiary care hospital are still significantly higher than the USA benchmarks. Alarming rates of drug resistance in Gram-negative pathogens were seen.

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.