Tertiary Care Hospital In Odisha Research Articles

Prevalence of Acute Bacterial Infections and Their Antibiotic Sensitivity Pattern in Children With Severe Acute Malnutrition From a Tertiary Care Hospital of Odisha

Prevalence of Acute Bacterial Infections and Their Antibiotic Sensitivity Pattern in Children With Severe Acute Malnutrition From a Tertiary Care Hospital of Odisha

Comparative Study of Anesthetic Agent Recovery Times in Outpatient Procedures: Insights from a Tertiary Care Hospital in Odisha

Comparative Study of Anesthetic Agent Recovery Times in Outpatient Procedures: Insights from a Tertiary Care Hospital in Odisha

IJCM_309A: Epidemiological Trends, Clinical Features, and Outcomes in Scrub typhus patients admitted to a tertiary care hospital in Odisha

Background: Scrub typhus is an emerging public health threat in South-Asian countries; with the growing number of cases in India, an understanding of local patterns of disease and factors that place individuals at risk is pivotal to future preventive measures. Objective: To analyze the epidemiological features- annual number of cases, age distribution, sex distribution, and seasonal distribution over the four years. To find out the clinical profile, laboratory features and outcomes of cases of scrub typhus, and to identify the predictors of disease severity. Methodology: A comprehensive retrospective review of scrub typhus cases reported over a 4-year period (2019-2023) was done, with a monthly trend of patients admitted. Data was collected from the case records of patients for demographic characteristics, clinical features, treatment, and outcomes, length of stay (LOS), complications, and mortality. Data was presented in frequencies and proportions, odds ratio (OR) was calculated and a p-value of Results: A total of 886 cases were reported over the four-years. There was a declining epidemiological trend in 2020-21 and then an increasing one. Scrub typhus cases exhibited seasonality, with a peak incidence during winter season. Males were more commonly affected (58.01%), and the age group most susceptible was 19-64 years (52.22%), followed by one-month to 18years (32.22%). Clinical presentations typically included fever (96%), eschar formation (8%) and rash (8%). Complications like pneumonia (13.88%) and AKI (11.73%), were observed in a significant proportion of cases. Mortality was reported in 4.40% of cases. Altered sensorium, deranged LFT, hypotension requiring ionotropic support, requirement of ventilatory support predicted poor outcome. Conclusion: Scrub typhus was seen to cause a multi-system infection among the studied population, causing significant morbidity and mortality. The conditions found associated with poor outcome and mortality can be used as risk factor predictors and help patient management.

Financial hardship of tuberculosis patients registered under National Tuberculosis Elimination Programme (NTEP) in rural India: A longitudinal study

BackgroundIndia shares a significant proportion of the Tuberculosis (TB) burden of the world. TB diagnosis, treatment, and success are complicated by the chronic nature of the disease as well as additional stressors including financial, psychological, and social hardships, adverse events associated with management, and poor compliance towards anti-tuberculosis medications. MethodsThis is a longitudinal study conducted in the Tuberculosis Units (TUs) of rural field practice areas of the Department of Community Medicine and Family Medicine in a tertiary care hospital in Odisha. 168 diagnosed TB patients from the TUs were enrolled after registration in NTEP and were followed up every month for 6 months or treatment completion. TB patient's cost estimate tool was used to collect data regarding the cost incurred by the patients before and during the diagnosis as well as in the post-diagnosis or treatment period. Results and conclusionOut-of-pocket expenditure was calculated as direct, indirect, and total cost in the pre and post-diagnostic phases of the disease. The median pre and post-diagnosis direct, indirect and total costs were ₹ 12,805, ₹ 16,960 and ₹ 31,192, respectively, with almost 62 % of participants spending more than 20 % of their annual income. In this study, 41 % of participants had to stop working for more than 60 days, and 53.1 % faced distress financing due to the disease. Through this study, we found that more than half of rural TB patients still visit private health facilities, and 20 % start anti-TB drugs by purchasing them from private pharmacies, which incur substantial out-of-pocket expenditure. Most participants faced catastrophic costs associated with hospitalisation, lower family income, and a delay in disease diagnosis.

Clinicopathological profile and survival analysis after pancreaticoduodenectomy for periampullary and pancreatic head malignancies: 7 year experience from Single Tertiary Care Hospital in Odisha, India

Clinicopathological profile and survival analysis after pancreaticoduodenectomy for periampullary and pancreatic head malignancies: 7 year experience from Single Tertiary Care Hospital in Odisha, India

EARLY DIAGNOSIS OF ANASTOMOTIC LEAKAGE AFTER ELECTIVE COLO-RECTAL SURGERY USING DUTCH LEAKAGE SCORE – A PROSPECTIVE OBSERVATIONAL STUDY

Introduction: Anastomotic leakage is a major complication after colorectal surgery, with reported incidence of 2–7%. To limit the clinical consequences, it should be detected and treated as soon as possible. Leak usually becomes apparent between 5 and 7 days postoperatively. A standardized post-operative score, Dutch Leakage Score (DLS) can be a useful clinical tool to reduce delay in diagnosis of anastomotic leak (AL) and reduce mortality. A score of <4 was considered negative while a score of 4 or more was considered positive. Methods: Total 110 patients were enrolled after written informed consent during March 2021–October 2022 at a tertiary care hospital in Odisha. DLS was measured before surgery and on POD2, POD3, and POD6. Results: Among the 110 patients, the AL rate was 16.4%. With respect to AL, DLS cutoff of 2.5 on POD2 had positive predictive value (PPV) of 53.10% and a negative predictive value (NPV) of 98.70%. DLS cutoff of 4.0 on POD3 had a PPV of 80.90% and a NPV 98.90%. DLS cutoff of 3.0 on POD6 had a PPV of 84.20% and a NPV of 96.70%.The most common day of AL was the fifth P.O.D (in seven patients) followed by sixth P.O.D (in five patients). Conclusion: DLS is a good positive and excellent negative predictor of AL. DLS is an easy bedside assessment to gauge the likelihood of AL in the early post-operative period.

Prevalence of target organ disease and its relation with HbA1c at the point of detection of type 2 diabetes mellitus – A cross sectional study from a tertiary care hospital in Odisha

Introduction and Aim: HbA1c is not only a valid indicator of chronic hyperglycaemia but also coincides with the increased risk of diabetic complications in the long term. This study focuses on the prevalence of target organ disease (TOD) and its relation with HbA1c at the point of detecting Type 2 Diabetes Mellitus(T2DM). Materials and Methods: This is a single-centre cross-sectional study done in the Department of General medicine at IMS and SUM Hospital, Odisha, between November 2020 and June 2022, including all newly diagnosed Type-2 Diabetes Mellitus patients aged > 30 years. Besides all the biochemical parameters, the demographic profile was noted in an excel sheet, and later on, using SPSS version 26, the data was analysed categorically. Results: 148 newly diagnosed Type 2 DM patients were enrolled in the study with male predominance (54.72%). The mean age was found as 52.49±9.40 years. There were 29 (19.5%) cases of diabetic retinopathy, 39 (26.3%) diabetic neuropathy, 32(21.6%) diabetic nephropathy and 23(15.54%) left ventricular diastolic dysfunction, with a minimal number of RWMA [7 (4.72%)], Concentric left ventricular hypertrophy [9 (6.08%)] and Ischemic DCM [1(0.67%)] found as complications of newly diagnosed Diabetes mellitus patients. The prevalence of coronary artery disease (CAD) is higher in our study than in other diabetic complications, i.e., 40 (27.02%).A statistically significant (p<0.05) correlation exists between newly diagnosed Diabetes patients with higher HbA1C and serum creatinine, serum urea, microalbuminuria, and positive monofilament test. Conclusion: This study underscores the significance of assessing target organ damage (TOD) prevalence for Type 2 Diabetes Mellitus (T2DM) detection, highlighting the utility of HbA1c testing. HbA1c, a rapid and precise diagnostic tool, holds promise, especially in resource-limited settings, aiding in timely T2DM diagnosis and improved patient care amid the global diabetes epidemic.

Cost-effective Analysis of Prescribed Oral Hypoglycemic Agents amongst Pre-obese and Obese Diabetic Patients in a Tertiary Care Hospital in Odisha

Objectives: Diabetes is more prevalent in middle- and higher-income groups and is spreading at an alarming rate. Drug therapy is compulsory because of the chronic and progressive nature of the disease. With such multifactorial background of high prevalence, progressive nature of the disease leading to various complications, increased healthcare cost, and availability of multiple therapeutic regimens prescribed, this study has been done to evaluate the cost-effective analysis of oral hypoglycemic agents. Materials and Methods: This is a prospective, parallel group, and comparative observational study conducted by the Department of Pharmacology in collaboration with the Department of Endocrinology at Kalinga Institute of Medical Sciences, Bhubaneswar. The duration of the study was of 2 years. A total number of 220 patients were selected and based on body mass index, patients were categorized into preobese (new and old diabetic patients) and obese (new and old diabetic patients) categories. In this study, cost-effectiveness analysis (CEA) was done to evaluate the cost differences between two or more medication groups, with a similar clinical effect. Results of CEA are expressed as an average cost-effectiveness ratio or as an incremental cost-effectiveness ratio. Results: From this study, it is observed that in terms of benefit, dual therapy of Metformin and Dapagliflozin was most efficacious followed by Metformin and Sitagliptin as well as Metformin and Glimepiride combinations. If cost is considered, Metformin montherapy and metformin and Glimepiride dual therapy was most cost-effective. In triple regimen, MET+VOG+GLIM combination was seen to be more cost effective than gliptin combination, both in terms of control of FBS as well as PPBS. The cost of treatment goes parallel with duration of disease, being higher in the old cases of long-standing duration. Conclusion: The present study shows that SGLT2 inhibitors are better class of oral hypoglycemics in terms of long-term benefits and this group is prescribed as dual therapy more frequently but cost of therapy is the greatest barrier. Metformin and Sulfonylureas remain the most beneficial combination, both in terms of efficacy and cost. The cost of treatment was varying, depending on the duration of disease, being higher in old cases and lower in new cases.

A Retrospective Study of Demographic Profile and Management Appraisal Non-Gonococcal Urethritis in Male Patients Attending a Tertiary Care Hospital in Odisha.

Male urethritis is primarily sexually transmitted in India and has also shown a high rate. Urethritis or inflammation of the urethra is a multifactorial condition. It is called gonococcal urethritis (GU) when Neisseria gonorrhoeae is detected in a urethral smear of the patient and non-gonococcal urethritis (NGU) when this organism cannot be visualized. To study the demographic profile and management pattern of NGU retrospectively in male patients. Urethritis cases were identified from the dermatology outpatient record. A retrospective study of data of patients diagnosed with NGU was done for 5 years from August 2015 to July 2020. We included only male patients more than 10 years of age. Chlamydia trachomatis (CT, 48%) was the most common causative organism found. The diagnosis was confirmed by demonstrating ≥5 polymorphonuclear lymphocytes (PMNLs) from the anterior urethra using a Gram-stained urethral smear followed by the polymerase chain reaction (PCR.) of urine. The most common age group affected was 21-30, (30, 46%) years with a mean ± standard deviation (SD) of 30.32 ± 10.80. Most patients were from low socioeconomic status, labourers (36, 55%). A history of heterosexual behaviour, (57, 88%) was the most common and it had been seen that sexual exposure was more common in unmarried patients (38, 59%). Associated features were seen in 18 patients. Among recommended initial therapies for NGU, doxycycline and azithromycin might be improved by the addition of antimicrobial coverage for Trichomonas vaginalis (T. vaginalis). Further, it was seen that response to doxycycline therapy was better than azithromycin. Though there is an increased incidence of Herpes infections, we found Chlamydia infection to be the most common cause of NGU. Doxycycline showed better results in NGU due to Chlamydia infection.

Comparative Evaluation of RLEP-PCR and Conventional Laboratory Methods for Confirmation of Clinically Diagnosed Early-stage Leprosy in Eastern India

Introduction: Leprosy is an infectious disease caused by Mycobacterium leprae (M. leprae). Diagnosis of leprosy is confirmed based on cardinal signs and symptoms along with supportive laboratory investigations. Early diagnosis and treatment of new cases are essential to prevent disease burden and spread in community. Aim: To evaluate the efficacy of currently available laboratory tests like M.leprae-specific repetitive element Polymerase Chain Reaction (RLEP-PCR) and conventional methods like, Slit Skin Smears (SSS), Histopathology (HP) and Fite-Faraco (FF) staining for detection of M. leprae in clinically diagnosed cases of early- stage leprosy. Materials and Methods: A cross-sectional study of 82 newly diagnosed cases of leprosy was carried out in S.C.B Medical College, a tertiary care hospital of Odisha, India from September 2018 to August 2020. For every case, skin tissue was punched out to get biopsy for HP and FF staining and incised for SSS. At least two SSS slides were prepared per case. One SSS slide was stained by modified Ziehl-Neelsen (ZN) staining to demonstrate Acid Fast Bacilli (AFB). The other SSS slide was air dried and the dried material was scraped off to perform PCR. Data were analysed by Statistics software IBM Statistical Package for the Social Sciences (SPSS), version 24.0. Association between categorical variables was studied by using Chi-square test. Comparison of mean±SD and median (IQR) were done by using independent sample‘t’ test. Agreement on different types of laboratory methods was done by using Kappa test. Results: Among 82 cases, 68.3% were RLEP-PCR positive, 56% had relevant chronic granulomatous features histopathologically, 39% were FF stain positive, and only 29% were ZN stain positive. Improvement in case detection of 39%, 29.3%, and 12.2% by PCR over SSS, FF Stain and HP respectively proved superiority of PCR over other procedures. Conclusion: PCR was most sensitive to detect leprosy both in pauci and multibacillary groups, thus considered as investigation of choice for diagnosis of early-stage leprosy.

Haematophysiological Study of Transfusion Dependent Beta-thalassaemia Patients in a Tertiary Care Hospital of Odisha, India

Introduction: The Transfusion Dependent Beta-thalassaemia (TDT) is an autosomal recessive disorder that affects the red blood cells, both in the decreased as well as absence in production of Adult Haemoglobin (HbA) and characterised by severe anaemia, splenomegaly and bone deformities and require lifelong transfusion therapy, iron chelation and/ or bone marrow transplantation for successful control. Aim: To evaluate the haematophysiological status of various TDT patients. Materials and Methods: This is a cross-sectional study conducted in the Hematology Department of SCB Medical College and Hospital Cuttack, Odisha, India. The study was done in the duration of 10 months, from April 2021 to January 2022. The blood samples were collected from 62 diagnosed cases of Beta-thalassaemia. Haematophysiological parameters were studied by asking research questionnaire developed for this purpose and analysing various clinical complaints and laboratory data. The haemoglobin variants were analysed by fully automated capillary zone electrophoresis to confirm the diagnosis of homozygous state of Beta-thalassaemia by decreased or absence of globin chain synthesis (HbA2) of the haemoglobin component. The data was anlysed using Statistical Package for Social Sciences (SPSS) version 19. Results: In the present study majority of the patients 39 (62.9%) were below the age of 10 years. The clinical examination showed anaemia in all the patients with haepatomegaly and splenomegaly in 51 (82.25%) and 57 (91.93%) cases respectively. The mean haemoglobin was markedly decreased to 5.98±1.69 ranged from 3 gm% to 10 gm% followed by Foetal Haemoglobin (HbF) was raised up to 78.39±26.73% (normal absent to 0.02%) and adult haemoglobin (HbA2) was increased up to 8.00±5.72 (normal 95% to 98%). Conclusion: TDT is one of the commonest haemoglobinopathy causing major health problem. Common sign and symptoms includes low-grade fever, severe anaemia and haepatosplenomegaly. The Present study helped the families having TDT beta thalassaemia for early detection and avail the facilities given by Government of Odisha.

Experience of performing Hepatic Interventional Radiological Procedures in a Tertiary Care Hospital in Odisha

Experience of performing Hepatic Interventional Radiological Procedures in a Tertiary Care Hospital in Odisha

Comparison Of Artificial Neural Network and Decision Tree Methods for Predicting the Maternal Outcome in A Tertiary Care Hospital in Odisha, India

Background: This study used an artificial neural network (ANN) and a decision tree to predict maternal outcomes and their major determinants. An artificial neural network (ANN) and a decision tree were used in this study to determine maternal outcomes and their significant determinants. Methods: Data was gathered from 955 pregnant women at a tertiary care hospital in Bhubaneswar, Odisha. A popular machine learning algorithm, artificial neural networks (ANN), was used to predict maternal outcomes and their determinants. Results: in the bivariate analysis, we found gestational age is significantly associated with maternal outcome (p=<0.001). The accuracy of the ANN model and decision tree was 0.882 and 0.823, respectively. Based on the variable importance of ANN, the significant determinants of maternal outcome were birth weight, systolic blood pressure, hemoglobin, gestational age, age of mother, diastolic blood pressure etc. Conclusion: This model can be utilized in future for Proper precautions and medical checkups required during the maternal period to avoid a negative maternal outcome.

A Study on Clinico-Social Profile of Animal Bite Cases Attending an Anti-Rabies Clinic of a Tertiary Care Hospital, Odisha - A Cross Sectional Study

Background: Human rabies continues to be endemic in India and according to a recent estimate 20,000 people die of this disease every year. However at the same time, it is also 100% preventable through timely and proper post exposure prophylaxis. Aims and Objectives: The present study was undertaken to assess the socio-clinical profiles of animal bite cases attending the anti-rabies clinic of a tertiary care hospital of Odisha, to find out the association of socio-clinical factors with Category III bite cases and to study the first aid practices of such patients. Methodology: A hospital based cross section study was conducted at an anti-rabies clinic of S.C.B. Medical College & Hospital, Odisha between the months of January and March 2018. New animal bite cases that gave the consent to participate were included in the study. 20% of the new eligible cases i.e., 1200 were taken by using consecutive sampling of 15 patients per day. A pretested and predesigned questionnaire was used to collect the data. Analysis was done in SPSS. Results: In this study Males (70%). are predominantly affected. About 26% cases were children <15 yrs. Dog bite was seen in 80% cases. Lower limb (60%) was the most commonly the bitten site. A majority had category III (76%) exposure. About 75% bites were unprovoked bites. Most of the cases (55%) came from the rural area. 43% cases applied bitter gourd and turmeric paste on their wounds. Conclusion: From this study, we observed that males have a higher incidence of animal bite than females and most of the cases were >15 years age. The most common animal biting people is a dog. A majority had category III exposure.

Spectrum of magnetic resonance imaging (MRI) patterns in hospitalised hypoxic ischemic encephalopathy babies in a tertiary care hospital of Odisha

Background: Hypoxic ischemic encephalopathy (HIE) refers to the CNS dysfunction associated with Perinatal Asphyxia (PA) which is an important causes of permanent damage to CNS tissue. MRI imaging methods attributes to better understanding of pathological events and disease progression that may provide decision regarding intervention. MRI has a higher sensitivity and is extremely valuable in assessing the extent of hypoxic-ischemic brain damage during the early postnatal period and later infancy. It is also more specific which clearly differentiates fluid filled cavities, oedema, gliosis and hemorrhage. On this background this study was undertaken to evaluate the MRI changes of all grades of HIE patients. They were also followed up at different time intervals for upto 1 year to correlate the MRI changes and neurodevelopmental outcome. Objectives: To find out different MRI findings in hypoxic ischemic encephalopathy babies. Assesment of severity of HIE from MR imaging and correlate these findings with clinical & neurodevelopmental outcome. Methods: All hemodynamically stable HIE babies irrespective of their severity were subjected to MRI between day 7 and day 21 of life and their findings were interpreted.

Maternal and neonatal outcomes among women with and without severe acute respiratory syndrome corona virus-2 infection: A retrospective analytical study.

BackgroundCorona virus disease (COVID-19) is an infectious disease caused by the novel corona virus known as severe acute respiratory syndrome corona virus 2 (SARS Cov-2). Physiological changes occurring during pregnancy can have a positive or negative effect on the disease progression. The objective of the study was to evaluate the maternal and neonatal outcomes in pregnant women with COVID-19 compared to pregnant women without COVID-19 and to determine its influence on the healthcare system.Material and methodsThis was a retrospective analytical study conducted at a tertiary care hospital in Odisha, India, over 3 months, from 1 September 2020 until 30 November 2020. Results were compared in both groups.ResultsThree hundred and three (303) women delivered, out of whom 92 were COVID-19 positive. Incidence of COVID-19 positivity was 30.3% with 93.47% asymptomatic patients. The majority of the patients were 26–35years of age. Average gestational age at delivery for both groups was 37–40 weeks. COVID-19 positivity was seen more in primigravidas than in multigravidas. Comorbidities such as GDM/type 2 DM, PIH, PROM, APH and jaundice were similar in both groups and statistically non-significant, whereas association of anaemia and hypothyroidism were statistically significant (p<0.05) in the positive group. A single maternal death was reported in the positive group. There was an increase in Caesarean section (p=0.002) with higher incidence of preterm births and lowbirth weights in the positive group. Only 3 babies tested positive for COVID-19, so vertical transmission probability was low. Overall, all babies were healthy and the majority of women were discharged without any complications.ConclusionThere was no significant effect of the infection on maternal and fetal outcomes, but further studies and long-term follow-up is needed to look for any delayed effects on the babies and mothers.

Seroprevalence of SARS Cov 2 Immunoglobulin among First Year Medical Students in a Tertiary Care Hospital of Odisha

Introduction: COVID 19 caused by SARS coronavirus two has halted life across the globe since its emergence in December 2019. Most of the infected persons are asymptomatic or have mild symptoms. Serosurvey is vital for the estimation of the burden of infection. In this context, our study objective is to estimate the Seroprevalence of SARS CoV 2 IgG among the first-year medical students after the first wave in February 2021.Method: A cross-sectional study was conducted among the first-year medical students of Veer Surendra Sai Institute of Medical Sciences And Research. All the students were enrolled, and their data &amp; serum sample was collected. Serum samples were tested for the presence of Anti-Spike IgG. Data were analyzed by using appropriate statistical tests.Results: The Seroprevalence of anti-SARS CoV 2 IgG was estimated to be 38.8 %. Most (82 %) of the students used the mask per recommendation. Use of mask, BMI, Contact history with COVID 19 patient, attending social gathering &amp; previous COVID 19 were associated with Seropositivity. Regular mask use, BMI, and Previous COVID 19 were significant predictors for Seropositivity. Conclusion: The Seroprevalence of SARS Cov 2 after the first wave of the pandemic is less than 40 %. It calls for the proper implementation of a vaccination program with strict vigilance and surveillance to stop subsequent waves.

Nonfermenting, Gram-Negative Bacilli Causing Neonatal Sepsis in Odisha, India: Four-Year Surveillance.

IntroductionIn India, blood culture-positive sepsis results in mortality in 33%-35% of affected neonates. Nonfermenting Gram-negative bacilli (NFGNB), particularly Acinetobacter baumannii and Burkholderia cepacia commonly cause hospital-acquired infection.Materials and methodsWe performed a subgroup analysis as part of a prospective study conducted in a neonatal intensive care unit in a tertiary care hospital in Odisha, India, between January 2017 and December 2020. Neonates with blood culture-positive sepsis caused by NFGNB were enrolled in this study. Demographic characteristics of the neonates, clinical features of sepsis, complications, need for supportive care, and blood culture sensitivity patterns were recorded and analyzed.ResultsA total of 168 organisms were isolated in blood cultures during our study period, of which 48 (29%) were NFGNB species. Among these 48 species, A. baumannii (37.5%) and B. cepacia (33.3%) were the most common NFGNB in our study. Neonates with sepsis commonly exhibited feeding intolerance (64.5%), circulatory insufficiency that necessitated vasopressor treatment (54.1%), disseminated intravascular coagulopathy (35.4%), seizures (33.3%), and the need for respiratory support (56.2%). NFGNB were multidrug-resistant (MDR) in 70.8% of cases, and 93.7% of B. cepacia and 55.5% of A. baumannii were MDR.ConclusionsA. baumannii and B. cepacia are NFGNB commonly isolated in neonatal cases of blood culture-positive sepsis. The prevalence of MDR NFGNB sepsis is gradually increasing, which poses a threat to neonates. Strict aseptic precautions and antibiotic stewardship are thus mandatory in perinatal practice.

Antibiotic resistance pattern and clonal relationship of Enterobacter spp isolates from different clinical samples in Odisha, India

Bacteria with increase antibiotics resistant caused serious health treat worldwide. Regular surveillance of resistance spectra and clonal relationship of infectious bacteria are important for appropriate use of antibiotics. In this study, we investigated the antibiotic resistant pattern and clonal relationship of Enterobacter spp isolated from different clinical samples of a tertiary care hospital of Odisha, India. The results of this study indicated the presence of multidrug resistant Enterobacter spp with multiple β-lactamases production. The phylogenetic tree showed three unique clusters of ERIC within the nineteen Enterobacter spp. isolates.

Health profile of security personnel in a tertiary care hospital in Odisha

Health profile of security personnel in a tertiary care hospital in Odisha