Tertiary Care Hospital In Delhi Research Articles

Clinical Practice: Estimating the Breakpoints for EUCAST Fast Antimicrobial Susceptibility Testing Using Flagged BacT/Alert Blood Culture Bottles

<i>Introduction</i>: The escalating prevalence of multidrug resistance is a global threat to human health particularly in critically ill patients with bloodstream infections (BSIs). Delay in the administration of the appropriate antimicrobial treatment is associated with higher mortality rates and adverse consequences. This study attempted to estimate the rapid antimicrobial susceptibility testing (RAST) breakpoints directly from flagged BacT/Alert blood culture bottles in clinical practice. <i>Material & Methods</i>: A descriptive, cross-sectional study conducted at a tertiary care hospital in Delhi over a period of two months. The RAST was performed directly from the clinical samples for blood cultures received in our laboratory in parallel with the routine antimicrobial testing as per standard CLSI guidelines. Blood cultures were routinely incubated in BacT/Alert 3D. The inhibition zones were read at 4, 6, 8 and 16-20 hour of incubation as per European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. The identification of the isolates was confirmed by Vitek-2 compact system. <i>Results</i>: In our study, the area of technical uncertainty (ATU) percentage was initially high at 4 hours but decreased significantly in later incubation periods. At 4 hours, none of the <i>S. aureus</i> isolates showed >90% categorical agreement (CA) for any antimicrobial tested. However, clindamycin achieved the highest CA (100%) at 6 hours and 90% thereafter, with no very major errors (VME) or major error (ME). Cefoxitin required 8 hours to reach >90% CA, with no VME observed at any time point, but up to 75% ME at 8 hours. At 4 hours, most antimicrobials had high (>1.5%) rates of VME among <i>Enterobacteriales</i>. By 6 hours, only Meropenem and Gentamicin had >90% CA, with no VME observed for other antibiotics. <i>Conclusion</i>: The RAST method is relatively easy to implement in clinical microbiology labs, offering cost-effectiveness, simplicity, and rapid results, especially in resource-limited settings. However, reporting RAST results can be complex due to potential challenges with CA, VME, and ME, particularly in the initial hours of incubation and within the ATU.

Clinical Spectrum of Heatstroke in a Tertiary Care Hospital during the 2024 Delhi Heat wave Peak

Abstract Background: Heat-related illnesses (HRIs) have a wide spectrum from relatively mild heat cramps to heatstroke in its severest form. The 2024 heat wave in Delhi, with temperatures consistently above 40°C, resulted in over 270 deaths due to heatstroke. This study examines nine cases of classical heatstroke admitted over a 24-h period to a tertiary care hospital in Delhi. Materials and Methods: This is a cross-sectional study of patients presenting to emergency with altered consciousness during the 24-h period just before the culmination of the 40-day long heat wave period. In the absence of alternative etiologies on the investigation, a diagnosis of classical heatstroke was entertained. The sociodemographic details, clinical features, investigations, treatment, and outcomes of nine such patients are being reported. Results: Common symptoms observed in the patients were hyperthermia (100%), dehydration (100%), altered sensorium (100%), vomiting (33%), and seizures (33%). Laboratory findings showed respiratory alkalosis (100%), hypokalemia (88.8%), thrombocytopenia (88.8%), and transaminitis (77.7%). Eight heatstroke patients required mechanical ventilation. Despite intensive treatment, three patients died, whereas six were discharged in stable condition. Conclusion: The 2024 heat wave in Delhi highlighted the severe impact of extreme heat on health. The spectrum of clinical features in classical heatstroke has been outlined. The impact of heat wave was such that even normal individuals accustomed to high-heat environments developed HRI. Early recognition and rapid cooling are crucial in managing heatstroke. Improved public awareness, healthcare infrastructure, and management protocols are essential to mitigate the effects of future heat waves.

Immature platelet fraction in patients diagnosed with COVID-19.

The recent pandemic caused by the newly identified virus, SARS-Cov-2 is associated with thromboembolic events. Patients infected with COVID-19 have been found to have thrombocytopenia. A decrease in platelet count may be caused by increased destruction and consumption of platelets or by decreased production of platelets in the bone marrow. Immature platelet fraction (IPF) is a new platelet parameter that is an indicator for peripheral destruction and consumption of platelets. To assess the immature platelet fraction (IPF) in patients infected with COVID-19. The present study is a retrospective study where secondary data obtained from previous laboratory records of COVID-positive patients admitted at a tertiary care hospital in Delhi from 4 January to 4 February 2022 was analyzed. Sixty-eight COVID-positive patients were included. Platelet parameters included from the automated hematology analyzer Mindray were platelet count, mean platelet volume (MPV), immature platelet fraction (IPF), and platelet large cell ratio (P-LCR). Data was analyzed using SPSS Version 25. A P value less than 0.05 was considered statistically significant. In the present study mild thrombocytopenia was noted in 40% of the patients infected with COVID-19 admitted to the hospital. The median platelet count in these patients was found to be 91,000/mm3 (64,000-1,31,000). Low platelet count was associated with a significantly higher IPF, MPV, PDW, P-LCR, and a significantly lower PCT as compared to patients infected with COVID-19 with normal platelet count. There was a significant increase in IPF with a decrease in platelet count (P value < 0.05). A significant increase in IPF was noted with an increase in MPV and P-LCR (P value < 0.05). The present study suggests that thrombocytopenia in patients infected with COVID-19 may probably be due to peripheral destruction and consumption of platelets.

Emerging role of vitamin D deficiency as a risk factor for retinal venous occlusions and need for public health measures for its prevention.

To estimate levels of serum vitamin D in patients of retinal vein occlusion (RVO) and compare with age- and sex-matched controls. A prospective case-control study of 54 patients of RVO and 54 age- and sex-matched attendants of patients presenting to a tertiary care hospital in Delhi was performed. Patients on vitamin D supplementations and RVO due to infective or immunological causes or patients of glaucoma were excluded. Serum vitamin D levels of all the study participants along with relevant blood investigations with history and examination were documented. Vitamin D deficiency was defined as <20 ng/ml. The mean serum vitamin D levels seen in RVO patients and the control group were 14.19 ± 5.23 ng/ml and 19.42 ± 10.27 ng/ml, respectively (P value = 0.001) with an odds ratio of 10.558 (CI = 2.34-47.50), indicating vitamin D deficiency to be strongly correlated with RVO. Maximum patients of RVO (46.3%) were seen during the winter season. The study noted hypertension [odds ratio 20.22 (CI = 5.812-70.347)], dyslipidemia, and anemia [odds ratio 4.107 (CI = 0.62-26.90)] to be the risk factors for RVO as previously proved in the literature. Smoking, diabetes, alcohol intake, and body mass index did not emerge as risk factors for RVO. Vitamin D deficiency is associated with RVO; hence, estimation of serum vitamin D levels should be advised as a part of routine investigations while looking for the cause of RVOs. Public health measures like food fortification with vitamin D micronutrients and public awareness towards increased sunlight exposure in the community are simple, inexpensive measures that can decrease the burden of sight-threatening disease of RVO in the community.

Journey of Guillain Barre syndrome from the pre-pandemic era to the pandemic era: A 4-year retrospective study.

To study demographic and clinical profiles of Guillain Barre syndrome (GBS) in the pre-pandemic and coronavirus disease 2019 (COVID-19) pandemic era and to compare the GBS incidence, severity, and its outcome in the pre-pandemic and pandemic eras. This is a 4-year retrospective study done in a tertiary care hospital in Delhi, India, between March 2018 and March 2022. Patients were divided into the pre-pandemic era and pandemic era (2 years before and 2 years after March 2020). The number of patients (N) was 25 in the pandemic/vaccine era, while N = 49 in the pre-pandemic era. The mean duration of hospitalization was significantly higher (P = 0.03) during the pandemic era (10.68 ± 6.67 days) compared to the pre-pandemic era (7.59 ± 3.55 days). There was no statistical difference in age (P = 0.56), gender (P = 0.70), GBS variants (P = 0.40), clinical spectrum, antecedent infection (P = 0.91), Hughes Disability Score on admission and discharge (P = 0.93 and P = 0.52, respectively), respiratory involvement requiring a ventilator (P = 0.19), and mortality (P = 0.26) in both the eras. Our study showed no association of the incidence of GBS with the ongoing COVID-19 pandemic. The mean hospitalization days were significantly increased during COVID-19 in view of associated respiratory involvement. The commonly held hypothesis of the increase in GBS cases during the pandemic/vaccine era has not been observed in our study.

Gait analysis and geriatric syndromes: An association among elderly patients attending a teaching hospital of Delhi

ABSTRACT Background: Gait abnormalities are prevalent, affecting a substantial portion of the elderly population, and leading to mobility limitations, reduced quality of life, falls, hospitalizations, and premature death. Objectives: The study aims to assess gait patterns among individuals aged 75 years and above attending the geriatric OPD of a tertiary care hospital in New Delhi and evaluate their association with various geriatric syndromes. Materials and Methods: This cross-sectional study, conducted at a tertiary care hospital in Delhi, from May 2019 to November 2021, involved 100 participants aged 75 and above. It encompassed a thorough assessment protocol covering demographics, health history, clinical and functional evaluations, depression, cognition, balance, frailty, urinary incontinence, polypharmacy, nutrition, comorbidities, and gait analysis. Results: In this study of elderly individuals, the mean age was 78.56 years, and the mean BMI was 23.11. The participants had an average of 1.74 comorbidities, with hypertension being the most prevalent (62%), followed by diabetes (25%), chronic obstructive airway disease (COAD) (11%), and coronary artery disease (15%). Geriatric assessments revealed varying proportions of frailty (34%), polypharmacy (40%), and urinary incontinence (9%). The mean scores for activities of daily living, instrumental activities of daily living, nutritional status, cognitive function, Timed Up and Go Test, and depression scale were also reported. Various gait parameters demonstrated significant correlations with these geriatric factors, including frailty, comorbidities, BMI, and mobility scores. Conclusion: The study identified significant associations between gait patterns and various geriatric syndromes, emphasizing the importance of gait analysis in assessing the health and mobility of elderly individuals.

Health education: A vital tool in changing environmental hygiene knowledge, attitudes and practices among food handlers in a tertiary care hospital of Delhi

BackgroundEnvironmental hygiene in food establishments is an important determinant of health. Health education package using combination of strategies is essential in preventing cross-contamination. ObjectiveTo determine change in environmental hygiene knowledge, attitudes and practices among food handlers following implementation of health education intervention. MethodsA before and after interventional study was conducted on 111 food handlers of food establishments in a tertiary care hospital of Delhi in 2021–22. Tool based on WHO & FSSAI guidelines was prepared with a scoring system to rate environmental hygiene knowledge (0–12), attitudes (0–10) and practices (0–12) including cleaning of surfaces, pest control, waste disposal & segregation, packaging of food along with utensil washing steps (0–10). Health education was given and scores on same tool were reassessed after 8 weeks of intervention. Nail bed swabs were taken as an indicator of bacteriological contamination. ResultsThe differences of mean scores of knowledge, attitudes and practices before & after intervention were statistically significant differences of 9.95 ± 0.95, 8.02 ± 0.68 and 7.91 ± 1.16 respectively (p < 0.05) while utensil washing practices before and after intervention were 2.78 ± 0.59 & 6.77 ± 0.74 with statistically significant difference of 3.99 ± 0.85. Before intervention, pathogenic organisms were isolated in nail bed swabs of 91 % of study participants while after intervention it was 12.6 %. Common species isolated were Klebsiella spp. (55.5 %), E. coli (15.9 %), Staphylococcus spp. (10.9 %) and Acinetobacter spp. (9.9). ConclusionImprovement in environmental hygiene KAP emphasizes need of ensuring implementation of existing guidelines. Thus, health education using planned combination of channels and strategies can achieve desired change.

NUTRITIONAL STATUS OF PERSONNEL CONTROLLING TRAFFIC IN A TERTIARY CARE HOSPITAL OF DELHI: A PROSPECTIVE PILOT STUDY

Background: Traffic controllers work in the middle of innumerous noisy and polluting vehicles and endure physical strain in an environment polluted by fumes, exhaust of vehicles, use of blowing horns, blow of dust in the air, etc. Their stressful lives often make them resort to unhealthy food choices, ill-timed and unbalanced meals, leading to many problems. Objective: The present study aimed to analyse the nutritional status of personnel controlling traffic in a tertiary care hospital of Delhi through the ‘ABCD’ approach of nutritional assessment: Anthropometric, Biochemical, Clinical and Dietary status to get a fair idea about their individual nutritional needs. Methodology: It was a prospective analysis done in hospital of Delhi by assessing anthropometry, biochemical, clinical parameters, and dietary status on a sample size of 48 personnel controlling traffic. Results: The results of the study showed that only few of the subjects were of appropriate weight (29%), were consuming adequate calories (18.75%), and were consuming adequate proteins (16.66%). Majority of them had health problems with deranged blood parameters and many were also subjected to substance abuse and had very little and inaccurate nutritional knowledge. Conclusion: The study highlighted the need for proper nutrition education sessions for them and the importance of nutritional counseling amongst them. Better health outcomes can thus be hoped with this prospective study in the target population.

THE AWARENESS AND PRACTICES OF POSTNATAL CARE IN MOTHERS DELIVERED AT A TERTIARY CARE CENTRE: A HOSPITAL-BASED STUDY Authors

Introduction: The postpartum period is the most crucial phase in a mother’s life. The unawareness of postpartum care can have disastrous consequences on both the mother and newborn. This study helps in the identification of gaps in postpartum care by studying awareness and practices in our postnatal women. Methods: This cross-sectional studywas conducted at a tertiary care hospital in Delhi, India between July 2022 to May 2023.Ethical clearance was obtained. About 200 postnatal women were enrolled in the postnatal clinic during their follow-up visit at six weeks of delivery. After informed consent,the details were collected as per the predesigned proforma. The awareness and practices on breastfeeding, family planning, and postpartum health were recorded. Results: Among 200 women, the majority were in the age group of 25 to 30 years. About 51% were multipara and 33.5% were graduates and most belonged to upper lower socioeconomicclass. About 86.5% were aware of exclusive breastfeeding practice and 81.5% had awareness of family planning methods. About 73% of our participants were aware of postnatal danger signs. The prevalence of anemia was 70.4% and 56.5% were noncompliant with iron and calcium supplements. Conclusion: Postnatal care constitutes an indispensable component of maternal health care. The high prevalence of postpartum anemia and non-compliance to iron and calcium intake among our postnatal mothers calls for an urgent need to emphasize counseling regarding the diet as well as iron and calcium prophylaxis during the discharge of postnatal women.

Out-of-pocket expenditure for antenatal care among women in a tertiary care hospital - A cross-sectional study

Background: The government of India has promoted several initiatives to provide support to all women during their pregnancy. Despite this, various studies report out-of-pocket expenditures (OOPEs) amongst antenatal women nationwide. Aims: We wanted to assess OOPE amongst antenatal women attending the outdoor patients’ department in a tertiary care hospital in Delhi. Materials and Methods: A cross-sectional study was conducted in 405 antenatal women attending the outdoor patients’ Department of Gynaecology and Obstetrics, VMMC and Safdarjung Hospital, New Delhi. During outpatient department hours, data were collected through purposive sampling in September 2022 using a self-developed, pre-tested interview schedule. Results: Median OOPE during the antenatal period was 5000 (interquartile range: 2350–9003) INR. The highest median cost for OOPE was reported for laboratory investigations, followed by the purchase of medicine(s) and consultation charges (at private facilities). Ninety-six per cent of the participants met OOPEs via salary, wage or pension. Conclusions: Our study reported OOPE amongst antenatal women visiting the outdoor patients’ Department of Gynaecology and Obstetrics of a tertiary care hospital. A substantial majority of participants were meeting their OOPE through salary, wage or pension. These findings underscore the financial burden faced by individuals during the antenatal period, particularly in accessing essential healthcare services.

Are we ushering into the pre-antibiotic era: alarming trends of antibiotic resistance in chronic otitis media in a tertiary care hospital in Delhi, India

Background: Chronic otitis media is an infection of the middle ear cleft for at least 12 weeks or more. It has a high prevalence rate in India pertaining to factors like malnutrition, overcrowding and poor hygiene. Thanks to greats like Paul Ehrlich and Alexander Fleming, Antimicrobials are a powerful and readily available form of treatment for this disease. Methods: In this study we re-evaluated the changing trends in bacteriological profile of COM and the antibiotic sensitivity pattern to most of the currently available antibiotics in a tertiary care hospital in India. Results: Most common pathogens found in our study were Pseudomonas aeruginosa, Staphylococcus aureus, Proteus mirabilis, Proteus vulgaris, Enterococcus, Escherichia coli and Morganella morganii. A declining pattern in the sensitivity towards commonly used antibiotics with an alarming increase in MRSA was observed. Conclusions: The trends observed in our study warrant an urgent need for antibiotic policies, judicious use of antibiotics and vigilance in our hospitals.

A Study of Clinical and Socio-Demographic Profile of Elderly Patients with Opioid Use Disorder on Agonist Treatment Attending a Tertiary Care Teaching Institute of India

Background: Opioid use is one among the major substance of use in Indian population which is not only seen in younger age group but rather is an upcoming concern in the elderly population as well. Opioid agonist treatment for opioid use disorder is a better way of management, among which buprenorphine is a safer option. Despite, being an important area of health concern, opioid use is poorly studied in the geriatric population. Objective: To study the clinical and socio-demographic profile of elderly patients with opioid use disorder on agonist treatment attending a tertiary care teaching institute of urban Delhi. Method: A retrospective study was done in an OPD based opioid treatment centre of a tertiary care hospital in Delhi to analyze the socio-demographic, clinical profile, pattern of opioid use disorder and opioid agonist treatment (Buprenorphine) in elderly Indian population over a year. The data collected was further analyzed for descriptive and analytic statistics using SPSS version 23.0. Results: A total of 32 subjects of age &gt; 60years, with predominant male population having mean age of 63.6years we seen. They had heroin use by inhalation route as a major opioid use. The main source of referral was by friends and self with significant medical and psychiatric comorbidities that was seen in the elderly group. An average dose of 2.34mg of Buprenorphine was found to effectively manage the geriatric opioid use disorder. Conclusion: Opioid Used Disorder is common in Geriatric population and is often associated with both psychiatric and medical co-morbidities. Opioid agonist treatment is an effective approach in management of elderly cases of opioid use disorder. Declaration of Interest : None

A study of sexual dysfunction in females having major depressive disorder

Introduction: Major depressive disorder has the highest lifetime prevalence of any psychiatric disorder and negatively impacts sexual functioning in many patients. Females hesitate to discuss sexual problems due to cultural barriers. So sexual dysfunctions are under-reported and under-studied. Method: This is a cross-sectional study to evaluate the pattern of sexual dysfunction in 18 to 40-year-old married females having major depressive disorder attending psychiatry OPD in a tertiary care hospital in Delhi, India. The severity of depression was assessed by the Hamilton Depression Rating Scale (HAM-D), and sexual functioning was assessed by the Arizona Sexual Experience Scale (ASEX) and Female Sexual Function Index (FSFI) scales. Data was analysed using SPSS. Mean and standard deviation (±SD) were used to describe quantitative data meeting normal distribution. As appropriate, the chi-square or Fisher’s exact test was used to compare categorical data amongst independent groups. Results: 64% and 56% of participants in drug naïve and on-treatment groups respectively had sexual dysfunction as per ASEX scale as compared to 10% of controls. As per the FSFI scale, 84% and 76% of participants of drug naïve and on-treatment groups had sexual dysfunction compared to 20% of the control group. Of all domains of sexual functioning, domains of desire, arousal, and orgasm were most commonly affected. Conclusion: This study showed a high prevalence of sexual dysfunction in depressed females emphasizing the need for direct inquiry about sexual problems by the treatment provider and appropriate management for the benefit of patients.

Effect of COVID-19 Pandemic on Knowledge, Attitude and Practices Towards Antenatal Care Among Antenatal Women: A Study From a Tertiary Care Hospital in Delhi, India.

Effect of the COVID-19 pandemic on knowledge, attitude, and practices toward antenatal care among antenatal women. Prospective observational study. After taking written and informed consent, 3000 term/near-term SARS CoV2-negative antenatal women admitted to the hospital for emergency were enrolled; excluding those in advance labour or critically ill. An interview was conducted and a knowledge, attitude, and practices (KAP) questionnaire was filled out based on verbatim answers. All women were then given individualized antenatal and postnatal care as per hospital protocols and discharged accordingly. The data obtained during the study was recorded on predesigned case proforma and analysed at the end of the study using the SPSS v. 23 software, after the application of appropriate statistical tests. All women knew about the pandemic and its signs and symptoms along with precautions to be taken. Most of the women 2652 (88.4%) thought that they were at increased risk of contracting an infection during pregnancy and 2208 (73.6%) thought that coronavirus can harm the baby and will increase the risk of pregnancy. Awareness of nearby health facilities providing antenatal care was in 71.2% and 94% were aware of functional outpatient department services but only 1.4% were aware of teleconsultation services. About 2094 women have had any ANC visits. All of them knew that taking iron, Ca and vitamin supplements and getting an ultrasound and investigations were necessary but only 1524 (50.8%) took these supplements regularly, 1752 (58.4%) got their ultrasound done and 41.6% got investigations done. Two thousand four hundred thirty-six (81.2%) women had this fear that they would contract COVID-19 infection during their visit to the hospital. All the respondents of our study wanted to have hospital delivery and knew that it was necessary to have ANC registration and none of them wanted to have home delivery. Mastering correct knowledge will foster a positive attitude among antenatal women and will not only prevent disease transmission but also improve pregnancy outcomes.

Effectiveness of health education package on hand hygiene knowledge, attitude, and practices among food handlers in a tertiary care hospital in Delhi.

Food handlers can serve as a medium for potential foodborne infections through contaminated hands, posing a public health hazard. Poor handwashing practices among them can be a source of foodborne illnesses through cross-contamination. Health education intervention using multiple channels is one of the most effective tools for improving hand hygiene behavior. This study aimed to determine the change in hand hygiene knowledge, attitude, and practices (KAP) among study participants following the implementation of a health education intervention package. A before-and-after intervention study on 111 food handlers of food establishments in a tertiary care hospital in Delhi was conducted in 2021-2022. A tool was prepared with a scoring system to rate the hand hygiene KAP of food handlers. Health education was given to all, and scores on the same tool were reassessed after 8 weeks using an interview schedule and observational checklist based on the World Health Organization (WHO)'s five keys and Food Safety and Standards Authority of India (FSSAI) guidelines. The intervention package included a health talk, audiovisual aids, and a demonstration of handwashing steps. The mean scores of hand hygiene KAP improved significantly after the intervention with a difference of 5.24 ± 0.95 (P = 0.02), 3.14 ± 0.42 (P = 0.03), and 4.18 ± 1.97 (P = 0.03) out of total scores of 7, 5, and 15, respectively, with maximum improvement seen in practices of a duration of handwashing >20 seconds improving from 6.3% to 81.1% (P < 0.05) after the intervention and least improvement in use of towel or napkin to turn off tap improving from 2.7% to 4.5% after the intervention, respectively. The study findings conclude that handwashing with soap and water and following the steps of handwashing are one of the most important practices to improve hand hygiene practices. It emphasizes the need to ensure the implementation of the existing guidelines for food establishments strictly in medical institutions. Thus, education on hand hygiene using a combination of channels in medical institutions should be meticulously planned and held at regular intervals to achieve the desired change.

Trends in seroprevalence of enteric transmitted hepatitis virus infections at a tertiary care hospital in Delhi: a 4-year review

Background: Hepatitis A virus (HAV) and hepatitis E virus (HEV), both enteric hepatitis viruses, are transmitted through the feco-oral route. These infections can range from asymptomatic or subclinical cases to acute viral hepatitis, occasionally leading to mortality. To gain an understanding of the disease and develop effective management strategies, comprehending the disease burden is essential. This study aimed to provide insights into the prevalence of enteric transmitted hepatitis viruses among individuals with acute hepatitis in the Delhi region. Methods: A retrospective investigation was conducted at a prominent tertiary care super specialty hospital in Delhi, spanning from February 2019 to December 2022. Serum samples from patients suspected of having hepatitis and sent for HAV and HEV testing were included. The samples underwent enzyme-linked immunosorbent assay to detect HAV and HEV immunoglobulin (Ig)M antibodies. Collected data was analyzed using SPSS software version 21, employing Chi-square and Fischer exact tests where applicable. Results: Throughout the study period, a total of 1275 samples were incorporated. Viral etiology was evident in 197 patients (15.45%). Among these, IgM HAV was identified in 142 patients (11.13%), and IgM HEV was present in 55 patients (4.31%). HAV infection was notably more prevalent in the pediatric age group (20.89% or 89/426; p&lt;0.001), while HEV was significantly more common among adolescents and adults (5.77% or 49/849; p&lt;0.001). Conclusions: Regular surveillance of enteric transmitted viruses causing hepatitis should encompass both hospital and community levels to accurately gauge disease burden and evolving epidemiology.

Pre- and Post-COVID-19 Appraisal of Antimicrobial Susceptibility for Urinary Tract Infections at an Outpatient Setting of a Tertiary Care Hospital in Delhi.

This study was conducted to understand the effect of the COVID-19 pandemic on urine culture and sensitivity results in an outpatient setting. There are plenty of data from inpatient and ICU settings but there is a paucity of data in outpatient or community settings. Thus, this study primarily targeted change in antibiotic resistance of urinary tract infection (UTI) agents in the pre- and post-COVID-19 period. In the study, urine samples received in the Department of Laboratory Medicine (microbiology laboratory) with a preliminary diagnosis of UTI between April 2019 and March 2021 were analyzed. Urine cultures and antibiotic susceptibility tests of the patients included in the study were examined in two periods (pre-pandemic and post-pandemic). A total of 22,372 urine samples were received in the pre-pandemic period (April 2019 to March 2020) and 4885 samples in the post-pandemic period (April 2020 to March 2021). The positivity rate obtained from urine cultures sent post-COVID-19 pandemic (16%) was significantly higher than those sent before the COVID-19 pandemic (8%). According to cultures and antibiogram results, resistance to ampicillin, amikacin, ceftazidime (p < 0.05), co-trimoxazole, levofloxacin, gentamicin (p < 0.05), nitrofurantoin, fosfomycin, and tetracycline decreased compared with the pre-COVID-19 period. In this study, we found that the frequency of significant bacteriuria increased significantly in the post-pandemic period. However, resistance to antibiotics decreased significantly in the post-COVID-19 period compared to the pre-COVID-19 period. There was no significant change in the etiology of UTI during the two time periods.

Dermatological Adverse Effects of Covid-19 Vaccine among Healthcare Workers: Findings from a Tertiary Care Hospital in Northern India

Objectives: The objective of this study was to identify the cutaneous manifestations that developed after covid-19 vaccination, with Covaxin and Covishield, in healthcare workers (HCW) and to identify any associated factors. Materials and Methods: A cross-sectional study was conducted over 3 months using an online and offline questionnaire that was circulated among the HCW working at a tertiary care hospital in Delhi. All the vaccinated HCWs who gave consent (n = 676) (n = number of participants) were included in the study. Data were summarised in an excel sheet and then analysed using SPSS, version 25. Results: Out of the 676 vaccine recipients, a higher number of participants were vaccinated with Covishield compared to Covaxin. Only 14 (2.0%) subjects developed new adverse dermatological manifestations following either vaccination. A higher incidence of adverse reaction was observed with Covaxin than with Covishield, but the difference was not significant. A significantly higher number of vaccinated paramedical workers developed new dermatological manifestations in the study period [P-value (probability value)] (P = 0.018). Conclusion: Our study demonstrated a low rate of cutaneous adverse reactions following vaccination with either Covaxin or Covishield. Further studies are hence needed to corroborate our findings.

Increased Pill Burden and Adverse Effects of Psychotropics Correlated with Poor Quality of Life and Medication Nonadherence: A Cross-sectional Drug Utilization Study at a Tertiary Care Hospital in Delhi during COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to an increase in mental health problems such as depression and anxiety. This study aims to investigate the prescribing pattern of psychotropic drugs in patients with common mental disorders which might be altered during the pandemic and also whether the pandemic could alter their quality of life (QOL) and medication adherence. After prior ethical approval, a descriptive cross-sectional drug utilization study (DUS) of 200 prescriptions was undertaken to evaluate the pattern of psychotropic drug usage as per WHO (World Health Organization)/International Network of Rational Use of Drugs (INRUD) guidelines. The correlation of the average number of drugs per prescription with QOL was observed. The correlation of adverse drug reactions (ADRs) with medication adherence was also analyzed. The average number of drugs per prescription during the pre-COVID-19 and COVID-19 period was estimated to be 2.48 and 2.96. The percentage of drugs prescribed by generic name in the two different periods (pre-COVID-19 and COVID-19) was 97.40 and 95.77%. The percentage of drugs prescribed from the list of essential medicines was 89.40 and 85.12%, respectively. The percentage of prescriptions with injections was 0.45% and 0.53%, respectively for the two periods. The QOL during the COVID-19 pandemic was found to be negatively correlated to the average number of drugs per prescription (correlation coefficient = -0.61) and medication adherence was found to be poor in patients who developed ADRs with the drugs prescribed (p-value of 0.001). In the tertiary care hospital described, rational drug prescribing was followed. Increase in the number of drugs per prescription was found to be associated with poor QOL and the development of ADRs led to medication nonadherence in the patients. Further studies with larger sample sizes are needed to confirm these results. How to cite this article: Kumar A, Halder S, Srivastava S, et al. Increased Pill Burden and Adverse Effects of Psychotropics Correlated with Poor Quality of Life and Medication Nonadherence: A Cross-sectional Drug Utilization Study at a Tertiary Care Hospital in Delhi during COVID-19 Pandemic. J Assoc Physicians India 2023;71(9):14-18.

Effect of COVID-19 on the Burden and Profile of Orthopaedic Patients Admitted Post-Resumption of Routine Services in a Tertiary Care Hospital in Delhi.

Purpose On resumption of routine services post-lockdown during coronavirus disease 2019 (COVID-19), we expected a backlog of orthopaedic patients who could not get appropriate and timely care and would now present with complications due to missed or delayed treatment. This study aimed to quantify the effect of COVID-19 on the burden and profile of orthopaedic patients admitted post-resumption of routine services. Materials and methods Data on all the patients admitted to the orthopaedic department were collected using an interviewer-administered schedule for a complete one-year period after the resumption of routine orthopaedic services in a tertiary care hospital in Delhi. For comparison of the burden of trauma patients with that during the pre-COVID-19 period, data were obtained from a similar study done on trauma patients in 2017 at the same institution. For patients with non-traumatic conditions, previous hospital records were used. Results A total of 1585 patients were admitted during the one-year period post-resumption of routine services following COVID-19 restrictions, which was 41% less than that compared to the corresponding pre-COVID-19 data. The proportion of patients from other neighbouring states showed a decline from 52% in the pre-COVID-19 period to 41.55% when healthcare services resumed during the COVID-19 period. Out of all admitted trauma patients in 2021, 12.7% presented with a missed or complication of treatment as compared to 3.1% in the pre-COVID period. Around half of them (52.5%) attributed their complications to a COVID-19-related lockdown. Conclusion There was a significant decline in the number of patients post-resumption of routine orthopaedic care services. Converting whole tertiary care teaching hospitals to COVID-19-dedicated hospitals must not be done as it leads to an increase in missed or complication of orthopaedic treatment.