Tertiary Care Hospital In Kashmir Research Articles

Clinico etiological spectrum and antibiotic sensitivity profile of bacillary dysentery in a tertiary care hospital in Kashmir, India

Background: Diarrheal disorders along with dysentery constitute the second killer infections in childhood. In fact, more than half of the dysentery cases are recorded in children under 9 years of age. Shigella infection comprises well over 60% of dysentery cases in age group of 6 month to 5 years. Shigella flexneri is the commonest etiology encountered in developing nations. E. coli and campylobacter comprises the second important bacterial isolates in childhood dysentery. The objective of this study was to ascertain the clinical spectrum, etiological profile and local antibiotic sensitivity of the enteropathogens isolated.Methods: 147 serial dysentery cases admitted in GB Panth hospital Srinagar, which is an associated hospital of government medical college Srinagar from October 2014 to September 2015 were taken up for the study. A thorough and detailed history and examination was taken and recorded as per the proforma. Freshly collected stool sample was subjected to gross and microscopic examination; and after due bacteriological instructions was cultured on enrichment and selective media as per the need. Antibiotic sensitivity was done using disc diffusion method.Results: Maximum cases occurred in 1-5 years age group. Malnutrition grades II and III recorded the highest admissions. Most of cases had moderate dehydration. Although not frequent severe anemia, paralytic ileus and renal failure were the commoner complications. Shigella was grown in 12.24% of cases. Among them Shigella flexeneri serotype was encountered in 65% patients. Drug resistance was seen for many of the antibacterials like amoxycillin, ampicillin, norfloxacin, cotrimoxazole and nalidixic acid. However, they were susceptible to ceftriaxone and amikacin in well over 80% cases. E. coli isolates had similar antibiotic sensitivity profiles, with most susceptibility to amikacin and ceftriaxone.Conclusions: Drug sensitivity and resistance pattern is a variable phenomenon and changes from place to place and time to time. Hence there is a need to document the local pattern of an area so as to guide a judicious antibiotic administration.

Therapeutic drug monitoring of phenytoin using high performance liquid chromatography in a tertiary care hospital of Kashmir, India

Background: Phenytoin is the most commonly used anti-epileptic drug (AED) in this set up due to cost effectiveness and easy availability. Significant fluctuations in serum phenytoin levels leading to toxicities or treatment failures make it an ideal candidate for therapeutic drug monitoring (TDM).Methods: Patients of age ≥18 years who were put on phenytoin were enrolled in this study. Estimation of serum phenytoin levels was done using HPLC. Data was analysed using SPSS version 20.0. Chi square test, Kruskal Wallis test were used to analyse the data.Results: A total of 105 patients enrolled in the study, twenty patients (19%) had normal or therapeutic serum phenytoin levels. Thirty-nine patients (37.2%) had sub therapeutic serum phenytoin levels, while forty-six patients (43.8%) had toxic serum phenytoin levels.Conclusions: The TDM of phenytoin should adopt a multi-disciplinary approach with active involvement of neuro-physicians, pharmacologists, pharmacists and other technical staff for improving the overall management of epilepsy. TDM data will provide the clinicians with greater insight into the factors determining the patient’s response to drug therapy.

The Spectrum of Histopathological Patterns Observed in Prostate Specimens in a Tertiary Care Hospital in Kashmir

The Spectrum of Histopathological Patterns Observed in Prostate Specimens in a Tertiary Care Hospital in Kashmir

Neonatal acute kidney injury in a tertiary care hospital in Kashmir, Jammu and Kashmir, India

Background: Acute kidney injury (AKI) is a common entity in neonates admitted to the neonatal intensive care unit (NICU). Neonatal AKI is associated with increased morbidity and mortality and a greater risk of chronic kidney disease among the affected ones in future. Objectives: The objectives of this study were to study the incidence and outcome of neonatal AKI in our NICU. Materials and Methods: This single-center retrospective study included all infants who were admitted in a tertiary care hospital, J and K, from June 2013 to May 2014. Neonates, who had known congenital kidney diseases or if they did not survive beyond the first 48 h of life or had a hospital stay for <24 h, were excluded from the study. AKI was defined according to the kidney disease: Improving global outcomes criteria. Both AKI and non-AKI neonates were followed up until NICU discharge. Outcomes studied included mortality and length of NICU stay. Results: A total of 1439 neonates were studied among whom 72.89% (1049/1439) were normal weight, 11.46% (165/1439) were low birth weight, and 15.63% (225/1439) were very low birth weight. Of 1436 studied, 72% (1036) were term babies and 28% (403) were preterm babies. Perinatal asphyxia accounted for 43% (620/1439), seconded by neonatal sepsis 31.6% (455/1439) as a cause of NICU admission. Incidence of neonatal AKI in our study was 8.33% (120/1439). Mortality rate among the neonatal AKI patients was 34.1% (41/120). Conclusion: Our study shows an incidence of 8.3% among the NICU patients with a high mortality rate of 34.1%, implying a heightened awareness and very close monitoring of renal function during hospitalization and after discharge in such infants.

Economic Burden of Rabies: An Experience from a Tertiary Care Hospital in Kashmir, India

Background: Post-exposure prophylaxis (PEP) is the mainstay of prevention in suspected exposure to rabies virus. Exposed patients are able to obtain anti-rabies vaccine in the anti-rabies clinic pro bono but they have to pay for passive immunization and cover other associated costs.
 Aim: To estimate and analyze the direct and indirect costs of rabies PEP.
 Methods: This study was conducted on 429 patients, who were exposed to bites from various animals and reported to Shri Mahraja Hari Singh Hospital (SMHS), an associated tertiary hospital of Government Medical College, Srinagar, Kashmir. Patient socio-demographic profile, details of animal bite exposure, the cost incurred for PEP was collected. The data were analyzed using a descriptive statistic.
 Results: The study revealed a total median cost incurred on patients for receiving a PEP as 29.3 USD (United States Dollar), with an Inter-quartile Range (IQR) of 0.2 USD to 43.1USD. The direct median cost was 20.5 USD with an IQR of 6.2 USD to 29.4USD, while the indirect median cost was 20.3USD with an IQR of 13.5USD to 24.4USD.
 Conclusion: Post-exposure prophylaxis imposes a significant economic burden to bite victims especially those of low socio-economic strata for whom the cost is substantial.

Clinico-Socio Demographic Profile of Children with Autism Spectrum Disorders from a Tertiary Care Hospital in Kashmir, India

This case study describes the journey of a kindergartner with Down Syndrome in an inclusive classroom. Characteristics of the participant are discussed in comparison to characteristics of children with Down Syndrome and the impact of those characteristics for the child’s overall development. Various strategies that were effectively used to facilitate the child’s participation, transitioning, academics, and social skills are addressed. The child’s improvements in various areas of development as a result of inclusion in the kindergarten classroom are discussed. Finally, investigating the efficacy of inclusion for children with moderate to severe intellectual disabilities is recommended for further research.

The Pattern of Psychiatric Morbidity in Chronic Obstructive Pulmonary Disease: A Cross-Sectional, Case-Control Study from a Tertiary Care Hospital in Kashmir, North India.

Introduction:Psychiatric morbidity has an increased prevalence in chronic obstructive pulmonary disease (COPD). Patients overall psychosocial status plays an important role in the development of depression which, when major, is said to occur in 19%–42% of cases of COPD. We aimed to study patterns of psychosocial issues in patients with COPD.Materials and Methods:This study was conducted over a period of 6 months in an Outpatient Department of Government Chest Disease Hospital Srinagar. A total of 100 COPD patients and 100 sex- and age-matched controls were included in this study and compared. The diagnosis of COPD was assessed by spirometry. Patterns of psychiatric morbidities were assessed using the Mini-International Neuropsychiatric Interview.Results:The frequency of psychiatric comorbidities was significantly higher (P < 0.001) in COPD patients (47%) as compared to controls (12%). The highest frequency of psychiatric morbidities in COPD patients was major depressive episode in 28% in comparison to 9% of controls. Other morbidities include panic disorder, dysthymia, generalized anxiety disorder, and suicidality.Conclusion:The frequency of psychiatric morbidities is increased in COPD patients as compared to controls. We recommend that all patients with COPD should be screened for psychiatric morbidity as there is enough scope for psychiatric services to be made available to these patients.

A prospective study on quality of life in patients with pulmonary tuberculosis at a tertiary care hospital in Kashmir, Northern India

BackgroundPulmonary Tuberculosis (PTB) is a contagious, airborne infection that destroys when M. tuberculosis primarily attacks the lungs. PTB is curable with an early diagnosis and antibiotic treatment. Stigmatization and negative emotions resulting from the illness could result in long term impairment of patients psychological well being which may result in work absenteeism resulting in loss of productivity and reduced monthly income. MethodsThis was a prospective study which was conducted over a period of one and half year. A total of 198 patients were recruited for the study. Quality Of Life (QOL) was assessed at baseline and at the end of intensive phase. For QOL WHO based QOLBREF was used. ResultsIn the present study patients scored lowest in the baseline physical (8.36 ± 1.60) followed by the psychological domain (10.40 ± 1.72) however at the end of intensive phase both physical (11.98 ± 1.70) and psychological (12.75 ± 1.) domains improved very much and the difference was statistically significant. ConclusionWe conclude that HRQOL is significantly reduced in patients with PTB, and that it improves rapidly and significantly with DOTS-based intensive phase of treatment. Special focus on reduction of stigmatization should be given in the management of TB to reduce the psychological distress.

The Pattern of Psychiatric Morbidity in an Outpatient Child Psychiatry Clinic: A Cross-sectional, Descriptive Study from a Tertiary Care Hospital in Kashmir, North India.

Background:Psychiatric disorders are ubiquitous and affect not only adults but also children and adolescents. The age factor plays an important role in the pattern of these psychiatric disorders. The objective of our study was to find the pattern of psychiatric morbidity in children and adolescents at the child and adolescent outpatient service of a tertiary care hospital.Materials and Methods:A semi-structured questionnaire was used to record the sociodemographic status. The state of mental health and psychiatric morbidity was assessed after a thorough clinical assessment. Intelligence quotient was assessed by a clinical psychologist as and when needed. All the diagnoses were made on the basis of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria.Results:A total of 529 patients were included. Most patients belonged to the age group of 6–16 years (70.5%). Boys (67.9%) outnumbered girls. Most of the patients were from rural background (56.7%) and from nuclear families (53%). Attention-deficit hyperactivity disorder (31%) and mental retardation (29%) were the most frequent diagnoses, followed by pervasive developmental disorders (10%). Comorbidity was present in about 18% of our patients.Conclusion:The child psychiatry is gaining acceptance, and children and adolescents with minor mental health issues are being identified and referred for specialized services.

Profile of Strabismus at a Tertiary Care Hospital in Kashmir

Profile of Strabismus at a Tertiary Care Hospital in Kashmir

Antibiotic Resistance in Helicobacter pylori: A Mutational Analysis from a Tertiary Care Hospital in Kashmir, India

Background:Helicobacter pylori infection is recognised as type 1 carcinogen by the International Agency of Research on Cancer. Previous studies in our hospital have revealed high prevalence of H. pylori in our population with a high recurrence rate after completion of treatment. This prompted us to undertake this study. Aim: This study aimed to determine common gene mutations leading to resistance to clarithromycin, metronidazole, tetracycline and quinolones in H. pylori in patients attending our hospital. Settings and Design: This is a cross-sectional hospital-based study. The study was approved by the Institutional Ethics Committee. Materials and Methods: This study was conducted on 196 adult dyspeptic patients with an indication for upper gastrointestinal endoscopy. Gastric biopsies collected from them were subjected to histopathological examination, rapid urease test (RUT) and culture. Of the 196 patients, 95 met the inclusion criteria. Drug susceptibility testing (DST) by various polymerase chain reaction-based methods was done for 47 RUT-positive biopsies and 13 H. pylori isolates. Results: Maximum resistance was seen to metronidazole (81.66%) followed by clarithromycin (45%) and quinolones (3.33%). No high-level resistance was seen to tetracycline. In clarithromycin-resistant cases, A2142G mutation was more prevalent than A2143G mutation. Multidrug resistance (resistance to metronidazole and clarithromycin) was seen in 41.66% of patients. Conclusions: Tetracycline and quinolones could be the antibiotics of choice in the eradication of H. pylori in this region, while recurrence of the infection with H. pylori could be expected among patients receiving either metronidazole or clarithromycin, for eradication therapy. DST should be done on a routine basis utilising both phenotypic and genotypic methods to prevent further emergence of resistance in this region.

Laparoscopic totally extraperitoneal repair of inguinal hernia using three-dimensional mesh: a 5 years experience at a tertiary care hospital in Kashmir, India

Background: Inguinal hernia repair by laparoscopy is gaining acceptance worldwide. A flat mesh used in laparoscopic inguinal hernia repair is associated with more complications especially early and late postoperative pain owing to the need of mechanical fixation of this mesh. A three-dimensional mesh in this context is an emerging alternative which needs no or minimal fixation.Methods: A retrospective study of 123 patients was carried out from July 2012 to August 2017. All patients who underwent TEP by a single surgical team using three-dimensional mesh were included in the study. Data collected was analysed retrospectively.Results: Out of a total of 123 patients, 114 patients had unilateral hernia and 9 had bilateral hernia. A total of 132 laparoscopic hernia repairs were done using three-dimensional mesh. All the patients were male aged 29 to 75 years with a mean age of 51.5 years. Indirect hernias were more common comprising of 87.7%. The mean operative time was 46.9 minutes. The average mesh fixation time was 12.6 minutes. No major intraoperative complications were noted in any of the patients. Three patients (2.45%) experienced severe postoperative pain. Most of the patients 117 (95.12%) were discharged within 24 hours of surgery. Mean hospital stay in our study was 1 day. The mean length of follow-up was 12 months. Mild persistent groin pain was found in four patients (3.25%). Seroma was noted in five patients (4.06%). Hematoma and wound infection was noted in none. One patient (0.81%) had recurrence after completion of follow up. We found use of 3D mesh costly.Conclusions: Laparoscopic inguinal mesh hernioplasty using 3D mesh is a viable alternative of hernioplasty with minimal post-operative pain and recurrence and using 3D mesh has a technical advantage of easy insertion in an anatomically correct position with minimal fixation.

A Preliminary Study of Adverse Drug Reactions in a Tertiary Care Hospital of Kashmir

Purpose: To study the adverse drug reactions (ADR’s) reported from Dermatology ward in SMHS hospital of Srinagar. The adverse drug reactions were analyzed by Naranjo’s causality assessment scale and the outcomes were studied. Methods: This observational and cross-sectional study was conducted for one month of July 2018 in an inpatient setting of Dermatology ward of SMHS hospital. The data collection was done only in Dermatology ward. Patients of all age groups and either sex were included in this study. The adverse drug reactions were assessed for their causality by performing the Naranjo’s algorithm scale. The outcomes were studied. Result: Total 3 adverse drug reactions were reported from Dermatology ward. 20-40 years age group was studied for adverse drug reactions. The most commonly affected organ is the Skin 2 (66.66%), followed by Reproductive system 1 (33.34%).The 3 reported ADR’s were Acute Urticaria in 2 patients and Azoospermia in 1 patient. According to Naranjo’s algorithm scale, out of 3 suspected ADR’s 2 (Azoospermia: Cyclophosphamide and Acute Urticaria: Sulfasalazine) were probable and 1 suspected ADR (Acute Urticaria: Tetanus Toxoid) was possible. Out of 3 patients, 2 with Acute Urticaria recovered while as patient with Azoospermia continued with the problem during study.Limitations: Study was conducted only in one ward i.e., Dermatology and patient number was also less.

The pattern of psychiatric comorbidities in globus: A cross-sectional study from a tertiary care hospital in Kashmir, North India

Background and Aims: Globus is the physical sensation of a lump in the throat presenting as difficulty in swallowing. Since there is a paucity of literature regarding the psychiatric comorbidity in globus, we aimed to study the psychiatric comorbidities in these patients visiting a tertiary care center in Kashmir. Materials and Methods: It was a noncontrolled, noninterventional, cross-sectional, hospital-based study carried out from August 2014 to July 2015 among the patients with a diagnosis of globus. Patients were selected from the outpatient unit, visiting the Institute of Mental Health and Neurosciences Kashmir. About 51 patients with globus who fulfilled the inclusion criteria and gave written informed consent were selected as study cases. For diagnosing psychiatric comorbidities, we used the Mini-International Neuropsychiatric Interview. Results: The mean age of our cases was 39.58 years. Females outnumbered males in cases by a ratio of 3:1 approximately. Psychiatric disorders were seen in 70.588% of globus patients. Major psychiatric disorders seen in our patients were major depressive episode (23.53%) and generalized anxiety disorders (11.76%). Conclusions: Majority of patients with globus who present to a tertiary care center have comorbid psychiatric disorders. We need to screen these patients for such comorbidities and develop a holistic approach for better outcome in such cases.

Clinical profile of enteric fever in tertiary care hospital of Kashmir

Background: Enteric fever is common cause of pyrexia in children and its diagnosis poses several problems, the diagnosis most often remains either as an unsubstantiated clinical impression or a serological diagnosis and occasionally confirmed by blood culture. Typhoid fever is a commonly encountered systemic disease caused by the gram-negative bacteria Salmonella enterica serovar typhi. It is a major public health problem in India. The incidence of enteric fever can be regarded as an index of sanitary measure practiced in our country. Aim of our study was to know the clinical profile, hematological features of clinically and serologically suspected typhoid cases, antibiotic pattern in use, the time to defervescence with the treatment received and over all hospital stay days.Methods: This was a retrospective record file review of all admitted children for pyrexia under evaluation who were clinically suspected as cases of enteric fever and serologically proven by significant titres of O and H antigen and few were culture proven cases of enteric fever carried out at a tertiary care children hospital in Kashmir valley over the period January 2012 to January 2016.Results: During this period, a total of 129 children with typhoid fever were admitted to Pediatric ward. Of the 129 children, 69 (53.5%) were boys and 60 (46.5%) were girls. The age range of the study population was 1 year to 15 years. The predominant symptoms of typhoid fever were fever 123 (95.3%), anorexia/weakness 58 (45.0%), abdominal pain 53 (41.1%), pallor 47 (36.4%), coated tongue 42 (32.6%), headache 30 (23.3%) and gastrointestinal symptoms/ dysentry 9 (7.0%). Diarrhea 25 (19.4%) was more common than constipation 5 (3.9%) in this study. Hepatomegaly 26 (20.2%) and splenomegaly 67 (51.9%), lymphadenopathy 24 (19.4%) and seizure in 5 cases (3.9%) were other major physical findings. Typhoid complications were seen in the form of jaundice (deranged LFTs) 25 (19.4%), abdominal distention 20 (15.5%) and tenderness 14 (10.9%), encephalopathy 5 (3.9%), shock 3 (2.3%) and UTI 4 (3.1%). Blood culture was positive in 36 (27.9%), 20 (15.5%) percent of the isolates were Salmonella typhi, while 16 (12.4%) were Salmonella paratyphi A. low yield was attributed to oral antibiotics received outside hospital setting. Ceftriaxone was used to treat all the patients diagnosed with enteric fever. Oral Azithromycin was added to treatment regime in those patients who were persistently febrile after 6 days. Those patients who were discharged before 14 days, therapy was completed with oral cefixime. The mean duration of hospital stay was 9.6 days for uncomplicated cases. Leukopenia was seen in majority of the patients with mean cell count of 6492.7cubic/mm. The mean time to defervescence in patients who received prior antibiotics was 4 days while that in those who did not receive prior antibiotics was 5 days.Conclusions: Atypical presentations are seen in typhoid fever patients so we need to be cautious about it, clinical symptoms and signs can vary with different regional studies, may be attributed to use of empirical oral antibiotic that alter the clinical presentation of enteric fever. Low culture positivity is due to prior or ongoing antibiotic treatment outside hospital setting. Leucopenia could be an important marker of typhoid. Ceftriaxone is important available cephalosporin for sensitive cases. Combination treatment was used to treat persistently febrile child.

Etiological profile of adult onset seizures: a hospital based prospective study from Kashmir, India

Background: Adult onset seizure (AOS) is considered the epilepsy that start after the age of 18 years. It is a common neurological disorder with multiple etiologies. Objective was to study the etiologies, diagnosis and treatment of AOS in Kashmiri population and to compare its different clinical and etiological profiles in different age groups.Methods: All patients who developed seizure after the age of 18 years were recruited in the current prospective study. In total 144 subjects with AOS were included in this study. The study was done in the Neurology unit of Sher-i-Kashmir Institute of Medical Science, Srinagar- a tertiary care hospital in Kashmir, India from August 2014 to July 2016.Results: Among the 144 recruited subjects, the 25-34 years age group was more susceptible to onset seizures. Generalized tonic-clonic seizure with a percentage of 48.8% was the most common seizure type among the studied subjects. Gender wise males were more susceptible to intracerebral hemorrhage while as cerebral venous sinus thrombosis is more common among females. Among the infection group, encephalitis was a leading causal factor in 10 (6.9%) patients and age wise younger population is more susceptible to encephalitis and central nervous system, while prion disease was more frequent in subjects with age of ≥55. On comparing various cerebrovascular diseases and seizures, ICH was responsible in most number of subjects (12.5%). MRI and EEG (59.7% and 52.8% respectively) findings were abnormal in maximum number of subjects and both findings showed statistically a significant positive correlation (r=0.73; p=&lt;0.01).Conclusions: Idiopathic factors are the main cause of AOS with EEG and MRI being the mainstay for identifying, classifying and localizing seizures among the study patients.

Squamous Cell Carcinoma Lung with Skeletal Muscle Involvement: A 8-year Study of a Tertiary Care Hospital in Kashmir.

Aims:Lung cancer is the most common malignancy throughout the world. Nonsmall cell lung cancer (NSCLC) is the most common type, and squamous cell type is most common in India. Mostly, patients present with chest-related symptoms and signs. Isolated skeletal muscle metastasis (ISMM) is rarely seen. The aim was to see muscle metastasis and its prognosis.Materials and Methods:We are presenting our data of 8 years about this common malignancy with relation to muscle metastasis, either alone or with other system metastasis.Results:Muscle metastasis is seen 1.5% of patients, with male: female of 8:1. Overall median survival was 15 months and progression-free survival was 12 months.Conclusion:One peculiarity seen was ISMM with no pulmonary system and severe paraneoplastic hypercalcemia. Local therapy may be having an impact on overall survival in metachronous muscle involvement.

Pattern of dermatoses in two groups of admitted psychiatric patients: a cross-sectional study from a tertiary care hospital in Kashmir.

Various specific and non-specific dermatological manifestations can be found in patients with psychiatric ailments. Most studies in this regard have been conducted on an outpatient basis and not much work has been done on patients admitted with psychiatric diseases. This cross-sectional hospital-based study involved two groups of admitted psychiatric patients over a period of 1 year, involving 100 patients in each group. In the family ward group patients were admitted with accompanying family members, whereas in the closed ward group patients were kept under custodial care. In the family ward setting, eczema was the most common finding, observed in 29 patients, followed by atrophic scarring in 28 patients, erythema ab igne in 25 patients, and bacterial infections in five patients. Various forms of nail changes were seen in 18 patients. In the closed ward group, most common dermatological involvement was parasitic infestation, seen in 56 patients, followed by generalized pruritus in 53 patients and atrophic scarring in 52 patients. Thirty-eight patients had nail changes. Skin manifestations are more common in chronic neglected psychiatric patients under custodial care. The authors stress upon the importance of familial care provided to psychiatric patients living in custodial settings.

Prevalence and antimicrobial susceptibility of methicillin resistant staphylococcus in a tertiary Care hospital in kashmir

30Apr 2016 Prevalence and antimicrobial susceptibility of methicillin resistant staphylococcus in a tertiary Care hospital in kashmir. Azher Mushtaq , Sheikh Imran , Mohd Yaqoob Bhat and Nazia Hilal.

Species Distribution and Drug Susceptibility of Candida Isolates from Various Clinical Specimens at a Tertiary Care Hospital in Kashmir

Aims: The aim of our study was to identify the distribution of Candida species among clinical isolates and their sensitivity pattern for common antifungal drugs. Study Design: Prospective observational study.