Tertiary Care Hospital In Kolkata Research Articles

Neutrophil-lymphocyte Ratio as Independent Prognostic Factor among Breast Cancer Patients in a Tertiary Care Hospital, Kolkata, India

Introduction: The most important prognostic factor for breast cancer is tumour stage and tumour grade. However, the assessment of the above parameters are time-consuming and require expertise. Thus evaluation of the prognosis of breast cancer is still limited to tertiary care hospitals, with appropriate facilities for histopathological techniques. Recently, inflammatory blood markers have shown a role as a prognostic factor. Out of all the inflammatory blood markers, neutrophil-lymphocyte ratio has emerged as the most useful. Abundant evidence suggests the role of NLR as an adverse prognostic factor in breast cancer. NLR is simple and inexpensive. It can be easily obtained, as the differential count of every patient is done routinely. Thus it can act as an indicator of high-risk patients who are likely to show poor prognosis. Though NLR has been found to play a role in prognosis prediction in breast cancer, much is unknown in this field. Aim: To assess the effectiveness of Neutrophil-Lymphocyte Ratio (NLR) as an independent prognostic parameter among breast cancer patients in a tertiary care hospital in Kolkata, India. Materials and Methods: This observational cross-sectional study was conducted in Department of Pathology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India, where 140 female patients undergoing mastectomy for breast cancer were studied from 1st February 2019 to 31st January 2020. The clinicopathological parameters, histopathological parameters, and molecular subtypes were evaluated. NLR was calculated and related with the other prognostic parameters. Data entry was done in Microsoft Excel and analysis was done using Statistical Package for Social Sciences (SPSS) software version 20.0. One way Analysis of Variance (ANOVA) test and Chi-square test was conducted to assess the relationship of NLR with various other prognostic factors. Results: Out of 140 patients, 78 patients showed NLR values within 1.8 to 3.33. Higher NLR (>3.33) was associated with poor prognostic factors like higher T stage (T4) {17 (53.1%)}, higher stage (stage III) 95 (67.8%), skin involvement 19 (47.5%), Lymphovascular involvement in 23 (39.7%), perineural involvement in 10 (71.4%) and in patients with HER2 positive molecular subtype in 8 (5.7%). Conclusion: This study suggests that a high NLR value was associated with poor prognosis in breast cancer patients. Thus, it can be used as an independent marker of poor prognosis and can help guide the treatment of breast cancer patients. The more we study the role of NLR, the more useful it will be in predicting the course of breast cancer as early as possible.

An observational study on utilization of blood and blood components in a tertiary care hospital of Kolkata, West Bengal

Background: Blood is essential for human survival though it is a scarce and precious resource. Blood Transfusions also have some risks, like immunomodulation in the recipients, transmission of infectious agents, and may lead to serious adverse reaction. Hence, it is necessary to make an efficient use of blood and blood products. Aims and Objectives: With this background, the present study was carried out at the blood bank of Medical College and Hospital, a tertiary care hospital of West Bengal, India to evaluate the utilization pattern of blood and blood components. Materials and Methods: Facility based, observational, descriptive, and cross-sectional epidemiological study was conducted on the basis of secondary data collected from records of blood bank, medical college, Kolkata, regarding blood and blood component transfusion pattern of patients who were admitted in medical college and hospital and received blood and blood components from blood bank medical college, Kolkata during period from September 1, 2021, to September 15, 2021. Results: Total number of transfusion recipients during the study period was 1339. Total 2621 no of blood and blood components were issued. About 66.84% (895) of all recipients were transfused with single unit of blood or blood component. Packed red blood cells were the maximum utilized blood component. The most common diagnosis for patients requiring blood and blood components was anemia. Conclusion: A large proportion of patients were transfused with single unit of blood or blood component, which might not be beneficial. Training, regular meeting with clinicians and periodic assessment of blood usage are recommended to prevent inappropriate transfusion.

Loneliness and Social Support Experienced by COVID-19 Patients Attending a Telemedicine Centre of a Tertiary Care Hospital in Kolkata: A Cross-sectional Study

Introduction: Telemedicine acted as one of the biggest medium in treating Coronavirus Disease-2019 (COVID-19) patients during the second wave of the still ongoing pandemic. Although the symptoms were taken care of and treated through teleconsultation, the loneliness and social support system of these patients went largely unrecognised. The morbidity pattern, effect of self-isolation and quarantine, uncertainties in social support were major contributors to loneliness among patients suffering from COVID-19. Aim: To estimate the proportion of loneliness and level of social support experienced by COVID-19 patients seeking advice from a telemedicine centre of Kolkata and to find out their socioclinical profile and the associated relationship. Materials and Methods: An observational study with crosssectional design was conducted on 403 COVID-19 patients who had taken advice from the telemedicine centre of Institute of Post Graduate Medical Education and Research (IPGME and R), Kolkata for a period of 12 weeks (May-July 2021). Loneliness was assessed by the 11-item De Jong Gierveld Loneliness scale, whereas social support was assessed using 12-item Multidimensional Scale of Perceived Social Support scale through telephonic interview. Data were tabulated in the Microsoft Office Excel 2019 (Microsoft Corp, Redmond, WA, USA) and the analysis was performed using Statistical Package for the Social Sciences (IBM, New York City, USA) version 25.0. Results: Out of 403, more than half of the study population, 194 (48.2%) belonged to 18-35 years of age. Of the total, 235 (58.3%) were males, 319 (79.2%) were currently married and 300 (74.4%) were Hindus. About 142 (35.2%) respondents had experienced severe loneliness, while 297 (73.7%) had experienced high social support. There was a significant negative correlation found between loneliness and social support (r=-0.495, p-value <0.01). It was found that being male, belonging to nuclear family, education upto higher secondary level, being addicted, loneliness due to physical distancing, and those who had socialised frequently had higher odds of loneliness, whereas unemployed, unskilled, semiskilled and skilled occupation, having one chronic disease had lower odds of social support. Conclusion: About 338 (84%) patients had experienced loneliness which was strikingly high. This shows a deeper aspect into the actual picture of how COVID-19 impacts mental health of those who are affected. Future interventions are needed to address loneliness and develop social support system along with addressing healthcare needs of COVID-19 patients.

Effect of Maternal Age and Anaemia on Auditory Brainstem Response of Preterm Infants in a Tertiary Care Hospital of Kolkata, West Bengal: A Cross-sectional Study

Introduction: Adolescent pregnancy and maternal anaemia have a detrimental effect on infant growth and development. They are associated with greater risk of premature births and Low Birth Weight (LBW). Wave Interpeak Latencies (IPLs) of infant Auditory Brainstem Response (ABR) indicate the degree of maturation of brainstem auditory pathways among preterm infants. Previous studies indicated that preterm infants show prolonged wave Interpeak Latencies (IPLs). Whether maternal parameters like age and haemoglobin level contributes to the changes in infant ABR is debated. Aim: To study the effect of maternal age and anaemic status on Brainstem Evoked Response Audiometry (BERA) changes among preterm infants. Materials and Methods: An observational, descriptive study of cross-sectional design was undertaken in the Neurophysiology laboratory of Department of Physiology, RG Kar Medical College and Hospital, Kolkata from December 2019 to December 2022. Total of 119 mother-preterm infant dyads were included. Click BERA was performed on the babies aged between 3 months to 1 year. Absolute and IPLs of wave I,III and V were obtained. Mothers were assigned anaemic status {Haempglobin (Hb) level<9gm/dL} based on the information in their antenatal card. Student’s t test, Fisher’s exact test, one way ANOVA test were used for data analysis. A p-value less than 0.05 was considered significant. Results: Out of 76 adolescent mothers (age between 10 to <18 years), 43 (56.6%) were anaemic. Out of 43 adult mothers (with age ≥18 years), 33 (76.7%) were anaemic. Mothers were divided into four groups, namely adolescent anaemic (n=43) and adolescent non anaemic (n=33), adult anaemic (n=33) and adult non anaemic (n=10). Distribution of data with respect to education years, social class and occupation among four mothers’ group was comparable [p-value>0.05]. Preterm infants born to both anaemic adult [Hedges g=2.51] and anaemic adolescent mothers [Hedges g=1.06] showed dyssynchronous shortening of wave latencies compared to non anaemic counterparts (p-value<0.05). Magnitude of difference with respect to infant ABR for non anaemic adolescent mothers vs non anaemic adult counterparts was large [Hedge s g=1.05] with p-value<0.05. While maternal anaemia showed either shortening or prolongation of IPLs, adolescent maternal age was related with prolongation of the wave I-V. Effect size of maternal anaemia on infant ABR was more than for adolescent maternal age. Conclusion: Maternal anaemia may exaggerate abnormal maturation of the brain stem pathways in preterm infants irrespective of maternal age.

Monkeypox, a global health concern: A study on awareness and adherence to preventive measures among medical students in a tertiary care hospital, Kolkata

Background: The re-emerging Monkeypox disease is spreading worldwide, thus if prevention measures are not followed or awareness is not raised, chaos could result. Aims and Objectives: The present study aimed to assess the awareness and preventive measures of Monkeypox among medical students in a tertiary care hospital of Kolkata. Materials and Methods: A hospital-based, descriptive, observational, and cross-sectional study was conducted over 6 weeks, among final year MBBS students of Medical College Kolkata. Convenience sampling was done. Minimum sample size calculated was 110. A pre-designed, pre-tested, semi-structured, and self-administered questionnaire which was face and content validated by experts used as the study tool in this study. Questionnaire was answered while keeping their identities confidential. Data were collected and entered in a coded manner in MS Excel. Using SPSS version 25, tabulation, the necessary tables, and diagrams were created. The Institutional Ethics Committee of the Medical College in Kolkata was consulted for ethical approval. Results: The students lacked sufficient information. Majority of them responded well when asked about the disease’s cause, incubation period, natural host signs and symptoms, mode of transmission, preventive measures, and treatment, but it was clear that they were unsure about identification of a suspected, probable, or confirmed case and definitive diagnosis. Conclusion: The present study reported that the students had limited knowledge about Monkeypox disease.

Circumstances, Patterns, and Reporting of Incidents of Workplace Violence among Resident Doctors Posted at Selected Departments of a Tertiary-Care Hospital in Kolkata, India

Objective: Violence at work is a major cause of workplace inequality, discrimination, stigmatization, and conflict. The present study intends to describe the pattern of workplace violence (WPV) in a tertiary-level hospital in India with the objectives of discovering the magnitude of self-reported violence, its type, and the circumstances surrounding and response to such incidents.Material and Methods: The study is of a descriptive type. Its participants were either undergraduate or postgraduate residents at the selected hospital. The data collection tool was and a questionnaire adapted from that used in the World Health Organization’s Workplace Violence in the Health Sector Survey. The period of data collection was one month.Results: Three hundred and twenty two completed questionnaires were analyzed; 76.1% of respondents experienced violence at their workplace. The incidents of psychological violence were higher than those of a physical nature (63.1% vs. 42.9%, respectively). Psychological violence was significantly higher during day shifts and in outdoor or emergency room settings, while physical violence was common during night shifts and in indoor wards. Repeat incidents were more commonly associated with psychological violence. Even though most incidents were not reported, 96.0% of respondents considered WPV a major concern, and the improvement of security measures was most widely suggested as a solution to prevent violence at work.Conclusion: The high incidence of WPV in a tertiary healthcare setting reported in this study is in agreement with the findings of similar studies. Improving security measures and doctor- patient communication may help reduce such occurrences. Designing a robust reporting system and conducting regular and thorough audits of violent incidents can help boost the morale of healthcare staffs as well as plan preventive strategies.

Assessment of psychiatric comorbidities and sociodemographic profiles of the patients referred to the general hospital psychiatric unit of a tertiary care hospital in Kolkata, West Bengal

Background: According to the previous studies, psychiatric symptoms are high in patients with physical illness, but the referral rates are much below expectation. Aims and Objectives: Here a descriptive cross-sectional study has been conducted using self designed semi structured proforma to asses the socio demographic profile and psychiatric diagnosis of patient with physical illness referred from other departments in a tertiary medical care centre for consultation liaison (C-L) psychiatry care. Materials and Methods: The study population consists of the patients referred to psychiatry department for consultation purpose from all the other departments in a 4 months period. The data were collected on a self designed semi structured pro forma and all the diagnosis were made according to International Classification of Disease -10 (ICD-10) criteria. Analysis has been done using descriptive statistics. Results: A total numbers of 203 patient has been referred to psychiatry department during the study period . Among them 144 were inpatient and 59 were outdoor based referral. Majority were female, married . The maximum referral were from general medicine department followed by neuromedicine. Most common reason of referral being suicidal attempt by different means followed by patients having depressive features .The most common psychiatric diagnosis was depression followed by delirium. Conclusion: C-L psychiatry plays a significant role in better evaluation and management of patients with psychiatric comorbidities referred from non-psychiatric departments.

A Case Series on Unusual Neck Masses.

Neck masses can be defined as any abnormal swelling or growth from the level of base of skull to clavicle. They can be benign or malignant so a thorough investigation is necessary to reach to a final diagnosis. Here we report a case series of three unusual neck masses presenting to the Out patient Department of Otorhinolaryngology and Head and Neck Surgery in R. G. Kar Medical College, a tertiary care hospital of Kolkata in a span of 1.5 years. The rarity of the etiology behind the neck masses makes this case series unique.

Unusual renal tumor in an infant

: Two-month-old female presented with left loin swelling and pain. The swelling was 8cmx6cm and it was ballotable in nature. It was gradually increasing in size.: To find out the incidence of this rare, high index of suspicion, investigations including cytopathology and histopathology, early diagnosis and management.: The informed consent from the parents of the patient was taken. The study was carried out in a tertiary care hospital in Kolkata. On CT a heterogenous renal mass was detected. Fine Needle Aspiration cytology from the mass showed mature neural elements, squamous epithelium, mature fat cells a few atypical oval to spindle shaped cells. Cytologically diagnosed as mature teratoma. The tumor was excised. Histopathological examination revealed the diagnosis of immature teratoma. : Immature teratoma is one of the rare causes of Pediatric Kidney Tumor.Renal teratoma is an extremely uncommon tumor in infancy. But it is one of the differential diagnoses of renal mass in infants. Diagnosis may be suspected from radiological investigation and confirmed by histopathological examination. A good prognosis can be expected after proper management.

A quantitative assessment of body iron status and its relationship with glycemic control in patients of type 2 diabetes mellitus in a tertiary care hospital of Kolkata

Background: Diabetes is one of the most common disease which is observed in every household of Indian population. The longevity of the diabetic patients is dependent upon the frequency of complication and comorbidity that they encounter. Serum iron and ferritin, both being the aggravators to the oxidative stress accelerating the development of complications, gives us the reason to venture into the territory exploring the possibility of monitoring the body iron stores and taking prevent measures to control such complication. The current study was designed with an aim to knot the relationship between body iron stores and glycemic control in patients of type-II diabetes mellitus.
 Aims and Objectives: To measure the levels of serum ferritin, serum Iron, transferrin saturation and HbA1C and finding out the relationship between body iron stores and glycemic control in patients of Type-II Diabetes Mellitus.
 Materials and Methods: A total of 50 diagnosed cases of type II DM and 50 healthy controls between the age group of 35-65 years were taken following inclusion and exclusion criteria. Body iron stores were assessed by measuring serum ferritin, Serum iron and Transferrin saturation and Glycemic control was assessed by measuring levels of HbA1C.
 Results: A significant increase in serum ferritin, serum iron and Transferrin saturation (P<0.001) was noted in diabetic patients as compared to controls. There was a positive correlation between serum iron and transferring saturation in the diabetic patients.
 Conclusion: The co-morbidities and complications in the Diabetic population can be prevented by monitoring Body iron stores as they can significantly contribute to the oxidative stress leading to the complication and decreased life expectancy. Early detection in the abnormality in the body iron store can help us in employing proper measures for a better management of Type-II diabetic patients and thereby improving their survival.

POS-623 COVID19 IN MAINTAINENCE HEMODIALYSIS PATIENTS - CLINICAL MANIFESTATIONS AND OUTCOMES

The unprecedented pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2, began in December 2019 in China and rapidly spread globally. ESRD patients on maintenance haemodialysis (MHD) are vulnerable to COVID19 due to various comorbidites like Diabetes Mellitus, Hypertension, Cardiovascular disease. There is limited experience about the clinical profile of hemodialysis patients with COVID19 infection.We describe our experience of 35 MHD patients who developed COVID19 at a tertiary care hospital in Kolkata, India. We also compared the clinical and laboratory parameters of critical and non-critical patients. This is a single center, observational, retrospective study, recording the demographic data, exposure history, clinical features, laboratory and radiological findings, treatment and outcome data for all patients with laboratory-confirmed COVID-19 (RT-PCR test) between15 March to 15 Sept, 2020. RT-PCR was repeated every 5 days and a patient was considered as negative for COVID-19 if RT-PCR was negative two times 24 hours apart. Patients were divided into critical (ICU admissions) and non-critical (domiciliary/ward admissions) groups. Out of 394 patients on MHD, 35(8.88%) were found to be COVID-19 positive during these 6 months. 27 (77.1%) patients were symptomatic and hospitalised; 17(48.6%) in wards and 10 (22.9%) in ICU. Rest 8 patients with mild or no symptoms received domiciliary treatment. Common underlying comorbidities were hypertension (88.6%), DM-2 (48.6%), obesity (14.3%). There was no statistical difference in the comorbidities between both groups The table shows clinical symptoms and radiological parameters. 8 (22.9%) patients were asymptomatic and detected on routine screening. Generalized fatigue and fever were the commonest symptoms. Cough, dyspnoea & pneumonia were found to be significantly higher in patients admitted to ICUs. Reason for hospitalization in 70.37 % patients was a lower respiratory tract infection . 51.85 % of the admitted patients developed pneumonia. HRCT chest showed ground glass opacities in 77.1% and consolidation in 42.9%. 50% of the patients in ICU required mechanical ventilation due to hypoxic respiratory failure. 30% required NIV support and 20 % required high flow nasal oxygen. Four patients died due to COVID pneumonia and ARDS. Median time from admission to death was 12 days. Mortality was 11.42% . 24 patients recovered and became COVID-19 negative. Mean time to virus negativity was 16.4 days. Median duration of hospitalization was 14 days (range 4 to 25 days). Laboratory parameters like CRP, LDH, D-Dimer, Serum ferritin levels in the ICU group were higher with significantly lower absolute lymphocyte count. Oxygen saturation levels were lower in the ICU group (Mean-91.8% vs 98% in the Non-ICU group) at the time of admission. Patients receiving MHD are susceptible to COVID19 and hemodialysis centers are high risk areas for cross infection during the pandemic. Increasing preventive efforts, instituting triage and screening, isolating patients of COVID19, contact tracing, and dialysing them in isolated centers would be help in prevention and disease contention.

Study of lipid profile in β thalassemia major pediatric patients with multiple blood transfusion and its correlation with serum ferritin level in tertiary care hospital in Kolkata

Background: β-Thalassemia major is associated with iron overload toxicity. This study was done to investigate lipid profile abnormality in β-Thalassemia major patients and to establish their correlation with serum ferritin. Another motto of this study was to signify deleterious effect of multiple blood transfusion and facilitate to understand how it will affect the lipid profile parameters changes so that we can also prevent early dyslipidemia induced complications like atherogenesis by early detection of lipid profile abnormality and also to establish derangement of lipid profile as an indirect evidence of iron overload.Methods: 102 nos. β-Thalassemia major paediatric patients with multiple blood transfusion (≥10) in age group of 6 to12 years admitted in pediatric ward of tertiary care hospital (NRSMCH) were enrolled. Serum ferritin level and lipid profile were investigated and their correlation were assessed.Results: Among 102 β-Thalassemia major pediatric (6 to 12 years) patients 55.88% were male and 66.67% were Hindu by religion and 69.61% children came from lower socio-economic class. The average value of number of previous blood transfusion was 42.79±7.510. The mean value of serum ferritin was 2263.53±833.904 ng/ml. The average value of serum total cholesterol, LDL and HDL were 153.84±5.428 mg/dl and 97.16±3.982 mg/dl and 29.45±4.445 mg/dl respectively and their correlation with serum ferritin were negative (r=-0.941 and r=-0.964 and r=-0.751 respectively). Average value of serum triglyceride and VLDL were 206.22±67.407 mg/dl and 36.16±3.385 mg/dl respectively and their correlation with serum ferritin were positive (r=+0.606 and r=+0.973 respectively).Conclusions: There was significant lipid profile derangement. As the serum ferritin level increases, serum total cholesterol, HDL, LDL decreases and serum triglyceride, VLDL level increases.

Clinical and Biochemical Profile of COVID-19 Patients Admitted in a Tertiary Care Hospital of Kolkata

Introduction: The disease caused by Coronavirus (COVID-19), is now pandemic all over the world including India. There are different manifestations of the disease from asymptomatic and mild to severe form. Clinical severity varies from country to country. This study was conducted to document different clinical and biochemical profiles in this Tertiary Care Hospital of Kolkata. Aim: The study was done to observe and to compare the clinical and biochemical profile in asymptomatic to mild and moderate to severe symptomatic patients. Materials and Methods: This was an observational study conducted in Medical College, Kolkata, West Bengal, India. The study was conducted from June 2019 to mid-August 2019. Total 573 Real Time Polymerase Chain Reaction (RT PCR) positive COVID patients were included in this study. All patients were examined and investigated with blood parameters. Patients were divided into two groups (Group A-asymptomatic and mild symptoms and Group B moderate and severe symptoms) clinically. Statistical calculators like Statistical Package for Social Sciences (SPSS) and Soccalculator were used and different biochemical parameters were analysed using Chi-square, unpaired T-test to find out significance among these two groups. Results: Among 573 patients, 222 were in group A and 351 were in group B. Fever was the most common presenting feature (69.6%) followed by dry cough and shortness of breath. Other features were malaise/fatigability, diarrhoea and anosmia. Among the co-morbidities hypertension and diabetes were significantly different between the two groups. Among the biochemical parameters Neutrophil-Lymphocyte Ratio (NLR), C-Reactive Protein (CPR), D-dimer, Prothrombin time, Serum Glutamic Oxaloacetic Transaminase (SGOT), Serum Glutamic Pyruvic Transaminase (SGPT) were significantly different between the two groups. Conclusion: In a tertiary care hospital of Kolkata, fever is the most common presentation followed by dry cough and fatigability in COVID patients. Diabetes and hypertension are the common co morbidities. CRP, NLR, D-dimer, prothrombin time, SGOT and SGPT should be monitored to differentiate between mild and severe cases.

Does infertility affect the quality of life of infertile women? A study in a gynecology outpatient department of a tertiary care hospital of Kolkata

Background: Infertility, which is an inability to conceive after a prolonged time period, is a neglected domain of reproductive health. Infertility affects couples physically and psychologically and leads to discrimination and stigma in society, especially to women. Various sociodemographic, physiological, and environmental attributes and access to health care may interplay with the quality of life (QoL) of the women afflicted with infertility. Objectives: The aim of this study was to assess the QoL and its predictors among women diagnosed with infertility. Materials and Methods: A cross-sectional study was conducted among 247 women diagnosed with infertility and receiving treatment for at least 6 months at a gynecology outpatient department in a tertiary care hospital of Kolkata. Results: The mean (±standard deviation) score of total ferti-QoL was 65.76 (±11.15). Differential mean scores were observed in domains of ferti-QoL such as emotional (58.49 ± 12.75), body/mind (47.67 ± 16.14), relational (78.36 ± 15.51), social (60.71 ± 12.43), core (61.31 ± 12.71), environment (80.09 ± 10.77), tolerability (70.95 ± 11.97), and treatment (76.44 ± 10.36). Nearly half of them also reported abuse in terms of verbal (50.6%) and physical (6.9%). On multivariable analysis, unsatisfactory QoL was significantly associated with age above 32 years (adjusted odds ratio [AOR] = 2.76, confidence interval [CI] = 1.07–7.12), increasing duration of infertility (AOR = 1.46, CI = 1.17–1.82), and presence of chronic diseases (AOR = 2.21, CI = 1.01–4.83). Conclusion: There is, till date, no provision of management for women suffering from infertility in the Reproductive and Child Health Programme. The problem of infertility must be considered as a public health problem, and all policymakers, health administrators, and other stakeholders should come forward with exemplary guidelines specially targeted for providing relief to these affected women in every stratum of the health-care system.

The other corona warriors: A KAP study on COVID-19 among janitors and housekeeping staff from a tertiary care hospital in Eastern India

BACKGROUND: Janitors and housekeeping staff are an integral part of our health-care system and are also in the frontline to fight this pandemic. COVID-19 infection is a new disease which currently has no specific treatment and vaccine, but this disease is preventable if there is a high level of awareness. This is especially important for housekeepers as they are unable to get adequate protection unlike doctors and nurses. They also receive less importance and appreciation than other frontline workers. OBJECTIVES: To assess the knowledge, attitude, and practice (KAP) of janitors and housekeeping staff of a tertiary care hospital on COVID-19 and to find out the factors associated with KAP. MATERIALS AND METHODS: An observational study was carried out among 214 janitors and housekeeping staff of a tertiary care hospital in Kolkata. The data were analyzed using SPSS software version 20.0. Each response was scored, and subjects having a total score above the median score of KAP scores were said to have adequate knowledge, positive attitude, and satisfactory practice, respectively. Multivariate logistic regression was done to check the association between KAP of the study population with their sociodemographic profile. RESULTS: About 53.3% of the study population had adequate knowledge, 56.1% had positive attitude, while 62.6% had satisfactory practice (≥median score). Age, posting in medicine & allied departments and surgery and allied departments were found to have statistically significant odds of inadequate knowledge. Odds of having negative attitude was found to be statistically significant in those working as security and kitchen staff and residing within the institution premises. Odds of having unsatisfactory practice was found to be statistically significant in the age group of 34 years and above and those following Islam religion. CONCLUSION: The janitors and housekeeping staff had adequate knowledge on COVID-19, and their attitude was mainly positive with satisfactory practice. However, the proportion of adequate knowledge, positive attitude, and satisfactory practice could have been higher. As the global threat of COVID-19 continues to increase, greater efforts through campaigns that target frontline workers and the wider population are urgently needed.

Deciding the Appropriate Route and Method of Hysterectomy for Women with Benign Diseases: A Cross-sectional Study at a Tertiary Care Hospital, India

Introduction: Different factors may influence the route of hysterectomy for benign indications. Each of the three main approaches of hysterectomy has its own set of risks and benefits. A rational and evidence-based decision to select a right method for a particular patient is necessary to bring about the best possible outcome with least complications. Aim: To compare three groups of hysterectomy, i.e., laparotomy for Total Abdominal Hysterectomy (TAH), Non-descent Vaginal Hysterectomy (NDVH) and Total Laparoscopic Hysterectomy (TLH), with regard to the patient and clinical factors, surgical outcomes and complications, in order to decide the optimum route and method of hysterectomy in a patient with benign disease. Materials and Methods: In this hospital-based cross-sectional study, 120 women, with 40 patients each in the TAH, NDVH and TLH groups, were admitted due to benign gynaecological conditions in a tertiary care hospital in Kolkata, India from May 2013 to April 2014. They were operated, and then followed-up at 6-12 weeks after surgery. All the relevant information, e.g., clinical diagnosis, operating time, intraoperative blood loss, length of stay in hospital, postoperative pain score, intraoperative and postoperative complications, etc., were recorded. Data were analysed statistically by simple proportions and statistical tests, i.e., Chi-square test and F-test. Results: The most common indication for hysterectomy was benign diseases in all the groups, 47.5%, 40% and 37.5%, respectively in the TAH, NDVH and TLH groups. The mean operating time (minutes) was significantly higher in the TLH group (163.5) as compared to the TAH (75.03) and NDVH groups (84.88) (p=0.039). A significantly lesser mean intraoperative blood loss (mL) was observed in the NDVH (85.67) and TLH groups (98.63) as compared to the TAH group (168.47) (p=0.021). The observations in regard to other surgical outcome parameters, i.e., postoperative pain score, hospital stay, were also favourable in the NDVH or TLH group. The complication rate was higher in the TAH group (22/40 or 55%) as compared to the NDVH (14/40 or 35%) and TLH (17/40 or 42.5%) groups. Conclusion: NDVH or TLH is the preferred method over TAH in case of benign uterine disease due to lesser operative morbidity and faster recovery.

Role of histopathology in diagnosis of ovarian neoplasms: Our experience in a Tertiary Care Hospital of Kolkata, West Bengal, India.

Ovarian tumours are known to be diverse biologically, varying from non-malignant to malignant tumours having implication on course of the management and prognosis. To address the paucity of such study on ovarian neoplasm from our region of West Bengal, we planned and executed this study. The aim of the study was to analyse the distribution of various ovarian tumours and classify them according to the biological behaviour, age, laterality, and mode of the presentation. It was a retrospective study done in a tertiary care center of Kolkata, India. A retrospective data of 4 years comprising 84 cases were included in the study from January 2016 to December 2019. All the slides were retrieved from the archives and re-evaluated and cross-checked with patients' clinical history, demographic, and macroscopic findings. Out of these 84 tumours, maximum cases were of surface epithelial neoplasms (69%) followed by germ cell tumours (26.1%). Age interval of 19-40 years accounted for the highest number of individuals with equal predominance of both sites of the ovary. Serous cyst adenocarcinoma was the most common malignant tumour. Histological examination remains the mainstay in the early diagnosis of ovarian tumours and facilitates timely appropriate management of patients, and hence, reduces overall mortality in women.

Phenotypic Characterisation, Virulence Determination and Antimicrobial Resistance Pattern of Enterococcus Species Isolated from Clinical Specimen in a Tertiary Care Hospital in Kolkata

Introduction: Enterococci are usually normal human commensal of gastrointestinal tract predominantly. They are considered as an important nosocomial pathogen now a day due to its intrinsic as well as increasing acquired antibiotic resistance resulting in a great threat to modern Medicine. Aim: To determine prevalence of Enterococci isolated from clinical specimens with special reference to its virulence and antibiogram conventionally. Materials and Methods: A cross-sectional observational study was conducted over a period of two years (January 2019 to December 2020) with 326 Enterococci, isolated from various clinical specimens received by Department of Microbiology. Enterococci isolated from stool samples were excluded. They were identified and speciated conventionally as per standard laboratory protocol. Gelatinase, haemolysin and biofilm formation was determined for each isolate. Their antibiogram was also determined by disc diffusion methods over Blood agar followed by Minimum Inhibitory Concentration (MIC) testing (as per Clinical and Laboratory Standards Institute (CLSI) guideline). All statistical analysis was done by Chi-square test using Software Statistical Package for the Social Sciences (SPSS) version 22.0. Results: Among the total 4516 samples collected, growth of Enterococci was noted in 7.22% cases. Out of them, E. faecalis (84.05%) out numbered E. faecium. Urine was the most predominant (55.22%) sample. 73.93% isolates produced biofilm whereas 18.40% produced haemolysin and 19.94% produced gelatinase. Most of the isolates were susceptible to vancomycin (94.79%) and linezolid (98.77%). High level gentamicin resistance was seen in 54.6% cases. Ciprofloxacin was the most resistant antibiotic. Vancomycin Resistance Enterococcus (VRE) was detected in 5.21% cases only, out of which Van A type was detected phenotypically in most cases. Conclusion: The high rate of resistance to high-level gentamicin could fail treatment of gentamicin in combination with penicillin group of antibiotics. In clinical samples, the emergence of VRE strains makes treatment options more challenging.

Hand hygiene in housekeeping staffs: An assessment of their perceptions and practices in a tertiary care hospital of Kolkata

Hand hygiene in housekeeping staffs: An assessment of their perceptions and practices in a tertiary care hospital of Kolkata

A cross-sectional study on association between diabetic retinopathy and glycated hemoglobin level among type 2 diabetes mellitus patients in a tertiary care hospital of Kolkata

Background: Diabetes mellitus (DM) is a large public health problem which is rapidly increasing globally as well as in India affecting all age groups. Uncontrolled diabetes increases risk of microvascular complications such as diabetic retinopathy (DR). Aim and Objective: The aim of the study was to establish the association between glycated hemoglobin A1C (HbA1C) level and presence and severity of DR. Materials and Methods: The present study was conducted in a tertiary care teaching hospital in Kolkata approved by the institutional Research and Ethics Committee. In this study, 107 Type 2 diabetic patients of 40 years of age and above were taken. Direct Ophthalmoscopy for examination of retina and blood for fasting blood sugar (FBS), post-prandial blood sugar (PPBS), and HbA1C estimation was done. Results: Results were analyzed using SPSS version 20. Chi-square test, Fischer Exact test, Mann–Whitney U and Kruskal–Wallis test were used in statistical analysis as appropriate. Results showed that there was significant association between uncontrolled HbA1C level and presence and severity of DR. Conclusion: Proper screening of HbA1C at an early stage of diabetes can give an alarm to develop DR and thus help people to prevent it. The healthcare workers should make patients aware of the consequences of diabetes and should give advice about the regular checking of HbA1C level at frequent interval.