Tertiary Care Hospital In India Research Articles

Colistin resistance in carbapenem non-susceptible Acinetobacter baumanii in a tertiary care hospital in India: clinical characteristics, antibiotic susceptibility and molecular characterization.

Acinetobacter baumanii (AB) is a bacterium of concern in the hospital setup due to its ability to thrive in unfavorable conditions and the rapid emergence of antibiotic resistance. Carbapenem resistance in this organism is disheartening, further clouded by the emergence of colistin resistance. The present prospective study aims to note the epidemiology, molecular profile, and clinical outcome of patients with colistin resistance AB infections in a multispecialty tertiary care setup in Odisha, Eastern India. All AB strains received from March 2021 to February 2022, identified by Vitek2 (Biomerieux) and confirmed by oxa-51 genes, were included. Carbapenem and colistin resistance were identified as per CLSI guidelines. Known mutations for blaOXA-23-like, blaIMP, blaVIM, blaKP, lpxA, lpxC, pmrA, pmrB, and plasmid mediated mcr (mcr1-5) were screened by conventional PCR techniques. The clinical outcome was noted retrospectively from case sheets. Data was entered in MS Excel and tabulated using SPSS software. In the study period, 350 AB were obtained, of which 317(90.5%) were carbapenem resistant (CRAB). Among the CRAB isolates, 19 (5.9%) were colistin resistant (ABCoR). The most valuable antibiotics in the study were tigecycline (65.4% in ABCoI; 31.6% in ABCoR) and minocycline (44.3% in CI; 36.8% in CR). There was a significant difference in mortality among ABCoI and ABCoR infections. bla OXA was the predominant carbapenem resistance genotype, while pmrA was the predominant colistin resistant genotype. There were no plasmid mediated mcr genes detected in the present study.

Diagnostic accuracy of Lipoarabinomannan detection by lateral flow assay in pleural tuberculosis

BackgroundLipoarabinomannan (LAM) antigen serves as an attractive biomarker to diagnose Tuberculosis (TB). Given the limitations of current diagnostic modalities for Pleural TB, current study evaluated LAM’s potential to serve as a point-of-care test to diagnose pleural TB.MethodsA cross sectional, diagnostic accuracy study was conducted during February to November 2021 in a tertiary care hospital in India. LAM antigen detection was performed on pleural fluid as well as early morning urine specimen of suspected pleural TB patients by “Alere/ Abott Determine TB LAM” lateral flow assay (LAM-LFA). The results were compared to microbiological reference standards/MRS (Mycobacterial culture or NAAT) and Composite reference standards/CRS (MRS plus Clinico-radiological diagnosis).ResultsA total of 170 subjects were included in the analysis, including 26 with Definite TB, 22 with Probable TB, and 122 with No TB. Compared to MRS and CRS, the sensitivity (61.54% & 45.83%) and positive predictive value (PPV) (57.14 & 78.57%) of Pleural LAM-LFA testing were found to be suboptimal, whereas the specificity (91.67% & 95.08%) and negative predictive value (NPV) (92.96% & 81.69%) of the assay were found to be good. Urinary LAM-LFA performed even worse than pleural LAM-LFA, except for its higher specificity against MRS and CRS (97.2% and 98.3%, respectively). Specificity and PPV of pleural LAM detection increased to 100% when analysed in a subgroup of patients with elevated ADA levels (receiver operating curve analysis-derived cut off value > 40 IU/ml).ConclusionDetection of LAM antigen by LFA directly from pleural fluid was found to be a useful test to predict absence of the disease if the test is negative rather than using as a POCT for diagnosis.

Lipid Profile and Total Antioxidant Status in Major Depressive Disorder Patients in North Indian Tertiary Care Hospital: A Case Control Study

Lipid Profile and Total Antioxidant Status in Major Depressive Disorder Patients in North Indian Tertiary Care Hospital: A Case Control Study

Knowledge, attitude and practice towards Ayurveda among patients attending cardiology and neurology clinics at a tertiary care institute in India.

Background Ayurveda, the Indian system of medicine, has been practised in India since ages. We evaluated the overall awareness regarding Ayurveda among patients attending two specialty clinics at a tertiary care institute. Methods We did a cross-sectional study on patients attending the cardiology and neurology clinics at a tertiary care hospital in India. We conducted this paper-based survey using a standardized, validated questionnaire. Statistical analysis was performed using STATA version 14.2. Results Three hundred and ninety-seven patients agreed to participate in the study. Their mean (SD) age was 45.65 (15.02) years. Among them 68.5% were men and 56.9% were from urban areas. Participants perceived that Ayurveda comprised herbal drugs (77.6%), metallic/herbo-mineral preparations (44.3%), Panchakarma therapy (22.2%) and personalized medicine (37.8%). Principal sources of information were TV promotional programmes (34.7%) and newspaper advertisements (13.9%). Nearly two-thirds (63%) of participants opined that Ayurveda is effective in chronic disorders. Although only 9.1% of participants reported the use of Ayurvedic medicines, 89.2% believed it would be beneficial if the All India Institute of Medical Sciences (AIIMS), New Delhi had Ayurveda services. Three-fourths (75.8%) of respondents were interested to participate in research studies integrating Ayurveda with modern medicine. Conclusion Imprecise knowledge and awareness towards Ayurveda appears to prevail in addition to the low practice among the patients surveyed. We found imprecise knowledge of Ayurvedic therapies and its low usage among patients attending specialized OPDs in a tertiary care hospital. The major source of information reported was promotional advertisements in the print and electronic media. Our survey shows a need for awareness programmes for general public at various levels.

Comparing commercial versus low-cost gelatinous phantoms for ultrasound-guided needle tracking: A randomized crossover trial, among emergency medicine residents.

The objective of this study was to devise a low-cost indigenous gelatin-based vascular phantom and to compare this newly constructed phantom with a commercially available phantom. This was a randomized crossover study conducted at a tertiary care hospital of India. The aim of the study was to develop a prototype low-cost gelatin-based vascular phantom and compare it with a commercially available phantom. Gelatin, psyllium husk, corn starch, antiseptic liquid, food-coloring agent, latex balloons, and metallic containers were used to prepare the gelatin phantom. The newly prepared gelatin model was labeled "Model A" and the commercially available gelatin model was labeled "Model B." Emergency medicine residents (n = 34) who routinely perform ultrasound (USG)-guided invasive procedures were asked to demonstrate USG-guided in-plane and out-of-plane approach of needle-tracking in both the models and fill out a questionnaire on a Likert scale (1-5). An independent supervisor assessed the image quality. The cost of our phantom was USD 6-8 (vs. USD 1000-1200 for commercial phantom). The participants rated the ease of performance and tissue resemblance as 4 (interquartile range [IQR]: 4-5) for both the models "A" and "B." The supervisor rated the overall performance as 4 (IQR: 3-4) for both the models. In all the parameters assessed, model A was noninferior to model B. The indigenously developed vascular phantom was noninferior to the commercially available phantom in terms of tissue resemblance and overall performance. The cost involved was a fraction of that incurred with the currently available commercial model. The authors feel that gelatin-based models can be easily prepared in resource-constraint settings which may be used for USG-guided training and medical education in low- and middle-income countries.

Knowledge, attitude, and practice towards neonatal palliative care of medical and nursing staff in an Indian context: A web-based survey

Objectives: Neonatal palliative care (NPC) is a holistic and interdisciplinary approach towards newborns with life-limiting conditions and encompasses their physical, psychosocial, and spiritual care and the redressal of pain. This study was designed to determine the knowledge, attitude, and practices towards NPC by the medical and nursing staff involved in neonatal care. Material and Methods: It was a questionnaire-based prospective cross-sectional study done at a tertiary care hospital in India by collecting data using the Neonatal Palliative Care Attitude Scale (NiPCAS) survey which has 26 attitudinal questions on a Likert scale. Results: There were 87 participants including 58 doctors (66.7%) and 29 (33.3%) nurses. Almost all of the respondents agreed that palliative care was necessary in neonatal nursing and medical education; but less than half had received education for the same. There was an overall agreement in the organization, resources, and clinician subscale by both medical and nursing respondents. Conclusion: There were similarities and differences in perceptions of NPC between medical and nursing staff. Several facilitators and barriers of NPC were identified. Efforts should be taken to strengthen facilitators while simultaneously mitigating barriers.

Situational Analysis of Selected NCDs-Type 2 Diabetes Mellitus and Hypertension among PLHIV Attending ART Center of Tertiary Care Hospital in India: A Mixed Methods Study.

Antiretroviral therapy (ART) has transformed the life of PLHIV with a longer life expectancy. The rising coexistence of non-communicable diseases (NCD)s especially type 2 diabetes mellitus (DM) and hypertension (HTN) among PLHIV (people living with HIV) is much more complicated and demanding for the health system, patients, and their families. To document the current status of type 2 DM and HTN among known diabetic/hypertensive PLHIV attending ART center, tertiary care hospital of South Gujarat. A mixed method study (cross-sectional survey followed by qualitative in-depth interview) was conducted among 184 PLHIV on ART with history of Type 2 DM and/or Hypertension who were registered and availing services from ART center, tertiary care hospital. Convenient sampling technique was used. All the participants were interviewed using pre-designed, semi-structured questionnaire, during their routine visits. In -depth interview (IDI) has been conducted to explore the delivery of NCD services at ART Centre. Out of 184 PLHIV on ART, the most common co-morbidities were Type 2 DM (46.2%), HTN (39.13%), and 14.67% had both. Among total 184 participants, 64.1% were males and 35.9% were females. Only 22.3% of participants were availing treatment services for the above at tertiary care hospital. The study results showed a range of findings involving ART adherence, BMI, RBS, and BP measurements were included. IDI results described the NCD service delivery at ART Center. Study results suggest that the services received by PLHIV with NCD require an overhauling. Routine monitoring and strengthening of existing services should be focused to upgrade the quality and continuum of the care provided to PLHIV with NCD.

The Relationship between Patient Load and Nursing Staffing Strength in Various Shifts of the Day in Emergency Department of a Major Tertiary Care Hospital in India

Abstract Introduction A hospital has to function 24 hours a day, which makes shift duties almost inescapable for the nurses. However, shift wise staffing of nursing in emergency departments (EDs) of most hospitals continues to parallel that of other clinical departments. Objective The aim of this study was to see the adequacy of staffing in reference to patient load in the different shifts of the day in the ED of a major tertiary care hospital in India. Methods This is a prospective cross-sectional study. The number of patients entering the ED in each shift as well as the number of nurses assigned in each shift were taken from the rotation over a period of 1 week. A single point questionnaire was also administered to all five nurses in each shift over the study period to assess staff perception of patient load in the shift. Ethics approval was taken from institutional ethics committee. Results For calculating the differential patient load in different shifts. We have calculated the average number of registered patients entering the emergency in over 1 week was 24 in the morning shift, 24 in the evening shift, and 81 in the night shift. The average nursing strength was 11 in morning shift, 11 in the evening shift, and 10 in the night shift. The average response from 15 nurses after interviewing them was 1 (overstaffed) in the morning, 2 (properly staffed) in the evening shift (properly staffed), and 4 in the night shift. Conclusion The ratio of registered patients entering the emergency and the number of nurses deployed in each shift does not match, which gives an important view to revise roster in such a way that will not compromise the patient care.

Effect of Integrated Yoga as an add-on therapy in adults with clinical depression - A randomized controlled trial.

Depression is a leading cause of disability and the conventional management has several limitations. Recent studies demonstrated the benefits of yoga in psychological disorders. To evaluate the efficacy of the Integrated Yoga Module (IYM) to standard care with added yogic education on lifestyle modification (YELM) in patients with clinical depression. A PROBE trial was conducted at a single tertiary care hospital in India. Adults aged 18 to 64 with clinical depression were randomized to either an IYM or an active control group using a computer-generated mixed block randomization sequence. Both groups received YELM in addition to standard care and the intervention group practiced IYM, for 8 weeks. The primary outcome was the reduction in depression symptoms assessed using the Beck Depression Inventory (BDI-II), and secondary outcomes involved self-compassion, brief resilience, positive and negative experiences, and quality of life, evaluated at 8 weeks. The mean ± SD age of participants was 32.2 ± 10.0 and 54.3% were females. The IYM group showed statistically significant improvements in BDI-II scores β = -6.7 (95% CI [-10.8, -2.5]; p = .001), resilience β = 0.4 (95% CI [0.02, 0.80]; p = .037), physical health domain of WHOQOL - BREF β = 10.1 (95% CI [0.7, 19.5]; p = .035) and negative emotions (SPANE-N) β = 2.8 (95% CI [0.1, 5.4]; p = .037). However, no significant differences were found in SCS-SF β = -0.3 (95% CI [-0.7, 0.0]; p = .053). IYM as an adjunct is superior to conventional medical management in reducing symptoms and improving positive psychological resources in clinical depression.

Risk factors and trends in neonatal mortality in NICU in a tertiary care hospital in India

Introduction: The most vulnerable period of human life is neonatal period, which accounts for most of the morbidities and mortalities. Most of them are preventable with adequate health-care facilities. Objectives: The aim of the study was to determine the trends of neonatal mortality and identify the risk factors, most of which are preventable and measure the progress of health-care services. Methods: A retrospective study was conducted in neonatal intensive care unit (NICU) of Al-Ameen Children Hospital (AMCH) Vijayapura, Karnataka, India. Data were extracted from paper medical records at AMCH of a period of 1 year and digitized. Data obtained included age, sex and birth weight, place of delivery, morbidity profile, mortality profile, diagnosis, and period of stay in NICU. Results: A total of 648 neonates were admitted in NICU during the study period of 1-year duration, between January and December 2021. A total of 382 (58.9%) infants were discharged on recovery, 65 (10.3%) were referred due to unavailability of advanced surgical intervention, 39 (6%) were discharged against medical advice, 162 (25%) died due to various reasons. Male neonatal deaths outnumbered female neonates (56.8%). Among the total neonatal deaths, 82 (50.6%) were preterm neonates, 73 (45.1%) were term neonates and 7 (4.3%) were post-term neonates. It was noticed that among neonatal deaths, 87 (54.3%) babies were out-born and 75 (46.2%) babies were inborn. In this study, it was noticed that the mortality percentage of the neonate falling in the category of 1.5–1.9 kg was high compared to other categories. In our study, respiratory distress syndrome was the main cause of mortality accounting for 19.1% (31 cases) of total cases and prematurity was the most common risk factor. Conclusion: Improving the standard of antenatal care and encouraging deliveries in institutions having good NICU facility and early identification of risk factors help to reduce the mortality and its complications.

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.

Clinical Evaluation and Management of Varicose Veins of Lower Limb at a Tertiary Care Hospital in India

Objectives Varicose veins are defined as dilated, tortuous and elongated veins in the lower limbs. Being one of the most common chronic vascular disorders of the lower limb, the varicose veins affect approximately 10% of the population. If left untreated, the patient may end up with complications like ulceration. The present study is aimed at evaluating the demography, risk factors, clinical features and management of varicose vein patients attending the Department of General Surgery at a tertiary care hospital. Material and Methods This is a prospective observational study conducted at a tertiary care hospital involving patients with lower limb varicose veins. Demographic factors like age, gender, etiology, clinical features, site of incompetence, type of surgical procedure and postoperative complications were studied. Results Out of 74 patients, majority of them (47.2%) were between 41 and 50 years of age, with a predominance of males (51 cases). Analysis of the history of the patients showed that many were chronic alcoholics (72.9%) and chronic smokers (66.2%). Nearly, 91.8% of them presented with visible dilated veins and pain (60.8%) in the affected limb. The long saphenous vein was greatly involved, and majority of them were managed by saphenofemoral flush ligation + subfascial ligation of perforators (SFFL + SFLP) with minimal postoperative complications. Conclusion Varicosity of the veins of the lower limb is common in patients with long-standing jobs, chronic alcoholics and smokers. Involvement of the long saphenous vein is observed in majority of the patients. Duplex ultrasound is the most sensitive diagnostic procedure and surgery is the primary modality of the treatment.

Genotypic characterization of hypervirulent Klebsiella pneumoniae (hvKp) in a tertiary care Indian hospital.

HypervirulentKlebsiella pneumoniae(hvKp) is an emerging pathogen and causes endophthalmitis, liver abscess, osteomyelitis, meningitis, and necrotizing soft tissue infections in both immunodeficient and healthy people. The acquisition of the antibiotic resistance genes of hvKp has become an emerging concern throughout the globe. In this study, a total of 74K. pneumoniaeisolates were collected and identified by VITEK2 andblaSHVgene amplification. Out of these, 18.91% (14/74) isolates were identified as hvKp by both phenotypic string test and genotypiciucAPCR amplification. The antibiotic susceptibility revealed that 57.14% (8/14) isolates were multidrug-resistant (MDR) and 35.71% (5/14) isolates were extremely drug-resistant (XDR). All the isolates were resistant to β-lactam, β-lactamase + inhibitor groups of antibiotics, and the least resistance to colistin. Of 14 hvKp isolates, all isolates are positive for iroB(100%),followed byiutA(92.85%),peg344(85.71%), rmpA (57.14%), and magA(21.42%) genes. Among serotypes, K1 was the most prevalent serotype 21.4% (3/14), followed by K5 14.3% (2/14). The most common carbapenemase gene was blaOXA-48 (78.57%) followed by blaNDM (14.28%) and blaKPC (14.28%) which co-carried multiple resistance genes such as blaSHV (100%), blaCTX-M (92.85%), and blaTEM (78.57%). About 92.85% (13/14) of hvKp isolates were strong biofilm producers, while one isolate (hvKp 10) was the only moderate biofilm producer. The (GTG)5-PCR molecular typing method revealed high diversity among the hvKp isolates in the tertiary care hospital. Our findings suggest that MDR-hvKp is an emerging pathogen and a challenge for clinical practice. In order to avoid hvKp strain outbreaks in hospital settings, robust infection control and effective surveillance should be implemented.

Assessment of Drug Adherence and Adverse Effects of Disease-Modifying Antirheumatic Drugs (DMARDs) in Patients of Rheumatoid Arthritis Attending a Tertiary Care Hospital in India

Adherence to drug treatment is one of the key factors in treating chronic diseases like rheumatoid arthritis (RA) to maintain remission and prevent functional disability. Poor medication adherence is directly associated with a worse prognosis and an increase in healthcare utilization, adding to a financial burden. Hence, the present study was proposed to assess drug adherence in diagnosed patients of RA attending a tertiary care hospital. The study was initiated after obtaining institutional ethics committee permission, and written informed consent was requested from all the eligible patients before their enrolment. This cross-sectional questionnaire based study was conducted on RA patients attending the rheumatology outpatient department. The patient’s adherence to the drugs prescribed was assessed using the 19-item Compliance Questionnaire Rheumatology (CQR), and the correlation betweendrug adherencewithvariousdemographic,disease,andmedication-relatedvariableswasstudied. After screening 103 patients, 75 patients fulfilling the selection criteria were enrolled, and theirdatawasanalyzed. The adherence measured using the CQR score was in therange of 54.39% to 68.42%, with a mean CQR score of 62.27 ± 2.76.Anegative correlation was found between the CQR score and the number of ADRs (r=-0.12,p>0.05) and age (r=-0.06, p>0.05). A positive correlation was found between the CQR score and variables like sex, education, and number of medications, but none were statistically significant. Unsatisfactory compliance was evident in the present study. Therefore, integrating drug treatment with strategies to improve patient adherence may improve clinical outcomes and quality of life, reducing healthcare costs.

The Prognostic Value of De Ritis Ratio on the Survival Rate of ICU-Admitted COVID-19 Patients During the Second Wave: A Retrospective Study in a Tertiary Care Hospital in India.

Background Prognostic markers are essential for optimizing COVID-19 patient care. This retrospective study examines the prognostic value of the De Ritis ratio (DRR) in intensive care unit (ICU)-admitted patients during the second wave of the pandemic. Methods A retrospective study of four-monthduration (March to June 2021) was conducted on 161 ICU-admitted COVID-19 patients in a tertiary care hospital in India. The data included demographics, comorbidities, laboratory results, ICU admission dates, and survival outcomes. The De Ritis ratio was calculated on day 0, day 2, and day 5. The analyses included descriptive statistics, diagnostic accuracy, and logistic regression. Results Survival rates decreased with ICU stay: day 0 (survival, 58.4%; mortality, 41.6%), day 2 (survival, 54.5%; mortality, 45.5%), and day 5 (survival, 49.5%; mortality, 50.5%). De Ritis ratio's diagnostic accuracy varied, with increasing specificity and negative predictive value (NPV). Logistic regression showed higher day 5 De Ritis ratios, and male gender was associated with reduced survival odds. Conclusion The De Ritis ratio demonstrates promise as an early prognostic marker for COVID-19 patients, with an increase in predictive accuracy over time. The results emphasize the De Ritis ratio's potential as an early indicator of disease severity, offering clinicians a tool to recognize patients at higher risk and enhance the effectiveness of critical care interventions.

Clinical and Microbiological Profiles of Urinary Tract Infections in Febrile Children Aged Six Months to Five Years Attending a Tertiary Care Hospital in India

Clinical and Microbiological Profiles of Urinary Tract Infections in Febrile Children Aged Six Months to Five Years Attending a Tertiary Care Hospital in India

Insight into the Burden of Antimicrobial Resistance among Bacterial Pathogens Isolated from Patients Admitted in ICUs of a Tertiary Care Hospital in India.

Intensive care unit (ICU) patients are prone to develop infections by hospital prevalent organisms. The aim of the study was to determine the bacteriological profiles and their drug resistance pattern among different infections in ICU patients of a tertiary care hospital. The record-based retrospective data of culture reports of the patients admitted to all the ICUs of a tertiary care hospital during the period from January 2020 to May 2022 were analyzed. A total of 3,056 samples were obtained from 2308 patients. The infection rate among ICU patients was found to be 53.40%. Isolates belonged equally to males (50.86%) and females (49.14%). The most common culture-positive clinical specimen received was blood (39.08%) followed by respiratory samples (29.45%). Acinetobacter sp. (33.02%) was the most common organism isolated from various clinical specimens, followed by Klebsiella pneumoniae (20.89%), and Escherichia coli (13.8%). More than 80% of Acinetobacter species were found to be resistant to third-generation cephalosporins, aminoglycosides, and carbapenems, whereas minocycline (56.31% S) and colistin (100% S) were the most effective drugs. Klebsiella sp. was found to be more resistant than E.coli, and the least resistance was observed to be tetracycline (43.97%) and doxycycline (55.84%). Among Staphylococcus aureus, 82.78% of strains were methicillin-resistant (MRSA). Vancomycin-resistant Enterococci (VRE) sp. accounted for 16.67% of the isolates. Evidence-based knowledge regarding the local bacterial organisms and their antimicrobial resistance pattern is pivotal in deciding empirical drug therapy, ultimately leading to the management of antimicrobial resistance (AMR).

The Pregnancy Tele-yoga Module to Combat Stress, Anxiety, and Depression Associated with Pregnancy: An Exploratory Open-label Multicentric Study.

Untreated stress, anxiety, and depression during the perinatal period can lead to adverse maternal and infant outcomes. Yoga, the practice of body-mind-spirit techniques has been shown to reduce stress, anxiety, and depression. The aim of the study was to examine the feasibility and limited efficacy of the 4-week practice of pregnancy tele-yoga module (PTYM) delivered and monitored through an online platform. A multicentric, open-label, exploratory study was conducted in the antenatal clinics (ANCs) of three tertiary care hospitals in India. Pregnant women between 13 and 32 weeks of gestation were invited to participate. PTYM was taught by the trained research staff. A YouTube link demonstrating the PTYM developed by the researchers was shared with consenting participants. Using the Yoga Performance Assessment (YPA), research staff monitored the online performance of the PTYM. Pre- and postintervention, women were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Preintervention, among 162 consented pregnant women, anxiety (62.34%) was the most common mental health condition, followed by stress (55.55%) and depression (45.67%). YPA at the end of week 1, week 2, week 3, and week 4 was 19.45, 21.35, 24.15, and 28.45, respectively. Postintervention anxiety, stress, and depression persisted in 19.78%, 11.44%, and 10.41% of women. Pregnant women with stress (DASS-21 ≥15; n = 90), anxiety (DASS-21 ≥8; n = 101), and depressive (DASS-21 ≥10; n = 74) symptoms after undergoing 4 weeks of PTYM reported significant reduction in the scores. The current study demonstrated the feasibility and limited efficacy of PTYM in ANCs of a tertiary care hospital in India.

Application of center for disease control and prevention standardized antimicrobial administration ratio to an Indian hospital.

Rigorous antibiotic stewardship is advised by international societies to combat rising antibiotic resistance. A major component of these programs is the metric used for antibiotic consumption measurement. A method for standardized antimicrobial administration ratio (SAAR) is suggested by the Centre for Disease Control & Prevention-National Healthcare Safety Network (NHSN). We applied the SAAR method to calculate antibiotic consumption in a tertiary care hospital in India. We also validated a limited sampling approach to calculate SAAR. The prospective study was conducted in three medical intensive care units over a period of 12 months. Monthly antibiotic consumption was measured by the hospital electronic records. Limited sampling was performed by weekly bedside review of the antibiotic orders. Formulae for SAAR calculation were derived from the NHSN guide. SAAR obtained by electronic records and limited sampling were compared to validate this approach. SAAR was calculated as >1 for an Indian hospital (1.49 by electronic records and 1.43 by limited sampling approach). The difference between the two ratios was not statistically significant (P = .47). SAAR in our setting is 1.49, which is slightly higher than the NHSN benchmark. Antibiotic usage (AU) risk adjustment based on data from the NHSN might not be adequate for calculating SAAR for Indian hospitals. There is a need to perform AU risk factor analysis for Indian settings for better defining SAAR in Indian context. The limited sampling approach can be adapted for calculation of SAAR in settings with limited resources.

Assessment of Risk Prediction Using Edmonton Frail Scale and European System for Cardiac Operative Risk Evaluation II among Older Patients Undergoing Coronary Artery Bypass Graft Surgery in a Tertiary Care Hospital in India

Abstract Background: The risk assessment for outcomes of older people undergoing cardiac surgery employ scales such as the Euro-Score II, and STS (Society for Thoracic Surgeons), which use clinical and laboratory data. Some studies have suggested a lower accuracy in older patients. Frailty assessment, using functional parameters, has shown promise in this age group. The aim of this study is to compare the validity of risk prediction of Euro-score II, with the Edmonton Frail Scale (EFS), in older patients undergoing elective coronary artery bypass grafting (CABG). Methods: This was a prospective, observational study of a cohort of patients above 60 years scheduled for elective CABG in a single centre. The patients were graded on the Euro-Score II scale and the EFS scales. The primary outcome of 30th day mortality, and the secondary outcome of immediate post-operative complications during hospitalization were recorded. Results: A total of 487 patients were recruited. The mean age was 68 years. Male subjects comprised 81.1% of the study group. Classification of risk as per the EFS placed 76.3 % as low risk, 23.4% as intermediate, and none were considered to be high risk. The EuroScore II classification placed 86% in the intermediate and high risk groups. The AUC in the ROC (receiver operator curve) for the EFS was 0.793 and for the and EuroScoreII it was 0.752. The 30th day mortality threshold fit occurred at 5/6 score for both EuroScore II and EFS. Euroscore- II sensitivity/specificity was 66.7%/75.1% respectively. The EFS had a sensitivity of 66.7% and a specificity of 77.1%. The ROC curves for the secondary outcomes were not significant. Conclusion: Both scales are of modest value in predicting short-term mortality in older patients, and require further refinements for improving clinical decision-making in the individual patient.