Tertiary Care Hospital In Kolkata Research Articles

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.

Standard for TB care in India (STCI) guidelines- A study on knowledge, attitude and practice among junior doctors of a tertiary care hospital of Kolkata

Introduction: Standards for TB Care in India was produced in 2014 which set out the standard of TB treatment and TB testing & diagnosis in India that should be provided by the RNTCP in all parts of the country. Objectives: to assess the knowledge, attitude and practices regarding Standards for TB Care in India (STCI) guidelines among junior doctors in a Tertiary Care Teaching Hospital of Kolkata. Materials and Methods: An institution-based observational descriptive study, cross-sectional in design, was conducted among 244 junior doctors of a tertiary care Government Teaching Hospital of Kolkata, from May 2016 to June 2016 using a pre designed pre tested structured questionnaire. Results: Though junior doctors had satisfactory knowledge about symptoms of presumptive TB & diagnosis; they had unsatisfactory knowledge regarding drug regimen, follow up sputum, diagnosis of MDR TB, XDR- TB and TB HIV.; they had positive attitude regarding seriousness of TB and regular upgradation of TB knowledge and had discordant practices regarding drug regimen, duration of treatment and TB notification. Conclusions: Structured and periodic training and re-training to ensure continuity of correct knowledge is need of the hour. Keywords: STCI, Junior doctors, Knowledge, Attitude, Practice.

Quality of life and its determinants: A study among cancer patients in radiotherapy outpatient department of a tertiary care hospital of Kolkata

Introduction: Cancer patients suffer a lot physically, emotionally & practically. In some cancer disease quality of life has become an important end point for treatment. Thus quality of life assessment becomes an important issue among cancer patients. Objective: To evaluate the quality of life of cancer patients attending Radiotherapy OPD in IPGMER, Kolkata and to find out, if any association of socio-demographic profile with the quality of life. Materials and Methods: A descriptive type of observational study, with cross sectional study design was conducted among the patients attending Radiotherapy OPD of I.P.G.M.E.R. & S.S.K.M Hospital. Results: The most negatively affected domain by cancer was the psychological domain which had the lowest mean score among all the domains (37.25±16.3). Mean scores in psychological (41.4) and environmental domain (54.3) were significantly (p Conclusions: Most affected by cancer is psychological quality of life. But with longer duration of cancer patients seemed to get adjusted with the suffering. Undergoing surgery not only improved physical perception of health, but also acted as a psychological boost up. Keywords: Quality of life, Domains, Duration of cancer, Cancer related surgery.

Functional outcome of arthroscopic Bankart repair in post-traumatic recurrent shoulder dislocation in a private tertiary care teaching hospital in eastern India

<p class="abstract"><strong>Background: </strong>Recurrent anterior shoulder dislocations are quite common in young patients with Bankart lesions. The open Bankart repair was the gold standard for years, however arthroscopic Bankart repair has gained popularity. The aim of the study was to evaluate the functional results of arthroscopic Bankart repair in patients with post-traumatic recurrent anterior glenohumeral instability.</p><p class="abstract"><strong>Methods: </strong>Patients who underwent arthroscopic Bankart repair for post-traumatic recurrent anterior shoulder dislocation were included in the study. This was a prospective study conducted at a tertiary care Hospital in Kolkata, India between August 2017 to May 2019. All patients were followed up at an interval of 2 weeks, 6 weeks, 12 weeks, 6 months, 9 months and 1 year. Rowe score was used to assess the functional outcomes of the patients.</p><p class="abstract"><strong>Results:</strong> 34 (91.9%) patients reported good to excellent results, whereas only 2 (5.4%) patients had fair outcome and 1 (2.7%) patient demonstrated poor surgical result. The total rowe score improved from 46.62 pre-operatively to 94.20 post-operatively after 1 year (p<0.01). By the end of 1-year follow-up, 35 (94.6%) patients had full range of motion in all the planes. Majority of (89.2%) patients did not have any complications. Only 1 patient out of 37 had a recurrence (2.7%).</p><p class="abstract"><strong>Conclusion: </strong>Arthroscopic Bankart repair is an effective, cosmetic and safe surgical procedure with good clinical outcomes and excellent post-operative shoulder range of motion. This surgical intervention also has low recurrence rate and minimum surgical complications.</p>

A Case-Control Study On Risk Factors Of Breast Cancer Among Women Attending A Tertiary Care Hospital In Kolkata, India

A Case-Control Study On Risk Factors Of Breast Cancer Among Women Attending A Tertiary Care Hospital In Kolkata, India

Changes in antimicrobial resistance and molecular attributes of Salmonellae causing enteric fever in Kolkata, India, 2014–2018

Globally, enteric fever caused by Salmonella Typhi (S. Typhi, ST) and S. Paratyphi A (SPA) remain one of the major diseases of public health importance. In this study, a total of 457 (380 ST, 77 SPA) blood isolates were collected from three tertiary care hospitals in Kolkata during 2014–18. Additionally, 66 (3.4%) ST and 5 (0.25%) SPA were recovered from blood culture of 1962 patients attending OPD of one pediatric hospital during 2016–18. The study isolates were tested for antimicrobial resistance (AMR) profiles; AMR genes; molecular sub-types by PFGE, MLVA and CRISPR. Among the total 446 ST and 82 SPA isolates, fluoroquinolone (FQ) resistance was very common in both serovars. Ciprofloxacin resistance of 24.9% and 9.8% & ofloxacin resistance of 20.9% and 87.8% were found in ST and SPA respectively. Majority (>70%) of the isolates showed decreased susceptibility to ciprofloxacin (DCS). A single point mutation in gyrA gene (S83F) was responsible for causing DCS in 37.5% (n = 42/112) ST and 63% (n = 46/73) SPA isolates. Multidrug resistance (MDR) was found only in 3.4% ST isolates and encoded the genes blaTEM-1, catA, sul, strA-strB, class 1 integron with dfrA7. All MDR ST (n = 15) possessed non-conjugative non-IncHI1 (180 kb) plasmid except one having conjugative IncHI1 (230 kb) plasmid and one without plasmid. The MDR genes were integrated near chromosomal cyaA gene site in ST with/without the presence of plasmid (nonIncH1). Almost 65.7% resistant ST belonged to H58 haplotype. PFGE showed clonally related isolates with 81% similarity in ST and 87% in SPA. Similarly, CRISPR typing showed less diversity among the isolates. However, the isolates (ST and SPA) were found to be more diverse by MLVA typing (D value 0.987 and 0.938). The study reports decrease in MDR and increase in FQ resistance among typhoidal Salmonella isolates over the years giving interesting information for enteric fever treatment.

Relative safety of steroid sparing agents in frequently relapsing, steroid dependent and steroid resistant nephrotic syndrome in pediatric patients

Background: In patients with frequently relapsing nephrotic syndrome (FRNS), steroid-dependent nephrotic syndrome (SDNS) and steroid resistant nephrotic syndrome (SRNS) steroids are either used for prolonged period of time or ineffective. To reduce the degree of steroid dependency and avoid steroid toxicity, several immunosuppressive steroid sparing agents (SPAs) have been proposed to treat these children. The present study tried to study the relative safety of most commonly steroid sparing agent in such children.Methods: A multi-centred, prospective observational study was conducted in paediatric nephrology OPD of two tertiary care hospitals in Kolkata over a period of 24 months. All consecutive children with diagnosed FRNS, SDNS and SRNS who were started on steroid sparing agents were enrolled and followed up for at least 6 months. Records of clinical examination, laboratory tests were collected and measured at the baseline and regular intervals. Safety parameters were noted and statistically analysed.Results: A total 110 patients were screened, examined and enrolled. Levamisole, cyclophosphamide and MMF were commonly used SPAs. Of the two tertiary care hospitals, all the patients of FRNS and SDNS were started with levamisole and SRNS with cyclophosphamide in one set-up, while in the other hospital some SDNS patients were started with cyclophosphamide and SRNS with MMF but without clinically significant outcomes. In comparison with few minor adverse events in MMF group, some serious adverse events were documented in the both cyclophosphamide and levamisole groups.Conclusions: Levamisole being a very efficacious, safe and easily affordable drug, should be used as an initial first line SPA in treating FRNS and SDNS children. The side effect profiles of levamisole and MMF are much more patient friendly.

2217-PUB: Remogliflozin in Indian T2DM Patients: A Real-World Study

Introduction: Remogliflozin is new SGLT2i approved in India. It is prudent to evaluate its effectiveness and tolerability in real world setting. Methods: In this observational study, retrospective data from EMR of tertiary care hospital in Kolkata, India was retrieved. The records of patients who were uncontrolled (HbA1c>7.5) on dual therapy (Metformin + DPP-4 inhibitors/Sulphonylureas) and subsequently treated with Remogliflozin for period of at least 6 months were selected. The records with evidence of active UTI at baseline, receiving injectable antidiabetic drugs or recorded eGFR <45 mL/min were excluded. The effectiveness was assessed in terms of change in HbA1c, FBS, PPBS, body weight after 3 and 6 months of treatment. The safety was assessed by adverse events recorded in medical records in terms of abnormal symptoms, signs or laboratory reported values. The data was analysed using appropriate statistical techniques. Results: Medical records of 120 adult patients (56.7% male) with T2DM was selected. The mean baseline characteristics of the patients in terms of Age, HbA1c levels, FBS, PPBS, weight and BMI was 58±13 years, 8.2±0.6%, 132.8±12.4 mg/dL, 204±28.2 mg/dL, 71.8±5.4 kg and 28.2±2.6 kg/m2 respectively At end of 6 months of add on Remogliflozin treatment , the mean change from baseline in HbA1c, FBS, PPBS, Body weight and BMI was -1.3±0.4%, -17.2±9.2 mg/dL, -56.4±18.4 mg/dL, -4.2±1.8 kg, -1.8±0.6 kg/m2 (P<0.05 for all parameters). The reduction in body weight was more in patients on SUs as compared to DPP-4 inhibitors (-5.2 vs. -2.9kg). At end of 6 months, HbA1c reduced <8% in all patients while 66% achieved target HbA1c of 7%. No events of hypoglycaemia or electrolyte disturbances were reported. Combined incidence of UTI and GTI was 5.8% which were mild. In none of the patients Remogliflozin was discontinued for adverse events. Conclusion: In real world clinical practice, add on therapy of Remogliflozin to existing OHA regimen is observed to be an effective, safe and tolerable option in management of Indian patients with type 2 diabetes mellitus. Disclosure S. Bhattacharya: None. S. Katare: Employee; Self; Glenmark Pharmaceuticals Limited.

Incidence of central venous and Foley’s catheter related bacteraemia, organisms responsible and antibiotic sensitivity pattern: in cardio-thoracic intensive theraputic unit following elective surgery, in a tertiary care hospital of Kolkata, India

Background: Mortality from bacteraemia related to indwelling Central Venous Pressure (CVP) lines could be as high as 12 - 25% and that due to indwelling urinary catheters about 5%, in critically ill patients. Hence, initiation of early and aggressive antibiotic therapy, often even before the culture- sensitivity reports are available is necessary. Objectives of the study was to find out the incidence of bacteraemia related to indwelling CVP catheters &/or Foley’s catheters in post operative patients in Cardio-thoracic Intensive Theraputic Unit (ITU) and to understand the antibiotic sensitivity patterns against the organisms causing such bacteraemiaMethods: 48 hours after their insertion, CVP catheter tips, Foley’s catheter tips and Peripheral blood samples were collected for cultures in 50 patients who underwent elective cardiothoracic surgery, over a period of one year and results were interpreted.Results: Incidence of bacteraemia associated with indwelling CVP catheters was 8% and was caused by both - Gram positive (Staphylococcus aureus, Enterococcus faecium) and Gram negative (Acinetobacter baumanii, Pseudomonas aeruginosa) organisms. Foley’s catheter was not related to such blood stream infection. Vancomycin and Linezolid were effective against the Gram positive organisms; while Piperacillin- Tazobactam, Meropenem, Polymyxin B and Colistin were effective against the Gram negative organisms.Conclusions: Indwelling CVP catheters were associated with blood stream infection in 4 post operative patients in our ITU. An idea about the organisms responsible, as well as their antibiogram may help in early initiation of antibiotics empirically before culture-sensitivity reports are available.

SUN-LB112 Efficacy & Safety After Switchover to Remogliflozin in Indian T2DM Patients - a Real World Study

INTRODUCTON: Remogliflozin is new SGLT2i recently approved in India, but more economical than the previously available SGLT2i. It is prudent to evaluate its effectiveness & tolerability in comparison to other SGLT2i in real world setting. METHODS: In this observational retrospective study, medical data from EMR of tertiary care hospital in Kolkata was retrieved. The records of adult Type 2 diabetes mellitus (T2DM) patients who were on a dual therapy of Metformin plus SGLT2i (Canagliflozin, Dapagliflozin or Empagliflozin) for at least 6 months with adequate glycaemic control (HbA1c to target based on age & duration of diabetes) & subsequently switched over to Remogliflozin 100 mg twice daily because of economic reasons were screened. The day of switchover was considered as index day (Day 1) The patient records whose data was unavailable, metformin dose was altered during period of next 6 months, who had evidence of active UTI on index day, were receiving injectable anti-diabetic drugs or had recorded eGFR <45 mL/min were excluded. The effectiveness was assessed in terms of maintenance of HbA1c, FBS, PPBS, body weight after 3 & 6 months of treatment. The safety was assessed by adverse events recorded in medical records in terms of abnormal symptoms, signs or laboratory reported values during the observation period of 6 months & compared to equivalent period of 6 months before index day. The data was collected & analysed using appropriate statistical techniques. RESULTS: After screening, medical records of 50 adult T2DM patients (54% male) were found to be eligible. The mean baseline characteristics on Index day in terms of Age, HbA1c levels, FBS, PPBS, weight & BMI was 51.3±12.5 years, 6.8±0.4%, 108.7±8.1 mg/dL, 144.5±21.3 mg/dL, 65.5±5.7 kg & 25.8±2.8 kg/m2 respectively. After treatment period of 6-months with Remogliflozin-based regimen, the mean HbA1c, FBS, PPBS, -Body weight & BMI was 6.7±0.8%, 110.3±10.5 mg/dL, 138.5±12.7 mg/dL, 66.3±6.5 kg & 25.9±3.2 kg/m2 Mean change from baseline in HbA1c levels, FBS, PPBS, weight & BMI were-0.1±0.19%, -1.6±7.2 mg, -6.0±8.3 mg, +0.8±0.2kg, & +0.1±0.0.7 kg/m2 respectively. These change from baseline of all above parameters were not found to be statistically significant (P>0.05) No events of hypoglycaemia, disturbance in electrolytes or any unusual adverse events were reported. Combined incidence of UTI & genital Mycotic infection was similar during 6 month observation period as compared to 6 months prior to index day. (8% vs 6%) CONCLUSION: In real world clinical practice, replacement of ongoing SGLT2i with Remogliflozin was observed to provide consistent glycaemic control without any tolerability issues. Hence, novel SGLT2i Remogliflozin can be considered as equivalent alternative for SGLT2i based regimen in management of Indian T2DM patients

Incidence of scrub typhus in a tertiary care hospital in Kolkata, India

Background: Authors aimed to identify incidence of scrub typhus among patients of fever. Scrub typhus is an endemic disease in India caused by Orientia tsutsugamushi, transmitted by trombiculid mites. It is an important cause of acute febrile illness in India. Signs and symptoms include fever, headache, myalgia and GI symptoms and is generally associated with morbilliform rash (&lt;40%), eschar (&lt;50%) which is due to bite of the mite. Abnormal LFTs and lymphocytosis are commonly seen in early phase of illness. It’s often labelled as PUO. Early diagnosis and prompt administration of therapy mostly leads to complete recoveryMethods: Authors screened 100 patients presenting with fever, malaise, headache, with or without rash for more than a week from the month of May to December 2019. Routine blood investigations with fever profile (Dengue NS1 antigen, MP, MPDA, TyphidotM) and cultures were done. Patients in whom no cause of fever could be established, having lymphocytosis, hyponatremia and transaminitis, they were tested for Scrub typhus by using Indirect immunofluorescence &amp; detection of IgM antibody.Results: Total 22 patients were found positive for scrub typhus by using the aforementioned method (22%). Male: Female ratio was 3:4 (9 vs 12). Patients were in the age group of 16-76 years. Lymphocytosis, hyponatremia and transaminitis were cardinal features seen in almost all patients diagnosed with Scrub Typhus.Conclusions: This study will help clinicians to have a stronger suspicion of scrub typhus in undiagnosed febrile patients.

Clinical and Microbiological Profile of Neonatal Septicemia in A Tertiary Care Hospital in Kolkata

Clinical and Microbiological Profile of Neonatal Septicemia in A Tertiary Care Hospital in Kolkata

English

English

Detection of Metallo-β-lactamase producing gene (bla VIM) among gram negative non-fermenting bacteria causing wound infection in patients attending a tertiary care hospital in Kolkata

Detection of Metallo-β-lactamase producing gene (bla VIM) among gram negative non-fermenting bacteria causing wound infection in patients attending a tertiary care hospital in Kolkata

Menstrual hygiene practices among women aged 15-49 years attending a medical college hospital in Kolkata: A cross-sectional study

Background and Aims:Menstruation is a normal physiological process and a key sign of reproductive health in women in the reproductive age group. Poor menstrual hygiene affects the educational activities as well as the day to day activities of women. The objective of this study is to assess the practices of menstrual hygiene among women aged 15-49 years attending a tertiary care hospital in Kolkata and to assess their knowledge regarding menstrual hygiene.Materials and Methods:This was a hospital-based cross-sectional study conducted among the women belonging to the age group of 15-49 years attending the outpatient department of Gynaecology. Predesigned, pretested, semi-structured questionnaire was used as a study tool. Interview method was used for data collection after obtaining informed consent from the participants. Data were analysed by SPSS 20v software. Association between variables was checked by Chi-square test & P < 0.05 was considered as significant.Results:Mean age of respondents was 28.03 ± 7.01 years. The cause of menstruation as a normal body function constituted maximum response (43.5%) whereas the reason was unknown to many (37%). Regarding restrictions during menstruation, it was mentioned that avoiding worshipping was the commonest restriction (90.2%), followed by restriction in diet (32.6%). Use of readymade absorbents was found in most of the subjects (91%) followed by homemade reusable (6.5%) and homemade disposable (2.2%). Around 77.2% of them packed the napkins and disposed in garbage. Those who were aware about menstrual hygiene were found to be practicing satisfactory perineal cleaning (p < 0.05).Conclusion:Health education and awareness programme focusing on menstrual hygiene must be intensified. School curriculum can play a vital role in implementing health education.

Beta-lactamase Profile and Biofilm Production of Pseudomonas aeruginosa Isolated from a Tertiary Care Hospital in Kolkata, India

Introduction: Nosocomial infections caused by Multidrug Resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa) have become a major clinical and public health concern. Moreover, the biofilm production protects the bacteria from antibiotics and thereby makes the drugs ineffective. Aim: To find out the β-lactamases profile of antimicrobial resistance and biofilm production of P. aeruginosa isolated from different clinical specimens of patients attending a tertiary care hospital of Kolkata, West Bengal, India. Materials and Methods: A total of 394 consecutive, non-duplicate isolates of P. aeruginosa were identified from 3559 Gram negative bacilli over a period of two years from July 2016 to June 2018. Identification of the isolates and antibiotic sensitivity testing was performed by using automated method and interpreted. Extended Spectrum β-Lactamases (ESBLs), Amp-C β-lactamase (AmpC) and Metallo-β-Lactamases (MBLs) were phenotypically detected by disk synergy test and MBL-encoding genes were detected by multiplex Polymerase Chain Reaction (PCR). Biofilm production was done by tissue culture plate assay. Laboratory data and test results were statistically analysed in counts and percentages using MS Excel 2010 version. Results: Out of 394 strains of P. aeruginosa 288 (73.10%) were isolated from male patients whereas 106 (26.90%) were isolated from female patients. Maximum number of cases (67.26%) were from adult populations. The resistance pattern showed 72.33% resistance to ticarcillin-clavulanic acid followed by ciprofloxacin (53.80%), levofloxacin (50.25%), gentamicin (51.52%), ceftazidime (CAZ) (45.93%), cefoperazone-sulbactam (40.1%), aztreonam (34.77%), imipenem (33.5%), piperacillin/tazobactum (30.96%) and Meropenem (MRP) (29.18%). Out of 394 Pseudomonas spp. isolates, 204 (51.77%) were MDR. Overall, ESBLs, AmpC and carbapenemase (MBL) production was detected in 145 (36.80%), 51 (12.94%) and 49 (12.43%) isolates by phenotypic methods. By genotypic method 53.34% were carbapenemase producing and blaNDM-1 (68.75%) was the most prevalent carbapenemase gene detected followed by blaVIM (18.75%) and co-production of blaNDM-1+ blaVIM was 12.5%. Biofilm production was observed in 158 (40.10%) isolates. Conclusion: Early detection of these β-lactamases production is crucial not only for epidemiological study and effective infection control practices to limit the spread of infection but also for planning appropriate therapy according to the resistance mechanisms of the MDR strains.

Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata

Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata

A STUDY TO EVALUATE SELF-FOOT CARE BEHAVIOUR IN INDIAN PATIENTS WITH TYPE 2 DIABETES MELLITUS

BACKGROUND:The benefits of self-foot care management are well recognized in type 2 diabetes subjects. However, a substantial proportion of patients don't perform self-foot care assessment at all. We aimed to enumerate the barriers to self-foot care management in Type 2 Diabetes Mellitus (T2DM) patients and factors associated with these barriers. METHODOLOGY: A cross-sectional study of successive 600 type 2 diabetes patients attending routine out-patient diabetes clinics in tertiary care hospitals in Kolkata, India from 1st June 2018 to 31st March 2019.Besides demographic details, patient particulars, laboratory investigations, the questionnaire included 2 direct questions on possible barriers to self-foot care management. The questions were grouped into five categories viz. environmental (4 questions), behavioral (9 questions), occupational (2 questions), physical inability (7 questions) and medical reason (1 question). RESULTS:An overwhelming 60% of the study population have more than one barrier to self-foot management. Alarger proportion of females (69.9%) were not taking self-foot care management compared to their male counterparts (55.5%). Around one-third of the male participants cited lack of time as a major barrier to self-foot care management. Around 40% females reported lack of foot care education and training as the major obstacle to self-foot care management. CONCLUSION: This study elaborates the need for awareness regarding possible barriers when counseling T2DM patients. Behavioral causes seem to be the commonest barrier to self-foot care management and hence strategies to target the same needs to be thought of.

Clinico-radiological correlation with outcome in EDH in paediatric age group -a two year study in a tertiary care hospital

Introduction: Aim of the study was to assess the correlation between clinico -radiological features with outcome in traumatic extradural hematoma in paediatric age group at a tertiary care hospital in Kolkata. Materials and Methods: Total of 47 cases of traumatic paediatric extradural hematoma were analysed prospectively for the period of two years to find out the clinic-radiological pattern with outcome in study group patients. Results: Maximum number of patients were between 1-5 years (55.32%) and male patients slightly outnumbered female (55.32% male vs 44.68% female). Loss of consciousness was the most common clinical presentation. Pretreatment GCS score was found to be directly related to the speed of recovery and outcome. Those in whom there were other associated intracranial injuries showed relatively poor recovery. No sex difference was seen in outcome. Location and volume of EDH did not seem to influence the outcome. Conclusion: Traumatic extradural hematoma in children is an uncommon trauma sequel. Most commonly EDH in children is due to fall from height and Road traffic accident. Classical presentation with lucid interval is uncommon and has no direct effect on outcome. Associated intracranial injuries are common and affect outcome. EDH volume itself does not affect the outcome if timely intervention is done. GCS score at presentation is the most important factor determining the outcome. Keywords: Extradural Hematoma (EDH), Paediatric Age Group, Traumatic

Barriers to Exercise in Type 2 DM Patients: An Institutional Cross-Sectional Descriptive Study

Background: The benefits of regular exercise are well recognized in type 2 diabetes subjects. However, a substantial proportion of patients don’t exercise at all. We aimed to enumerate the barriers to exercise in Type 2 Diabetes Mellitus (T2DM) patients and factors associated with these barriers. Methodology: We conducted a cross-sectional study of successive type 2 diabetes patients attending routine out-patient diabetes clinics in five tertiary care hospitals in Kolkata, India from 1st April,2017 to 31st March 2018. All patients who matched our study eligibility criteria were interviewed by diabetes care providers using a structured questionnaire modeled after a systematic review of similar studies but tuned to regional preferences. Besides demographic details, patient particulars and laboratory investigations, the questionnaire included 2 direct questions on possible barriers to exercise. The questions were grouped into five categories viz. environmental (4 questions), behavioral (9 questions), occupational (2 questions), physical inability (7 questions) and medical reason (1 question). Patients’ who didn’t meet the ADA-EASD recommended exercise (at least 150 minutes moderate intensity aerobic physical activity viz. brisk walking at 3-4 km-hr) were classified as non-exercisers. Results: The present study included a total of 1061 patients of which 617 were males versus 444 females. 636 (59.9%) were not doing physical activity as per current international standards. A substantial higher proportion of females (68.9%) did not exercised as compared to males (53.5%), which is statistically significantly higher, p&lt;0.001. Insulin usage was found to be significantly associated to hamper exercise (p=0.017), physical activity being 8% lower (34.5% in insulin users versus 42.5% in non-insulin users). Male gender (OR-1.877, 95% CI=1.217-2.894, p=0.004) and doctor’s prior advice for exercise (OR-3.397, 95% CI=2.035-5.671, p&lt;0.001) were found as significant predictors for increased physical activity. Conclusion: This study elaborates the need for awareness regarding possible barriers when counseling T2DM patients. Exercise remains one of the cheapest pillars of DM management, the benefits of which extend beyond glycemic control. However, as this study illustrates about 60% of patients with T2DM do not carry out the recommended exercise. This study also highlights the importance of physician advice regarding exercise. Behavioural causes seem to be the commonest barrier to exercise and hence strategies to target the same needs to be thought of.