Tertiary Care Hospitals Of Jammu Research Articles

Histopathological spectrum of oral cavity lesions – A tertiary care experience

Oral cancer is one of a major health problem in some parts of the world especially in the developing countries. Oral cancer is the sixth most common cancer in the world whereas in India it is one of the most prevalent cancer. Oral cavity lesions are usually asymptomatic. Accurate diagnosis of the lesion is the first step for the proper management of patients and histopathology is considered as the gold standard. The objective is to study the different patterns of oral cavity lesions seen in a tertiary care hospital of Jammu: One year retrospective study. Post graduate department of pathology.: It was a retrospective study carried out in a tertiary care centre for a period of one year from March 2020 to Feb 2021. 148 cases of oral cavity lesions were included in this study. The parameters that were included in the study were sociodemographic data, site of the lesion, clinical features and histological diagnosis. Data collected was analysed.148 cases of oral lesions were identified during the period of study. The age of patients varied from 5 to 78years and Male to Female ratio was 2.2:1. Buccal mucosa (30%) was the most common site involved which was followed by tonsil (19%). Out of 148 cases 70 cases were malignant, 10 cases pre malignant and 21 cases were benign. Squamous cell carcinoma (33.7%) was the most common lesion present in our study. Oral cavity lesions have a vast spectrum of diseases which range from tumour like lesions to benign and malignant tumours. Our study concluded that squamous cell carcinoma was the most common malignant lesion of oral cavity. Histological typing of the lesion is important for confirmation of malignancy and it is essential for the proper management of the patient.

Risk Factors for Ectopic Pregnancy: A Case-Control Study in Tertiary Care Hospitals of Jammu and Kashmir

Introduction: An ectopic pregnancy occurs when a fertilized egg attaches somewhere outside the uterus.There are many risk factors for ectopic pregnancy. This study will help us to prepare a list of risk factors associated with ectopic pregnancy in our state. In addition, it will help implement a risk-reduction counseling program before conception, which will help us screen high-risk patients and reduce and manage ectopic pregnancy. Materials and methods: The present study was conducted in our department for two years, from August 2018 to July 2019. Cases included all patients with ectopic pregnancy admitted in labor. A total of 192 cases were taken, out of which 8 cases refused to participate in the study, so 184 patients were included in the study. Results: Patients with previous ectopic pregnancy have 6.34 times increased risk of a repeat ectopic pregnancy (odds ratio 6.34, confidence interval 1.40-28.77), and this association was highly significant (p = 0.006). The risk of ectopic pregnancy is 3.02 times increased (odds ratio 3.10; 95% confidence interval, 1.16-7.84) if the patient once had the pelvic inflammatory disease and is statistically significant (p = 0.01). The study also revealed that 17 (10.3%) patients with ectopic pregnancy had a history of tubal ligation or some other tubal surgery done in the past compared to 3 (2.2%) patients among controls, and this finding is statistically highly significant (p = 0.001). Conclusions: In the present study, we found that the main risk factors for incidence of ectopic pregnancy are prior ectopic pregnancy, prior tubal ligation, and prior pelvic/abdominal surgery. In addition, ectopic pregnancy was positively related to the previous history of ectopic pregnancy, abortion, cesarean section, and infertility. These findings can be helpful for early diagnosis of ectopic pregnancy to pursue proper medical therapy instead of unnecessarily surgical treatment.

A RETROSPECTIVE STUDY OF BLOOD TRANSFUSION PRACTICES IN A TERTIARY CARE HOSPITAL OF NORTH INDIA.

INTRODUCTION: Blood transfusion is an important concern for the society, as it is life saving for patients with bleeding disorders, accidents, surgeries, inherited/acquired hematological diseases and malignancies. Generally, donors are classied into the following categories: voluntary, family replacement, remunerated or paid donors, and autologous donor. AIMS & OBJECTIVES:To understand the importance of Blood & its safe Transfusion practice in a Teaching Hospital. METHODOLOGY: An Observational study was conducted over a period of 12 months from January 2019 to December 2019 in a 750 –bedded Tertiary Care Hospital of Jammu(UT). OBSERVATIONS: In addition to providing Blood-Transfusion Services to the patients admitted in SMGS Hospital Jammu & Other Associated Hospitals of GMC Jammu, the Blood-Bank is also catering to the needs of Registered Private Nursing Homes & Hospitals of Jammu(UT).This Blood-Bank has exceptionally maintained a record of consuming the whole stock of Blood without wasting even a single pint of blood. DISCUSSION: The Aim of Blood Transfusion Services is to supply good Quality of Blood & its Components to the Patients & avoid any risk to the Donors as well as Recepients. Hence it is extremely essential to institute strict Quality Control Measures RECOMMENDATIONS: Recommended that Upgradation of Blood-Bank is essential to cater with the needs of Additional bed-strength that SMGS Hospital is going to acquire in the coming future.

A RETROSPECTIVE STUDY TO DETERMINE THE EFFECT OF “REFERRAL-IN” ADMISSIONS ON THE FUNCTIONING OF GYNECOLOGY & OBSTETRICS DEPARTMENT IN A TERTIARY CARE HOSPITAL OF NORTH INDIA.

Introduction: Regionalization envisages a two-way ow of patients & services designated as “Referralin” and “Referral-out” cases.”Referral-in” generally means patients from Sub Center, Primary Health Center, Community Health Center & District Hospitals Referred to Tertiary Care Hospital for Specialized care.”Referred-out” Generally means patients from Tertiary Care Hospitals to Higher Centers like Apex Institutions including AIIMS (New Delhi),SKIMS(Srinagar).PGIMER(Chandigarh, SGPGI(Lucknow), etc. for Super specialized treatment. Objective: To determine the effect of Referral- in admissions on the functioning of Gynecology & Obstetrics Department in a Teaching Hospital. Methodology: An Observational study was conducted over a period of 12 months from February 2019 to January 2020 in a 750 –bedded Tertiary Care Hospital of Jammu(UT) popularly Known as Shri Maharaja Gulab Singh(SMGS) Hospital, Jammu. Observations & Results: A detailed description of academic as well as functional status of Gynae & Obs. Department including Faculty-position, OPD patients, Inpatients admitted, Deliveries conducted(LSCS & MLE), Surgical Operations(Major as well as Minor) along with Bed-Occupancy Rate(BOR) & Referred-in Admissions during the study duration was recon ciliated & put forth in Tabulated Form after collecting from the Medical Records Department of the Hospital & displayed Statistically in Bar-Charts & pie-Chart. Discussion: Excessive Referral-in admissions to Teaching Hospital from PHC,SDH,DH & AH Level results in Overcrowding/Congestion in Hospital Wards culminating in Exhaustion of Resources like Drugs, Medicines, Reagents & other logistics. Supportive Services like Sanitation, Ambulance Transportation & Dietary facilities get worsened thereby exaggerating the Sepsis as well as nasocomial infection rate. There are increased chances of Corruption, & Violence/Verbal Scufes between Hospital Staff & Attendants of patients. Conclusion & Recommendation: Instead of irrationally referring the patients to Teaching Hospitals from Lower level Health Care Facilities(HCF), they should be rst sent to Associated Medical College Hospitals established at different Districts before being referred to Provincial Tertiary care Hospital thereby reducing the extra-load over Teaching Hospitals resulting in rapid depletion of resources as well as Medico- Social and Law & Order problems.

Pediatric Cutaneous Leishmaniasis: A Clinico-Epidemiological Study from North India.

Background:There has been an upsurge in the cases of cutaneous leishmaniasis over the past few years in the pediatric population of Jammu and Kashmir, hitherto a nonendemic area for the disease., The aim of this study was to describe the clinico-epidemiological profile and therapeutic outcome of pediatric cutaneous leishmaniasis (PCL) over a 10-year period in J and K.Materials and Methods:An observational study was conducted at two tertiary care hospitals of Jammu and Kashmir over a period of 10 years (July 2010–June 20). Children presenting to the outpatient department with lesions suggestive of CL were enrolled. Patients suspected of having CL based on clinical criteria were subjected to slit skin smears (SSS) and histopathological examination (HPE) for validation of the diagnosis. Intralesional or systemic sodium stibogluconate (SSG) was the treatment modality used for the management of patients. Clinical follow-up was done at intervals of 2 weeks for the first 2 months and monthly thereafter.Results:A total of 376 cases of CL in children aged 1.5–15 years (mean age 8.4 ± 1.4 years) were included in the study. The duration of the disease ranged from 8 to 52 weeks (mean 22.52 ± 1.5 weeks). Lesions were noted mainly on exposed parts of the body, with face being the most commonly affected site (89.0%). Nodulo-ulcerative plaques were the predominant clinical presentation (62.76%). The diagnosis was confirmed by the demonstration of Leishman Donovan (LD) bodies in 54.25% on SSS- and 25.79% on hematoxylin and eosin -stained tissue sections. In cases where diagnosis could not be confirmed by demonstration of LD body, a histological pattern conforming to CL and response to a therapeutic trial of SSG provided evidence of leishmanial infection. Complete healing was achieved in 95.02% of the cases at the end of treatment.Conclusion:CL is an emerging health problem in the pediatric population of Jammu and Kashmir. Awareness among pediatric health workers regarding this disease and recognition among the differential diagnosis of ulcerated papules or plaques in the pediatric population is imperative.

Clinical and epidemiological study of cutaneous leishmaniasis in two tertiary care hospitals of Jammu and Kashmir: An emerging disease in North India

BackgroundAn increasing number of patients with cutaneous leishmaniasis (CL) are reporting to tertiary care centers in Jammu and Kashmir, an area that has previously been non-endemic for this disease. This merits consideration of CL as a major health problem of considerable epidemiological importance. The aims of this study were firstly to describe the clinico-epidemiological profile, therapeutic characteristics, and outcomes of patients with CL and secondly to highlight this union territory as a new focus of endemicity for CL. MethodsA two-center hospital-based prospective cohort study was conducted at two tertiary care hospitals in Jammu and Kashmir over a period of 10 years (July 2009 to June 19). All patients presenting to the outpatient departments with lesions suggestive of CL were enrolled for the purpose of this study. Demographic data were recorded on a proforma questionnaire, along with a detailed history and the results of a meticulous examination. Patients diagnosed with CL based on clinical criteria were subjected to slit skin smear (SSS) and histopathological examination for confirmation of the diagnosis. An intralesional pentavalent antimonial, sodium stibogluconate (SSG), was administered at a dose of 0.5 mL/cm2 (100 mg/mL solution) three times weekly to those patients with smaller lesions, and intravenously or intramuscularly at a dose of 20 mg/kg/day to those with larger lesions. The response to treatment was assessed by total re-epithelialization of the lesion and an absence of infiltration and erythema, with or without scarring. Treatment was given until complete resolution of the lesions or for a maximum duration of 10 weeks when given intralesionally and 3 weeks when given systemically. Clinical follow-up was performed twice weekly for the first 2 months and monthly thereafter. The final response to treatment was assessed at 6 months. ResultsThe study included a total of 1300 patients with a mean age of 26.7 ± 18.5 years. The mean duration of the disease was 28.52 ± 13.5 weeks, ranging from 8 to 64 weeks. Lesions were noted mainly on exposed parts of the body, with the face being the most commonly affected site (89.00%). Nodulo-ulcerative plaques were the predominant lesion type observed (73.92%). The presence of Leishman–Donovan bodies could be demonstrated on SSS and histopathology in 60.69% and 39.54% of patients, respectively. The presence of a recognizable histological pattern conforming to CL and a response to a therapeutic trial of SSG was considered to be confirmatory in the remaining patients. Complete cure was achieved in 84.23% of cases during the study period. Single lesions were more likely to respond to treatment as compared to multiple lesions. The route of administration did not have any significant impact on the final outcome. ConclusionsWith the disease showing an escalating trend in Jammu and Kashmir, the possibility of a new focus of endemicity and its impact on public health need to be contemplated, and appropriate measures should be initiated to contain its spread.

Effectiveness of Nursing Intervention Strategies on Physiological and Psychosocial Problems among Patients with Chronic Kidney Disease in Selected Hospital of Kashmir

Background:Chronic Kidney Disease (CKD) is a worldwide serious condition associated with increased premature mortality, decreased quality of life and increased health-care expenditures. Learning about issues such as: disease process, strict adherence to renal diet, exercises and relaxation therapies in addition to adherence the medical treatment have helped chronic kidney disease patients to self regulate and improve their physical and social functioning. With this background the investigator got strongly convinced to design some evidence based ‘Nursing intervention strategies’ for CKD patients through clinical research to alleviate their sufferings with better clinical outcomes. Methodology:A quasi-experimental study based upon two group pre-test post-test control group design was conducted on 200 adult chronic kidney disease patients (100=experimental group and 100=control group) with an aim to evaluate the effectiveness of ‘Nursing intervention strategies’ in improving their physiological and psychosocial problems in nephrology ward of a tertiary care hospital of Jammu and Kashmir i.e. Sher-i-Kashmir Institute of Medical Sciences (SKIMS) from 5th March 2012 to 31st July 2013. Result: The findings revealed that the subjects in experimental group who received the ‘Nursing Intervention Strategies’ for two weeks within hospital as well as at home till first follow up visit had shown a significant (p ≤ 0.05) improvement in 9 health problems, 11 biochemical parameters, 5 physiological parameters and 2 psychosocial parameters than the subjects in control group who reported improvement in: only 6 health problems; 5 biochemical parameters and 3 physiological parameters. Conclusion: It can be concluded that ‘Nursing Intervention Strategies’ such as: Dietary advice, progressive muscle relaxation, deep breathing, leg massaging, leg elevation and talk therapy were effective in reducing the magnitude of physiological and psychosocial problems among chronic kidney disease patients. However the long term efficacy of these strategies needs to be investigated.

Quality of life of head and neck cancer patients before and after cancer-directed treatment - A longitudinal study.

Head-and-neck cancer (HNC) is a major health problem worldwide and even disproportionately bigger in India. Their diagnosis and treatment create severe impact on the quality of life (QOL). We chose to study such patients because we were already reporting these cancers to the Indian Council of Medical Research as part of project titled "Pattern of care and survival studies." The aim of the study is to assess and compare QOL of H and N cancer patients before and after the completion of cancer-directed treatment (CDT). The present study was a hospital-based study conducted in the tertiary care hospital of Jammu with longitudinal study design. All newly diagnosed HNC patients registered with the Department of Radiotherapy and ENT on inpatient or outpatient basis were included over a period of 6 months. Each patient was followed for 4-6 weeks after the completion of CDT. QOL was assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ C30) (general) and EORTC QLQ H and N-35 (specific) questionnaires. Paired t-test was calculated to compare pre- and postmean scores. Pre- and post-Cronbach alpha reliability coefficient was also calculated. The most frequent site was larynx followed by the oral cavity. Regarding both EORTC QLQ C-30 questionnaire and Global health status and EORTC H and N-35 specific questionnaires, the mean scores across all domains showed worsening of QoL from their baseline. The worsening was more severe in emotional function (functional scale), while physical, cognitive, and social functions were comparatively less affected. Pain, swallowing, speech, and mouth problems were most worsened. QoL showed worsening after CDT in all domains due to acute and subacute adverse effects of chemotherapy and radiotherapy in treatment course.

Knowledge, attitude and practices about hemovigilance among practitioners: a cross-sectional study

Abstract: Transfusion by blood and blood products forms an important part of treatment. But this is not free from transfusion reactions which may be in the form of fever, rashes, shivering, anaphylaxis or even death. Hemovigilance is a programme of reporting such events.Materials and Methods: The present study was conducted in a tertiary care hospital of Jammu, (J& K). Permission was taken from Institutional Ethics Committee, Govt. Medical College, Jammu. A pretested questionnaire was prepared and circulated among practitioners. They were given time of 15 minutes to fill that questionnaire. After 15 minutes, the filled questionnaire were collected and were analysed. The data was presented in tabulated form.Results: Total 50 practitioners were included in the study. All the practitioners had knowledge about transfusion reactions. Only 10% of the practitioners had knowledge that transfusion reactions can be prevented, 40% of the practitioners had knowledge about hemovigilance programme and had an idea that transfusion reactions can be reported. But only 10% of the practitioners knew where to report and who can report, 6% knew how to report. Only 48% of the practitioners thought that transfusion reactions should be reported, 70% of the practitioners thought that transfusion reactions can be dangerous. 40% of practitioners told that seminars/CMEs should be planned. 80% of practitioners had encountered transfusion reactions, but only 2% had documented the same. 10% of the practitioners had attended seminars, CMEs. Many reasons were quoted for not reporting transfusion reactions.Conclusion: Overall, most of the practitioners have a positive attitude towards transfusion reaction reporting but knowledge regarding the haemovigilance concept is poor and the majority of them never reported such reaction. Hence, our study demands increased awareness and continued training to strengthen the haemovigilance system.

Awareness of HIV among health care workers in a tertiary care hospital of Jammu

HIV/AIDS has emerged as the single most formidable challenge to public health and Health Care professionals. Apart from doctors and nurses, laboratory technicians and nursing orderlies are an important component of the health care delivery system and form a potential risk group for HIV/AIDS spread due to frequent and prolonged contact. In this group an adequate knowledge of the different aspects of the disease are of great importance, hence a cross-sectional study was carried out in a tertiary care hospital to assess the level of awareness of HIV/AIDS in health care workers. A pretested questionnaire was used as an investigating tool and distributed among the various respondents. The awareness regarding the infectious nature of the virus and methods of transmission was adequate though information regarding vertical transmission was a grey area in the respondents. Regarding the prevention of transmission of HIV in terms of practicing universal precautions was found to be in order of 88%, 84%, 84% and 74% among technicians, doctors, nurses and class IV workers. Availability of diagnostic tests for HIV infection was known mainly to doctors (92%) and less than 60% of other workers. Knowledge of respondents about the benefits of PEP (post exposure prophylaxis) and ART (anti retro viral therapy) was not satisfactory. Thus, sensitizing the hospital staff to the various aspects of disease through an active health education programme in the form of CME’s, posters, group discussion is required for effective control of the disease. Keywords: HIV Awareness, Mode of transmission, Prevention, Risk Factors, Treatment.

Seroprevalence of HIV, HBV, HCV, Syphilis and Malaria among blood donors in a tertiary care hospital of Jammu

Seroprevalence of HIV, HBV, HCV, Syphilis and Malaria among blood donors in a tertiary care hospital of Jammu

Increased preoperative collection of autologous blood with recombinant human erythropoietin therapy in tertiary care hospitals of Jammu

Introduction:To study whether the administration of recombinant human erythropoietin increases the amount of autologous blood that can be collected before orthopaedic surgery.Materials and Methods:We conducted a randomized controlled trial of recombinant human erythropoietin in 68 adults scheduled for elective orthopedic procedures. The patients received either erythropoietin 600 units/kg of body weight or placebo intravenously every 5th day prior to each phlebotomy for 21 days during which time up to 5 units of blood was collected. Patients were excluded from donation when their hematocrit values were less than 33%. All patients received iron sulphate 325mg orally 3 times daily. The mean number of units collected per patient was 4.33 ± 0.4 for erythropoietin group and 3.05± 0.71 for the placebo group.Results:The mean packed red cell volume donated by patients who received erythropoietin was 32% greater than that donated by patients who received placebo (196.3 vs. 169.4 ml, p<0.05). 68% in the placebo group and 9% of patients treated with erythropoietin were unable to donate ≥4 units. No adverse effects were attributed to erythropoietin. While participating in the study, complications developed in 2 patients one in each group necessitating their removal from the study.Conclusion:We conclude that recombinant human erythropoietin increases the ability of the patients about to undergo elective surgery to donate autologous blood units.