Tertiary Care Medical College Hospital Research Articles

The Clinical and Serological Profile of Pediatric Dengue.

To classify suspected dengue into dengue, dengue with warning signs and severe dengue, based on clinical features as per the revised WHO guidelines with special emphasis on serology. It was a prospective cross-sectional study for five years from 2011-2016 in a tertiary care medical college hospital in Bangalore. All cases of fever of three to five days duration with symptoms like dengue were enrolled for the study. They were categorized into three groups as per the Revised WHO 2012 criteria. Laboratory parameters, serology, ultrasound abdomen and X-ray were done in almost all patients. Data was analysed by SPSS software, version 16, and different groups were compared with Chi square test. Five hundred sixty eight children were diagnosed to have dengue fever; 4.2% of the sample belonged to infancy. Majority were in the age group of 5-10 y (42.6%). Fever and flushing were present in majority of the children. Gastrointestinal bleed was more commonly seen in the severe dengue group. Dengue nonstructural protein antigen (NS1Ag) was positive in 78%, immunoglobulin M (IgM) in 15.8% and immunoglobulin G (IgG) in 14.6%. Children with IgG had more complications, though not statistically significant. Mortality was reported in 1.2%. Dengue serology helped to confirm the diagnosis, however did not help in patient management. There is a considerable overlap in the symptomatology of dengue with warning signs and severe dengue. More studies are required on the severity and type of response to treatment in infants and obese adoloscents with severe dengue.

Gastrointestinal Stromal Tumors – A Case Series – Our Experience Over Four Years in a Tertiary Care Medical College Hospital

Gastrointestinal Stromal Tumors – A Case Series – Our Experience Over Four Years in a Tertiary Care Medical College Hospital

Gastrointestinal Stromal Tumors –A case series –Our Experience Over Four Years in A Tertiary Care Medical College Hospital

Gastrointestinal Stromal Tumors –A case series –Our Experience Over Four Years in A Tertiary Care Medical College Hospital

Pattern of congenital heart diseases among children with Down syndrome attending a tertiary care medical college hospital

Background: Down syndrome (DS) is the most common chromosomal abnormality associated with learning difficulties with reported incidence between1/600 -1/1000 live births. DS (trisomy 21) is the most common chromosomal abnormality seen in clinical practice. Most children with DS have trisomy 21, due to chromosomal non-disjunction during meiosis; however, other abnormalities, such as Robertsonian translocation, mosaic, double or triple aneuploidies have been reported. The association between DS and congenital heart disease (CHD) is well established. Congenital heart disease is the most common cause of death among patients with DS and affected children have an increased risk of mortality.Methods: The present descriptive study was conducted on children who had clinical features suggestive of Down syndrome and who were karyotypically proved as Down syndrome.Results: In 100 cases of down syndrome 60 children were males and 40 children were females. 45 children had congenital heart diseases. The frequency of CHD in down syndrome is 45%. Ventricular septal defect was the most common CHD found 40% children with down syndrome.Conclusions: All children with Down’s syndrome should have a cardiac evaluation at birth. Early referral and screening of all babies born with the clinical phenotype of DS should be encouraged due to the high prevalence of congenital heart defects.

Analysis the Clinical Profile of children Admitted with Kerosene Poisoning in a tertiary care Medical College Hospital

Analysis the Clinical Profile of children Admitted with Kerosene Poisoning in a tertiary care Medical College Hospital

Etiological study of seizures among paediatric age group (1-18 years) in tertiary care medical college hospital

Etiological study of seizures among paediatric age group (1-18 years) in tertiary care medical college hospital

Full Volume Isotonic (0.9%) vs. Two-Thirds Volume Hypotonic (0.18%) Intravenous Maintenance Fluids in Preventing Hyponatremia in Children Admitted to Pediatric Intensive Care Unit-A Randomized Controlled Study.

We aimed to compare the effect of two different intravenous fluid regimes on the incidence of hyponatremia in children. Children 1 month to 18 years of age, admitted to pediatric intensive care unit (PICU) of a tertiary care medical college hospital were randomized to receive either isotonic fluid (0.9% saline in 5% dextrose) at the standard maintenance rate or hypotonic fluid (0.18% saline in 5% dextrose) at two-thirds of the standard maintenance rate. A total of 240 children were randomized (120 isotonic, 120 hypotonic). In all, 16.7% children in hypotonic group developed hyponatremia compared with 7.5% in isotonic group (p = 0.029). Duration of PICU stay was significantly more in Hypotonic group. We conclude that use of 0.9% saline in 5% dextrose as maintenance fluid helps in reducing the incidence of hospital-acquired hyponatremia and duration of intensive care unit stay among children admitted to PICU.

Color Doppler Evaluation of Carotid Arteries in Stroke Patients: A Study Conducted in A rural Tertiary Care Medical College Hospital in South india.

Color Doppler Evaluation of Carotid Arteries in Stroke Patients: A Study Conducted in A rural Tertiary Care Medical College Hospital in South india.

The Epidemiological Aspects of Tuberculosis Patients in a Tertiary Care Medical College Hospital of Bangladesh

Background and Aims: To assess the clinical and socio-demographic characteristics of tuberculosis patients in a tertiary care medical college hospital of Bangladesh. Methods: An observational study was conducted over a period of one year from September 2015 to August 2016 in the Outpatient Department of Jahurul Islam Medical College Hospital and Department of Pathology, Jahurul Islam Medical College, Kishoregonj, The inclusion criteria of the study were pulmonary and extra pulmonary tuberculosis cases receiving antitubercular drugs therapy. Primary data from each patient was included in tuberculosis patient profile form such as age, gender, educational level, annual income in taka, occupational status and selected social habits like smoking, alcohol. Results: Out of 112 patients studied, 50 (44.6%) were male and 62 (55.4%) were female. The majority of patients 69 (61.7%) were in the age group of 15-34 years. Annual family income of 78 (69.6%) patients ranged between 36,000- 1,50,000 taka. In total 112 patients 43 (38.4%) were illiterate and 36 patients (32.2%) were unemployed. 50% of the patients were smoker. The most common sites involved in extrapulmonary tuberculosis were the lymph nodes (38.2%) followed by the pleura (36.4%). The most common symptoms observed in pulmonary tuberculosis patients were cough with expectoration (96.5%) followed by weight loss (80.7%), fever (73.7%) and loss of appetite (54.4%). Conclusion: Prevalence of infection was noticed between PTB and EPTB with age and it was more common in younger age. However, based on our results TB control programme might usefully target young middle age populations for early diagnosis of TB to decrease TB morbidity and mortality.

Study of Retinal Nerve Fibre Layer Thickness and Visual Contrast Sensitivity in HIV Positive Individuals.

Measurement of Retinal Nerve Fibre Layer Thickness (RNFLT) by Optical Coherence Tomography (OCT) is a sensitive, non invasive and cheap method of detecting early retinal changes in a variety of diseases. In HIV infection, RNFLT is altered and this may have effect on other visual functions like Contrast Sensitivity (CS) and visual acuity. Such ocular pathology can affect the daily life and profession (especially driving) of HIV infected individuals. However, studies on this topic in HIV infected population are rare from India. To study RNFLT, CS and their correlation in a sample of HIV positive Indian population. The present cross-sectional study was done in a tertiary care medical college hospital of Eastern India between May 2016 and September 2016. We did this study on HIV positive subjects with no clinically apparent ocular infection or other pathology. In this study, we have measured the RNFLT using the HRA-OCT Spectralis machine. The CS was tested using a smartphone version of the Pellie-Robson chart. CD4 count, visual acuity and colour vision were also tested. The data was analysed using SPSS version 20.0 for any correlation between these parameters. Pearson coefficient was used for continuous data and Spearman rank correlation was used for categorical data. A p-value <0.05 was considered significant. We had 17 patients, that is 34 eyes. RNFLT loss was found in 21% of the eyes and borderline thinning was found in a further 26%. Predominantly, the temporal quadrant was involved. The mean of log CS was 1.33±0.38. Taking 1.5 as the cut-off value for normalcy, 47% of the eyes tested showed decreased CS. Log CS showed significant correlation with RNFLT of the temporal quadrant only (r=0.37; 95% C.I. 0.041 to 0.631; p=0.02). Temporal RNFLT also showed statistical correlation with the CD4 count. The low CS was also significantly correlated with low visual acuity (r=0.5). In HIV infected persons, subtle ocular changes may occur and this may affect visual functions quite early. Hence, a comprehensive eye check-up should include parameters like CS and OCT.

Socio-demographic Patterns of Tuberculosis Patients, Experience of a Tertiary Care Medical College Hospital of Bangladesh

Pulmonary tuberculosis is an air born infectious disease caused by Mycobacterium tuberculosis and is a major cause of morbidity and mortality particularly in developing countries. There are 33 million cases of tuberculosis worldwide, 3 million annual death and 8 million persons developed active tuberculosis every year. If tuberculosis is detected early and fully treated, people with the disease quickly become non-infectious and are eventually cured. However multi-drug resistance tuberculosis, HIV associated tuberculosis and weak health system are the major challenges. An observational study was conducted over a period of one year from September 2015 to August 2016 in the Outpatient Department of Jahurul Islam Medical College Hospital and Department of Pathology, Jahurul Islam Medical College, Kishoregonj, Bangladesh. Most of the patients were in the age group of 15-34 years (61.7%). 69.6% of the patients belonged to lower income group. 50.9% patients had pulmonary tuberculosis, 43.7% patients had extra pulmonary tuberculosis and 5.4% had both pulmonary and extra pulmonary tuberculosis. The most common symptoms observed in pulmonary tuberculosis patients were cough with expectoration (96.5%) followed by weight loss (80.7%), fever (73.7%) and loss of appetite (54.4%) whereas in extrapulmonary tuberculosis patients majority had weight loss(79.6%), fever (67,3%), loss of appetite (61.2%).

Effectiveness of Integrated Teaching Module among Final Year Medical students

AbstractBackground: Didactic lectures and the current practice of teaching in Medical colleges has many limitations. Correlation and integration of knowledge into practice becomes difficult in the absence of integrated teaching at appropriate levels in medical curriculum.Aim: To assess the effectiveness of the vertical integrated teaching method among the final year MBBS students and to study the attitude towards integrated teaching. Materials and Methods: This is a prospective study conducted among 102 final year MBBS students at a tertiary care medical college hospital in South India. The teaching was implemented by the active participation of faculty from the departments of Physiology, Pathology and General Medicine on a single topic. Students' knowledge about the subject before and after the session was evaluated by a questionnaire of 20 questions (Pre-test and Post-test). The mean score before and after the session was compared using the paired't' test. The students were also asked to give their feedback about the usefulness of this method in improving their knowledge.Results: The mean scores before and after the session were 8.8± 2.87 and 16.88±1.23 (p value &lt; 0.001). Majority of the students (97.1%) opined the need for integrated teaching to be a part of medical curriculum. Most of them (54.9%) felt the need for integrated teaching to be conducted monthly. On self-grading the knowledge on a scale of 1 to 10 before and after the session, the mean scores were 4.73±1.84 and 7.83±1.86 respectively (p value &lt; 0.001). Conclusion: The integrated teaching was found to be an effective method of teaching. Medical students had a positive attitude towards integrated teaching.

Role of IVUS, OCT and FFR in peripheral vascular intervention

COPD is a chronic progressive and inflammatory respiratory disease. Close, complex & bidirectional association of cardiovascular morbidity exists with COPD. There is growing evidence that LV function is also commonly impaired in COPD patients, more so with diastolic dysfunction (LVDD) than systolic (LVSD). The present study is a cross-sectional observational study conducted in a tertiary care medical college hospital in Kerala to understand the prevalence of LV dysfunction, systolic and diastolic in COPD patients and their association with the 8 traditional risk factors- age, smoking, sex, hypertension, diabetes mellitus, coronary artery disease(CAD), dyslipidemia, thyroid disease. Our study found significant LVDD in 45% patients, and a significant association of thyroid disease with COPD and LVDD. The prevalence of LVSD was 24%, significant when COPD is associated with CAD, hypertension and dyslipidemia independently. This study emphasizes the need to consider possibility of LV dysfunction in COPD patients, along with the traditional risk of right heart failure. The assessment and treatment modalities of COPD patients with LV dysfunction needs to be revised, since they are at increased risk of pulmonary edema and mortality.

Scoring system to preoperatively predict choledocholithiasis.

The incidence of common bile duct (CBD) calculi has been reported to be 8 % to 20% among the patients with cholelithiasis. Failure to detect CBD stones on the part of the surgeon not only fails to relieve symptoms but also subjects them to potentially life-threatening complications such as cholangitis, pancreatitis or obstructive jaundice. Modalities for detection of CBD stones have evolved over time from CBD exploration based on clinical and operative findings to intraoperative cholangiography (IOC), to endoscopic retrograde cholangiopancreaticography (ERCP) and, recently, to magnetic resonance cholangiopancreaticography (MRCP) and endoscopic ultrasonography (EUS). We felt a need for a scoring system to predict a patient population having a higher risk of choledocholithiasis so that these modern interventions can be selectively utilized. This study was performed in a tertiary care medical college hospital in a metropolitan city. This is a prospective observational study. All patients with symptomatic cholelithiasis admitted to the hospital were included. Patients were diagnosed as having choledocholithiasis either by ultrasonography (USG), computed tomography scan, MRCP, EUS or ERCP and were followed up for at least 6weeks. The prevalence of choledocholithiasis among the 275 patients with symptomatic biliary colic in our study was 18.9% (n = 77). On bivariate analysis, dilated bile duct on USG (>6mm), raised total bilirubin, raised alkaline phosphatase (ALP), raised amylase, raised SGPT and SGOT were significantly associated with choledocholithiasis (p < 0.05). On multivariate analysis also, all these factors except amylase and SGPT showed a significant correlation with choledocholithiasis (p < 0.05). These observations were used to build a scoring system consisting of four factors: dilated bile duct on USG (>6mm), total bilirubin >2mg/dL, ALP >190IU/L and SGOT >40IU/L. A positive predictive value of 3 or more factors was over 95%, necessitating an endoscopic intervention. A negative predictive value of the absence of any factor was 100%, which ruled out CBD calculi. If only one or two factors are positive, then further evaluation is recommended preferably using non-minimal or minimal invasive investigations like EUS or MRCP.

Analysis of profile of childhood kerosene poisoning in a tertiary care medical college hospital

Background: Children are very vulnerable to acute accidental poisoning. One of the most important poisoning in children is accidental ingestion of kerosene which is a common household substance. Its prevention plays a major role in reducing its morbidity and mortality in children. Objective: To understand the profile of accidental kerosene poisoning in children with special reference to symptoms, complications, radiological changes, course and outcome after treatment. Materials and Methods: Children hospitalized with acute poisoning at the paediatric intensive care unit (PICU) between January 1st 2010 and December 31st 2015 were retrospectively evaluated from hospital records. A detailed history was taken using the proforma having special reference to age, sex, poisoning agents and route of intake ,time of admission of the poisoned patients,socio- economic status of the family and cases with acute kerosene poisoning (AKP) were analysed. Results: In the PICU out of a total of 5806 patients admitted, 401 (6.9%) were due to acute poisoning . Among them AKP was noted in 91 (22.7%) patients and was second only to pharmaceutical medicine poisoning in 128 (28.7%) cases. All the children were admitted to the PICU, but most only required supportive care. There was no mortality following AKP during the study period. Conclusion: All paediatric age groups are at risk of AKP. Most children suffer due to unintentional poisoning because of easy availability of kerosene in their house itself. As AKP is preventable it must be given due importance in health control programs at all levels of health care.

Clinicopathological Study of Tuberculosis Patients in a Tertiary Care Medical College Hospital

Background: The aim of the study was to assess the clinical and socio-demographic characteristics of tuberculosis (TB) patients in a tertiary care medical college hospital of Bangladesh. Methods: An observational study was conducted over a period of 1 year from September 2015 to August 2016 in the Outpatient Department of Jahurul Islam Medical College Hospital and Department of Pathology, Jahurul Islam Medical College, Kishoregonj. The inclusion criteria of the study were pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) cases receiving anti-tubercular drugs therapy. Primary data from each patient were included in TB patient profile form such as age, gender, educational level, annual income in taka, occupational status and selected social habits like smoking and alcohol. Results: Out of 112 patients studied, 50 (44.6%) were male and 62 (55.4%) were female. The majority of patients 69 (61.7%) were in the age group of 15 - 34 years. Annual family income of 78 (69.6%) patients ranged between 36,000 and 150,000 taka. Out of 112 patients, 43 (38.4%) were illiterate and 36 patients (32.2%) were unemployed. Half of the patients were smoker. The most common sites involved in EPTB were the lymph nodes (38.2%) followed by the pleura (36.4%). The most common symptoms observed in PTB patients were cough with expectoration (96.5%) followed by weight loss (80.7%), fever (73.7%) and loss of appetite (54.4%). Conclusion: Prevalence of infection was noticed between PTB and EPTB with age and it was more common in younger age. However, based on our results, TB control programme might usefully target young middle-aged populations for early diagnosis of TB to decrease TB morbidity and mortality. Clin Infect Immun. 2016;1(2):41-44 doi: https://doi.org/10.14740/cii56e

Knowledge about an emerging disease: Ebola viral fever, among medical professionals in a medical college, South India

Background: Knowledge among health care professionals of any emerging disease, with a potential of causing high morbidity and mortality, is vital to diagnose and manage suspect cases, to prevent transmission and control an outbreak of the disease. This study attempts to assess the essential knowledge of medical professionals in a teaching hospital in South India about key aspects of an emerging disease: Ebola Viral Fever. Methods: A cross-sectional study using structured, pre-tested questionnaire in a tertiary care Medical College Hospital in South India was conducted in January 2015. Analysis was done using Epi Info 7 and SPSS 16. Results: Only 6% of the respondents in the study had a good knowledge score, while 72% had moderate knowledge and in 22 % the knowledge was inadequate. The knowledge scores were not based on ‘must know’ essential facts of EVF, which included early diagnosis of suspect cases, appropriate management of diagnosed cases and measures to prevent transmission. This knowledge deficit of essential facts was statistically significant (p<0.001). 86% of the respondents reported print and electronic media as their source of information. Official and government circulars were quoted by only 14%. Conclusions: The result reveals insufficient knowledge among health professionals about an emerging disease, at a time when it was perceived as an emergency of global importance. This is a pointer to the policy makers in conducting regular Continuing Medical Education sessions and maintaining an effective surveillance system.

Status of Micro and Macro Nutrients in Patients with Type 2 Diabetes Mellitus Suggesting the Importance of Cation Ratios

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic polymetabolic disorder characterized by chronic hyperglycemia resulting from resistance to insulin action or inadequacy of insulin secretion. Role of the micro & macro nutrients in the pathogenesis of T2DM has not been studied thoroughly. The aim of this study was to evaluate the status of calcium, magnesium, zinc and chromium in relation to HbA1c in a group of subjects with T2DM patients. Methodology: The study comprised of seventy three patients with T2DM, attending the OP of a tertiary care medical college hospital. Thirty four individuals were with HbA1c 7%). Cation ratios were significantly associated with the glycemic control in T2DM.

Incremental yield of second sputum smear examination for diagnosis of tuberculosis patients at a tertiary care teaching hospital in Puducherry, India

Background and Objectives: The Revised National Tuberculosis Control Programme (RNTCP) guidelines recommend two sputum smear examinations for the diagnosis of tuberculosis (TB). This does not reduce the patient's inconvenience and laboratory workload. So, the present study was conducted to assess the contribution of second sputum smear examination for the diagnosis of TB. Materials and Methods: A retrospective record review of TB laboratory registers at a tertiary care medical college hospital in Puducherry, India was conducted from April 2009 to December 2012. Results: A total of 2,917 patients were recorded in the RNTCP laboratory registers during the study period. Of these, 2,869 (98.4%) patients had given sputum samples for diagnosis and 48 (1.6%) were follow-up cases on TB treatment. Among 2,869 TB suspects, 397 (13.8%) were acid-fast bacilli (AFB)-positive although 616 (21.5%) failed to submit their second sputum samples. Further, among 2,253 (78.5%) TB suspects who submitted two sputum samples, 361 (16.0%) were AFB-positive. Of these, 98.3%, 98.6%, and 96.9% were positive on the first, second, and both sputum smear examinations, respectively. The additional yield of the second sputum smear was 1.7%. Conclusions: The incremental yield of second smear examination is low; this indicates that single sputum smear examination is enough for the diagnosis of TB in tertiary health care settings.

Occupational Health and Safety Measures in a Mortuary of a Private Tertiary Care Medical College Hospital, Bangalore

Occupational Health and Safety Measures in a Mortuary of a Private Tertiary Care Medical College Hospital, Bangalore