Tertiary Care Teaching Hospital Research Articles

An observational prospective cross-sectional study on extravascular lung water by lung ultrasound as a guide to fluid resuscitation therapy in adult septic shock in tertiary care hospital in central India

Background Septic shock is a life-threatening condition characterized by systemic inflammation and organ dysfunction, with fluid resuscitation being a cornerstone of management. However, indiscriminate fluid administration can lead to fluid overload and worsen outcomes. Extravascular lung water (EVLW) estimation by lung ultrasound has emerged as a promising tool for guiding fluid therapy in septic shock, allowing clinicians to assess pulmonary edema and tailor resuscitation strategies accordingly. Methods This prospective observational study aims to evaluate the utility of EVLW estimation by lung ultrasound in guiding fluid resuscitation therapy in adult patients with septic shock admitted to a rural tertiary care teaching hospital. Eligible patients admitted to the intensive care unit (ICU) will undergo baseline demographic and clinical assessments, including lung ultrasound, to quantify EVLW using B-line analysis. Fluid resuscitation therapy will be initiated based on EVLW findings, with subsequent adjustments guided by repeat lung ultrasound examinations at 6, 12, 24, and 48 hours post-initiation. Outcome measures include changes in mean PaO2/FiO2 ratios, respiratory parameters, renal function, fluid balance, and mortality rates. Expected Outcome We anticipate that EVLW-guided fluid resuscitation therapy will lead to more precise and tailored management of septic shock, potentially reducing the incidence of fluid overload, ARDS, and renal dysfunction. By optimizing fluid management strategies based on individual patient characteristics and responses, we aim to improve clinical outcomes and enhance the delivery of care for patients with septic shock.

Complications of placenta previa: A retrospective observational study at tertiary care hospital

: Placenta previa (PP) is condition where the placenta is inserted completely or partially into the lower uterine segment, at or after 28 weeks of gestation. Maternal and fetal risks are antepartum haemorrhage (APH), postpartum haemorrhage (PPH), abnormal adherence of placenta, low birth weight (LBW), intra uterine growth restriction (IUGR), preterm births and congenital malformations. The purpose of this study was to determine the proportion of placenta previa, the demographics of patients, types- severity, complications and the feto-maternal outcome in patients of placenta previa.: After due permission of Institutional Review Board, this retrospective observational study was carried out at tertiary care teaching hospital from July 2020 to November 2022.Proportion of pregnancies with placenta previa was 0.3%. Majority 44(91.7%) patients were registered, 38(79.2%) of patients were in age group of 21-30 years, 38(79.1%) patients were multigravida, 41 (85.4%) had major degree of placenta previa, 29(60.4%) patients admitted after 37 weeks of gestation and 47(97.9%) of patients were delivered by caesarean section. Majority of patients, 20 (41.7%) had mild anemia. Major complications were bleeding episodes during antenatal period/APH in 23 (47.9%) and PPH in 22 (45.8%) patients. Maternal mortality occurred in 1 (2.1%) patient. All babies were live at time of birth and 44(91.7%) babies were alive at the time of discharge and neonatal death occurred in 4 (8.3%) preterm babies (28-33 week gestation). Majority of patients were multigravida. No patient was severely anaemic. Majority of patients were delivered by CS. APH and PPH were major complications. About two third of patients required blood transfusion in ante/intra/post-natal period. Obstetric hysterectomy was required in about one tenth of patients. Majority of babies were alive at the time of discharge due to higher number of registered patients who took regular antenatal care, hospital delivery and good NICU facilities. Once diagnosed, placenta previa and morbidly adherent placenta should be managed at tertiary care centre with multidisciplinary approach so as to lessen the feto-maternal morbidity and mortality. Prevention is better than cure. Multiparity increases the risk of placenta previa. Hence, family planning with an aim to reduce unwanted pregnancies and abortions will help to reduce the chances placenta previa. CS increases the risk of development of placenta previa. Efforts should be made to reduce the primary caesarean section rate as it poses more risk of placenta previa, morbidly adherent placenta and its related complications in subsequent gestations.

Early identification of thyroid illness and its intricate relationship to renal function may be crucial for therapy planning

An epidemiological shift has occurred in India, where the burden of chronic illnesses is increasing, and communicable diseases are declining. Chronic diseases such as diabetes mellitus, cancer, and chronic respiratory disorders are on the rise, and this trend has been attributed to unhealthy lifestyles, increased urbanization, and changes in society and the environment. Such a category did not include chronic kidney disease (CKD). End-stage renal disease (ESRD) is defined as glomerular filtration rate (GFR) <15 ml/min/1.73 m2, while chronic kidney disease (CKD) is defined as a sustained eGFR of <60 ml per minute per 1.73 m2 of body-surface area for more than three months irrespective of the underlying cause while glomerular filtration rate (GFR) <15 ml/min/1.73 m2 is considered as end-stage renal disease (ESRD). CKD is classified into five stages ranging from mild dysfunction to complete failure. Globally, CKD is a significant cause of morbidity and death and there is a 38% increase in mortality linked to renal failure in developing nations like India. It has been shown that the epidemiology of CKD in India differs from that in the West; patients in India were, on average, five to twenty years younger Pregnancy-related malnutrition, environmental variables, genetics, or postponed medical care that accelerates the course of CKD are among the likely reasons and birth weight.The present hospital-based, cross-sectional, observational study was conducted in the a tertiary care teaching hospital in South India from December 2020 to January 2024. The study comprised 50 patients of CKD between 30 and 70 years of age of both sexes with no previous history of any thyroid dysfunction, while 50 apparently healthy age and sex-matched individuals from the same ethnic population with normal renal function and no past history of thyroid disorders served as a control group.The results of this study and most others, there is a possibility that abnormal thyroid hormone activity may result in a decline in renal function. Early identification of thyroid illness and its intricate relationship to renal function may be crucial for therapy planning.The current cross-sectional hospital-based observational study discovered that uremic patients had considerably lower mean TT3 and TT4 and higher mean TSH when compared to healthy controls, regardless of the kind of medication or duration of the disease. Based on the results of this study and most others, there is a possibility that abnormal thyroid hormone activity may result in a decline in renal function. Early identification of thyroid illness and its intricate relationship to renal function may be crucial for therapy planning.

Knowledge, Attitude, and Practice on Over-the-counter Drugs among Undergraduate Students of a Tertiary Care Teaching Hospital

INTRODUCTIONOver-the-counter drugs are those which are safe and effective for the general public to use, without consulting a health care professional. Self-medication with over-the-counter drugs is common among medicine and health science students. This study aimed to assess the knowledge, attitude, and practice on over-the-counter drugs among undergraduate students of a tertiary care teaching hospital. MATERIAL AND METHODSA descriptive cross-sectional study was conducted among first and second year undergraduate students from June 2023 to September 2023. Data was collected through self-administered questionnaire and was entered and analyzed in Statistical Package for Social Sciences version 16. Descriptive statistical analysis was carried out to find out knowledge, attitude and practice of over the counter drugs. RESULTSAmong 352 students, 272 (77.27%) had good knowledge (with mean knowledge score of 7.22±1.43 out of 9) on over the counter drugs. Almost all of the students 350 (99.43%) had a positive attitude toward over the counter drugs use, (with a mean attitude score of 27.55±2.70, out of 40). Only 195 (55.40%) students always read the instructions on the medicine’s label before use. Most commonly used over the counter drugs was antipyretics 264 (75%). CONCLUSIONMajority of the students had good knowledge and practice and positive attitude towards over the counter drugs use, however, there were few inappropriate practices. Awareness on proper use of over the counter drugs among students is necessary in medical institutions to prevent the misuse of these drugs.

Evaluation of Pharmacotherapy of Cancer Pain in Patients with Head and Neck Cancer at a Tertiary Care Teaching Hospital

Evaluation of Pharmacotherapy of Cancer Pain in Patients with Head and Neck Cancer at a Tertiary Care Teaching Hospital

Baseline characteristics, reperfusion treatment secondary prevention and outcome after acute ischemic stroke in three different socioeconomic environments in Europe.

The differences in vascular risk factors' and stroke burden across Europe are notable, however there is limited understanding of the influence of socioeconomic environment on the quality of secondary prevention and outcome after acute ischemic stroke. In this observational multicenter cohort study, we analyzed baseline characteristics, reperfusion treatment, outcome and secondary prevention in patients with acute ischemic stroke from three tertiary-care teaching hospitals with similar service population size in different socioeconomic environments: Bern/CH/n = 293 (high-income), Gdansk/PL/n = 140 (high-income), and Lutsk/UA/n = 188 (lower-middle-income). We analyzed 621 patients (43.2% women, median age = 71.4 years), admitted between 07 and 12/2019. Significant differences were observed in median BMI (CH = 26/PL = 27.7/UA = 27.8), stroke severity [(median NIHSS CH = 4(0-40)/PL = 11(0-33)/UA = 7(1-30)], initial neuroimaging (CT:CH = 21.6%/PL = 50.7%/UA = 71.3%), conservative treatment (CH = 34.1%/PL = 38.6%/UA = 95.2%) (each p < 0.001), in arterial hypertension (CH = 63.8%/PL = 72.6%/UA = 87.2%), atrial fibrillation (CH = 28.3%/PL = 41.4%/UA = 39.4%), hyperlipidemia (CH = 84.9%/PL = 76.4%/UA = 17%) (each p < 0.001) and active smoking (CH = 32.2%/PL = 27.3%/UA = 10.2%) (p < 0.007). Three-months favorable outcome (mRS = 0-2) was seen in CH = 63.1%/PL = 50%/UA = 59% (unadjusted-p = 0.01/adjusted-p CH-PL/CH-UA = 0.601/0.981), excellent outcome (mRS = 0-1) in CH = 48.5%/PL = 32.1%/UA = 27% (unadjusted-p < 0.001/adjusted-p CH-PL/CH-UA = 0.201/0.08 and adjusted-OR CH-UA = 2.09). Three-months mortality was similar between groups (CH = 17.2%/PL = 15.7%/UA = 4.8%) (unadjusted-p = 0.71/adjusted-p CH-PL/CH-UA = 0.087/0.24). Three-months recurrent stroke/TIA occurred in CH = 3.1%/PL = 10.7%/UA = 3.1%, adjusted-p/OR CH-PL = 0.04/0.32). Three-months follow-up medication intake rates were the same for antihypertensives. Statin/OAC intake was lowest in UA = 67.1%/25.5% (CH = 87.3%/39.2%/unadjusted-p < 0.001/adjusted-p CH-UA = 0.02/0.012/adjusted-OR CH-UA = 2.33/2.18). Oral intake of antidiabetics was lowest in CH = 10.8% (PL = 15.7%/UA = 16.1%/unadjusted-p = 0.245/adjusted-p CH-PL/CH-UA = 0.061/0.002/adjusted-OR CH-UA = 0.25). Smoking rates decreased in all groups during follow-up. Substantial differences in presentation, treatment and secondary prevention measures, are linked to a twofold difference in adjusted 3-months excellent outcome between Switzerland and Ukraine. This underscores the importance of socioeconomic factors that influence stroke outcomes, emphasizing the necessity for targeted interventions to address disparities in treatment and secondary prevention strategies.

Experience of Antenatal Thalassemia Screening and Prenatal Diagnosis from a Tertiary Care Teaching Hospital in Punjab

Experience of Antenatal Thalassemia Screening and Prenatal Diagnosis from a Tertiary Care Teaching Hospital in Punjab

EFFECTS OF NEUROLEPTICS WITH OR WITHOUT ANTI-CHOLINERGICS AMONG SCHIZOPHRENIC PATIENTS OF SOUTH GUJARAT

Objective: Neuroleptics (or anti-psychotics) indicated for the treatment of schizophrenia have significant dose-limiting extra-pyramidal side effects (EPS). Literature suggests limited evidence for the efficacy of anticholinergics in the treatment of neuroleptic-induced EPS. Thus, the present study was conducted to understand the effects of anti-cholinergics on EPS among schizophrenics already on neuroleptics (typical and atypical). Methods: This prospective, cross-sectional, observational study was conducted at a tertiary care teaching hospital in South Gujarat for 15 months. A total of 200 participants were included based on selection criteria and distributed equally among four groups (A, B, C, and D) of 50 participants each. The collected data were analyzed for sociodemographic profile, current treatment regimen, type of neuroleptic drug, present complaints of EPS, and addition of any anti-cholinergic agent. An abnormal involuntarily movement scale score was used for examining movement disorders in all study participants. Descriptive statistical analysis was done using Microsoft Excel 2019 and IBM SPSS software version 28, and p&lt;0.05 was considered statistically significant. Results: Hundred patients who were prescribed typical neuroleptics were divided into groups A (with anti-cholinergic) and B (without anti-cholinergic), whereas the remaining 100 patients being prescribed atypical neuroleptics were divided into groups C (with anti-cholinergic) and D (without anti-cholinergic) by simple randomization. The majority of 56% were young adults (18–35 years) with an overall male pre-ponderance (2.14:1). Out of 50 participants in both groups A and B, a higher number of group B participants experienced tremors, rigidity, difficulty in movements, and tardive dyskinesia (TD) (48/50 vs. 30/50, 36/50 vs. 6/50, 24/50 vs. 1/50, 36/50 vs. 19/50) as compared to group A, respectively. Similar results were noted with groups C and D, where a higher number of group D participants experienced tremors, rigidity, difficulty in movements, and tardive dyskinesia (TD) (15/50 vs. 5/50, 11/50 vs. 3/50, 18/50 vs. 2/50, and 16/50 vs. 4/50, respectively). All the results were statistically significant (p&lt;0.05). Conclusion: There was a significant reduction in EPS among schizophrenia patients who were prescribed atypical over typical neuroleptics. The addition of one anticholinergic to the drug regimen also significantly reduced the frequency of EPS in schizophrenia patients.

PRESCRIPTION AUDIT AND EFFECTS OF COMORBIDITIES ON INDOOR COVID-19 PATIENTS OF A TERTIARY CARE TEACHING HOSPITAL

Objective: Management of COVID-19 has been a challenge to the health-care system. The COVID-19 pandemic led to prescribing a greater number of drugs for curing the disease in the initial phase of the pandemic due to a lack of understanding of the pathophysiology of COVID-19, symptomatic treatment was given as no definite treatment was available. This presented an opportunity to assess prescribing practices during the pandemic. Methods: The study presents a retrospective cohort to assess 300 random prescriptions from indoor COVID-19 patients of a tertiary care teaching hospital. The parameters analyzed in the process of the prescription audit were patients’ demographics data, prescribing standards according to the World Health Organization core indicators, clinical diagnosis with the comorbid condition, legibility of handwriting, doctor’s name and signature, and outcome of the disease. Results: Out of 300 cases analyzed, a total of 298 (99.66%) prescriptions were with antimicrobialsa total of 55 (18.3%) patients received antivirals. 167 (55.67%) admitted patients having comorbidities such as hypertension (28%) and diabetes (24.3%). Conclusion: It is observed almost every patient has received antimicrobial in the form of antibiotic or antiviral. About 18.3% of patients received antiviral drugs. The effect of co-morbidity has a significant influence on the outcome of patients having COVID-19, as in this study, mortality rate in diabetic patients is higher up to 11.48% than in non-diabetics.

MORBIDITY AND MORTALITY PROFILE OF NEONATES ADMITTED IN NEONATAL INTENSIVE CARE UNIT IN A TERTIARY CARE HOSPITAL, SOUTH-EASTERN RAJASTHAN, JHALAWAR MEDICAL COLLEGE, JHALAWAR: A RETROSPECTIVE STUDY

Objective: The objective of this study was to study the morbidity and mortality patterns in a special newborn care unit (SNCU)/neonatal intensive care unit (NICU) of a tertiary care teaching hospital. Methods: A retrospective study was carried out in the SNCU/NICU of Jhalawar Medical College, Jhalawar. The duration of the study was 3 years. A retrospective case record review and analysis was done. Secondary data collected from the online SNCU Software (National Health mission Government of India). Results: Eight thousand seven hundred and forty-eight neonates were admitted in NICU. 2488 (59.9%) were male and 1657 (40.1%) were female, 4047 (46.3%) were normal birth babies, and 4701 (53.7%) were low birth weight babies. According to the outcome, total 6753 (77.19%) were discharged successfully, 1464 (16.66%) died, 382 (4.36%) were referred, and 149 (1.7%) were leave against medical advice. Birth asphyxia was the most common morbidity 2404 (27.36%) followed by neonatal sepsis (18.06%) and neonatal jaundice (15.44%). Birth asphyxia were more in inborn unit (p&lt;0.0001). Sepsis is more prevalent in out born unit (p&lt;0.0001). Hypoxic ischemic encephalopathy/moderate-to-severe birth asphyxia was the most common cause of death (28.23%), followed by neonatal sepsis (20.62%) and respiratory distress syndrome (19.35%), and major congenital malformations were cause of death in 106 (7.24%). Mortality due to neonatal sepsis was significantly high in outborn unit (p&lt;0.0001). Conclusion: Birth asphyxia, neonatal sepsis, and respiratory distress syndrome were the leading causes of mortality in this study. These leading causes of mortality in the study could be prevented by adequate training of nursing staff and doctors, timely referral to tertiary care if required.

Comparative Analysis of Costing Methods for Magnetic Resonance Imaging in a Tertiary Care Teaching Hospital: An Observational Study

Abstract Background: Health-care costs, often determined through outdated methods, fail to capture the true costs of care delivery. Traditional costing methods in the health-care sector have proven insufficient, leading to potential revenue losses and increased patient out-of-pocket expenses. Activity-based costing (ABC) and time-driven ABC (TDABC) offer alternative approaches to cost calculation, aiming for a more accurate reflection of resource consumption. Methodology: This descriptive observational study was conducted in the magnetic resonance imaging (MRI) center of a tertiary care teaching hospital, focusing on a single noncontrast MRI scan costing. Direct observations and record reviews, including standard operating procedures, policy letters, financial documents, and miscellaneous records, were employed. Results: Using traditional costing, the unit cost of an MRI scan was calculated at INR 1291.51. ABC yielded a unit cost of INR 3613.77, while TDABC resulted in a unit cost of INR 2764.39. A comparison between the three costing methods revealed potential revenue losses with traditional costing. In contrast, TDABC appeared to strike a balance between financial prudence and reduced patient out-of-pocket expenses. Conclusion: The study emphasizes the significance of understanding true costs in health-care delivery. The results advocate for the adoption of TDABC as a favorable compromise, enabling the hospital to retain revenue without burdening patients with additional costs. Notably, the study highlights the necessity for a granular understanding of true costs for successful transitions from volume to value in health care.

Impact of Educational Intervention on Knowledge, Attitude &amp; Practice About Pharmacovigilance in Nursing Students in A Tertiary Care Teaching Hospital in India: A Cross-Sectional Study

Background: It is crucial for healthcare professionals to know how to report adverse drug reactions (ADRs). To improve reporting rates, it is essential to improve knowledge, attitude and practice (KAP) of healthcare professionals regarding Pharmacovigilance (PV) and adverse drug reactions (ADR) reporting. According to previous studies, there has been a lack of knowledge in nursing students regarding Pharmacovigilance (PV) and reporting of adverse drug reactions (ADR). Hence, this study was planned to assess the impact of educational intervention on nursing students' knowledge, attitude, and practice of pharmacovigilance at a tertiary care teaching hospital in India. Materials and Methods: This was an interventional study conducted among 93 BSc nursing students at a tertiary care teaching hospital, India. Each participant was explained the purpose of study and asked to fill in a questionnaire about their knowledge, attitude and practice of pharmacovigilance. The post-KAP questionnaire was re-circulated among participants at the end of the intervention and data was analyzed using Chi square test. Results: The study involved 93 BSc nursing students aged 21.52 ± 1.11 years, with a male to female ratio of 1:2. All statistical calculations were performed using Graph Pad prism v10.1.0. Results showed significant differences in understanding pharmacovigilance between pre-intervention and post-intervention, and a significant change in attitudes towards pharmacovigilance due to the educational intervention. A statistically greater proportion of students learned about Pharmacovigilance and ADR reporting forms. Conclusion: The Continuing Medical Education (CME) and group discussions significantly enhanced the knowledge and attitude of nursing students regarding pharmacovigilance.

Prevalence and predictors of polypharmacy in elderly patients discharged from a tertiary care teaching hospital in Swat, Pakistan: A retrospective cross-sectional study

Background: The use of polypharmacy in the elderly has been the subject of much consideration in recent years. However, its prevalence and risk factors are yet to be properly investigated in Pakistan. Objective: The study investigated the prevalence and risk factors of polypharmacy at discharge in Pakistan. Method: A retrospective cross-sectional study of elderly patients' medical profiles for the year 2021 was performed, and the profiles that met the inclusion criteria were included. Results: The total sample size was 800, and 51.9% of patients received polypharmacy at discharge. The authors found that the female gender (OR = 0.469) has comparatively less risk of receiving polypharmacy. Furthermore, patients with an increased length of stay and increased medication use in the hospital (OR 1.1295, OR = 17.189, respectively) have a high risk of receiving polypharmacy at discharge. Furthermore, patients diagnosed with peripheral vascular disease (OR = 4.689), cerebrovascular accident (OR = 2.764), chronic obstructive pulmonary disease (OR = 3.748), asthma (OR = 2.321), and diabetes mellitus (OR = 2.754) had higher risks of receiving polypharmacy. Conclusion: The study found a high prevalence of polypharmacy at discharge in Pakistan and identified several risk factors that could help to reduce polypharmacy by targeting vulnerable groups.

Seasonal Decomposition of Sexual Victimization-Related Cases in Hyderabad, Pakistan

The issue of sexual assault is a serious concern that contributes to abuses of human rights and risks to public health. Evaluating situations like these is absolutely necessary in order to make the judicial process easier for both the victim and the person who committed the crime. When the seasonality of sexual assault-related incidents is determined, it can provide the community and law enforcement authorities with information that can help them implement preventative measures. Objective: To assess the seasonality of sexual assault-related cases at casualty department of a teaching hospital in Hyderabad, Pakistan. Methods: In current descriptive/prospective study, ninety two sexual assault-related medico-legal cases (MLCs) were included. This study based on the seasonality of sexual assault-related MLCs using seasonal decomposition of three-year from January 2020 to December 2022 data from a leading tertiary care teaching hospital in the Hyderabad region. Results: Most of the cases (N=42) were reported in the year 2021. The percentage of sexual assault-related MLCs was found to be concentrated from June to August (10.86% to 14.13%). The highest number of sexual assault-related MLCs occurred in July. The seasonal decomposition also showed pronounced peaks in summer, with intense peaks in July for rape and total sexual assault cases. Conclusions: The number of sexual assault-related cases was aggregated in mid-year, showing a higher trend in summer season. Efficient preventive measures in certain seasons and education of vulnerable groups can minimize sexual violence in the community

Pattern of Mechanical Asphyxia Deaths in Forensic Autopsies at Medicolegal Section of Liaquat University Hospital, Hyderabad

Asphyxia is characterized by oxygen deprivation in cells resulting from insufficient or altered oxygen supply. Mechanical asphyxia refers to inadequate breathing caused by external forces. This study assessed the pattern of mechanical asphyxia-related autopsies carried out at a medico-legal section of Liaquat University Hospital, Hyderabad. Objective: To assess the pattern of mechanical asphyxia-related autopsies carried out at a medico-legal section of a tertiary care teaching hospital. Methods: This prospective observational study was performed to analyze the forensic autopsy reports from January 2021 to December 2022 at Liaquat University Hospital. Hyderabad and 103 medico-legal cases of mechanical asphyxia were enrolled. All autopsy reports related to mechanical asphyxia were included. The data were collected on a predesigned pro forma. Autopsies of non-medicolegal nature and related to unnatural deaths apart from mechanical asphyxia were excluded. Results: Most of the cases (n=51) were identified as caused by the drowning. The hanging and strangulation occurred in an equal number of mechanical asphyxia-related autopsies (n=26 each). The male gender dominated the frequency of drowning and strangulation while hanging was more prevalent in females. Conclusions: Drowning was observed as the most prevalent mechanism of mechanical asphyxia in medico-legal autopsies conducted over a period of two years

Correlation of Inflammatory Biomarkers (Interleukin-6, Interleukin-8, and Tumor Necrosis Factor-alpha) with Severity of Acute Pancreatitis

Background: Early assessment of severity of acute pancreatitis is very essential for the selection of patients who will require intensive care to prevent local complications and organ dysfunction. Several scoring systems have been developed, but these require large number of clinical and biochemical parameters, making them overly complicated and cumbersome. There is a need to develop simple clinical investigations which would help in assessing the severity of acute pancreatitis. Hence, the present study is undertaken to evaluate the role of inflammatory biomarkers (interleukin-6 [IL-6], IL-8, and tumor necrosis factor-alpha [TNF-α]) in the assessment of severity in acute pancreatitis. Materials and Methods: This cross-sectional study was conducted at a tertiary care teaching hospital in North India and enrolled 50 patients with acute pancreatitis. Serum levels of IL-6, IL-8, and TNF-α were measured within 24 h of admission. Results: The levels of IL-6, IL-8, and TNF-α were found to be significantly higher in patients with severe pancreatitis as compared to mild disease. With a cutoff level of &gt;46.379 pg/ml, IL-6 had a sensitivity of 96.15%, specificity of 95.83%, and diagnostic accuracy of 96% for predicting progression to severe acute pancreatitis. Similarly, IL-8 &gt;39.54 pg/mL had a sensitivity of 92.31%, specificity of 91.67%, and diagnostic accuracy of 92%. TNF-α &gt;11.80 pg/mL had a sensitivity of 53.85%, specificity of 95.83%, and diagnostic accuracy of 74%. Conclusion: The current study results suggests that IL-6 and IL-8 levels measured within 24 h of admission can be used for predicting progression to severe acute pancreatitis.

Impact of Educational Intervention on Pharmaceutical Waste Management in a Tertiary Care Teaching Hospital-Healthcare Staff Centered Study

Expired and unused medicines are potentially toxic substances that should be managed effectively to avoid accumulation of potentially toxic pharmaceuticals in the hospital and environment. This study aimed to identify and assess the disposal practices of pharmaceutical waste at tertiary care teaching hospital. A cross-sectional prospective questionnaire study was conducted for a period of six months at tertiary care teaching hospital with a sample size of 120. Healthcare professionals above the age of 18 years were included in the study. Data from the questionnaire was analyzed using appropriate statistical tools and Chi-square test. A pre and post educational intervention study was conducted among 120 participants. The study found that 90.83% (109) participants were under the age group of 18-25 years. Among them 77.5% (93) were female and 22.5% (27) were male. Before intervention only 80.8% (97) participants were aware of different types of bags used to dispose pharmaceutical waste, whereas after educational intervention 97.5% (117) are aware of bags used to dispose pharmaceutical waste (x2=0.000&lt;0.001). Before intervention 55.83% (67) of participants were known of drug takeback system, after intervention 99.16% (119) known of drug takeback system (x2=0.000&lt;0.001). Majority of the study participants agreed that safe pharmaceutical disposal practice is an important concern in both pre and post study. Hence awareness and concern regarding the problem is high. It was observed that the knowledge of healthcare staff about pharmaceutical waste management was good. We found that educational programs can improve staff awareness level on pharmaceutical waste management.

Hematological, clinical, cytogenetic and molecular profiles of confirmed chronic myeloid leukemia patients at presentation at a tertiary care teaching hospital in Addis Ababa, Ethiopia: a cross-sectional study

BackgroundIn low-income countries there is insufficient evidence on hematological, clinical, cytogenetic and molecular profiles among new CML patients. Therefore, we performed this study among newly confirmed CML patients at Tikur Anbesa Specialized Hospital (TASH), Ethiopia.ObjectiveTo determine the hematological, clinical, cytogenetic and molecular profiles of confirmed CML patients at tertiary care teaching hospital in Addis Ababa, Ethiopia.MethodsA facility-based cross-sectional study was conducted to evaluate hematological, clinical, cytogenetic and molecular profiles of confirmed CML patients at TASH from August 2021 to December 2022. A structured questionnaire was used to collect the patients’ sociodemographic information, medical history and physical examination, and blood samples were also collected for hematological, cytogenetic and molecular tests. Descriptive statistics were used to analyze the sociodemographic, hematological, clinical, cytogenetic and molecular profiles of the study participants.ResultsA total of 251 confirmed new CML patients were recruited for the study. The majority of patients were male (151 [60.2%]; chronic (CP) CML, 213 [84.7%]; and had a median age of 36 years. The median (IQR) WBC, RBC, HGB and PLT counts were 217.7 (155.62–307.4) x103/µL, 3.2 (2.72–3.6) x106/µL, 9.3 (8.2–11) g/dl and 324 (211–499) x 103/µL, respectively. All patients had leukocytosis, and 92.8%, 95.6% and 99.2% of the patients developed anemia, hyperleukocytosis and neutrophilia, respectively. Fatigue, abdominal pain, splenomegaly and weight loss were the common signs and symptoms observed among CML patients. Approximately 86.1% of the study participants were Philadelphia chromosome positive (Ph+) according to fluorescence in situ hybridization (FISH). P210, the major breakpoint protein, transcript was detected by both qualitative polymerase chain reaction (PCR) and quantitative real time polymerase chain reaction (PCR).ConclusionDuring presentation, most CML patients presented with hyperleukocytosis, neutrophilia and anemia at TASH, Addis Ababa. Fatigue, abdominal pain, splenomegaly and weight loss were the most common signs and symptoms observed in the CML patients. Most CML patients were diagnosed by FISH, and p120 was detected in all CML patients diagnosed by PCR. The majority of CML patients arrive at referral center with advanced signs and symptoms, so better to decentralize the service to peripheral health facilities.

A study of cutaneous adverse drug reactions in the dermatology department of a tertiary care teaching hospital in Gujarat

Background: Various drugs are responsible for different cutaneous adverse drug reactions (CADRs). Considering variation in drug responses and the day-to-day increasing burden of ADRs, this study was done with emphasis on the need for effective evaluation and the reporting of the ADR reporting programme. Methods: This was an observational cross-sectional study conducted for the duration of six months in the dermatology department to evaluate various clinical patterns of CADRs. Results: A total of 60 CADRs were reported. Among them, 51.67% were present in males and 48.33% were present in females. The most common CADR was FDE (35%), followed by macula-papular rash (25%). Antimicrobials were most commonly responsible for CADRs, followed by NSAIDs, antiepileptic, anti-gout, and anti-hypertensive medications. Conclusions: For better patient care, drug safety, and rational use of medicines, knowledge of various drugs responsible for CADRs can be useful for health care professionals to reduce mortality and morbidity by monitoring, reporting, and assessment of CADRs whenever detected.

Sustaining Medical Education During COVID-19 Pandemic: Student’s Perspective on Online Teaching and Learning in a Tertiary Care Teaching Hospital of Odisha, India

Sustaining Medical Education During COVID-19 Pandemic: Student’s Perspective on Online Teaching and Learning in a Tertiary Care Teaching Hospital of Odisha, India