Tertiary Care Teaching Hospital Research Articles

Assessment of Hemorrhagic Risk in Maintenance Hemodialysis Population using Different Clinical Tools

BACKGROUND: End stage kidney disease (ESKD) patients receiving maintenance hemodialysis (HD) face an elevated bleeding risk. There are the factors such as body mass index (BMI), comorbidities, and medications such as antiplatelet, anticoagulants, and nonsteroidal anti-inflammatory drugs that increase the bleeding risk. The validity of bleeding risk assessment tools in the ESKD population needs to be studied. MATERIALS AND METHODS: This was a prospective, observational study in a HD unit at a tertiary care teaching hospital in Ajman. Sixty adult patients on regular maintenance HD sessions were included in the study. Severity of bleeding was categorized based on the World Health Organization (WHO) classification. Each patient’s risk of bleeding was assessed monthly using 9 different bleeding risk assessment tools (HASBLED, ATRIA, HEMORR2HAGES, ORBIT, IMPROVE, OBRI, S2TOP-BLEED, intracranial-B2 LEED3S, and Glasgow Blatchford Score for gastrointestinal bleeding) for 6 months’ period. Patients were categorized into low- and high-risk groups according to their risk scores. The predictive power of risk assessment tools was assessed by calculating its sensitivity and specificity. Receiver operating characteristic (ROC) curve was plotted, and the area under the curve was estimated for each risk assessment tool. Logistic regression model was also done using the SPSS software version 29. RESULTS: The mean age of the study group was 56 years, and the average BMI was 27 kg/m2. A total of 20 bleeding events were reported among ten patients (16.7%). The WHO category 1 and WHO category 2 bleeding were observed in 15 and 5 bleeding events, respectively. None had category 3 or 4 bleeding. Bleeding risk was found to be associated with ethnicity and obesity but not to other patient demographic factors or medication use. Based on sensitivity, specificity, positive predictive value, negative predictive value, and the area under the ROC curve, HEMORR2HAGES score showed better prediction of bleeding risk compared to the other tools used. CONCLUSION: In conclusion, most of the risk assessment tools showed poor predictive value in the maintenance HD population. Existing bleeding risk tools may not be helpful in dialysis patients. A more valid bleeding risk tool needs to be developed for the ESKD patient population.

Ab. No. 174 Physiotherapists-Led Workplace Health Promotion Program: A Cross-Sectional Need Analysis

Introduction: Workplace health promotion programs are an effective strategy for improving health status of large number of participants. They have several advantages and recently, INDIA-WORKS Trial demonstrated that standardized programs can be scaled to different worksites. Many chronic-health conditions benefit from physiotherapy interventions but physiotherapists roles in workplace health programs have not been established. Developing physiotherapists-led workplace programs have the potential to scale-up access to physiotherapy interventions. The aim is to determine the burden of chronic-health conditions and need for physiotherapy interventions among selected health professionals in a workplace setting. Methods: 39 nurses (Age: 48±4 years; 90% women) with leadership roles (Assistant Nursing Superintendents-3, Floor Supervisors–4, Patient Care Coordinators-5 & Ward In-charges–27) participated in the study. In the previous year, physiotherapy screening was included as part of annual health check-up of employees in tertiary-care teaching hospital wherein 1135 employees were screened using standardized proforma. This identified several opportunities for developing workplace health promotion programs. The current study represents phase 1 of program development, wherein nurses in leadership roles were shortlisted for determining the burden of chronic health conditions amenable to physiotherapy interventions and their willingness to participate in workplace health promotion program using a standardized questionnaire. Result: Among the participants, 18(46%) had diabetes or hypertension or both, 19(49%) were stratified as low-moderated risk using STarT Back Screening Tool (NPRS=5.2±1.4) and 14(36%) had mild disability due to back pain. Musculoskeletal pain at other sites were also common. All participants expressed willingness to participate in workplace health promotion program. Conclusion: There is significant burden of chronic health conditions in select group of healthcare professionals and all identified problems are amenable to workplace health promotion programs. Implications: There is significant potential for developing physiotherapists-led workplace health promotion program.

Knowledge, attitude, and practice of pharmacovigilance among undergraduate medical students in a tertiary care teaching hospital of Northern Maharashtra

Background: Adverse drug reactions (ADRs) contribute significantly among underlying reasons of morbidity and mortality in the health-care system. ADR reporting is the core of pharmacovigilance program but still insufficient reporting by health professionals exists in various part of our country. Aims and Objectives: The study was designed to evaluate the knowledge, attitude, and practice (KAP) of undergraduate medical students about ADR and pharmacovigilance. Materials and Methods: It was a cross-sectional study. Questionnaire was comprising 21 questions to evaluate the KAP of pharmacovigilance among undergraduate medical students. Descriptive statistics were analyzed and analysis of variance test was applied for statistical difference between the groups. Results: One hundred and eighty-six students participated in the study. The average score of 2nd year, 3rd year, and 4th year for knowledge was (4.50, 5.15, and 4.59) and for attitude was (5.37, 5.70, and 5.59) and for practice was (1.14, 1.78, and 1.36). There is a significant difference in average score between groups for knowledge and attitude, but not for practice. They have higher attitude and knowledge, but poor practice regarding pharmacovigilance. Conclusion: Respondent of the study was not completely aware of pharmacovigilance and ADR reporting. There is an increased need to create awareness and to train students about pharmacovigilance.

Analysis of Trends in Dengue Infection among Patients Attending a Tertiary Care Teaching Hospital: A Retrospective Observational Study

Introduction: Dengue, a common mosquito-borne arboviral infection in tropical countries, presents cyclical epidemics and seasonal variations with diverse clinical outcomes. Over the past three decades, it has become endemic in India, leading to a rising mortality trend, primarily due to its severity and antibody-dependent enhancement in secondary dengue cases. Therefore, understanding the trend of dengue infection in specific geographical areas is crucial for more efficient prophylaxis. Aim: To provide a comprehensive overview of the seroprevalence of dengue virus infection in Surat district, including the trends in gender, age distribution, and seasonal variations of dengue infection from 2014 to 2021. Materials and Methods: The present retrospective observational analysis was conducted in the Department of Microbiology, Government Medical College (tertiary care teaching New Civil Hospital), Surat, Gujarat, India. A total of 31,683 blood samples were received from patients with clinical suspicion of dengue-like illness from January 2014 to December 2021. Data collection took place from March 2022 to May 2022, and the analysis was conducted in June and July 2022. All samples underwent dengue infection detection using the Enzyme-linked Immunosorbent Assay (ELISA) method by Non structural 1 (NS1) antigen detection and Immunoglobulin M (IgM) antibody detection by Mac capture ELISA. Demographic and clinical details were obtained and recorded from laboratory request forms using a structured data sheet in using Microsoft Excel software version 2013. The data were entered and analysed using EpiInfo software version 3.5.1. Results: Among the 31,683 blood samples tested, 5,994 (18.91%) cases were confirmed for dengue infection through ELISA testing. The highest number of positive cases (33.6%) was observed in the 20-29 years age group, with males outnumbering females in terms of dengue positivity at a ratio of 1.37:1. The maximum number of dengue cases occurred during the postmonsoon and early winter periods, with 96.5% of cases reported from Surat district, India. Conclusion: The rising trend of dengue infection in different age groups over the years underscores the need for continued implementation of surveillance and preventive strategies before the monsoon, aiming to reduce severe dengue infections in the future.

Sports-Related Musculoskeletal Injuries in Medical Students.

Little attention is paid to the problem of sports-related injuries in amateur or nonathletes or recreational student athletes. We investigated the prevalence of sports-related musculoskeletal (MSK) injuries in medical students and attempted to identify the risk factors for these injuries. We conducted a cross-sectional questionnaire-based observational study on medical students of a tertiary care teaching hospital in central India. A total of 500 medical students were approached; the questionnaire consisted of details, such as age, gender, height, weight, predominant sport played or the sport during which they sustained an injury, estimated time spent playing every week, if they had undergone any formal training for the sport, any preexisting MSK condition, details of the injury and the treatment taken, if any, after joining medical school, and duration from getting injured to return to studies and sports. The odds ratio (OR) and logistic regression were calculated for multiple parameters. Statistical significance was set at P ≤ 0.05. Seventy-four of the 402 students who responded reported sustaining a sports-related injury; 33 and 41 students reported injury while playing contact and noncontact sports, respectively. Of these, 58 students reported that they had received formal training in sports. Football, volleyball, cricket, and kabaddi were the sports during which most injuries occurred. The injury rate was 3.7 per 1000 playing or practice hours. Almost one-fifth of the students reported sustaining a sports-related MSK injury after joining medical school. The risk factors identified for these injuries were male gender, participation in team sports, participation in noncontact sports, and lack of adequate preparation or practice.

Clinical characteristics, management, outcome, and cost of stings and bites in patients admitted to a tertiary care teaching hospital.

The objective of this study was to identify the clinical epidemiology and medical cost of stings and bites at a tertiary care hospital in South India. The medical records of hospitalized patients in the tertiary care unit between 2016 and 2020 with the history of either being stung or bitten by insects were reviewed retrospectively. The patient's demographic details, clinical symptoms, treatment chart, expenditure details, and outcomes were collected in pre-structured case report forms. The data were analyzed using SPSS Version 20.0. A total of 66 patients were enrolled, with a mean age of 45.86±23.37 years. The majority of the incidence was due to bee stings (61%). Anaphylaxis was reported in 38% of the cases, followed by acute kidney injury (10.6%). The cost of hospitalization was found to be higher for spider bites at 896.73±1414.95 USD, followed by wasp stings at 989.81±1185.57 USD. In patients with complications, the average cost of stings and bites was 438.81±685.81 USD. Most of the patients received antibiotics (75.8%), followed by steroids (62.1%). Stings and bite injuries may appear harmless initially, but they can cause severe complications in unidentified cases and for those who do not seek urgent medical attention. Antibiotics and corticosteroids can help in the management of envenomation.

Evaluation of cardiovascular drugs in medical intensive care unit patients: A prospective observational study

Background: Nowadays, due to various factors such as stress, the number of patients suffering from cardiovascular disease particularly acute attacks of myocardial infarction (MI) and other CVS conditions is increasing. As the number of patients with CVS disease increases, the evaluation of various CVS drugs used in intensive care unit plays a very important role in improving the rationality of prescription as well as the quality of treatment. Aims and Objectives: The aims and objectives are to study the various cardiovascular drugs prescribed for patients admitted in the medical intensive care unit of a tertiary care teaching hospital, Udaipur, Rajasthan. Materials and Methods: It was a prospective and observational study conducted from August 2021 to March 2023. The required data were obtained from the patient’s prescription after obtaining consent. The prior permission was obtained from the institutional ethics committee of the college. Results: Nine hundred and thirty-six patients who fulfilled the inclusion criteria were studied. Among 936, 217 patients suffered from CVS disorders. 916 CVS drugs including antihypertensive drugs were prescribed for patients. Diabetes (26.40%) is the most common comorbidity found. Around 50.23% of patients were of MI. Noradrenaline (10.89%), atorvastatin (1.089%), furosemide (9.83%), and aspirin (6.30%) were the most commonly prescribed medications among inotropes, hypolipidemic, diuretics, and anti-platelet groups, respectively. Conclusion: After studying the various aspects, it was concluded that the cardiovascular health of the people in general is at stake of risk which may be due to lifestyle, stress, etc. The pharmaco-epidemiological studies should be conducted so that rational prescribing practices can be promoted.

Assessment of knowledge, attitude, and practice of rational antibiotic use among medical students in a tertiary care teaching hospital of upper Assam – A cross-sectional study

Background: Antibiotics serve as wonder drug to combat against harmful microorganisms. Inappropriate and rampant antibiotics use is a major contributing factor for antibiotic resistance in the community. Insufficient knowledge about antibiotics usage and wrong prescribing pattern among the prescribers add to the magnitude of antibiotic resistance. Assessing the knowledge, attitude, and practices (KAP) of the future prescribers with regard to rational antibiotic use can help in planning and formulating suitable educational strategies for them during the course of study itself. Aims and Objectives: The primary objective of the present study was to evaluate the KAP of rational antibiotic usage among 3rd-year medical students in a tertiary care teaching hospital of Assam, India. Materials and Methods: A pre-validated and structured questionnaire was utilized to gather data on demographic profile and KAP of medical students pertaining to antibiotic usage. Data collected were subjected to descriptive analysis. Results were expressed as percentage under each response category. Results: A greater lot of the respondents (95.87%) had adequate knowledge about antibiotic use. The notion of antibiotic resistance was heard of but not clearly understood. The attitude results revealed that 79.34% of the respondents took antibiotics for common cold while 21.64% of respondents stopped taking antibiotic when they started feeling well. Approximately (25.77%) of participants admitted to have procured antibiotics without a valid prescription. Conclusion: The study provides baseline evidence and paucity in KAP regarding use of antibiotic among medical students in a tertiary care teaching hospital of Assam, India. Suitable educational interventions are a requisite to reinforce existent courses and instruction about rational use of antimicrobials with greater emphasis on antimicrobial stewardship.

A Prospective Observational Study to Evaluate Adverse Drug Reactions Inpatient Ward of Tertiary Care Teaching Hospital

A Prospective Observational Study to Evaluate Adverse Drug Reactions Inpatient Ward of Tertiary Care Teaching Hospital

Clinical Profile and Outcome of Pediatric Scrub Typhus: A Prospective Observational Study from Eastern India

Abstract Background: Scrub typhus is a bacterial infection caused by Orientia tsutsugamushi, which is transmitted to humans through the bite of infected chiggers (larval mites). While scrub typhus can affect individuals of all ages, including children, its clinical presentation and management in children may differ slightly from adults. There is a dearth of studies on pediatric scrub typhus from Eastern India. Materials and Methods: This prospective observational study was carried out in the pediatrics department of a tertiary care teaching hospital for 18 months. A total of 64 children aged <14 years were included. All the data related to demography, clinical and laboratory parameters, and treatment outcomes were recorded. Descriptive statistics were used to analyze and report the data. Results: The children affected most commonly belonged to the age group of 5–10 years (53.1%). Males were most commonly affected (61%). Fever was the presenting complaint in all but one case (98.4%). Other common symptoms were headache, vomiting, cough, seizure, and pain abdomen. Hepatomegaly was the most common physical finding seen in 84.4% of cases and Eschar in 75% of cases. Meningitis/encephalitis was the most common complication seen (43.8%). All children responded to the injection doxycycline, but one died (mortality rate 1.6%). Children who were cured did not show any sequelae at discharge. Conclusions: This study concludes that scrub typhus is a neglected rickettsial disease prevalent in our country. For timely diagnosis, treatment, and favorable outcome, a high degree of suspicion and knowledge about geographical distribution and clinical manifestations is important. This study can provide clues for primary care physicians to diagnose and treat scrub typhus early.

Analysis of Cesarean section rates using Robson’s ten-group classification system in comparison with the MCS population reference

Abstract Background: The escalating global prevalence of Cesarean section (CS) deliveries raises concerns. To address this, the World Health Organization (WHO) suggests employing Robson’s ten-group classification system (RTGCS) for assessing and comparing CS rates among obstetric units. The aim of our study was to assess our hospital’s CS rate per group and juxtapose it with WHO Multi-Country Survey (MCS) population reference data. Furthermore, we delve into prevalent obstetric Indications for CS and examine potential strategies for mitigating the high CS rate. Materials and Methods: This observational cross-sectional study occurred at an Indian tertiary care teaching hospital from October 2018 to May 2020. Women delivering during this period were classified based on RTGCS, and Cesarean rates were computed across various groups. These rates were then compared with the WHO’s MCS population reference guidelines. Additionally, we investigated obstetric Indications for CS within these groups. Results: Of 2994 deliveries during the study period, 42.55% were CS. Notably, group 5 (29.75%) and group 1 (21.74%) had the highest CS rates. The CS rate of nulliparous women was 40.9%. Primary CS groups frequently cited fetal distress as the reason, while group 5 showed repeat CS due to previous CS with obstetric complications, on-demand CS, and scar integrity concerns. Conclusion: Despite our hospital’s overall high CS rate, group-specific contributions align with existing research. High-risk pregnancies, previous CS cases, and preterm CS for neonatal care notably contribute. Efforts should target in reducing CS in low-risk groups.

Exploring the impact of telepharmacy and digital health at a rural tertiary care teaching hospital: A comprehensive questionnaire based cross-sectional study

Exploring the impact of telepharmacy and digital health at a rural tertiary care teaching hospital: A comprehensive questionnaire based cross-sectional study

Socioclinical risk factors for cervical dysplasia and presence of human papillomavirus among women attending a tertiary care teaching hospital of Central Odisha

Abstract Introduction: Carcinoma cervix being the second-most common gynecological malignancy in India contributes nearly 14% of all cancers in females. Cervical dysplasia and presence of human papillomavirus (HPV) DNA are the two most important factors for developing cervical cancer. Hence, our study aims to be a flag bearer to raise the awareness for cervical screening with the main objective (i) to estimate the magnitude and distribution of cervical dysplasia among the women of 21–65 years and (ii) to find association between different socio-clinical risk factors and cervical dysplasia and HPV infection among the study subjects. Methods: It was a cross-sectional study carried out in a tertiary care hospital of Central Odisha, with a sample size of 176. Purposive sampling was done. Predesigned pretested questionnaire along with Pap smear and endocervical smear sample for HPV determination were used for data collection. Results: Nearly 62% of women suffered from cervical dysplasia. Women aged ≥35 years were found to have nearly thrice the risk of having cervical dysplasia. Nearly 20% of women tested positive for HPV DNA and these women were found to be 11 times more prone for developing cervical dysplasia compared to women tested negative for HPV DNA. Conclusion: Women with repeated genital infection with HPV and aged more than 35 years were more susceptible to cervical dysplasia. Those with early age at menarche, itching per vaginum, postcoital bleeding, and postmenopausal bleeding, etc., had a significant risk for developing cervical dysplasia. Hence, such symptomatic women should be made aware to undergo screening for cervical cancer at the earliest.

Comparison of Lichtenstein repair and mesh plug repair methods in the outcome of inguinal hernia

Background: Over 20 million people have inguinal hernia repairs every year, making it one of the most frequent operations performed worldwide. The goal of a successful hernia repair is to minimize the rate of recurrence while enabling the patient to quickly and comfortably resume normal activities. Aim: To evaluate an improved and simple technique in inguinal hernia patients between mesh plug with patch repair and Lichtenstein repair techniques and to identify which technique is superior. Materials and Methods: A prospective study was conducted on 96 patients (48 Group A, 48 Group B) who underwent inguinal hernia surgery in the Department of General Surgery at a tertiary care teaching hospital for a year (October 2018–September 2019). Before surgery, the two groups were assessed for study parameters, operated, and complications were compared between patients. Patients were monitored for 2 years. Observation: No statistically significant differences were found between the study parameters and complications (P > 0.05). This difference between the two groups with respect to the duration of surgery, mean duration of hospital stay in patients, and day 1 pain in both the groups was statistically significant (P < 0.05) with a positive inclination toward the mesh plug system. Conclusion: Mesh plug repair was observed to be safe and easier. It shortens the duration of operation and hospitalization and is superior to Lichtenstein’s technique regarding postoperative pain and quality of life.

Acquaintance of medical students with the National List of Essential Medicines

Background: Undergraduate medical students are future prescribers of medicines, and they must understand the concept of essential medicines and their importance in healthcare. Regulations on Graduate Medical Education Amendment 2019, has revolutionized Indian medical education by introducing competency-based medical education which states that the major goals for an Indian medical graduate are to acquire the competency of a “clinician who understands and provides preventive, promotive, curative, palliative, and holistic care with compassion.” The National List of Essential Medicines (NLEM) has been included as a core topic in the curriculum of undergraduate medical students. This research attempted to understand the level of knowledge regarding the NLEM among undergraduate medical students. Aim and Objective: To assess the baseline level of knowledge regarding the NLEM among undergraduate medical students. Materials and Methods: A questionnaire-based study was done among medical students of a government tertiary care teaching hospital in India. 1st year students were excluded as they were not taught about Essential Medicines and NLEM. A pre-validated multiple-choice questionnaire was distributed to medical students and information was collected related to knowledge regarding NLEM significance, criteria for inclusion in NLEM, terminologies, and drugs in NLEM that are used for common conditions. Results: Out of 600 students 237 (39.50%) students responded. 98 (41.35%) students were aware of recent NLEM-2022, 91 (38.40%) students were aware of terminologies used in NLEM, and 71 (29.96%) students were aware of the criteria for inclusion of any drug in NLEM. 175 (73.84%) students were unaware of updates in NLEM-2022. 165 (69.62%) students were unaware of the number of medicines added and deleted in NLEM-2022.155 (65.40%) students were not able to answer the questions regarding drugs for anaphylaxis and new antihypertensive drugs included in recent NLEM-2022. Conclusion: Knowledge regarding NLEM is limited among undergraduate medical students. To sensitize medical students to rational drug therapy, there is an urgent need to improve their knowledge related to NLEM via educational interventions.

Assessment of prescribing pattern in uncomplicated and complicated Type 2 diabetes mellitus in a tertiary care hospital

Background: Diabetes mellitus (DM) is a major public health problem globally and in India. Many studies in the past have documented inadequate glycemic control and complication rates among the Indian diabetic population due to inappropriate or inadequate pharmacological treatment. Studies assessing the prescription pattern are also very scare from the country. The present study has been conducted with the objective of assessing the profile of diabetic patients admitted to a tertiary care teaching hospital and the prescription pattern of anti-diabetic medication among them. Aims and Objectives: The aimed to analyze the current prescribing patterns for patients with both uncomplicated and complicated Type 2 DM in a tertiary care hospital and to identify the most commonly prescribed antidiabetic medications and their combinations in both uncomplicated and complicated cases. Materials and Methods: The present study was a retrospective case record review of 136 patients with Type 2 DM admitted in the ward of general medicine department of a tertiary and is teaching hospital. Results: The mean age was 54.39 ± 12.46 years and 61.03% of participants were males. Comorbidities such as systemic hypertension were present in 21.32% of participants and hyperlipidemia was present in 11.76% of participants. The proportion of subjects, who had complicated DM, was 52.21%. Among the study population, 77 (56.62%) had oral hypoglycemic agents (OHA) alone, 27 (19.85%) had insulin alone, and 32 (23.53%) had Insulin + OHA. Among the study population, 70 (51.47%) had single OHA, 32 (23.53%) had dual combination of OHA, and 7 (5.15%) had triple combination OHA. The majority (53.70%) people were taking metformin, 20 (14.71%) people were taking glimepiride, 16 (11.76%) people were taking glibenclamide, 13 (9.56%) people were taking gliptins. Among the study population, 34 (25%) people were taking actrapid, 32 (23.53%) people were taking mixtard, and 10 (7.35%) people were taking lup Insulin. Among the study population, 32 (23.53%) had anti-hypertensive drugs, 19 (13.97%) had statins, 14 (10.29%) had antiplatelet, 12 (8.82%) had antibiotics and 4 (8.94%) had diuretics. The mean fasting blood sugar at admission was 178.51 ± 69.56 g/dL and at the discharge was 123.23 ± 24.92 g/dL and the mean difference (55.29) between two groups was statistically significant (P < 0.001). The mean postprandial blood sugars at admission was 228.92 ± 67.03 g/dL and at the discharge was 166.66 ± 30.73 g/dL, and the mean difference (55.29) between two groups was statistically significant (P < 0.001). Conclusion: The treatment intake was inadequate and glycemic control was poor in majority of the diabetic population. There is high reliance on metformin and sulfonylureas and insulin is underutilized even in patients with poor glycemic control. There is strong need to optimize the therapy in diabetic patients.

Blood lead levels in pregnant women and their newborn infants at an Indian teaching hospital.

With the growth of the world's economy and industrialization, lead (Pb) contamination in the environment has become a major issue on a global scale. Lead is typically linked to unfavorable pregnancy outcomes such as stillbirth, low birth weight preterm, and spontaneous abortion. In this study, we evaluated the blood lead levels of pregnant women and their birth outcomes attending an Indian tertiary care teaching hospital, those who were not exposed to any lead-associated industry or shops. A descriptive study was undertaken to evaluate blood lead estimation in pregnant women and umbilical blood lead levels in a community hospital. Blood samples from 104 mothers during the 1st trimester, 90 mothers during 3rd trimester, and from the umbilical cord were collected. Self-administered questionnaires were used to collect information on demographics, medical history, and concerns linked to pregnancy. Following acid digestion, the levels of lead in whole blood were determined by an atomic absorption spectrometer. The DNA damage in high blood lead-concentrated pregnant women was evaluated by comet assay methods. Among 194 blood samples of pregnant women, 31 (15.98%) samples revealed ≥5 μg/dL blood lead levels. High lead concentration (≥5 µg/dL) in 1st trimester pregnant women, end of 3rd trimester and cord blood were detected 20.19%, 11.11% and 1.11% respectively. The mean blood lead levels in 1st trimester, 3rd trimester, and cord blood were 3.88 ± 3.19, 2.66 ± 1.82, and 1.53 ± 1.06 mg/dL, respectively. The blood lead concentrations were significantly higher in the 1st trimester of pregnancy than in the 3rd trimester of pregnancy (P < 0.0017). A positive correlation between maternal and infant blood lead levels was revealed (P < 0.0001). When the comet assay was used to assess the genotoxic consequences of elevated blood lead levels during pregnancy, higher amounts of DNA damage were found in the samples (P < 0.01). In this descriptive study, there was a significant amount of lead transferred from mother to baby through the placenta. All mothers were not exposed to lead-associated industry and most were housewives. This article may be viewed as an eye-opener for understanding the blood lead concentration during pregnancy to avoid abnormal birth outcomes. To minimize exposure to environmental lead, all possible measures should be undertaken.

Improving the Quality of Paediatric Discharge Summaries at the University Teaching Hospital: A Retrospective Chart Review

Introduction: The Discharge Summary (DS) is a vital document for ongoing patient care. Poor quality of DS may lead to adverse events, medication errors, readmission, or unnecessary repetition of diagnostic work-ups. DSs provided by academic institutions may not meet expectations and, therefore, need to be evaluated. Aim: To improve the quality of DSs issued from the paediatric ward of a tertiary-care teaching hospital. Materials and Methods: The present retrospective chart review was conducted in the Department of Paediatrics, Shree Krishna Hospital (a rural tertiary care teaching hospital), Karamsad, Gujarat, India, from May 2018 to May 2020. Thirtythree summaries were randomly selected from the last quarter (October to December) of each calendar year 2017, 2018, and 2019 (a total of 99 summaries), representing the pre-intervention, post-intervention, and retention phases, respectively. In the absence of a contextual paediatric DS assessment tool, a novel scoring system was developed to evaluate 33 components of the DS under seven broad domains. This scoring system was consensually validated. Residents responsible for preparing the DS were empowered in small groups. Peer audits of the summaries prepared by each resident were conducted on multiple occasions by consultants, followed by feedback highlighting areas for improvement. Review of the summaries by senior residents or consultants were promoted. Discussions on discharge processes were emphasised during ward rounds including important DS documentation points. The percentage mean±Standard Deviation (SD) domain scores and the total final score were compared using Analysis of Variance (ANOVA) with post-hoc comparisons by Scheffe’s test using Statistics and Data (STATA) software version 14.2. Results: Out of 33 summaries from 2017, one patient file was not traceable at the time of the study, and reviews of 30 and 32 DSs could be reviewed for the years 2018 and 2019, respectively. The scoring tool demonstrated good inter-rater reliability. The mean±SD total % score was 78.50±8.23 in 2017, 85.48±8.91 in 2018, and 88.48±9.05 in 2019. There was a significant improvement (p-value=0.012) from 2017 to 2018. Domains such as history, physical examination, and discharge plan showed significant improvement, while the hospital course domain remained resistant to improvement. Conclusion: The DS score improved consecutively for both years. The quality of DSs prepared by residents in a teaching institute can be enhanced through education, audit feedback, and changes in the work system. These methods can be incorporated into postgraduate training to improve documentation.

Assessment of prescribing pattern in uncomplicated and complicated Type 2 diabetes mellitus in a tertiary care hospital

Background: Diabetes mellitus (DM) is a major public health problem globally and in India. Many studies in the past have documented inadequate glycemic control and complication rates among the Indian diabetic population due to inappropriate or inadequate pharmacological treatment. Studies assessing the prescription pattern are also very scare from the country. The present study has been conducted with the objective of assessing the profile of diabetic patients admitted to a tertiary care teaching hospital and the prescription pattern of anti-diabetic medication among them. Aims and Objectives: The aimed to analyze the current prescribing patterns for patients with both uncomplicated and complicated Type 2 DM in a tertiary care hospital and to identify the most commonly prescribed antidiabetic medications and their combinations in both uncomplicated and complicated cases. Materials and Methods: The present study was a retrospective case record review of 136 patients with Type 2 DM admitted in the ward of general medicine department of a tertiary and is teaching hospital. Results: The mean age was 54.39 ± 12.46 years and 61.03% of participants were males. Comorbidities such as systemic hypertension were present in 21.32% of participants and hyperlipidemia was present in 11.76% of participants. The proportion of subjects, who had complicated DM, was 52.21%. Among the study population, 77 (56.62%) had oral hypoglycemic agents (OHA) alone, 27 (19.85%) had insulin alone, and 32 (23.53%) had Insulin + OHA. Among the study population, 70 (51.47%) had single OHA, 32 (23.53%) had dual combination of OHA, and 7 (5.15%) had triple combination OHA. The majority (53.70%) people were taking metformin, 20 (14.71%) people were taking glimepiride, 16 (11.76%) people were taking glibenclamide, 13 (9.56%) people were taking gliptins. Among the study population, 34 (25%) people were taking actrapid, 32 (23.53%) people were taking mixtard, and 10 (7.35%) people were taking lup Insulin. Among the study population, 32 (23.53%) had anti-hypertensive drugs, 19 (13.97%) had statins, 14 (10.29%) had antiplatelet, 12 (8.82%) had antibiotics and 4 (8.94%) had diuretics. The mean fasting blood sugar at admission was 178.51 ± 69.56 g/dL and at the discharge was 123.23 ± 24.92 g/dL and the mean difference (55.29) between two groups was statistically significant (P &lt; 0.001). The mean postprandial blood sugars at admission was 228.92 ± 67.03 g/dL and at the discharge was 166.66 ± 30.73 g/dL, and the mean difference (55.29) between two groups was statistically significant (P &lt; 0.001). Conclusion: The treatment intake was inadequate and glycemic control was poor in majority of the diabetic population. There is high reliance on metformin and sulfonylureas and insulin is underutilized even in patients with poor glycemic control. There is strong need to optimize the therapy in diabetic patients.

A questionnaire-based study to assess the knowledge, attitude, and practice of Materiovigilance among health-care professionals of a tertiary care teaching hospital in Gujarat

Background: Medical devices are now an essential component of modern healthcare, providing better illness screening, diagnosis, and treatment. Every medical equipment has some level of health risk. Health-care professionals such as resident doctors, intern doctors, and nursing staff play an important role in identifying and reporting adverse events caused by medical devices. Aim and Objective: The study aimed to evaluate doctors’ awareness and attitudes concerning Materiovigilance within a tertiary care hospital setting. Materials and Methods: This was a cross-sectional questionnaire-based study done among resident doctors, intern doctors, and nursing staff of a Tertiary Care Teaching Hospital. To collect the relevant data of the study variable, a self-administered Google Forms-based questionnaire was created. It consists of a total of 18 questions related to KAP aspects of the Materiovigilance. The study participants were given access to the questionnaire via a digital web link using several social media platforms, and their responses were collected. Results: A total of 147 participants responded, of which 40.1% were resident doctors, 29.9% were intern doctors, and 29.9% were nursing staff. After analysis of responded data, 50% had proper Knowledge, 77.5% had proper Attitude, and 37.4% had a proper practice of materiovigilance. Conclusion: It was discovered that the participants in our study lacked adequate Materiovigilance knowledge and practice, but had better attitudes toward Materiovigilance. For the purpose of raising awareness and encouraging the reporting of adverse events caused by medical devices, more workshops and training programs must be held.