Tertiary Care Teaching Hospital Research Articles

Neutrophil-to-Lymphocyte Ratio (NLR) and Mean Platelet Volume (MPV) to Platelet Count Ratio in the Prognosis of Neonatal and Pediatric Sepsis.

To calculate and assess the role of neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV)/ platelet count (PLT) ratios and their trends as prognostic indicators in neonates and children with sepsis. This prospective observational study was planned over a period of two years at a tertiary care teaching hospital. Two hundred seventy children with clinical suspicion of or diagnosed as sepsis were enrolled. Serial hemograms (day 1, 4, 7, 10) and trends of NLR and MPV/PLT ratios were reviewed. NLR on day 10 of hospital stay had maximum sensitivity of 65% and specificity of 62%. Day 1 MPV was significantly higher in the mortality group. There was a significant correlation between lower Pediatric Sequential Organ Failure Assessment (p-SOFA) score and MPV in the survival group. MPV/PLT ratio on day 7 had maximum sensitivity of 85% and specificity of 74% in prediction of mortality. Serial decreasing trend of NLR (2.88-1.16) and MPV/PLT from day 1 to 10 (8.58-8.48) were associated with improved outcome (p < 0.001). High NLR, MPV and MPV/PLT on admission are associated with increased mortality in neonatal and pediatric sepsis. Serial decreasing trends in NLR, MPV and MPV/PLT ratio are associated with improved prognosis.

Species Identification and Antifungal Susceptibility Profile of Candida Isolates from Various Clinical Specimen: A Three Years Study at a Tertiary Care Teaching Hospital in Coimbatore, TN

Species Identification and Antifungal Susceptibility Profile of Candida Isolates from Various Clinical Specimen: A Three Years Study at a Tertiary Care Teaching Hospital in Coimbatore, TN

A Prospective Study of Drug Utilization and Evaluation in Gastrointestinal Disorders at a Tertiary Care Teaching Hospital

Drug Utilization Evaluation (DUE) is a comprehensive study examining the marketing, distribution, prescription, and use of medications within a society. This evaluation encompasses a range of medical, social, and economic factors related to drug use, with the primary goal of ensuring that drug therapy adheres to current standards of care. This prospective observational study conducted at Navodaya Medical College Hospital and Research Centre (NMCH &amp; RC) from 15th February to 15th August 2024 aimed to evaluate prescription patterns for gastrointestinal disorders, focusing on drug utilization from the Essential Drug List (EDL) and adherence to WHO core prescribing indicators.150 prescriptions were analyzed, revealing that 64.66% of patients were male, with the majority aged 20-39 years. Acute gastroenteritis was the most common diagnosis (34%), and common symptoms included abdominal pain, loose stools, and vomiting. Antibiotics, particularly metronidazole, were the most prescribed drug class (25.35%). Of the prescribed drugs, 75.95% were from the EDL, but only 8.91% were prescribed by generic name, and 64.82% involved injections. The average number of drugs per prescription was 6.65, indicating polypharmacy and drug interactions were prevalent. The study highlighted concerns about moderate antibiotic use, high injection rates, low generic drug prescriptions, and polypharmacy, underscoring the need for improved rational prescribing practices to enhance patient safety and cost efficiency.

A Study on Drug Prescribing Pattern in Psychiatry Out-Patient Department from a Tertiary Care Teaching Hospital

Background: Conventional public health statistics, which concentrate on mortality rather than morbidity or dysfunction, severely underrepresent the massive burden of sickness caused by behavioral and psychiatric illnesses. Objective: To determine the prevalence of psychiatric disorders and the patterns of psychotropic drug prescriptions. Materials and Methods: It was a hospital-based prospective observational study was conducted in the Department of Pharmacology &amp; Therapeutics, Sir Salimullah Medical College &amp; Hospital during July’ 2022 to December’ 2022. A total of 765 prescriptions were selected. All patients attending the psychiatry OPD during the period of the study were included and analyzed as per the WHO drug indicators. Results: Clonazepam constitutes 119 (51.74%), Lorazepam 74 (32.17%), and Others 37 (16.09%) of the 230 anxiolytics listed in the table. In 195 antidepressant drugs, 76 (38.97%) were escitalopram, 33 (16.92%) were amitriptyline, 47 (24.10%) were imipramine, and 39 (20%) were other antidepressants. Antipsychotics were detected in 194 patients (21% of the cohort population). This includes Olanzapine (88.36%), Haloperidol (34.54%), Risperidone (14.22%), and Other Antipsychotics (12.89%). Trihexyphenidyl was prescribed to 75 of the 88 study participants, accounting for 85.23% of the total. Prescribing Indicators and it was observed that an average number of drugs per prescription were 2.59±1.37. Average number of Antipsychotics prescribed per prescription was 2.73±1.46. The number of antipsychotic drugs prescribed by generic name was 52.94%. Percentage of injectable drugs prescribed 2.48%, Percentage of the prescriptions containing psychotropic FDC 20.78%, Percentage of psychotropic drugs prescribed from essential drug list 42.75%, Percentage of psychotropic drugs prescribed from hospital pharmacy 62.22%. Conclusion: The most frequently prescribed antidepressant, antipsychotic, and BZD medications were escitalopram, olanzapine, and clonazepam, in that order. Carbamazepine was preferred over lithium as a mood stabilizer.

A COMPARATIVE STUDY ON EFFICACY AND SAFETY OF STREPTOKINASE AND RETEPLASE IN PATIENTS WITH MYOCARDIAL INFARCTION IN A TERTIARY CARE TEACHING HOSPITAL

Objectives: This study compares the efficacy, safety, and cost-effectiveness of streptokinase and reteplase in treating patients with acute myocardial infarction (AMI) at SRM Hospital. A total of 86 patients were divided into two groups, each receiving either streptokinase or reteplase, with outcomes tracked over a 3-month period. Methods: Over the course of 3 months, the results of 86 patients who were split into two groups and given either reteplase or streptokinase were monitored. Results: The duration of hospital stays (6.05 days vs. 9.79 days) and the time it took to relieve symptoms (4.58 h vs. 8.74 h for streptokinase) were both significantly shortened by reteplase, according to the results. However, streptokinase was found to be more cost-effective. Both treatments showed similar increases in creatine phosphokinase (CPK) and CPK-MB biomarkers post-thrombolysis, but reteplase demonstrated superior efficacy. While reteplase was associated with a higher incidence of bleeding, streptokinase had more cases of hypotension and hypersensitivity. No significant mortality or morbidity was observed during the study period. Conclusion: This study highlights the clinical advantages of reteplase over streptokinase, despite its higher cost.

Induction training programme of resident doctors: The need of the hour

ABSTRACT Background: An induction training program is a structured process to acclimatize and orient the newly inducted staff or employees to an organization. As per the literature, there is no structured induction training program for resident doctors available in tertiary care teaching hospitals in India. Unlike other institutions, hospitals are complex places with several departments, processes, and patient services. Resident doctors in teaching medical institutions are a valuable human resource as they form the frontline doctors for delivering healthcare services. Therefore, the resident doctor needs to be oriented to the institution as early as possible to ensure quality in patient care services. The study aims to develop an induction training program for newly joined residents in teaching medical institutions and evaluate its effectiveness. The study setting was AIIMS, Bhubaneswar and the duration of the study was 6 months. Methodology: The ADDIE (analyze, design, develop, implement, and evaluate) model of human resource management was used as the study tool to develop the training program. An online national survey was conducted in the analyze phase to identify the training needs of residents. A comprehensive training module was developed based on the findings and referring the NABH Standards. The modules were implemented in a pilot mode in the study setting, and feedback was collected to understand the effectiveness of the program. Results: A training program for residents with 14 modules was developed and implemented. It consisted of 22 credits. The findings of the online survey and the feedback of the training program were found to be similar in many aspects though study participants were different in the analyze and evaluate phases. The Hospital Infection Control Practices, Hospital Management Information Systems, and Medico-legal Module were rated high by the residents. The study outlined the need for an induction training program for resident doctors in medical institutions. Based on the survey, the module was prepared and implemented. This module can be a model that can be replicated in other medical institutions. Conclusion: An induction training program for resident doctors was developed that helped them to get oriented to their workplace and improve their skills. This activity directly affects the quality of healthcare services thereby significantly contributing to patient safety.

Clinical Profile, Immunization Status And Antitoxin Administration Of Diphtheria Cases During An Outbreak In Rural North India

Introduction: Diphtheria is an acute potentially fatal infectious disease caused by the toxigenic strains of Corynebacterium diphtheriae. Acute respiratory obstruction, toxic myocarditis and neurologic weakness are the most important complications of diphtheria. The clinical presentation and severity of diphtheria vary in immunised and non immunised children. Early diagnosis and prompt treatment including administration of diphtheria antitoxin and antibiotics minimise mortality. Methods: Records of 215 children admitted with the diagnosis of clinical diphtheria in a tertiary care teaching hospital in Nuh, Haryana, from January, 2019 to December, 2019 were analysed with respect to clinical features, immunization status, complications and mortality. Patients were divided into survivors and non-survivors and variables were compared between the two groups. Results: Data of 215 children was obtained. Young children (median age 5 year) were predominantly affected, and only 5(2.3%) children were fully immunized. Pseudo membrane was present in 113 (52.5%) cases. Albert staining and culture were positive in 57.2% (123) and 8.8% (19) cases, respectively. Complications developed in 38.1% (n=82) cases and included: airway compromise 15.3% (n=33), palatal palsy 4.7% (n=10), symmetric polyneuropathy 0.9% (n=2), diphtheritic cardiomyopathy 8.8% (n=19), acute kidney injury 2.3% (n=5), thrombocytopenia 6.6% (n=12) and hepatitis 0.4% (n=1) cases. Anti-diphtheritic serum(ADS) was administered to all admitted patients. Tracheostomy was done in (n=33)(15.3%) children. Case fatality rate was 12.1%. Conclusion: Diphtheria mostly affected young unvaccinated or partially vaccinated children. Complications and mortality was high in unimmunized or partially immunized young children and those with bull neck, pseudo membrane, delayed (≥5days) administration of ADS, acute kidney injury, thrombocytopenia and leucocytosis. Regular monitoring helped to detect asymptomatic myocarditis. The outbreak highlighted the need to improve awareness about diphtheria and better vaccination coverage. Administration of diphtheria antitoxin within 72 hours of presentation decreases the development of neurological complications.

Clinicoepidemiology and Diagnosis of Hepatitis C: Evaluating HCV Core Antigen Assay as a Diagnostic Tool in a Tertiary Care Teaching Hospital of North India.

One of the main causes of primary hepatocellular carcinoma and chronic hepatitis is the hepatitis C virus (HCV), with significant variability in its genotypes affecting pathogenicity and treatment outcomes. In India, prevalence ranges from 0.5 to 1.5%, with certain regions showing higher rates. Diagnostic methods include serological and molecular assays, with the HCV core antigen (HCV cAg) assay emerging as a cost-effective substitute for HCV RT-PCR testing. This study enrolled 292 suspected hepatitis cases from May 2019 to May 2020 in a North Indian tertiary care institute. Demographic, biochemical, and clinical data were collected. Seroprevalence was determined using QualisaTM HCV ELISA. Sixty seronegative and 30 seropositive samples underwent HCVc-Ag testing and HCV RT-PCR. Genotyping was carried out using AmpliSens® HCV-genotype PCR kit. The HCV core antigen assay was evaluated by taking HCV RT-PCR as the gold standard test. Of the 292 patients, 98 (30%) were seropositive for HCV, predominantly in the 40-59 age-group. Surgery and blood transfusion were significant risk factors. Co-infections included human immunodeficiency virus (HIV) (3.06%) and hepatitis B virus (HBV) (6.12%). Genotype 3a was the most prevalent. HCV core antigen assay showed 93.75% sensitivity, 93.10% specificity, 88.24% positive predictive value, 96.43% negative predictive value, and 93.33% accuracy. Hepatitis C virus core antigen is a dependable and economical substitute to HCV RT-PCR for diagnosing HCV infection. Regular screening in high-risk groups is essential for early detection and prevention. Rautela A, Raj N, Verma A, et al. Clinicoepidemiology and Diagnosis of Hepatitis C: Evaluating HCV Core Antigen Assay as a Diagnostic Tool in a Tertiary Care Teaching Hospital of North India. Euroasian J Hepato-Gastroenterol 2024;14(2):176-181.

Variations in physiological responses to painful stimuli in preterm and term neonates: an observational study

Background: Appropriate neonatal pain assessment and management is a key component of quality medical care. Assessment of pain, however, is a challenge due to their inability to verbalize this subjective sensation. Preterms are hyper-sensitive to pain and experience it for prolonged periods but it is postulated that they may not express it as robustly and reliably as term neonates. This paper aims to assess and compare the behavioral and physiological pain responses in these groups. Methods: This prospective observational study was conducted in the outpatient and post-natal wards of a tertiary care teaching hospital. 90 clinically stable term and late preterm neonates requiring IV cannulation, IV blood sampling or heel prick were included. NIPS Pain Scale Scores and physiological parameters (heart rate, respiratory rate, SpO2, mean arterial pressure, total crying time) were recorded before and after the procedure. Results: 90 neonates were analysed. Significant pain response was noted in both groups post-procedure. In response to the same procedures, preterm neonates demonstrated lower NIPS Scores (4.00 vs. 4.93, P=0.003) and shorter cry times (64.30s vs. 87.35s, P=&lt;0.05). Also noted were higher heart rates and respiratory rates with a prolonged fall in SpO2 and Mean Arterial Pressures in this group. Conclusions: Preterms, compared to term neonates demonstrate a blunted behavioral response to pain but a heightened and prolonged physiological response. This potential underestimation of pain in preterms indicate the need for incorporation of behavioral cues, physiological parameters and gestational age in the assessment of pain in newborns.

Prescription patterns and drug utilization in respiratory tract infections: implications for antimicrobial stewardship at a tertiary care teaching hospital.

Respiratory tract infections (RTIs) are common causes of hospital admissions and are often treated with multiple medications, including antibiotics, contributing to antimicrobial resistance. Effective drug utilization evaluation (DUE) is essential for ensuring rational drug use in RTI management. This study aimed to assess prescription patterns and drug utilization in RTI patients at a tertiary care hospital, focusing on the rationality of drug use, polypharmacy, adherence to clinical guidelines, and implications for antimicrobial stewardship. A cross-sectional study was conducted at Vivekananda General Hospital, Hubballi, India, from August 2023 to January 2024. Data from 200 RTI inpatients, including demographics, medication types, administration routes, and prescription patterns, were analyzed. Descriptive and inferential statistics were used to evaluate adherence to guidelines and rational drug use. DUE revealed that 50.99% of patients were not prescribed cough syrup. Oral (52%) and intravenous (48%) routes were the most common. Budesonide was the most frequently prescribed bronchodilator (26.49%), and 72.45% of patients received oxygen. Ceftriaxone (12.68%) and azithromycin (11.88%) were the most commonly prescribed antibiotics. A high prevalence of polypharmacy was identified, with 39.50% of patients receiving more than three antibiotics, raising concerns about drug interactions and rationality. The study underscores the need for stricter adherence to clinical guidelines and targeted antimicrobial stewardship in RTI management. Enhanced DUE practices could improve patient outcomes and promote rational drug use.

Clinico-pathological spectrum of oral cavity lesions with their radiological, histopathological, and immuno-histochemistry correlation at a tertiary care teaching hospital: A study of 200 cases

: The oral cavity is vulnerable to different types of environmental insults and chemical injuries specifically with the use of tobacco. Among the various oral cavity lesions, oral squamous cell carcinoma (SCC) is a major burden in the developing countries. Diagnosis is done mainly by histopathological examination while few cases need immunohistochemistry (IHC). Some neoplastic lesions are small and deep-seated and need CT or MRI for further evaluation. This study was aimed at studying the spectrum of oral cavity lesions with respect to age, gender and location and to analyse their radiological and histopathological aspects.: The aim of this article is to study the spectrum (neoplastic and non-neoplastic) of the oral cavity lesions with respect to age, gender, and location/site distribution, to analyse the radiological aspect of the oral cavity lesions and to analyse the histopathological aspect of the oral cavity lesions.: This is a retrospective and prospective study of 200 cases over a period of one and a half years. The information like age, gender, etc. was recorded from the requisition forms and the departmental record and studied statistically. p63, CD45, CD19, CD20 IHC markers were done.: The most involved age group was 41 to 50 years. The male: female ratio was 2.27:1. Out of 200 studied cases, 102 (51%) were malignant lesions. In SCC, the buccal mucosa was the most common site with ulcero-proliferative presentation and association with tobacco consumption. : Histopathological examination is the gold standard for the diagnosis of oral cavity lesions. IHC is helpful to confirm an epithelial lineage. Prevention as well as early detection and treatment of oral SCC improves the lifestyle of affected individual and reduce the overall morbidity and mortality associated with oral SCC.

Histopathological audit of hysterectomies for analysis of indication and respective pathology at tertiary care teaching hospital

Histopathological audit of hysterectomies for analysis of indication and respective pathology at tertiary care teaching hospital

Analysis of Blood Utilization Practices and Quality Indicators in a South Indian Teaching Hospital in Puducherry, India

Abstract Introduction: The transfusion of donated blood is the mainstay of treatment for medical or surgical conditions. It is the primary responsibility of blood transfusion services to provide a safe, sufficient, and timely supply of blood products. It is recommended to conduct regular audits to know usage trends. This study aims to analyze the utilization pattern and quality indicators of transfusion services. Materials and Methods: This is a retrospective study conducted in the blood center of a tertiary care teaching hospital in Puducherry, India. We collected and analyzed data on the request and utilization of blood and its products from January 2023 to December 2023. The department-wise utilization of blood and its components, crossmatch to transfusion ratio (C: T ratio), transfusion probability (T%), and transfusion index (TI), were calculated. Results: Packed red blood cells (PRBCs) were the most utilized blood product. The intensive care unit ward received the highest blood supply, followed by obstetrics/gynecology and orthopedics. Patients with anemia, followed by surgery and pregnancy, required a majority of PRBCs. The CT ratio, TI, and TP% were 2.7%, 0.42%, and 0.37%, respectively. Conclusions: The overall transfusion indicators, namely C/T ratio, TI, and TP, were near optimal compared to standard values. However, the majority of the cross-matched blood remained unused. It is crucial to conduct a periodic review of the blood component usage in a hospital.

Out of Pocket Expenditure Among Patients Covered Under Voluntary Health Insurance for Kidney Replacement Therapy in a Tertiary Care Teaching Hospital in Coastal Karnataka

Background Chronic kidney disease (CKD) is a global health concern and is associated with high cost of care. This study aims to evaluate the out-of-pocket expenditure (OPE) among CKD patients covered by voluntary health insurance (VHI) for kidney replacement therapy (KRT) services and assess their knowledge and satisfaction with existing coverage. Materials and Methods Data were collected from 68 patients covered by 14 VHI schemes. Sociodemographic characteristics, morbidity details, and health insurance specifics were analyzed using SPSS software. Statistical tests, including Chi-square and Mann-Whitney U, were used to assess associations and median satisfaction scores. Results Significant differences were found between government and private health insurance companies regarding morbidity (X2=8.094, p=0.004) and annual family income (X2=5.057, p=0.03). Statistically significant variations (p &lt; 0.001) were also observed in policy type, beneficiary type, annual premiums, coverage amounts, enrollment duration, and frequency of hospital admissions. OPE showed no significant difference. Satisfaction scores for reimbursement and affordability were high but not statistically significant. Many participants lacked awareness about aspects of their health insurance policy, regardless of the provider. Conclusion Despite VHI coverage, CKD patients undergoing KRT experience substantial financial burden. Improved patient education and policy transparency are essential to address gaps in coverage and alleviate financial strain. These findings underscore the need for policy reforms and patient-centered interventions to enhance healthcare access and affordability for CKD patients in India.

Out-of-Pocket Expenditure (OOPE) on Selected Surgeries in the Obstetrics and Gynaecology Department incurred by Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Private Health Insurance and Uninsured Patients in a Tertiary Care Teaching Hospital in Karnataka state of India.

Introduction OOPE for healthcare services is a major concern within the Indian healthcare system. 30% of the population remains uninsured despite increasing health insurance coverage. For obstetrics and gynaecology (OBG) patients financial obstacles like OOPE can delay access to health care, evaluating spending patterns can inform policies to enhance accessibility, affordability and equitable health. Methodology A retrospective study was conducted at a tertiary care teaching hospital in Karnataka state of India to analyze OOPE for 905 OBG patients who underwent Cesarean Section(C-Section), Laparoscopic Hysterectomy, Laparoscopic Cystectomy, Laparoscopic Myomectomy and Laparoscopic Assisted Vaginal Hysterectomy (LAVH). These were the top five most performed obstetrics and gynecology surgeries in the tertiary care teaching hospital between January 2023 and July 2023. Data was collected across AB-PMJAY, private health insurance, uninsured patients and analyzed using descriptive statistics (mean, median) and the Shapiro-Wilk test for data normality. Results The study analyzed OOPE across 905 OBG patients. Findings show AB-PMJAY provided full coverage with zero OOPE for all surgeries. Though private health insurance reduced OOPE compared to uninsured patients under private health insurance still faced significant financial burden. Variations existed in minimum and maximum OOPE and percentage of OOPE across different private insurances. All the uninsured patients incurred 100% OOPE, with a median OOPE of Rs. 33,257 (405.67 USD) to Rs. 57,053 (695.76 USD) and a mean OOPE of Rs. 39,848 (485.95 USD) to Rs. 60,687 (740 USD) across the surgeries. Discussion Findings of the study show that AB-PMJAY is highly effective in reducing OOPE and enhancing financial risk protection for OBG patients. Patients covered by private health insurance incurred less OOPE, yet the burden remained considerable. High OOPE rates for uninsured patients (100%) and private health insurance (38.15%) compared to 0% OOPE in AB-PMJAY emphasizes the need for the continued expansion of AB-PMJAY.

A CLINICAL STUDY OF NEONATES FROM A TERTIARY CARE TEACHING HOSPITAL IN SOUTHERN HARYANA

Objectives: The present investigation has been undertaken to study certain aspects of neonates clinically at a tertiary care teaching hospital in southern Haryana. Methods: All the patients attending the pediatric department referred from peripheral healthcare facilities to the study site and neonates delivered at the study site formed the study population. Neonates subjected to two or more inter-healthcare facility referrals, neonates with surgical conditions and neonates whose parents/legal caretaker denied consent, were excluded from this study. Results: Among 256 neonates, 59 (23.0%) neonatal sepsis was present out of which 16 (17.8%) were inborn neonates and 43 (25.9%) were outborn neonates. One hundred and ninety-nine (77.7%) neonates were discharged after treatment out of which 76 (84.4%) were inborn neonates and 123 (74.1%) were outborn neonates. One hundred and ninety-nine (77.7%) neonates were discharged after treatment out of which 76 (84.4%) were inborn neonates and 123 (74.1%) were outborn neonates, whereas 40 (15.6%) unfortunately experienced a fatal outcome (death) out of which 9 (10.0%) were inborn neonates and 31 (18.7%) were outborn neonates. Conclusion: Respiratory distress syndrome, neonatal jaundice, and meconium aspiration syndrome are significant contributors to morbidity in newborns. The most prevalent causes of mortality included prematurity, respiratory distress syndrome, birth asphyxia, and sepsis.

Utilizing Lactation Acuity to Improve Lactation Services in a U.S. Hospital.

National staffing guidelines for hospital lactation services do not account for the lactation acuity of breastfeeding patients. Higher acuity breastfeeding couplets require a higher level of knowledge and skill from lactation care providers. In these cases, a referral to an International Board Certified Lactation Consultant (IBCLC) is recommended for appropriate management. Use of a lactation acuity classification system as a clinical practice innovation was implemented at Oklahoma University Medical Center to improve the distribution of staff resources for optimal care of breastfeeding patients. Lactation service reports from this facility, a tertiary care teaching hospital, were reviewed to evaluate staffing, number of lactation consults, reason for and acuity of consults, and time spent. The review included over 10,000 lactation consults completed over a 1-year period. Once the lactation acuity system for IBCLC staff was in place, there was an increased mean direct consult time and acuity level with 85% of IBCLC time allocated to high acuity consults. Trained bedside nurses handled most low-acuity patients. The percentage of patients needing a lactation consult who received one increased along with the number of consults per patient. Data on time spent per consult were stratified by acuity, location, and reason for consult, including details on priority consults for neonatal intensive care unit patients. The productivity of the lactation team was higher with the use of a lactation acuity system compared to without it. The data reported support the use of lactation acuity in making recommendations for staffing of hospital lactation services.

Study of factors leading to cancellation of elective surgeries in a tertiary care hospital

Background: The postponement of elective surgeries is a major problem that increases the time for patients on surgical waiting lists and can negatively affect psychologically and physically to patients and their families. Cancellation rates reported within the literature are highly variable with considerable differences depending on type of hospital, national health care systems or policies, geographical region, patient population, providers, and also the perioperative management practices present at specific institution. Aims and Objectives: The current study was to thoroughly understand the causes to minimize such cancellations in our institute. Materials and Methods: A prospective observational study was conducted in the Department of General Surgery in a tertiary care teaching hospital in North India. All the patients admitted for elective surgeries in the Department of General Surgery over a period of December 1st, 2022–May 30th, 2023 were noted and out of them, details of patients in whom surgery was cancelled were taken and they were followed for 2 months. Results: Out of a total 1065 patients, 92 patients got cancelled during the study period. Out of them, 67 patients (67.8%) were cancelled on the scheduled date of surgery or after reaching operation theatre whereas, 25 patients (27.2%) were cancelled on day before scheduled date of surgery. Maximum number of cancelled patients were of cholelithiasis planned for laparoscopic cholecystectomy followed by inguinoscrotal swellings. Maximum number of patients were deferred due to administrative-related factors, followed by medical related factors. Conclusion: This study will act as a quality improvement initiative by reducing the surgery cancellation rate thus improving utilization of limited resources and valuable time to provide better health care services in our institute. Such cancellations can be minimized by better planning and active inter-departmental communication regarding proposed plan of surgery.

Analysis of Preanalytical Errors in Clinical Biochemistry Laboratory of a Tertiary Care Hospital: A Retrospective Study

Introduction: Pre-analytical phase of laboratory testing is the most susceptible phase, as errors in this phase leads to more than 50% of erroneous results and often breaches the trust of the stakeholders on the quality of the laboratory results. Many pre-analytical errors occur during the pre-analytical phase, encompassing sample collection, labelling and transportationfactors often beyond the laboratory’s direct control. Aim: To determine the type and frequency of pre-analytical errors leading to sample rejection in clinical biochemistry laboratory. Materials and Methods: Being a retrospective descriptive study, convenient sampling was used to analyse sample rejection due to pre-analytical errors in clinical biochemistry laboratory of a tertiary care teaching hospital- PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India for a period of six months from May 2023 to October 2023. All the cases/blood samples from Outpatient Department (OPD) and Inpatient Department (IPD), received and rejected during this period were included under study. The data collection and analysis was done over a period of five months using the sample rejection and resample description from Laboratory Information System (LIS). Using Statistical Package for the Social Sciences (SPSS) version 28.0, data were summarised using descriptive statistics such as numbers and percentages. Results: During the six months period out of the total of 667454 samples, 1505 (0.23%) samples were rejected due to pre-analytical errors. The majority of the samples which were rejected were from IPD than OPD. Among the pre-analytical errors, haemolysis accounted for 806 (53.6%), clotted samples 256 (17%), delta check 217 (14.4%), insufficient sample 129 (8.6%), contamination 74 (4.9%), identification error 14 (0.9%), sample without request form 3 (0.2%) while missing samples, billing error, inappropriate tube, delay in transport and wrong test selection accounted for &lt;3 (0.1%). Conclusion: Haemolysis and clotted samples were the most common pre-analytical causes for sample rejection in the laboratory. The samples from IPD were rejected more often than OPD due to incorrect phlebotomy techniques. This accentuates the need for proper hands-on phlebotomy training sessions for novice nurses following their recruitment, as their competency will be instrumental in bringing down the errors in pre-analytical phase.

Prevalence of peripheral neuropathy in children with transfusion-dependent thalassemia: A hospital-based cross-sectional study.

Our study aimed to determine the prevalence of Peripheral Neuropathy (using nerve conduction studies (NCS)) in children with transfusion-dependent thalassemia aged between 5 to 18 years and to study its correlation with chronic anemia, ferritin levels, chelation status, annual transfusion requirement, deficiency of serum Vitamin B12, and Folate levels. In this hospital-based cross-sectional study, 100 eligible children were enrolled in a tertiary care teaching hospital in New Delhi, India. Neurological examinations focusing on peripheral neuropathy followed by NCS were performed on all the patients. Age-wise cutoff values outside of 2.5 SD of normal were taken as abnormal. None of the children had clinical features of peripheral neuropathy, although 77% had abnormalities in NCS. Of these, 33% had pure motor nerve changes, 7% had pure sensory nerve changes, 1% had abnormal F responses, and 26% had mixed nerve changes. These changes correlated significantly with chronic anemia and duration of iron chelation but not with other factors. In children with transfusion-dependent thalassemia who do not exhibit any neurological signs or symptoms, however, it is not uncommon to observe abnormal NCS at an average hemoglobin (Hb) level of less than 9.5 g/dl. Further comprehensive case-control studies are necessary to determine if a more specific Hb target range of 9.5 to 10.5 g/dl is appropriate and to investigate the potential impact of chelation therapy on these changes.