Tertiary Care Teaching Hospital Research Articles

Study on Drug Utilisation in Medicine Department Under National Health Scheme of Ayushman Bharath Arogya Karnataka in Tertiary Care Teaching Hospital

Study on Drug Utilisation in Medicine Department Under National Health Scheme of Ayushman Bharath Arogya Karnataka in Tertiary Care Teaching Hospital

Identification and resolution of drug-related problems among neonates in neonatal intensive care unit (NICU): A prospective longitudinal observational study

BackgroundDrug related problems (DRPs) can interfere with the desired therapeutic outcomes. Neonates are susceptible for DRP occurrence due to clinical heterogeneity, inappropriate formulations, complexity of drug regimens and polypharmacy. Thus, the objective of this study was to characterize the DRP, their resolutions and associated risk factors among neonates in the Neonatal Intensive Care Unit (NICU). MethodsA cross-sectional study was carried out in NICU ward at tertiary care teaching hospital for 18 months. Clinical pharmacists participated on daily basis to collect patient information and assess their medication therapy for DRPs. DRPs were classified into problems and their causes according to Pharmaceutical Care Network Europe (PCNE) Version 9.1. Clinical pharmacist implicated evidence-based interventions to resolve DRPs. SPSS V.25 was used for the statistical analysis. Univariate logistic regression analysis was used for the determination of risk factors for DRPs, with a p-value <0.05 for associations that were statistically significant. ResultsA total of 426 neonates were enrolled with a mean gestational age of 35.2 ± 7.5 weeks and a mean birth weight of 2316 ± 1814 g. A total of 486 DRPs were found among 55.6 % neonates. Among them, majority of DRPs were belongs to treatment effectiveness [n = 427 (87.8 %)]. In total, 559 interventions were made, resulting in the resolution of 87.4 % of the DRPs. Furthermore, neonates staying in hospital for more than 5 days identified as most significant risk factor of DRPs. ConclusionDRPs are common in neonates admitted to NICU. Clinical Pharmacist can play significant roles in identifying, preventing and resolving DRPs among neonates.

Outcome of Severe Pneumonia with Adjunct Corticosteroid Therapy at a Tertiary Care Teaching Hospital in Nepal

Outcome of Severe Pneumonia with Adjunct Corticosteroid Therapy at a Tertiary Care Teaching Hospital in Nepal

Incidence density rate of multidrug-resistant organism (MDRO) at a tertiary care teaching hospital: A retrospective cross-sectional study

: Multidrug-resistant organisms (MDROs) has become a major public health concern. Rise of MDROs and their negative consequences on patient’s survival and health care costs need the assessment of their burden and implementation of practices to control their emergence and spread. There is a lack of literature mentioning incidence density rates (IDR) of various MDRO infections in Indian hospitals. Therefore, the study was conducted to determine the infection IDR and trend of various MDROs at a tertiary care teaching hospital. It will serve as a benchmark data for similar facilities using the same surveillance definitions and methodology. : A retrospective cross-sectional study was conducted using culture data of ten years (January 2014 to December 2023) at Shree Krishna Hospital, Karamsad. MDRO studied included Methicillin-resistant (MRSA), V (VRE), (CRE), Multidrug-resistant (MDR) spp. and MDR . A total of 7311 MDRO were detected from 1321793 in-patients, showing the overall IDR of 5.53 per 1000 patients-days. CRE (n = 3056, 42%) was the most common MDRO. The overall IDR per 1000 patient-days of MRSA, VRE, CRE, MDR- ., and MDR- was 0.81, 0.23, 2.31, 1.29 and 0.89 respectively. Overall MDRO IDR has increased from 4.20 to 8.77 from 2014 to 2023. An increasing IDR was observed for MRSA (0.57 to 1.48) and MDR- (0.43 to 1.60). Around 80% of the . were MDR as compared to other MDRO. MDROs have been identified as a significant problem at our institute showing an increasing trend. We recommend following stringent infection control practices including isolation protocols as well as adherence to hospital antibiotic policy to reduce the burden of MDROs.

PREVALENCE OF POLYCYSTIC OVARIAN SYNDROME AMONG YOUNG WOMEN WHO ATTENDED TERTIARY CARE HOSPITAL, VISAKHAPATNAM

Objective: The present study aimed to determine the prevalence of PCOS among young adults attended to medical OP in a Tertiary care teaching hospital. Materials: It is a retrospective study conducted in a Tertiary care teaching hospital, Visakhapatnam using existing records in the Department of Obstetrics and Gynaecology. The study was conducted from July 2021 to July 2023. The study population includes young adults of age in between 18-30 y. PCOS was defined by Rotterdam's criteria having presence of any two of the three features. Hormonal assays were conducted using immunoradiometric assay for TSH, LH, FSH. Results: Majority of the PCOS cases 39% were reported in the age group of 26-30 Y. Among the 100 cases reported, the majority of them are reported with menstrual irregularity 62%. However, it was identified from the results that the mean values of cholesterol and triglycerides levels are quite higher suggested hyperlipidemia. The hormonal levels of TSH, LH and FSH were normal. Conclusion: Although the overall frequency of PCOS is low and evaluating PCOS in young adults can be difficult, the condition is becoming more common at this age. Changes in lifestyle are essential at this age to avoid long-term metabolic and reproductive issues.

A CROSS-SECTIONAL SURVEY OF KNOWLEDGE, ATTITUDE AND PRACTICE OF P-DRUG IN A TEACHING HOSPITAL.

Objective: Postgraduates represent the future generation of practitioners and there aren't many studies on the P-drug idea that specifically target them. Hence, we have taken up this study to assess the knowledge, attitude and practice of P-drug among the postgraduates. Methods: A prospective observational study with a cross-sectional design was conducted at a Tertiary Care Teaching Hospital. Participants' responses were gathered using a pre-validated questionnaire. It evaluated participants' understanding of the P-drug concept, attitudes about P-drugs as treatments for illnesses, and actual P-drug prescribing behaviours. Statistical Package for Social Sciences (SPSS) software version 26 was used to analyze data after compiling data in the Excel sheet. Results: Out of 230 participants, majority were the females (67.8%). 63% of participants were aware of the “rational use of medicines,” and around 57% of them knew about the P-drug concept. 44.8% were aware of STEP criteria which is applied to select P-drug. Only 66 were practising with the P-drug list and the majority of them opined that teaching programmes are necessary to create awareness about the practice of the P-drug. Conclusion: It is encouraging that the current study's findings point to reasonable drug usage rather than irrational use. The P-drug idea is a useful instrument for enhancing medical treatment and encouraging ethical drug usage. Furthermore, additional research has to be done to determine how P-drug use affects patient outcomes and healthcare expenditures over the long run.

Evaluation of hand hygiene practices of health care workers in tertiary care hospital by systematic hand hygiene audits

: Hand hygiene (HH) holds a pivotal role in infection control. However, compliance with hand hygiene has remained low worldwide. Hospital Acquired Infection (HAI) incidence is rising in most healthcare facilities. It is postulated that around 30% of HAI can be reduced by following strict hand hygiene protocols by healthcare workers (HCWs). This study was done to evaluate the level of compliance of healthcare personnel in our tertiary care hospital with respect to appropriate hand hygiene practices by employing HH audits. A cross-sectional observational study was conducted in a tertiary care teaching hospital over six months. A single‑ observer direct observation technique was used to collect the HH compliance data conducted by trained Infection control nurses. HCWs, including doctors, nurses, CRMIs and technicians, were observed for compliance in all the critical areas, outpatient and inpatient sections across all departments. The HH audit form designed based on the WHO's HH audit tool kit was used in the study. The audits were conducted randomly in all the areas for at least 20 minutes per day. : A total of 583 HCWs were observed for the Hand Hygiene Compliance audit. The overall HH compliance rate was 67.88%, with doctors at 74.31%, followed by nurses at 70.42%. Compliance was observed in OBG/Labour ward at 78.7% and the oncology ward at 78.5%. WHO moments-specific hand hygiene adherence showed the least compliance rate of 55% for moment 1, followed by moment 5 with 58.9%. Best compliance was observed for moment 3, with 79.2%.: The overall hand hygiene compliance was comparatively better in our study. Specific measures such as improved facilities, training and monitoring are needed to attain good H`H compliance.

Prevalence of ESKAPE pathogens and Antibiotic Susceptibility Status in Skin and Soft Tissue Infections from a tertiary care teaching hospital in South India

Background: ESKAPE “(Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter sp.)” pathogens are commonly found in infections affecting the skin and underlying tissues. ESKAPE pathogens often exhibit widespread multidrug resistance in hospitals, contributing significantly to Hospital-acquired infections. ESKAPE pathogen prevalence can combat the vast challenge of Antibiotic Resistance (ABR). Materials and Methods: “The microbiological statistics of ESKAPE infections and sensitivity between January 2020 and October 2022 were extracted from the laboratory records and analysed for the bacterial profile and antibiotic sensitivity pattern”. Results: Out of the 2037 pathogens isolated from Skin and soft tissue infection, 1308 were ESKAPE pathogens accounting for a prevalence of 64.2%. Staphylococcus aureus (n=340/1308; 25.99%) was the predominant pathogen followed by Pseudomonas aeruginosa (n=332/1308; 25.38%). Among Gram-negative isolates, 29.43% exhibited multidrug resistance (MDR). Carbapenemase was found to be a frequent mechanism of resistance, highest among Acinetobacter species (n=99; 64.7%), followed by Klebsiella pneumoniae (n=109; 37.07%). Amp C production was seen most commonly in Enterobacter species (n=93; 61.2%), followed by Klebsiella pneumoniae (n=172; 58.5%) whereas ESBL production was seen in Enterobacter species (n=46; 30.03%). Conclusion: ESKAPE pathogens are critical etiologic agents of Skin and soft infections. Regular studies are vital for evaluating bacterial susceptibility and highlighting the importance of policies to reduce hospital infections and enhance antibiotic prescription oversight. Understanding virulence and resistance markers is critical for tailoring treatment strategies based on local antibiograms and managing related infections.

Knowledge and awareness of bloodborne infections among medical laboratory technology students and technicians from a tertiary care teaching hospital in Karnataka, India: A cross-sectional study

Knowledge and awareness of bloodborne infections among medical laboratory technology students and technicians from a tertiary care teaching hospital in Karnataka, India: A cross-sectional study

Compliance Among Healthcare Workers on Hydroxychloroquine Prophylaxis in a Tertiary Care Teaching Hospital during COVID-19 Pandemic

Background: The Indian Council of Medical Research (ICMR), under the Ministry of Health and Family Welfare, recommended chemoprophylaxis with Hydroxychloroquine (HCQ) for asymptomatic healthcare workers treating patients with suspected or confirmed COVID-19 disease during the initial period of the pandemic. Compliance remains a major determining factor behind the success of any Community prophylaxis program. Objective: The study aimed to assess the extent of compliance with the Hydroxychloroquine (HCQ) prophylaxis schedule as per ICMR guidelines among healthcare workers and to find out the factors associated with compliance. Methods: Informed consent was obtained from the study participants, and a questionnaire on parameters and associated factors affecting compliance were filled out by every study participant upon completion of their HCQ prophylaxis. Results: A total of 160 participants were enrolled in the study. The majority of the staff enrolled was the nursing staff (34%). 66% of the total participants were involved in the care of the suspected or confirmed case of COVID-19. The major source of information about HCQ prophylaxis for COVID- 19 infection among all the participants was from the Institutional circular (56%). 10% of healthcare workers believed that HCQ could give them 100% prevention against COVID-19 infection. 56% of the enrolled healthcare workers consumed the medicine on the same day of collection throughout the schedule. 24% of enrolled healthcare workers completed the full course as per ICMR guidelines. The most motivating factor for compliance was the presence of cases of COVID-19 in the hospital. The most common factor for lack of compliance among enrolled healthcare workers was cited to be no contact with COVID-19-positive patients. Conclusion: In our study, 24% of healthcare workers enrolled for HCQ prophylaxis completed the full course of the prescribed regimen as per ICMR guidelines. The main reason for the lack of compliance was the absence of direct contact with COVID-19-positive patients, followed by fear of ADRs.

Assessment of safety and adverse events following COVID-19 vaccination and their predictors in first 30 days among healthcare workers of a tertiary care teaching hospital in North India

BackgroundThe COVID-19 vaccines were rolled out as an emergency measure, with an expedited approval to contain the pandemic. The objective of this study was to assess the incidence, pattern and severity of AEFIs reported following COVID-19 vaccination and their predictors among the healthcare workers. Materials and methodsA prospective cohort study enrolling healthcare workers of a tertiary care Institute in North India receiving COVISHIELD™ from February to May 2021 was carried out to assess the incidence, pattern and severity of AEFI over the next 30 days. Both active and passive surveillance methods were used for AEFI recording. Bivariate analysis was performed to ascertain the predictors of AEFIs. ResultsA total of 836 healthcare workers who received the first dose of COVISHIELD™ were included in the study of which 201 (24.0 %) experienced one or more AEFIs. Majority of AEFIs were of minor grade (99.8 %) and resolved spontaneously. Majority (96.0 %) had onset of the AEFIs within 48 hrs of vaccination. Serious AEFIs, leading to hospitalization was noticed in 2(0.2 %) participants, both females, with suspicion of immunization stress related response (ISRR). Both of them recovered without any sequelae. No deaths were recorded. Factors found to be significantly associated with the occurrence of AEFIs in the participants were female gender (p = 0.02), monthly income > 20,000 INR (p = 0.007), presence of any chronic illness (p < 0.0001), history of allergic reaction to any drug/vaccine (p = 0.01), history of COVID-19 infection (p < 0.00002) and history of hospitalization due to COVID-19 (p < 0.0002). ConclusionMajority of the AEFIs observed were of minor grade with spontaneous resolution of the symptoms indicating safety and well tolerability of the vaccine. Female gender, higher income, history of allergy and co-morbidities, history of COVID-19 infection and history of hospitalization were found to be major predictors for the development of adverse events and require more watchful vaccination.

A Cross Sectional Study on Prescription Pattern of Antiepileptic Medication among Children of Southern Rajasthan in a Tertiary Care Teaching Hospital

A Cross Sectional Study on Prescription Pattern of Antiepileptic Medication among Children of Southern Rajasthan in a Tertiary Care Teaching Hospital

Seroprevalence of transfusion -transmitted infections among blood donors in a tertiary care hospital in and around Koodapakkam, Puducherry, India

Introduction: Even though blood transfusion safety has come a long way, Transfusion-Transmitted Infections (TTI), which include bacterial, viral, parasitic, and prions, can still spread with each transfusion. The main goal of this study was to determine the seroprevalence of the five TTIs that are required to be tested in India among blood donors at our facility. Accurate estimates of the risk of TTIs are essential for monitoring the safety of the blood supply. Methodology: This was a retrospective descriptive study conducted in the blood centre of a tertiary care teaching hospital in Puducherry, from 2017 to 2023. Records from blood banks were reviewed to collect data on all donors who underwent appropriate testing for HIV, hepatitis C, Hepatitis B, syphilis, and malaria. Enzyme-linked immunosorbent assay was done for HIV, HCV, HBsAg/hepatitis B surface antigen, and rapid card testing was done for syphilis and malaria. Results: There was a total of 2570 donors during the study period. In the present study, the overall seroprevalence of TTIs was 1.40%. The individual seropositivity rates were 0.03% for HIV, 0.93 % for HBsAg, and 0.43 % for syphilis. There were no cases of malaria and HCV detected in the study period. The highest percentage of prevalence was observed for HBV, followed by Syphilis and HIV. Conclusion: The overall seroprevalence of TTI in Puducherry was smaller than those reported elsewhere in the country. It was comparatively lesser than the national average for HIV, HCV, and HBV and much higher for syphilis.

Chronic Kidney Disease of Unknown Etiology in A Tertiary Care Center at Tertiary Care Teaching Hospital

Chronic Kidney Disease of Unknown Etiology in A Tertiary Care Center at Tertiary Care Teaching Hospital

Evaluation of Electrical Cardiometry to Assess Fluid Responsiveness in Patients with Acute Circulatory Failure: A Comparative Study with Transthoracic Echocardiography.

Acute circulatory failure is commonly encountered in critically ill patients, that requires fluid administration as the first line of treatment. However, only 50% of patients are fluid-responsive. Identification of fluid responders is essential to avoid the harmful effects of overzealous fluid therapy. Electrical cardiometry (EC) is a non-invasive bedside tool and has proven to be as good as transthoracic echocardiography (TTE) to track changes in cardiac output. We aimed to look for an agreement between EC and TTE for tracking changes in cardiac output in adult patients with acute circulatory failure before and after the passive leg-raising maneuver. Prospective comparative study, conducted at a Tertiary Care Teaching Hospital. We recruited 125 patients with acute circulatory failure and found 42.4% (53 out of 125) to be fluid-responsive. The Bland-Altman plot analysis showed a mean difference of 2.08 L/min between EC and TTE, with a precision of 3.8 L/min. The limits of agreement (defined as bias ± 1.96SD), were -1.7 L/min and 5.8 L/min, respectively. The percentage of error between EC and TTE was 56% with acceptable limits of 30%. The percentage error beyond the acceptable limit suggests the non-interchangeability of the two techniques. More studies with larger sample sizes are required to establish the interchangeability of EC with TTE for tracking changes in cardiac output in critically ill patients with acute circulatory failure. Sharma S, Ramachandran R, Rewari V, Trikha A. Evaluation of Electrical Cardiometry to Assess Fluid Responsiveness in Patients with Acute Circulatory Failure: A Comparative Study with Transthoracic Echocardiography. Indian J Crit Care Med 2024;28(7):650-656.

Association between Iron deficiency and hypothyroxinemia in first-trimester pregnant women: A study from a tertiary care hospital

ABSTRACT Background: Iron deficiency (ID) is a common nutritional concern worldwide. Hypothyroidism during pregnancy also has harmful effects on both mother and child, such as post-partum hemorrhage, pre-eclampsia, low-birth weight, pre-term labour and abruptio placenta. Few articles have shown an association between ID and hypothyroidism. Aims: To evaluate the association between hypothyroidism, hypotriiodothyroninemia and ID in pregnant women. Materials and Methods: This cross-sectional study was conducted between January 2017 and June 2019 at JSS Hospital, a Tertiary Care Teaching and Research Hospital attached to JSS Medical College in Mysuru City, South India. Five hundred consecutive pregnant women aged 18–45 years in the first trimester of pregnancy were recruited. A venous blood sample of approximately 5 mL was drawn and sent for analysis of haemoglobin, thyroid-stimulating hormone (TSH), T3, T4, anti-thyroid peroxidase (TPO) antibodies and serum ferritin. T3, T4, TSH, anti-TPO antibody and serum ferritin levels were measured by chemiluminescence for all pregnant women. Correlation and linear regression analyses were performed to determine the association between ID and T3, T4 and TSH levels. Results: Out of 500 women, nine were excluded because of pre-analytical errors; hence, there were 491 pregnant women in the first trimester. Mean values of T3, T4, TSH and ferritin in the study were 1.45 ± 0.72, 9.29 ± 2.53, 2.37 ± 3.17 and 31.54 ± 30.28. There was a positive correlation between serum ferritin and T4 levels, with a correlation coefficient of 0.135. The scatter plot also showed a linear relationship between serum ferritin and T4 levels. There was no significant correlation between serum ferritin, T3 and TSH levels. Linear regression analysis also showed an association between ferritin and T4 levels, with a significance of 0.003. Linear regression analysis was insignificant for TSH, T3 and serum ferritin levels. Conclusion: ID anaemia (IDA) is associated with hypothyroxinemia in pregnant women. Further extensive studies are needed to evaluate the causal association between hypothyroidism and IDA. Iron therapy might improve thyroid parameters in patients with subclinical hypothyroidism and ID without thyroxine, which requires further research.

Utilizing Maternal Morbidity as a Novel Screening (MMS) Tool for Predicting Peripartum Morbidity at a Rural Tertiary Care Teaching Hospital in Central India.

Background The majority of complications and deaths related to childbirth are concentrated in developing and disadvantaged nations, where the rates are unacceptably elevated. These incidents predominantly occur in the vicinity during the intrapartum period and immediately after childbirth. The peripartum period is especially critical for expectant mothers, as it represents the time when a significant number of complications and deaths occur.This study aimedto develop, validate, and assess theefficacy ofthe maternal morbidityscreening(MMS) toolfor predictingperipartum morbidity. Methodology The study was conducted in two phases: Phase one involved developing, validating, and piloting the MMS tool, while Phase two focused on evaluating and comparing the MMS tool with the modified early obstetric warning system (MEOWS) chart for predicting peripartum morbidity. An observational analytical clinical study design was utilized. Result In Phase one, theMMS tool was developedand validated by subject experts, resulting in a reliability score of 0.90. Therefore, the tool was deemed reliable and valid. Phase two results revealed that obstetric morbidity in the maternal morbidity group was 66.66%, higher than the 32% observed with the MEOWSchart. The MMStool demonstrated significantly higher sensitivity at 95.24%, specificity at 89.50%, and predictive value at 98.50%, yielding an overall accuracy of 90.50%. In comparison, theMEOWSchart exhibited a sensitivity of 70.51%, specificity of 86.81%, predictive value of 92.94%, and accuracy of 83.71%. Conclusion The occurrence of maternal morbidity in the trigger zone was significantly higher than in the non-trigger zone in the MMStool. The MMS tool was significantly more effective as a predictor of peripartum morbidity compared to the MEOWSchart.

Smoking and the Risk of Type 2 Diabetes: A Cross-sectional Analytical Study

Background: India is undergoing epidemiological transitions with the increase in noncommunicable disease (NCD) burden. Targeting the modifiable risk factors through lifestyle changes in the early years of life remains the most effective strategy for decreasing the prevalence of type 2 diabetes mellitus (T2DM). To determine the association between cigarette smoking and T2DM. Materials and Methods: An analytical cross-sectional study was conducted among the patients attending the outpatient department of a tertiary care teaching hospital in Kolkata, West Bengal, India. Patients aged more than 35 years were enrolled, and details regarding sociodemography, clinical status, and NCD risk factors were collected using pretested semistructured questionnaires after obtaining IEC approval. Data collected were entered in MS Excel and analyzed using SPSS software. Simple logistic regression and multivariable logistic regression analysis were used to calculate the crude and adjusted odds ratio with 95% confidence interval. Results: Out of 434 participants, 37.3% had diabetes mellitus, 51.6% were males, and 28.6% had alcohol consumption. Univariate logistic regression analysis revealed age, BMI, systolic BP, diastolic BP, and cigarette smoking were significantly associated with increased risk of T2DM. Multivariable logistic regression analysis revealed cigarette smoking, systolic BP, age, and female gender were significant risk factors for T2DM. Conclusions: Our study reported cigarette smoking and systolic BP are modifiable risk factors associated with T2DM. Early identification of smoking through screening and appropriate control of hypertension in T2DM patients will decrease the morbidities and mortalities in T2DM cases.

FACTORS ASSOCIATED WITH ACCEPTANCE AND REFUSAL FOR PPIUCD AT TERTIARY CARE TEACHING HOSPITAL IN MAHARASHTRA

FACTORS ASSOCIATED WITH ACCEPTANCE AND REFUSAL FOR PPIUCD AT TERTIARY CARE TEACHING HOSPITAL IN MAHARASHTRA

Assessment of Health-Related Quality of Life of Epileptic Patients within the Indian Population at a Tertiary Care Teaching Hospital

Background: Epilepsy is one of the most limiting chronic disorders. There is a notable social stigma attached to epilepsy and is often associated with a decline in the overall quality of life of affected patients. It is crucial to identify and manage factors that affect the health-related quality of life of an epileptic patient and plan therapy to improve the same. Aim: The study aimed to evaluate the health-related quality of life in individuals with epilepsy and examine the various factors influencing the same. Materials and Methods: A prospective cross-sectional study was conducted in the general medicine wards of a tertiary care teaching hospital for six months. A total of 111 epileptic inpatients of both genders, above 18 years of age were included in the study. SF-36 questionnaire was used to assess the quality of life of the patients. Results: The study found that multiple detrimental factors affect the quality of life of epileptic patients such as age, gender, marital and employment status, presence of comorbidities, seizure frequency, alcohol intake and duration of alcohol intake. Conclusion: Management of epilepsy concerning these key factors is just as essential as lowering the stigma surrounding the disease in India.