Tertiary Care Teaching Hospital Research Articles

A cross-sectional study to estimate the prevalence of text neck syndrome among medical students in a tertiary care teaching hospital in Andhra Pradesh

Abstract Background: The overuse of handheld mobile technology is leading to detrimental effects on the human body, one of which is text neck syndrome (TNS). This refers to neck pain and disability due to repetitive stress injury. Text neck can cause symptoms such as neck pain, shoulder pain, upper back pain, and increased curvature of spine. Objectives: The objective of this study was to estimate the prevalence, awareness, frequency, severity, and radiation of pain experienced by medical students and to determine the association between the duration of gadget usage and the severity of pain. Methodology: In this cross-sectional study, 1000 medical students were surveyed regarding the awareness and prevalence of TNS. The questionnaire consisted of 16 questions which included, demographic details and education details, and questions related to frequency, duration, purpose and time of usage, and position during use. Results: Out of 1000 students, 500 of the respondents did not know of TNS, 10 knew the term in detail, 160 were familiar with the term, and 330 had only heard of the term. The usage of electronic gadgets increased with age and was found statistically significant with P < 0.05. A significant positive association (P < 0.05) was found between the duration of usage of gadgets and the severity of pain. Conclusion: TNS is a real problem, and the students are not aware of the problem. The study showed that the longer the duration of gadget usage, the more adverse the symptoms.

Sino-Orbital IgG4 Related Disease- An Uncommon Entity.

IgG4 related disease (IgG4-RD) is an auto immune fibro-inflammatory condition, characterised by presence of IgG4 positive lymphoplasmacytic infiltrates and extensive fibrosis of the involved organ. It commonly affects pancreas, biliary tract and salivary glands. Sino-orbital involvement is a relatively rare presentation. There is extensive fibrosis of the involved organ. Biopsy is often diagnostic and it shows extensive necrosis and lymphoplasmocytic infiltrates. They show dramatic response to steroid therapy. Here we present three cases of IgG4-RD disease involving orbit and para nasal sinuses who were evaluated and treated in a tertiary care teaching hospital over a period of 2 years.

Identification of DRPs and Assessment of Health-Related Quality of Life in Cardiovascular Patients in Tertiary Care Teaching Hospital

Identification of DRPs and Assessment of Health-Related Quality of Life in Cardiovascular Patients in Tertiary Care Teaching Hospital

Insights into Antihypertensive Medication Adherence: A Tertiary Care Teaching Hospital Study on Patient Compliance and Influencing Factors

Insights into Antihypertensive Medication Adherence: A Tertiary Care Teaching Hospital Study on Patient Compliance and Influencing Factors

Monitoring the frequency of microalbuminuria in treatment-naïve hypertensives in a tertiary care teaching hospital in Andhra Pradesh, India

Abstract Background: Hypertension is a serious public health issue in the general population, with a considerable proportion of cases inadequately being treated. Methods: This hospital-based prospective study was carried out at our tertiary care teaching hospital between November 2019 and November 2021. One hundred patients who were recently diagnosed to have hypertension were studied. Results: The age of the subjects ranged from 31 to 78 years with a mean age of 49 years. Of these, 40% were in the 40–49 years’ age group; there were 68 males. The body mass index (BMI, Kg/m2) distribution of the study subjects showed 22% with normal weight, 62% in overweight and 16% in obese category. Microalbuminuria was evident in 28% of newly diagnosed hypertensives. The sex-wise distribution of microalbuminuria revealed that 17 of 68 males (25%) and 11 of 32 females (34.4%) had microalbuminuria. Conclusions: The chronicity of hypertension, age and BMI were the main factors determining microalbuminuria.

IJCM_52A: Profile and outcome of gestational diabetes mellitus in a tertiary care teaching hospital

Background: Gestational Diabetes Mellitus (GDM) is a Glucose tolerance disorder first diagnosed during pregnancy. WHO recommend that all pregnant women or at least women with predisposing risk factors should be screened at the beginning of the 3rd trimester of pregnancy with the Oral Glucose Tolerance Test (OGTT). Here, blood glucose level is screened 2hrs after giving a 75g oral glucose load. This is recommended for both screening and diagnosis. Not many studies have been done regarding the outcome of GDM mothers in India. Objective: 1. To describe the Obstetric profile of the mothers 2. To assess the outcome of GDM among the Mothers 3. To determine the neonatal outcome of GDM. Methodology: Study setting: The study was carried out at Kasturba Medical College Hospital, Attavar, and District Lady Goschen Hospital, Mangalore. Study design: Hospital based retrospective study. Study population: Pregnant women admitted to above mentioned hospitals with GDM and the new born. Inclusion criteria: All women diagnosed with GDM and have delivered in District Lady Goschen Hospital or KMCH Attavar. Sample size was 266. Results: Our study concluded that 24.8% of the women with GDM also had Pregnancy Induced Hypertension, which is comparable to the study done in Qatar where they found 19.2% of the women with GDM suffered from PIH. We also found that 15.8% of the women suffered from Pre-Eclampsia, over twice the percentage of people surveyed in the Qatari study. However the amount of babies suffering from Macrosomia was only 6.8% as opposed to 10.3% according to the aforementioned study and 19.3% as was found in a study in Poznan, Poland. Conclusion: No significant association was found between obstetric profile and antenatal & postpartum complications.

Clinico-patho-radiological study of mass in the right iliac fossa

Abstract Background: Sparse recent data are available regarding the aetiological causes of the right iliac fossa (RIF) mass from Andhra Pradesh. Methods: We prospectively studied the clinical presentation, diagnosis and management of consecutive cases (n = 100) presenting to our tertiary care teaching hospital with a RIF mass over 2 years. Results: Majority of RIF masses were seen in the third and fourth decades of life, and the male-to-female ratio was 2.8:1; 64% of the cases were due to appendicular pathology (appendicular mass [48%] and appendicular abscess [16%]), followed by ileocaecal tuberculosis (TB) (12%) and carcinoma caecum (10%) among others. Carcinoma caecum was more common in males (70%) as compared to females (30%). The majority (78%) were managed surgically; 4% died. Post-operative complications included wound infection and respiratory tract infection. Conclusions: Our observations suggest that appendicular pathology, ileocaecal TB and carcinoma caecum are common aetiological causes for RIF mass. Abdominal ultrasonography and computed tomography will facilitate early localisation.

Experiences from a COVID-19 vaccination center at a tertiary care teaching hospital in Delhi, India: Challenges and solutions.

India began its nationwide coronavirus disease 2019 (COVID-19) vaccination program on January 16, 2021, in a phased manner. In this paper, we have discussed our experience at one of the COVID-19 vaccination centers in the country and have identified a few of the major challenges and their implications. The guidelines for COVID-19 vaccination in the country were changing frequently, leading to ambiguity among the beneficiaries. Co-WIN software, used for program implementation, had some glitches, which caused dissatisfaction among the service providers and beneficiaries. Vaccine hesitancy and eagerness caused low vaccine uptake initially and overcrowding at vaccination centers later. Some of the vaccination centers had the potential to become hot spots for further spread of the virus due to insufficient infrastructure. The disparity in access to vaccines for the homeless and other vulnerable groups was another hurdle for adequate vaccination coverage. These challenges could have been addressed by pretesting the information technology platform, long-term planning with a vision for handling vaccine hesitancy and eagerness, strong communication systems, removing disparities in vaccine access, and maintaining uniformity in messages for frequently updating guidelines.

Core Procedural Skills to be Taught for III-Year Undergraduate Medical Students: A Modified Delphi Study.

While medical students are expected to learn procedural skills during their training, there is no consensus on their level of learning. Further, the most essential procedural skills across medical curricula which need to be taught during their III-year clinical posting are often not considered. The purpose of this study was to identify the core procedural skills needed to be taught during the III-year undergraduate medical students clinical posting. A three-round, online Modified Delphi method was used to identify consensus on selecting the most essential procedural skills prescribed in National Medical Commission (NMC) curriculum 2019. In Round 1, a list of 54 procedural skills from the National Medical Commission's (NMC) Graduate Medical Education Regulations (GMER) 2019 curriculum was distributed to 22 experts in pre-clinical medical education and multidisciplinary clinicians.They rated the skills in terms of importance. In Round 2, the skills that received consensus in Round 1 were presented, resulting in 13 skills for evaluation. Round 3 further narrowed down the skills to a final consensus of 6. An interclass correlation coefficient of 0.767 among experts indicates a substantial level of reliability. Consensus was achieved for six procedural skills, each demonstrating over 80% agreement among the experts. These skills include basic life support, intravenous cannulation, urinary catheterization for both male and female patients, nasogastric tube insertion, oxygen administration, and basic suturing. Notably, all these skills received the highest level of agreement, surpassing 90% consensus. The results of the modified Delphi study offer crucial insights into the procedural skills that should be included in the curriculum for third-year undergraduate medical students during their clinical rotations in a tertiary care teaching hospital. Faculty members at these institutions differ in their opinions regarding the importance of teaching specific procedural skills, influenced by their teaching background and the student cohorts they instruct. From a comprehensive list, six skills have been pinpointed as the most vital through the modified Delphi technique. Moreover, the Delphi technique is acknowledged as a valuable method for achieving a consensus on prioritizing the training of certifiable skills.

Analysis of Pediatric Procedural Dermatology at a Tertiary Care Referral Hospital in Eastern India

Background: Pediatric procedural dermatology is a broad and emerging aspect in the field of dermatology. Pediatric procedures require great expertise, skill, empathy, and confidence on the part of the treating physician. The challenging factors such as parental anxiety and doubts, the child’s cooperation, and the risks versus benefits are further contributory. Objective: The objective of the study was to summarize the risks of intra- and postoperative complications/side effects during diagnostic and therapeutic procedure in the pediatric population. Materials and Methods: We conducted a retrospective study in our hospital. Patients were taken between ages 0 and 18 years who had attended the dermatology outpatient department from January 2019 to March 2022. Results: In a total of 527 outpatient department patients, 267 (50.66%) were males and 260 (49.33%) were females (male:female ratio 1.02:1). Out of diagnostic procedures, the most commonly performed procedures were punch biopsy (14.61%), followed by autologous serum skin test (11.81%) and slit-skin smear (1.90%). Out of 15 therapeutic procedures, intralesional steroids (21.34%) were the most frequently performed therapeutic procedure, followed by radiofrequency cauterization (16.51%), autologous skin therapy (6.98%), cryotherapy (8.76%), nail surgery (2.79%), chemical peeling (2.79%), comedone extraction (2.66%), chemical cauterization (2.54%), neodymium-doped yttrium aluminum garnet laser (2.16%), platelet-rich plasma therapy (1.39%), diode laser (1.27%), measles, mumps, and rubella vaccine injection (0.89%), fractional carbon dioxide laser (0.63%), suction blister epidermal grafting (0.63%), and platelet-rich fibrin therapy (0.25%). Conclusions: This study provided comprehensive data on the various dermatological procedures done for pediatric cases in a tertiary care teaching hospital. Both diagnostic and therapeutic procedures caused mild and transient side effects such as pain, edema, erythema, burning sensations, and irritation that did not affect the patient’s lifestyle.

Knowledge and attitude on childhood cancer survivorship among healthcare trainees: a multicentre study from India

BackgroundThe proportion of childhood cancer survivors (CCS) in low/middle-income countries (LMICs) is rising. CCS often develop several physical and psycho-social long-term adverse effects, with unique healthcare needs. Primary healthcare providers...

Prevalence and feto-maternal outcomes of subclinical hypothyroidism in pregnancy among mothers attending a tertiary care hospital of Darjeeling District, West Bengal, India

Background: Pregnancy is a stressful test for the mother’s thyroid function. The frequency of hypothyroidism in pregnant women is high. However, there are no adequate studies to evaluate the adverse effects of subclinical hypothyroidism (SCH) during pregnancy. Aims and Objectives: This study was carried out to evaluate the prevalence of SCH in pregnancy and its adverse feto-maternal outcomes among mothers attending a tertiary care teaching hospital in Darjeeling district, West Bengal, India. Materials and Methods: The present study was an institution-based observational descriptive study with a prospective longitudinal design conducted for 1 year among pregnant women attending the antenatal clinic of the study institution in the first trimester of their pregnancy. The sample size for the present study was calculated to be 200. A consecutive sampling technique was utilized. The enrolled women were evaluated for thyroid status by assessing serum thyroid stimulating hormone and free T4 level. All the enrolled mothers were kept under close follow-up and they were evaluated for the development of any antenatal, intranatal, and postnatal complications. Results: The mean age was found to be 23.1±4.2 years, most of the women were nulliparous (60%). Of the women, 74% were euthyroid, while the prevalence of SCH was found to be 16%. On follow-up till the termination of their pregnancies, mothers suffering from SCH had statistically significantly higher incidence of maternal complications such as hypertensive disorders in pregnancy (P=0.001), abortion (P<0.001), postpartum hemorrhage (P=0.020) and also fetal adverse outcomes, such as intrauterine growth restriction (P=0.018), fetal premature birth (P=0.035), and low birth weight (P=0.004) when compared with euthyroid mothers. Conclusion: The burden of SCH high in the study population, and it was significantly associated with a number of different maternal as well as fetal complications and adverse outcomes.

IJCM_35A: Prevalence and risk factors for domestic violence against infertile women in central India

Background: Infertility is a public health issue affecting a large part of the world’s population. Violence against women, Spousal or intimate partner violence is the most common form of domestic violence; a preventable cause of morbidity and mortality in women. Especially sexual violence, is one of the most pressing public health concerns affecting women today. Objective: To estimate the prevalence of spousal violence, various types of spousal violence and factors associated with it among reproductive age group women. Methodology: This was an analytical cross-sectional study conducted in Urban Health Training Centre area of a tertiary care teaching hospital in Nagpur, India among married women between 15-49 years of age. The reproductive age group women were 3985 according to health survey done by UHTC. Out of which the data was collected in a sample of 82 infertile women by face-to-face interview and analysed using SPSS v22. Predesign pretested questioner use for data collection. The ethical consideration was taken from the institute for the study. Results: The prevalence of spousal violence among reproductive age group (15-49 years) women was found to be 79.7%; emotional violence (64.1%) being the most common, followed by physical (71.2%) and sexual (53.6%) violence in that order Conclusion: Infertility and associated domestic violence is a significant public health issue, it would be necessary to pay attention to infertile women to ensure the quality of their of reproductive health.

Implementing the practice of early skin-to-skin contact among infants ≥35 weeks gestation born vaginally: a quality improvement study

BackgroundEarly skin-to-skin contact (SSC) at birth has been shown to improve neonatal outcomes due to enhanced cardiorespiratory stability, thermoregulation and breastfeeding success.Local problemThe practice of early SSC was virtually non-existent...

Descriptive Analysis Of Electrolyte Imbalance In Relation To Severity Of Illness In Covid-19 Pediatric Patients Admitted In A Tertiary Care Hospital In Rawalpindi Pakistan

Objective To determine the frequency of electrolyte imbalance in pediatric COVID-19 patients and their impact on the severity of disease and outcome. Methods: A retrospective observational study was done from January 2021 to July 2021 on 61 children admitted in Benazir Bhutto Hospital Rawalpindi, a tertiary care teaching hospital affiliated with Rawalpindi Medical University (RMU) Pakistan. The age of the patients ranged from infants to 12 years. All the children who were PCR positive or those whose HRCT was suggestive of COVID-19 were included in the study. Results: During the study period of 7 months, 61 confirmed COVID-19 patients were admitted. 37(60.7%) were males and 24 (39.3%) were females. The age of the patients ranged from infants to 12 years with a mean age of 27.25 months. Out of 61 admitted cases, 28 children (45.9%) had moderate & 33(54.1%) patients had severe disease. 46(75%) patients were discharged while 15(25%) patients expired. A number of electrolyte abnormalities were observed. A total of 30 patients (49.2%) were hyponatremic &13 patients (21.3%) were hypernatremic. Hypokalemia was observed in 34(55.7%) & hyperkalemia was found in 2 patients (3.3%), hypochloremia was observed in 13(21.3%) while hyperchloremia was present in 3(4.9%) patients. Hypocalcemia was found in 9(14.7%) patients. 11(18%) patients with Hyponatremia and 6(9.8%) patients with hypernatremia expired. The potassium abnormalities were also associated with significant mortality.14(22.9%) patients with hypokalemia and 2(3.2%) with hyperkalemia expired. Hypocalcemia was found in 9(4.9%) patients who expired. Conclusion: Hypokalemia and hyponatremia were frequent electrolyte disorders in children with COVID-19. These electrolyte abnormalities were associated significantly with severity of disease and a higher risk of death in children with COVID-19 Keywords: COVID-19, Electrolytes, Hypokalemia, Hyperkalemia, Hyponatremia, Hypernatremia, Hypocalcemia

Pattern and clinical profile of patients with ocular trauma presenting to the emergency department of a teaching hospital in India: A prospective observational study.

One major contributor to avoidable ocular morbidity is ocular trauma (OT). The study aimed to document the epidemiological factors, pattern of injury, and outcome among patients with OT presenting to the emergency department (ED). This was a prospective observational study conducted in the ED of a tertiary care teaching hospital in Eastern India after due approval from the institutional ethics committee. The data were collected during the period from March 2021 to February 2022. Data pertaining to age, sex, type of injury, mechanism of injury, time and place of injury, details of tissue involvement, visual acuity, any prior history of injury, initial diagnosis, and management were noted. To estimate the severity of the injury and the probable visual outcome, we calculated through OT score (OTS), including one raw score and OTS. Statistical analysis was performed using the R, version 4.6.1. A total of 180 patient's data were included for final analysis. The median (interquartile range) age of the patients was 32 (24-45) years. The majority were males (n = 147 [81.6%]) with a male-female ratio of 4.5:1. Road traffic accidents (RTA) were the common cause of injury (n = 122 [67.7%]). Unilateral eye involvement was the most common (n = 147 [81.6%]). In the pattern of injury, most of the patients sustained closed globe injuries (CGIs) (n = 158 [87.7%]). Among the CGIs, injury to the ocular adnexa and conjunctiva (n = 141 and 127, respectively) was the most common. Injury to the retina and choroids occurred in 20 (11%) patients. The vision was not affected in most of the cases (n = 125 [69.4%]) with a visual acuity of > 6/18. The majority (n = 120 [67%]) of the patients had an OTS of grade-4, followed by grade-2 (n = 22 [12%]). Most of the patients required only medical management (n = 100 [56%]), whereas 77 (43%) patients required surgical interventions. OT was a common presentation in the ED. Male patients with monocular injuries involved in RTAs were mostly affected. The vision was preserved in most of the cases.

Longitudinal Assessment of ROX and HACOR Scores to Predict Non-Invasive Ventilation Failure in Patients with SARS-CoV-2 Pneumonia.

NIV (Non-invasive ventilation) and HFNC (High Flow nasal cannula) are being used in patients with acute respiratory failure. HACOR score has been exclusively calculated for patients on NIV, on other hand ROX index is being used for patients on HFNC. This is first study where ROX index has been used in patients on NIV to predict failure. This study investigates the comparative diagnostic performance of HACOR score and ROX index to predict NIV failure. We performed a retrospective cohort study of non-invasively ventilated COVID-19 patients admitted between 1st April 2020 to 15th June 2021 to ICU of a tertiary care teaching hospital located in Central India. We assessed factors responsible for NIV failure, and whether these scores HACOR/ROX index have discriminative capacity to predict risk of invasive mechanical ventilation. Of the 441 patients included in the current study, 179 (40.5%) recovered, while remaining 262 (59.4%) had NIV failure. On multivariable analysis, ROX index > 4.47 was found protective for NIV-failure (OR 0.15 (95% CI 0.03-0.23; p<0.001). Age > 60 years and SOFA score were other significant independent predictors of NIV-failure. The AUC for prediction of failure rises from 0.84 to 0.94 from day 1 to day 3 for ROX index and from 0.79 to 0.92 for HACOR score in the same period, hence ROX score was non-inferior to HACOR score in current study. DeLong's test for two correlated ROC curves had insignificant difference expect day-1 (D1: 0.03 to 0.08; p=3.191e-05, D2: -0.002 to 0.02; p = 0.2671, D3: -0.003 to 0.04; p= 0.1065). ROX score of 4.47 at day-3 consists of good discriminatory capacity to predict NIV failure. Considering its non-inferiority to HACOR score, the ROX score can be used in patients with acute respiratory failure who are on NIV.

COVID-19 surveillance in a bone marrow transplantation unit: experience from a Brazilian tertiary-care teaching hospital.

In this work, we aimed to describe the strategy of the weekly SARS-CoV-2 RT-PCR surveillance program that was implemented in our bone marrow transplantation (BMT) unit. Our unit performed SARS-CoV-2 RT-PCR before admission and then weekly during hospitalization even if the patient was asymptomatic. From May 2021 to May 2022, we collected data from all patients that were admitted in the BMT unit to perform transplantation. The total of SARS-CoV-2 RT-PCR performed and the positive rate were described. During the study period, 65 patients were admitted for HSCT. A total of 414 SARS-CoV-2 RT-PCR were performed. Two cases were detected (positivity rate, 0.48%). After the positive test, both patients were isolated outside the BMT unit. We postulate that diagnosing these patients and isolating them outside the transplantation unit may have prevented secondary symptomatic cases.

Development of Hospital Formulary for an Emergency Drug List in Tertiary Care Teaching Hospital

Background: In an emergency situation, timing is an important factor that requires sound knowledge about the patient's health condition, diagnosis, and treatment, as well as the administration of an appropriate drug at the appropriate time, which helps save a patient’s life. To ease the workflow, we decided to develop an emergency drug formulary. The study aims to develop a hospital formulary for an emergency drug list and compare it with the WHO standard formulary and the National Formulary of India. Methods: A prospective observational study was carried out at Vivekananda General Hospital, Hubballi, for a period of six months. A monograph of emergency drugs was drafted based on the needs of the hospital and prepared by referring to various different sources of data. The developed hospital formulary was made into electronic copies and handbooks, and a review was obtained from healthcare professionals. Results: The results showed that there were 130 drugs in the emergency drug formulary. It includes various categories of medication given in the case of different emergency conditions (cardiac emergencies, neurological emergencies, endocrine emergencies, poisoning emergencies, respiratory emergencies, fluid and electrolyte emergencies, and miscellaneous emergency drugs). While comparing the contents of the monograph with other formulary monographs, we found that the formulary that we had developed was more effective. There were five fixed-dose combinations (FDCs), 27 drugs that are safe to use during pregnancy, 84 drugs that should be used with caution while pregnant, and 1 drug that was contraindicated. We also found that there were 59 drugs that were compatible with breastfeeding; 63 needed to be used with caution; and 12 should be avoided during breastfeeding. Conclusion: The developed emergency formulary acts as a quick reference, helps in selecting the appropriate drug at the appropriate dose and time, and also helps in selecting low-cost alternative brands.

Effective implementations to reduce medication administration errors in a tertiary care teaching hospital

Background: Medication Administration Errors (MAEs) can lead to unmet therapeutic objectives as these errors can directly harm the patient and affect the outcome of therapy. Materials and Methods: This was an implementation research planned to evaluate the effect of interventions on the prevalence and severity of MAEs over three years, from 2020 to 2022, at a tertiary care hospital where clinical pharmacists were allotted to look into medication-related activities. Amedication error reporting form, developed by the pharmacologist, was used to collect MAE data. Analysis of this information aided in the planning of interventions to curtail the occurrence of such errors in the future. Interventions included drug and disease education leaflets, bedside training, vial/ampoule reading training, understanding different dose strengths, maintaining patient bedside boxes, antibiotic reconstitution leaflets for reference, and charts to guide safe drug administration. Results: The effect of these interventions was analyzed at the end of each year on the prevalence and nature of MAEs, where a decline of 38.97% was found in 2021 and a further 34.88% in 2022, considering the number of opportunities. The most prevalent was the wrong dose (~57%) errors commonly found with oral solid dosage forms and the cardiovascular group of drugs (42.5%). These MAEs were mainly of no harm category C (64%), while only 1.5% of them had caused harm (category E) to the patient, but none of these was sentinel. Conclusion: Interventions by clinical pharmacists successfully helped reduce MAEs and prevented patient harm in the further study period.