Tertiary Care Teaching Institute Research Articles

Is there any materno- foetal risks in mothers with gestational weight gain (WHO & IOM) based on their pre-pregnancy body mass indices? Our experience in a tertiary care teaching institution in North Kerala

: This research was done to learn the impact of pre-pregnancy BMI and gestational weight gain (GWG) on subsequent risks of adverse pregnancy outcomes in a tertiary care teaching institution in North Kerala, India. A descriptive study in a tertiary care teaching institution in Kozhikode, North Kerala. : 296 singleton pregnant women with BMI categorised as per Asian Standards and adverse maternal outcomes were looked out for. Pregnant women were underweight (82.8%) achieved less than recommended weight during pregnancy as compared to 18.4% obese mothers. Mothers with high BMI gained more than recommended weight during pregnancy as compared to the underweight and normal weight woman. GDM was 3.03 times(p=0.019)and Hypertensive disorders of pregnancy was 1.116 times more common in higher pre-pregnancy BMI mothers. In the present study, gestational weight gain had no impact on maternal anaemia, Gestational diabetes, Gestational hypertension, foetal growth restriction and rate of caesarean deliveries. A statistically significant positive correlation was obtained between pre-pregnancy BMI and baby weight, p<0.001. A statistically significant positive correlation was obtained between gestational weight gain and baby weight, p=0.005. Weight gain during pregnancy had no significant impact on maternal pregnancy outcomes and caesarean delivery.

Assessment of knowledge, attitude and practice of fixed-dose combinations amongst attending physicians and residents: a cross-sectional evaluation.

Fixed-dose combinations (FDCs) were brought into the market with the intent of providing benefits primarily to patients and physicians. Nevertheless, despite their multiple advantages, they have their own set of drawbacks, especially regarding irrational FDCs. If physicians continue to prescribe them, prohibiting their sale would become all the more challenging. This cross-sectional survey study was planned to comprehend the level of knowledge, attitude and practice of physicians regarding such FDCs at a tertiary care teaching institute of western Uttar Pradesh, India. A pre-validated questionnaire was communicated electronically to all the attending physicians. For data analysis, descriptive statistics were applied and a χ2 test was performed for inter-group comparison. Amongst the 108 respondents, participation was almost comparable from both medical and surgical branches, with most participants being junior residents (58%). Even with sound knowledge of FDCs, only 46.30% of them were aware of banned FDCs. Similarly, only 6.48% could correctly identify the disadvantages associated with the use of FDCs, and 33.18% could correctly recognize irrational FDCs. This finding was consistently reflected in their attitude and practice and only 15.74% of respondents cross-referenced FDCs with the available literature. Furthermore, despite 88.89% of respondents checking for rationality of FDCs before prescribing them, a compendium of irrational FDCs is routinely prescribed. To amend these shortcomings in prescribing of irrational FDCs, some recommendations are proposed by the authors herein.

Role of Renal Sonography in the Diagnosis of Chronic Kidney Disease

Aim: to use sonographic imaging in grading CKD and assess the serum creatinine, renal longitudinal size,parenchymal thickness and compare these parameters based upon ultrasonographic grade.Material and Methods: Present cross-sectional; study was conducted at the Department of Radiology, Tertiary Care Teaching Institute of India for the duration of 1 year. There are 120 participants with CKD in the research.All patients received a questionnaire, and a thorough clinical examination was done. Each participant underwent sector curved array transducer of 3.5–5 MHz ultrasound images of their liver and kidneys. Low tissue harmonic and speckle reduction imaging techniques are used to measure the echogenicity of the kidney and liver while reducing interobserver bias. In all the participants, the mean values of both the kidneys renal longitudinal size and parenchymal thickness were calculated. Renal cortical echogenicity was compared and graded with the echogenicity of the liver and renal medulla.Results: The mean age of the CKD patients was found to be 45.23 ± 06.05 years. It was found that 50 patientshad Grade 1, 40 patients had Grade 2, 20 patients had Grade 3 and 10 patients had Grade 4. The results showed that, when the comparison was done, serum creatinine was found to be significant among echogenicity grades with ANOVA. when the comparison was done; the mean longitudinal size was found to be significant among echogenicity. On comparison was found to be mean Parenchymal thickness was found to be significant among echogenicity grades.Conclusion: Renal cortical echogenicity and its grading in relation to longitudinal length, parenchymal thickness, and cortical thickness in CKD patients are the best sonographic parameters that correlate with blood creatinine. It is possible to use renal cortical echogenicity as a metric of renal function since it has the benefit of being irreversible in compared to serum creatinine levels.

Pretreatment Thyroid Profile and its Relationship with Response to Treatment with Lithium in Bipolar Mood Disorder: A Longitudinal Study from Northeast India

Abstract Background: The thyroid hormone’s significant impact on the treatment of depressive and other mood disorders is well documented. Even minor hypothyroidism can modify the progression and treatment results of major depressive disorder. This research aims to explore the correlation between initial thyroid levels and the treatment outcome in bipolar mood disorder using lithium, a well-established treatment method. Methodology: The study involved 45 bipolar mood disorder patients diagnosed according to the Diagnostic and Statistical Manual 5 criteria and admitted to a tertiary care teaching institute in Northeast India. The patients received lithium treatment, with injectable lorazepam used for immediate agitation control when necessary. On the 1st day, a semi-structured questionnaire and Brief Psychiatric Rating Scale (BPRS) 24-item scale were used to evaluate symptoms, and samples were collected for a thyroid profile, including T3, T4, FT3, FT4, and thyroid-stimulating hormone (TSH). The BPRS scale was used again on the 30th day to assess treatment response. Results: The BPRS subscale showed the highest treatment response for grandiosity and the lowest for depression. Factors such as age, illness duration, substance use, and family history of mood disorder were inversely correlated with the BPRS score’s decrease. Initial thyroid levels were identified as a predictor of treatment response, with baseline T4 levels showing a significant positive correlation with treatment response, while baseline TSH levels showed a negative correlation. Conclusion: Lithium proved to be an effective treatment for bipolar mood disorder, particularly for the manic subtype. Initial T4 and TSH levels were found to significantly predict treatment response, with T4 showing a positive correlation and TSH showing a negative correlation.

Comparative study between 0.5% bupivacaine versus 0.5% ropivacaine in peribulbar anesthesia for cataract surgery

Background: For intraocular surgery, the optimal local anesthetic agent must have a rapid onset of action and a sufficient duration of effect so as to enable a painless, motionless procedure without prolonging akinesia. Aims and Objective: This prospective, comparative observational study compares ropivacaine and 0.5% bupivacaine for cataract surgery peribulbar block. Hyaluronidase is utilized in both groups because it promotes local anesthetic diffusion. Material and Methods: Present prospective, observational, comparative study performed at the Department of Anesthesia Tertiary Care Teaching Institute of India for the duration of 1 year. All eligible patients were allocated in two groups as GROUP B and GROUP R. GROUP B: 10 mL of 0.5% bupivacaine and 15 I.U./mL of hyaluronidase. GROUP R: 10 mL of 0.5% ropivacaine and 15 I.U./mL of hyaluronidase. Patients were assessed for sensory block, eyelid, and ocular movements at an interval of 2 min, and Visual Analog Scale score for pain assessment. Results: Age and gender did not differ significantly between the two study groups, according to the findings. Comparable and similar patient characteristics distinguished the two study groups. (P>0.05). The difference in onset of eyelid motor blockade between the two groups was not statistically significant. The difference in the onset of motor blockade [ocular movement] between the two groups was not statistically significant (P>0.05). (P>0.05) Analgesia duration differed significantly between the two groups in a statistical sense. Ropivacaine exhibits a significantly prolonged duration of analgesic effect than bupivacaine (P≤0.05). Conclusion: Peribulbar block utilizing 0.5% ropivacaine is a more favorable and secure option for a local anesthetic that effectively extends postoperative pain alleviation, in comparison to the use of 0.5% bupivacaine.

The Blood Donor Deferral Rate and the Reasons for Deferral at a Tertiary Care Teaching Institute in Northeastern Malaysia.

A deferral takes place when donors fail to meet the eligibility criteria for donating blood during their visit to a blood collection site. Deferral periods, which can be either permanent or temporary, are implemented to protect the well-being of both the donor and the recipient.This study aimed to investigate the frequency of deferrals and the various factors contributing to them.A retrospective analysis was conducted at the Transfusion Medicine Unit of Hospital Universiti Sains Malaysia (USM), utilizing data obtained from blood donors during the period from January 2022 to June 2023. The research included a cohort of 18,751 donors who visited our transfusion unit for blood donation. Data, including gender, age, and reasons for deferral, were collected by reviewing the records of donors who were deferred. Descriptive statistics were employed to analyze the data of deferral blood donors.Out of 18,751 blood donors, 3,533 (18.84%) were deferred, consisting of 1,267 males (35.86%) and 2,266 females (64.14%). The age group of 18-25 years accounted for the highest number, comprising 1,875 donors (53.07%). Among the deferred cases, 53.33% were first-time donors, followed by 25.28% regular donors and 21.40% lapsed donors. The deferral of blood donors resulted from various reasons. The most common cause of overall deferral among blood donors was low hemoglobin (38.33%), followed by upper respiratory tract infections (8.38%), chronic medical illness (7.08%), and high blood pressure (7.02%). Temporary deferrals were more prevalent than permanent deferrals, accounting for 91.57% of cases compared to 8.43% for permanent deferrals.Voluntary non-remunerative blood donors constitute the backbone for a safe and reliable blood supply in transfusion services. Utilizing a comprehensive database will enable effective counseling of temporarily deferred donors, providing insights into the reasons for their deferral, the expected duration, and the appropriate treatments. This information is crucial for motivating these donors to recruit again in the donor pool. Public education initiatives aimed at raising awareness about the causes of deferral and promoting regular health check-ups can play a pivotal role in minimizing these deferrals.

CONVERSION TO OPEN CHOLECYSTECTOMY - A SAFE ALTERNATIVE, NOT A FAILURE!

Background: Understanding factors that predict conversion in laparoscopic cholecystectomy (LC) to an open procedure is important as it allows better patient selection, preparation, operating list planning, referral, counseling and lowers the threshold for a safe conversion, thereby minimizing undue prolongation of attempts at laparoscopic completion and inadvertent complications.Methods: Records of 1010 consecutive patients who were taken up for LC, at a tertiary care teaching institute in northern India, were reviewed retrospectively. Preoperative and intraoperative characteristics of patients who underwent a successful LC were compared with those who required conversion to open surgery.Results: The conversion rate was 7.5% (76 patients). The most common reason for conversion was the inability to define the ‘Critical view of safety’ in 48, (63%) of patients. Other reasons included dense peri-cholecystic 9 (12%) and intra-abdominal 8 (11%) adhesions, suspicion of bile duct injury 4 (5%) or malignancy 3 (4%). Prior upper abdominal surgery, intraoperative finding of a contracted and thick-walled gallbladder (GB), empyema GB, Mirizzi’s syndrome, cholecysto-enteric fistula, and a prior endoscopic common bile duct stone clearance were significant predictors of conversion. Xanthogranulomatous cholecystitis was found more commonly (43% vs 5%) in the conversion group.Conclusion: Conversion to an open procedure during LC should always be treated as an integral component of sound judgement to achieve the safest outcome in a particular patient. Due consideration of pre-operative and intra-operative factors predictive of a higher chance of conversion assists pre-operative patient preparation and counseling as well as surgical planning, conduct and mentoring of residents-in-training.

Analysis of Cutaneous Adverse Drug Reactions (ADR) Reported at an ADR Monitoring Center of a Tertiary Care Teaching Institute in Central India.

Background Cutaneous adverse drug reactions (ADRs) are among the most frequent ADRs. Knowledge of the pattern of cutaneous ADRs (CADRs) and causal drugs helps prevent and reduce the incidence of CADR, which in turn reduces the incidence of hospitalization and expenses for the patient. Objectives To analyze CADR according to demographic profile, morphological pattern, causative drugs, severity, and outcome in patients suffering from CADRs. Materials and methods Retrospective data analysis was conducted in the Adverse Drug Reaction Monitoring Centre (AMC) of the tertiary care teaching institute between February 2020 and September 2023 under the Pharmacovigilance Program of India (PvPI). All ADRs reported were analyzed based on the following parameters: total number of ADRs reported, number of CADRs, information related to demographic parameters, the clinical presentation of CADRs, and suspected medication. Causality assessment was done using theWorld Health Organisation-Uppsala Monitoring Centre (WHO-UMC) scale. Severity was assessed using a modified Hartwig and Seigel scale. Results A total of 125 CADRs were analyzed. Considering the gender-wise distribution,65 females and 60 males suffered from CADR. The most common drug category responsible for CADRs was antimicrobials (63.2%), followed by topical agents (12.8%). Maculopapular rash (33.6%) was the most common presenting symptom, followed by itching (27.2%). Few patients suffered from serious CADRs such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Conclusion A wide clinical spectrum of CADRs ranging from maculopapular rash to fixed-drug eruption to serious SJS was observed in our study. The most common causative agents for CADRs were antimicrobials, followed by topical agents and NSAIDs. For early diagnosis and management of CADRs,it is critical to have data on the potential cutaneous adverse effects of commonly used drugs, to educate the patients regarding common early symptoms of drug reactions (e.g., erythematous rash, edema, urticaria, mucosal erosions, itching, burning of skin, etc.), and to monitor the patient, especially during the start of therapy.To ease the burden of CADRs, a therapeutic plan of anticipating, avoiding, recognizing, and responding to ADRs should be implemented.

A Study of Clinical and Socio-Demographic Profile of Elderly Patients with Opioid Use Disorder on Agonist Treatment Attending a Tertiary Care Teaching Institute of India

Background: Opioid use is one among the major substance of use in Indian population which is not only seen in younger age group but rather is an upcoming concern in the elderly population as well. Opioid agonist treatment for opioid use disorder is a better way of management, among which buprenorphine is a safer option. Despite, being an important area of health concern, opioid use is poorly studied in the geriatric population. Objective: To study the clinical and socio-demographic profile of elderly patients with opioid use disorder on agonist treatment attending a tertiary care teaching institute of urban Delhi. Method: A retrospective study was done in an OPD based opioid treatment centre of a tertiary care hospital in Delhi to analyze the socio-demographic, clinical profile, pattern of opioid use disorder and opioid agonist treatment (Buprenorphine) in elderly Indian population over a year. The data collected was further analyzed for descriptive and analytic statistics using SPSS version 23.0. Results: A total of 32 subjects of age > 60years, with predominant male population having mean age of 63.6years we seen. They had heroin use by inhalation route as a major opioid use. The main source of referral was by friends and self with significant medical and psychiatric comorbidities that was seen in the elderly group. An average dose of 2.34mg of Buprenorphine was found to effectively manage the geriatric opioid use disorder. Conclusion: Opioid Used Disorder is common in Geriatric population and is often associated with both psychiatric and medical co-morbidities. Opioid agonist treatment is an effective approach in management of elderly cases of opioid use disorder. Declaration of Interest : None

Demographic Profile of Patients with Cleft Lip and Palate Anomaly: 15-year Experience from a Tertiary Care Hospital and Teaching Institute in Wardha District of Maharashtra, India.

Cleft lip and palate (CLP) is considered to be a congenital defect involving the orofacial region. This defect affects the esthetics, speech as well and psychological well-being of a person. The study was performed to analyze the prevalence of different types of cleft deformity reported in a tertiary care hospital which would aid in spreading awareness and thereby reducing the prevalence of this congenital defect. To study the demographic profile of patients with CLP in the Wardha region. A single-center retrospective cross-sectional study was performed. The patients with cleft deformity report under the "Smile Train Project" under the Department of Orthodontics and Dentofacial Orthopedics along with the Department of Oral and Maxillofacial Surgery. The data retrieved included the name of the patient, age, gender, residential address, contact details, and type of cleft. This data was segregated focusing on the gender and type of cleft as per the concern of this study. The datasets were then entered in the Microsoft Excel sheet and the statistical graphical representation was done using Microsoft PowerPoint. In the present study we tried to find out the profile of CLP in the local population. We reported the high prevalence of this orofacial deformity among the population of this area. The data from the present study will help to provide a deeper insight into the burden of CLP anomaly. Based on the data obtained from the present study, future research can be conducted, and cleft-care improvement outcomes can be measured. There are several etiological factors that are responsible for the development of CLP. Also, due to a lack of awareness regarding this, there is an increased prevalence of this defect. In India, due to a lack of knowledge regarding cleft anomaly, poverty, and social stigma, many patients do not report to the hospitals, and hence, there is a need to spread awareness which would encourage people to access the healthcare facilities at an early age and would reduce the complications in later stages. Shivlani VI, Niranjane PP, Diagavane PS, et al. Demographic Profile of Patients with Cleft Lip and Palate Anomaly: 15-year Experience from a Tertiary Care Hospital and Teaching Institute in Wardha District of Maharashtra, India. Int J Clin Pediatr Dent 2023;16(S-3):S278-S282.

An evaluation of drug promotional literature in clinical practice

Background: In current clinical practice, pharmaceutical companies use drug promotional literatures (DPLs) as a promotional tool to introduce new products entering into the market to medical practitioners. DPLs play a major role in providing important information about the drug to the health-care professionals and to convince them to prescribe the same. Aims and Objectives: The aims and objectives of the study are to evaluate the appropriateness of DPLs as per the World Health Organization (WHO) criteria for rational drug promotion and for other information such as the pictures given and the presence of self-boasting words, if any. Materials and Methods: A cross-sectional observational study was conducted from December 2022 to May 2023 at a tertiary care teaching institute in southern Rajasthan, India. 330 DPLs, using convenient sampling, were collected in the form of hard and soft copies of flyers, leaflets, brochures, and pamphlets from various registered medical practitioners from a variety of departments and were evaluated based on the WHO guidelines. Results: A total of 330 DPLs were evaluated. Generic name was present in 98.2%, brand name in 97.9%, amount of active ingredient in 90%, name of manufacturer in 100%, and reference to scientific literature in 57.6%. About 75.5% of DPLs depicted photographs and 53% mentioned self-boasting words or phrases. Conclusion: Only few DPLs fulfilled all eleven criteria laid down by the WHO. Hence, doctors should not rely solely on promotional literature and appropriate policies must be made for vigilance of the DPLs.

Glycopyrrolate as an Adjunct in the Management of Anastomotic Leak Following Repair of Esophageal Atresia: A Clinicoradiological Perspective.

Anastomotic leak after primary repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a well-known complication and can represent a challenging clinical scenario. The present study aimed to evaluate the role of glycopyrrolate as an adjunct in the treatment of anastomotic leak after primary repair of EA Vogt type 3b. A retrospective study was carried out in our tertiary care teaching institute from January 2015 to December 2022. Neonates with EA with distal TEF with primary repair who had developed anastomotic leak, managed by the author(s), were studied. The study included patients with major, minor, and radiological leaks. Glycopyrrolate was administered in the dose of 4 μg/kg 8 hourly. The outcomes of the study were either resolution or progression of the leak. There were 21 patients who were managed with glycopyrrolate in addition to the classical treatment of the anastomotic leak following repair of EA with distal TEF. The male: female ratio was 1:1.1. All the cases had anastomotic leaks with either clinically detectable in the chest tube (15) or radiological leak (6). The leaks were detected early in patients with major leak (mean = 3.2 ± 0.84 days) compared to minor leak (mean =4.9 ± 1.29 days). Radiological leaks were detected in all the neonates on postoperative day 7. In five patients with major leak, there was a negligible reduction in the amount of chest tube output, and were subjected to diversion procedures. There were a total of three deaths out of five in this group. In 10 patients with minor leak, there was complete resolution of anastomotic leak in eight patients (80%); there was one patient each with mortality and diversion procedure. The patients with a radiological leak (6) did not show any deterioration, and they were fed 1-5 days after the esophagogram. Glycopyrrolate may be an advantageous postoperative adjunct in the management of minor and radiological leak after tracheoesophageal repair.

Noonan syndrome: Clinical and molecular profile with review of literature

Background: Noonan syndrome is a rare genetic disorder, characterized by dysmorphic facies, short stature, congenital heart diseases, and delay in development of variable degree. Aims: The aim of this study was to highlight the clinical spectrum, molecular profile, and outcome of Noonan syndrome patients from India. Settings and Design: A retrospective observational study was carried out between 2017 and 2020 in our tertiary care teaching institute. Materials and Methods: The retrospective data of consecutive patients were collected including clinical profile, investigations, and molecular analysis. Results: There were seven pediatric patients with Noonan syndrome. Characteristic facies, broad nose, low-set ears, short stature, and congenital cardiac anomalies (pulmonary stenosis) were present in all 7/7 (100%) patients. Short neck was present in 6 (85.71%), depressed nasal bridge in 5 (71.43%), development was grossly delayed in 5 (71.43%), and chest wall deformities in 4 (57.14%) patients. Cryptorchidism was present in 5 out of 6 (83.33%) male patients. Mutation in protein-tyrosine phosphatase nonreceptor type 11 gene was detected in all 4 out of 7 (57.14%) patients in whom genetic study was performed. Conclusions: A high index of suspicion for Noonan syndrome should be kept in mind in a patient presenting with facial dysmorphism, short stature, and congenital heart diseases with genitourinary abnormalities including cryptorchidism. A proper health education and counseling to the parents about the problem and alternative methods for having a healthy baby should be emphasized. Molecular confirmation is essential for prenatal diagnosis.

A Comparative Study between Butorphanol and Fentanyl as an Analgesic in Patients Undergoing Abdominal Surgeries under General Anesthesia

Background: Narcotic analgesics are frequently utilized during epidural anesthesia in addition to local anesthetics (LA). However, the parent drug, morphine, had a long latency and was poorly soluble in lipids when it was first used for epidural analgesia. Fentanyl and butorphanol have not been compared in any research as supplements for intraoperative epidural anesthesia. For lower abdominal surgery, the current study compared the effectiveness and safety of epidural fentanyl versus epidural butorphanol. Materials and Methods: Patients undergoing abdominal surgery in the Department of Anesthesiology at a Tertiary Care Teaching institute in Tamil Nadu participated in a hospital-based randomized clinical study. All of the patients in the Department of Anesthesiology who had elective abdominal surgery were included in the 15-month research. The patients were split into two groups: Group A received an intravenous dose of 40 μg/kg butorphanol, whereas group B received an intravenous dose of 2 μg/kg fentanyl. Results: There were 100 participants in all, with men making up the majority (57.0%) and having a M:F ratio of 1.3:1. The participants in the study were 46.9 ± 6.8 years old on average. Conclusion: Butorphanol is found to be a better analgesic when compared to fentanyl, along with cardio-stability and fewer complications.

The Effects of an Increased Workload in Cataract Surgery Since the Pandemic in a Tertiary Care Clinic.

Objective: To evaluate the progress of cataract surgery in a training institution providing tertiary care since the removal of pandemic restrictions. To evaluate ocular and demographic characteristics of cataract cases in a tertiary care teaching institution since the lifting of pandemic restrictions. Methods: Patients who underwent cataract surgery in our clinic in the pre-pandemic period September 2019-March 2020 (group 1, n=353) and in the post-pandemic period September 2021-March 2022 (group 2, n=459) were retrospectively screened. The cases were operated by two educator ophthalmologists and residents. The main parameters evaluated were cataract morphology, surgical parameters, and posterior capsular rupture complications. Results: The case rate increased by 30% in group 2 once pandemic restrictions were relaxed. Preoperative best corrected visual acuity (BCVA) in groups 1 and 2 was 0.840±0.63 and 1.26±0.75 log MAR, respectively (p<0.001). The percentage of mature cataracts was 15.3% in group 1 and 31.2% in group 2 (p<0.001). Significantly higher cumulative dissipated energy (CDE), total aspiration time, and fluid amount (p<0.001 for all) were found in group 2. During the training phase, 25.2% of the cases in group 1 and 24.6% in group 2 were performed by resident doctors (p=0.870). Residents in groups 1 and 2 had mature cataract case rates of 6.7% and 13.3%, respectively (p<0.001). The incidences of posterior capsule rupture in the instances of residents was 3.4% in group 1 and 4.4% in group 2 (p=0.498). A negative correlation (r=-0.424, p<0.001) between CDE and BCVA and a positive correlation (r=0.40, p<0.001) between cataract hardness and CDE were both found. Conclusions: The number of cataract surgeries increased after the COVID-19 pandemic. Poor vision and increasing rates of mature cataracts are other effects of this backlog. Residents have to deal with challenging cases. Our results are just the tip of the iceberg. Urgent planning is needed to deal with the remaining cases. Abbreviations: COVID-19 = coronavirus infection, PCR = posterior capsular rupture, BCVA = best corrected visual acuity, IOP = intraocular pressure, CDE = cumulative dissipated energy, TAT = total aspiration time, ZD = zonular separation.

Robson\'s 10-group Classification System Analysis of Cesarean Deliveries Performed at a Tertiary Care Teaching Institution

Robson\'s 10-group Classification System Analysis of Cesarean Deliveries Performed at a Tertiary Care Teaching Institution

Nursing Professionals' Awareness of Adverse Drug Reactions and Pharmacovigilance in an Institute of National Importance in India: A Cross-Sectional Study.

Background Globally, there is a growing concern about adverse drug reactions (ADRs) as they can lead to increased hospital admissions and healthcare expenses, lower patient satisfaction with treatment outcomes, and even fatalities. Pharmacovigilance is crucial for minimizing the risks associated with drug therapy, but underreporting of ADRs is a prevalent issue. Nursing professionals are an important stakeholder in ADR reporting, as they are often the first point of contact for patients to identify and report adverse drug reactions. Objectives The objectives of the study were to evaluate the knowledge and practices of nursing professionals regarding ADR reporting in a tertiary care teaching institute and the factors influencing their knowledge of ADR reporting. Methodology This was a cross-sectional study involving 275 nursing officers at AIIMS Raebareli, who gave their informed consent and completed a questionnaire on demographics, knowledge, and practice domains. Multiple linear regression analysis was used to compare independent variables' influences on knowledge scores. SPSS version 26 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. Results The study revealed that the mean knowledge score was 6.378 (total score of 13), with a standard deviation of 2.299 (95% CI 6.10-6.65). About 50.18% of the participants had a knowledge score below 6.5. Multiple regression analysis revealed that working experience, female gender, working in an emergency department, and previous training on ADR reporting significantly influenced the knowledge scores. Conclusion The study found that nursing professionals had limited awareness about ADR reporting, even though they worked at an Institute of National Importance. Based on the findings, it can be concluded that there is a need for improved education and training on ADR reporting and to address barriers to reporting, such as a lack of awareness about reporting procedures, and alleviate the fear of legal consequences.

Evaluation of Bacteriological Contamination Pattern of Open Fractures of Extremities- A Study from Tertiary Centre at Western India

Background and Aim: In underdeveloped countries, open fractures are fairly prevalent. Open fractures can be caused by a variety of factors, including a car accident, a fall from a great height, a gunshot, an attack, machine injuries, and others. Infection is a typical side effect of open fractures. The goal of our study was to describe the pattern of bacterial contamination, antibiotic susceptibility, and possible antibiotic resistance in open fractures that arrived at our institute within 6 hours after injury. Material and Methods: A one-year prospective study was undertaken on 200 patients with open fractures of the extremities admitted to the accident and emergency department of Tertiary Care Teaching Institute of India. The first swab is obtained at the primary wound assessment, followed by the second culture swab shortly after debridement, the third culture swab on the day of the first aseptic dressing, and the fourth culture swab if the infection persists or the asepsis score is greater than 20 for a period of four days. Reports on culture and sensitivity were collected in order to analyse the pattern of bacterial isolates and their sensitivity. Results: The majority of the patients in this study were men (83%). We discovered 144 (72%) open fractures in the lower limb, with the tibia being the most often fractured bone, with 76 (38%) occurrences with right sided predominance (58%). Out of 200 patients, 78 (39%) had Gustilo II open fractures, followed by type IIIA (33%). Pre-debridement swabs were collected from all 200 patients with open fractures of the extremities upon admission. 26 (13%) of the patients were determined to be culture positive. Conclusion: In the therapy of patients with open fractures of the extremities, cultures acquired during the first aseptic dressing are considerably more predictive than pre- and post-debridement cultures, and are important in developing an antibiotic policy. It is thus recommended that cultures acquired during the first aseptic dressing provide direction in the selection of antimicrobial therapy, which, when paired with complete wound debridement, will allow for early wound closure and fewer problems.

Evaluation of Socrates Method of Teaching in Medical Education- A case Study Exemplifying Implementation Amongst Medical Students at Tertiary Care Teaching Institute in the Northeastern Region of India

Evaluation of Socrates Method of Teaching in Medical Education- A case Study Exemplifying Implementation Amongst Medical Students at Tertiary Care Teaching Institute in the Northeastern Region of India

Knowledge and perception regarding adverse drug reactions among undergraduate medical students of Bihar, Eastern India.

Adverse drug reactions (ADRs) have national and international monitoring and are part of teaching-learning of undergraduate medical course and curriculum. To find the knowledge and perception of ADRs among undergraduate medical students in a tertiary care teaching institute in eastern India. This was an observational cross-sectional study conducted among the MBBS medical students by administration of pre-designed, pre-tested, semi-structured questionnaires. The data on their knowledge and candid reflections on ADRs were analyzed question by question using software and compared with peers. The responses from the participants on knowledge and perception of ADRs varied widely. Final-year students had the most precise response on classification, filing an ADR report, national reporting centers, and the first step in monitoring ADRs; the majority accepted their first- hand experience and legal and professional responsibilities on ADRs. Third-year students responded well on objectives, methods, and scope of patients on direct reporting or drug overdose and monitoring; respect patient confidentiality while reporting; and expect feedback from monitoring centers, with special training on ADR. Second-year students responded well on definitions, pharmacovigilance programs in India, alertness of banned drugs because of ADR, and related capacity building. The awareness and insight on ADRs of the undergraduate medical students were quite reasonable. However, further reinforcement is needed in future to be updated to relevant issues to their practice as primary care physicians.