Rural Tertiary Care Teaching Hospital Research Articles

Assessment of knowledge, attitude and practices of generic drugs and their potential nocebo effects among second year medical students in a rural tertiary care teaching hospital: a cross-sectional study

Background: As drugs contribute significantly to healthcare costs, reduction in their cost by using generics offers a significant advantage so evaluation was done of knowledge, attitude, and practices of generic drugs and their potential nocebo effects among second year medical students in a tertiary care teaching hospital. Methods: A prospective, observational, and questionnaire-based study was conducted after approval by the Institutional Ethics Committee. Pretested and validated questionnaire consisting of 26 questions about generic drugs was filled by 92 participants. The filled questionnaires were collected and analyzed on Microsoft Excel sheet. Results: Majority (90.2%) students had heard about generic drugs, however, only 18.5% students thought there was a nocebo effect associated with the use of generic drugs. Majority of the study population had a positive attitude towards use of generic drugs and believed them to be equally efficacious as branded drugs in addition to not having more side effects than branded drugs, though their current practices did not reflect this knowledge and attitude. 63% also said that following this study, they were likely to prescribe or consume generics as future doctors and patients. Conclusions: The participants had sufficient knowledge and positive attitude towards use of generic drugs. Knowledge regarding the possible nocebo effects of generic drugs was lacking.

The Preventive Role of Perceived Social Support in Postpartum Psychiatric Morbidity: Insights from a Rural Tertiary Care Teaching Hospital in South India

Abstract Introduction: Postpartum psychiatric disorders show a rising trend in developing countries, where the lack of social support is a major risk factor. Evidence from Western scientific literature also reports of similar preventive role of social support in postpartum psychiatric states. However, the attitudes toward childbearing may differ across cultures and also within the same cultural sphere. With this background, we aimed to assess the perceived social support and its association with postpartum psychiatric morbidity in a rural setting in South India. Methodology: A total of 100 postpartum women who met the inclusion and exclusion criteria were included in the study following their consent. Sociodemographic data sheet and Edinburgh Postnatal Depression Scale, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM IV-TR), and Multidimensional Scale of Perceived Social Support were administered on them. Appropriate statistical analysis was done. P <0.05 was considered statistically significant. Results: The majority of our sample recorded high perceived social support (76%), with 90% reporting high support from a special person. 10% had major depressive disorder, out of which 6% recorded melancholia, and 7% recorded suicidality on DSM IV-TR. Increasing age had lower perceived social support, P = 0.024. As perceived social support was reduced, increased psychiatric morbidity was significantly noted, with suicidality and melancholia. Conclusions: Our study finds a significant association between perceived social support and postpartum depression (PPD). Lesser social support was associated with increased suicidality and melancholia features in cases of PPD. Amplification of social support in expectant mothers is a useful way to safeguard against postpartum psychiatric disorders.

A Comparative Study of Peripheral Smear Findings with RBC Indices and Automated Analyzer Generated RBC Histograms in the Diagnosis of Anemia's

Abstract Introduction The red blood cell (RBC) indices generated by cell counters help in the morphological classification of anemia. The importance of microscopic examination of peripheral blood smears (PBSs) stained by Leishman stain cannot be used alone when it comes to interpretation of the underlying cause of anemia. Hence, all three RBC histograms, indices, and microscopic examination of PBSs are very essential for a complete assessment of anemia. Aims and Objectives To diagnose the type of anemia by examination of PBSs, automated cell-generated RBC histograms, and RBC indices and to compare and correlate the findings of RBC indices and automated cell-generated RBC histograms with PBS examination. Materials and Methods This was a prospective comparative study done on 500 cases of anemia for a period of 5 months from August 2023 to December 2023 in a rural tertiary care teaching hospital and all the patients' RBC indices, RBC histogram findings, and PBS findings were noted and analyzed. Results Among 500 samples, normocytic normochromic anemia consists of the majority of the cases 272 (54.4%), followed by microcytic hypochromic anemia cases 183 (36.6%), macrocytic anemia cases 27 (5.4%), normocytic hypochromic anemia were 10 (2%) cases, and dimorphic were 8 cases (1.6%). When compared with RBC histogram, 265 (53.0%) cases showed normal bell-shaped curve, 188 (37.6%) cases showed left shift, 27 (5.4%) cases showed broad based curve, 10 (2%) cases showed right shift, and 10 (2%) cases showed bimodal curve suggesting normocytic normochromic, microcytic hypochromic, normocytic hypochromic anemia, macrocytic, and dimorphic anemia, respectively. Conclusion This study showed a well correlation in the findings of the automated hematology analyzer with the microscopic examination. Histogram alone could be used as a screening method but when combined with RBC indices and PBS findings, they act as useful supplements and by correlating findings of all three, we could diagnose the majority of anemia.

Adverse pregnancy outcomes with respect to treatment modalities in women with gestational diabetes mellitus at a rural tertiary care teaching hospital.

To estimate the prevalence of gestational diabetes mellitus (GDM) and compare adverse pregnancy outcomes with respect to treatment modalities in a peri-urban teaching hospital in Telangana. A prospective study was conducted on GDM cases delivered from January 2019 to March 2020. GDM was diagnosed using a two-step procedure of screening using IADPSG criteria. Women diagnosed with GDM were divided into four groups - diet group, metformin group, metformin plus insulin group and insulin group based on the treatment modalities. Adverse pregnancy outcomes of the women managed with different treatment modalities were recorded. Good glycaemic control (FBS, P = 0.04, 2 hrs PLBS, P = 0.01) was achieved in diet and metformin groups. Incidence of Gestational hypertension (P = 0.01) and preeclampsia (P = 0.01) were found to be higher in the insulin group when compared to the metformin and insulin group, metformin group and diet group. No difference was noted with respect to polyhydramnios, preterm birth, premature rupture of membranes, induction labour and caesarean delivery rates between the treatment groups. Apgar score at 5 min of <7 (P = 0.02), neonatal intensive care unit admissions for >24 hrs (P = 0.03) and neonatal hypoglycaemia (P = 0.01) were found to be higher in insulin-required groups. Rates of shoulder dystocia, stillbirth, early neonatal death within 1 week and respiratory distress did not vary significantly between the treatment groups. Universal screening of women for GDM and multidisciplinary management of women once diagnosed tend to lessen maternal and fetal complications. Metformin can be an effective, cheaper and non-invasive alternative to insulin in the management of GDM.

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.

An observational prospective cross-sectional study on extravascular lung water by lung ultrasound as a guide to fluid resuscitation therapy in adult septic shock in tertiary care hospital in central India

Background Septic shock is a life-threatening condition characterized by systemic inflammation and organ dysfunction, with fluid resuscitation being a cornerstone of management. However, indiscriminate fluid administration can lead to fluid overload and worsen outcomes. Extravascular lung water (EVLW) estimation by lung ultrasound has emerged as a promising tool for guiding fluid therapy in septic shock, allowing clinicians to assess pulmonary edema and tailor resuscitation strategies accordingly. Methods This prospective observational study aims to evaluate the utility of EVLW estimation by lung ultrasound in guiding fluid resuscitation therapy in adult patients with septic shock admitted to a rural tertiary care teaching hospital. Eligible patients admitted to the intensive care unit (ICU) will undergo baseline demographic and clinical assessments, including lung ultrasound, to quantify EVLW using B-line analysis. Fluid resuscitation therapy will be initiated based on EVLW findings, with subsequent adjustments guided by repeat lung ultrasound examinations at 6, 12, 24, and 48 hours post-initiation. Outcome measures include changes in mean PaO2/FiO2 ratios, respiratory parameters, renal function, fluid balance, and mortality rates. Expected Outcome We anticipate that EVLW-guided fluid resuscitation therapy will lead to more precise and tailored management of septic shock, potentially reducing the incidence of fluid overload, ARDS, and renal dysfunction. By optimizing fluid management strategies based on individual patient characteristics and responses, we aim to improve clinical outcomes and enhance the delivery of care for patients with septic shock.

Knowledge, attitudes and practices of Materiovigilance among physicians in a rural tertiary care teaching hospital in Puducherry- a cross sectional study

Background: In India, medical devices are considered as drugs. A medical device may lead to problems either due to a defect during manufacture or transport, improper handling by health care professionals or patients, or failure to comply with recommendations. Aim &amp; Objective: To evaluate the knowledge, attitude, and practice of Materiovigilance among health professionals at the Tertiary Care Hospital. Methods: This was a Cross-Sectional Questionnaire Based study. The questionnaires were circulated among 100 medical professionals. The structured survey tool comprised of two parts. The first part contains demographic data, and the second part consists of 15 questions, with 5 each pertaining to the awareness, attitude, and practice domains. All the data were entered into a Microsoft Excel sheet and analyzed using GraphPad Instat software version 5.0. Results: Medical professionals with above-average knowledge scores were 57 %, and the practice percentage of Materiovigilance was 60%, but there is a positive attitude (72%) towards Materiovigilance. A significant difference was noted Between the knowledge scores of professors and residents (p-value - 0.0491). There was no significant difference in knowledge scores between medical, surgical, and pre/para specialties. However, there was a positive correlation between the knowledge and attitude scores of the medical professionals. Conclusion: We conclude that the Knowledge aspect and also the practice of Materiovigilance among Physicians in our tertiary care hospital is lacking. However, their positive attitude to reporting adverse events is reassuring.

Microbial Spectrum of Keratitis at a Rural Tertiary Care Teaching Hospital.

Microbial keratitis poses a significant threat to vision and is a common ocular infection. Its causative agents encompass a wide spectrum, including bacteria, fungi, viruses, and parasites. The microbiological profile of microbial keratitis is influenced by factors such as patient demographics, geographical location, climate, and occupational hazardsand evolves over time. Corneal scrapings were collected from 75 patients with a provisional diagnosis of microbial keratitis.The samples were processed in the microbiology laboratory, and the bacterial and fungal growth isolated in the study were identified according to standard procedures. Among the 75 patients, 48 (64%) were maleand 27 (36%) were female.Corneal ulceration was found in individuals of all age groups, with the highest prevalence of 77.33% (58/75) observed in the 21-60 age range. Farmers exhibited a higher susceptibility, constituting 66.67% (50/75) of the cases.The study noted a higher occurrence of keratitis from November to February, accounting for 69.33% (52/75). Microbial etiology was identified in 25.33% (19/75) of scrapings, with fungi accounting for 68.42% (13/19) and bacteria for 31.57% (6/19). The prevalent fungal species included Fusarium (7/13, 53.84%),Aspergillus(3/13, 23.07%),Colletotrichum(2/13, 15.38%), andCurvularia​​​​​​​(1/13, 7.69%). Bacterial isolates featuredStreptococcus pneumoniae(5/6, 83.33%) and Klebsiella pneumoniae (1/6, 16.66%). This study underscores the importance of regularly updating local microbial profiles and understanding antimicrobial resistance patterns. Such updates are critical for informed decision-making in selecting optimal topical treatments for microbial keratitis.

Study of Medico-legal cases in a Tertiary Care Teaching Hospital

Medico-legal cases are pivotal in the pursuit of justice for victims and the accused. It is essential for medical professionals to be well-versed in the intricacies of medico-legal cases to ensure that they follow the procedures of the law of the land diligently. Understanding the patterns of medico-legal cases in a specific region can assist government authorities in devising strategies to prevent such incidents. This study was conducted at a rural tertiary care teaching hospital over a span of seven months, from January to July 2023, and examined 139 medicolegal cases. The age group of 21 to 40 years, predominantly comprising males, emerged as the most affected demographic in our study. Road traffic accidents were the predominant cause of medico-legal cases, with head injuries being the most frequently observed. Understanding the demographics and injury patterns of medico-legal cases in this rural area serves as a foundation for tailoring medical care and legal interventions to the specific needs of the community. By continuing to investigate and analyze medico-legal cases, healthcare providers and law enforcement agencies can work collaboratively to not only address the immediate medical needs of victims but also to develop proactive strategies to minimize the occurrence of such cases and improve overall community well-being.

Exploring the dynamics of pharmacotherapy in intensive cardiac care unit of a tertiary care teaching rural hospital

Background: An intensive cardiac/coronary care unit (ICCU) plays a crucial role in managing cardiovascular emergencies globally. Cardiovascular diseases (CVDs) are major contributors to global mortality, with the burden notably affecting the Indian population. The ICCU specializes in life-saving interventions for acute conditions such as acute coronary syndromes and cardiac arrhythmias. Swift administration of specific drug groups, including antiplatelets, anticoagulants, and fibrinolytics, is imperative for optimal patient outcomes. Aims and Objective: This study aims to analyze drug utilization, morbidity patterns, and medication costs within the ICCU, recognizing the unit’s significance in addressing CVDs. Materials and Methods: This prospective observational study, conducted in a tertiary care teaching hospital’s ICCU, involved 150 patients over 18 months. Inclusion criteria covered patients admitted for more than 24 h, ensuring a comprehensive analysis. Data collection included patient demographics, medical history, drug charts, and outcomes. Confidentiality measures were strictly adhered to, ensuring patient privacy. Results: The study highlighted that the majority of ICCU-admitted participants were aged 51–60 years, predominantly male, and exhibited a higher prevalence of hypertension and diabetes. Unstable angina was the most frequent diagnosis, and drug usage, especially antiplatelets, adhered to ACC/AHA guidelines. Tramadol’s use in place of morphine revealed a significant deviation from recommendations. The study identified inappropriate prescribing behavior, emphasizing the importance of generic names to reduce costs. Conclusion: This comprehensive study provides valuable insights into ICCU practices, emphasizing the need for adherence to guidelines, standardized prescribing, and cost-effective strategies. The findings contribute to optimized patient care strategies, ensuring timely administration of essential medications and enhancing overall outcomes for individuals facing critical cardiac conditions. The study’s focus on the entire treatment cost adds a unique perspective to existing research, prompting consideration for more efficient and cost-effective practices within ICCUs.

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

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

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

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

Microbial Profile of Tourniquets Used in Phlebotomy at a Rural Tertiary Care Teaching Hospital.

Background Reusable phlebotomy tourniquets may become contaminated through repeated use on the skin surfaces of multiple patients, the hands of healthcare workers, or various surfaces. Noncompliance with the protocol guidelines for managing tourniquets can contribute to the cross-transmission of microorganisms among patients. This study was conducted to determine the microbial flora and antimicrobial sensitivity pattern of reusable phlebotomy tourniquets. Methodology Tourniquets were randomly sampled across the different areas of the hospital and were transported to the microbiology laboratory for isolation, identification, and antibiotic susceptibility testing of microorganisms using standard microbiological techniques. Results The overall bacterial colonization rate of the 50 tourniquets was 80%. The most prevalent isolate on tourniquets was Coagulase-negative Staphylococcus (9, 22.54%), followed by Micrococcus (6, 15%), Staphylococcus aureus (5, 12.5%), diphtheroid (5, 12.5%), Acinetobacter (4, 10%) Enterococcus (3, 7.5%), Pseudomonas (3, 7.5%), Bacillus (3, 7.5%), and Escherichia coli (2, 5%). Conclusions Regular surveillance and disinfection of reusable tourniquets in resource-poor settings are recommended to decrease healthcare infections and the transmission of multidrug-resistant (MDR) strains.

A study of drug prescribing pattern among pregnant women in the obstetrics and gynecology outpatient department at a rural tertiary care teaching hospital of Maharashtra

Abstract: CONTEXT: Antenatal period is the crucial period in women. It is very much essential to know the rationality of drug use and the patients’ knowledge in this aspect as evident from various literature. AIMS: The aim was to evaluate the prescribing pattern among pregnant women visiting in the obstetrics and gynecology (OBGY) outpatient departments (OPD) teaching hospital and to appraise their knowledge regarding safe drug use during pregnancy. SETTINGS AND DESIGN: This was descriptive, cross-sectional, observational drug prescription study in OBGY OPD. SUBJECTS AND METHODS: In a sample size of 200 pregnant women, socioeconomic parameters were assessed. Prescriptions were analyzed as per the World Health Organization (WHO) core prescribing indicators. The knowledge of the patients regarding safe drug use during pregnancy was assessed through the standard questionnaire. STATISTICAL ANALYSIS USED: Analysis was primarily descriptive with values mainly expressed as percentages using Microsoft Excel. RESULTS: Majority of patients were from the rural area depending on the peripheral/primary health services for OBGY conditions. Most of pregnant women were in the age group of 21–25 years. In terms of WHO prescribing indicators, it was evident that prescribing pattern of health-care providers in the study site was irrational. The knowledge of study participants regarding safe drug use during pregnancy was of mixed in terms of defined parameters. The most commonly prescribed classes of drugs in pregnant women were vitamins, followed by iron and calcium preparations. CONCLUSIONS: This study helped to conclude the irrational drug prescription pattern and estimation of attitude and awareness among this vulnerable patient group about the drugs and possible risk associated with the medications in this clinically important phase.

Study of reasons for discarding whole blood and its components in a blood bank in a rural tertiary care teaching hospital in Maharashtra

Abstract Introduction: Each unit of blood is valuable; thus, it must be used as efficiently as possible with the least amount of waste. Supply of blood in an emergency requires stringent storage conditions with quality checked and should be available at the time of demand to the needy. So blood banks play a vital role in this demand-supply process. On the other hand, because of the biological nature of blood, it is very vulnerable to contamination by infections, early expiry and hemolysis. The purpose of this study was to determine the reasons for the wastage of blood and blood components. Materials and Methods: At our tertiary care teaching hospital blood bank we conducted a retrospective analysis of data of all whole blood and blood component samples collected from January 2013 to December 2020. Results: 391 (9%) of the 4022 entire blood bags collected were discarded 132 (32%) of them were eliminated due to hemolysis and lipolysis and the same 32% expired due to completion of the life span of RBC. Sero-reactivity for TTI or transfusion-transmitted diseases was 22.4% and only 13% were rejected for use because of some leakage or inadequate quantity of blood in the bag. Conclusion: An adequately conducted donor screening, notification and counseling of permanently deferred donors will help in discarding less number of bags that are positive for different TTI. Properly implemented blood transfusion policies will help to utilize the blood components in a proper way resulting in discarding the number of blood bags due to expiry.

Absolute eosinophil count is a reliable prognostic marker in patients with liver cirrhosis: a cross-sectional study at rural central India

BackgroundVarious laboratory parameters like C-reactive protein (CRP), Cortisol, and Von Willebrand factor antigen have been evaluated independently in foreseeing outcomes of cirrhotic patients. As these parameters lack cost-effectiveness in a rural setup, there is a need for a cost effective and feasible prognostic marker for cirrhotic patients. The present study was aimed at evaluating the role of Absolute Eosinophil Count (AEC) as a prognostic marker in cirrhotic patients.MethodsThis cross-sectional study was conducted at a rural tertiary care teaching hospital in central India from August 2019 to September 2021. AEC was measured from counter report as a part of automated complete blood counts. Child-Turcotte-Pugh (CTP) score and Model for end stage liver disease (MELD) score were calculated at the time of admission. AEC levels on admission were correlated with mortality and with CTP score and MELD score.ResultsA total of 110 patients were enrolled with mean age of 46.37 ± 11.6 years. AEC was the significant predictor of mortality at cut off point of ≤ 120 with 80.30% (AUC 0.803; 95% CI: 0.716 to 0.873). AEC was the significant predictor of CTP score ≥ 11 at cut off point of ≤ 148 (AUC 0.726; 95% CI: 0.633 to 0.807). AEC was the significant predictor of MELD score ≥ 25 at cut off point of ≤ 136 (AUC 0.74; 95% CI: 0.647 to 0.819). Significant negative correlation was seen between AEC with Child–Pugh score and MELD score with correlation coefficient of -0.257 and -0.258.ConclusionLow level of AEC on admission fairly predicted raised CTP score and MELD score on admission. Low AEC levels predicted increased mortality in cirrhotic patients making it a cheap and reliable prognostic marker in a rural setup.

Risk factors of sepsis and prevalence of multidrug-resistant organisms in pediatric cardiac surgery in tertiary care teaching rural hospital in India: A retrospective observational study.

Cardiac surgery and cardiopulmonary bypass result in an immunoparalyzed state in children making them susceptible to sepsis and other hospital-acquired infections. Therefore, identification of the risk factors of sepsis would lead to appropriate management. The current study seeks to evaluate the prevalence of sepsis and risk factors linked to sepsis in pediatric cardiac surgical patients and the subsequent prevalence of multidrug-resistant organisms. A retrospective, single-center observational study was conducted including 100 pediatric patients admitted to the pediatric intensive care unit (ICU) after cardiac surgery between January 2017 and February 2018. All patient data were obtained from the medical record department of the hospital. Patient case report form comprised demography, surgery details, preoperative and postoperative hematological reports, and clinical details. After collecting the data, chi-square test and logistic regression analysis were used to determine the risk factors linked to sepsis. The prevalence of sepsis in our population was 27% and the mortality rate due to sepsis was 1%. The only statistically significant risk factor for sepsis we discovered in this analysis was prolonged ICU stay for more than 5 days. A total of eight patients had blood cultures positive for bacterial infection. The alarming finding was that all eight were infected with multidrug-resistant organisms, demanding the last line of antibacterials. Our study indicates that special clinical care is required when ICU stay is prolonged to lower the risk of sepsis. These new and upcoming infections not only promote high mortality and morbidity rates but also contribute to increased cost of care due to the use of newer broad-spectrum antibiotics and longer hospital stay. The high prevalence of multidrug-resistant organisms is unacceptable in the current scenario and hospital infection and prevention control play a crucial role in minimizing such infections.

Agreement of Revised Premature Infant Pain Profile Scoring between Healthcare Providers and Laypersons: A Cross-sectional Study

Introduction: The experience of pain during the neonatal period has short and long-term consequences. The Revised Premature Infant Pain Profile (PIPP-R) is a globally accepted and validated tool for assessing pain in neonates. Adequate pain management measures can be implemented using the PIPP-R, even in the absence of consultants. Aim: To assess the agreement among healthcare providers and laypersons in scoring the PIPP-R. Materials and Methods: A cross-sectional study was conducted at Shree Krishna Hospital, a rural Tertiary Care Teaching Hospital in central Gujarat, India. The duration of the study was one year and six months, from January 2021 to June 2022. The study included 12 volunteers from various fields, such as consultant neonatologists, first year postgraduate students in Department of Paediatrics, neonatal nurses, social workers, Bachelor of Medicine, Bachelor of Surgery (MBBS) interns, and mothers of newborns. A neonatology consultant provided training on the PIPP-R scoring system using handouts and a presentation. The volunteers then evaluated 100 prerecorded videos of newborns undergoing painful procedures. Agreement between volunteers for the total PIPP-R score and its subcomponents was assessed using Bland-Altman analysis and Cohen’s Kappa statistics. Results: A total of 100 videos of newborns (51 girls, 49 boys) undergoing painful procedures were evaluated for the PIPP-R score. The mean age, gestational age, and birth weight of the newborns were 2.21±1.55 days, 37±2.44 weeks, and 2.56±0.72 kg, respectively. The procedures included heel prick for Random Blood Sugar (RBS) (44%), intravenous sampling/insertion (34%), and intramuscular vitamin K injection (22%). The mean difference with 95% Confidence Limits (CL) of total PIPP-R scores between the two consultants (neonatologists) was -0.640 (-5.196, 3.916). The length of the CL was -9.112, which fell outside the defined CL of 4.2 (20% of the total score), indicating unacceptable agreement between the two consultants. Similarly, agreement between each consultant and any of the other participants, including residents, nurses, interns, mothers, and social workers, regarding the total PIPP-R score, as well as its subcomponents, was also deemed unacceptable. Conclusion: The present study concluded that the inter-rater reliability of the PIPP-R score and its subcomponents was unacceptable between consultants and with any of the other participants.

EXPLORATORY STUDY ABOUT KNOWLEDGE, ATTITUDE AND PRACTICE ABOUT PHARMACOVIGILANCE AND ADR REPORTING AMONG RESIDENTS OF A TERTIARY CARE TEACHING HOSPITAL

Objective: This study, aimed at investigating the knowledge and attitude of resident doctors about ADR reporting in a tertiary care teaching hospital. Methods: This was a cross-sectional, observational, questionnaire-based study conducted in Shri Krishna Hospital and Medical Research Centre, 550 bed tertiary care teaching rural hospital attached to Pramukhswami medical college, Karamsad, Gujarat. Results: 50 questionnaire forms were analysed, giving a response rate 86.20%. Of the respondents 56% were men, remaining were women. Mean age of the respondents was 25+1.05 y. All but one resident have heard the term ‘pharmacovigilance,’ but 34 out of 50 were able to define it accurately. Twenty participants preferred email for ADR reporting while 14 preferred direct contacts for ADR reporting. Telephone is liked by 9 participants. All residents admitted the importance of pharmacovigilance in unison. Majority of the residents (96%) were in view to teach pharmacovigilance actively to students. Seventeen out of 50 residents were aware about Pharmacovigilance Program of India, a program by Government of India for pharmacovigilance and ADR reporting. 28 residents did not know about any such program. Three residents opined that no specific national program is running and India is following a program undertaken by WHO. The most preferred method of ADR reporting by residents is email/website followed by direct contact. Twenty were in favour of the first method, while 14 preferred the later method. Nine residents selected the telephone method as method of ADR reporting. Conclusion: Today’s residents are future’s consultants. So it is the need of the hour to stimulate residents to report ADRs.

Study of drug utilization pattern in the gynecology outpatient department of a rural tertiary care teaching hospital of Maharashtra

ContextDrug utilization studies help medical practitioners and health policy makers to decide an individualized specific drug pattern for a particular disease or disease group.AimsThis study was planned to study drug utilization patterns among patients visiting the Gynecology Outpatient Department (OPD) of a rural tertiary care teaching hospital.Settings and designThis was a prospective, descriptive, cross-sectional, observational study conducted over 2 months in the gynecology Outpatient Department of a rural tertiary care teaching hospital in Maharashtra state.Patients and methodsA total of 200 prescriptions of patients were studied. Various prescribing indicators by WHO were used for the analysis.Statistical analysis usedStatistical analysis was primarily descriptive with values mainly expressed as percentages using Microsoft Excel.ResultsIn majority of the rural middle-aged patients, all patients received 3.8 drugs per encounter indicating a trend of polypharmacy. Majorly, the drugs were prescribed by brand names than generic names, which lead to extra cost to the patients. The most commonly reported diseases were reproductive tract infections, sexually transmitted infections, pelvic inflammatory diseases, and dysmenorrhea. The most commonly prescribed groups of the drug were antibiotics majorly metronidazole, doxycycline followed by clindamycin followed by NSAIDs followed by iron, folic acid, and calcium.ConclusionIt can be concluded that physicians prescribe medicines based on their knowledge, previous experience with the drug, their perceptions, habits, and peer influences. Drug utilization studies like this are important for continuous approaches toward a positive change in the use of medicines and promotion of rational use of medicines in the community.