Tertiary Health Care Hospital Research Articles

Grading of Knee Osteoarthritis Based on Kellgren-Lawrence Classification and Finding an Association Between Radiographic Features and Pain: A Cross-Sectional Study at a Tertiary Health Care Hospital

Grading of Knee Osteoarthritis Based on Kellgren-Lawrence Classification and Finding an Association Between Radiographic Features and Pain: A Cross-Sectional Study at a Tertiary Health Care Hospital

Estimation of Stature from Anthropometric Measurements of the Sternum in Nepalese Population at the Tertiary Health Care Hospital

Introduction: Stature estimation is crucial for identifying human remains in forensic and anthropological contexts, aiding in mass casualties, criminal investigations, and archaeological studies. Traditionally using long bones, alternative methods are necessary when these bones are unavailable or fragmented. Objectives: The main purpose of this study was to access the morphometric measurements of the study population and compare the findings between the two sexes. Method: A study of 100 medico-legal autopsies at Department of Forensic Medicine, Maharajgunj Medical Campus, Nepal investigated stature estimation from sternal lengths. During autopsies, cadaver length was measured using a steel tape. An incision was made from the suprasternal notch to the pubis, the sternum was removed, and the combined manubrium and mesosternum length was measured with sliding callipers. Results: The study included 67 male and 33 female cadavers, with a mean age of 37.46 years. The mean length of the manubrium was 43.34 ± 6.88 mm (44.58 ± 7.15 mm for males, 40.81 ± 5.59 mm for females). The mesosternum averaged 101.85 ± 15.65 mm (104.40 ± 16.68 mm for males, 96.66 ± 11.92 mm for females). The combined sternal length was 146.12 ± 16.64 mm. Body length correlated weakly but significantly with manubrium, mesosternum, and combined sternal lengths (r = 0.242, 0.206, 0.320 respectively). Conclusion: Stature estimation from sternal length is valuable for identifying mass casualty victims, with males showing greater measurements. Combined manubrium and mesosternum lengths are better stature estimators.

Study of Otorhinolaryngological Manifestations in Symptomatic COVID-19-Positive Patients at Tertiary Health Care Hospital: A Cross-sectional Study.

Introduction The coronavirus disease 2019 (COVID-19), also referred to as the 2019 novel coronavirus, is caused by a single-stranded positive-sense RNA virus. This infectious agent spreads through respiratory routes, primarily utilizing aerosols. In our study, we shed light on ear, nose, and throat (ENT) manifestations, which can be considered as prognostic clinical biomarkers to reduce forthcoming complications among such critically ill patients. This makes it feasible for researchers to investigate or fetch early diagnosis in such cases with ease without the use of large, extensive hospital-base setups. Objective To study the otorhinolaryngological (ENT) manifestations in symptomatic COVID-19 patients. Methods From January to December 2021, a cross-sectional observational study was conducted at the Department of ENT of a tertiary care hospital in central India. All eligible symptomatic COVID-19 patients admitted to this institution during the study period were consecutively enrolled. The Institutional Ethics Committee gave its permission for the project. Results Out of the total of 1,375 patients, 78% of the patients diagnosed with COVID exhibited symptoms related to the ENT, while the remaining 22% did not display any ENT manifestations. Anosmia (71.2%), sore throat (55.62%), headache (44.3%), and loss of taste (66.3%) were among the most common ENT symptoms. Conclusion The present study highlights ENT manifestations, which play a crucial role in the early diagnosis of COVID-19 patients, ensuring faster treatment and isolation for better containment of the disease. Symptomatic treatment has shown efficacy, but objective tests are needed to prevent overestimation, understand pathogenesis, and enhance treatment.

Knowledge, attitude and practices of surgeons regarding venous thromboembolism prophylaxis in tertiary healthcare hospitals of the Rawalpindi Districts.

To assess doctors' knowledge, attitudes and practices regarding venous thromboembolism prophylaxis. The cross-sectional study was conducted from April to September 2021 in three public-sector hospitals affiliated with the Rawalpindi Medical University: Holy Family Hospital, Benazir Bhutto Hospital and Rawalpindi District Headquarters Hospital, Rawalpindi, Pakistan, and comprised physicians of either gender who were actively involved in patient care. Data was collected using a predesigned questionnaire regarding venous thromboembolism. Data was analysed using SPSS 25. All the 220(100%) subjects approached responded positively to the study questionnaire. There were 144(65.45%) general surgeons, 50(22.72%) gynaecologists and 26(11.81%) orthopaedic surgeons. Overall, there were 26(11.81%) senior consultants, 65(29.54%) postgraduate residents and 129(58.63%) house officers. There were 150(68.2%) doctors who reported having witnessed deep-vein thrombosis in their patients, and 113(51.4%) had witnessed deaths related to pulmonary embolism. Among the methods employed for DVT diagnosis, the use of clinical criteria was the most common 136(36.1%), while venography was the least common technique used by 8(2.2%). While 210(95.5%) subjects expressed the desire for adopting an institute-wide regimen for venous thromboembolism prophylaxis, only 66(30%) were currently following such a regimen.

Emergence of bla NDM-1-carrying Enterobacter chengduensis in China.

Enterobacter chengduensis was defined as a novel species in the genus. Enterobacter in 2019, however, antimicrobial resistance, such as carbapenem resistance, has rarely been described in E. chengduensis. This study described the molecular features of four carbapenem-resistant E. chengduensis strains collected from a tertiary health care hospital in Southwest China. Whole genome sequencing (WGS) was used to determine the genome sequence of four E. chengduensis strains. The precise species of strains were identified by average nucleotide identity (ANI) and in silico DNA-DNA hybridization (isDDH). The clonal relatedness of four E. chengduensis strains and additional 15 ones from NCBI were examined through phylogenetic analysis. The molecular features of E. chengduensis and genetic structure of carbapenemase- encoding plasmids were characterized through genomic annotation and analysis. The results revealed the emergence of bla NDM-1-carrying E. chengduensis strains in China. Multilocus sequence typing (MLST) analysis showed that all 19 E. chengduensis belonged to the same sequence type of ST414. Core SNP analysis suggested the potential intrahospital clonal transmission of ST414 E. chengduensis. The carbapenemase-encoding gene bla NDM-1 was harbored by an IncC-type plasmid, which was experimentally confirmed to be able to conjugate. This study reports the first emergence and potential clonal transmission of bla NDM-1-carrying E. chengduensis. Further surveillance should be advocated to monitor the dissemination of carbapenem-resistant E. chengduensis and bla NDM-1-harboring IncC-type plasmids in China.

The Proposed Model for Pharmacy Led Med-to-bed Discharge Service in Tertiary Care Hospital

Introduction: The pharmacy-led discharge medication delivery to bedside (Med-to-bed) service in a tertiary care Johns Hopkins Aramco Healthcare (JHAH) hospital aims to optimize medication management during patient transitions from admission to discharge, especially for those with chronic conditions. The service entails the direct delivery of discharge medications to patients at the pharmacy following their discharge from inpatient wards, accompanied by comprehensive medication counseling. The pharmacy-led Med-to-Bed service aims to reduce patient wait times and improve overall clinical outcomes. Methods: This article highlights common challenges in medication reconciliation and post-discharge prescription fulfillment, highlighting the need for standardized protocols and improved hospital adherence to ensure seamless care transitions. It also discusses future considerations for optimizing the Med-to-Bed service, including proposed pharmacy renovations, installing a dedicated robotic dispensing system, and providing private spaces for patient counseling during medication pickup. Additionally, the proposal suggests deploying more pharmacy staff to address delayed discharge orders and making systemic enhancements to the EHR system to streamline prescription pickup. Result: The successful implementation of the proposed pharmacy-led Med-to-Bed service demonstrates the efficacy of interdisciplinary collaboration among nurses, physicians, and pharmacists. Through this collaborative approach, the Med-to-Bed service has shown tangible improvements in operational efficiency and patient outcomes, underscoring its potential to transform healthcare delivery models. Conclusion: Overall, this proposed model provides valuable insights into the transformative impact of integrated care initiatives like the Med-to-bed service in tackling complex medication management and enhancing quality patient care in hospitals.

Factors Associated with Carbapenem-resistant Klebsiella pneumoniae Infections among Inpatients in a Tertiary Health Care Hospital

Factors Associated with Carbapenem-resistant Klebsiella pneumoniae Infections among Inpatients in a Tertiary Health Care Hospital

Screening of Intensive Care Unit Patients for the Presence of Carbapenem-resistant Enterobacterales (CRE) on Admission as a Measure of Infection Control

The global spread of carbapenem-resistant Enterobacteriaceae (CRE) has been fostered by the lack of preemptive screening of patients in healthcare facilities that could prevent patient-to-patient transmission. To screen patients admitted to Medical Intensive Care Unit (MICU) for CRE carriage to take appropriate infection control measures. This prospective surveillance study was conducted in the MICU of a tertiary healthcare hospital between September to December 2022. Patients more than 18 years of age admitted to the MICU were included in the study. Patients transferred from different units within the hospital to MICU were excluded. Immediately after admission, two rectal swabs were collected after obtaining consent from the patients. These patients were selected based on the questionnaire framed from the Centers for Disease Control and Prevention (CDC) CRE tool kit. The samples were further analyzed and the antimicrobial susceptibility test was performed. The present study included 91 study subjects of which 53% were males. Of selected participants, 63.7% did not have any specified medical intervention or device placed and 78% had not used antibiotics previously. Of the tested isolates, Of the tested isolates, 12 (13.2%) were observed to be CRE colonized. These isolates were found to be resistant to both imipenem and meropenem. An association was reported between CRE and device placement (p = 0.000) as well as between CRE and previous use of antibiotics (p = 0.000). Current use of antibiotics (p = 0.6381) and gender (p = 0.6066) did not show any association with CRE colonisation. The study concludes that the presence of CRE is an existing danger for patients in ICUs and that there is a possible association between CRE and device placement as well as previous use of antibiotics which can be further studied.

When compassion, aka karuna, enters the Indian psychotherapy space: A mixed‐method case‐series study of compassion‐focused therapy in depression

AbstractBackgroundCompassion‐focused therapy (CFT) is transdiagnostic. It primarily targets shame and self‐criticism in persons with depression. While there have been studies in the West to explore the beneficial effects of CFT, there is a need to unpack how CFT functions in the East.MethodThis study aimed to explore the utility and process of CFT in North‐East India. The authors tailored a 12‐session CFT module based on the suggestions of three local mental health professionals. A mixed‐method design was employed. Five mental health service users in a tertiary mental healthcare hospital diagnosed with depression based on ICD‐10 criteria were recruited in the study. For quantitative measurements, the Hamilton Depression Rating Scale (HDRS), Others as Shamer Scale (OAS), Fears of Compassion Scales (FOC), The Forms of Self‐Criticizing and Reassuring Scale (FSCRS) and Compassionate Engagement and Action Scales (CEAS) were administered. Three time point assessments were taken, that is, baseline, post‐intervention and 1‐month follow‐up. To understand the process of CFT, qualitative narrative analysis was undertaken on session notes, memos and reflective journals focusing on the nature of compassion, blocks of compassion, sense of shame and self‐criticality.ResultsQuantitative findings indicated improvement of depressive symptoms and changes in sense of shame, fear of compassion, self‐criticality, self‐reassuring tendencies and compassionate engagements and actions. The qualitative findings shed light on the process of CFT.ConclusionThe authors discussed the findings anchoring the existing theories of CFT and relevant studies. The findings support the preliminary evidence of the utility of CFT in persons with depression.

Study of histopathological spectrum of ovarian tumors in a tertiary care hospital in India

Abstract Background: Ovarian tumors rank as the third leading cause of mortality among female genital tract malignancies. This study examined the histopathological spectrum of ovarian neoplasms based on our center’s 2020 World Health Organization (WHO) classification. Materials and Methods: This descriptive study was carried out over 5 years at our tertiary healthcare hospital, including 406 cases of ovarian neoplasms. After proper fixation and gross examination, sections were routinely processed and examined. The histopathological spectrum of ovarian neoplasms was analyzed according to the 2020 WHO classification. Results: Out of the 406 cases studied, 329 (81.03%) were benign, 65 (16.01%) were malignant, and 12 (2.95%) were borderline. The cases included 326 (80.29%) surface epithelial tumors, 58 (14.28%) germ cell tumors, 19 (4.68%) sex cord-stromal tumors, and 2 (0.49%) metastatic tumors. The majority of ovarian tumors (n = 340, 83.74%) occurred in the 20–60 years age group. Conclusion: The study reveals that benign tumors were more prevalent than malignant ones, with serous tumors being the most common among the benign cases. We observed a higher incidence of malignancy in women over the age of 40. Therefore, early and accurate histological diagnosis is crucial for initiating an appropriate management plan.

Health Promotion Practices among Pregnant Women Attending Antenatal Clinics at a Tertiary Hospital in Nigeria.

A cross-sectional study conducted in a semi-urban tertiary healthcare hospital in South western Nigeria to assess health promotion practices and associated sociodemographic factors among pregnant women attending antenatal clinics. A total of 220 pregnant women were studied. Results showed that 95.0% of the participants had good health promotion practices with physical activities having the lowest while spiritual values had the highest score. Moreover, age, religion, education, and occupation were significantly associated with health promotion practices among the pregnant women.

Systemic Regulatory Abnormalities in Glycemic Control and its Relation with Depression - A Cross-Sectional Study

Globally, depression is the 3rd leading cause of disability-adjusted life years. The presence of depression and its symptoms has been associated with improper control of glucose and poor glycemic index and a bidirectional relationship was seen between depressive disorders and diabetes mellitus. Depression, even at subclinical levels, has the tendency to increase the risk of incident type 2 diabetes by 25–60%. This study aims to find the prevalence of Type 2 diabetes mellitus(T2DM) in depression patients and to find the relationship between the severity of depression and the severity of T2DM in a Cross-sectional study. A total of 178 patients who attended psychiatry OPD of a tertiary healthcare hospital for a study period of 6 months were recruited into the study after considering inclusion and exclusion criteria evaluated by an experienced psychiatrist. Details like sociodemographic profiles and clinical data related to Major depression and T2DM were collected through self-structured proforma. To assess the severity of depression, HAM-D scale was used and the glycemic severity measure was used to assess the severity of T2DM by a well-trained psychiatrist. Statistical analysis was done and results were framed. The prevalence of Type 2 Diabetes mellitus in depressive disorder patients was found to be 25.2%. A significant association was seen between the severity of T2DM and the severity of depression, with a p-value of 0.013 and a chi-square value of 12.699. Significance with certain clinical factors like insulin usage (F=5.635; p = 0.019) and drug compliance (F=16.841; p <0.001) was seen in T2DM patients with depression. Nearly ¼th of the patients with depression had T2DM and the severity of hyperglycaemia was also found to be high as those patients were on insulin administration, other medical comorbidity disorders were present and drug compliance was found to be poor. Triglyceride glucose index was also found to be high in patients with severe depression, which contributes to improper blood glucose balance. Treating and reducing both the severity of T2DM and depression simultaneously is needed to improve the functioning of the patients and improve the retention in treatment and drug compliance, thereby preventing morbidity and mortality.

To study the impact of expressing breastmilk inside the neonatal intensive care unit (NICU) besides a neonate, in comparison to expression outside the NICU: A quasi experimental study

Introduction: The proximity of the mother to the newborn following delivery is essential for the early initiation and establishment of exclusive breast feeding. It leads to the conditioning of the oxytocin reflex, allowing the expression of breast milk. However, preterm and sick babies are nursed in an environment away from their mothers in the NICU, thus leading to delayed initiation and inadequate expression of breast milk. Objective: To estimate the volume of breastmilk expressed close to the baby in comparison to breastmilk expressed away from her baby. Method: This quasi-experimental study was conducted in a tertiary healthcare hospital in Hyderabad over a duration of one month. Postpartum mothers of newborns delivered in this hospital and admitted to the NICU were included in the study. The enrolled mothers were shown a video and poster on manual expression of breast milk and were assisted by lactational counselors for support. The enrolled mothers initially expressed milk in the mother’s room, and an average of three expressions was taken. The next day, the mother was asked to go near the baby in the NICU and express milk in front of her baby, and the average of three feeds was determined in a similar fashion. Data analysis was done using a paired t-test. Results: A total of 30 postnatal mothers were enrolled in the study. The mean volume of breast milk expressed by the mother in the mother’s room was 9.9 ± 2.5ml and the mean volume of breast milk obtained when expressed close to her baby in the newborn care unit was 11.2 ± 2.7ml. The volume of milk expressed near the baby was significantly higher when compared to milk expressed away from the newborn (p<0.001). Conclusions: This study showed that mothers who expressed their feed near their admitted newborns in the newborn care unit had a significant increase in the volume of expressed breastmilk in comparison to expressing the milk away from their babies.

Workplace Violence Against Nurses in Psychiatric Hospitals in Oman: A cross-sectional multi-centre study.

This study aimed to assess the prevalence of workplace violence (WPV) against nurses in Oman's psychiatric hospitals and explore associated factors. This cross-sectional study was conducted between October and December 2021 and included all tertiary mental healthcare hospitals in Oman (Al Masarra Hospital and Sultan Qaboos University Hospital, Muscat, Oman). The participants completed a sociodemographic survey and a questionnaire on WPV in the health sector. A total of 106 participants (response rate = 80.3%) were included in this study. Most were female (52.8%) and Omani (72.6%) and aged 30-39 years. WPV prevalence was high (90.6%), with verbal (86.8%) and physical violence (57.5%) being the most common types. WPV incidents were more frequent on weekdays (26.4%) and during morning shifts (34%), while 81.1% of the nurses worked in shifts and had direct physical contact with patients (83.0%). The majority (92.5%) were aware of standardised WPV reporting procedures and 89.7% confirmed the presence of such procedures in hospitals. WPV was more prevalent among nurses in inpatient wards (P = 0.047). WPV against nurses in Omani psychiatric hospitals is alarmingly high. Future studies should investigate contributing factors among healthcare providers and emphasise violence prevention by providing staff nurses with effective training to handle violent incidents involving psychiatric patients.

Considerations, barriers and enablers of deprescribing among healthcare professionals in Ogun State, Southwest, Nigeria: a cross-sectional survey

BackgroundDeprescribing is a clinical intervention aimed at managing polypharmacy and improving older adults’ health outcomes. However, evidence suggests that healthcare professionals (HCPs) may face challenges in implementing the intervention. This study aimed to explore the considerations, barriers and enablers of deprescribing among HCPs in Southwest Nigeria.MethodsA quantitative cross-sectional survey was carried out among consecutively sampled HCPs including physicians, pharmacists and nurses in two public tertiary healthcare hospitals in Ogun State, Southwest, Nigeria. A structured 43-item self-administered questionnaire was used to explore the participants’ sociodemographics, HCPs’ experience, considerations, barriers and enablers of deprescribing in older adults. The data were summarised using descriptive statistics including frequency and percentage. The Kruskal–Wallis test was used to determine differences in perceptions among the groups on a Likert scale. A p-value < 0.05 was considered significant.ResultsOverall, 453 copies of the questionnaire were analysed. Of the participants 204 (45.0%) were within the age group of 20–30 years; 173 (38.2%) claimed that older adults occasionally requested deprescribing of their medications. The majority (417; 92.1%) considered patients’ quality of life to be very important in deprescribing; 423 (93.4%) opined that having a care goal known to members of the HCP team is an enabler for deprescribing while 308 (68.0%) disagreed or strongly disagreed that lack of incentives and remuneration for HCPs that de-prescribe is a barrier to deprescribing. There is a significant difference among the participants across professional groups on the assertion that pressure from pharmaceutical companies is a barrier to deprescribing in older adults (p = 0.037).ConclusionsThe participants in this study had various considerations for deprescribing medication in older adults including patients’ quality of life. Having a care goal known to every HCP involved in managing a patient is an enabler for deprescribing while the lack of incentives and remuneration for HCPs that de-prescribe may not necessarily be a barrier to deprescribing. There is a need for regulations and policies to support the identified enablers among HCPs and reduce the barriers to effective deprescribing process.

Comparative Study Of Impulse Oscillometry And Spirometry In Patients With Asthma Visiting A Tertiary Health Care Hospital

Comparative Study Of Impulse Oscillometry And Spirometry In Patients With Asthma Visiting A Tertiary Health Care Hospital

Morbidity pattern of communicable diseases in a tertiary care hospital in metropolitan city of western Maharashtra

Background: In India, infectious diseases continue to be predominant with emerging non-communicable diseases, imposing a double burden of diseases on health care system. Hence, the tertiary health care hospital-based study was done to compare the morbidity pattern of communicable diseases with respect to non-communicable diseases. Methods: A 2 years’ record-based data of admitted patients was collected in a tertiary health care hospital. The data was analysed using Microsoft Excel version 365. Significance of association and difference in proportions has been checked with chi-square test and Z test for SEDP respectively at significance level of 0.05. Results: During the study period of two years, 6818 patients were admitted in the hospital, of which 74.51% suffered from communicable diseases while 25.49% suffered from other types of disease including non-communicable diseases. Of the 5080, patients with communicable diseases, 57.74% were males and 42.26% were females. Communicable diseases and non-communicable diseases had male predominance (p&lt;0.05) and was higher amongst age group 0-15 years (p&lt;0.05). Hospital stay was prolonged in patients suffering from communicable disease (p&lt;0.05). Significant increased difference was found in AFI, Malaria, Dengue and in Leptospirosis prevalence and significant decreased difference was found in acute gastroenteritis, IV, Covid-19, Respiratory infections and enteric fever (p&lt;0.05). Conclusions: Communicable diseases continue to be a major threat to public health system in India. Through effective surveillance programmes, any change in trends of disease can be identified and suitable measures can be adapted to control and prevent it.

An Epidemiological Investigation Report of a Cluster of Chickenpox Cases in a Ward of a Tertiary Healthcare Hospital in Delhi

An Epidemiological Investigation Report of a Cluster of Chickenpox Cases in a Ward of a Tertiary Healthcare Hospital in Delhi

Therapeutic Benefits of N-Acetylcysteine in the Management of Contrast-Induced Nephropathy

Abstract Objective This study aimed to assess the beneficial effects of N-acetylcysteine (NAC) in the treatment of contrast-induced nephropathy (CIN). Materials and Methods A prospective study was conducted in the department of cardiology of a tertiary health care hospital. A sample of 100 patients who had developed CIN through coronary angioplasty were categorized into two groups: one group treated with intravenous fluids (IVF) monotherapy and the other group treated with the combination of IVF and NAC therapy. Statistical Analysis The data were analyzed using statistical software SPSS software version 26 and statistical significance was set at p &lt; 0.05. Independent t-test and paired t-test were used to analyze the parameters. Results The rate of incidence of CIN was found to be 10%. We observed that the IVF + NAC combination therapy significantly decreases the serum creatinine compared to IVF monotherapy (p = 0.004). Both therapies show similar treatment outcomes with no significant difference (p = 0.556) in the case of estimated glomerular filtration rate (eGFR). Based on creatinine clearance, the results show adding NAC does not impact any additional benefits (p = 000). The duration of hospital stay of the NAC group was reduced significantly (p = 0.000). Conclusion At present, we found that the treatment outcomes which we analyzed based on factors such as serum creatinine, eGFR, and creatinine clearance, are too inconsistent to conclude the beneficial effect of NAC in the management of CIN.

Correlation Between Demographic Features and PD-L2 Expression in Mucoepidermoid Carcinoma of Salivary Glands

OBJECTIVE: This study was conducted to determine PD-L2 expression and its association with grading in patients with mucoepidermoid carcinoma METHODOLOGY: : This descriptive study was conducted over a period of 1 year after taking approval from Institutional Ethical Review board. A total of twenty-four cases of MEC were recruited from different tertiary health care hospitals in Lahore and Multan. Data consisting of demographics and clinical features was collected. Histopathological analysis was done according to Seethala's grading system. Immunohistochemistry (IHC) was performed to observe PD-L2 expression. Data was analyzed by using SPSS 25 RESULTS: : The mean age was 30.08±12.8 years and there were 41.7% males and 58.3% females. Most common site of involvement was found to be parotid gland. A total of (54.2%) cases were of low grade. Strong PD-L2 expression was observed in 12(50%) cases while in 5(21%) cases there was week expression. No significant association of PD-L2 expression with grade of tumor was observed. CONCLUSIONS: Among salivary gland tumors, Mucoepidermoid carcinoma is emerging as most frequently diagnosed malignancy. These tumors originate mainly from parotid glands usually during fourth decade of life. As preliminary data generated from current research has highlighted the expression of PD-L2 in malignant MEC. The expression of PD-L2 was observed in all of the tissue specimens in the current study as detected through IHC irrespective of the grade of the tumor KEYWORDS: Programmed cell Death 1 Ligand 2 (PD-L2), Mucoepidermoid Carcinoma (MEC), ImmunohistoChemistry (IHC).