South Indian Tertiary Hospital Research Articles

Rationalizing irrational prescribing-infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India.

Antibiotic use in paediatric surgical specialties is understudied. We investigated the antibiotic prescribing practices of paediatric general and cardiovascular surgical teams in a tertiary hospital in South India. Mixed-methods study including observations from ward rounds, semi-structured interviews, and review of antibiotic prescribing. Field notes from observations and interview transcripts were coded using NVivo and thematically analysed. Data collection and analysis were iterative and continued until thematic saturation. Quantitative data were analysed using descriptive statistics. Data included 62 h of observation, 24 interviews, one case study and 200 patient chart reviews (100/specialty). Senior surgeons make key decisions, referring to their own experience when prescribing antibiotics. Being outcome-driven, the doctors often prescribe antibiotics at the earliest indication of infection with a reluctance to de-escalate, even when an infection is not diagnosed. This practice is more acute among surgeons who consider themselves responsible for their patients' health and attribute the consistently low surgical site infection rates to this practice.In general surgery, 83.3% (80/96; 4 lost to follow-up) of patients were prescribed antibiotics for the duration of their stay with oral antibiotics prescribed at discharge. The surgeons use antibiotics prophylactically for patients who may be vulnerable to infection. The antimicrobial stewardship team was considered to have limited influence in the decision-making process. Outcome-driven decision-making in surgery leads to overprescription of antibiotics and prolonged surgical prophylaxis. The rationale for suboptimal practices is complicated by the surgeons' beliefs about the contextual determinants of health in India.

A Study of the Knowledge, Attitude, Practices, and Burden of Full-time Family Caregivers in the Care of Older Adults in Bengaluru, India

Abstract Background: Globally, the aging population is expanding rapidly, impacting every aspect of the society. In developing nations like India, where family members primarily serve as caregivers for older adults, inadequate knowledge about their complex needs increases caregiver burden. The topic of caregiving has been extensively studied worldwide, mainly focused on the negative aspects of caregiving. The present study aims to assess the knowledge, attitude, practice, and burden of family caregivers providing care to older adults at homes in South India. Methods: This was a descriptive, observational study, which was conducted using a questionnaire-based approach. In this study, a purposive sampling technique was used, and a total of 56 family caregivers participated, who were caregivers to the patients admitted to a tertiary hospital in South India. Data Collection: A prevalidated questionnaire from previous studies was used to explore the knowledge, practices, and attitudes of caregivers of older patients.Caregiver burden was measured using Zarit Burden Interview. Results: The data were analyzed using SPSS v21. Caregiver burden was found to be high among those who cohabited with the patient (P < 0.05). Sons/daughters and grandchildren had a better grasp about the medical conditions of older people, P < 0.05. Attitude toward caring for older adults was strongly positive irrespective of the age category. Conclusion: Our study revealed that caregivers’ knowledge on the medical needs of the older population was inadequate. This study could pave the way for developing hospital policies, as well as planning action research, training, and counseling programs to strengthen family caregiver capacity and promote active and healthy aging.

Health-Related Quality of Life of Patients with Chronic Kidney Disease on Maintenance Hemodialysis and Its Determinants: A Study from a Tertiary Hospital in South India

Health-Related Quality of Life of Patients with Chronic Kidney Disease on Maintenance Hemodialysis and Its Determinants: A Study from a Tertiary Hospital in South India

Profiling of swallowing function in head and neck cancer patients prior to radiation therapy-Findings from a tertiary hospital in South India

PurposeHead and neck cancer (HNC) patients often face difficulties with swallowing, which can be due to the cancer itself or the treatment modalities like radiation therapy. The presentation of HNC can vary between developing and developed countries due to socioeconomic factors. The current study aimed to profile the swallowing function of HNC patients before starting radiation therapy in a tertiary hospital in India. MethodThis cross-sectional observational study examined patients with HNC who were scheduled for radiation therapy. The Functional Oral Intake Scale (FOIS) and Karnofsky Performance Status Scale were used to assess the patients’ swallowing status and functional abilities, respectively. The study also evaluated the relationship between swallowing function and clinical-demographic factors. ResultsOur assessment of 162 HNC patients found that the cancer site significantly affects swallowing. Although 92% of patients had an oral diet, 64% made dietary modifications. Patients with non-oral intake had either oral or pharyngeal cancer, and over 80% of oral cancer patients and 60% of those with pharyngeal cancer had already made changes to their diet. Patients with laryngeal cancer had a better oral intake, with 58% reporting no swallowing issues. ConclusionPatients with HNC scheduled for radiation therapy may experience varying degrees of swallowing difficulty. Early intervention and teaching of safe swallowing strategies are crucial to prepare for the potential worsening of swallowing difficulties resulting from the treatment. Advanced tumor stages and oral/pharyngeal cancers increase the risk of significant swallowing issues.

Correlation Between Depression and Quality of Life Among Patients With Parkinson's Disease: An Analytical Cross-Sectional Study.

Introduction Parkinson's disease (PD) is a progressive complex degenerative disorder characterised by several motor and non-motor symptoms that result in disability and deterioration of the patient's quality of life (QOL). Depression is the most common non-motor symptom that may severely alter the QOL. The objective of this study was to examine the correlationbetween depression and QOL among patients with PD who received treatment from a movement disorder clinic of a tertiary care teaching hospital in South India. Methods This was an analytical cross-sectional study conducted among 220 PD patients who received treatment from a movement disorder clinic of a tertiary care teaching hospital inSouth India. The participants aged between 40 and 80 years, who can comprehend Malayalam or English and were clinically diagnosed with PD according to United Kingdom PD Society Brain Bank criteria were included in the study. Depression was assessed using the Hospital Anxiety and Depression Scale, motor function using the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III, and the quality of life was assessed using the Parkinson's Disease Questionnaire 39. Results The results of this study showed that there was a significant positive correlation between depression andQOL (r=0.699, p<0.01) among patients with PD who received treatment from a tertiary care teaching hospital.The correlation with domains of QOL also identified that depression was significantly correlated with all domains of QOL and more to the emotional domainof QOL (r=0.799, p<0.01). Conclusion Depression is the most common neuropsychiatric condition in PD and the most important determinant of QOL.Depression mayoccur at any stage of PD and can significantly impact the QOL of patients and their caregivers.Hence it should be recognized early and managed by pharmacological and nonpharmacological measures to improve the QOL.

Comparison of Ocular Blood Flow in Glaucomatous Eyes and Nonglaucomatous Eyes at a Tertiary Hospital in South India: A Prospective Case-control Study.

To compare the ocular blood flow in glaucomatous eyes and normal healthy eyes. This study compares open-angle glaucoma patients to healthy adults by measuring various parameters in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary artery (SPCA). A total of 50 glaucomatous eyes and 50 normal eyes were included in a prospective case-control study over 1 year. The color Doppler imaging (CDI) was conducted using a noninvasive linear multifrequency probe with a frequency range of 5-9 MHz. OA, CRA, and SPCA were measured for peak systolic velocity (PSV), end-diastolic volume (EDV), pulsatility index (PI), and resistivity index (RI). When compared with controls, PSV was decreased in all three vessels, with the results being remarkable only in CRA. The EDV also showed a remarkable decrease in all three vessels. Additionally, all three vessels showed significant increases in PI and RI except OA, p-value < 0.05. Blood velocity is decreased, and resistive indices are increased in glaucomatous eyes compared with normal eyes. Variations in ocular blood flow could be a cause or consequence of glaucomatous optic neuropathy and are an important predictor of disease progression. Murugesan MAD, Venkat P, Basetti B. Comparison of Ocular Blood Flow in Glaucomatous Eyes and Nonglaucomatous Eyes at a Tertiary Hospital in South India: A Prospective Case-control Study. J Curr Glaucoma Pract 2024;18(2):45-50.

TVS-guided cervical strain elastography is more effective than measuring cervical length as an independent predictor of spontaneous preterm delivery in asymptomatic, high-risk women during the mid-trimester

Introduction TVS (Transvaginal Sonography) guided Cervical strain elastography (CSE) is now available in tertiary referral centers of LMICs (Low- and Middle-Income Countries). TVS cervical length (CL) assessment is being used routinely. Still, elastography is not used in clinical settings, although enough evidence suggests good predictive value towards sPTD (spontaneous Preterm Delivery). The clinical utility of elastography has not been tested among high-risk populations of LMICs for the prediction of sPTD. Aim To test the performance of TVS-CSE in predicting sPTD among asymptomatic women in the mid-trimester at risk of sPTD either due to clinical factors or due to a short cervix. Method Prospective observational study performed at a tertiary hospital in South India. Asymptomatic pregnant women between 16 and 24 weeks who had one or more clinical risk factors for sPTD or CL <2.5 cm were included. GE Voluson E-8 ultrasound machine was used. After CL measurement, elastography color coding was noted around the internal-os in the sagittal view. The strain ratio (SR) was calculated using the trace method on three ROIs (Region of Interest): Internal-os in sagittal view (IN), whole cervix in sagittal view (WN), and internal-os in axial view (AN). Reference Tissue (RT) of similar size and depth was chosen in the darkest blue region on elastography (stiffest area) outside the cervix, posterior/lateral to the cervix over the ligament insertion. Lower the SR – softer the cervix. Two trained fetal medicine consultants performed the initial 57 cases until intra/inter-observer correlation was satisfactory. Delivery before 37 weeks (after 26 weeks), in which the process of labor has begun spontaneously, or labor was induced after PPROM—was considered as sPTD. SRs were assessed to determine how well they could predict sPTD independently or combined with cervical length. Results Out of 221 recruited,17 were lost to follow-up after 32 weeks; 204 were delivered in our hospital. Irrespective of the route of delivery, 71 (34.8%) had sPTD. Of the remaining 133, 106 delivered at term, and 27 underwent medically indicated PTD. Apart from multiple pregnancies, no other preterm-related risk factors (including CL < 2.5 cm) showed significant association with sPTD. Red CSE pattern around internal-os was associated with a significantly higher (54.5%) incidence of sPTD. CLs were similar (3.63 ± 0.67 vs. 3.63 ± 0.80, p = .981) whereas SRs in all three ROIs were significantly lower among sPTD group versus no sPTD group (IN:0.65 ± 0.29 vs 0.79 ± 0.30 p = .001, WN:0.34 ± 0.13 vs 0.39 ± 0.15, p = .013, AN:0.37 ± 0.16 vs 0.48 ± 0.26, p = .002, respectively). Using ROC curves, while CL was not predictive (AUROC 0.49, p = .81), SRs showed moderate predictive value toward sPTD with the best AUC of 0.624 (p = .003) at IN. Prediction was slightly better for early sPTD <32 weeks (AUC 0.653 p = 0.03). The best cutoff for SR at IN was 0.72, below which there was a moderate accuracy in predicting sPTD (sensitivity 52.11%, specificity 60.9%, PPV 41.57%, NPV 70.44%, diagnostic OR 1.69 and overall accuracy of 57.84%). A weak positive correlation is seen between IN and CL (Pearson’s correlation R = 0.181). Multi-variable binary logistic regression analysis suggested that SRs at IN (Adjusted OR − 0.259 CI 0.079–0.850), AN (Adjusted OR 0.182 CI 0.034–0.963), Multiple Pregnancy (Adjusted OR 3.5 CI 1.51–8.13) and previous sPTD/PPROM (Adjusted OR 2.72 CI 0.97–7.61) independently predicted sPTD. Conclusions TVS CSE performed better than CL as an independent predictive tool toward sPTD, although predictive efficacy was modest at best. Since technology is now available in high-end USG machines in tertiary care centers, we propose optimal utilization of CSE in LMICs to triage at-risk populations since low SRs are strongly associated with sPTD.

Performance of the QuantiFERON- TB gold test in children receiving immunosuppressive therapy for rheumatic diseases

ObjectivesThe mainstay of treatment for pediatric rheumatological disease is disease-modifying anti-rheumatic agents which are immunosuppressive in nature and increase the susceptibility to tuberculosis. The aims and objectives were to evaluate the performance of the QuantiFERON®-TB Gold test (QFT) and Tuberculin skin test (TST) to diagnose latent tuberculosis in children receiving immunosuppressive therapy for rheumatic diseases in a tertiary hospital in South India. MethodsThis was a prospective observational study. 60 consecutive children diagnosed with various rheumatic diseases attending the Paediatric Rheumatology clinic on immunosuppressive therapy were included. The QFT and TST were performed on the same day. Data regarding the demography, diagnosis, treatment received and test results were collected and analysed. ResultsAmong patients included (n = 60), two children had positive QFT and one child had positive TST. The agreement between tests was k = 0.85 and the proportion of latent tuberculosis was 5 %. All the children included were on conventional DMARDs and 3.3 % were on biological DMARDs. There was a significant decrease in the mitogen induced interferon level in children on treatment with hydroxychloroquine (p = 0.022) and a significant increase in the level in children on azathioprine (p = 0.006). Children on steroids had a lower range of mitogen-induced interferon levels. ConclusionQFT may be a more reliable test than TST for the detection of latent tuberculosis in children with rheumatic diseases receiving immunosuppressive treatment. The use of hydroxychloroquine and steroids might influence the mitogen-induced IFN-γ secretion and may interfere with the interpretation of the QFT test.

Prevalence of childhood trauma in patients with psychiatric disorders and its association with perceived social support and suicide attempts: A cross-sectional observational study in a tertiary hospital in South India

Background: Adverse childhood experiences include exposure of children to physical abuse, physical neglect, emotional neglect, emotional abuse, and sexual abuse. Children exposed to severe maltreatment and trauma during their early childhood are at a higher risk of early onset of psychiatric disorders. Aim: To find the prevalence of childhood adverse experiences in psychiatric patients and its association with perceived social support and suicidal attempts. Materials and Methods: A cross-sectional observational study was conducted in the psychiatry outpatient department at a tertiary care hospital in Kerala. Patients with a diagnosis of substance use disorders, psychotic disorders, mood disorders, and neurotic disorders according to ICD-10 (F10-F45) and in remission were included in the study. Institutional Ethical Committee approval and informed consent from the participants were obtained. Socio-demographic and clinical details were obtained. Childhood Trauma Questionnaire-Short Form and Multidimensional scale of Perceived Social Support were administered. Descriptive statistics and Chi-square test were employed for data analysis. Results: Eighty-five per cent of the subjects had a history of at least one type of childhood trauma. Emotional abuse was the most commonly reported type of trauma. Among patients with childhood trauma, 47.2% reported high levels of perceived social support, whereas 18.5% individuals reported a history of at least one suicide attempt. Conclusions: A significant proportion of patients with psychiatric disorders in an Indian setting have experienced childhood trauma. Childhood trauma in psychiatric disorders is associated with a higher risk of attempting suicide.

Study of the Immunohistochemical Expression of p63 in Benign Lesions and Carcinoma of the Breast at a Tertiary Hospital in South India.

Invasive breast carcinoma is among the most common female cancers worldwide, causing high morbidity and mortality. Considerable disagreement in the interpretation of diagnostically challenging breast lesions based on histology alone has been documented. One of the essential histopathological findings that help distinguish benign from malignant lesions is the presence of the myoepithelial cell layer. Myoepithelial markers such as tumor protein 63 (p63) help distinguish invasive carcinoma from benign proliferations. p63 antibody is superior to other myoepithelial markers as it selectively stains the nuclei and is negative in stromal cells. To study the expression of p63 in various histological subtypes and grades of breast carcinomas. After routine hematoxylin and eosin stain, 65 cases of breast lesions were subjected to immunohistochemistry for p63 antigen using Novacastra ready-to-use monoclonal antibody p6. All cases were analyzed for p63 expression, and its staining arrangement was interpreted. In all benign lesions, immunoreactivity was noted in the myoepithelial cells, forming a continuous layer surrounding the luminal epithelial cells. The benign papillary lesions showed p63 staining in the fibrovascular core of the papillary fronds and at the periphery. A few single myoepithelial cells stained by p63 were also seen scattered discontinuously in ductal carcinoma in situ (DCIS). All invasive carcinomas and encapsulated papillary carcinomas were completely devoid of peripheral p63 staining of myoepithelial cells. p63 is a specific nuclear marker of myoepithelial cells in the breast and can, therefore, aid in distinguishing invasive ductal carcinoma from DCIS or rare questionable hyperplastic lesions. They also play a significant role in distinguishing various papillary lesions of the breast and, hence, can be incorporated into routine reporting for definitive diagnosis and accurate treatment.

Clinical profile of hemophilia children admitted in a tertiary care hospital in South India: a cross sectional study

Background: Hemophilia is a rare inherited genetic blood disorder that needs a high index of suspicion and appropriate laboratory facilities for diagnosis. Unfortunately, it has not received the same patronage as other bleeding disorders like thalassemia and sickle cell anemia. Its management is expensive and requires lifelong treatment. Methods: This is a hospital-based cross-sectional study done at a hemophilia treatment center in a tertiary hospital in South India to study the clinicoepidemiological profile and complications in hemophilia children admitted during the period of January 2022 to June 2023. Results: 40 children with hemophilia were included in the study, and all of them had Hemophilia A with the majority being of severe type (62.5%). The mean age of diagnosis was 10 months. Hemarthrosis was the presenting complaint in about 50 % of children at admission while the majority had bruises and ecchymosis as clinical presentation at the time of first diagnosis (40%). 5 children tested positive for inhibitors among those tested. Intracranial hemorrhage was the most common occurring complication (17.5%). Knee (60%), elbow (47.5%) and ankle (40%) were the most common target joints. Conclusions: There is a need for awareness of this disease among clinicians and people for appropriate diagnosis. The government should ensure the availability of factor replacement therapy and other treatment modalities even at District hospitals for easy accessibility of patients. Management goals should shift from on-demand therapy to prophylactic therapy for hemophilia children for better living standards and prevent complications like arthropathy in these patients.

Pattern of pediatric dermatoses in a tertiary hospital in South India

Background: Several cross-sectional studies in the form of school surveys and studies on paediatric patients visiting dermatology OPD in tertiary care hospital has been conducted in the last three decades. This study was conducted to note the pattern of paediatric dermatoses and also to compare the difference in disease pattern with other studies conducted in southern India in last decade. Methods: A retrospective cross-sectional study was conducted at the Dermatology department of MVJ teaching hospital to determine the pattern of pediatric dermatoses from May 2021 to October 2021 after obtaining institutional ethics committee clearance. Cases under the age of 18 years were included in the study. Cases with age above 18 years, incomplete data, dermatoses where diagnosis was uncertain were excluded from the study. A total of 150 children were included in the study. The results were entered and tabulated in MS-excel sheet and descriptive analysis was done. Results: 150 children were included in the study.36 types of dermatoses were noted overall. Eczematous diseases (32.7%) contributed to the maximum followed by infections and infestations (25.3%). The most frequent dermatoses found were Atopic dermatoses (10%), pityriasis alba (8.6%), scabies (8.6%), Acne vulgaris (8.6%). Eczematous diseases and hypersensitivity disorders were noted to have increased frequency when compared to other studies in last one decade Conclusions: Rising trend in atopic dermatitis has been noted which might be due to changing environmental factors and also due to better recognition of condition by physicians in last one decade. With respect to spectrum of skin infections and infestations not much of difference is appreciated when compared to previous studies

Effectiveness of health literacy and relaxing music on quality of sleep and risk for antenatal depression.

Pregnant women experience increased sleep disturbances during the third trimester of their pregnancy, which may result in the development of psychological issues in the perinatal period. There is a dearth of interventional studies that combine health literacy and the provision of music for the benefit of pregnant women in South Asia. To determine the effectiveness of a combination of Comprehensive Health literacy And Relaxing Music (CHARM) interventions on quality of sleep and risk for antenatal depression among women visiting antenatal outpatient departments of a tertiary hospital in South India. A four-arm parallel-group randomized controlled trial was adopted; 128 low-risk primigravid women were recruited and randomly assigned to the four groups using block randomization. The interventions included relaxing music interventions, comprehensive health-literacy interventions, combinations of both as CHARM interventions, and standard antenatal care. All the interventions were provided for four weeks. The quality of sleep among pregnant women was assessed using the Pittsburgh Sleep Quality Index Scale at baseline and after four weeks of intervention. Women at risk of developing antenatal depression were screened using the Edinburgh Postnatal Depression Scale-Antenatal Version. Pregnant women who received CHARM interventions had significant improvement in quality of sleep when compared with other interventions (F(3,124) =15.0, P < .001, effect size η p2= 0.27). Also, 38 (29.6%) of the included pregnant women were at risk of developing antenatal depression, which was reduced to 21 (16.4%) following the intervention. CHARM intervention could promote quality sleep and reduce the risk of developing antenatal depression, thereby improving perinatal mental health.

Lip vitiligo: a clinico-epidemiological study in a tertiary hospital of South India

Vitiligo is a common autoimmune pigmentary disorder characterized by destruction of functional melanocytes resulting in the appearance of depigmented patches on the skin and mucosa. These lesions pose a cosmetic challenge. The involvement of the mucosa is less, but may be the first symptom of this pathology. Depigmentation in the lips can be more easily observed and patients can be counseled regarding the condition and guided for treatment. Aims: The study describes the various clinic-epidemiological factors associated with lip vitiligo. Materials and Methods: The study sample included 100 patients of lip vitiligo of all age groups and gender. Patients with a history of herpes labialis, and history suggestive of post inflammatory depigmentation of lips secondary to various causes were excluded from this study. Also, patient vitiligo patients without lip involvement were excluded. The frequency, site, extension, association with vitiligo elsewhere, and systemic association were noted and tabulated. Results: Among 100 patients, 57 were males and 43 were females. Majority of our study subjects (63%) had onset of vitiligo between 11 and 30 years and 24% between 31 and 50 years. In the present study, 41 patients had only lip vitiligo, 55 patients had lip and vitiligo in other parts, four had involvement of lip and genital mucosa. Out of 100 patients, 71 complained that the lips were the initial lesion. The most type of vitiligo seen in our study subjects was the isolated lip vitiligo (41) and the least common was universal vitiligo (2). Leukotrichia was seen in three patients. In our study six patients had exclusive upper lip vitiligo and 40 patients had lower lip vitiligo. The remaining patients had both lower lip and upper lip involvement. Angle of the mouth was involved in 31 patients and five had marginal extension onto the skin. Of 100 patients with vitiligo nearly 19% had atleast one co-morbid condition. The most common autoimmune disease was thyroid dysfunction seen in 17% of patients. Conclusion: Though rare, lip vitiligo could be one of the earliest presentations of vitiligo and will aid in counseling the patients regarding the chronicity and thereby reduce the psychological morbidity. The data on lip vitiligo is sparse and to the best of our knowledge, there is no study on the demographic characteristics and clinical patterns of lip vitiligo.

Risk factors associated with suicide attempts in patients with schizophrenia: an observational study from South India

BackgroundAs a suicide attempt is an important predictor of suicide in patients with schizophrenia, it is essential to assess risk factors to prevent suicides. This study aimed to assess the clinical factors and reasons associated with suicide attempts in patients with schizophrenia. A chart review of the patients diagnosed with schizophrenia from January 2014 to December 2019 was conducted at a tertiary hospital in South India. Socio-demographic and clinical details were extracted using a pro-forma. Details of suicide attempts were collected for all the patients.ResultsOut of 300 patients, 54 patients (18%) had at least one suicide attempt. Comorbid depression (p < 0.001,φ = 0.32) and substance abuse (p = 0.043,φ = 0.1) were significantly more in patients with suicide attempts. The group with suicide attempts had a significantly higher record of poor treatment compliance (p = 0.001, φ = 0.19). The most common methods of suicide attempts were drug overdose and consumption of poison (20.3% each). The most common reasons were the presence of depressive symptoms (24.1%) and delusions (24.1%). Hallucinations contributed to 22.2% of the suicide attempts.ConclusionsSuicide attempts were common among schizophrenia patients in up to 18%. Evaluation and early treatment of depressive symptoms and substance abuse and improvement of treatment adherence may help prevent suicide in patients with schizophrenia.

Pathways to care in alcohol use disorders: A cross-sectional study from a tertiary hospital in South India

The study examined the pathway patients with alcohol use disorders followed to access tertiary care psychiatry services. We assessed 110 patients and one family member for each patient who sought psychiatry care for alcohol-related problems for the first time using the WHO encounter form. Only 5.5% of patients followed a direct pathway. The rest reached the tertiary hospital after third, fourth, and fifth encounters with other service providers such as traditional and faith healers, medical practitioners, and general hospitals. Although the family decided to seek the first consultation, medical professionals played a pivotal role in referring patients to psychiatry care.

Time Elapsed from onset of symptoms to antituberculosis treatment in children with central nervous system tuberculosis in a tertiary hospital in South India: A mixed-methods pilot study.

A pilot study with a mixed-methods design was conducted to estimate the time for tuberculosis (TB) treatment initiation and associated factors among children with central nervous system-TB (CNS-TB). A total of 38 children were enrolled for the quantitative component, and 20 in-depth interviews were conducted. The median duration (interquartile range) from onset of symptoms to treatment initiation was 23 (11, 55) days. About 44% and 31% of the children presented with Stage II and Stage III of CNS-TB, respectively. The major reasons for delay were symptoms not taken seriously (50%) and too many referrals (21%). About 89% of the families went into catastrophic health expenditure due to the disease. The treatment delay may be due to both patient delay and health system delay. Tailoring approaches to target the pediatric population could further improve early detection and treatment initiation of CNS-TB.

The Facilitating Factors and Barriers for Nurses, to Utilize the Screening Services for Cervical Cancer in Tertiary Hospital of South India

Background: Cervical cancer screening needs to be considered as an integral part of maintaining women’s healthincluding the healthcare providers.Objective: The objective of the study was to assess the barriers and facilitators, women health professionals face,when accessing the cervical cancer screening services.Research Method: This is a descriptive, cross-sectional , mixed method study. The participants of the study werefemale nurses from selected tertiary level hospital from Tamilnadu, India. For quantitative method, standardizedvalidated tool was used with author’s permission. The participants participated were 125 in number. Qualitativeinterviews were conducted.Results: The result showed that the common perception about the pap- smear procedure was being uncomfortable,anxiety provoking and painful as expressed by (35.2%, 33.6 and 33.6%) respectively. This overall poor attitudeand carelessness of the female nurses may greatly hamper the screening program. Major barriers for cervicalcancer screening among the nurses were found to be as follows: 31.2% said Taking off Clothes for the screeningprocedure is considered as a barrier, 20% said they do not prefer the presence of male staff during the procedureand 20% said its time consuming.Conclusion: To conclude, if health care providers lack health awareness, they cannot motivate their patientsto do the same. Thus, the initial step in breast and cervical cancer screening is health care providers shouldfocus of their own health.

Esophageal Malignancy - Endoscopic and Clinicopathologic Patterns Study and Their Outcome in a Tertiary Hospital in South India

Esophageal Malignancy - Endoscopic and Clinicopathologic Patterns Study and Their Outcome in a Tertiary Hospital in South India

Costs & outcomes of hospitalized scrub typhus infection in a tertiary hospital in south India.

Scrub typhus is a rickettsial infection seen along the Asian-Pacific rim and imposes a considerable burden on affected people in low- and middle-income countries. The present study was aimed to determine the direct cost of hospitalization of scrub typhus and its trend over six years. This was a retrospective, observational, hospital based study of individuals admitted to the hospital, diagnosed with scrub typhus over six years, from January 2013 to December 2018. The potential out of pocket expenditure was evaluated. A total of 198 patients were included in the study. The median cost of admission (adjusted to INR 2020) for the six years (2013 to 2018) was found to be ₹ 37,026 (US $ 490) [interquartile range (IQR) 22,996-64,992]. The median cost for patients admitted to the intensive care unit (ICU) was ₹ 128,046 (US $ 1695) (IQR 71,575-201,171), while the cost for patients admitted to the ward-alone was ₹ 33,232 (US $ 440) (IQR 19,609-45,373). The multivariable analysis showed that ARDS and SOFA score were the independent predictors of ICU admission. Hospitalisation for scrub typhus is associated with a substantial healthcare expense. The predictors of increased cost were the presence of acute respiratory distress syndrome (ARDS), shock, increasing sequential organ failure assessment (SOFA) score and duration of hospital stay.