Department Wards Research Articles

Improving Thoracic Surgery Ward Round Quality and Enhancing Patient Safety in a Referral Centre.

Introduction Ward rounds are vitalclinical processes that facilitate an opportunity for daily review and management of thoracic surgery inpatients. The aim of this study was to comparethoracic surgery ward round documentationagainst locally agreedstandards and design a template to improve the detail and uniformity of this process to enhance patient care. Materials and methods Data for this audit was collected retrospectively and prospectively. Data was collected during three auditing periods and managed on Microsoft Excel. Descriptive statistics were used for its analysis. Chi-square and Fisher's Exact tests were used to test for differences in reporting rates. Results and discussion Initially, a total of 199 ward round notes were reviewed. Imaging results (19%) and discharge planning (23%) were not reported. eCARE (electronic Clinical Assessment for Round Evaluation) was developed to ensure that all aspects of patient evaluation recommended by the guidelines were included. Reporting rates significantly improved after such changes. We analysed the effect of the new ward round note on discharge planning (23.3 vs 41%, p<0.001), complication rates (32.6 vs 21.9%, p=0.03), post-surgical length of stay (LOS) (7.0 vs 5.0, p<0.001). Conclusion Over a year, we auditedthe Thoracic Surgery Department's ward round documentation against locally agreed standards in line with national recommendations. Several important items were not regularly reported. Using closed-ended questions improved reporting rates, and patient care was optimised. Further research should explore the impact of this new documentation method on patient care and postoperative outcomes in our Trust as well as other cardiothoracic centres.

The Pregnancy Outcome in Women with Polycystic Ovary Syndrome

Background: In women of reproductive age, polycystic ovarian syndrome (PCOS) is a prevalent endocrine condition. Menstrual irregularities (oligomenorrhea or amenorrhea), hirsutism, persistent acne, androgen-dependent alopecia, abdominal obesity, hypertension, and infertility are all clinical signs of PCOS.Objective: To assess the success of pregnancy in patients with polycystic ovary syndrome.Materials and Methods: This observational cross-sectional study was carried out in the Department of Obstetrics and Gynaecology at Khwaja Yunus Ali Medical College and Hospital, Enayetpur, Sirajganj, Bangladesh from June 2020 to May 2022 for a period of two years. Women diagnosed with PCOS were willing to participate in our study were recruited from obstetrics Out patient Department (OPD) and antenatal ward of Department of Obstetrics and Gynaecology at Khwaja Yunus Ali Medical College and Hospital. After obtaining an informed consent from them, a detailed interview schedule containing socio- demographic details, menstrual/marital/ obstetric/past/personal/ family history was taken.Results: Concerning complications Preeclampsia was found in 5 (9.1%) of the PCOS patients but not in the non-PCOS patients. The differences in gestational age and mode of birth between the two groups were not statistically significant (p&gt;0.05). Perinatal outcome: 21 (39.6%) PCOS patients were admitted to the Neonatal Intensive Care Unit (NICU), compared to 11 (20.0%) non-PCOS patients. Which of the two groups was statistically significant (p&lt;0.05).Conclusion: The present study suggested that preeclampsia is a relatively common condition, and complications such gestational hyperglycemia, gestational hypertension, and preeclampsia were frequent in the PCOS group. In comparison to the non-PCOS group, the PCOS group had considerably greater rates of low birth weight and NICU admission. KYAMC Journal Vol. 14, No. 01, April 2023: 30-34

“STUDY OF MATERNAL AND FETAL OUTCOME IN TERM PRELABOR RUPTURE OF MEMBRANES STRATIFIED WITH AFI SCORE.”

Background: Amniotic uid index (AFI), a component of modied Biophysical prole, is commonly used for antepartum fetal surveillance, and can be considered an essential parameter to predict adverse fetal and maternal outcome in patients with PROM. The present study is Objective: undertaken to study the feto-maternal outcome in patients with term PROM by stratifying them into two groups with AFI &lt;5 and AFI ≥5. Methodology: Prospective cross-sectional study was conducted on 151 pregnant term, singleton live gestation with cephalic presentation with PROM admitted to the labor ward in Department of OBG at ESIC &amp; PGIMSR. On admission based on amniotic uid index measured by ultrasonography the study population was grouped as Group A with AFI &lt; 5cm and Group B with AFI ≥5 cm. Patients with AFI &lt;5 cm Results: (Group A) had higher febrile morbidity (p-0.0001). Caesarean delivery was signicantly higher in Group A (50%, p-0.0001), most common indication was fetal distress (60.9 %). Group A also had higher incidence of wound infection (9.8%, p-0.008) and increased duration of hospital stay (p-0.0001). More patients in Group B had successful induced vaginal delivery (82.6%). Higher incidence of perinatal morbidity with APGAR&lt;7 (p-0.032) and prolonged NICU admissions were observed in Group A (p - 0.0001). The present study co Conclusion: ncludes that AFI stratication in patients with term PROM on admission is useful to predict maternal and neonatal outcomes

A CROSS SECTIONAL STUDY OF ASYMPTOMATIC BACTERIURIA IN TYPE 2 DIABETES MELLITUS AND THEIR ANTIBIOTIC SUSCEPTIBILITY

Background: Diabetes is a metabolic disease characterized by hyperglycemia because of defect in insulin secretion or action or both. Asymptomatic bacteriuria (ASB) is common in diabetics and elderly which predisposes them to severe urinary tract infections. Reports on prevalence, etiology, antibiotic susceptible pattern are sparse in southern India. This study aimed to determine the prevalence of asymptomatic bacteriuria in patients with type 2 Diabetes mellitus Material &amp; Method: This cross sectional study was conducted among the diabetic patients presenting to inpatient and outpatient ward in department of general medicine AVMC&amp;H with ailments other than urinary tract infection were included. patients with symptoms of UTI, vulvovaginitis, pregnancy, recent history of hospitalization, recent urinary tract instrumentation, use of antimicrobial in last 14 days or UTI in recent past were excluded. Mid stream urine samples were collected from consented subjects. Urine samples were processed and examined for the various pathogens using the standard microbiological procedures. The spectrum of organisms causing asymptomatic bacteriuria and their antibiotic susceptibility prole. All data were collected by the investigator and was analysed statistically to nd the level of signicance of the study using SPSS v21. Results: In the present study total of 150 diabetic patients fullling inclusion criteria are included, with mean age of 55.6±10yrs, among them 66 were female and 84 were male patients. The isolates found to be in 50 patients (33.33%) out of 150 patients. Among the isolates, majority were with Escherichia Coli 52%, followed with 22% showing Klebsiella pneumoniae, 16% with Enterococcus species, 6% with proteus and 2% with Coagulase negative staphylococcus. Conclusion:The present study document 33.33% of the patients showing the asymptomatic bacteriuria. Among the isolates Escherichia coli was the most common organism among the patients with ASB. The presence of isolates was also correlated with the poor glycaemic control among the study participants, as one of the risk factor for ASB. Most isolates showed multiple resistance, indicating the need to speed up sensitization against antibiotic abuse

Analysis of the difference in MGMT promoter status in gliomas and its significance in prognosis assessment

The data of 1 268 newly diagnosed gliomas from the Fourth Ward of Neurosurgery Department of Beijing Tiantan Hospital between April 2013 and March 2022 were retrospectively analyzed. Based on postoperative pathology, the gliomas were divided into groups: oligodendrogliomas (n=308), astrocytomas (n=337) and glioblastomas (n=623). According to the O6-methylguanine-DNA methyl transferase (MGMT) promoter status defined by the 12% of best cut-off value in previous research results, patients were divided into methylation group (n=763) and non-methylation group (n=505). Methylation level [M (Q1, Q3)] in patients with glioblastoma, astrocytoma and oligodendroglioma was 6% (2%, 24%), 17% (10%, 28%) and 29% (19%, 40%), respectively (P<0.001). Compared with non-methylation patients, the progression-free survival (PFS) and overall survival (OS) of glioblastomas patients with methylation of MGMT promoter demonstrated more favorable prognosis [M (Q1, Q3)]) of PFS: 14.0 (6.0, 36.0) months vs 8.0 (4.0, 15.0) months, P<0.001; M (Q1, Q3) of OS: 29.0 (17.0, 60.5) months vs 16.0 (11.0, 26.5) months, P<0.001]. In astrocytomas patients, the PFS was much longer for those with methylation [the median PFS of patients with methylation was not observed at the end of follow-up, but those without methylation showed a median PFS of 46.0 (29.0, 52.0) months] (P=0.001). However, no statistically significant difference was observed in OS [the median OS of patients with methylation was not observed at the end of follow-up, but those without methylation had a median OS of 62.0 (46.0, 98.0) months] (P=0.085). In oligodendrogliomas patients, no statistically significant differences of PFS and OS were observed between patients with methylation and those without methylation. MGMT promoter status was a related factor affecting PFS and OS in glioblastomas (PFS: HR=0.534,95%CI: 0.426-0.668, P<0.001; OS: HR=0.451, 95%CI: 0.353-0.576, P<0.001). Moreover, MGMT promoter status was also a related factor affecting PFS in astrocytomas (HR=0.462, 95%CI: 0.221-0.966, P=0.040), but not for OS (HR=0.664, 95%CI: 0.259-1.690, P=0.389). The methylation level of MGMT promoter differed substantially in different types of gliomas, and the status of MGMT promoter profoundly affected the prognosis of glioblastomas.

A study of airflow patterns among patients attending a hospital set up in Manipur

Background: Clinicians and surgeons often require instant knowledge of the lung function of their patients during the course of their management though they rely on the symptoms most of the time. Yet unexpected, abnormal respiratory airflow patterns are found in various diseases which affect the management whereas many respiratory complaints used to turn out to be normal. Respiratory symptoms often but not always correlate with airflow abnormality, thus making office spirometry an important tool for addressing these problems. Aims and Objectives: An evaluation of the profile of airflow patterns observed among patients attending regional institute of medical sciences (RIMS) hospital, Manipur, is carried out. Materials and Methods: The spirometry test performances of total 221 patients (120 males and 101 females) aged between 11 and 80 years sent from outpatient and wards of different departments of our hospital (RIMS Imphal, Manipur) were done after taking informed consents. The period of test performance was from June 2016 to November 2018 on all working days in the department of physiology. For this, a computerized spirometer (Helios model no. 401) was used. Results: 176 (79.6% of the total studied) patients presented with symptoms of respiratory diseases and after spirometry test, 121 (54.7% of the total) were having different patterns of abnormal airflow. About 60% of 111 patients complaining only of breathlessness are found to have normal lung function. Among 13 patients with a common disease such as chronic obstructive pulmonary disease, unexpectedly 2 cases of restrictive type of airflow and another 2 patients with normal airflow were found. Conclusion: Awareness of such altered and unexpected occurrence in lung spirometry epidemiology would be informative to the physicians in disease management.

Association between Placenta Malaria Parasites and Preeclampsia/Eclampsia among Parturient Mothers in Alex Ekwueme Federal University Teaching Hospital Abakaliki

In tropical countries, malaria and preeclampsia/eclampsia are common diseases of pregnancy; and placenta have been implicated in the pathophysiology of both disease processes. The two diseases have pathophysiologic similarities in the placenta such as placenta ischaemia, endothelial dysfunction and production of pro-inflammatory cytokine. Yet, there is paucity of studies on the association of these two disease processes. Determining the association between the two disease processes may help to unravel the pathogenesis of preeclampsia and also help in its prevention and patient management. Objective: Determined the association between placenta malaria parasitemia and preeclampsia/eclampsia among parturients at Alex Ekwueme Federal University Teaching Hospital Abakaliki. Materials and Methods: This was a case control study that was conducted in the Labour wards of department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA) and Mile 4 Missionary Hospital Abakaliki, a comprehensive health care centre in Abakaliki, Ebonyi state. It was conducted over a period of 6 months between 1st October 2021 and 31st March, 2022. The cases in this study were parturients that developed preeclampsia/eclampsia in the course of pregnancy, while the controls were parturient without preeclampsia/eclampsia. Interviewer-administered questionnaires were used to collect data on socio-demographic characteristics, obstetrics and medical histories. Histological examinations were conducted to isolate plasmodium falciparum parasites from placenta samples obtained from the maternal surface of the placenta. The data was processed using Epi Info software. Categorical variables were analyzed using Mc Nemar X2 test, with a p-value of 0.05 considered statistically significant. Logistic regression models were used to estimate the odds ratios (OR) and 95% CI of the association between placenta malaria parasites and preeclampsia/eclampsia was conducted. Relative risk with 95% CI was used to determine both fetal and maternal outcomes. Results: The prevalence of preeclampsia during the study period was 2.9%. Placenta malaria was positive in twenty one (21) of the 67 cases of preeclampsia/eclampsia analyzed, giving a prevalence of 31.3% and in eleven (11) out of 68 controls (normotensive) patients analyzed, giving a prevalence of 16.2%. The presence of placenta malaria significantly increased the odds of developing preeclampsia/eclampsia among parturients (OR = 2.4, 95% CI = 1.0 - 5.4, P value = 0.04). Presence of placenta malaria in mothers with preeclampsia/eclampsia was associated with adverse pregnancy outcomes such as cerebrovascular accident (RR = 19.2, 95% CI = 1.1 - 341.7, P value = 0.04), DIC (RR = 10.9, 95% CI = 1.4 - 88.0, P value = 0.02), abruptio placenta (RR = 2.4, 95% CI = 1.2 - 4.8, P value = 0.01), pulmonary edema (RR = 2.7, 95% CI = 1.1 - 25.9, P value = 0.03), IUGR (RR = 2.1, 95% CI = 1.1 - 4.5, P value = 0.03) and IUFD (RR = 3.8, 95% CI = 1.3 - 11.7, P value = 0.02). Presence of placenta malaria also increased the risk of NICU admission (RR = 2.6, 95% CI = 1.1 - 6.0, P value = 0.03), Low 1st minute APGAR score (RR = 2.7, 95% CI = 1.2 - 6.1, P value = 0.02) and Low 5th minute APGAR score (RR = 3.0, 95% CI = 1.0 - 8.6, P value = 0.04) among neonates delivered by mothers with preeclampsia/eclampsia. However, presence of placenta malaria did not significantly increase maternal and perinatal mortalities. Conclusion: There is a higher prevalence of placenta malaria among mothers with preeclampsia/eclampsia when compared with normotensive controls and this was associated with increased risk of certain maternal and perinatal morbidities. Placental malaria was not associated with increased risk of either maternal or perinatal mortality.

Frequency of Acute Kidney Injury in Patients Presenting with Acute ST-Elevation Myocardial Infarction and Its Relationship with In-Hospital Mortality

Objective: To determine the frequency of acute kidney injury in patients presenting with acute ST elevation myocardial infarction and to compare the frequency of in-hospital mortality between patients presenting with acute ST elevation myocardial infarction with versus without acute kidney injury at a tertiary care hospital. Design: It was a descriptive case series. Study Settings: Department of Cardiology, Shaikh Zayed Hospital Lahore-Pakistan over a period of 6 months from January 2021 to June 2021. Material and Methods: A total of 128 patients of both genders aged between 18-70 years presenting with in first 12 hours of acute STEMI at emergency ward of cardiology department were included in this descriptive case series study. An informed written consent was taken from all the participants. All these patients were managed as per standard departmental protocols. Renal function was assessed within 30 minutes of presentation and then after 72 hours of admission and acute kidney injury was labelled if there was ≥0.5 mg/dl increase in serum creatinine level from baseline. These patients were followed till discharge and death of the patient during hospital stay was noted. It was then compared between patients with versus without acute kidney injury. Results: The patients had mean age of 53.8±11.3 years. There were 86 (67.2%) males and 42 (32.8%) females with a male to female ratio of 2.1:1. 97 (75.8%) patients were obese, 65 (50.8%) patients were diabetic and 87 (68.0%) patients were hypertensive. 72 (56.3%) patients were active smokers. 25 (19.5%) patients with acute STEMI developed acute kidney injury while 10 (7.8%) patients died during hospital stay. The frequency of in-hospital mortality was significantly higher in acute STEMI patients with AKI as compared to those without AKI (24.0% vs. 3.9%; p-value=0.004). When compared similar difference was noted in in-hospital mortality between acute STEMI patients with versus without AKI across various subgroups based on age, gender, BMI, diabetes, hypertension, smoking, ASA status, thrombolysis and need for PCI. Conclusion: A substantial proportion of patients presenting with acute ST-segment elevation myocardial infarction developed acute kidney injury that was associated with increased frequency of mortality among such patients which warrants routine monitoring of renal function among patients presenting with acute ST-segment elevation myocardial infarction and consideration of cases positive of AKI at higher risk of mortality so that risk stratification and anticipated management may improve the outcome of such patients in future practice. Keywords: Acute ST Elevation Myocardial Infarction, Acute Kidney Injury, In-Hospital Mortality.

Drug-related problems among hospitalized hypertensive and heart failure patients and physician acceptance of pharmacists' interventions at a teaching hospital in Ghana.

BackgroundHypertensive and heart failure patients frequently require multiple drug therapy which may be associated with drug‐related problems (DRPs).AimTo determine the frequency, types, and predictors of DRPs, and acceptance of pharmacists' interventions among hospitalized hypertensive and heart failure patients.MethodIt was a prospective cross‐sectional study at the internal medicine department wards of Korle Bu Teaching Hospital (KBTH) between January and June 2019 using a validated form (the pharmaceutical care form used by clinical pharmacists at the medical department). DRPs were classified based on the Pharmaceutical Care Network Europe (PCNE) Classification scheme for DRPs V8.02. Descriptive and inferential statistics were used for data analysis.ResultsA total of 247 DRPs were identified in 134 patients. The mean number of DRPs was 1.84 (SD: 1.039) per patient. Most DRPs occurred during the prescribing process (40.5%; n(DRPs) = 100), and the highest prescribing problem was untreated indication (11.7%; n = 29). Other frequent DRPs were medication counseling need (25.1%; n = 62), administration errors 10.1%(n = 25), drug interaction (10.5%; n = 26), and “no” or inappropriate monitoring (10.5%; n = 26). The number of drugs received significantly predicted the number of DRPs (adjusted odds ratio [AOR]: 9.85; 95% CI: 2.04–47.50; p < 0.001). Clinical variables were significant predictors of number of DRPs (diabetic status: AOR: 0.41, 95% CI: 0.18–0.98, p < 0.05; statin use: AOR: 0.34, 95% CI: 0.14–0.81, p < 0.05; antiplatelet use: AOR: 5.95, 95% CI: 2.03–17.48, p < 0.01). Average acceptance of interventions by physicians was 71.6% (SD: 11.7). Most (70.6%; n = 48) accepted interventions were implemented by physicians (resolved).ConclusionDRPs frequently occur, with most problems identified in the prescribing process. Medication counseling was frequently needed. Patients' number of drugs and clinical factors predicted the occurrence of DRPs. Physicians accepted and implemented most interventions. Our findings suggest that clinical pharmacists have an important role in cardiovascular patient care, but this study should be replicated in other hospitals in Ghana to corroborate these findings.

Manual Method vs Breast Pump for Breast Milk Expression in Mothers of Preterm Babies During First Postnatal Week: A Randomized Controlled Trial

ObjectivesTo compare breast milk volume between manual method and breast pump expression in mothers of preterm infants at different time point of first week.DesignRandomized controlled trial.SettingPostpartum ward of Obstetrics department and tertiary level neonatal intensive care unit (NICU) in a single institution in Orissa between October, 2020 and May, 2021.ParticipantsMothers who delivered before 34 completed weeks of gestation.InterventionsManual breastmilk expression (ME) group using Marmet technique and breast pump milk expression (PE) group using pigeon manual breast pump, initiated milk expression within one hour of delivery.Outcome measuresExpressed breast milk (EBM) volume in mothers of preterm infants at different time point of first week, and cumulative milk volume.ResultsOut of 170 mothers (83 PE and 87 ME group), 7-days milk volume data was available for 137 (71 ME and 66 PE) mothers. In per protocol analysis for 126 mothers (63 in each group), the median (IQR) EBM volume on day 2 and day 7 of ME and PE groups were similar [10 (5,20) vs 12 (5,28), P=0.10] and [280 (220–356) vs 280 (220–360), P=0.66]. The median (IQR) cumulative EBM volume over first 7 days in ME group was not significantly different from PE group [733 (593–995) vs 848.5 (571–1009)] P=0.55). A similar number of mothers in the PE and ME group [56 (88.9%) vs 58 (92%); P=0.14] provided exclusive breast milk for their neonates during the first week. Similar results were found on intention to treat analysis.ConclusionEBM volume expressed was comparable between mothers expressing manually or with breast pump.

A STUDY OF INSULIN RESISTANCE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background Systemic lupus erythematosus (SLE) is the prototypic autoimmune chronic inammatory disorder that predominantly affects women during their reproductive years and characterized by multisystem organ involvement and by high titres of auto-antibodies against several nuclear and cytoplasmic antigens. Increased risk of CHD in SLE is not explained by classic CHD risk factors.Insulin resistance and Metabolic syndrome are clearly strong candidates to justify the increase in CHD in patients with SLE and they provide insights into the pathogenesis of insulin resistance associated with inammation. Insulin resistance is a key component of the World Health Organization–dened metabolic syndrome that is increased in patients with SLE. The study was carried out in All SLE patients attending Rheumatology OPD and other outpatientMethods department or in various ward of Department of medicine at Assam medical College and hospital satisfying the inclusion criteria.continuous variables were expressed as mean +-standard deviation.categorical variable were expressed as frequency and percentage.p value were considered statistically signicant when it was less than 0.05 In our study ,the most common age group was found to be between 21-25 years(28%)Results followed by 16-20 years(20%).The female accounts for 96% and male accounts for 4%.From the study ,it was found that 47% of the study population had insulin resistance compared to 16% of that of healthy control.it indicates presence of signicant insulin resistance in the study group (p value&lt;0.05). The mean HOMA-IR score in the case was 3.54±3.41 and that in the control was 1.97±1.27. In the study conducted by C_intia N. H. Miyake et al , they found the similar result. The mean HOMA-IR score in the case and control were 1.85±1.68 and 1.40±0.86 respectively. (p value &lt;0.05). Sanaa Gazareen et al study also showed signicant insulin resistance in study group compared to control group. The mean HOMA-IR score in case was 1.5±0.86 and that in the control was 0.84±0.27.There was no signicant difference in insulin resistance between male and female.There was no signicant difference in insulin resistance between the newly diagnosed cases and the previously diagnosed cases who were on treatment.from the study it was also found that, as the disease activity increased,insulin resistance was also increased with co-relation coefcient(R) is 0.6053 and it was statistically signicant (p value&lt;0.05). Systemic lupus erythematosus (SLE) is a chronic,Conclusions multifaceted inammatory disease that can attack every organ system of the body. As the overall prognosis for persons with SLE has improved in recent time due availability of medications but cardio-vascular morbidity or mortality has been increasing rapidly. In recent studies of SLE, we have seen a marked increase in the prevalence of the metabolic syndrome. Insulin resistance is a key component of the World Health Organization–dened metabolic syndrome that is increased in patients with SLE In this part of the country, 47% of the SLE cases were having insulin resistance compared to 16% of the healthy population ( p value &lt;0.05). There was no difference in insulin resistance in SLE cases who were newly diagnosed not on medication and the diagnosed cases those were on medication. Insulin resistance was signicantly associated with disease activity. There was no co-relation of insulin resistance with disease duration. Fasting serum insulin level was signicantly higher in SLE cases with insulin resistance compared to cases without insulin resistance. Though triglyceride level was signicantly higher in SLE cases compared to healthy population but there was no difference in fasting lipid prole parameters in cases with insulin resistance and in cases without insulin resistance.

POISONING SEVERITY SCORE AND IT'S ABILITY TO PREDICT OUTCOME IN CASES OF POISONING

Background: Poisoning is a huge epidemic of noncommunicable disease in this century. Among the unnatural deaths, deaths owing to poisoning fall next only to road trafc accident deaths. Management of these critically ill patients will largely get better if the general causes of poisoning are properly dened[1] The PSS is a classication scheme for cases of poisoning in adults and children[2] . This scheme should be used for the classication of acute poisonings regardless of the type and number of agents involved. To study the clinical andAIMS AND OBJECTIVES: laboratory prole of cases of poisoning in J.A. Group of Hospitals, Gwalior To evaluate the “Poisoning Severity Score (PSS)” and its ability to predict outcome in cases of poisoning. Data for this study was obtained from indoorMATERIAL AND METHODS RESEARCH SETTING - wards of Department of Medicine, G.R.MEDICAL COLLEGE &amp; J.A. Group of hospitals Gwalior. The study was scheduled to be completed in a time duration from January 2019 to June 2020.It is a Prospective Descriptive study consisting of total 60 cases of Acute poisoning. Severity score was assessed by the information in case sheets using Poisoning severity scoring (PSS) system. The outcome was measured in terms of morbidity and mortality Out of 60 cases according to PSS 55% were grade 1 cases, 25% were grade 2 cases, 15% were grade 3 cases and 5 % wereRESULT: grade 4 ordeath.39 of patients did not require to be intubated. Poisoning is one of the medical emergencies and causesCONCLUSIONS: signicant mortality and morbidity. Suicidal intent was signicantly higher than other modes of poisoning (p=0.001). Organophosphorus compounds are the commonest agents involved in poisoning followed by rat killer poison. Banning or restricting their use may decrease mortality and morbidity from poisoning .In this study, we found that PSS was a very helpful tool in predicting the mortality in patients of poisoning .

Frequency of Postpartum Hemorrhage following Oxytocin use during Labor

Post-partum hemorrhage is one of the major causes of maternal morbidity and mortality worldwide. Efficient and timely management of 3rd stage of labor decreases the loss of blood and reduces the chances of hemorrhage. Prophylactic use of oxytocics plays a key role in the management of 3rd stage of labor. Use of xytocin for augmentation of labor is itself a risk factor for post-partum hemorrhage. This study was designed to find frequency of postpartum hemorrhage following oxytocin use during labor. Objective: To determine frequency of postpartum hemorrhage following oxytocin use during labor. Methodology: It was a Descriptive case control study. Cases were those patients in whom postpartum hemorrhage observed after delivery. Controls were those patients in whom in whom postpartum hemorrhage was not observed after delivery. In both cases and controls, it was observed whether oxytocin was used for augmentation of labor or not. In both groups, frequency of PPH was observed following oxytocin use during labor. Study was conducted in labor ward of Department of Obstetrics &amp; Gynaecology, Sheikh Zayed Hospital, Rahim Yar Khan from 18th June 2018 to 17th December 2018. Results: Mean age of the patients was 27.60±0.19 vs. 27.39±0.20 years respectively in Cases and Controls. Mean gestational age was 38.46±0.05 vs. 38.54±0.06 weeks in Cases and Controls respectively. Oxytocin use was observed in 130(53.28%) vs. 106(43.44%) among Cases and Controls respectively. Conclusion: There is almost 1.5 times increased risk of having post-partum hemorrhage in patients having augmentation with oxytocin during labor. Keywords: Post-partum hemorrhage, augmentation of labor, oxytocics, oxytocin, 3rd stage of labor

Remote Participant Recruitment for Pediatric Research During the COVID-19 Pandemic

Background The COVID-19 pandemic exposed significant vulnerabilities of traditional in-person recruitment methodology in the context of limited access to clinical facilities. Remote recruitment is a potential solution, but its yield and efficiency are unknown. Objective This study aimed to determine remote recruitment and enrollment rates for a pilot feasibility trial of an electronic monitoring device (EMD) for asthma in the pediatric population. Methods Children aged 4-18 years with persistent asthma receiving inhaler medications compatible with an EMD were screened for enrollment in a feasibility and acceptability trial. The emergency department (ED) and inpatient wards were identified as initial in-person recruitment locations prior to the pandemic. Owing to the COVID-19 pandemic, recruitment sites transitioned from exclusive ED or inpatient enrollment to outpatient primary care or pulmonary clinics in an attempt to increase enrollment rates. Study staff called families to determine their interest in the study. Patient age, race and ethnicity, insurance, contact attempts, and reasons for enrollment or refusal were recorded. e-Consent was obtained through the REDCap database, and baseline surveys were administered by telephone. Results Since November 2019, the study staff reached 147 out of 278 (52.3%) eligible families by telephone. In total, 37 (13%) families contacted were enrolled in the study. It took the study staff a mean of 2 attempts to reach individuals for initial enrollment but a mean of 4 additional attempts to complete consent forms. Of the families approached, 47% were Hispanic or Latino, 26.5% were Black or African American, 24.5% were White, and 2% were Asian. Among patients approached, 20% Asian, 16% White, 14.5% Hispanic or Latino, and 12% Black patients were enrolled in the study. Conclusions Telephone recruitment had a low yield across all racial and ethnic groups, averaging approximately 1 successful enrollment per 8 candidates approached. A substantial number of contacts was required to obtain e-consent forms and complete survey questionnaires after participants agreement to enroll. The study findings suggest that when there are barriers to in-person recruitment, remote recruitment is a feasible alternative, but the yield is relatively low, and enrollment requires persistent, repeated follow-up contact. Conflicts of Interest None declared.

Practice of Person-Based Discharge Communication Practices in General Surgery Wards at The Kenyatta National Hospital

Purpose: The current study sought to investigate the practice of person-based discharge communication practices in general surgery wards at the Kenyatta National Hospital.&#x0D; Methodology: The study used the descriptive research design approach. A stratified sampling technique was used to recruit 180 patients who had been discharged in the last one month prior to the study from surgical wards namely the General surgery ward, Urology ward and Neurology ward. A semi-structured questionnaire was used to collect both qualitative and quantitative data. A statistical Package for Social Sciences (SPSS version 25) was used in the data analysis.&#x0D; Results: The findings show that 77 of the respondents in the Neurology unit (mean = 2.97), 51 of them in the general surgical unit (mean = 1.80) and 52 of them in the urology unit (mean = 2.11) agreed that person-based discharge communication practices affect patient health outcomes. There was also a significant difference between the mean responses of the patients in the Neurology ward and Urology ward (-.267*, P=0.026). Likewise, there was a significant difference between the mean responses of the patients in the Urology ward and General surgery ward (-0.313*, P=0.017). Furthermore, the findings indicated that there is a statistically significant relationship between person-based discharge communication practices at KNH given the Neurology ward, Urology ward and General surgery ward departments {(F (2, 177) =3.517, p=0.032&lt; 0.05}. This was supported by the regression findings that indicated that person-based discharge communication practices have a positive and significant effect on patient health outcomes at KNH (β= 0.305, p=0.000). This implies that improvement in one unit of person-based discharge communication practices leads to an improvement in patient health outcomes at KNH by 0.305 units (vice versa is also true).&#x0D; Unique contributions to theory, policy and practice: Based on the study findings, the current study, therefore, recommends the health care practitioners to continuously appreciate the importance placed on constant and regular use of this discharge communication for better patient health outcomes and staff satisfaction, as well as contribute to cost savings to the organization.

State of uric acid in Iraqi patients with Parkinson disease

Uric acid has recently been proposed as a possible cause of Parkinson's disease (PD). The researchers wanted to see how uric acid levels were in persons with Parkinson's disease compared to an age-matched healthy control group. Researchers employed a case control study and a random comparison of plasma uric acid concentrations of collected samples in a clinical neurology department ward at Baghdad education hospital/Medical City and a Parkinson's disease movement disorder clinic. Participants were enrolled in the study from October 2015 to October 2016. We looked examined blood Uric acid levels in 40 Parkinson's disease patients and 40 age-matched healthy controls after controlling for age, sex, race, and geographic location. The Most Important Outcome Measures: Suboptimal Uric acid concentrations have been seen in Parkinson's patients. The results indicated that patients with PD (65%) had lower uric acid levels than controls (22.5%), and that the mean uric acid concentration in PD was (3.24) considerably (P.05) lower than in controls (4.08). The study's findings show that PD patients had much lower uric acid levels than healthy controls. These findings suggest that uric acid may have a role in Parkinson's disease.

Short-Term Outcomes and Clinical Features Analysis of Anterior Cervical Discectomy; Effect of Non-Instrumented Vs. Instrumented Fusion

Aim: To investigate the impact of instrumental and non-instrumental anterior cervical decompression and fusion procedures on various cervical degenerative diseases in terms of reducing pain and disability. Study Design: A prospective case series. Place and Duration: The study was conducted in the Neurosurgery Ward of Ayub Medical Complex, Abbottabad and Neurosurgery department of Hayatabad Medical Complex, Peshawar for duration 1 year from 1st Jan 2021 to 31st Dec 2021. Material and Methods: A total of 40 patients who underwent surgery for cervical degenerative diseases were selected and patients with more than one level segment were excluded from the study. Clinical symptoms and preoperative pain and disability were recorded using the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) and the Nurick grading. Post-operative score was recorded with improvement or deterioration in VAS, JOA score, and Odom criteria. Results: 40 patients, 24 (60%) men and 16 (40%) women were enrolled in the analysis. The mean age was 56.6 years ± 6.7 SD. Mean length of symptoms was 12.05 months with 5.65 SD. The total mean span of stay in the postoperative period was 4.55 days ± 1.05 SD. 24 (62.5%) patients reported neck pain, 18 (45%) patients with symptoms of radiculopathy, and 12 (30%) sensory deficits. In the study, 13 (32.5%) patients had features of cervical myelopathy. There was hand weakness in 11 (27.5%) cases and reduced range of neck motion in 15 (37.5%) cases. Anterior cervical decompression and fusion (ACDF) were performed in 24 (60%) patients, and anterior cervical discectomy (ACD) was performed in only 16 (40%) patients. The median of pre-operative VAS was 7.9 (mean 7.2) ± 1.35 SD, and the median of post-operative VAS after 2 weeks of follow-up was 3.00 (mean 3.04) ± 0.64 SD and 2.00 (mean 1.91) ± 0.94 SD after 3-month follow-up. Similarly, the median pre-operative JOA score was 15.20 (mean: 12.7) ± 3.30 SD, and after 3 months of follow-up, it was 16.00 (mean: 15.5) ± 1.01 SD. The reduction of the median VAS (Z = -4.46) and JOA (Z = -4.22) scores for both intervention groups was statistically significant after 3 months of follow-up (p &lt;0.001). Conclusions: Anterior cervical procedures are associated with excellent short-term outcomes in reducing pain and disability. ACDF requires longer operative time, but the length of postoperative stay was comparable in both groups. Keywords: Anterior cervical discectomy and fusion, Cervical spondylosis and Surgical result

Randomized Clinical Trial for Comparison of Drain Versus no Drain Thyroidectomy

Drains have been traditionally used routinely after thyroidectomy despite limited evidence to suggest any benefit. In many facilities, drains are routinely inserted after thyroidectomy with the aim of preventing hematoma formation and accumulation of seroma. Objective: To compare the outcome of drain versus no drain after thyroidectomy in patients presenting with clinically benign lesions of thyroid Methods: Study design is Randomized control trail. Settings are Department of Surgery, Mayo University Hospital Ireland. Study was completed in 6 months after the approval of synopsis 13-07-2015 to 31-05-2016. After taking approval from Hospital Ethical Committee, 60 patients fulfilling the inclusion criteria were selected from ward of Department of Surgery, Mayo University Hospital Ireland. Informed consent was taken. The demographic information was obtained. Patients were randomly divided in two groups by using lottery method. In group A, drain was inserted after surgery while in group B, no drain was inserted. All surgeries were done by a single surgical team. After surgery patients were shifted to ward and were followed-up there. At time of discharge, duration of hospital stay was noted. Patients were advised to follow-up in OPD after 7 days of surgery. Patients were assessed for seroma and hematoma formation. Results: Mean age of women in Group-A and in Group-B was 43.73±10.51 years and 40.23±9.07 years. In Group-A there were 13(43.3%) male and 17(56.7%) females while in Group-B there were 18(60%) male and 12(40%) females. In Group-A mean hospital stay of patients was 5.80±1.42 days and in Group-B mean hospital stay of patients was 3.76±1.10 days. In Group-B patients rate of hematoma and seroma formation was low as compared to that of Group-A patients but this difference was not statistically significant. Conclusion: Outcome of thyroidectomy is better in terms of shorter hospital stay, and other post operative complications in patients without drain. Now the controversy is clear that thyroid surgery without drain results in good outcome for patients. So there is no beneficial aspect seen in patients with the use of drain after thyroidectomy. Keywords: Thyroidectomy, outcome, drain, benign lesions, thyroid disease.

Clinico-epidemiological study of burn patients admitted in a tertiary care hospital of Solapur, Western Maharashtra

Background: Burn injuries constitute a major public health problem and account for a significant cause of high mortality and morbidity amongst the Indian population. This results in heavy social, economic and clinical burden to the nation. The aim of the study was to evaluate the demographic and clinical profile of burns patients admitted in a tertiary care center and to study the socio-demographic and clinical profile of burn patients and to assess the outcome of burn patients.Methods: Hospital based descriptive study with cross sectional design was done using the records of all burn patients admitted in burn ward of surgery department during 1st January 2019 to December 31st 2019.Results: Burn injuries were most common in the age group of 41-60 years. The male to female ratio was 0.65: 1. Most of the burn incident took place in rural area (73%) and rest (27%) in urban area. Most of the mode of burn injury (88.7%) were accidental burns, 8.2% had alleged history of suicide and in rest 3.1% homicide was suspected. Mortality ratio was 33.30% and 66.70% of patients got discharged from the hospital. A higher TBSA involvement is statistically associated with an increased risk of mortality (p&lt;0.05).Conclusions: The prevention strategies for burns should address the hazards of specific burn injuries, awareness education for vulnerable population and targeted first aid training. The burn units should be established well to reduce the mortality.

Issues on Powder Forms for Oral Solution and Suspension for Pediatric Patients in Japan: A Questionnaire-Based Observational Survey to Pediatric Pharmacists.

Powders for oral solutions and suspensions (POS) are commonly used as pediatric oral medicines worldwide, except for Japan. Although global pediatric formulation development accelerates POS importation to Japan without any formulation change, oral solid multiparticulates remain to be the preferred pediatric forms in the country. This study aimed to evaluate the acceptance situation of four typical POS form products (mycophenolate mofetil, sildenafil citrate, valganciclovir hydrochloride, and voriconazole) that were recently approved in Japan. A questionnaire on four products was completed by pharmacists in 29 children's hospitals with more than 100 beds each, between November and December of 2019. The questionnaire has six items on (#1) type of institution, (#2) formulary status, (#3) dispensing practice, (#4) reasons why POS form(s) were not selected as hospital formulary, (#5) advantages and disadvantages of POS form, and (#6) opinions for POS form. Of the 29 institutions, 7 (24%), 9 (31%), 4 (13%), and 10 (34%) institutions used POS of mycophenolate mofetil, sildenafil citrate, valganciclovir hydrochloride, and voriconazole, respectively. Reasons for not using these products were dispensed drug loss, formulation issues, and management issues in the pharmaceutical department and pediatric ward. Pharmacists preferred drug compounding such as tablet crushing and capsule opening to POS form use. POS forms might be an unsuitable formulation for the current hospital settings in Japan. Thus, appropriate dosage forms that reflect the current clinical settings are necessary.