Out-of-pocket expenditure among patients with diabetic foot ulcer in a tertiary care hospital of south India: A cross-sectional study

Diabetic foot ulcer is a debilitating complication of long-standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out-of-pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital-based cross-sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out-of-pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650-₹81 120) ($378.14 [$122.56-$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non-medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non-medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden.

Pregnancy-related Factors Responsible for Delivering Low Birth Weight Babies: An Institutional-based Cross-sectional Study, Jamnagar, Gujarat

Background

The WHO defines LBW as "Birth weight less than 2500 grams" regardless of gestational age. Being born with a low birth weight also incurs enormous economic costs, including higher medical expenditures and social service expenses, and decreased productivity in adulthood.

Objective

To study distribution of newborns' according to pregnancy related factors and its association with newborns' birth weight.

Methods

An institutional based cross-sectional study. New-borns delivered at study institute were considered as study participants. Estimated final sample size was 500. Guardians (mothers) were face-to-face interviewed and also recorded data were collected from the case file and Mother and Child Protection Card.

Results

Prevalence of LBW newborns was higher in mothers with late ANC registration, <4 ANC visits, chronic medical conditions, infection during pregnancy, PIH, anemia, consuming tobacco, exposure to second hand smoke, LSCS/Assisted delivery, in female newborns', current pregnancy birth order number more than 2, in pre term newborns' and mothers with bad obstetric history.

Conclusion

Create awareness and adoption of suitable family planning methods. Need to do early (within 12 weeks) ANC registration with minimum four ANC visits for better pregnancy outcome. Effective tracking and suitable intervention provided to improve current pregnancy outcome. Health care professional should pay special attention to high-risk pregnancy. Develop social culture in such a way that females are neither addicted nor exposed to any tobacco containing products in their life.

Rifampicin Resistance Pattern of Mycobacterium tuberculosis Infection in Tertiary Care Hospital Settings

Introduction Mycobacterium tuberculosis (MTB), the causative agent of tuberculosis (TB), continues to pose a significant global health threat, with increasing concerns about antimicrobial resistance (AMR). This study aims to elucidate the AMR patterns of MTB infections in tertiary care hospital settings. Materials and methods A retrospective analysis was conducted on 138 clinical samples collected from patients attending the outpatient ward with clinically suspected MTB infections from November 2022 to April 2023 in a tertiary care hospital, Saveetha Medical College and Hospital. The study focused on the sample isolates collected from various clinical specimens, such as sputum, pus, synovial fluid, wound swabs, and other forms of samples from the patients. The samples were processed and analyzed with routine microbiological confirmation tests using standard laboratory methods such as staining and culture. Further, the samples were subjected to a GeneXpert MTB/RIF assay to assess the resistance to Rifampicin (RIF). The results were interpreted, analyzed using standard statistical methods, and presented. Results The findings revealed marked resistance of the clinical isolate MTB to TIF, with positive and negative results through various peak levels shown by GeneXpert. Out of the 138 samples screened by GeneXpert for resistance, 14 samples were found to be positive (10.14%). Resistance to the first-line drug, namely RIF, was observed in the study, raising concerns about the effectiveness of standard tuberculosis treatment regimens followed in the country. Conclusion This study implies the urgency of monitoring and addressing AMR in MTB infections in tertiary care hospital settings. The emergence of resistance to even the first-line drugs necessitates continuous surveillance, the implementation of appropriate diagnostic strategies, and the development of effective treatment protocols. A comprehensive understanding of the AMR landscape in tuberculosis is crucial for optimizing therapeutic interventions, preventing the spread of drug-resistant strains, and ultimately curbing the global burden of tuberculosis.

Assessing the Impact of Precancerous Lesions on Oral Health-Related Quality of Life: A Study at Tertiary Care Hospital

Objective

The aim of this cross-sectional study was to assess the oral health-related quality of life (OHRQoL) in a cohort of 500 patients diagnosed with precancerous lesions and conditions at a tertiary care hospital in Central India.

Methods

500 patients with confirmed precancerous oral lesions and conditions were recruited for the study. The Oral Health Impact Profile (OHIP-14) questionnaire, a validated instrument consisting of 14 items, was used to assess the OHRQoL of the participants. The OHIP-14 questionnaire scores were statistically analyzed using appropriate methods.

Results

The majority of the participants were with a mean age of 48 years. The mean OHIP-14 score was calculated to be 45.1, indicating the overall impact of oral health on the quality of life of patients with precancerous lesions and conditions. The individual domains most affected were functional limitations and physical pain.

Conclusion

This study demonstrates that promoting oral health awareness and regular screenings in the community is needed to prevent the progression of oral precancerous conditions and ultimately reduce the burden of oral cancer.

Predictors of Extubation Failure in Very Low Birth Weight Infants at a Tertiary Care Hospital in Al Ain: A Retrospective Study

OBJECTIVES

To identify and analyze the factors leading to extubation failure among very low birth weight infants in a specific tertiary care setting in Al Ain, emphasizing clinical and demographic variables. The study used medical data of Very Low Birth Weight (VLBW) infants admitted to the Neonatal Intensive Care Unit (NICU) from 1st January 2015 to 31st December 2019, and evaluated the incidence and risk factors associated with extubation failure.

METHODS

Data was collected from the hospital's electronic records and tabulated in Excel sheets, with extubation failure defined as reintubation due to deterioration of respiratory condition within seven days post-extubation. The data was collected from the period of 1st January 2015 to 31st December 2019. Inclusion criteria included babies admitted to the NICU with a gestational age of ≤ 32 weeks, or of birth weight ≤1500 grams who were intubated within the first seven days of life. Results were analyzed using SPSS software, version 9.0 (SPSS Inc., Chicago) to determine the risk factors for extubation failure and short-term outcomes.

RESULTS

Gestational age, birth weight, antenatal steroids, mode of delivery, number of Survanta® (beractant intratracheal suspension) doses, Positive End-Expiratory Pressure (PEEP), Mean Airway Pressure (MAP), Mean Arterial Pressure (Blood Pressure (BP)), and Infectious Diseases (ID) (indicated by a positive blood culture) were found to be the key predictors of extubation failure in very low birth weight infants at a tertiary care hospital in Al Ain. The most common reasons for reintubation were FiO2 > 50% (23.53%), followed by Respiratory Acidosis (20.59%). Other factors, including maternal chorioamnionitis, Apgar scores, indication for intubation, caffeine, and pre-and post-extubation laboratory values, comorbidities, and hemoglobin (Hgb), creatinine and sodium levels were found to have no effect on the success of extubations.

CONCLUSIONS

The results of this research indicate that factors such as gestational age, birth weight, prenatal steroid use, delivery method, the quantity of Survanta® doses, PEEP, MAP, MAP (BP), and ID (+ve blood culture) were the primary determinants of unsuccessful extubation in VLBW babies at a tertiary healthcare facility in Al Ain. The predominant cause for needing reintubation was a FiO2 level above 50%, followed by Respiratory Acidosis. Additional ®®investigations are required to validate these findings and pinpoint other potential predictors of extubation failure within this demographic.

Prevalence of Latent Tuberculosis Infection Among Nurses Working in Critical Areas at a Tertiary Care Hospital in Riyadh, Saudi Arabia

Introduction Tuberculosis is a critical health issue worldwide. Most infected persons are asymptomatic and categorized as having a latent tuberculosis infection (LTBI). Healthcare workers (HCWs) are more prone to being infected with tuberculosis and should be enrolled in a screening program for early detection. Objectives The study aims to estimate the prevalence of LTBI among nurses working in critical areas which include adult intensive care units, pediatric intensive care units, emergency departments, oncology departments, dialysis departments, tuberculosis labs, isolation rooms, and cardiac center intensive care units. Methods A record-based cross-sectional survey measured the prevalence of LTBI among nurses working in critical areas at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. We reviewed the occupational health records of all nurses working in critical areas from June 1, 2021, to June 1, 2022. We recorded the data reviewed throughout the year in the Occupational Health Department at PSMMC. We excluded all participants with previously documented positive tuberculin skin test (TST) from the study. We analyzed the sociodemographic data, working years, working location, job title, and TST results. Results We included a total of 771 out of 2025 nurses in this study. Participants were mostly women (88%) and in the 26-35-year age group (67.7%). Most of the participants were originally from the Philippines (66.3%). The overall LTBI prevalence among nurses was 34.5%. The highest prevalence of LTBI was among nurses working in the cardiac intensive care unit (53.5%), and the lowest prevalence was among nurses working in the isolation department (8.9%; p-value <0.0001). Those who worked more in the hospital were significantly more infected with LTBI (p-value <0.04). Conclusion LTBI remains a significant health risk worldwide and in the Middle East as well as among HCWs. This underscores the necessity of comprehensive pre-hiring screening, annual screening, infection control protocols, and active management of HCWs with LTBI.

Prospective assessment of mental and physical health of maternal near-miss women: A low-middle-income country's experience

Background

Traumatic birth experience is an unaddressed arena, especially in Asian women, with several societal stigmas lingering around.

Aim

A study was undertaken to simultaneously assess the post-partum mental and physical health follow-up of maternal near-miss (MNM) women and compare it with women of uneventful deliveries.

Materials and Methods

The prospective cohort study enrolled 88 MNM women (case cohort) and 80 women with an uneventful peri-partum period (control cohort) at the same time. The participants were followed up with Edinburgh Postnatal Depression Scale (EDPS), PTSD Checklist - Civilian Version (PLC-C), and a 36-item short-form-survey form over 6 months after the delivery.

Results

The case group had higher mean EPDS and PLC-C scores, with poor quality of life (QOL) performance, compared to the control group at 6 weeks and 3 months, and 6 months follow-up (P < 0.05). At the sixth-week follow-up visit, the study observed that 28 (31.8%) women from the case group required a psychiatry consultation compared to the control group with only two (2.5%) participants (P < 0.001). At 3 months, an evident difference was noted on various QOL parameters, such as limitations due to physical health and emotional problems, energy fatigue, general health, and health change parameters between the two groups (P < 0.05). The difference persisted at 6-month follow-up as well for limitations due to physical health, energy fatigue, and general health parameters only (P < 0.05).

Conclusion

There is an urgent need for a multi-departmental collaborative approach at the hospital level and policy-making decisions at higher levels for the mental health of Asian women facing MNM events.

An Audit of Preoperative Informed Consent in Surgical Patients at a Tertiary Care Hospital in Lahore, Pakistan

Informed consent plays a crucial role in modern clinical practice, representing a fundamental aspect of patient rights and medical ethics. The purpose of informed consent is to ensure that patients fully comprehend the procedures to which they are providing consent and the recognition that the surgeon is not guilty of battery. Moreover, clinicians safeguard themselves against potential repercussions by documenting the risks adequately conveyed to patients before performing surgery. Therefore, the significance of informed consent cannot be overstated. This survey encompassed patients from various surgical departments who underwent surgery in April 2023 at a tertiary care hospital. For the survey participants above the age of 18 were selected undergoing either emergency or elective surgical procedures. The survey employed a structured questionnaire for interviews, assessing whether patients had given informed consent before surgery. The questionnaire also inquired whether patients received information about the diagnosis, proposed surgical procedure, associated risks, and any available alternative treatment options. Furthermore, patients were asked about the proposed anesthesia type and whether the associated risks were communicated to them before the surgery. A random selection of 50 patients was done for this study, and the process of block randomization was used with the help of a computer app to reduce bias and allow the representation of the various surgical subspecialties present in the tertiary care hospital. No evidence of consent being taken was present in two patients(4%) or the document on which the consent was signed was not present in the file. Only 48% of the patients acknowledged that they fully understood the provided information. While 60% of the patients were informed about the type of anesthesia proposed, a mere 8% were provided information regarding anesthesia risks. None of the patients in the emergency setting signed the consent form themselves, regardless of their capability to do so. Conversely, only 24% of the patients in the elective setting signed the consent form themselves. The study revealed that the quality of informed consent signing in this tertiary care hospital is below average. Healthcare professionals, including doctors and staff, need education regarding the importance of informed consent and the patient's right to comprehend any procedure or intervention to which they are subjected. A shift in the paradigm of decision-making about a patient's health needs to emphasize that the patient is the most critical entity in these decisions. The main aim of the study is twofold, primarily we want to analyze the existing method of taking informed consent by comparison with the guidelines and check whether the current practice of informed consent achieves its goal of involving the patients in their treatment. Secondarily, we want to discuss the effect that patient-doctor communication might have on the delivery of the above-mentioned information.

Naturalistic Evaluation of ERAS Bundle Implementation Feasibility in Elective Cesarean Deliveries of Tertiary Care Hospital in a Low-Middle-Income Country

The present study assessed whether applying enhanced recovery after surgery (ERAS) guidelines for cesarean delivery is feasible in the tertiary care setting with an add-on objective to identify barriers to successful implementation. The cross-sectional study included women undergoing elective CS and willing to participate. The study attempted to understand barriers to ERAS implementation through timely interviewing study participants. Sixty-two patients participated in the study. Antenatal and fetal complications were observed in 39(63%) and 32(51%) participants. The study observed that at least 80% of the proposed components could be applied to 71% of the study population. All 15 components could be applied to 7(11.2%) patients, and at least 50% could be applied to 58(94%) patients. The least applied component was minimizing starvation by taking clear liquids until 2 hrs before surgery in 26(42%) patients due to waiting hours outside the operation-theater (OT). When fitness-for-discharge was assessed against the percent components of ERAS implemented, the area under the curve (AUC) value was 0.75, with a specificity value of 95.65% and a positive predictive value of 94.12%. In the postoperative ERAS bundle, fitness-for-discharge on day-two was statistically associated with early and frequent breastfeeding (p = 0.000) and prevention of intra-op hypotension (p = 0.03). In conclusion, the primary barriers to implementing ERAS were resource limitations in the form of single functional OT and limited doctors.

Pattern of Violence Among Healthcare Workers in a Tertiary Care Government Hospital and a Multi-Specialty Private Hospital in Sagar, India: A Cross-Sectional Study

Background Workplace violence in hospitals is an occupational hazard that affects healthcare workers (HCWs) negatively in many aspects and causes deterioration of the doctor-patient relationship, resulting in providence of substandard healthcare. This study was conducted to compare the pattern of violence in a tertiary care government teaching hospital and a multi-specialty private trust hospital in Sagar district, Madhya Pradesh, India. Methodology After ethical clearance of this cross-sectional, observational study, participants (frontline healthcare workers, including doctors and nurses) were asked about the type, frequency, department, and place of violence, etc., along with its perceived causes, solutions, and arrangements made by hospitals for dealing with it using a pretested, semi-structured questionnaire. Data analysis was performed using IBM SPSS Version 26.0 (IBM Corp., Armonk, NY). Categorical variables were described using frequency and percentages, and inferential analysis was conducted using the chi-square/Fisher's exact test. A P-value of <0.05 was considered statistically significant. Results Among the 113 participants, 67 (59.3%) were female, 53 (46.9%) were doctors, and 60 (53.1%) were nurses. The mean age of participants was 30.9±7.3 years. Predominantly verbal, emotional, and physical violence were present in 96.5%, 43.4%, and 6.2% of participants, respectively. Violent incidents against healthcare workers were more frequent in government hospitals as compared to private hospitals. Most healthcare workers (87.6%) tried to resolve violent incidents peacefully, and 1.8% tried to fight back. The most perceived cause of violence in both setups was a lack of morality and literacy among patients and their relatives (i.e., 83.2%), followed by a lack of proper facilities and a lack of trust in healthcare workers. Conclusion Both setups faced a substantial amount of violence. The loopholes in both setups, considering resources, security, and other facilities, are clearly visible, and specific steps must be adopted to protect both systems from violence.

A Case of Acute Catatonia Precipitated by Psychosis Successfully Treated With Lorazepam: A Case Report

Catatonia is a multifaceted neuropsychiatric syndrome characterized by a spectrum of psychomotor disturbances that can severely impact the well-being of affected individuals. It may manifest as a primary psychiatric disorder or be associated with underlying medical, neurological, or psychiatric conditions. This case report details the clinical journey of a 22-year-old male who initially presented with psychotic symptoms and subsequently developed acute catatonia within three days of admission to a tertiary care hospital. The patient was successfully treated with intravenous lorazepam, resulting in a rapid and complete resolution of his catatonic state. This case underscores the intricate relationship between psychosis and catatonia and highlights the efficacy of lorazepam in managing catatonia. Recognition and timely intervention are pivotal for optimal patient outcomes. By shedding light on the importance of early diagnosis, comprehensive evaluation, and targeted treatment for catatonia, this case report adds to the body of knowledge in psychiatric practice. It underscores the need for clinicians to consider catatonia as a potentially reversible condition, particularly in individuals with psychotic disorders, and emphasizes the critical role of lorazepam in its management.

Prevalence and risk factor of anemia among pregnant women admitted in antenatal ward in PBMH Bhubaneswar, Odisha

Background

Anemia is one of the contributing factors for morbidity and mortality during pregnancy in developing country including India, which eventually leads to fetal and maternal consequences. Growing fetus depends completely on mothers for all its growth and maturity. Anemia is one of the nutritional deficiency disorders and around 56% of women are suffering from anemia in India. It is one of the reasons for maternal deaths and fetal complication during pregnancy.

Aim

The aim of the study was to assess the prevalence of anemia and to determine the risk factors of anemia among pregnant women in PBMH hospital, Bhubaneswar, Odisha.

Materials and Methods

A descriptive cross-sectional study was conducted over a period of 1 month from October 11, 2022, to November 11, 2022, from the Department of Obstetrics and Gynecology of Pradyumna Bal Memorial Hospital KIMS, Bhubaneswar. A total sample comprised of 52 pregnant women who were interviewed by using self-structured questionnaire for data collection and classification of anemia was performed according to the Indian Council of Medical Research (ICMR) criteria.

Results

A total of 52 antenatal mothers were admitted during this study period (October 11, 2022, to November 11, 2022), and all were selected as study sample. The incidence of anemia among antenatal mother in PBM hospital was found as follows: 17 (33%) mild, 04 (07%) moderate, and 02 (04%) were severe in this present study. The most common indication of anemia among antenatal mother as per the present study was found to be H/O infection (21%), chronic malaria (15%), hook worm (27%), and birth interval (42%).

Conclusion

The study implies that the prevalence rate of Anemia is high, that is, 44.2%. Spacing between pregnancy and H/O infection plays a significant role in considering anemia in pregnant women, which eventually affects both maternal and fetal condition.

Antibiotic Utilization and Prophylaxis in Paediatric Cardiac Surgery: A Retrospective Observational Study at a Rural Tertiary Care Hospital in India

Introduction Antimicrobial prophylaxis, involving short antibiotic courses preceding surgical procedures, is recommended to minimize postoperative infections. Paediatric cardiac surgeries are classified as clean procedures, though infection challenges persist due to illness severity and extended ICU stays. Antimicrobial prophylaxis varies, ranging from single doses to extended administration until catheters are removed. Typically lasting 24 to 48 hours, it has proven infection-reduction benefits. Despite these practices, uncertainties surround the optimal nature, timing, and duration of administration. This concern is amplified by escalating antimicrobial resistance driven by antibiotic overuse. Vulnerable paediatric populations bear heightened consequences of irrational antimicrobial use, contributing to global resistance trends. Yet, a defined optimal prophylaxis schedule for paediatric cardiac surgery is lacking. Importing adult guidelines may be inadequate due to paediatric research complexities and population diversity. Developing effective prophylaxis protocols is crucial for children undergoing cardiac surgery, given global antibiotic overuse and evolving drug resistance. Establishing an optimal prophylactic strategy remains a challenge, necessitating further research for evidence-based protocols to mitigate infections in this vulnerable patient cohort. Methods This study investigates antibiotic use in paediatric cardiac surgery. A retrospective analysis of 100 patients from a rural Indian hospital (2017-2018) assesses antibiotic patterns, including type, dose, duration, and adherence to prophylaxis protocols. Results In the studied cohort of paediatric cardiac surgery patients, complete compliance (100%) with antibiotic prophylaxis was observed. However, deviations were identified: 30% received antibiotics prematurely, and 30% did not align with institutional protocol criteria. Concerning antibiotic selection, 87% followed hospital policy with the recommended cefoperazone and sulbactam combination plus amikacin, while 9% received piperacillin/tazobactam + amikacin due to sepsis. Irregular use (22%) based on clinical records occurred. Furthermore, 4% received piperacillin/tazobactam + teicoplanin, with one instance of inappropriate higher antibiotic use. Regarding prophylaxis duration, only 27% adhered to the appropriate timeline, with 40% exceeding 48 hours, indicating extended use. Upon discharge, a notable proportion (45 patients) received antibiotic prescriptions. Among them, 73% were prescribed rationally, while 27% exhibited irrational antibiotic use. Conclusion The findings of this study shed a significant light on the issue of antibiotic misuse within the context of paediatric cardiac surgery. It underscores the pressing need for more stringent measures to regulate and address this concerning trend. The study underscores the pivotal importance of adhering rigorously to established protocols and guidelines for antibiotic prophylaxis. This adherence not only holds the potential to elevate the overall quality of patient care but also plays a critical role in combating the escalating challenge of antibiotic resistance. Through a concerted effort to optimize antibiotic usage, we can simultaneously enhance patient outcomes and contribute to the ongoing fight against the emergence of antibiotic-resistant strains, thus preserving the efficacy of these vital medications for future generations.

Clinico-Demographic Profile and Factors Affecting Duration of Hospital Stay Among Burn Patients in an Emergency Department of a Tertiary Care Center, South India: A Hospital-Based Cross-Sectional Study

Background Burns continue to be a serious public health problem in India. It persists as an endemic disease in spite of implementing various preventive measures at the individual and community levels. Etiology and factors influencing burns are varied. There is a paucity of data regarding the clinico-demographic profile of burns disease, especially from emergency tertiary care settings in India. Objective To assess the proportion of burn patients having longer hospital stays (>1 week) and the influence of clinico-demographic factors associated with it among the burn patients presenting to the emergency department of a tertiary care institute in south India. Methodology An institution-based cross-sectional analytical study was conducted among burns patients attending the Emergency Medicine Department (EMD) of a tertiary care center between January 2017 and December 2017. Information on clinico-demographic profile and duration of hospital stay were captured using semi-structured data collection proforma. Results All the 327 burns injury patients who presented to our EMD during the study period were included. Among the 327 patients, 259 (79%) were admitted to the EMD. Among 259 admitted patients, 142 (55%) patients were discharged home. Among these 142 patients, 106 (74.6%; 95%CI 66.8-81.2) had longer hospital stays (more than one week). Female gender and facial/inhalational burns were found to have an independent effect on the length of hospital stay even after adjusted analysis. Conclusion Length of hospital stay is independently influenced by female gender and facial/inhalational burns. This study also identified the need for better home safety, child-proofing, proper pre-hospital care, and dedicated burns units in the community.

Postpartum Depression at a Tertiary Care Hospital in Saudi Arabia: Prevalence and Associated Factors

Objectives Postpartum depression (PPD) is a significant health concern associated with several risk factors. This study aims to assess the prevalence of PPD and its related factors in a tertiary care hospital in Riyadh, Saudi Arabia, specifically King Khalid University Hospital (KKUH). Methods A cross-sectional study was conducted of 187 females aged 18 to 50 years old who gave birth at KKUH. Data were collected from the same participants at two stages using the same questionnaire, which consisted of the Edinburgh Postnatal Depression Scale (EPDS) and demographic questions. In the first stage, the participants were selected randomly. The second stage included participants who scored less than 9 on the EPDS in the first stage and were asked to retake the questionnaire four weeks later. Results The prevalence of PPD found in this study was 50.3%, which is higher than in other studies that have been conducted in the country. Furthermore, factors such as sleep disturbances (p = 0.005), loss of interest in daily activities (p = 0.031), mood swings (p = 0.021), frequent bouts of sadness (p < 0.0001), and frustration or worry (p < 0.0001) were all found to significantly increase the risk of PPD. Conclusion This study demonstrates a high prevalence of PPD in women who delivered at KKUH. More studies with a more rigorous methodology are warranted.

Perceived social support among pregnant women attending the antenatal clinic of a tertiary care hospital

BACKGROUND

Social support among pregnant women is identified to have a positive influence on maternal, fetal outcome, personal competence, and self-esteem. This study was conducted with the aim to assess the social support as perceived by pregnant women and to find out the association between perceived social support and sociodemographic, obstetric variables.

MATERIALS AND MATERIALS

After obtaining approval from the Institutional Ethics Committee, a cross-sectional study was carried out among pregnant women attending the Antenatal Clinic of a Tertiary Care Hospital for a period of two months. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to assess social support among study participants.

RESULTS

A total of 111 pregnant women were included. Majority, 98 (88.30%), were educated till High School. Nearly 87 (78.40%) were in the third trimester and 68 (61.30%) were primigravidae. Mean MSPSS score was found to be 5.36 ± 0.83. Majority, 75 (67.60%), had high social support (mean total score of 5.1-7.0). Those engaged in occupation had 2.922 odds for high social support (adjusted odds ratio = 2.92, 95% confidence interval = 0.612-13.95) when compared to housewives (P < 0.05). Women in third trimester had 2.104 odds for high social support, when compared to those in first and second trimesters (adjusted odds ratio = 2.014, 95% confidence interval = 0.715-6.185).

CONCLUSION

Majority scored high on MSPSS. Furthermore, involvement in occupation was found to be a significant predictor of high social support among the study participants.

In meeting the increasing demands for total knee arthroplasty, can we achieve high levels of quality care in a small community hospital? A mixed-methods study

Purpose

Small community hospitals (SCHs) help meet the demand for total knee arthroplasty (TKA). This mixed-methods study compares outcomes and analyses of environmental differences following TKA at a SCH and a tertiary care hospital (TCH).

Methods

Quantitative: A retrospective review of 352 propensity-matched primary TKA procedures at both a SCH and a TCH, based on age, body mass index, and American Society of Anesthesiologists class, was completed. Groups were compared by length of stay (LOS), 90-day emergency department visits, 90-day readmissions, reoperations, and mortality. Qualitative: Based on the Theoretical Domains Framework, seven prospective semistructured interviews were performed. Interview transcripts were coded and belief statements were generated and summarized by two reviewers. Discrepancies were resolved by a third reviewer.

Results

Quantitative: The average LOS for the SCH was significantly shorter than that for the TCH (2.0 ± 0.2 vs. 3.6 ± 2.7 days; p < 0.001), a difference that persisted following a subgroup analysis of ASA I/II patients (2.0 ± 0.2 vs. 3.2 ± 2.2; p < 0.001). There were no significant differences in other outcomes. Qualitative: The main themes that revolved around a higher case load for physiotherapy at the TCH resulted in patients waiting longer to be mobilized after surgery. Patient disposition also affected their discharge rates.

Conclusion

Given the increasing demand for TKA, the SCH represents a viable option to increase capacity, while reducing LOS. Future directions to reduce LOS include addressing social barriers to discharge and patient prioritization for assessment by allied health services. When TKA is performed by the same set of surgeons, the SCH provides quality care with a shorter LOS and comparable with urban hospitals, and this can be attributed to the differences in resource utilization in the two hospital settings.

Pattern of Adverse Drug Reactions among Pregnant Women and Pediatric Patients in a Tertiary Care Hospital

BACKGROUND

Adverse drug reactions (ADRs) among pregnant women and pediatric patients are a significant public health concern. ADRs monitoring and documentation are considered essential practices to decrease the chances of ADRs and ensure the safe use of drugs.

OBJECTIVE

Therefore, the study was designed to evaluate the pattern of adverse drug reactions among pregnant women and pediatric patients in a tertiary care hospital.

METHODS

The study was conducted at Kalpana Chawla Government Medical College and Hospital, Karnal, Haryana, for a period of 2 years. During this period, ADRs reported by the healthcare professionals of gynecology and pediatric department to the ADRs monitoring centre of our institute were included in the study.

RESULTS

Out of 54 total ADRs, 40 ADRs occurred among pregnant women, and 14 ADRs were reported in pediatric patients. The majority of the ADRs were observed in the age group of 21-30 years (pregnant women) and 3-5 years (pediatric patients). Antibiotics were most commonly implicated in ADRs among pregnant women (60%) and pediatric patients (79%). In our study, the dermatological system was mostly affected among pregnant women and pediatric patients. Urticaria, contact dermatitis, and erythematous rash were the most commonly reported ADRs among pregnant women and pediatric patients.

CONCLUSION

Over-prescribing and irrational use of antibiotics make these vulnerable populations more susceptible to ADRs and antibiotic resistance. Therefore, there is a need to create awareness among health care professionals regarding the spontaneous reporting of ADRs for ensuring drug safety and reducing morbidity and mortality among pregnant women and pediatric patients.

Incidence of Healthcare-associated Urinary Tract Infections in Thai Children

BACKGROUND

Urinary tract infection is one of the most common types of healthcare-associated infections. There is currently limited data regarding the incidence and characteristics of healthcare-associated urinary tract infections (HA-UTIs) in children. This study was conducted to determine the incidence of HA-UTIs and their characteristics and associated risk factors.

METHODS

A case-control study was performed from 2016 to 2020 on children under 15 years old who were diagnosed with HA-UTI. Patients who had HA-UTI were compared to non-UTI patients. The incidence rate of HA-UTIs was calculated and reported as events per 1000 patient days. Potential associated risk factors were analyzed using multivariate logistic regression.

RESULTS

Eighty cases and 80 controls were included in the study. The incidence of HA-UTIs was 0.32 events per 1,000 patient days. The median time to UTI was 18 days. The most common causative organism was Escherichia coli (43.2%) and the rates of third-generation cephalosporin resistance and carbapenem resistance were 75.6% and 4.9%, respectively. Longer admission than 7 days (OR = 21.61, 95% CI 6.30-74.11; p < 0.001), neurogenic bladder (OR = 26.24, 95% CI 3.77-182.87; p < 0.001), mechanical ventilation (OR = 3.60, 95% CI 1.23-10.54; p = 0.019), and immunosuppressant (OR = 2.59; 95% CI 1.01-6.60; p = 0.047) were the risk factors significantly associated with HA-UTIs.

CONCLUSIONS

The incidence of HA-UTIs was low in this single-center experience. Identifying patients with the risk factor is imperative to preventing the development of HA-UTIs.

The Prevalence of Low Handgrip Strength and Its Predictors among Outpatient Older Adults in a Tertiary Care Setting: A Cross-Sectional Study

Background: Low muscle strength is linked to several adverse health outcomes. However, there are limited data regarding its prevalence and associated factors in Thai older adults. This study aimed to fill that gap. Methods: This cross-sectional study was conducted with patients aged ≥ 60 years at the outpatient clinic of the internal medicine department of a tertiary care hospital from April 2020 to December 2021. Patient characteristics were collected, and a handgrip dynamometer was used to measure handgrip strength (HGS). Low HGS was defined according to the 2019 recommendations of the Asian Working Group for Sarcopenia. Results: In total, 198 patients were recruited. The prevalence of low HGS was 51%. Median HGS was 17.8 kg and 27.7 kg in women and men, respectively. Every age per year increase, greater number of medications of any type, and lower Montreal Cognitive Assessment (MoCA) score were independent factors associated with low HGS, with adjusted odds ratios of 1.1, 1.2, and 0.9, respectively. Conclusions: Low HGS was prevalent among older patients in this setting, indicating a high degree of possible sarcopenia. As there were some modifiable factors associated with low HGS, routine measurement, medication review, and cognitive evaluation are recommended for early diagnosis and management.

Effectiveness of Cognitive Restructuring on Intensity of Pain in Cancer Patients: A Pilot Study in Oncology Department of Tertiary Care Hospital

Background:

Pain is a most feared symptom among cancer patients. It not only affects physical health but it is a psychological burden and affects overall quality of life in cancer patients. it interferes the activity of daily living and treatment outcome. cognitive restructuring is very useful psychological treatment to reduce pain.

Objectives:

The purpose of the study was to assess level of pain, evaluate effectiveness of cognitive restructuring on intensity of pain and to find association of pain with demographic variables.

Methods:

Quasi experimental study was conducted in oncology department of SKIMS tertiary care hospital. Purposive sampling technique was used to select 22 patients for study group and 22 patients for control group. CBPS and Numerical rating pain scale was used to measure intensity of pain. Data collected by interview method.

Results:

The results showed significant difference p<0.05 at only in anxiety,face and activity on CBPS scores. Mean score of NPRS was 27.27% of moderate pain and severe pain reduced from 63.64 to to 0.% in study group after CR. Results revealed Significant association of pain with age, gender and period of illness.

Conclusion:

Based on findings of the study it is concluded that CR has significant impact in cancer patients on reducing pain and can ease problems related to pain. CR is an appropriate intervention to reduce the symptoms of cancer patients which has indirect impact on cancer treatment.

Antibiotic Use, Incidence and Risk Factors for Orthopedic Surgical Site Infections in a Teaching Hospital in Madhya Pradesh, India

Orthopedic surgeries contribute to the overall surgical site infection (SSI) events worldwide. In India, SSI rates vary considerably (1.6−38%); however, there is a lack of a national SSI surveillance system. This study aims to identify the SSI incidence, risk factors, antibiotic prescription and susceptibility patterns among operated orthopedic patients in a teaching hospital in India. Data for 1205 patients were collected from 2013 to 2016. SSIs were identified based on the European Centre for Disease Prevention and Control guidelines. The American Society for Anesthesiologists classification system was used to predict patients’ operative risk. Univariable and multivariable backward stepwise logistic regressions were performed. Overall, 7.6% of patients developed SSIs over three years. The most common SSIs causative microorganism was Staphylococcus aureus (7%), whose strains were resistant to penicillin (100%), erythromycin (80%), cotrimoxazole (80%), amikacin (60%) and cefoxitin (60%). Amikacin was the most prescribed antibiotic (36%). Male sex (OR 2.64; 95%CI 1.32−5.30), previous hospitalization (OR 2.15; 95%CI 1.25−3.69), antibiotic prescription during hospitalization before perioperative antibiotic prophylaxis (OR 4.19; 95%CI 2.51−7.00) and postoperative length of stay > 15 days (OR 3.30; 95%CI 1.83−5.95) were identified as significant risk factors. Additionally, preoperative shower significantly increased the SSI risk (OR 4.73; 95%CI 2.72−8.22), which is unconfirmed in the literature so far.

Barriers faced by health-care workers in use of personal protective equipment during COVID pandemic at tertiary care hospital Uttarakhand, India: A qualitative study

BACKGROUND

To reduce the likelihood of transmission of infection to health-care workers (HCWs), personal protective equipment is used. However, wearing personal protective equipment (PPE) increases the risk of heat stress and loss of dexterity, leads to poor compliance to PPE. To address the issues of poor compliance to PPE, it was necessary to gain a deeper understanding about the factors that influence compliance. Thus this qualitative study was planned to explore barriers faced by HCWs while using PPE during a pandemic situation in a tertiary care hospital, Uttarakhand, India.

MATERIALS AND METHODS

A exploratory qualitative study was undertaken among health care workers involved in the care of COVID patients. FGDs were done and an unstructured interview guide with open-ended questions was used which helped to explore the factors which can be potential barriers to the HCWs while working wearing PPE.

RESULTS

Organizational and individual factors acting as barriers such as unavailability of essential personal protective equipment, a disharmonious work environment, lack of comfort, inadequate size, and quality of PPE were identified as the major barriers in the present study.

CONCLUSION

Future efforts to optimize PPE use should focus on to adequate supplies both in quality and quantity can help in avoidance of such barriers. Resources should be prioritized with the needs of the HCWs in the times of pandemic. Regular training and feedbacks are necessary for the satisfaction of HCWs and improving PPE compliance.

Resource Utilization and Caring Cost of People Living with Human Immunodeficiency Virus (PLHIV) in Saudi Arabia: A Tertiary Care University Hospital Experience

The human immunodeficiency virus (HIV) is associated with a significant burden of disease, including medical and non-medical costs. Therefore, it is considered to be a priority for all health authorities. The aim of this study is to determine healthcare and treatment costs of caring for PLHIV at one of the tertiary care university hospitals in Riyadh, Saudi Arabia. This was a micro-costing, retrospective, observational study from a tertiary care university hospital and included all confirmed HIV-infected patients who visited infectious disease clinics in the period from 1 January 2015 to 31 December 2018. A total of 42 PLHIV were included in this study. The mean age of the study participants was 38.76 ± 11.47 years with a mean disease duration of 5.27 ± 4.81 years. The majority of patients were male (85.7%) and Saudi (88.1%). More than half of included patients (59.5%) had a CD4 count of more than 500. During the study period, 26 patients (61.9%) were initiated on a single-tablet regimen. Overall, the main cost-driver was antiretroviral medications, which cumulatively represented more than 64% of the total cost. Patients who developed opportunistic infections had a statistically significant (p = 0.033) higher financial impact, both as a total and on a patient level, than those presented without opportunistic infections. On a patient level, the mean and median costs were higher and statistically significant for those with co-morbidities than those without co-morbidities (p = 0.002). The majority of the economic burden of PLHIV is attributable to antiretroviral therapy use. The healthcare costs of PLHIV can vary greatly, depending on the presenting illness, clinical stage, developed opportunistic infection, co-morbidity, and pharmacological therapy.

Experience from a COVID-19 screening centre of a tertiary care institution: A retrospective hospital-based study

BACKGROUND

The COVID-19 pandemic continues to be a significant public health concern across the whole world, including India. In the absence of any specific treatment or vaccine against COVID-19, the role of efficient testing and reporting has been uncontested so far as the number of cases is rising daily. In order to strengthen the screening activities and to prevent nosocomial infection, facility-based screening centres have been designed and operated at various levels of healthcare, including tertiary care institutions.

METHODS

The present study has been planned with an objective to understand the patient profile and evaluate the functioning of COVID-19 screening OPD (CS-OPD) at a tertiary care hospital. In this hospital-based retrospective study, data from individuals visiting the COVID-19 screening OPD during the period from 17th March 2020 to 31st July 2020 were collected. We documented and analysed relevant demographic, epidemiological and clinical characteristics of the patients.

RESULTS

A total of 10,735 patients visited the COVID-19 screening OPD during the defined study period of which 3652 individuals were tested. The majority of the patients, i.e., 65.67% (7050) were male and in the 15-59 years age group (84.68%). The most common symptoms among patients visiting CS-OPD was cough (9.86%). Of the total, 17.17% (1843) of patients reported to the CS-OPD with a contact history of COVID-19-positive patient. On the other hand, 13.49% (1448) of patients were with either domestic or international travel history. The overall testing rate and positivity rate for CS-OPD during this period were found to be 34.02% and 7.94%, respectively.

CONCLUSION

The clinical, demographic and epidemiological characteristics of patients visiting CS-OPD varied across the study period depending upon the containment and testing strategy. The CS-OPD played a crucial role in preventing nosocomial infection and maintaining non-COVID care at the tertiary care hospital.

Identifying the risk factors for the prevention of hypertensive disorders in pregnancy in a tertiary care hospital: A cross-sectional study

Introduction:

Hypertensive disorders in pregnancy accounts for maternal morbidity and mortality globally.

Aim and Objectives:

We conducted this study to know the demographic profile and risk factors pertaining to lifestyle and behavioral aspects for hypertension among the pregnant women.

Methodology:

It was a hospital-based cross-sectional study. During the routine antenatal checkups, those antenatal cases found hypertensive, were included in the study after taking written consent. A semi-structured questionnaire was prepared and pretested before conducting the actual study. Statistical analysis was done by SPSS (version 17) software. Participants’ sociodemographic characteristics were described using descriptive statistics. Results are presented using graphs, tables, mean, percentages, standard deviation, frequency, and significance.

Results:

We observed that most of the study subjects 110 (48.9%) were educated up to secondary level followed by primary level 47 (20.9%) while 25 (11.1%) of the subjects were illiterate. We also found that 113 (50.2%) of the study subjects consumed additional salt in their diet and 57 (25.3%) of the study subjects had a history of intake of visible fat. Among 225 study subjects, 174 (77.3%) did not consume tobacco in any form. Among the 225 study subjects, 142 (60.9%) did not have a family history of hypertension. It was observed that 121 (53.77%) subjects had normal BMI while 16 (7.11%) subjects were underweight while 51 (22.6%) subjects were pre-obese. A total of 32 (14.22%) subjects were obese class 1 followed by 5 (2.22%) subjects who were obese class 2. It was observed that among 225 study subjects, 155 (68.9%) subjects had mild hypertension while 70 (31.1%) subjects had severe hypertension.

Discussion:

The scarcity of data regarding hypertension in pregnancy in low and middle income countries despite this, a comparatively high prevalence of hypertension in pregnancy was observed due to behavioral risk factors, which is mostly preventable at the primary care level.

Recommendations:

It is possible to prevent PIH by eliminating behavioral risk factors through education and counseling to the pregnant ladies, at the primary care level by family physicians or primary care physicians which will reduce maternal mortality to a great extent.

Retrospective analysis to identify the association of various determinants on birth weight

Objectives:

LBW is the strong determinant of neonatal morbidity and mortality with a global prevalence of nearly 15%. India's prevalence, though not yet established, ranges from 16-30% and influenced by maternal nutritional status, antenatal care and associated maternal morbidity. Hence, the study was aimed to determine the influencing parameters for occurrence of LBW.

Study Design:

A retrospective observational study conducted for all live newborns delivered in a tertiary care centre during the study period of twenty four months.

Methods:

Data from institutional medical record section was recorded on predesigned questionnaire from a total of 1216 newborns.

Results:

The percentage of LBW was found to be 27.55% (335/1216) with a proportion of LBW to NBW babies was approximately 1:3. The occurrence of LBW was significantly higher in babies of anemic mothers (59.39%, P < 0.0001), young mothers (30.39%, P < 0.01), mothers with parity ≥ 3 (35.71%, P < 0.05), those with <3 ANC check-up (56.88%, P < 0.0001) and those with premature delivery (71.57%, P < 0.0001). Maternal anemia (OR 4.7, 95%CI 3.4-6.7, P < 0.001); ANC with <3 visits (OR 2.2, 95%CI 1.4-3.4, P < 0.01) and prematurity (OR 7.6, 95%CI 5.1-11.2, P < 0.0001) were considered as independent risk factor for LBW. Significant association of neonatal complications was found with LBW babies (OR 1.6, 95%CI 1.1-2.5, P < 0.05).

Conclusions:

Inadequate antenatal care, maternal anemia and other maternal illness causing premature delivery are considered critical determinants for LBW and thus associated with high neonatal mortality and morbidity. Continued focus for improving the overall maternal health status would lead to lowering burden of LBW.

Comparison of the extent and prevalence of prescription of potentially inappropriate medications prescribed to geriatric age group residing in old-age homes versus those receiving care from tertiary care hospital using Beers criteria

Context:

Certain medications have higher chances of causing adverse effects in geriatric age group. Evidence is against prescribing these medications to the elderly. A list of such medications is called Beers criteria, which was revised by the American Geriatrics Society in 2015.

Aims:

Using the Beer's list as reference, the researchers intend to find the extent and prevalence of potentially inappropriate medication (PIM) in geriatric population residing in different settings.

Settings and Design:

The researchers analyzed prescription pattern of 200 individuals with age ≥65 years, 100 individuals from old-age homes (OAHs) and 100 individuals from a tertiary care hospital. After collecting data, the researchers tallied each prescription with list of drugs in Beers criteria to find all the possible PIMs in both the groups.

Results:

It was found that the average age of residents of OAHs was significantly higher (P < 0.002) than the corresponding group from a tertiary care hospital. The residents of OAHs were also a receiving significantly higher (P < 0.0001) number of PIM than their counterparts from the tertiary care hospital. The average number of PIMs prescribed to females in OAHs was also significantly higher than those in the other group. About 55% of residents of OAHs received at least one PIM, compared to just 26% in the other group. At least 27% of individuals of OAHs received two or more PIMs, compared to just 2% in a tertiary care hospital. Lorazepam was the most commonly prescribed PIM in OAHs, whereas ranitidine was the most common PIM in a tertiary care hospital. Ibuprofen was the second most common PIM, with 15% of OAHs residents receiving this drug, while none of the patients from a tertiary care hospital received ibuprofen.

Conclusion:

All the results point toward a poor prescription pattern in the residents of OAHs compared to those receiving care from a tertiary care hospital.

Quality of life and factors affecting it in adult cancer patients undergoing cancer chemotherapy in a tertiary care hospital

BACKGROUND

Cancer is the second most common cause of deaths worldwide. Likewise, in India, it is a major health problem, and disease burden is escalating every year. Cancer chemotherapy produces unfavorable effects on the well-being of an individual. Since the past few years, quality of life (QoL) is considered as the main goal of cancer treatment in the survival of a patient.

AIM

This current study aimed to assess the QoL and factors affecting it in adult cancer patients undergoing chemotherapy treatment.

METHODS AND RESULTS

An analytical, cross-sectional study was conducted to achieve the objectives, employing the consecutive sampling method. A total of 120 adult (>19 years) patients were recruited from daycare chemotherapy unit of a tertiary care hospital. The data were collected using patient record form and Functional Assessment of Cancer Therapy-General (FACT-G), a quality of life (QoL) questionnaire. The overall mean score of quality of life (QoL) was 61.933 ± 5.85502. The domains of functional well-being and emotional well-being were most negatively affected after cancer chemotherapy. Education (illiteracy) and occupation (unemployment) were negatively associated with overall quality of life (QoL) of cancer patients on chemotherapy. Adverse drug reactions due to cancer chemotherapy negatively affect the quality of life (QoL) of cancer patients. Education (illiteracy) affects social well-being domain of cancer patients. Working in the government/private sector has a positive impact on functional well-being domain of quality of life (QoL).

CONCLUSION

The study findings suggest an overall low quality of life (QoL) among adult cancer patients undergoing chemotherapy at our setup. It has been identified as a stressful therapy, also affecting both psychological and physical well-being. Poor infrastructure, illiteracy, poverty, and lack of proper treatment facilities at most centres often lead to poor survival outcomes and hence focus has always been on achieving quantity of life rather than quality of life (QoL). This is further complicated due to nonavailability of validated tools in local vernacular, apathy of the treating physicians in the context of QoL aspects and social and cultural factors that are unique to this society. Psycho-oncology needs to become an integral entity of comprehensive cancer care.

Coronary Artery Anomalies in Tetralogy of Fallot Patients Undergoing CT Angiography at a Tertiary Care Hospital

Background

The aim of this study was to determine the frequency of coronary artery anomalies (CAAs) in Tetralogy of Fallot (TOF) patients undergoing computed tomography (CT)-angiography in a tertiary care hospital.

Methodology

In this observational study, we included consecutive TOF patients undergoing CT-angiography without prior history of cardiac surgery or congenital heart disease. CAAs were defined based on either origin or course of the artery.

Results

Out of 441 TOF patients, the prevalence of CCAs was 3.6% (16), of which 13 were below 18 years of age. Anomalous left main artery was observed in six (1.4%) patients, followed by left anterior descending artery and right coronary artery, observed in four (0.9%) patients each, and two (0.5%) patients had a single coronary artery originating from the left coronary cusp with an interarterial course.

Conclusions

CAAs were observed in a significant number (3.6%) of TOF patients. A CT-angiographic assessment before surgical correction would help identify the exact anatomy for better surgical planning to minimize complications.

Impact of Climatic Variations on Drug-induced Skin Reactions in Two Different Regions of India

BACKGROUND

Around 2-3% of hospitalizations have been reported due to dermatological adverse drug reactions. Recent studies suggest that climatic variations affect the skin barrier function and extreme conditions aggravate skin disorders.

OBJECTIVE

The present study was designed to compare the impact of climatic variations on drug-induced skin reactions in the Northern and Eastern regions of India.

METHODS

We performed a one-year retrospective study to evaluate the impact of climatic variations (temperature and humidity) on drug-induced skin reactions in the Eastern (Kalyani, West Bengal) and Northern (Karnal, Haryana) regions. Drug-induced skin reactions were reported month-- wise in both the Eastern and Northern regions. Temperature and humidity levels were also noted month-wise in both regions. The direct correlation between climatic variations and the number of drug reactions were assessed using Pearson's correlation and quadratic regression analysis.

RESULTS AND DISCUSSION

Overall, 99 and 81 dermatological adverse drug reactions were reported in tertiary care hospitals in the Northern and Eastern regions, respectively. During the summer season, the humidity level was found to be low in the Northern region as compared to the Eastern region. During this period, drug-induced skin reactions were reported significantly (p<0.05) more in the Northern region as compared to the Eastern region. Furthermore, quadratic regression analysis revealed that climatic variations contributed to drug reaction variability in the Northern region (68.5%) and Eastern region (23.5%).

CONCLUSION

Therefore, the difference in the prevalence of drug-induced skin reactions may be related to the different climatic conditions among these two regions. Further studies in controlled climatic conditions should be performed for definitive correlations and to look into possible solutions.

Dental services during the COVID-19 pandemic: A tertiary care hospital experience

The Aga Khan University is the largest tertiary care hospital in the biggest metropolis of Pakistan, in this paper six weeks of experience during the COVID‐19 pandemic is shared, we will discuss the measures that were taken to mitigate the spread of COVID‐19 amongst dental health care providers (DHCPS) and provide a neoteric workflow for the provision of safe dental care as dental services move towards normalcy. Furthermore topic such as fit testing, contact tracing, employee health and training are discussed and experience of such measures is shared. It is hoped that till the time new evidence based data is generated these communications may help spread awareness to help setup clinical protocols for other tertiary care settings.

Staff risks stratification in preparation for COVID-19 in a tertiary healthcare facility in Nigeria

Introduction:

this report is a documentation of a staff risk stratification programme, undertaken in University of Benin Teaching Hospital, with outcomes, and the actions taken to protect staff.

Methods:

an adapted risk stratification tool was circulated to all staff through their respective heads of departments/units. Staff were expected to voluntary assess their health and risk status in the context of COVID-19, using the tool. A central multi-disciplinary screening committee assessed submissions and invited staff who required further evaluation for physical interviews. Respondents were categorized into three risk/exposure groups from lowest to highest - A, B, and C, based on their individual health assessments, occupational exposures, and information obtained from direct interviews.

Results:

the committee received submissions from 746 staff, representing 19.4% (about a fifth) of the hospital’s 3,840 staff. One hundred and twenty two of these were invited for physical interviews, of whom 88 (72.1%) were categorized as high risk (Category C): pregnancy (53.4%); bronchial asthma (19.3%); hypertension (11.4%); cancer (3.4%) and sickle cell disease (2.3%); fractures and pulmonary tuberculosis (1%, respectively). These staff were recommended for redeployment from areas of high risk exposure to COVID-19.

Conclusion:

a management-driven risk assessment of hospital staff in preparation for the COVID-19 pandemic revealed that a fifth of staff assessed themselves as being vulnerable to adverse outcomes from exposure. It is our hope that similar risk stratification programmes will become standard practice in healthcare facilities during disease outbreaks, especially in Africa.

An epidemiological study of laboratory confirmed COVID-19 cases admitted in a tertiary care hospital of Pune, Maharashtra

Background

India has reported more than 70,000 cases and 2000 deaths. Pune is the second city in the Maharashtra state after Mumbai to breach the 1000 cases. Total deaths reported from Pune were 158 with a mortality of 5.7%. To plan health services, it is important to learn lessons from early stage of the outbreak on course of the disease in a hospital setting.

Objectives

To describe the epidemiological characteristics of the outbreak of COVID-19 in India from a tertiary care hospital.

Methods

This was a hospital-based cross-sectional study which included all admitted laboratory confirmed COVID19 cases from March 31, to April 24, 2020. The information was collected in a predesigned pro forma which included sociodemographic data, duration of stay, family background, outcome, etc., by trained staff after ethics approval. Epi Info7 was used for data analysis.

Results

Out of the total 197 cases, majority cases were between the ages of 31-60 years with slight male preponderance. Majority of these cases were from the slums. Breathlessness was the main presenting symptom followed by fever and cough. More than 1/5^th of patients were asymptomatic from exposure to admission. The case fatality rate among the admitted cases was 29.4%. Comorbidity was one of the significant risk factors for the progression of disease and death (odds ratio [OR] = 16.8, 95% confidence interval [CI] = 7.0 - 40.1, P < 0.0001).

Conclusion

Mortality was higher than the national average of 3.2%; comorbidity was associated with bad prognosis.

Dosing errors in total parenteral nutrition prescriptions at a specialized cancer care hospital of Lahore: The role of clinical pharmacist

STUDY OBJECTIVE

To determine the role of pharmacist in identifying the frequency of errors in total parenteral nutrition prescriptions in cancer patients for the years 2015 and 2016. Total parenteral nutrition has a high potential for medical errors because of its complex composition, thus leading to severe complications. Pharmacist review of the prescriptions reduces the risk of inappropriate prescribing, preparation, and administration of parenteral nutrition.

METHODOLOGY

An observational study was performed by collecting data of total parenteral nutrition prescriptions of 71 patients for the last two years from Pharmacy Department of specialized cancer care hospital.

RESULTS

It was found that the frequency of dosing errors and incomplete prescriptions was higher in 2015 compared to 2016. Additionally, the frequency of macro and micronutrients dosing errors were higher in adults (23.4% and 66.2%) compared to pediatrics (14.6% and 46.6%). Furthermore, the frequency of illegible prescriptions was higher (5.03%) in year 2016 as compared to year 2015 (1.64%). Nevertheless, such dose interventions improved patient's weight (20%) and promoted enteral feeding (42.3%). Major complication was hypophosphatemia (39.4%) followed by hyperglycemia (10%) and catheter-induced infection, i.e. sepsis (4.2%).

CONCLUSION

In conclusion, data suggested that pharmacist played instrumental role in identifying and rectifying total parenteral nutrition dosing errors for both micronutrients and macronutrients-with higher frequency in 2015 compared to 2016, leading to improvements in total parenteral nutrition-related complications and switches to enteral feeding.

Active surveillance of adverse events following immunization (AEFI): a prospective 3-year vaccine safety study

BACKGROUND

Vaccines used in national immunization programs are considered safe and effective but immunization safety has become as important as the efficacy of vaccination programs. The objective of the study was to detect adverse events following immunization (AEFIs) to all vaccines administered to a pediatric population in India.

METHODS

The prospective active vaccine safety surveillance study enrolled eligible children in the age group 0-5 years receiving vaccination from the immunization center at JSS Hospital, Mysuru. Study participants were monitored at the site for 30 min following vaccination and a telephonic survey was made after 8 days to identify all AEFIs. Causality assessment of the AEFIs were done using a new algorithm developed by the safety and vigilance department of the World Health Organization.

RESULTS

The incidence of reported AEFIs was 13.7%. The most frequently reported AEFI was fever (n = 3095, 93.2%) with an incidence of 109.7 per 1000 doses of vaccine administered, followed by persistent crying (n = 69, 2.4 per 1000 doses of vaccine) and diarrhea (n = 57, 2.0 per 1000 doses of vaccine). The majorly implicated vaccine for AEFIs was Pentavac® followed by BCG. Consistent causal association to immunization was observed in 93.4% of cases.

CONCLUSIONS

A high incidence rate of AEFI was observed in our study population when compared with previous published studies. AEFI surveillance studies help to detect changes in the frequency of adverse events, which may be an alert to consider vaccine quality or identify a specific risk among the local population.

Reasons for obstetric referrals from community facilities to a tertiary obstetric facility: A study from Southern Karnataka

CONTEXT

Pregnancy-related preventable morbidity and mortality remain high in India. Safe delivery services should focus on improving neonatal and maternal outcomes while also enabling a positive childbirth experience. However, high rates of intrapartum obstetric referrals are common.

OBJECTIVE

To describe the timing and the reasons for obstetric referrals to a public tertiary care hospital in Bangalore and characteristics of the referring facilities.

METHODS

We interviewed 320 women who delivered at the tertiary care hospital within a one-month time frame prior to the interview and who originally planned to deliver elsewhere.

RESULTS

Ninety four percent of women in the study reported that the decision to transfer to the tertiary hospital was made after the onset of labour. Referrals were made for medical as well as non-medical reasons. About a third (35%) had to take loans to cover the expenses of childbirth.

CONCLUSIONS

Referrals frequently occurred after the onset of labour. Our data imply that improving obstetric referral protocols will improve the birth experience and reduce the burden on tertiary care facilities and on the women themselves.

Utilization of Emergency Psychiatry Service in a Tertiary Care Centre in North Eastern India: A Retrospective Study

BACKGROUND

In a developing country like India, with a lot of psychosocial stressors and ample stigma toward psychiatry, we studied the sociodemographic pattern of the patients coming to a tertiary care center for emergency psychiatry services and also evaluated the types and pattern of emergency services provided to them. We also assessed the predominant presenting complaints with which patients presented at the emergency department, "reasons for referral" in an emergency by other departments, and types of psychiatric diagnoses in the patients.

SUBJECTS AND METHODS

Data were extracted retrospectively from the general emergency and psychiatry emergency register of Silchar Medical College and Hospital for 1 year and analyzed.

RESULTS

Out of 41,040 patients attending the hospital seeking emergency care, referral rate to the psychiatric emergency was only 2.8%. The commonest presenting complaint of subjects who were referred was "medically unexplained somatic complaints" (47.70%). The main reason for a referral from other departments was "no physical illness was detected" in the patient (38.59%). About 78.8% of the subjects were diagnosed as having a proper psychiatric illness, with the majority presenting with stress-related and somatoform disorders (F40-49) (43.45%).

CONCLUSION

This study highlights various important parameters regarding emergency services being provided and their utilization by the patients attending a psychiatric emergency, which could be helpful for future policies and resource allocation for providing superior quality and cost-effective mental health care to the patients.

Frequency, Awareness, and Symptoms of Chikungunya Among Patients in a Tertiary Care Hospital of Karachi: A Cross-Sectional Study

Background 

Chikungunya fever (CHIKF) is an infectious illness spread by the bite of mosquitoes and caused by an arbovirus known as Chikungunya virus (CHIKV). This disease has become an epidemic in Karachi and various other cities of Pakistan, affecting a large population, especially those from poor, socioeconomically underdeveloped areas. It is proving to be a severe and alarming cause of debility due to its prolonged detrimental effects on the joints. A significant number of cases are reported daily in different hospitals of Karachi, with Civil Hospital being one of the major tertiary care hospitals. The aim of this study is to determine the frequency and symptoms of chikungunya as well as to assess the participants’ awareness about the spread and preventive measures of this disease.

Methods

This is a cross-sectional study that was carried out in Civil Hospital Karachi by approaching patients in the out-patient department (OPD) and the emergency department with complaints of fever and joint pain. All the data was collected via a pre-coded questionnaire during May-June 2017 by taking prior informed verbal consent and were analyzed through Statistical Package for the Social Sciences (SPSS) version 22 software.

Results

The age group most affected by this disease was the 21-30 years range, which represented almost a quarter of the cases (n=83, 32.17%). Majority of the respondents (n=214, 82.95%) had heard of the disease, mainly due to their own prior experience with it (n=100, 38.76%). Lethargy (n=219, 84.88%), difficulty in walking (n=213, 82.56%), and headache (n=209, 81.01%) were the major symptoms reported apart from fever (n=258, 100.00%) and arthralgia (n=258, 100.00%).

Conclusion

CHIKF is proving to be a great threat to people as it impairs their quality of life to a great extent. The recent outbreak of chikungunya has victimized a considerable population of Karachi. This study mainly assessed the severity of the disease and its symptoms as well as the lack of awareness among patients. Proper and effective preventive measures can further help to eradicate this disease on a large scale and prevent future epidemics.

Effectiveness of Tuberculosis Screening Technology in the Initiation of Correct Diagnosis of Pulmonary Tuberculosis at a Tertiary Care Hospital in Thailand: Comparative Analysis of Xpert MTB/RIF Versus Sputum AFB Smear

Pulmonary tuberculosis (PTB) is one of the top 10 causes of mortality worldwide in 2016. Early detection is very important, as it can help early treatment. This study compared 2 separate methods of diagnosing PTB among suspected patients, specifically examining correct diagnosis and the duration of receiving a correct diagnosis. It was carried out in a tertiary care public hospital in Bangkok, Thailand. Ninety patients were randomly assigned to 2 groups, one with the Xpert MTB/RIF ( Mycobacterium tuberculosis/rifampicin) and the other with sputum AFB (acid-fast bacilli) smear. The proportion of correct diagnosis was 90.9% and 83.7% for the Xpert MTB/RIF and the comparison group, respectively. The difference was not statistically significant ( P > .05). However, the time to correct diagnosis in the Xpert MTB/RIF group was significantly shorter than the comparison group (2.23 days). This could lead to early diagnosis and lower transmission rate of PTB cases. Results support the provision of Xpert MTB/RIF as the initial diagnostic test for PTB in Thailand.

Novel human astroviruses in pediatric respiratory samples: A one-year survey in a Swiss tertiary care hospital

Although classical human astroviruses (HAstV) are known to be a leading cause of viral gastroenteritis, the pathogenesis and clinical manifestations of novel HAstV remain largely unknown. There is mounting evidence that, in contrast to classical astroviruses, novel HAstV exhibit tropism for the upper respiratory tract. This one‐year period prevalence screened all available clinical nasopharyngeal swab samples collected from pediatric patients aged ≤5 years for novel and classical HAstV using real‐time reverse transcription polymerase chain reaction. A total of 205 samples were tested; two novel HAstV cases were detected for a prevalence of 1.3%, with viral loads suggesting active upper respiratory tract replication. No classical HAstV was detected.

Prevalence of Rheumatic Diseases in a Tertiary Care Hospital of Karachi

BACKGROUND

Rheumatic diseases are referred to as conditions affecting joints, muscles, ligaments, tendons, and bones. According to a report by World Health Organization, rheumatic and musculoskeletal diseases were labeled as the second most reported cause of disability around the globe. The purpose of this study was to estimate the prevalence of rheumatic diseases in a tertiary care hospital of Karachi; additionally, associations with age groups, gender and comorbidities were obtained as well.

METHODS

A cross-sectional study was conducted at the Orthopedic Out Patient Department (OPD) of Dr. Ruth KM Pfau Civil Hospital, Karachi over a span of three months in 2018 (February till May). All 346 patients were follow-up diagnosed cases in the age range of 11-90 years, divided into groups of adolescents, young adults, adults, and older adults. The subjects were questioned about their symptoms, duration of illness, presence of comorbidities, genetic background and the therapy they are undergoing along with compliance. Simple statistical analysis of frequency was done, whereas chi-square test was applied to study associations with gender, age groups, and comorbidities.

RESULTS

During the study period, a total of 2000 patients visited the orthopedic OPD, 346 of which were diagnosed cases of rheumatic diseases, yielding a prevalence of 17.3%. The mean age of rheumatic patients who partook in the study was 46.15 ± 15.49 (Range: 12 - 84). Osteoarthritis was recorded as the most prevalent condition, followed by non-specific low back pain and rheumatoid arthritis. Osteoarthritis was statistically significant in young adults, adults, and older adults, while non-specific low back pain had significant associations with gender, young adults, and adults. Diabetes was significantly associated with osteoarthritis, non-specific low back pain, shoulder pain syndrome and psoriatic arthritis, while hypertension significantly co-existed with systemic lupus erthematosus.

CONCLUSION

Rheumatic diseases constitute a major disease burden in almost all of the age groups, especially in young patients (18-40 years) within our setup.

Death audit in the neonatal ICU of a tertiary care hospital in Bangladesh: a retrospective chart review

BACKGROUND

Expectant reduction of neonatal mortality and formulation of preventive strategies can only be achieved by analysis of risk factors in a particular setting. This study aimed to document incidence of neonatal death and to analyze the risk factors associated with neonatal death.

METHODS

This retrospective study was carried out in department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU) over a 12-month period from January to December 2015. The newborns that died within 28 d of life were defined as "Cases" and "Control" were the surviving newborn discharged to home as healthy. Two birth weight and gestational age matched controls were taken for each case. Maternal, obstetric, and newborn characteristics were analyzed between both the groups. Data analysis was performed using SPSS version 20.0 (SPSS Inc., Chicago, IL). A probability of < .05 was considered statistically significant. The strength of association was determined by calculating odds ratio and their 95% confidence intervals (CIs).

RESULTS

During the study period, the proportion of death was 9.6% (64/612). Both in Chi-square analysis and in logistic regression analysis, less than four antenatal visits (odds ratio (OR) 2.78; 95% CI: 1.23-6.28, p = .014) and sepsis (OR 2.37; 95% CI: 1.07-5.26, p = .034) were found to be independent risk factors for deaths, whereas LUCS found to be protective for deaths (OR 0.40; 95% CI: 0.19-0.83, p = .015).

CONCLUSION

In conclusion, less than four antenatal visits and presence of sepsis were found to be independent risk factors whereas LUCS protective of newborn death.

Novel and classical human astroviruses in stool and cerebrospinal fluid: comprehensive screening in a tertiary care hospital, Switzerland

Classical human astroviruses (HAstV) are the third most common cause of non-bacterial acute gastroenteritis. Due to the lack of routine molecular assays, novel HAstV are underdiagnosed and the magnitude of their contribution to clinical disease remains unknown. To better understand their prevalence and the susceptible patient profile, we conducted a comprehensive screening of novel and classical HAstV in stool and cerebrospinal fluid (CSF) samples collected for clinical care in a tertiary care hospital using a specially designed rRT-PCR panel for the detection of novel (MLB1-3 and VA1-4) and classical HAstV. Of the 654 stool samples, 20 were positive for HAstV, and the novel (n=10; 3 MLB1, 4 MLB2; 3 VA2) and classical (n=10) serotypes were equally prevalent. None of the 105 CSF samples were positive. Investigating the patient profile, we found a higher prevalence (P=0.0002) of both novel and classical HAstV in pediatric stool samples (3.4% and 3%, respectively) compared with adult stool samples (0.5% and 0.7%, respectively). Furthermore, all novel and classical HAstV-positive pediatric subjects were ≤four years old, demonstrating similar susceptible populations. Forty-five percent of positive patients were immunocompromised (novel: 40%, classical: 50%). A comparison of novel and classical HAstV-positive cases showed a lower viral load for novel HAstV (P=0.0007) with significantly more upper respiratory symptoms (70% of subjects; P=0.02); this observation may suggest a unique pathogenic pathway. This study confirms the clinical and epidemiological relevance of novel HAstV and identifies a target population in which routine screening may yield clinically valuable information.

Inpatient iron deficiency detection and management: how do general physicians and gastroenterologists perform in a tertiary care hospital?

BACKGROUND

Iron deficiency (ID) is often an indicator of underlying pathology. Early detection and treatment avoids long-term morbidity and allows for prompt iron repletion, avoiding ID anaemia (IDA) and the need for blood transfusion.

AIM

To evaluate the management of ID in two internal medicine units (general medical (GM) and gastroenterology (GE)) in a large metropolitan hospital and compare it to international guidelines.

METHODS

All consecutive inpatient admissions in the GM and GE units were retrospectively reviewed until 40 patients in each service were identified with anaemia and/or microcytic hypochromic blood counts. Patient records and electronic discharge summaries were then reviewed to assess the recognition, investigation and management of these abnormalities.

RESULTS

Overall, only 60% (48/80) of the cases of microcytic hypochromic picture and/or anaemia were recognised. Cases were more likely to be detected under the GE unit, 77.5% (31/40) versus 42% (17/40) in GM (P < 0.002). Of the 31 recognised GE cases, 28 (90%) were investigated further with iron studies and/or endoscopic procedures. ID was confirmed in nearly half (5/11) of those tested; however, only 2 of 5 received iron replacement. Among GM patients, only 11 of the 17 recognised cases (64%) were investigated further. Iron studies were performed in all 11, confirming IDA in 4 (36%), all of whom received intravenous iron. A faecal human haemoglobin test was performed in two GM patients and one GE patient.

CONCLUSION

There remains significant room for improvement in the recognition, investigation and management of ID in hospital practice in Australia.

Laboratory diagnosis of Clostridium difficile infection: Comparison of Techlab C. diff Quik Chek Complete, Xpert C. difficile, and multistep algorithmic approach

BACKGROUND

Clostridium difficile is a major pathogen responsible for nosocomial infectious diarrhea. We explored optimal laboratory strategies for diagnosis of C. difficile infection (CDI) in our clinical settings, a 1400-bed tertiary care hospital.

METHODS

Using 191 fresh stool samples from adult patients, we evaluated the performance of Xpert C. difficile (Xpert CD), C. diff Quik Chek Complete (which simultaneously detects glutamate dehydrogenase [GDH] and C. difficile toxins [CDT]), toxigenic culture, and a two-step algorithm composed of GDH/CDT as a screening test and Xpert CD as a confirmatory test.

RESULTS

Clostridium difficile was detected in 35 samples (18.3%), and all isolates were toxigenic strains. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of each assay for detecting CDI were as follows: Quik Chek Complete CDT (45.7%, 100%, 100%, 89.1%), Quik Chek Complete GDH (97.1%, 99.4%, 97.1%, 99.4%), Xpert CD (94.3%, 100%, 100%, 98.7%), and toxigenic culture (91.4%, 100%, 100%, 98.1%). A two-step algorithm performed identically with Xpert CD assay.

CONCLUSION

Our data showed that most C. difficile isolates from adult patients were toxigenic. We demonstrated that a two-step algorithm based on GDH/CDT assay followed by Xpert CD assay as a confirmatory test was rapid, reliable, and cost effective for diagnosis of CDI in an adult patient setting with high prevalence of toxigenic C. difficile.

Estimation of Need for Palliative Care among Noncancer Patients Attending a Tertiary Care Hospital

Context:

Palliative care services, until recently, were mainly restricted to cancer patients with incurable diseases. Hence, evaluative studies of palliative care are sparse in areas other than oncology.

Aims:

To estimate what proportion of patients attending the Departments of Neurology, Cardiology, and Nephrology of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, required palliative care and to identify the palliative care needs of those patients.

Settings and Design:

This was an exploratory descriptive study conducted in the three departments of JIPMER.

Materials and Method:

There was no predetermined sample size for the study. The participants were all adult inpatients and outpatients who were in need of palliative care in the departments of Cardiology, Nephrology, and Neurology on the day of study.

Statistical Analysis:

Percentage distribution was used to analyze the categorical variables such as education, gender, age, patients in need of palliative care, and their needs.

Results:

The study showed that one in ten non-cancer patients in tertiary care hospitals may require palliative care services. Apart from issues in physical domain, a substantial proportion of participants also had issues in the psychological, emotional, and financial domains.

Conclusion:

This study highlights the need for incorporation and initiation of palliative care services in other non-cancer specialties in tertiary care hospitals to ensure holistic management of such cases. Counseling service has also to be rendered as part of palliative care since a good share of the patients had psychological and emotional issues.

Knowledge and perception of off-label drug use amongst prescribing physicians in a tertiary care hospital

INTRODUCTION

Off-label drug use is commonly reported in various disciplines of medicine. Considering the lacunae of studies from prescribers in the Indian subcontinent, the present study was conducted to explore their awareness and views of off-label drug use.

METHODS

A validated questionnaire was administered to interns, junior residents and faculty members who were recruited in the present study of various medical and surgical departments of Subharti Medical College, Meerut, India, a tertiary care teaching hospital. Descriptive statistics was used for analyzing the data.

RESULTS

A total of 59/85 (69%) stated that they have used a drug in an off-label manner mainly [31/85 (36.5%)] related to indications. Nearly half of the study participants (41/85, 48.2%) considered prescribing an off-label drug illegal and only 25/85 (29.3%) participants felt that they had adequate knowledge regarding the use of drugs in off-label manner. Out of the total 70 participants who answered the question related to informing parents/relatives while prescribing an off label drug, only 39/70 (55.7%) answered affirmative. Out of the remaining 31/70 (44.3%) of participants who did not inform about prescribing an off label drug, 9/31 (29%) felt that it was illegal and more than two-third (24/31, 77%) felt their knowledge on off-label drug use was insufficient. Surprisingly, 74/82 (90.2%) participants felt that a drug approved to be used in adults cannot be used in children for the same indication despite not having any alternative in pediatric age group.

CONCLUSION

We found an inadequate knowledge regarding the off-label drug use amongst the prescribers in a tertiary care medical college hospital. Many of the physicians felt such use as illegal and do not inform the patient's relatives about such acts. Considering the legal issues, clearly there exists a need to patch up this lacuna in developing countries like India.

Palliative care consultation versus palliative care unit: which is associated with shorter terminal hospitalization length of stay among patients with cancer?

Hospital length of stay (LoS) may be used to assess end-of-life care aggressiveness and health care delivery efficiency. We describe the terminal hospitalization LoS of patients with cancer managed by a hospital-based palliative care (PC) program comprising a palliative care consultation (PCC) service and an inpatient palliative care unit (PCU). A total of 328 in-hospital cancer deaths were divided into 2 groups. The PCU group included patients admitted by the PC team directly to the PCU. The PCC group included patients admitted by other specialties and referred to the PCC team. The LoS of the PCU group was significantly shorter than that of the PCC group (9.9 [±9.4] vs 17.8 [±19.7] days, respectively; P < .001). Direct terminal hospitalization to PCU is not associated with longer LoS among cancer deaths managed by a hospital-based PC service.

Extent of delay in diagnosis in new smear positive patients of pulmonary tuberculosis attending tertiary care hospital

BACKGROUND

India is the highest tuberculosis (TB) burden country accounting for one-fifth of the global incidence. It is estimated that, annually, 1.9 million cases are from India and about 0.8 million are infectious, new smear, positive pulmonary TB cases. The present study was a cross-sectional study conducted in a tertiary care hospital to determine the extent of delay in diagnosis and initiating the treatment after diagnosis in new smear, positive pulmonary TB patients attending a tertiary care hospital of Haryana during a 1-year period.

METHODS

A total of 204 patients were interviewed after being diagnosed as new sputum, positive TB (NSP-TB) by the treating doctor at the tertiary care hospital and re-interviewed at their home after initiation of anti-TB treatment. Chi-square test and analysis of variance (ANOVA) were used for statistical analysis.

RESULTS

More than half of the study patients delayed their first consultation with a health care system. The mean and median patient delay was 32.97 and 16 days, respectively. Lack of awareness of the disease was the leading cause for the patient delay. The mean duration of delay at peripheral health care provider was 60.46 days. The mean and median delay at tertiary care hospital was 8.35 and 4 days, respectively. Most of the patients delayed for diagnosis as per revised national TB control program (RNTCP) guidelines. The mean total delay in diagnosis was 75.71 days.

CONCLUSIONS

There is an urgent need to scale up the information education communication activities to decrease the patient delay. Doctor at all level of health care need to be actively involved for subjecting the suspects to sputum examination at the earliest possible, as per RNTCP guidelines.