Does internal cardiac massage play a role in ROSC after prolonged CPR ? : Our experience in a tertiary care hospital

AbstractCardiopulmonary resuscitation (CPR) is a life-saving skill involving chest compressions & ventilation to pump oxygenated blood through the vital organs of the body. Among different techniques and devices for chest compression, no single method has been definitively shown to produce the best outcome and hence, direct comparisons between them are not possible. Internal cardiac massage is the manual squeezing of the heart through a surgical incision into the chest cavity, when the chest is already open for cardiac surgery. Unlike the usual cardiac arrest scenarios, internal cardiac massage is employed mostly in cardiothoracic surgical patients and will have more chance for survival and favorable neurologic outcomes across all durations of CPR. We describe two cases of return of spontaneous circulation (ROSC) after prolonged CPR with internal cardiac massage performed in hospital setting.

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Study of prescription pattern of antimicrobials used in post-operative surgical patients in tertiary care hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20212068 ◽

2021 ◽

Vol 10 (6) ◽

pp. 627

Author(s):

Jitendra H. Hotwani ◽

Nishikant H. Madkholkar

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Total Duration ◽

Hospital Setting ◽

Surgical Site Infections ◽

The Body ◽

Brand Names ◽

Surgical Patients ◽

Care Hospital ◽

Prescription Pattern

Background: Antimicrobials are used for prophylaxis and treatment of infections which occur following surgical procedures, to reduce the morbidity and mortality associated with surgical site infections (SSIs). A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. These are infections of the tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure.Methods: A prospective, non-interventional, observational study in tertiary care hospital for duration of 9 months. Sample size was 330.Results: The prescription pattern shows that nitroimidazoles were the most commonly prescribed group of antimicrobials in 72% of patients followed by penicillins (58%) and cephalosporins (42%). Metronidazole (72%), amoxicillin and clavulanic acid (51.21%) ceftriaxone (20.90%) were most commonly prescribed antimicrobials in these groups. Two antimicrobials were prescribed in 47% patients with nitroimidazole and penicillins being the most commonly prescribed combination of antimicrobial. Three antimicrobials were prescribed in 25% patients and four antimicrobials in 8% patients. This shows trend towards polypharmacy. About 82% of antimicrobials were prescribed by brand names and 64% of total antimicrobials prescribed from outside the hospital pharmacy source. About 12.42% of patients changed antimicrobial therapy after culture and sensitivity report.Conclusions: Total duration, number of anti-microbial used was more in clean-contaminated, contaminated, dirty wound surgeries as compare to clean wound surgeries. Our study provides a framework for continuous prescription audit of antimicrobials in a hospital setting and thus can help in rational use of antimicrobials in post-operative surgical patients.

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Prevalence and clinical correlation of hepatitis E virus antibody in the patients’ serum samples from a tertiary care hospital in Thailand during 2015–2018

Virology Journal ◽

10.1186/s12985-021-01616-x ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Atiporn Boonyai ◽

Anchalee Thongput ◽

Thidarat Sisaeng ◽

Parisut Phumchan ◽

Navin Horthongkham ◽

...

Keyword(s):

Pregnant Women ◽

Tertiary Care ◽

Laboratory Data ◽

Organ Transplant ◽

Hospital Setting ◽

Antibody Detection ◽

Enzyme Linked Immunosorbent Assay ◽

Care Hospital ◽

Serum Samples ◽

Igm Antibodies

Abstract Background Prevalence and incidence of hepatitis caused by HEV infection are usually higher in developing countries. This study demonstrated the HEV seroprevalence and incidence of HEV infection in patients with clinical hepatitis in a tertiary hospital in Thailand. Methods A laboratory-based cross-sectional study was conducted using 1106 serum samples from patients suspected of HEV infection sent to the Serology laboratory, Siriraj Hospital, for detecting HEV antibodies during 2015–2018. Prevalence of anti-HEV IgG and IgM antibodies in general patients, including organ transplant recipients and pregnant women in a hospital setting, were determined using indirect enzyme-linked immunosorbent assay (ELISA) kits. Comparison of laboratory data between groups with different HEV serological statuses was performed. Results HEV IgG antibodies were detected in 40.82% of 904 serum samples, while HEV IgM antibodies were detected in 11.75% of 1081 serum samples. Similar IgG and IgM antibody detection rates were found in pregnant women. Interestingly, anti-HEV IgM antibodies were detected in 38.5% of patients who underwent organ transplantation. Patients who tested positive for anti-HEV IgM antibodies had higher alanine aminotransferase levels than those who had not. In contrast, patients who tested positive for anti-HEV IgG had more elevated levels of total bilirubin than those who tested negative. Conclusions HEV seroprevalence and incidence in patients with clinical hepatitis were relatively high in the Thai population, including the pregnancy and organ transplant subgroups. The results potentially benefit the clinicians in decision-making to investigate HEV antibodies and facilitating proper management for patients.

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A RETROSPECTIVE STUDY OF BLOOD TRANSFUSION PRACTICES IN A TERTIARY CARE HOSPITAL OF NORTH INDIA.

10.36106/ijsr/5300991 ◽

2021 ◽

pp. 25-29

Author(s):

Rakesh Kumar Sharma ◽

Shahid Anjum Awan ◽

Vijay Sawhney

Keyword(s):

Blood Transfusion ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Transfusion Practice ◽

Blood Bank ◽

Control Measures ◽

North India ◽

Care Hospital ◽

Important Concern ◽

Life Saving

INTRODUCTION: Blood transfusion is an important concern for the society, as it is life saving for patients with bleeding disorders, accidents, surgeries, inherited/acquired hematological diseases and malignancies. Generally, donors are classied into the following categories: voluntary, family replacement, remunerated or paid donors, and autologous donor. AIMS & OBJECTIVES:To understand the importance of Blood & its safe Transfusion practice in a Teaching Hospital. METHODOLOGY: An Observational study was conducted over a period of 12 months from January 2019 to December 2019 in a 750 –bedded Tertiary Care Hospital of Jammu(UT). OBSERVATIONS: In addition to providing Blood-Transfusion Services to the patients admitted in SMGS Hospital Jammu & Other Associated Hospitals of GMC Jammu, the Blood-Bank is also catering to the needs of Registered Private Nursing Homes & Hospitals of Jammu(UT).This Blood-Bank has exceptionally maintained a record of consuming the whole stock of Blood without wasting even a single pint of blood. DISCUSSION: The Aim of Blood Transfusion Services is to supply good Quality of Blood & its Components to the Patients & avoid any risk to the Donors as well as Recepients. Hence it is extremely essential to institute strict Quality Control Measures RECOMMENDATIONS: Recommended that Upgradation of Blood-Bank is essential to cater with the needs of Additional bed-strength that SMGS Hospital is going to acquire in the coming future.

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Abstract 143: Electrocardiographic Changes Preceding In-Hospital Cardiac Arrests From Pulseless Electrical Activity / Asystole Provide Insights into Underlying Cause and Pathophysiology

Circulation ◽

10.1161/circ.138.suppl_2.143 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Jason J Yang ◽

Duc H Do ◽

Xiao Hu ◽

Noel G Boyle

Keyword(s):

Electrical Activity ◽

Real Time ◽

Tertiary Care ◽

Pulseless Electrical Activity ◽

Spontaneous Circulation ◽

Care Hospital ◽

Right Ventricular Strain ◽

Wave Morphology ◽

Electrocardiographic Changes ◽

Ecg Data

Introduction: Survival from in-hospital cardiac arrests (IHCA) due to pulseless electrical activity (PEA) or asystole remains extremely poor. Our understanding of the pathophysiology of PEA is limited, and management of IHCA largely follows a “one size fits all” approach due to the lack of reliable methods to determine underlying cause in real-time. Hypothesis: Changes on continuous electrocardiogram (ECG) preceding IHCA reflect the underlying cause and pathophysiology of IHCA. Methods: We evaluated adult patients with IHCA from PEA/asystole at a tertiary care hospital between 3/2010 - 8/2014 with at least 3 hours of continuous ECG data preceding IHCA. We determined the likely cause of IHCA by reviewing of clinical, lab, imaging, and autopsy data. We analyzed up to 24 hours of continuous ECG data evaluating for changes in rhythm, PR interval, QRS and ST/T wave morphology leading up to IHCA. Results: Eighty-nine patients were studied (mean age 62 ± 18 years, 54% male). Return of spontaneous circulation was obtained in 65 (73%) and 24 (27%) survived to discharge. We found 5 distinct patterns of ECG changes leading up to and including the arrest rhythm (Table). Causes of cardiac arrest were significantly different between the group (Fischer’s exact p<0.001). Notably, a severe right ventricular strain ECG pattern was found preceding PEA caused by pulmonary embolism, asphyxia from large mucus plugs or massive aspiration, acute respiratory distress syndrome, and cardiogenic shock with biventricular failure. Conclusion: Distinct patterns of changes in rhythm and ECG morphology which reflect different underlying causes and pathophysiology of IHCA were identified. Recognition of these patterns may provide an opportunity for better understanding of PEA mechanisms and outcomes, and allow for real-time prediction of IHCA cause to help direct management.

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A CLINICOEPIDEMIOLOGICAL STUDY ON PAEDERUS DERMATITIS IN A TERTIARY CARE CENTRE, CHENNAI

10.36106/ijsr/9100939 ◽

2021 ◽

pp. 25-27

Author(s):

P. Mohan ◽

P. Revathi Guru ◽

V. Sudha ◽

L. Balamurugan ◽

Pavithra Gunasekaran ◽

...

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Sudden Onset ◽

The Body ◽

Care Hospital ◽

Age Group ◽

Common Condition ◽

Tertiary Care Centre ◽

Linear Lesions ◽

Paederus Dermatitis

Paederus dermatitis is a form of irritant contact dermatitis due to contact with certain insects of the genus Paederus presenting with mostly erythematous linear lesions of sudden onset on exposed parts of the body. To study the clinico epi Aim: demiological features in patients with Paederus dermatitis. A retrospective analysis of clinicoepidemiological Materials & Methods: features of patients affected with Paederus dermatitis who had attended the Dermatology OPD, in a tertiary care hospital between January 2018 to December 2019 was done. All the required data had been collected from the OPD records and details were tabulated and analysed. A total of 56 patients had been affected with Result: Paederus dermatitis during the study period, of which 32 were males and 24 were females. 41out of 56 (73.21%) of patients presented between the months of August and December. Most common age group affected were between 11 to 30 yrs, with front and back of neck being the most common affected sites. In 42 out of the 56 patients the lesions resolved with post inammatory hyperpigmentation. Conclusion: Paederus dermatitis is a common condition that is often misdiagnosed and hence awareness is required for the clinicians and the general public to prevent it.

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A comparative study of impact on cognitive function between diabetic and non-diabetic patients in a tertiary care hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20183021 ◽

2018 ◽

Vol 7 (8) ◽

pp. 1547

Author(s):

Dharnaben A. Patel ◽

Dhruv J. Patel ◽

N. D. Kantharia

Keyword(s):

Cognitive Function ◽

Cognitive Decline ◽

Tertiary Care ◽

The Body ◽

Diabetic Patients ◽

Care Hospital ◽

Proper Understanding ◽

History Of ◽

Control Of Diabetes ◽

The Brain

Background: Diabetes Mellitus is a chronic metabolic disorder characterized by hyperglycemia, polyuria, hyperlipidemia etc, resulting from defects in insulin secretion, insulin action or both. It affects various organs of the body including the brain. Cognitive function is the thinking process of the brain. In any chronic disease evaluation of cognitive function is justified as it may affect various common day to day activities.Methods: It is a prospective, observational and non-interventional study. Thirty diabetic patients who were recently started on insulin i.e. within 7 days were enrolled in the study based on inclusion and exclusion criteria. Thirty non diabetic healthy individuals served as a control. Cognitive function was accessed by Adenbrooke’s Cognitive Examination (ACE III) at the time of enrollment.Results: The results were analysed using paired t-test. Attention, Memory and Visiospatial ability was significantly reduced in diabetic patients compared to control. Verbal fluency and language was also reduced but the change was not significant. Total ACE III score was significantly reduced in diabetic patients compared to control.Conclusions: Cognitive function is significantly reduced in Diabetic patients recently started on insulin. Hyperglycemia could be the possible reason of cognitive decline. Proper understanding of the natural history of Diabetes and the pathogenesis of cognitive decline as well as control of Diabetes can help to prevent development of cognitive dysfunction.

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SONOGRAPHIC MEASUREMENTS OF SCROTAL WALL THICKNESS

10.36106/ijsr/5103971 ◽

2021 ◽

pp. 31-32

Author(s):

Sahil Gandhi ◽

Asit Natekar

Keyword(s):

Wall Thickness ◽

Tertiary Care ◽

The Body ◽

Wall Thickening ◽

Temperature Sensitive ◽

Main Function ◽

Care Hospital ◽

Sperm Production ◽

Time Duration ◽

Anterior Posterior

Main function of scrotum is to hold testes at optimal temperature for spermatogenesis. Sperm production in the testes is a temperature sensitive process. It requires an environment that is 2 to 6°C cooler than the body core. The temperature of the testes is regulated by the scrotal wall. Tunica dartos muscle changes the surface area of the scrotal skin by contracting or relaxing depending on the ambient temperature. This study postulates that if the thickness or the tone of this muscle is more thereby contributing to scrotal wall thickening, it will hamper the thermoregulation and spermatogenesis leading to poor sperm production. This could be an besides varicocoele another cause of male infertility which has been an established cause. This study will help to suspect the patients of infertility caused by thick scrotal wall. This study is aimed to study scrotal wall thickness and with the help of Ultrasonography. to establish norms The study was conducted at department of Radio-diagnosis at the tertiary care hospital, Sangli. The study started after approval of institutional ethical committee. This is a cross sectional observational study for the duration of 4 months. Total number of 50 cases was achieved in this time duration which satised the inclusion criteria. Statistical method used was Student's T test. Scrotal ultrasonography was performed using linear and curvilinear probe with sta (5-12 MHz) (2-5 MHz) on Philips Afniti50, after ndoff pad allowing some time for the dartos muscle to relax and scrotal wall thickness is measured on either side on three surfaces (anterior, posterior and lateral) and means were obtained. This study found that there was no difference between anterior, posterior, lateral wall thicknesses on ipsilateral side or contralateral side. There is no need to take three different wall thicknesses and convenience and suitability of any scrotal wall thickness would be equally effective.

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Possibility of transmission of severe acute respiratory syndrome coronavirus 2 in a tertiary care hospital setting: A case study

Infection Prevention in Practice ◽

10.1016/j.infpip.2020.100079 ◽

2020 ◽

Vol 2 (3) ◽

pp. 100079

Author(s):

Shinichiro Morioka ◽

Keiji Nakamura ◽

Shun Iida ◽

Satoshi Kutsuna ◽

Noriko Kinoshita ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Hospital Setting ◽

Care Hospital

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Outcome of Internal Fixation of Metacarpal Fractures of Hand at a Tertiary Care Hospital, Kathmandu

Nepal Medical College Journal ◽

10.3126/nmcj.v21i1.24848 ◽

2019 ◽

Vol 21 (1) ◽

pp. 35-39

Author(s):

Praphulla Shrestha ◽

SR Paudel ◽

P Chalise

Keyword(s):

Pain Relief ◽

Internal Fixation ◽

Tertiary Care ◽

Kirschner Wire ◽

The Body ◽

Care Hospital ◽

Metacarpal Fractures ◽

Active Flexion ◽

Hand Fractures

Hand fractures are different from other fractures elsewhere in the body. Functional impairment of hand leads to a prominent issue to the patient. We have a common practice of treatment of hand fractures by using kirschner wire(s). The internal fixation using plates and screws for metacarpal fractures of the hand is technically demanding but it is beneficial to the patients as it permits early mobilization and better pain relief. We studied the outcome of this type of internal fixation of the metacarpal fractures at Nepal Medical College. We included 26 patients above 18years with isolated extraarticular, closed and open Swanson I metacarpal fractures of the hand. Fractures with rotation of the digit and unacceptable angulation, shortening and unstable fractures were included. Pain was evaluated by visual analogue scale and function using American Society for Surgery of hand Total Active Flexion (ASSHTAF) score. The mean pain score (VAS) was 0.27 at 12 weeks. The ASSHTAF score showed excellent results in 92.3% patients at 12 weeks. At the final follow up 92.3% patients had excellent results, 3.8% had good and 3.8% had poor results. Fracture union was seen in all patients at final follow up. The study shows that internal fixation of unstable metacarpal fractures gives significant pain relief to the patient and an excellent functional outcome.

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FACTORS ASSOCIATED WITH SEVERITY OF ILLNESS IN PATIENTS WITH DENGUE FEVER IN A TERTIARY CARE HOSPITAL IN SOUTHERN INDIA

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i3.23496 ◽

2018 ◽

Vol 11 (3) ◽

pp. 272

Author(s):

Melissa Sherrel Pereira ◽

Chandrashekar Udyavara Kudru ◽

Sreedharan Nair ◽

Girish Thunga ◽

Vijayanarayana Kunhikatta ◽

...

Keyword(s):

Tertiary Care Hospital ◽

Univariate Analysis ◽

Tertiary Care ◽

Elevated Serum ◽

Hospital Setting ◽

Severity Of Illness ◽

Southern India ◽

Severe Dengue ◽

Care Hospital ◽

Factors Associated

Objective: Denguefeveris one of the important tropical disease of public health significance caused by flavivirus. It is a major cause of morbidity and mortality worldwide. Identification of factors associated with severity of dengue can improve the prognosis of the disease.This study tried toassess the factors associated with severity of dengue.Methods: A record based study was conducted in a tertiary care hospital setting in southern India. A total of 550 case files were reviewed to ascertain demographic, clinical and laboratory parameters among confirmed cases of dengue. The severity of dengue was categorized using WHO 2009 classification.Results: Of 550 records reviewed, 449 (81.6%) were classified as non-severe dengue and 101 (18.4%) as severe dengue. Factors associated with severe dengue on univariate analysis were: gender, backache, skin rash, nausea and vomiting, abdominal distension, haemorrhage, breathlessness, oliguria, hepatomegaly, splenomegaly, ascites, leukopenia, hypoproteinemia, and elevated serum alanine transaminase (ALT) >63 IU/L.On multivariate analysis,haemorrhage (OR=11.75, 95%; CI=6.38-21.62), oliguria (OR=4.01, 95%; CI=1.32-12.15), ascites (OR=2.68, 95%; CI=1.19-6.01), ALT>63 IU/L (OR=1.77, 95%; CI=1.01-3.1) and hypoproteinemia (OR=5.57, 95%; CI=2.82-10.98) were found to have significant association with the development of severe dengue.Conclusion: This study indicates thatwhen dengue patients present with bleeding episodes, ascites, oliguria,raised ALT and low serum protein levels, clinicians should be alert to the appearance of severe complications. Early identification of these factors will help clinicians to recognise the severity of dengue illness and enable them to implement appropriate interventions.

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