scholarly journals Surgical Diseases Management during COVID-19 Crisis at a Tertiary Care Hospital of India: Our Institutional Strategy

2021 ◽  
Vol 07 (04) ◽  
pp. e366-e373
Author(s):  
Sudhir Kumar Singh ◽  
Amit Gupta ◽  
Harindra Sandhu ◽  
Rishit Mani ◽  
Jyoti Sharma ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Tertiary Care Hospital ◽  
Multiorgan Failure ◽  
Operative Procedure ◽  
Tertiary Care ◽  
Surgical Care ◽  
Care Hospital ◽  
Advanced Malignancy ◽  
Number Of Patients ◽  
Surgical Conditions

Abstract Introduction In response to the national coronavirus disease 2019 (COVID-19) pandemic, all hospitals and medical institutes gave priority to COVID-19 screening and to the management of patients who required hospitalization for COVID-19 infection. Surgical departments postponed all elective operative procedures and provided only essential surgical care to patients who presented with acute surgical conditions or suspected malignancy. Ample literature has emerged during this pandemic regarding the guidelines for safe surgical care. We report our experience during the lockdown period including the surgical procedures performed, the perioperative care provided, and the specific precautions implemented in response to the COVID-19 crisis. Materials and Methods We extracted patient clinical data from the medical records of all surgical patients admitted to our tertiary care hospital between the March 24th, 2020 and May 31st, 2020. Data collected included: patient demographics, surgical diagnoses, surgical procedures, nonoperative management, and patient outcomes. Results Seventy-seven patients were included in this report: 23 patients were managed medically, 28 patients underwent a radiologic intervention, and 23 patients required an operative procedure. In total eight of the 77 patients died due to ongoing sepsis, multiorgan failure, or advanced malignancy. Conclusion During the COVID-19 lockdown period, our surgical team performed many lifesaving surgical procedures and appropriately selected cancer operations. We implemented and standardized essential perioperative measures to reduce the spread of COVID-19 infection. When the lockdown measures were phased out a large number of patients remained in need of delayed elective and semi-elective operative treatment. Hospitals, medical institutes, and surgical leadership must adjust their priorities, foster stewardship of limited surgical care resources, and rapidly implement effective strategies to assure perioperative safety for both patients and operating room staff during periods of crisis.

First and second wave of COVID-19: A comparative study of tertiary care hospitalized patients in Jalgaon, Maharashtra

2021 ◽  
Vol 19 (3) ◽  
pp. 23-29
Author(s):  
Yogita G Bavaskar ◽  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical History ◽  
Care Hospital ◽  
Age Group ◽  
Number Of Patients ◽  
The Mean ◽  
Collection Form ◽  
Time Of Admission ◽  
Second Wave

Background: Most of the countries including India have witnessed two or more waves of Covid 19 pandemic. The present study was conducted to compare the differences in clinico-demographic characteristics and outcomes of Covid 19 patients admitted in first and second wave of Covid 19 pandemic in a tertiary care hospital at Jalgaon, Maharashtra. Methods: A retrospective observational study was conducted at a tertiary care Dedicated Covid hospital for Covid 19 at Jalgaon, Maharashtra. All microbiologically proven corona positive patients were included in the study. The demographic records and clinical history was extracted from the case history sheets of the patients from first as well as second wave using standardized data collection form. Clinical outcome of the patients, i.e., development of complications, death or discharge was also recorded for each enrolled subject. Results: 3845 patients of Covid-19 admitted in the hospital during the first wave of epidemic and 2956 patients during second wave of the epidemic were included in the study. The mean age of patients admitted in the second wave was significantly lower as compared to first [48.77(15.31) years vs 50.23 (14.33) years, P<0.005]. There is increase in proportion of patients in the age group of < 15 years in second wave as compared to first wave (74/2956, 2.5% vs 52/3845, 1.3%). The number of patients requiring admission in ICU at the time of admission increased by 13% in second wave as compared to first wave. [827/2956 (28%) vs 577/3845(15%), P<0.0001]. More than half of the patients who got admitted for Covid 19 in first as well as second wave were having one or more comorbidities.But the proportion of the patients with previous co-morbities was significantly higher in second wave (1684/2956, 57% vs 1960/ 3845, 51%, P= 0.0004). The mortality was also higher in second wave (533/2956, 18.03% vs 541/3845, 14%, P=0.0004). Conclusions: The demographic, clinical characteristics and outcome of Covid 19 patients was different in first and second wave of pandemic with involvement of younger patients, increased rates of admission to ICU and more mortality in the second wave as compared to first wave of the pandemic.

scholarly journals Management Strategy of Patients Attending at Epilepsy Clinic in a Tertiary Care Hospital of Bangladesh

2020 ◽  
Vol 6 (1) ◽  
pp. 3-8
Author(s):  
Mohammad Sayeed Hassan ◽  
Md Shafikul Islam Khan ◽  
Paritosh Kumar Sarkar ◽  
Anwar Israil ◽  
Ferdous Ara ◽  
...  
Keyword(s):  
Partial Seizure ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Partial Epilepsy ◽  
Absence Seizure ◽  
Care Hospital ◽  
Cross Sectional ◽  
Tonic Seizure ◽  
Number Of Patients ◽  
Generalized Epilepsy

Background: Epilepsy is a neuronal disorder that is observed globally but still it is not explored very well in most parts of the world. Objective: The aim of our study was to determine the types of epilepsies along with their treatment strategies among patients attending the outdoor epilepsy clinic in a referral tertiary care hospital. Methodology: This cross sectional study was carried out from the records of weekly epilepsy clinic of Department of Neurology at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from January 2018 to August 2019. Data were collected through a predesigned questionnaire containing information about demography, clinical features, EEG and imaging findings and treatment of patients. Results: A total number of 1832 patients were recruited. There was a male (55.3%) and urban (61.1%) predominance. Most (75.1%) of the patients were young (age range from 10 to 29 years). A large number of patients were student (44.4%) and 24.2% were unemployed. The duration of epilepsy in most patients were less than 5 years (40.7%). 58.3% patients took various forms of indigenous treatment prior to attending this clinic. 54.7% patients had no comorbid illness. EEG was abnormal in 34.5% patients of which 24.4% had focal abnormality and 10.1% had generalized epileptic discharge. In brain imaging (CT/MRI) only 16.4% showed abnormal findings. 49.5% patients were suffering from generalized epilepsy whereas 44.6% had partial epilepsy. Among the generalized epilepsy group, most of them had generalized tonic clonic seizure (GTCS) (75.4%), while 8.9% had absence seizure and 7.9% had tonic seizure. In partial epilepsy group, the majority were secondary generalized seizure (74.7%), followed by complex partial seizure (CPS) (18.7%) and simple partial seizure (6.6%).42.7% patients got single antiepileptic drug whereas 37.4% patients received dual drug. Polytherapy (three or more drugs) were prescribed in 14% patients. Valproic acid was the highest prescribed drug (29.3%) either as monotherapy or in combination. Carbamazepine (27.4%) was the second common drug followed by Levetiracetam (15.1%). Conclusion: Epilepsy affects almost all groups of the society. Most of the patients remain seizure-free with judicious anti-epileptic drugs. Therefore, more effort is needed for early accurate diagnosis and appropriate treatment of epilepsy Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 3-8

scholarly journals An Audit of Rational Use of Antibiotics in a Tertiary Hospital

2014 ◽  
Vol 2 (2) ◽  
pp. 64-67 ◽  
Author(s):  
Tanzima Begum ◽  
Md Ismail Khan ◽  
Shamima Kawser ◽  
Md Ehsanul Huq ◽  
Nadira Majid ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
Number Of Patients ◽  
Rational Use Of Antibiotics

Background: Drug can cure ailment when used rationally on the other hand they may become harmful or even may threaten a life when used irrationally. Absence of guidelines for antibiotic use, protocols for rational therapeutics and infection control committees, have led to overuse and misuse of antimicrobials even in different specialized units in hospitals. Objective: The study has been designed to get a picture of use of antibiotics in a tertiary care hospital of Bangladesh. Materials and method: Cross sectional study was conducted in the department of Medicine of Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, for 3 months from 1st January 2009 to 31st March 2009. Admitted patients of Medicine unit-1 who got antibiotics were included in the study. Total number of patients was 1563. Results: Five hundred out of 1563 patients were prescribed antibiotics (38%). Out of 500 prescriptions, 68(14%) prescriptions were found irrational. Conclusion: Continuous surveillance should be carried out to reduce the irrational use of antibiotics. DOI: http://dx.doi.org/10.3329/dmcj.v2i2.20526 Delta Med Col J. Jul 2014; 2(2): 64-67

Barriers to Accessing Surgical Care: A Cross-Sectional Survey Conducted at a Tertiary Care Hospital in Karachi, Pakistan

2013 ◽  
Vol 37 (10) ◽  
pp. 2313-2321 ◽  
Author(s):  
Lubna Samad ◽  
Fayez Jawed ◽  
Sana Zehra Sajun ◽  
Mohammad Hussham Arshad ◽  
Naila Baig-Ansari
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Care ◽  
Care Hospital ◽  
Cross Sectional Survey ◽  
Cross Sectional

scholarly journals Safety of elective abdominal and vascular surgery during the COVID-19 pandemic: a retrospective single-center study

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Sven Flemming ◽  
Mohammed K. Hankir ◽  
Simon Kusan ◽  
Manuel Krone ◽  
Friedrich Anger ◽  
...  
Keyword(s):  
Screening Program ◽  
Tertiary Care ◽  
Surgical Care ◽  
Care Hospital ◽  
High Quality ◽  
Surgical Department ◽  
Number Of Patients ◽  
Single Center Study ◽  
Study Population ◽  
Lower Franconia

Abstract Background Patients with coronavirus disease 2019 (COVID-19) who undergo surgery have impaired postoperative outcomes and increased mortality. Consequently, elective and semi-urgent operations on the increasing number of patients severely affected by COVID-19 have been indefinitely postponed.in many countries with unclear implications on disease progression and overall survival. The purpose of this study was to evaluate whether the establishment of a standardized screening program for acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is sufficient to ensure high-quality medical and surgical treatment of COVID-19 and non-COVID-19 patients while minimizing in-hospital SARS-CoV-2 transmission. Methods The screening program comprised polymerase chain reaction (PCR) testing of nasopharyngeal swabs and a standardized questionnaire about potential symptoms for SARS-CoV-2 infection. All elective and emergency patients admitted to the surgical department of a tertiary-care hospital center in Lower Franconia, Germany, between March and May 2020 were included and their characteristics were recorded. Results Out of the study population (n = 657), 509 patients (77.5%) had at least one risk factor for a potentially severe course of COVID-19 and 164 patients (25%) were active smokers. The average 7-day incidence in Lower Franconia was 24.0/100,000 during the observation period. Preoperative PCR testing revealed four asymptomatic positive patients out of the 657 tested patients. No postoperative SARS-CoV-2 infection or transmission could be detected. Conclusion The implementation of a standardized preoperative screening program to both COVID-19 and non-COVID-19 patients can ensure high-quality surgical care while minimizing infection risk for healthcare workers and potential in-hospital transmission.

scholarly journals Drug utilization study in ophthalmology department at a tertiary care hospital

2021 ◽  
Vol 10 (4) ◽  
pp. 396
Author(s):  
Pritpal Singh Ahluwalia ◽  
Mirza Shiraz Baig ◽  
Amarnath Awargaonkar ◽  
Varsha Nandedkar
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Essential Medicines ◽  
Care Hospital ◽  
Open Label ◽  
Prescribing Pattern ◽  
Medical College ◽  
Rational Drug ◽  
Number Of Patients ◽  
Current Health Care System

Background: Drug utilisation studies in present clinical practice have played significant role to promote rational drug use in the current health care system. The aim of present study was to analyse the prescribing pattern of drugs for various ocular conditions in Ophthalmology Department of Government Medical College and Hospital, Aurangabad, Maharashtra, India.Methods: Study was prospective, observational open label and descriptive clinical study which included 100 patients in OPD and IPD during November 2018 to February 2019 fulfilling inclusion criteria.Results: Out of the 100 study subjects, 56% were males and 46% were females, with the maximum number of patients falling in the age group 61-80 years. 38.26% patients received antibiotics as most prescribed drug while 69 % patients received analgesics and 47% anti-inflammatory. Among the antibiotics prescribed, fluoroquinolones were the most prescribed antimicrobial class. WHO prescribing indicators as analysed from the data collected were: average number of drugs per prescriptions was 3.79. Percentage of medicines prescribed by branded name- 33.79% and generic were 66.21%. 54% of the total drugs prescribed were from the National List of Essential Medicines 2017.Conclusions: Ocular ailments and conditions are frequently associated with high levels of utilization of drugs for their treatment. Thus, analysis of utilization of these drugs becomes very essential. In the present study, the drugs prescribed at our tertiary care hospital were found rational.

scholarly journals Management of Gastroschisis in a Tertiary Care Hospital

2013 ◽  
Vol 36 (3) ◽  
pp. 133-138
Author(s):  
MA Rashid ◽  
MM Hoque ◽  
AA Mamun ◽  
A Kabir ◽  
M Ibrahim ◽  
...  
Keyword(s):  
Birth Weight ◽  
Survival Rate ◽  
Abdominal Wall Defect ◽  
Operative Procedure ◽  
Tertiary Care ◽  
Developed Countries ◽  
Management Plan ◽  
Care Hospital ◽  
Number Of Patients ◽  
Neonatal Icu

Background : Gastroschisis is a congenital abdominal wall defect with high mortality in developing countries. In developed countries their survival rate is more than ninety percent. This is due to appropriate information about the disease and adequate management plan. We have a good number of patients, but majority of us are lacking appropriate information about this disease. Objectives: This study was done to give some information to our medical personals about this disease and to evaluate the out come of gastroschisis in relation to birth weight, age of neonate and procedure of closure of the defect. Methodology: This prospective observatinal study was done in the surgery department of Dhaka Shishu Hospital (DSH) in a period of two years. All gastroschisis patients admitted during this period were enrolled and their mortality were analyzed in relation to weight, age and operative procedure. Minimal intervention management of gastroschisis (MIMG) were performed in suitable cases. Results: A total of 32 patients were admitted. Mortality were significantly high among the VLBW babies than babies whose birth weight > 1500 gm (88.9% vs17.4%) and those who were admitted after 24 hours of age than who admitted before 24 hours of age (66.7% vs26.1%). Overall survival rate was 62.5% and after surgery 71.5%. Conclusion: Gastroschisis is not rare in our population. Birth weight, early hospitalization with primary closure as early as possible, proper selection of patient for MIMG effect outcome. Adequate supportive measures like TPN, neonatal ICU and information about the disease will further increase the survival rate. DOI: http://dx.doi.org/10.3329/bjch.v36i3.14276 BANGLADESH J CHILD HEALTH 2012; VOL 36 (3) : 133-138

scholarly journals A comparative study of post-operative astigmatism in superior versus superotemporal scleral incisions in manual small incision cataract surgery in a tertiary care hospital

2021 ◽  
Vol 5 (2) ◽  
pp. 009-015
Author(s):  
Hazra Soumyadeep ◽  
Saha Tapes Kanti
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Visual Outcome ◽  
Care Hospital ◽  
Small Incision Cataract Surgery ◽  
Small Incision ◽  
Postoperative Astigmatism ◽  
Number Of Patients

Background: In developing countries, manual small incision cataract surgery is a better alternative and less expensive in comparison to phacoemulsification and thus the incision is an important factor causing high rates of postoperative astigmatism resulting into poor visual outcome. Thus, modifications to the site of the incision is needed to reduce the pre-existing astigmatism and also to prevent postoperative astigmatism. Modification to superotemporal incision relieves pre-existing astigmatism majorly due to its characteristic of neutralizing against-the-rule astigmatism, which is more prevalent among elderly population and thus improves the visual outcome. Aims: To study the incidence, amount and type of surgically induced astigmatism in superior and superotemporal scleral incision in manual SICS. Methodology: It is a randomized, comparative clinical study done on 100 patients attending the OPD of Ophthalmology at a tertiary care hospital, with senile cataract within a period of one year and underwent manual SICS. 50 of them chosen randomly for superior incision and rest 50 with superotemporal incision. MSICS with PCIOL implantation were performed through unsutured 6.5 mm scleral incision in all. Patients were examined post-operatively on 1st day, 7th day, 2nd week and 4th week and astigmatism was evaluated and compared in both groups. Results: It is seen that on postoperative follow up on 4th week, 77.78% of the patients with ATR astigmatism who underwent superior incision had increased astigmatism whereas, only 13.63% of the patients with ATR astigmatism who underwent supero-temporal incision, had increased astigmatism but 81.82% had decreased ATR astigmatism. However, 77.78% of the patients with preoperative WTR astigmatism who underwent supero-temporal incision, had increased astigmatism, whereas 44.45% of the patients with WTR astigmatism preoperatively, had increased astigmatism in contrast to 50% had decreased amount of astigmatism. It is also seen that the supero-temporal incision group had more number of patients (78%) with visual acuity better than 6/9 at 4th postoperative week than superior incision group (42%). Conclusion: This study concludes that superior incision cause more ATR astigmatism postoperatively whereas superotemporal incision causes lower magnitude of WTR astigmatism, which is advantageous for the elderly. Besides superotemporal incision provides better and early visual acuity postoperatively.

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