Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia

2021 ◽  
pp. 153857442110225
Author(s):  
Joel Mathew John ◽  
Vimalin Samuel ◽  
Dheepak Selvaraj ◽  
Prabhu Premkumar ◽  
Albert A Kota ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Interventional Procedure ◽  
Tertiary Care ◽  
Arterial Disease ◽  
Multivariable Logistic Regression Analysis ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Exact Test ◽  
Institutional Review ◽  
Chi Square Test

Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.

FACTORS CAUSING DELAY IN TIME TO DOOR AT EMERGENCY DEPARTMENT(ED) IN CASES OF ACUTE STROKE AND IT'S IMPACT ON OUTCOME AT TERTIARY CARE CENTRE

2020 ◽  
pp. 67-70
Author(s):  
Yogender Kumar Yadav ◽  
Dina J Shah ◽  
Jyoti B Sharma ◽  
Nalini Bala Pandey
Keyword(s):  
Acute Stroke ◽  
Average Length ◽  
Tertiary Care ◽  
Onset Time ◽  
Signs And Symptoms ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
End Points ◽  
Exact Test

BACKGROUND: The effectiveness of stroke management is highly dependent on post onset time of treatment. The study hypothesized that perceptual, social and behavioral factors affect delay in seeking help after symptom onset and worsen the outcome and recovery. OBJECTIVE: To look at the causes of delay in arrival to denitive care hospital ED after symptoms of acute stoke and its impact on patient's clinical outcome. METHODS: An observational prospective study conducted on 63 patients with signs and symptoms of acute stroke (CPSS/NIHSS positive) reported to ED. Reasons for delay in arrival to ED observed. Patients divided into two groups, those who came within 4.5 hours of onset of acute stroke symptoms and those who came after 4.5 hours. Impact of delay on patient's outcome studied at time of discharge as primary end-points in terms of average length of stay (ALOS), complications and death. Secondary end-points evaluate in terms of improvement, deterioration and death within 30th day. Statistical analysis using Chi-square or Fisher's exact test applied to compare both the groups. Odds ratio with 95 % condence limit was also calculated. RESULTS: There were multiple overlapping causes of delay; most frequently was “rst went to physician who doesn't treat stroke (8; 38.1%) and non-availability of nearby stroke centre (8; 38.1%)”. Total 21 (33.34%) patients came after window period (4.5hours). Primary endpoints in terms of ALOS (8 days compared to 9 days, p=0.48), complications (OR=1.4, 95%CI:0.2-8.8, p=0.74) and death (OR=3, 95%CI:0.4-19.3, p=0.24) at time of discharge. Secondary endpoints in terms of improvement (OR=2.8, 95%CI:1.0-7.8, p=0.03), deterioration (OR=6.0, 95%CI:1.4-24.5, p=0.01) and death within 30 days (OR=1.2, 95%CI:0.2-5.5, p=0.81). CONCLUSION: Inadequate knowledge of stroke identication and management causes delay in arrival to hospital. This delay can cause signicant impact on patient outcome and recovery

scholarly journals Comparison of intravenous hydralazine and intravenous labetalol in the management of severe hypertensive disorders of pregnancy: a tertiary care centre study

2018 ◽  
Vol 7 (6) ◽  
pp. 2251
Author(s):  
Manvi Verma ◽  
Shashi Gupta ◽  
B. R. Bhagat ◽  
Aakanksha Mahajan ◽  
Baseerat Kaur
Keyword(s):  
Adverse Effects ◽  
Severe Hypertension ◽  
Tertiary Care ◽  
Fetal Outcome ◽  
Categorical Variables ◽  
Tertiary Care Centre ◽  
Low Birth Weight Infants ◽  
Chi Square ◽  
Exact Test ◽  
Student’S T

Background: Severe hypertension in pregnancy (SBP ≥160 mmHg &/or DBP ≥ 110 mmHg) must be treated judiciously to prevent maternal and fetal complications. The study was conducted to compare the efficacy, adverse effects, maternal and fetal outcome between Hydralazine and Labetalol which are the most commonly used drugs for the purpose.Methods: In a prospective study, 130 pregnant patients each with severe hypertension presenting to SMGS Hospital Jammu were randomized in 2 groups and administered hydralazine or labetalol intravenously. The efficacy of the two drugs was measured in terms of number of doses required to obtain target BP and the timing to achieve the same. The incidence of adverse effects, maternal and fetal outcomes were also compared. Comparisons among the two groups was performed by using independent Student’s t test for normally distributed variables, Fishers’ exact test, and Pearson Chi Square test for categorical variables. The level of significance was set at p<0.05 for all analysis.Results: There was no statistical difference between the two drugs in terms of efficacy. Significantly more low-birth weight infants were born in the hydralazine group. Also, the adverse effects were significantly more in the hydralazine group.Conclusions: Both hydralazine and labetalol can be used to treat hypertensive emergencies of pregnancy but hydralazine is associated with more side effects.

Prevalence Of Post Partum Depression Among Postnatal Women At A Tertiary Care Centre Using Edinburgh Post Partum Depression Scale

2021 ◽  
Vol 12 (4) ◽  
pp. 2395-2399
Author(s):  
Sivasundari Maharajan ◽  
Dhanvarsha Sumaldha Subbiah Ramkumar ◽  
Nimrah Amthul ◽  
Shrutiravali
Keyword(s):  
Postpartum Depression ◽  
Negative Impact ◽  
Post Partum ◽  
Tertiary Care ◽  
Depression Scale ◽  
Medical Intervention ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Post Partum Depression ◽  
Chi Square Test

Postpartum depression is a grave mental health problem, which is more prevalent than society realizes and poses great risk. It has been associated with lack of breastfeeding, aversion towards the baby and negative impact on the development of the child. A total of 300 women who delivered between January 14 to March 31 of 2020 at Saveetha Medical College and Hospital were chosen following ethical clearance. After explaining the aspects of the Edinburgh Postpartum Depression Scale in their native language, the questionnaire was provided. A score of 10 and above were considered positive. Data were evaluated using SPSS and Chi square test. The prevalence of PPD was seen in 14% of women. It was higher with vaginal delivery, in women who had multiple births, lack of financial and social support, with domestic violence and alcoholic partner. Medical help was advised to women who scored 10 and above; only 5% sought medical intervention. Others did not recognize depression as a health issue. This shows the lack of awareness among the population. Medical health professionals should spread awareness, conduct more studies to evaluate the prevalence, the predisposing factors, methods for early diagnosis and ways to help women overcome “THE OTHER SIDE OF MOTHERHOOD”.

scholarly journals Assessment of breastfeeding position and attachment (ABPA) in a tertiary care centre in Chennai, India: an observational descriptive cross-sectional study

2018 ◽  
Vol 5 (6) ◽  
pp. 2209
Author(s):  
Nalini Aswathaman ◽  
Mohamed Sajjid ◽  
C. N. Kamalarathnam ◽  
A. T. Arasar Seeralar
Keyword(s):  
Tertiary Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Tertiary Care Centre ◽  
Correct Position ◽  
Chi Square ◽  
Cross Sectional ◽  
Key Points ◽  
Chi Square Test ◽  
Correct Technique

Background: Effective breastfeeding becomes an art with experience. Correct position and attachment is the first step necessary for exclusive breast feeding. However, studies assessing correct position and attachment for breastfeeding in South India are sparse. Hence our study aimed to assess the percentage of mother infant dyads with correct breastfeeding position and attachment along with factors influencing them in a Tertiary care Hospital.Methods: A descriptive cross-sectional study was conducted among the stable dyads in Institute of Obstetrics and Gynaecology using quasi random sampling. 101 dyads were observed for correct position, attachment and effective suckling using WHO B-R-E-A-S-T feed observation form and were scored. Data was analyzed using SPSS software with chi square test, univariate logistic regression and spearman correlation test.Results: Among the 101 dyads, only 30.7% of them had good or average position, 52.47% had good or average attachment and 62.3% had effective suckling at breast. There was significant correlation between breast problem in mother with incorrect position and poor attachment. NICU stay and breast problems were significantly associated with poor attachment. Effective suckling improved significantly as gestational age matured and in infants who had no NICU stay.Conclusions: Practical demonstration on how to hold infants in correct breastfeeding position and drilling with key points for correct position and attachment as soon as possible after delivery will go a long way for promoting exclusive and effective breastfeeding by learning correct technique. Rechecking after counselling will reinforce this learned art.

scholarly journals Patterns and Severity of Injuries in Patients Following Physical Assault– A Medicolegal Aspects

2020 ◽  
Vol 2 (2) ◽  
pp. 16-20
Author(s):  
Archana Chaudhary ◽  
Srijana Kunwar ◽  
Samjhana Ghimire ◽  
Harihar Wasti
Keyword(s):  
Tertiary Care ◽  
Treatment Strategies ◽  
Point Of View ◽  
Physical Assault ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Mortality And Morbidity ◽  
Exact Test ◽  
Young Males ◽  
Far Eastern

Background and purpose: Physical assault (PA) is a common cause of mortality and morbidity throughout the world and the prevalence is still very high in underdeveloped and developing countries. With the objective to see the spectrum of injury following PA from the medico legal point of view, this study was design in a tertiary care centre at far eastern part of Nepal. Material and method: This is a prospective analytical study with non- probability consecutive sampling of physical assault cases presented in the emergency department over the duration of 4 months. All the patients who meet the inclusion criteria were collected in preformed proforma. Gender, types of weapons used for PA, location of external and internal injuries, various treatment strategies, and severity of injuries were presented in frequencies and percentage. Association of different age categories, gender and types of weapons used with severity of injuries were analysed using Chi square/ Fisher’s exact test wherever applicable. Result: There were total 99 patients presented with physical assault during the study period with mean age of presentation 31.69 (SD 13.38) Years with male (70%) predominance. Among various types of weapons used for PA; punches/ kicks were used in 50% of assaults followed by blunt heavy objects (35%) and sharp heavy weapons (14%). Location of the external injuries were more common in head and neck area . Obvious internal injuries were seen in 14% of the assaulted patients. Among all the case of PA, 42% patients needed some sort of surgical intervention during hospital stay. There were 9% cases of grievous injury and 6% had life threatening injuries. Conclusion: Physical assault is a common mode of injuries in eastern Nepal, where young males are more prone to such injuries. Violence are commonly carried out using fists, kicks and blunt objects. Severity of injuries is similar with all the types of weapons used.

scholarly journals Study of expression of PTEN and Cyclin D1 in endometrium at a tertiary care centre

2019 ◽  
Vol 6 (2) ◽  
pp. 495
Author(s):  
Shaffy Thukral ◽  
Shuaeb Bhat ◽  
Nusrat Bashir
Keyword(s):  
Cyclin D1 ◽  
Tertiary Care ◽  
Inverse Correlation ◽  
Premalignant Lesions ◽  
P Value ◽  
Nuclear Staining ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Normal Endometrium ◽  
Chi Square Test

Background: To study the expression of PTEN (Phosphatase and Tensin homologue) and Cyclin D1 in normal, hyperplastic and neoplastic endometrium by immunohistochemistry and to corroborate the interrelationship between PTEN and Cyclin D1 in normal to neoplastic endometrial disorders including endometrial carcinoma.Methods: Formalin fixed paraffin embedded (FFPE) sections of spectrum of endometrium in fifty different cases were taken from secretory phase to endometrial carcinoma and subjected to Immunohistochemistry using PTEN and Cyclin D1 .Results: Immunoreactivity was regarded as positive when brown staining was localized in the nuclei or cytoplasm. The intensity of nuclear staining was graded from 0 to 3+ and the extent was semi quantitatively estimated. If less than 10% of cells were positive a score of 0 was given, 11 % to 30% cell positivity was scored as 1+, 31% to 60 % positivity was scored as 2+ and more than 60% positive cells was labelled as 3+. Statistical analysis was performed with Chi-Square test and significant differences were noted between these 3 groups (p value < 0.05).Conclusions: The present study supports that an inverse correlation exists in the expression of PTEN and Cyclin D1 in normal, hyperplastic and neoplastic endometrium. The decreased PTEN expression is a marker of the earliest endometrial premalignant lesions, and we propose that use of PTEN immunostaining may be informative in identifying premalignant lesions that are likely to progress to carcinoma. Cyclin D1 expression in endometrial glands increases progressively in intensity and extent from normal endometrium to hyperplasia to carcinoma.

scholarly journals Proportion of ophthalmia neonatorum following prophylaxis with azithromycin eye ointment in newborns at a tertiary care centre in Central Kerala

2021 ◽  
Vol 8 (10) ◽  
pp. 1720
Author(s):  
Najeeba Chamban Mammooty ◽  
Madhu George ◽  
Jino Joseph ◽  
Abdul Tawab
Keyword(s):  
Tertiary Care ◽  
Newborn Care ◽  
Causative Organism ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Ophthalmia Neonatorum ◽  
Chi Square Test ◽  
Culture And Sensitivity ◽  
Neonatal Conjunctivitis

Background: The objective was to evaluate the proportion of ophthalmia neonatorum among 425 hospital born newborns who had received antibiotic eye prophylaxis within one hour of birth at a tertiary care centre in Central Kerala and to detect their causative organisms.Methods: The study design was an observational study done for a period of 10 months. A total of 425 term well newborn babies were included in the study. At delivery after the normal routine newborn care, babies were received azithromycin 1% eye ointment as prophylaxis for neonatal conjunctivitis in both eyes within one hour of birth. Babies were observed routinely during every vital monitoring for developing signs of neonatal conjunctivitis for the first 72 hours of life at hospital. During outpatient follow ups, 7 to 14 days and 14 to 28 days, these babies were examined for the presence of neonatal conjunctivitis. Babies having neonatal conjunctivitis were treated empirically with the same topical 1% azithromycin eye ointment after taking eye swab for culture and sensitivity in both eyes. The treatment has been modified based on the culture reports. Proportions were compared using Chi-square test with significance at p<0.05.Results: A total 15 (3.5%) of the 425 babies developed ophthalmia neonatorum. The most common isolate was Staphylococcus aureus which was 4 (26.7%) of all positive cultures followed by Escherichia coli 13.3%, Klebsiella pneumoniae 6.7%, Serracia marcescens 6.7%. None of the risk factors were found to be having association with conjunctivitis.Conclusions: This study concludes that a high proportion of neonatal conjunctivitis present despite eye antibiotic prophylaxis, though a greater reduction in cases has been shown when compared with no prophylaxis at our centre during the previous year. S. aureus was the most common causative organism isolated. 

scholarly journals Comprehensive study of insomnia and its association with specific burn characteristics: an experience from a tertiary care centre in North-West India

2018 ◽  
Vol 5 (9) ◽  
pp. 3807
Author(s):  
Rakesh Kumar Jain ◽  
Gautam Prakash ◽  
Manojit Midya ◽  
Pankaj Sharma ◽  
Akhilesh Jain
Keyword(s):  
Sleep Quality ◽  
Tertiary Care ◽  
Binary Logistic Regression ◽  
Burn Patients ◽  
Sleep Patterns ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
North West ◽  
Disturbed Sleep ◽  
Chi Square Test

Background: Burn injuries are devastating, sudden and unpredictable forms of trauma which affect the victims both physically and psychologically. Recent advances in medical management have drastically decreased mortality rates of burn patients. There is a significant relationship between acute burn pain and sleep. Alteration in sleep patterns are commonly seen in post burn patients. The objectives of the study were to determine the prevalence of insomnia in burn patients compared with a group of adequately matched controls; to determine risk factors associated with insomnia; to study the quality of sleep in post burn patients compared with a group of adequately matched controls.Methods: Sleep quality in post burn patients was analyzed and measured with the help of Pittsburg sleep quality index questionnaire and compared with a group of adequately matched controls. Post burn patients experienced prolonged and long lasting pain which is assessed with visual analogue scale. Data were tabulated and analyzed statistically using univariate and multivariate analysis (chi square test, odds ratio, Binary logistic regression).Results: The relationship between post burn patients with changed sleep architecture and pain was found to be statistically significant. Other important parameters were also evaluated and discussed.Conclusions: Post burn patients are more prone for disturbed sleep patterns. Any variation in sleep patterns and quality is significantly related to pain experienced by the post burn patients, thus this problem should be evaluated and analyzed meticulously.

scholarly journals Antenatal umbilical cord coiling index as a predictor of pregnancy outcome

2021 ◽  
Vol 8 (3) ◽  
pp. 383-387
Author(s):  
Lopamudra B John ◽  
Takkellapati Aanandini ◽  
Setu Rathod
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcome ◽  
Umbilical Cord ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Exact Test ◽  
Fischer Exact Test

: Fetal compromise as a major contributor to neonatal morbidity is of great concern for obstetricians. Antenatal risk assessment profiles are often insufficient in picking up these cases and hence need to be improved. Antenatal Umbilical cord Coiling Index (AUCI) is one such potential predictor which helps in identifying pregnant women who need close antepartum and intrapartum monitoring. It is determined by ultrasonogram antenatally and noted to be fixed throughout the pregnancy. This study aims at determining the association between AUCI and pregnancy outcome.: This was a hospital based prospective analytical study conducted in a tertiary care centre in Pondicherry from January 2019 to May 2020. 207 pregnant women were included in the study and Colour doppler was performed and AUCI was noted. Participants were followed until delivery and pregnancy outcomes were noted.: Chi square and Fischer exact test: In the present study, among 207 subjects, 166 had normal AUCI i.e., 0.41 to 0.61. Hypocoiling was noted in 20 (&#60; 0.41) and hypercoiling in 21(&#62;0.61) subjects. Hypocoiling was associated with hypertension and oligohydramnios in10% cases each. Nonreasssuring fetal (NRFHR) heart rate, meconium stained liquor and low APGAR values were present in 15, 20 and 10% cases respectively. Hypercoiling was associated with diabetes (10%), hypertension (5%), oligohydramnios (10%), polyhydramnios (5%), NRFHR (10%) and meconium stained liquor (5%). However, there was no statistical significance among the above mentioned parameters.

scholarly journals Age and Sex Differences in Sputum Smear Microscopy Results for Acid Fast Bacilli in a Tertiary Care Centre, South India

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Palanivel Chinnakali ◽  
Kalaiselvi Selvaraj ◽  
Pruthu Thekkur ◽  
Gomathi Ramasamy ◽  
Mahalakshmy Thulasingam ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Low Grade ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Age And Gender ◽  
Chi Square Test ◽  
And Gender ◽  
Age And Sex

Background and Objectives. Low counts are more difficult to find in microscopic sputum examination and thus are more likely to be missed. In this study, we aimed to estimate the proportion of low-count grading and assessing any age and gender differences in sputum smear grading in a low HIV prevalence setting. Materials and Methods. From the tuberculosis laboratory register information on sputum positivity including the grading of smears, age and gender were extracted for January 2011–December 2011. Smears were examined using Ziehl-Neelsen technique and graded as per the Program Guidelines. Positive smears were classified into low grade positive smears (scanty and 1+) and high grade positive smears (2+ and 3+). Differences in grading of smear based on gender and age were analysed using chi square test. Results. Of 9000 smears examined, 8210 (91.2%) were collected as diagnostic smears from tuberculosis suspects. Low grade positivity was 37.5% among diagnostic smears and 69.6% among follow-up smears. Sputum smears from female examinees had higher proportions of low grade positive smears (P=0.003). Stratification of age and sex within TB suspects had clearly demonstrated the observance of higher low grade positivity among female TB suspects at extremes of age.

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