scholarly journals Knowledge attitude practice and acceptance of postpartum intrauterine devices among postpartal women in a tertiary care center

2017 ◽  
Vol 6 (4) ◽  
pp. 1507 ◽  
Author(s):  
Sumitra Yadav ◽  
Ruchi Joshi ◽  
Monica Solanki
Keyword(s):  
Family Planning ◽  
Retention Rate ◽  
Low Cost ◽  
Care Center ◽  
Tertiary Care ◽  
School Level ◽  
World Health ◽  
Common Reason ◽  
Eligibility Criteria ◽  
Expulsion Rate

Background: PPIUCDs are the only method for couples requesting a highly effective and reversible, yet long acting, family planning method that can be initiated during the immediate postpartum phase. World Health Organization (WHO) medical eligibility criteria state that it is generally safe for postpartum lactating women to use a PPIUCD, with the advantages outweighing the disadvantages. PPIUCDs are cost-effective and they are low-cost intervention that reduces maternal, infant, and under-five Child mortality.Methods: After approval from the ethical committee and consent from the patients, the study was performed on 1000 postpartum women within 10 min. of delivery and up to 6 weeks of delivery at Labour Room of, M.Y. Hospital, Indore.Results: Majority of acceptor (72.5%) belong to age group of 18-25 years and 53% belonged to urban area. Acceptance was more in those who completed their secondary school level education (33%). Working women (55.5%) accepted PPIUCD more than the non-working. Out of 1000 women counselled only 10% agreed for PPIUVD insertion. During the study of 1 year duration (3.5%) of non-acceptors become pregnant and none of the acceptors conceived. Most common reason stated for accepting PPIUCD among acceptors, was that it is a reversible method (66%). Most common reason for not accepting PPIUCD among non-acceptors, because they are interested in Other Method of Family Planning (60%).Conclusions: Verbal acceptance is more than actual insertion of PPIUCD because of adoption of other method of family planning, family pressure, nonacceptance by partner, lack of awareness, fear of complication. Proper counselling can help to generate awareness and compliance for PPIUCD use in postpartum mother who have institutional delivery. Inserting CuT 380A within 10 min after placental delivery is safe and effective, has high retention rate. The expulsion rate was not high, and further can be reduced with practice could not be predicted.

Histopathological Study of Cystoscopic Bladder Biopsies in a Tertiary Care Center

2021 ◽  
Vol 6 (1) ◽  
pp. 1310-1314
Author(s):  
Rachana Dhakal ◽  
Hem Nath Joshi ◽  
Ramesh Makaju ◽  
Shailendra Sigdel
Keyword(s):  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Pathological Condition ◽  
Care Center ◽  
Tertiary Care ◽  
University Hospital ◽  
World Health ◽  
Histopathological Study ◽  
Neoplastic Lesion ◽  
Neoplastic Lesions

Introduction: Non-neoplastic urinary bladder lesions are not life threatening, but are an important source to cause clinical symptoms and signs. However, neoplasms of the bladder are a source of morbidity, mortality, and exhibit more clinical challenges. Cystoscopy provides overall information about an anatomical/pathological condition of the urinary bladder which will be helpful for patients' management. A cystoscopic biopsy is a primary diagnostic tool for diagnosing urinary bladder cancer. Objectives: The objective of the study was to find the frequency and histomorphological characteristics of urinary bladder lesions in Dhulikhel Hospital, to find the clinical presentation of urinary bladder lesions and to grade the urothelial tumors based on the World Health Organization (WHO)/ International Society of Urological Pathology (ISUP) classification 2004. Methodology: This was a retrospective, cross-sectional, observational study carried out in the Department of Pathology, Dhulikhel Hospital-Kathmandu University Hospital. Convenient sampling was done. All cystoscopy biopsies received from January 2014 to December 2018 were studied. All tissue blocks were retrieved, cut, and stained with Hematoxylin and Eosin. The stained slides were examined under a light microscope by the primary investigator. Result: A total of 70 cystoscopic biopsies were analyzed. The majority of patients 20 (28.6%) were in the age group between 60 and 69 years and males were predominant 43 (61.4%). The neoplastic lesions constituted 40 (57.1%) of all bladder lesions, among them urothelial carcinoma accounted for 38 (54.2%). Similarly, chronic cystitis 27(38.6%) was the most common non-neoplastic lesion. Conclusion: The study found that the neoplastic lesions were commonly encountered in urinary bladder lesions. Among them, lowgrade urothelial carcinoma was the most common bladder tumor. However, most of the non-neoplastic lesions were inflammatory in origin. Cystoscopy combined with histomorphological examination helps in the early detection of bladder lesions. 

scholarly journals Assessment of indications of caesarean section among high risk women by Robson criteria: a prospective study

2018 ◽  
Vol 7 (7) ◽  
pp. 2623
Author(s):  
Kaveri Shaw Patel ◽  
Roma S. Nag
Keyword(s):  
High Risk ◽  
Caesarean Section ◽  
Care Center ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
Group Classification ◽  
Classification Systems ◽  
World Health ◽  
Qualitative Assessment ◽  
Safe Delivery

Background: Caesarean section (CS) is a surgical intervention for safe delivery other than natural vaginal route. World Health Organization (WHO) has recommended ten group classification systems of Robson criteria which we have used to analyse CS at our center. The objective of the study to analyse the lower section caesarian section (LSCS) data under Robson criteria for implementation in regular practice in tertiary care center and to understand the need of it for future practice.Methods: A prospective analysis done for deliveries in Obstetric Department of Shalby Multispecialty Hospital of central India by Robson ten group classification criteria. The study was carried out for the period of two year from April 2016 to April 2018 including antenatal women attending labour room with high risks or referred cases from other centers.Results: The study reflected overall 196 live birth of high risk cases which were having other co morbidities like pre-eclampsia, eclampsia, hypothyroidism, diabetes, acute viral hepatitis. The data compared with Robsons guidelines and reflected that the centre is dealing with high risk primigravida (47.51%, 35-42% Robson criteria) cases with high CS rate (16.8%, group 5). There was multiple pregnancy, group 8, (2.32 %, >1.5-2% Robson Criteria) and preterm births as in group 10, 18.02 % (5% in Robson Criteria), exclusively high.Conclusions: The Robson criteria help to classify the population handled by the canter to develop the strategies for betterment of services. It has limitation in view of qualitative assessment of the data for comorbidities and severity of the disease.

scholarly journals 375. Cryptococcal Antigenemia in Advanced HIV Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S196-S196
Author(s):  
Jatin Ahuja ◽  
Manish Soneja ◽  
Naveet Wig ◽  
Immaculata Xess ◽  
Ashutosh Biswas ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Care Center ◽  
Tertiary Care ◽  
Latex Agglutination ◽  
Cd4 Count ◽  
North India ◽  
World Health ◽  
P Value ◽  
The Mean

Abstract Background Diagnostic importance of asymptomatic cryptococcal antigenemia is being increasingly recognized in the last few years. Recently, WHO (World Health Organization) has recommended routine screening of CrAg (cryptococcal antigen) among PLHA with CD4 ≤100/mm3, albeit this procedure is not yet adopted by many developing countries including India. Methods We conducted a prospective observational study in a large tertiary care center of North India, upon ethical clearance. Latex agglutination test was performed to assess serum CrAg levels, followed by the lumbar puncture for detection of CrAg levels in the CSF. We analyzed the prevalence and treatment outcomes of cryptococcal antigenemia among PLHA with CD4 ≤ 100 cells/mm3. Detailed clinical examination was conducted, with follow-up of upto 3 months. Multivariate analysis was performed for the estimation of risk factors. Results The mean age (years) and BMI (kg/m2) of all the participants were 41.4 ± 11.2 and 22.1 ± 2.6, respectively. Notably, the mean CD4 count (cu.mm) at the time of recruitment was 62.3 ± 20.5. Noteworthy, 62 (60.8%) of the patients were ART naïve. We found 9.8% (n = 10) of the patients were positive for serum CrAg, and only 2.9% (n = 3) had clinical features of meningitis and 6.8% (n = 7) were asymptomatic (subclinical) CrAg positive. Strikingly, 3.9% (n = 4) of the asymptomatic cryptococcal antigenemia patients were also positive for CrAg in CSF, with 1.9% (n = 2) were only serum CrAg positive, and 1 patient was lost to follow-up (Graph 1). Multivariate analysis revealed that patients with long duration of HIV (P = 0.04), headache symptoms (P = 0.004) and possessing features of meningismus (P value=0.08) are more likely to be CrAg positive. Conversely, patients on fluconazole were protective against cryptococcal antigenemia (P = 0.1) as shown in Table 1. Overall mortality observed was 11.3% among advanced HIV patients. Moreover, mortality in CrAg-positive patients was 33.3% in comparison to CrAg-negative patients who had 9% (P = 0.06) in 3-months follow-up. Conclusion Cryptococcal antigenemia is common (9.8%) among patients with CD4 count ≤100/mm3 in India. Screening for CrAg should be made routine for PLHA with CD4 count ≤100/mm3 and if required preemptive treatment to be given in this regard. Disclosures All authors: No reported disclosures.

scholarly journals Postpartum intrauterine contraceptive device (PPIUCD) insertion: practices and aftermath at tertiary care centre

2018 ◽  
Vol 7 (11) ◽  
pp. 4742 ◽  
Author(s):  
Kanchan Rani ◽  
Nirmal Kumar Pangtey ◽  
Garima Khanna ◽  
Mahima Rani
Keyword(s):  
Abdominal Pain ◽  
Family Planning ◽  
Tertiary Care ◽  
Unmet Need ◽  
Lower Abdominal Pain ◽  
Postnatal Period ◽  
Technical Committee ◽  
Contraceptive Device ◽  
Tertiary Care Centre ◽  
Expulsion Rate

Background: According to USAID/ ACCESS 2009 survey, in India, 65% of women in first year postpartum have an unmet need for family planning. Recommended spacing between birth to next pregnancy is at least 24 months and between abortion to next pregnancy is at least six months (WHO Technical Committee,2006). Pregnancy before 24 months of previous birth increase maternal and perinatal morbidity and mortality. So, during this postnatal period woman must be offered any form of reversible contraceptive. IUCD is most frequently use reversible method of family planning in the world. The aim of present study is to evaluate acceptability safety efficacy and complication of PPIUCD in tertiary care center.Methods: This is a retrospective study conducted at Government Medical College and Hospital in northern India over a period of 1 year from January 2016 to December 2016. Patients were followed up to 6 months period and their complaints and various parameters were analyzed.Results: 219 patients were inserted PPIUCD during 1-year period. Acceptance rate was higher in P2 (51.6%), between 20 to 25 years of age (47.49%) followed by 26 – 30 years of age (38.8%). On follow up 44.3% had no complaints. Most common complaints were lower abdominal pain (15%), missing thread (14.6%) and vaginal discharge (8.2%). 5.48% women came for removal of IUCD. Main cause of removal was pressure from family and lower abdominal pain. Expulsion rate was low (2.74%). There was no case of perforation or failure (pregnancy).Conclusions: During present study authors found that PPIUCD is highly effective, acceptable, safe and with fewer side effects. PPIUCD is especially beneficial in Indian population where accessibility for contraception is lower during interval period and women do not come for contraception during postpartum period.

Carcinoids of the ampulla: Long-term follow-up after endoscopic resection.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 430-430
Author(s):  
George Nyasha Baison ◽  
Nadav Sahar ◽  
Morgan M Bonds ◽  
Janelle F Rekman ◽  
Flavio G. Rocha ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Care Center ◽  
Benign Lesion ◽  
Tertiary Care ◽  
Case Series ◽  
World Health ◽  
Long Term Follow Up ◽  
Well Differentiated

430 Background: Neuroendocrine tumors (NET) or carcinoids of the ampulla are exceedingly rare in comparison to duodenal NET. Surgical management is widely accepted as the treatment of choice, but for patients that refuse surgery or are poor operative candidates, endoscopic resection may be option. We present a consecutive case series at a tertiary care center describing our experience with endoscopic resection of ampullary NET. Methods: This is a restrospective review with a long-term follow-up of patients with ampullary NET that were endoscopically resected. Outcomes were analyzed based on the histopathologic classification system proposed by the World Health Organization in 2000. Results: Twelve patients (9 male, 3 female), ranging in age from 41 to 86 (mean 59) underwent endoscopic ampullectomy for ampullary NET, with a mean follow-up time of 5 years. Patients had refused surgery or were poor surgical candidates. All, but one incidentally found case, were symptomatic on presentation, with gastrointestinal bleeding being the main symptom. No patients had a hormonal syndrome. The mean size of the lesions was 21 mm (6 mm to 35 cm). Six (50%) patients had a well-differentiated, benign lesion, 6 (50%) patients had a well-differentiated NET with unknown malignant potential (gangliocytic paragangliomas). Eight (67%) were completely excised during the initial endoscopy with 4 requiring re-excision. Only 2 patients developed recurrence, after 2.5 and 10 years and this necessitated a pancreaticoduodenectomy. Five patients had complications (2 for bleeding and 3 for post-ERCP pancreatitis), with zero deaths. Conclusions: Unlike duodenal carcinoids, ampullary NET are rare. Pancreaticoduodenectomy can be offered to fit patients except for gangliocytic paragangliomas that do not require an aggressive operation. However, for those that refuse surgery or are poor candidates, endoscopic ampullectomy can be an option with acceptable short and long-term outcomes.

scholarly journals The Burden of Laboratory-confirmed Influenza Infection in Lebanon Between 2008 and 2016: A single tertiary care center experience

2020 ◽  
Author(s):  
Aia Assaf-Casals ◽  
Zeina Saleh ◽  
Sarah Khafaja ◽  
Danielle Fayad ◽  
Hady Ezzeddine ◽  
...  
Keyword(s):  
Influenza A ◽  
Influenza Infection ◽  
Care Center ◽  
Severe Disease ◽  
Tertiary Care ◽  
High Rate ◽  
World Health ◽  
Influenza B ◽  
Age Group ◽  
Tertiary Care Center

Abstract BACKGROUND: Influenza is a major cause of morbidity and mortality worldwide. Following the 2009 pandemic, there was widened interest in studying influenza burden in all regions. However, since data from the World Health Organization (WHO) Middle East and North Africa (MENA) region remain limited, we aimed to contribute to the understanding of influenza burden in Lebanon. METHODS: A retrospective chart review extending over a period of 8 seasons from Jan 1st, 2008 till June 30 th , 2016 at a tertiary care center in Beirut was performed. All cases confirmed to have influenza based on rapid antigen detection or/and polymerase chain reaction on a respiratory sample were included for analysis. Data on epidemiology, clinical presentation, complications, antiviral use and mortality were collected for analysis. RESULTS: A total of 1829 cases of laboratory-confirmed influenza were identified. Average annual positivity rate was 14% (positive tests over total requested). Both influenza A and B co-circulated in each season with predominance of influenza A. Influenza virus started circulating in December and peaked in January and February. The age group of 19-50 years accounted for the largest proportion of cases (22.5%) followed by the age group of 5-19 years (18%). Pneumonia was the most common complication reported in 33% of cases. Mortality reached 3.8%. The two extremes of age (<2 years and ≥ 65years) were associated with a more severe course of disease, hospitalization, intensive care unit (ICU) admission, complications, and mortality rate. Of all the identified cases, 26% were hospitalized. Moderate-to-severe disease was more likely in influenza B cases but no difference in mortality was reported between the two types. Antivirals were prescribed in 68.8% and antibiotics in 41% of cases. There seemed to be an increasing trend in the number of diagnosed and hospitalized cases over the years of the study. CONCLUSION: Patients with laboratory-confirmed influenza at our center had a high rate of hospitalization and mortality. A population based prospective surveillance study is needed to better estimate the burden of Influenza in Lebanon that would help formulate a policy on influenza control.

scholarly journals Door-to-balloon time in the treatment of ST segment elevation myocardial infarction in a tertiary care center in Saudi Arabia

2020 ◽  
Vol 40 (4) ◽  
pp. 281-289
Author(s):  
Taimur Salar Butt ◽  
Eyad Bashtawi ◽  
Badis Bououn ◽  
Bhawoodin Wagley ◽  
Bandar Albarrak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Saudi Arabia ◽  
Coronary Artery ◽  
Care Center ◽  
Tertiary Care ◽  
Patient Acceptance ◽  
Eligibility Criteria ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Door To Balloon

ABSTRACT BACKGROUND: Atherosclerotic heart disease is still a leading cause of mortality despite improvements in cardiovascular care. Percutaneous coronary intervention (PCI) is the recommended reperfusion therapy in acute ST-elevation myocardial infarction (STEMI), and the international guideline is to achieve a door-to-balloon (D2B) time within 90 minutes of patient arrival to an emergency department (ED). OBJECTIVES: Describe interventions, data for the study period, challenges in ensuring 24/7 patient access to PCI and quality indicators. DESIGN: Retrospective observational study. SETTING: Tertiary care institution in Riyadh, Saudi Arabia. PATIENTS AND METHODS: We included all acute coronary syndrome patients from 2010-2018 who presented or were transferred to our ED from nearby non-PCI capable hospitals, and for whom a ‘code heart’ was activated. Electronic medical records and the patient care report from the ambulance services were accessed for data collection. MAIN OUTCOME MEASURES: D2B time, readmission and mortality rate. SAMPLE SIZE AND CHARACTERISTICS: 354 patients, mean age (standard deviation) 55.6 (12.6) years, males 84.5% (n=299). RESULTS: STEMI patients constituted 94% (n=334) of the study group; the others had non-STEMI or unstable angina. Hypertension (51%) was the most prevalent risk factor. Coronary artery stenting was the most frequent intervention (77.4%) followed by medical therapy (14.7%). The most common culprit artery was the left anterior descending (52.5%) followed by the right coronary artery (26.0%). A D2B time of within 90 minutes was achieved in over 85% of the patients in four of the years in the 278 patients who underwent PCI. The median D2B time (interquar-tile range) over 2010-2018 was 79 (31) minutes. CONCLUSION: Meeting the international benchmark of D2B time within 90 minutes for STEMI patients is achievable when the main stakeholders collaborate in patient-centric care. Our patient demographics represent regional trends. LIMITATIONS: Patient acceptance to our institution is based upon eligibility criteria. Transfer of ‘code heart’ patients from other institutions was carried out by our ambulance team. The credentials and experience of cardiologists, emergency physicians, and ambulance services are not standardized across the country. Therefore, the results may not be generalizable to other institutions. CONFLICT OF INTEREST: None.

scholarly journals Association of Fast Food and Supermarket Density with Neonatal Outcomes of Pregnancies Affected by Gestational Diabetes

2019 ◽  
Vol 36 (13) ◽  
pp. 1405-1411
Author(s):  
Ashley N. Battarbee ◽  
Lynn M. Yee
Keyword(s):  
Gestational Diabetes ◽  
Food Environment ◽  
Fast Food ◽  
Care Center ◽  
Tertiary Care ◽  
Social Determinant ◽  
Neonatal Outcomes ◽  
Large For Gestational Age ◽  
Food Density ◽  
Eligibility Criteria

Objective To measure the association of fast food density (FFD) and supermarket density (SD) with adverse neonatal outcomes in pregnancies with gestational diabetes mellitus (GDM). Study Design This was a retrospective cohort study of women with GDM who delivered at a tertiary care center in a large metropolitan area (1/2010–2/2016). ZIP codes were used to link women with surrounding food environment. FFD and SD were calculated as the number of establishments per 100,000 residents for each ZIP code and classified into quartiles. Quartile 1 represented lowest FFD or SD. Four neonatal outcomes were assessed: large for gestational age (LGA) neonate, shoulder dystocia, neonatal hypoglycemia, and neonatal intensive care unit admission > 3 days. Bivariable and multivariable analyses estimated associations of FFD and SD with outcomes. Results A total of 2,373 women met eligibility criteria. Insurance, race/ethnicity, language, and body mass index differed between quartiles, although GDM type did not. High FFD was associated with lower odds of LGA but not with other outcomes. Low SD and FFD:SD ratios were not associated with any outcomes. Conclusion Among women with GDM, high FFD was associated with some neonatal outcomes, but low SD and FFD:SD ratio was not. Food environment may not be the only social determinant of neonatal outcomes in pregnancies with GDM.

scholarly journals Comparative evaluation of postpartum IUCD versus interval IUCD at a tertiary care centre in Allahabad, India

2017 ◽  
Vol 6 (4) ◽  
pp. 1534 ◽  
Author(s):  
Urvashi Singh ◽  
Shubhangi Sonkar ◽  
Preeti Yadav ◽  
Meena Dayal ◽  
Veena Gupta ◽  
...  
Keyword(s):  
Removal Rate ◽  
Low Cost ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
P Value ◽  
Tertiary Care Centre ◽  
Postpartum Contraception ◽  
Expulsion Rate ◽  
Interval Group

Background: The use of Cu T in postpartum period can provide long term and effective contraception and this study compares PPIUCD versus interval IUCD.Methods: 300 women enrolled in the study were divided into two groups. Postpartum group-150; Postplacental or within 10 minutes/intracaesarean/within 48 hrs of delivery. Interval Group 150; after 6 weeks of delivery / postmenstrual. Cu T 380A was used in the study. Contraindication for PPIUCD were between 48 hrs and 6 wks postpartum, chorioaminionitis, PROM >18 hrs, unresolved PPH and puerperal sepsis. All were followed up for 6 months.Results: The continuation rate at 6 months was 81.81% in interval group and 88.23% in postpartum group. Complications occurred in 15.33% cases after PPIUCD and in 19.33% cases after interval IUCD. Expulsion rate was significantly higher in PPIUCD as compared to interval insertions (6.96% v/s 2.2%; p value <0.05). Removal rate of IUCD was almost similar in both the groups (4% in PPIUCD v/s 6.0% in interval).Conclusions: PPIUCD is an effective, safe, convenient, low cost and long term method of postpartum contraception irrespective of the mode of delivery.

scholarly journals Clinicoepidemiological Profile of Elderly PLHIV Attending a Tertiary Care Center in South India

2017 ◽  
Vol 16 (6) ◽  
pp. 620-623 ◽  
Author(s):  
Deepak Madi ◽  
Neha Ramakrishnan ◽  
Bhaskaran Unnikrishnan ◽  
John Ramapuram ◽  
Basavaprabhu Achappa ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
World Health ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Age Group ◽  
Elderly Age ◽  
Cross Sectional ◽  
Route Of Transmission

Background: Physicians are coming across a considerable number of HIV-positive patients belonging to older age-group, in practice. They pose a challenge as they might present with advanced forms and comorbid conditions. We aimed to describe the clinicoepidemiological profile of elderly people living with HIV. Methodology: We conducted a cross-sectional study at Kasturba Medical College, Mangalore. We analyzed the record of 120 patients from 2009 to 2014. Descriptive statistics were used to describe sociodemographic and clinical profile of patients. Results: Of 786 HIV-positive patients, 120 were elderly. Mean age was 55.9 ± 6.1 years. Majority 68% were male. In all, 63.33% were male. Commonest route of transmission was heterosexual intercourse, most presented at World Health Organization (WHO) stage 1 (64.17%). In all, 77.5% had hypertension and 26.6% had tuberculosis. The median CD4 count at presentation was 245 cells/mm3 (145-426 cells/mm3). Forty-two percent were late presenters (CD4 <200 cells/mm3). Conclusion: Treating physician should have a high index of suspicion in diagnosing HIV among elderly age-group.

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