scholarly journals Study of changes in non-stress test following antenatal corticosteroid therapy in preterm pregnancy

2019 ◽  
Vol 8 (11) ◽  
pp. 4435
Author(s):  
Renuka S. ◽  
Sathiya S. ◽  
Famida A. M. ◽  
Vijayalakshmi K. ◽  
Sailatha R.
Keyword(s):  
Tamil Nadu ◽  
Stress Test ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Morbidity And Mortality ◽  
Major Public Health Problem ◽  
Care Hospital ◽  
Antenatal Corticosteroid ◽  
Corticosteroid Administration

Background: Preterm birth is the largest unsolved problem in obstetrics and the single most significant cause of neonatal morbidity and mortality. Preterm labour constitutes 5-10% of pregnancies and is the leading cause of neonatal morbidity and mortality worldwide. It is a major public health problem in terms of loss of life, long term disability (cerebral palsy, blindness, deafness, chronic lung disease). The objectives of this study were to determine whether antenatal corticosteroid administration affects the non-stress test. To evaluate the effect of antenatal steroid on foetal movements. To assess the incidence of respiratory distress syndrome and neonatal mortality after antenatal corticosteroid administration.Methods: All antenatal cases between 28-32 weeks of gestation judged to be at risk for preterm delivery attending the outpatient department or admitted in a tertiary care hospital, Tamil Nadu during the study period of 3 years.Results: The present study was undertaken to evaluate the NST for a period of 3 days following antenatal corticosteroid administration and to study the immediate changes in the mother and the foetus. We found out that there was a statistically significant change (p <0.01) in non-stress test when compared with the pre-betamethasone assay.Conclusions: Corticosteroids can cause metabolic alterations in mother, short- and long-term effect in the foetus.

scholarly journals Microbiological Profile of Neonatal Septicemia by Automated Blood Culture System (BacT/ALERT) at a Tertiary Care Hospital in Jamnagar, Gujarat, India

2021 ◽  
pp. 17-22
Author(s):  
J. Ghedia Bindiya ◽  
Manish R. Shah
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Signs And Symptoms ◽  
Morbidity And Mortality ◽  
Automated System ◽  
Care Hospital ◽  
Coagulase Negative Staphylococci ◽  
Neonatal Septicemia ◽  
Gram Negative Organisms

Background: This study was carried out to do rapid diagnosis of neonatal septicemia to prevent septicemia related complications and neonatal morbidity and mortality. Materials and Methods: This study was carried out in a tertiary care hospital from a period of March 2014 to August 2015. This is a non-randomized, prospective study in which one hundred and nine cases of suspected neonatal septicemia on the basis of antenatal high risk factors and signs and symptoms of sepsis were studied. Blood samples were collected from neonates in whom septicemia was suspected usually before antibacterial agents were given and both positive and negative samples were detected by automated system BacT/ALERT. Results: Out of 109 samples tested, 69 samples were positive and 40 samples were negative. The incidence of neonatal septicemia due to Gram positive organisms (62.85%) was found to be high. Among them Coagulase negative staphylococci (CONS) (27) (38.57%) was most common organism followed by Staphylococcus aureus (11) (15.71%), Enterococcus spp. (7.14%) and Streptococcus spp. (1.43%). Rate of Gram negative organisms was quite low (32.85%). Out of them Acinetobacter spp. (17.14%) was most common followed by Klebsiella spp. (7.14%), E.coli (5.71%) and Pseudomonas spp. (2.86%). Conclusion: Early detection of infection in neonates and proper antibiotics for the treatment leads to reduced morbidity and mortality.

scholarly journals Outcome of Spinal Anesthesia during Emergency Cesarean Section for Severe Preeclampsia and Eclampsia Patients in a Tertiary Care Hospital

2019 ◽  
Vol 9 (3) ◽  
pp. 170-176
Author(s):  
Ashraful Islam ◽  
Easnem Khanum ◽  
Samiul Alom ◽  
Sumia Bari Sumi ◽  
Nasima Begum ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Severe Preeclampsia ◽  
Morbidity And Mortality ◽  
Anesthetic Technique ◽  
Close Monitoring ◽  
Care Hospital ◽  
Emergency Cesarean ◽  
Thiopental Sodium

Background: In Bangladesh eclampsia and severe preeclampsia or toxemia (PET) are the leading cause of perinatal morbidity and mortality. Its management is challenging for the obstetrician and anesthesiologist. Still now general anesthesia is commonly practiced for emergency LUCS in developing countries, but the outcome of spinal anesthesia is better than GA. Recently in developed countries like the UK and United States, spinal anesthesia is also accepted as a safer anesthetic technique. Objective: The objective of our study was to establish spinal anesthesia as a preferable method to reduce maternal and neonatal morbidity and mortality during emergency LUCS in severe PET and eclampsia patients. Materials and Methods: The study was done in the Department of Anesthesiology and ICU of Enam Medical College & Hospital, Savar, Dhaka during the period from January 2016 to December 2017. Total 62 cases of severe PET and eclampsia patients were selected by subarachnoid block for emergency LUCS. Each patient was given magsulph as prophylactic or maintenance dose and judiciously preloaded by crystalloid fluid. Thiopental sodium 50−100 mg was given to those who had convulsion during SAB. About 2−2.5 mL (10−12.5 mg) 0.5% bupivacaine heavy was used by 25−27 G spinocaine in L3−4 or L4−5 space. After the establishment of the desired block, LUCS was performed. Meticulous monitoring was done and all events were recorded and problems were effectively managed. Results: Our study shows higher maternal (96.6%) and neonatal (95.17%) success rate. Almost all patients were eclamptic (74.19%), primi (59.67%), term pregnancy (64.51%), aged between 21–30 years (43.54%) and rest of them had preeclampsia (25.80%), multigravida (40.32%), preterm (35.48%), aged <20 years (25.80%) and aged >30 years (30. 64%). Thiopental sodium was given in 9.65% cases for controlling convulsion during LUCS. Remarkable complications were hypotension (33.87%) with highly significant p value (0.000) and bradycardia (27.41%). Conclusion: With close monitoring of perioperative events, spinal anesthesia may be given as a safe alternative technique in severe preeclampsia and eclapmsia rather than GA or epidural even in cases of altered consciousness or restless in presence of an expert and skilled anesthesiologist and thereby perioperative maternal and neonatal morbidity and mortality will be reduced. J Enam Med Col 2019; 9(3): 170-176

scholarly journals Study of respiratory disease pattern in children aged 2 months-5 years admitted in a tertiary care hospital

2021 ◽  
Vol 8 (6) ◽  
pp. 1070
Author(s):  
Raja S. R. ◽  
Shabin J. ◽  
Mathivanan M. ◽  
Muthu Rama Subramanian M.
Keyword(s):  
Risk Factors ◽  
Tamil Nadu ◽  
Tertiary Care Hospital ◽  
Respiratory Infections ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Acute Respiratory Infections ◽  
Care Hospital ◽  
Use Of Resources ◽  
Common Diagnosis

Background: Acute respiratory infections (ARI) is one of the leading causes of under 5 mortality globally and in India. India accounts for 20% of deaths globally due to pneumonia. Reviewing the prevalence and profile of pneumonia admissions in a tertiary care hospital will reflect the burden in the community and thereby help to plan optimal use of resources and adopting proper preventive measures. Aim of study was to identify prevalence, various risk factors involved, morbidity and mortality of acute respiratory infections in children 2 months to 5 years old.Methods: A prospective observational study conducted at a tertiary care teaching hospital of southern Tamil Nadu, India over a period of 18 months (January 2016 to June 2017). All cases between the age group of 2 months to 5 years admitted to Paediatric department were included in the study. Demographic and clinical features were recorded. Statistical analysis was done using SPSS version 22.0.Results: A total of 2793 children were included, of which the prevalence of acute respiratory infection was 10.95% (306 children). Pneumonia was the most common diagnosis (38.5%) followed by bronchiolitis (15.3%). Mortality rate was 5.9% among the ARI cases. There was a significant influence of exclusive breast feeding and malnutrition over the morbidity and mortality of ARI cases.Conclusions: Identifying ARI cases with risk factors for developing severe and very severe pneumonia and children with risk factors for high mortality need to be referred to tertiary care centres as early as possible for better outcome.

scholarly journals Perinatal and Neonatal Outcomes of Triplet Gestations Based on Chorionicity

2017 ◽  
Vol 07 (01) ◽  
pp. e59-e63 ◽  
Author(s):  
Maureen Downing ◽  
Suela Sulo ◽  
Barbara Parilla
Keyword(s):  
Intrauterine Growth Restriction ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Neonatal Outcomes ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Intrauterine Growth ◽  
Increased Risk ◽  
Prenatal Management ◽  
Baseline Characteristics

Objective To compare perinatal and neonatal outcomes of dichorionic (DC) and monochorionic (MC) with trichorionic (TC) triplet gestations. Methods A retrospective cohort study of DC + MC versus TC triplet gestations delivered at a tertiary care hospital from 2009 to 2015. The results include 42 sets of triplets (TC, n = 26; DC + MC, n = 16). Maternal demographics and pregnancy data were compared. Neonatal outcomes were assessed using composite morbidity and mortality. Results Maternal baseline characteristics including age, mode of conception, race, parity, body mass index, and previous preterm delivery were statistically comparable. Comparison of prenatal management and complications yielded no significant differences in terms of presence of shortened cervix, cerclage placement, use of tocolytics, intrauterine growth restriction, premature rupture of membranes, pregnancy-induced hypertension, or gestational diabetes. However, evaluation of composite morbidity and mortality (RDS, IVH, NEC, IUGR, and death) illustrated that all infants born from DC + MC triplet gestations suffered some morbidity or mortality compared with TC pregnancies (p < 0.01). Conclusion DC + MC triplet gestations are at an increased risk of neonatal morbidity and mortality compared with TC triplet gestations.

scholarly journals Knowledge on cervical cancer and perceived barriers to the uptake of HPV vaccination among health professionals

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Poongodi Chellapandian ◽  
Sindhura Myneni ◽  
Divya Ravikumar ◽  
Padmavathy Padmanaban ◽  
Kavin Mozhi James ◽  
...  
Keyword(s):  
Health Care ◽  
Cervical Cancer ◽  
Health Care Professionals ◽  
Tamil Nadu ◽  
Healthcare Professionals ◽  
Hpv Vaccination ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Care Hospital

Abstract Background Despite the fact that cervical cancer is preventable and curable in the early stages, it still remains to be a major public health problem in India. This study was conducted to assess the knowledge and awareness regarding the Human Papilloma Virus (HPV) vaccination among health care professionals working in a tertiary care hospital in urban India. Methods To this aim, we conducted a cross-sectional study among 318 health care professionals working in tertiary hospitals across Chennai, Tamil Nadu, India. Our research group designed a structured questionnaire with 31 items to assess the knowledge and attitudes on cervical cancer, its prevention, and HPV vaccination. Results Among the 318 respondents, 90.6% were aware of cervical cancer, 83.3% were aware that PAP (Papanicolaou) smear test detects cervical cancer, and 86.2% of the respondents knew that HPV causes cervical cancer. 29.2% of the eligible respondents underwent the screening against cervical cancer, and 19.8% of the study participants were vaccinated for HPV. Only 34.9% know that the HPV vaccine could be given to boys. The most common reason for not being vaccinated against HPV was the lack of awareness. In our study, 77.2% of the respondents were willing to be vaccinated and recommend HPV vaccination to their family members. Conclusion From this study, it was evident that there is a lack of awareness about HPV vaccination and its importance in preventing cervical cancer among healthcare professionals. Our finding clearly establishes the need to devise intervention programs to promote vaccination against HPV and periodical screening for cervical cancer among healthcare professionals.

scholarly journals Pattern of Acute Poisoning Attending a Tertiary Care Hospital of Western Nepal

2016 ◽  
Vol 4 (2) ◽  
pp. 90
Author(s):  
Raju Prasad Shakya ◽  
Suraj Adhikary ◽  
Rohit Bajracharya
Keyword(s):  
Tertiary Care ◽  
Public Health Problem ◽  
Tertiary Hospital ◽  
Acute Poisoning ◽  
Oral Route ◽  
Morbidity And Mortality ◽  
Major Public Health Problem ◽  
Care Hospital ◽  
Effective Prevention ◽  
Awareness Programs

Introduction: Poisoning with various substances is a major public health problem and a reason for significant morbidity and mortality throughout the globe. It is one of the most common presentation in an emergency department. This study was conducted to determine the sociodemographic, poisoning types, and mode of poisoning in cases attending a tertiary hospital of Western Nepal.   Methods: A retrospective observational study of two years was conducted from July 2014 to June 2016. Demography details, name of poisonous substance, and reasons for poisoning were reviewed and analyzed using descriptive statistics.   Results: A total of 65 cases of poisoning were recorded. The occurrence was more common in female (n=44, 67.7%) than in male (n=21, 32.3%) with a F:M ratio of 2.1:1.  Poisoning  was most  common in the age group of 11-20 years (32.3%). Most of the cases were students (37%) followed by farmers (26%). The most commonly abused poisoning substance were organophosphorous compounds, zinc-phosphate,  and  kerosene in adults, adolescents, and children respectively. Oral route was the most common (99%) route of administration. Suicidal attempt, as a mode of poisoning, accounted for 70.8% of total poisoning cases.   Conclusion: Female and young people are at greater risk of acute poisoning. Insecticide was the most common agent and self administer poisoning was the most common mode of poisoning. The occurrence of poisoning and its morbidity and mortality can be reduced by developing and implementation of effective prevention strategies like restricting easy poison sales, establishing drug and poison information centers,  and community awareness programs.

scholarly journals Frequency, risk factors and materno-foetal outcomes among cases of Placenta previa at a tertiary care hospital: a two year study

2019 ◽  
Vol 8 (6) ◽  
pp. 2240
Author(s):  
Pamulaparthi Bindu Reddy ◽  
Gurram Swetha Reddy
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Tertiary Care Hospital ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Previous History ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Early Date

Background: Placenta previa refers to the presence of placental tissue that extends over the internal cervical os.  Placenta previa is linked to maternal hypovolemia, anaemia, and long hospital stay and with prematurity, low birth weight, low APGAR score in newborn. So it is very important to identify the condition at an early date to warn the condition thereby reducing the maternal and foetal morbidity and mortality. The present study was aimed to estimate the prevalence of PP, its associated predisposing risk factors and maternal morbidity, mortality and the perinatal outcome.Methods: A prospective observational study for two years was conducted at a tertiary care hospital. Pregnant mothers with >28 weeks of age with H/o ante partum haemorrhage were screened for placenta previa, confirmed by ultra sonography and included in the study. Clinical history, obstetric examination was done and followed up till the delivery. Maternal and foetal outcomes were recorded. Data analyzed by using SPSS version 20.Results: 1.4% incidence of PP was noted, mean age of group was 29.17±1.6 years. Age group of 21-30 years, multiparity Gravida 2-4, previous history of caesarean section and less number of ante natal checkups were significant risk factors and LSCS was most common outcome. Prematurity, low birth weight and APGAR <7 score for 1 minute was common foetal outcomes.Conclusions: Our study strongly suggests foetal surveillance programmes in cases of placenta previa. Measures should be made to bring awareness about PP, in urban slums and to increase medical checkups regularly. Making USG mandatory during every ANC and referral of cases of PP to tertiary care centres would definitely reduce the chances of morbidity and mortality.

FC 096THE EFFECT OF INCREMENTAL START OF HAEMODIALYSIS ON BLOOD PRESSURE AND INTERDIALYTIC WEIGHT GAIN: PRELIMINARY FINDINGS FROM THE ENDURE STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Adil Hazara ◽  
Victoria Allgar ◽  
Maureen Twiddy ◽  
Sunil Bhandari
Keyword(s):  
Blood Pressure ◽  
Propensity Scores ◽  
Phase 1 ◽  
Tertiary Care ◽  
Residual Renal Function ◽  
Care Hospital ◽  
Interdialytic Weight Gain ◽  
Matching Criteria ◽  
The Impact

Abstract Background and Aims Mortality rates are high in patients starting haemodialysis/haemodiafiltration (HD) therapy. Incremental HD may help reduce this risk by reducing the burden of early treatment whilst patients are still adapting to long-term HD therapy. A feasibility study (ENDURE study – Clinical trials ID: NCT04268264) is being conducted with the primary objectives of evaluating the acceptability and tolerance of a new incremental HD regime. Its secondary aims are to evaluate the impact of this form of incremental HD on indicators of patient safety and wellbeing. These indicators include blood pressure (BP) control and interdialytic weight gains (IDWG) which are independently associated with adverse cardiovascular outcomes in patients on long-term HD. We present preliminary findings from the study related to systolic BP and IDWG. Method The ENDURE study is being carried out at a tertiary care hospital in the United Kingdom. Patients aged &gt; 18 years known to renal services for at least 90 days, referred for start of HD, were eligible for participation. Following approved consenting procedures, they are started on a new regime of incremental HD starting dialysis twice weekly with progressive increases in the duration and frequency of sessions over 15 weeks. This period is split in to four phases; phase 1 representing the first two days of dialysis (baseline) whereas phases 2 – 4 representing the pre-specified incremental steps. Propensity scores were calculated to match each participant (incremental HD group) with two controls from a database of patients who previously started HD at our centres using the standard protocol of 3 times weekly, 4hr long sessions. The matching criteria accounted for 14 key demographic, clinical and laboratory characteristics. Results were analysed as intention to treat. In comparing BP and IDWG between the two groups, only readings taken pre-dialysis at the first session of the week was considered. This study has been approved by the West of Scotland Research Ethics committee-4 (Ref: 19/WS/0019). Results Baseline characteristics of the first 15 participants (target 20) and their matched controls are presented in table 1. The proportion of females and duration of previous specialist input was higher in the incremental HD group. Conclusion The ENDURE study tests the feasibility of starting patients on a novel incremental HD regime. Early data suggest that control of systolic BP and IDWG are comparable to patients who start dialysis at 3 times weekly. Further work is needed to understand the impact of reducing dialysis frequency on BP control correlating the findings with changes residual renal function and objective measures of fluid overload.

Abstract 147: Hypertension-related Admission and Mortality at a Referral Hospital in Tanzania - A Call to Action

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Naomi Shike ◽  
Santosh Vardhana ◽  
Judith Briant ◽  
Robert Peck
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Tertiary Care ◽  
Sub Saharan Africa ◽  
Morbidity And Mortality ◽  
Hospital Death ◽  
Care Hospital ◽  
Common Cause ◽  
Related Disease ◽  
Reasonable Approach

Introduction The WHO has been increasingly emphasizing and calling for research on the vast unattended burden of non-communicable diseases in the developing world. Hypertension (HTN) in particular is thought to play a growing role in morbidity and mortality in these regions, but has yet to gain significant momentum in public health initiatives. Objective To determine what role HTN and comorbid diseases play in admission and mortality in Bugando Medical Center (BMC), a tertiary care hospital in Tanzania serving 13 million people. Methods We conducted a retrospective analysis of all patients admitted to the internal medicine service at BMC over 34 months between 2008 and 2011. Data on admission diagnoses and mortality had been collected prospectively by Tanzanian doctors in hand-written logs. For patients with heart failure or stroke, the ward logs specified if this was primarily related to hypertension or other risk factors. Data were copied into an Excel database and analyzed to determine the proportion of admissions and deaths primarily related to hypertension. Results In 34 months 8,037 patients were admitted and 1,508 died. HTN-related disease led to 1,997 admissions (25%), while HIV-related illness led to 2,076 (26%). Similarly, HTN led to 377 deaths (25%) and HIV to 579 (38%). HTN-related disease was second only to HIV-related disease as a cause of admission and death. Among hypertensives, the most common cause of admission was congestive heart failure (446; 27%) and of death was stroke (147; 49%). In non-hypertensives, HIV-related disease was the most common cause of both admission (2029; 32%) and death (566; 46%). Conclusions HTN-related disease was second only to HIV as a cause of admission to our hospital and in-hospital death. Better strategies for early diagnosis and treatment of HTN are desperately need in sub Saharan Africa to prevent this morbidity and mortality. Building HTN screening and treatment on top of the extensive infrastructure for HIV disease may be a reasonable approach.

Assessing the Severity of Acute Pancreatitis with CT Severity Index and Other Conventional Methods in a Tertiary Care Hospital in Tamil Nadu, India – A Comparative Cross-Sectional Study

2021 ◽  
Vol 8 (41) ◽  
pp. 3541-3546
Author(s):  
Jayaprakash Subramani ◽  
Rajesh Prabhu ◽  
Jagadeesapandian Palpandi
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Predictive Value ◽  
Tamil Nadu ◽  
Objective Assessment ◽  
Tertiary Care ◽  
Severity Index ◽  
Apache Ii ◽  
Care Hospital ◽  
Male Predominance

BACKGROUND Acute pancreatitis is not uncommon in surgical practice with variable clinical presentation. Because of its potential notable catastrophic complications, it is mandatory to assess the severity at the earliest. In recent times, the decision making in the management is quite difficult due to its complications and outcome. So, an objective assessment of severity based on clinical and laboratory scoring verses computed tomography (CT) severity is still debate, hence the need for study. The purpose of this study was to compare the efficiency of CT severity index verses APACHE II and Ranson criteria in predicting the severity of acute pancreatitis. METHODS A total number of 36 consecutive cases of acute pancreatitis who were admitted between January 2013 and December 2014 in Apollo Specialty Hospitals – Madurai were included in the study. Written informed consent was obtained from all study participants. RESULTS In our study, out of 36 patients, 30 (83.33 %) were males and 6 (16.66 %) were females. The sex distribution shows a clear male predominance. Most of the patients in the present study belonged to the middle age group. Alcohol was the most common cause accounting for 41.7 % of the cases followed by the billiary pathology. CT severity index was the superior tool for prediction of the prognosis and early complications. CONCLUSIONS When using contrast enhanced computed tomography, it was found that there was a significant correlation between the development of organ failure and severity of pancreatitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Ranson and acute physiology and chronic health evaluation – II (APACHE II) at 48 hours of admission with acute pancreatitis does not correlate in determining the severity of acute pancreatitis. KEYWORDS Acute Pancreatitis, Severity Markers, CT Severity Index

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