A study to test the validity of diabetic ulcer severity score (DUSS) at tertiary care hospital

Background: For classification of ulcer of feet in diabetes, various systems of classification are in use. Notable among them are the University of Texas (UT) system and the Wagner system. One of the most recent such type of classification system is DUSS (Diabetic Ulcer Severity Score). Studies are required to validate the same. Objective was to test the validity of Diabetic Ulcer Severity Score (DUSS).Methods: Present follow up study was carried out among 50 known cases of diabetes having ulcer over foot. DUSS scoring was applied. Ulcer was graded into five grades. Patients were followed till the outcome was noted.Results: Most common ulcers were of DUSS score of 3. Major amputation was done in 15 (30%) patients and minor amputation in 12 (24%) patients. Toe amputation was done in total of 15 patients. None of the patients had forefoot amputation. Below knee amputation was done in total of 11 (22%) patients. Majority of the foot ulcers among study population with DUSS score 0, 1 and 2 healed by primary intension or skin grafting i.e., 1 (100%), 3 (75%) and 6 (46.15%) respectively. However, among those with score 3 and 4 majority required amputation i.e., 14 (70%) and 10 (83.33%) respectively. This difference in the DUSS score among the three groups was found to be statistically significant (P=0.004). The probability of healing with DUSS score 0 was 100%, 75% with DUSS score 1, 84.61% with DUSS score 2, 30% with DUSS score 3, 16.67% with DUSS score 4. The mean time for healing was 77 days. The mean time for amputation was 100 days.Conclusions: The proposed score classification system for the diabetic foot may enable better quality of life for diabetic patients and promote better low-cost care for millions of individuals worldwide.

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ETIOLOGICAL AND CLINICAL PROFILE OF CASES OF CHRONIC LEG ULCERS ADMITTED IN TERTIARY CARE HOSPITAL OF TELANGANA

10.36106/gjra/8604464 ◽

2020 ◽

pp. 1-3

Author(s):

mohd Abdul Rehman

Keyword(s):

Varicose Veins ◽

Tertiary Care ◽

Skin Grafting ◽

Tertiary Hospital ◽

Healing Time ◽

Care Hospital ◽

Wide Range ◽

The Mean ◽

Mean Time ◽

Chronic Leg Ulcers

Clinical study of Chronic leg ulcer (CLU) was carried out at local Telangana tertiary hospital revealed certain important data. Incidence of CLU were more common in above 51yrs(45%), in males (72%) and in diabetics (34%). Followed by venous (26%), traumatic (16%), arterial (9%), malignant (5%), trophic (3%) and other ulcers (7%). Among 26 patients with varicose veins, 23 underwent surgery in form of Trendelenburg's operation, ligation and sub-fascial ligation. 2 patients with DVT underwent skin grafting. The mean time for healing was 16.4 days. Among 34 diabetics, 30 were managed with regular dressings, antibiotics, slough excision and or debridement along with anti-diabetics. Four patients underwent amputation and 12 underwent skin grafting which healed in average of 11days. However, mean healing time was 21.5 days. With availability of lab investigations, wide range of antibiotics and with ever improving dressing material, there is certainly a great improvement in treatment of CLUs.

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Prevalence of diabetic complications and risk factors among diabetic foot ulcer patients: a retrospective hospital-based study

International Surgery Journal ◽

10.18203/2349-2902.isj20184631 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3608

Author(s):

Shanmuga Raju P. ◽

Venkata Ramana N. ◽

Surya Narayana Reddy V. ◽

Bhagya Seela S. ◽

Sachin G.

Keyword(s):

Risk Factors ◽

Health Care ◽

Blood Sugar ◽

Diabetic Foot ◽

Tertiary Care ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Diabetic Patients ◽

Care Hospital ◽

The Mean

Background: Diabetic foot ulcer is a painful, demands increased health care utilization, and increases healthcare costs for the patients as well as the health care system. The purpose of this study was to analysis the prevalence of diabetic foot complications and risk factors among diabetic patients at tertiary care Hospital, Karimnagar.Methods: Total 60 sample sizes were included in the study. The study was conducted at General Surgery ward, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar from July 2017 to June 2018. Demographic, complications and risk factors were recorded, and outcomes were analyzed using SPSS statistics version 21.0.Results: The Mean age of the study group is 50.31±14.26 years. The male to female distribution is 47 (78.3%) and 13 (21.7%) respectively. The mean duration of illness in days is 96.68±289.21, while mean HbA1C is 9.44±9.02. The mean fasting blood sugar and postprandial blood sugar is 159.78±70.01 and 157.78±86.28 which shown no significance difference (p = 0.87). Odds ratio with 95% confidence interval was computed to the level of significant.Conclusions: There was no significant outcome was found in diabetic foot ulcer. Patient with high risk complications need as early detection, foot care education, moderate physical, exercise, fitted foot wear and diabetic diet should be decrease the risk of diabetic foot ulcers.

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EFFECT OF DIABETES MELLITUS ON RIFAMPICIN PEAK SERUM CONCENTRATION

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2016v8i10.13238 ◽

2016 ◽

Vol 8 (10) ◽

pp. 149

Author(s):

Saranya P. ◽

Parthasarathy V. ◽

Hariprasad B. ◽

Shobha Rani H.

Keyword(s):

Diabetes Mellitus ◽

Serum Concentration ◽

Pulmonary Tuberculosis ◽

Tertiary Care ◽

Peak Serum Concentration ◽

Peak Serum ◽

Diabetic Patients ◽

Care Hospital ◽

Significant Difference ◽

The Mean

Objective: To comparatively analyze the peak serum concentration (Cmax) of rifampicin and to determine the incidence of decreased Cmax between diabetic and non-diabetic adult pulmonary tuberculosis patients.Methods: A cross-sectional observational study was carried out in the chest and tuberculosis (TB) department of a tertiary care hospital after the approval of the institutional ethics committee. Five millilitre (ml) of blood was withdrawn by venipuncture from each patient at a time point of 2 h post dose administration at steady state concentration (Css). The separated serum was centrifuged at a rate of 3500 rotations per minute (rpm) for a period of fifteen minutes and the resultant serum was stored at-70 ° C until analysis. Estimation of rifampicin concentration was carried out in Thermo TSQ Ultra (MS/MS) with Shimadzu 20 AD UFLC LC-MS.Results: The mean (Standard Deviation (SD)) age of the study population was 46.8 (14.2) years. The mean serum Cmax of rifampicin was significantly less in diabetic patients with pulmonary tuberculosis (p=0.0305). Statistically, a significant difference in the incidence of a decrease in Cmax was found between diabetic and non-diabetic patients (p=0.0335). Diabetes mellitus was found to be the predominant factor that affects rifampicin Cmax.Conclusion: In this study, an effect of diabetes mellitus (DM) on the peak serum concentration of rifampicin was observed. Patients with hyperglycemia levels had significantly reduced levels of rifampicin serum concentrations, thus showing an inversely proportional relationship between blood glucose and rifampicin serum levels.

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To explore the impact of following the pre-operative fasting guidelines by ASA (American society of anesthesiologists), in improving patient outcome.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.07.4783 ◽

2021 ◽

Vol 28 (7) ◽

pp. 1018-1021

Author(s):

Maqsood Ahmed Siddiqui ◽

◽

Ashok Perchani ◽

Hamid Raza ◽

Ahmeduddin Soomro ◽

...

Keyword(s):

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Start Time ◽

Time Duration ◽

Cross Sectional ◽

Emergency Procedures ◽

The Mean ◽

The Impact ◽

Mean Time

Objective: To analyze the occurrence and consequences of a prolonged preoperative-fasting. Study Design: Cross-sectional study. Setting: Large tertiary care hospital in Pakistan. Period: October 2018 to October 2019. Material & Methods: We collected data for all the procedures that occurred during the study period and divided the cases into emergency procedures, add-on procedures and elective cases. We excluded the first cases of the day and excluded the emergency and add-on cases. We studied the patients NPO duration and their scheduled start time of the procedure and compared with their actual start time of the procedure. Results: The study population was n= 434 cases. Of these 434 cases n= 164 cases were performed on time and n= 270 cases were delayed by 60 minutes or more from their scheduled time. The most frequent reason was a previous cases running longer than expected in 59.25% of the cases, the second most common reason was a change in sequence and order of the procedures which was the case for delay in 14.44% of the cases. The overall mean time of NPO for the patients was found to be 770.1 +/- 130.6 minutes, for the delayed cases the mean time duration of NPO was 812.3 +/- 105.3 minutes. The mean time of case delay was 155.2 +/- 102.7 minutes for overall cases and for the significantly delayed case the mean time period of delay was 190.2 +/- 92.1 cases. Conclusion: Our results showed that 60% of the cases have a prolonged NPO status due to delays in start of their surgical procedure as compared to the scheduled times.

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Evidence generation to guide policymaking for effective control of progress of diabetes mellitus

The Journal of Medical Research ◽

10.31254/jmr.2020.6610 ◽

2020 ◽

Vol 6 (6) ◽

pp. 302-304

Author(s):

Muley Arti ◽

◽

Sanghavi Anshool ◽

Mansuri Raihaan ◽

◽

...

Keyword(s):

Diabetes Mellitus ◽

Tertiary Care ◽

Effective Control ◽

Diabetic Patients ◽

Care Hospital ◽

Public Health Policies ◽

Validated Questionnaire ◽

The Mean ◽

Evidence Generation

Background: Currently data on awareness and attitude of patients about diabetes in India is scanty which is extremely important to plan public health policies aimed at preventing and controlling diabetes. Objective: This study was done to assess the knowledge, attitude and practices related to diabetes amongst patients coming to a rural tertiary care hospital. Methods: It was a questionnaire based study. 112 diabetic patients above the age of 18 years were included in the study and were assessed regarding 3 domains - knowledge, attitude and practices (KAP), about diabetes based on a structured, validated questionnaire. Each question was given a score, the maximum possible score being + 36 and minimum possible score being -18. Results: The mean age of the subjects was 50.91±8 years with the overall maximum KAP score of the subjects being 24 and minimum being -1, with mean score being 12.4. Conclusion: Although patients were knowledgeable and had a positive approach to a certain extent towards their disease, the same was not reflected in their daily practices towards diabetes mellitus. Policies and schemes targeted towards informing patients specifically regarding the complications of diabetes and significance of exercises in controlling diabetes and thus reducing progression to complications may lead to positive practices and aid in reducing morbidity due to type 2 diabetes.

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Clinical profile of post flood fever in a tertiary care hospital in Kerala

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20213917 ◽

2021 ◽

Vol 9 (10) ◽

pp. 2971

Author(s):

Bhagyanath T. ◽

Anoop Joseph ◽

Jacob K. Jacob ◽

Suma Samuel ◽

Rakhi R. Kurup ◽

...

Keyword(s):

Tertiary Care Hospital ◽

Renal Involvement ◽

Tertiary Care ◽

Clinical Findings ◽

Care Hospital ◽

Unified Approach ◽

Source Of Infection ◽

Hepatic Involvement ◽

The Mean ◽

Mean Time

Background: Floods are an important source of infection epidemic worldwide. Analysis of different infections presenting during floods can lead us to have a unified approach during such periods.Methods: This study describes the clinical features of fever patients presented to a tertiary care hospital in Kerala after the 2018 flood. Clinical findings of the confirmed leptospirosis cases were also compared with non-leptospirosis cases.Results: A total of 48 patients with fever and myalgia were studied and majority of them were males (77%). 40 patients had contact with contaminated water. But only 10 of them had taken prophylactic doxycycline. Complications were seen less among those who took prophylactic doxycycline. The mean time from the first symptom to first medical care was 4.4 days. Leptospirosis was seen among 15 patients and 2 patients had dengue fever. Hepatic involvement and renal involvement were seen significantly higher among leptospirosis patients.Conclusions: This study emphasized the importance of prophylactic doxycycline and early initiation of antibiotics during flood outbreaks. Awareness among treating doctors and patients is required for the control of outbreaks and prevention of mortality during floods.

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Early detection of laryngeal cleft in infants by novel technique of flexible endoscopy with sustained pharyngeal inflation

10.22541/au.163590608.83566966/v1 ◽

2021 ◽

Author(s):

Wen-Jue Soong ◽

Chia-Feng Yang ◽

Pei-Chen Tsao ◽

Yi-Hung Sung ◽

Yen-Hui Soong

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Flexible Endoscopy ◽

Type I ◽

Care Hospital ◽

Type Ii ◽

Novel Technique ◽

Detailed Assessment ◽

The Mean ◽

Mean Time

Objective: Report a novel technique of flexible endoscopy (FE) with noninvasive ventilation (NIV) and sustained pharyngeal inflation (FE-NIV-SPI) in assessing aeroesophageal tracts (AET) to facilitate early detect laryngeal clefts (LC). Methods: Medical charts and FE videos of the children who were diagnosed as LC in a tertiary care hospital between 2000 and 2020 were retrospectively reviewed and analyzed. FE-NIV-SPI technique was applied for all the reviewed children. Results: Of all the FE videos reviewed, twelve infants with laryngeal clefts were collected. This equates to a prevalence of 0.28% in all the children underwent FE at our institution. Their mean age was 5.0 ± 4.9 month-old and the mean body weight was 4.7 ± 2.3 kg. Nine (75%) infants were referred in without LC diagnosis, which was missed by 11 prior bronchoscopy and 5 computer tomography exams. With FE-NIV-SPI, the pharyngolaryngeal space could be pneumatically expanded and allowed detailed assessment. All LC types and coexisted AET lesions were visualized at the first FE-NIV-SPI examination with a mean time of 4.2 ± 0.9 minutes. They were eight type I, two type II and one type III. Ten (83.3%) infants coexisted airway malacia. Conclusion: Routinely using the FE-NIV-SPI technique can help detect the LC defect and associated AET lesions at the first assessment.

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Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.9.peds14207 ◽

2015 ◽

Vol 15 (4) ◽

pp. 420-426 ◽

Cited By ~ 32

Author(s):

Esther L. Yue ◽

Garth D. Meckler ◽

Ross J. Fleischman ◽

Nathan R. Selden ◽

Dianna M. E. Bardo ◽

...

Keyword(s):

Tertiary Care ◽

Surgical Revision ◽

Shunt Malfunction ◽

Csf Shunt ◽

Care Hospital ◽

Shunt Pathway ◽

Test Characteristics ◽

The Mean ◽

Study Completion ◽

Mean Time

OBJECT Quick brain magnetic resonance imaging (QB-MRI) is a rapid, radiation-free technique to detect life-threatening CSF shunt malfunction. QB-MRI has not been widely studied or adopted. The primary objective of this study was to evaluate the test characteristics of QB-MRI for detecting shunt malfunction. Test characteristics of brain computed tomography (CT) and QB-MRI were then compared. Secondary objectives included comparison of time to study completion and use of sedatives for both modalities, as well as comparison of time to study completion for QB-MRI before and after implementation of a Pediatric Emergency Department (PED) shunt clinical pathway. METHODS A retrospective chart review was performed at 2 tertiary care hospital PEDs. The authors reviewed the charts of children who underwent QB-MRI or CT for suspected shunt malfunction between July 2008 and June 2012. They also reviewed the patients' neuroradiology reports and classified ventricular size as positive (enlarged) or negative (normal, smaller, or unchanged). Shunt malfunction was defined by surgical revision within 30 days. RESULTS Nine hundred ninety-seven PED visits (involving 724 QB-MRIs and 273 CTs) were included. Surgical revision was performed in 235 cases (23.6%). For QB-MRI, sensitivity was 58.5% (95% CI 51.1%–65.6%) and specificity was 93.3% (90.8%–95.3%). For CT, sensitivity was 53.2% (95% CI 38.1%–67.9%) and specificity was 95.6% (92%–97.9%). The mean time to completion of QB-MRI was 115 minutes versus 83 minutes for CT (difference 32 minutes, 95% CI, 22–42 minutes, p < 0.001). The mean time from presentation to completion of QB-MRI prior to application of the CSF shunt pathway was 132 minutes versus 112 minutes after application of the CSF shunt pathway (difference 20 minutes, 95% CI 5–35 minutes, p = 0.01). Anxiolytic medications were used in 3.7% of CT studies and 4.4% of QB-MRI studies (p = 0.74). CONCLUSIONS QB-MRI and CT have similar test characteristics for detecting CSF shunt malfunction in children and similar requirements for sedation. The longer interval from order placement to imaging completion for QB-MRI is arguably justified by reduction of radiation exposure in this population subject to frequent brain imaging.

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Frequency of Dyslipidemia in Patients with Type-II Diabetes Mellitus

10.53350/pjmhs211582243 ◽

2021 ◽

Vol 15 (8) ◽

pp. 2243-2245

Author(s):

Bilal Rafique Malik ◽

Aneeqa Ilyas ◽

Rehan Anwar

Keyword(s):

Diabetes Mellitus ◽

Lipid Profile ◽

Type Ii Diabetes ◽

Tertiary Care ◽

Type Ii Diabetes Mellitus ◽

Diabetic Patients ◽

Care Hospital ◽

Type Ii ◽

Pathology Laboratory ◽

The Mean

Introduction: Dyslipidemia is one of the major risk factors for cardiovascular disease in diabetes mellitus. Early detection and treatment of dyslipidemia in type-2 diabetes mellitus can prevent risk for atherogenic cardiovascular disorder. Objective: To determine the frequency of dyslipidemia in patients with type II diabetes mellitus presenting in a tertiary care hospital for routine check-up Materials and Methods Study design: Cross sectional study Setting: Department of Medicine (South Medical Ward), Mayo Hospital, Lahore Duration: Six months i.e. 1st July 2020 to 31st December 2020. Data collection procedure: Total 220 patients fulfilling selection criteria were enrolled in the study. Then blood samples were obtained and sent to the pathology laboratory of the hospital for assessment of lipid profile. Reports were assessed and level of cholesterol and triglycerides were noted and dyslipidemia was labeled, if levels were high. All this data was recorded in proforma. Results: In this study, the mean age of patients in this study was 52.71 ± 7.46 years. There were 104 (47.3%) males and 116 (52.7%) females. There were 92 (41.8%) patients of normal BMI, 72 (32.7%) patients were overweight and 56 (25.5%) patients were obese. The mean duration of diabetes was 18.30 ± 3.92 months. Dyslipidemia was diagnosed in 97 (44.09%) patients. Conclusion: Results of this study showed high frequency of dyslipidemia among diabetic patients. Key words: Dyslipidemia, Type II, Diabetes mellitus, Lipid profile

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Validation of a Dysphagia Screening Tool in Acute Stroke Patients

American Journal of Critical Care ◽

10.4037/ajcc2009961 ◽

2010 ◽

Vol 19 (4) ◽

pp. 357-364 ◽

Cited By ~ 63

Author(s):

Jeff Edmiaston ◽

Lisa Tabor Connor ◽

Lynda Loehr ◽

Abdullah Nassief

Keyword(s):

Acute Stroke ◽

Health Care Professionals ◽

Screening Tool ◽

Tertiary Care ◽

Screening Tools ◽

Care Hospital ◽

Stroke Patients ◽

Aspiration Risk ◽

The Mean ◽

Mean Time

Background Although many dysphagia screening tools exist, none has high sensitivity and reliability or can be administered quickly with minimal training. Objective To design and validate a swallowing screening tool to be used by health care professionals who are not speech language pathologists to identify dysphagia and aspiration risk in acute stroke patients. Methods In a prospective study of 300 patients admitted to the stroke service at an urban tertiary care hospital, interrater and test-retest reliabilities of a new tool (the Acute Stroke Dysphagia Screen) were established. The tool was administered by nursing staff when patients were admitted to the stroke unit. A speech language pathologist blinded to the results with the new tool administered the Mann Assessment of Swallowing Ability, a clinical bedside evaluation, with dysphagia operationally defined by a score less than 178. Results The mean time from admission to screening with the new tool was 8 hours. The mean time between administration of the new tool and the clinical bedside evaluation was 32 hours. For the new tool, interrater reliability was 93.6% and test-retest reliability was 92.5%. The new tool had a sensitivity of 91% and a specificity of 74% for detecting dysphagia and a sensitivity of 95% and a specificity of 68% for detecting aspiration risk. Conclusions The Acute Stroke Dysphagia Screen is an easily administered and reliable tool that has sufficient sensitivity to detect both dysphagia and aspiration risk in acute stroke patients.

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