ANTI TUBERCULAR DRUGS INDUCED HEPATOTOXICITY IN A NEW TERTIARY CARE HOSPITAL OF A TRIBAL DISTRICT OF ODISHA

Objective: India accounts for about one-fourth of the global TB burden. WHO TB statistics for India for 2018 gives an estimated incidence fig. of 2.69 million cases (199 per one lakh population). Drug-induced Hepatotoxicity is responsible for significant morbidity and mortality of the TB patient if these drugs continued after symptoms of hepatotoxicity develop. Whether the hepatotoxicity is due to individual drugs or due to additive effects is still unclear. The management therapy for TB patients with anti-TB DIH is imperative to ensure successful TB treatment and not recurrence DIH. Aim of the current study is to find out the pattern of Liver enzyme raised after antitubercular therapy in the tribal population of Koraput district where different phylogenetic populations reside where clinically it was observed by the physician little early onset of hepatotoxicity than national and international data. Methods: A prospective study was done after clearance from the Institutional Ethical Committee, Saheed Laxman Nayak Medical College, Koraput, from January 2019 to December 2019. Patients with>15 y of age with pulmonary and extrapulmonary tuberculosis with normal liver enzymes were included. Patients having abnormal liver enzymes before treatment, seropositive TB patients with human immunodeficiency virus infection, pregnant ladies and children<15 y of age were excluded. Results: Out of 922 patients in total; 4.78% (44) tuberculosis patients developed anti TB DIH. 68.18% (30) patients are below 50 y of age and 31.82% (14) are above 50 y of age group among TB patients with DIH. Age has no statistically significant influence on the occurrence of anti-TB DIH, but there is a statistically significant influence of sex on the occurrence of anti TB DIH. The mean occurrence of anti TB DIH is 18±18.16 d. One case of anti TB DIH patients shows signs and symptoms as early as on day 6th. The commonest symptoms are nausea and vomiting in 64% of patients who developed DIH. Interruption of ATT after DIH occurred in 79.54% of patients with recurrence in only 9.9% of patients after the reintroduction of ATT. Conclusion: Anti TB DIH mostly occurred between 7-28 d of starting the ATT in this geographical region. The duration of the anti TB ATT regimen is prolonged due to DIH. We recommend that all patients should have LTs 2 w after starting ATT, even if asymptomatic.

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Clinico-pathological Correlation with Liver Enzymes in Dengue Infection

Journal of Medical Science & Research ◽

10.47648/jmsr.2017.v2702.05 ◽

2017 ◽

Vol 27 (Number 2) ◽

pp. 27-30

Author(s):

A H M Kamal ◽

K H Mollah ◽

K E Khuda ◽

A Lslam ◽

N Sultana ◽

...

Keyword(s):

Liver Enzymes ◽

Dengue Infection ◽

Tertiary Care ◽

Signs And Symptoms ◽

P Value ◽

Care Hospital ◽

College Hospital ◽

Medical College ◽

Hepatic Involvement ◽

Atypical Manifestations

Dengue infection is a major vector borne disease. The classical signs and symptoms include high fever, severe headache, chill, and rash. Atypical manifestations of dengue infection with hepatic involvement are frequently reported, ranging from mild elevations of liver enzymes to acute liver failure. Analysis of 110 serologically confirmed cases of dengue infection in Holy Family Red Crescent Medical College hospital a tertiary care hospital was done. Patients with normal aminotransferase levels were categorized into Grade A, patients with at least one of the enzymes raised above normal but less than 3 times were categorized into Grade B, those with at least one of the enzymes elevated more than 3 times but less than 10 times were graded as C, and those with elevations more than 10 times as Grade D. 83.7% patients had alterations of transaminase levels, with 45.5% categorized into grade b, 30.9% into grade C, and 7.3% into grade D or acute hepatitis (P value 0.224). Rise of aspartate aminotransferase (AS7) levels were higher compared to the levels of alanine aminotransferase (AL7). Liver damage with alteration of aminotransferases is a common manifestation of dengue infection and also valuable markers for monitoring these patients.

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Thrombocytopenia in children: a clinico-etiological profile in an urban tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20185195 ◽

2018 ◽

Vol 6 (1) ◽

pp. 131

Author(s):

Subramanian V. ◽

Santosh Kumar K.

Keyword(s):

Platelet Count ◽

Viral Infections ◽

Tertiary Care ◽

Care Hospital ◽

Drug Induced ◽

Medical College ◽

Clinical Complications ◽

Paediatric Department ◽

The Relationship ◽

Haematological Finding

Background: Thrombocytopenia is a common haematological finding that we come across while managing a sick child. Etiological profile and presentation of thrombocytopenia varies among children. The objective of this study was to study the clinical and laboratory profile of children with thrombocytopenia, associated clinical complications and assess the relationship between platelet levels and severity of disease.Methods: The study was carried out in 644 children between 1 month and 12 years, admitted in Paediatric Department of Raja Rajeshwari medical college and hospital, Bangalore between August 2012 to August 2014.Results: The commonest causes of thrombocytopenia in our study were of infectious aetiology (86.6%). Among Infections Viral infections were the major cause in more than 78% of cases. Other causes included haematological problems, drug induced thrombocytopenia and connective tissue disorders. Bleeding manifestations were present in 33.07% of patients and the commonest bleeds were skin and mucous membranes. Bleeding manifestations were seen most commonly in children with a platelet count less than 50000/µl.Conclusions: Viral Infections were the commonest cause for thrombocytopenia in Children. Platelet count was neither predictive of bleeding manifestations nor predictive of need for platelet transfusion.

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Clinical evaluation of total abdominal hysterectomy - a prospective study in a tertiary care hospital

Northern International Medical College Journal ◽

10.3329/nimcj.v6i2.23178 ◽

2015 ◽

Vol 6 (2) ◽

pp. 76-77

Author(s):

Shirin Akhter ◽

Rumana Nazneen

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Care Hospital ◽

College Hospital ◽

Cross Sectional ◽

Medical College ◽

Before And After ◽

A Prospective Study

Total abdominal Hysterectomy are gradually rising in our country. This study has been designed to find out the common indications of abdominal hysterectomy in a tertiary care hospital,. to know the clinical characters of the patients and. o elucidate postoperative complication of abdominal hysterectomy.Methodology : Cross- sectional observational study was done during 1st October 2007 to 30th September 2008. Holy Family Red Crescent Medical College Hospital (HFRCMCH). Total 100 patients were selected following enclusion & exclusion criteria hyperposive sampling. Data were recorded before and after operation and analyzed by SPSS version 15.Result : In the present study patients with leiomyoma of uterus was found to be the major indication of hysterectomy followed by dys functional uterine bleeding (DUB) 18.0%, Pelvic inflammatory disease (PID) 14.0%, chronic cervicitis 10.0%, adenomyosis 10.0%, pelvic endometriosis 6.0%, cervical polyp 2.0%, ovarian cysts 1.0% and chriocarcinoma 1.0%. Mean duration of operation (hour) and hospital stay was 1.15 hours and 7.48 days respectively. Most common complication of present series was fever 20.0% followed by 13.0% had wound infection, 6.0% UTI and 2.0% wound dehiscence.Conclusion : Hysterectomy is now the most widely performed major operation in gynaecology. Indication and post operative complications of hysterectomy varies from region to region.Northern International Medical College Journal Vol.6(2) 2015: 76-77

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The outcome of resurgence of diphtheria in older children in a tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190696 ◽

2019 ◽

Vol 6 (2) ◽

pp. 607

Author(s):

Sachin K. R. ◽

Ramesh H. ◽

Sachin K. G. ◽

Siddharth E. S.

Keyword(s):

Tertiary Care ◽

Case Fatality ◽

Signs And Symptoms ◽

Neurological Complications ◽

Care Hospital ◽

Older Children ◽

Strict Adherence ◽

Medical College ◽

National Immunisation ◽

Developed Nations

Background: Diphtheria is a fatal bacterial infection which affects the mucous membranes of oropharyngeal and nasal cavity, caused by aerobic gram-positive bacteria Corynebacterium diphtheriae. With the advent of universal immunization against diphtheria the incidence of this infectious disease has declined dramatically with few developed nations having eradicated the disease. No large outbreaks have been reported in India in recent times.Methods: In present study, authors reviewed an outbreak of diphtheria in Davangere between the months of June 2017 and July 2018. Case records of children suspected to have diphtheria, admitted to hospitals affiliated to JJM Medical College, Davangere were retrospectively analysed.Results: 15 cases were suspected to have diphtheria on clinical examination. The mean age of presentation was 7.5 years. Fever, sore throat, difficulty in swallowing, neck swelling and patch in oral cavity were the common signs and symptoms. Airway compromise, myocarditis and neurological complications were noted. Antidiphtheritic serum (ADS) was tried in all 15 cases. Case fatality rate was 40%.Conclusions: Diphtheria is a resurgent problem in India. Prompt identification and early appropriate treatment is essential to prevent morbidity and mortality. Strict adherence to the national immunisation schedule should also be emphasized.

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Predictors of slow clinical response and extended treatment in patients with extra-pulmonary tuberculosis in Pakistan, A hospital-based prospective study

PLoS ONE ◽

10.1371/journal.pone.0259801 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259801

Author(s):

Atiqa Ambreen ◽

Sabira Tahseen ◽

Ahmad Wali ◽

Muhammad Jamil ◽

Syed Zeeshan Haider Naqvi ◽

...

Keyword(s):

Clinical Response ◽

Extrapulmonary Tuberculosis ◽

Tertiary Care ◽

Signs And Symptoms ◽

Multivariate Regression Analysis ◽

Care Hospital ◽

Duration Of Treatment ◽

Extended Treatment ◽

Tb Treatment ◽

Optimal Duration

The optimal duration of treatment in different forms of extrapulmonary tuberculosis (EPTB) is not clearly defined. This study aimed to identify predictors of slow clinical response and extended anti-TB treatment in EPTB patients. Socio-demographic, clinical, and microbiological characteristics of EPTB patients registered for anti-TB treatment at a tertiary care hospital, were analysed for identification of predictors of extended treatment. A total of 251 patients (137 lymphadenitis, and 114 pleuritis) were included in the analysis. Treatment was extended to more than 6 months in 58/251 (23%) patients. In the multivariate regression analysis, culture-positive EPTB (p = 0.007) [OR (95% CI) = 3.81 (1.43, 10.11)], history of diabetes (p = 0.014) [OR (95% CI) = 25.18 (1.94, 325.83)], smokeless tobacco use (p = 0.002) [OR (95% CI) = 17.69 (2.80, 111.72)], and slow regression of local signs and symptoms after 2 months of treatment (p < 0.001) [OR (95% CI) = 17.09 [(5.79, 50.39)] were seen to be significantly associated with treatment extension. Identification of predictors of extended treatment can help clinical decisions regarding optimal duration of treatment. Further studies are needed to identify subgroups of EPTB patients who can benefit from a shorter or longer treatment regimen.

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Study of maternal and fetal outcome in antepartum eclampsia in a tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180902 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1108

Author(s):

Aruna Rani R. ◽

Dheeba Jayanthi R. ◽

Eswari S.

Keyword(s):

Gestational Age ◽

Tertiary Care ◽

Mode Of Delivery ◽

Fetal Outcome ◽

Care Hospital ◽

College Hospital ◽

Medical College ◽

Obstetric Emergencies ◽

One Year ◽

A Prospective Study

Background: In modern obstetrics, the prevalence of Eclampsia and its complications are high, so we decided to study pregnancy outcome in all Antepartum Eclampsia patients. The present study was carried out to investigate the maternal and fetal outcome in patient with Antepartum eclampsia.Methods: A prospective study was conducted in Government Mohan Kumaramangalam Medical College Hospital, Salem, India over a period of one year from January 2016 to December 2016 in all Antepartum Eclampsia patients. Analysis was done regarding the age of women, parity, gestational age, imminent symptoms, mode of delivery, fetal outcome and maternal morbidity and mortality.Results: Incidence of Antepartum Eclampsia in our hospital is 0.7%. It is more common in age group of 20 to 25years (68.5%) and primigravida (56%) and gestational age >37 weeks (51.85%). Commonest mode of delivery was by caesarean section (72%). Out of 54 patients of Antepartum Eclampsia 3 (5.5%) died and 18 (33%) had complications. Out of 50 live babies, 16 (32%) died.Conclusions: Eclampsia is still one of the important and common obstetric emergencies and it has a significant role in maternal and fetal outcome. The early identification of risk factors and timely intervention is needed to improve maternal and perinatal outcome.

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Nasal Trauma in Neonates receiving CPAP And its Prevention in tertiary care hospital.

JMS SKIMS ◽

10.33883/jms.v20i2.27 ◽

2017 ◽

Vol 20 (2) ◽

pp. 96-100 ◽

Cited By ~ 2

Author(s):

Mushtaq Ahmad Sheikh ◽

Altaf Ahmad Bhat ◽

Rukaya Akhthar ◽

Mudassir Ahad Wani ◽

Tariq Wani

Keyword(s):

Tertiary Care ◽

Maternity Hospital ◽

Care Hospital ◽

Medical College ◽

Nasal Trauma ◽

Group 2 ◽

Neonatal Care Unit ◽

Grade 3 ◽

A Prospective Study ◽

Group 1

Objectives: This study was done to evaluate the frequency and severity of nasal trauma secondary to nasal continuous positive airway pressure (NCPAP) in neonates and different methods to reduce the nasal septum injury via CPAP Methods: This is a prospective study carried out in the Neonatal Care Unit (NCU) of LAL DED maternity hospital associated with department of pediatrics Government Medical College, Srinagar, Kashmir. The study included newborns that underwent NCPAP with prongs on admission and those receiving NCPAP after weaning from ventilator, from 1st January 2016 - 1st jan 2017. Neonates noses were monitored from the first day of NCPAP treatment until its weaning. Nasal trauma was reported into Three Grades: (I) Erythema/pressure indentation (II) superficial Erosion and (III) Septal necrosis. Results:-258 newborns were included in study, 136 males and 122 females. All enrolled newborn received CPAP. Babies were randomly allocated to different groups in which no barrier and different barriers were applied. Randomization ofgroup of infants who received no barrier(group 0) and different barriers( group 1,2,&3) was done by systematic allocation, in which first newborn was randomly designated to no barrier group 0 on particular day of admission ,and subsequently alternating with other three groups i.e group 1,group 2, group 3. The mean gestational age, birth weight and CPAP days in each group is 31wk (GA28-35 wks),1200 gms(0.7kg-1.8kg) & 5 days(3-10days) respectively. Incidence of Septal necrosis was 26.7% in the babies that had ‘No barrier applied at septal hudson prongs interface (Group0), which was significantly more (p<0.001) when compared with other three groups, within which its incidence was 2.8% in Cotton applied at septal and hudson prongs interface with glycerine (Group1), 7.1% in Danaplast applied at interface(Group2) and 0.0% in Cotton soaked with normal saline(Group3) respectively. In Group 0 nasal septal injury Grade 1 is (35%),grade 2 (35%),and grade 3(30.0%), in Group 1, grade 1 septal injury is (84%), grade 2(12.7%) & grade 3(2.8%),In Group 2 grade 1 is (65.7%),grade2(30.0%),grade3 (4.3%) and Group3 grade1(80.7%),grade2(19.3%) and Grade3 (0.0%) Conclusions: Nasal trauma is a frequent complication of NCPAP, especially in preterm babies and babies requiring nasal prongs for longer duration. And can be prevented by applying a barrier as in group 1,2 &3 in our study shows statistically significant decreased in severe nasal septal injury. JMS 2017;20(2):96-100

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A PROSPECTIVE STUDY OF ADVERSE DRUG REACTIONS DUE TO PLATINUM ANALOGS - CHEMOTHERAPY IN A TERTIARY CARE HOSPITAL

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i6.24849 ◽

2018 ◽

Vol 11 (6) ◽

pp. 215

Author(s):

Sumit Kumar ◽

Badruddeen Badruddeen ◽

Singh S P ◽

Mohammad Irfan Khan

Keyword(s):

Adverse Drug Reactions ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

World Health ◽

Care Hospital ◽

Drug Reactions ◽

Medical College ◽

Health Organization ◽

A Prospective Study ◽

Platinum Analogs

Objective: The objective of this study was to analyze the types of adverse drug reactions (ADRs) associated with platinum analogs (cisplatin, carboplatin and oxaliplatin) used for cancer chemotherapy in a tertiary care hospital and determine their causal relationship with the offending drug.Methods: This prospective, observational, non-interventional study was conducted in a tertiary care hospital at GSVM Medical College Kanpur, India, for 4 months. Patients of all age and either sex were included in the study. ADRs were reported by the physicians of oncology department of the hospital and ADRs were assessed for different parameters -causality, outcome, and seriousness of ADR as per the World Health Organization (WHO), type of ADRs as per expanded Rawlins and Thompson’s classification, predictability using council for international organization of medical sciences guidelines and severity using modified Hartwig’s scale. Descriptive statistics were used for data analysis.Results: A total of 140 ADRs were reported from platinum analogs following treatment of different types of cancer in hospital. The burden of ADRs in each patient was 2.41. Most of the ADRs were observed in the age group of 40–60 years. Vomiting (27 ADRs) was commonly reported reaction. Among platinum analogs, cisplatin leads to 82 ADRs (58.57%) followed by carboplatin with 53 ADRs (37.86%) and least with oxaliplatin 5 ADRs (3.57%). Most of the ADRs on causality assessment were possible (104, 74.29%) and probable (36, 25.71%) in nature. Type -A ADRs account for 4/5th of the total reported ADRs, followed by Type-B and C. Severity of 90.71% ADRs was found to be mild followed by moderate, with no case of severe and serious nature. Nearly, most of the ADRs were of predictable type (97.14%).Conclusion: The potential of platinum analogs to cause ADRs is high; thus, the need of effective ADRs monitoring is highly emphasized.

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Clinical profile of snake bite patients in tertiary care hospital in Himachal Pradesh: a prospective study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20182833 ◽

2018 ◽

Vol 6 (7) ◽

pp. 2444 ◽

Cited By ~ 1

Author(s):

Madan Kaushik ◽

Vikas Banyal ◽

Sachin Sondhi ◽

Manish K. Thakur ◽

Aseem Kaushik

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Himachal Pradesh ◽

Snake Bite ◽

Clinical Profile ◽

Care Hospital ◽

Female Ratio ◽

Medical College ◽

Gandhi Medical College ◽

A Prospective Study

Background: To study clinical profile of snake bite patients in tertiary care hospital in Indra Gandhi Medical College at Shimla, Himachal Pradesh of North India.Methods: Hospital based prospective observational study was conducted in the Department of Medicine, for the duration of one year from 1st June2013 to 31st May 2014.Results: A total of 78 patients were admitted with mean age of 38.46 years with male to female ratio of 1:1.6. Seasonal variation with peak incidence during rainy season was seen. Most common snake identified was green coloured and peak timing of snake bite was between 07:00am-04:00pm. There was delay in admission of more than 6 hours in 66.67% of cases. Hemotoxicity was predominant manifestation seen in 62.82% of cases and persistence of coagulopathy was most common complication (51.02%) despite giving optimal ASV. There was paucity in ASV administration seen in only 59.46% of referred patients. Mean ASV vials used were 23.41 vials ±8.72 vials.Conclusions: Mass education is required at both general population and health professional levels to improve snake bite management and monovalent ASV against Green pit viper is more practical option to manage cases in this region.

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Rationale in management of entero-cutaneous fistula following routine and emergency surgery: a prospective study in a tertiary care hospital of Odisha

International Surgery Journal ◽

10.18203/2349-2902.isj20185034 ◽

2018 ◽

Vol 5 (12) ◽

pp. 4000

Author(s):

Jagmohan Mishra ◽

Afroza Firodous ◽

Biplab Mishra

Keyword(s):

Gastrointestinal Tract ◽

Emergency Surgery ◽

Surgical Complication ◽

Enterocutaneous Fistula ◽

Tertiary Care ◽

Care Hospital ◽

Medical College ◽

Surgical Nutrition ◽

Enteric Perforation ◽

A Prospective Study

Background: The enterocutaneous fistula is an abnormal communication between gastrointestinal tract and skin. It is a grave surgical complication following surgery on gastrointestinal tract. Despite in surgical nutrition and critical care, mortality from enterocutaneous fistula remains high. Improvements in outcome are focused on prevention and when fistula occurs, prompt recognition and intervention is essential.Methods: This is institutional based prospective observational study which was conducted in S.C.B Medical college, Cuttack, Odisha for a period from September 2015 to September 2017 on 30 patients with enterocutaneous fistulae occurring as post-operative complication among patients admitted and operated at our institution for various gastrointestinal conditions and also referred from other centres after complication had set in. Detailed history, physical examination, routine workup, management and its outcome were studied.Results: The maximum number of fistulae (86.7%) developed after emergency surgery than routine. Incidence of enterocutaneous fistulae was observed in cases operated for intestinal obstruction (40%) followed by operation for enteric perforation (28%). The highest incidence of enterocutaneous fistula occurred on 8th post-operative day (36.7%). 24 cases were treated conservatively while 6 patients underwent operative treatment.Conclusions: Hence, the enterocutaneous fistula is frequently seen with emergency surgery of gastrointestinal tract, particularly on ileum, usually occurring around 8th post-operative day and most of them end in spontaneous closure with conservative treatment.

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