Cost of Hemodialysis in a Tertiary Care Hospital in North India

BACKGROUND: Chronic kidney disease (CKD) is a worldwide public health problem with significant health consequences and involvement of high cost on treatment worldwide. Although renal transplant is a cost effective treatment option for ESRD, use of hemodialysis in patients with ESRD patients remains one of the most resource intensive and expensive therapeutic intervention. OBJECTIVE: To estimate cost of hemodialysis treatment for patients with ESRD that would help in making policy decisions and enable cost efficient utilization of ESRD programme and hemodialysis. METHODS: 58 patients with ESRD on chronic hemodialysis were incorporated in the present study at a tertiary care teaching hospital between January 2010 to December 2010. Patients who survived less than 3 months after commencement of treatment were excluded. RESULTS: Mean age of the study patients was 46.4±8 in yrs. Among the 54 patients studied 51 % were male. 86% of patients received three sessions of hemodialysis weekly, with duration per session varying between 2 - 4 hours. Average cost was Rs. 2001.84 per session. Estimated total annual burden was Rs. 209449.10 per patient. Average cost borne by hospital was Rs. 951.84 per session/patient (47.55 % of cost bone by the patient); cost born by hospital per patient per year was Rs. 123647.70. Principal expenses (% wise) were: staff salary cost 20.84 %, instrument cost (purchased locally from market) 32.50%, salary cost 20.84%, and rental cost 18.20 %. CONCLUSION: The costs estimated in this study comparable with national average cost of hemodialysis in India but lower as compared to that in other SARC countries; approaches to reduce cost further are needed. JMS 2012;15(1):47-50.

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Clinico-Epidemiological Profile of Viral Sexually Transmitted Infections in Seropositive Patients Attending a Tertiary Care Hospital in North India

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325957416686196 ◽

2017 ◽

Vol 16 (4) ◽

pp. 331-337 ◽

Cited By ~ 1

Author(s):

Shikha Chugh ◽

Vijay Kumar Garg ◽

Rashmi Sarkar ◽

Kabir Sardana

Keyword(s):

Sexually Transmitted Infections ◽

Tertiary Care ◽

Clinical Manifestations ◽

Public Health Problem ◽

Developed Countries ◽

North India ◽

Major Public Health Problem ◽

Care Hospital ◽

Sexually Transmitted ◽

Hiv Seropositive

Sexually transmitted diseases are a major public health problem both in developing and in developed countries, and especially with the co-synergy with HIV infection, there is an increasing need to have a proper understanding of the clinicodemographic patterns of sexually transmitted infections (STIs) for planning and implementing control strategies. Worldwide, there is an increased preponderance of viral STIs. Increasing incidence and altered clinical presentation of viral STIs in patients with HIV pose a diagnostic challenge; thereby, we studied the demographic profile of HIV-seropositive patients and compared clinical manifestations of viral STIs in HIV-seropositive patients to those in seronegative individuals. Twenty-seven HIV-seropositive patients with viral STI (herpes/molluscum/warts) and same number of age-, sex-, and STI-matched seronegative patients were studied for variability in clinical profile. There were significant differences in the demographic factors (education, income, and migration) and sexual practices (number of contacts and source of infection) in the 2 groups. Lesional symptoms, increased extent of lesions, and resistance to treatment were significantly more common in HIV-seropositive patients.

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THE PHARMACOECONOMIC IMPACT OF GASTRO-PROTECTIVE AGENTS AT A TERTIARY CARE HOSPITAL

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2022.v15i1.43412 ◽

2021 ◽

pp. 92-96

Author(s):

NIRUPAMA KULKARNI ◽

MOPIDEVI RASI ◽

NAZARIYA NIZAR ◽

NISHOJA DAVID ◽

PRASAD N BALI ◽

...

Keyword(s):

Effective Treatment ◽

Cost Benefit Analysis ◽

Tertiary Care ◽

Medical Science ◽

Cost Effective ◽

Care Hospital ◽

Statistical Tool ◽

Protective Agents ◽

Cost Effective Treatment ◽

Study Results

Objectives: The study aimed to evaluate the pharmacoeconomic impact of gastro-protective agents (GPA) by carrying out cost-benefit analysis (CBA) and cost-effective analysis (CEA). Methods: This prospective observational study was carried out by simple randomization technique at Karnataka Institute of Medical Science, Hubballi. Data used were socio-economic details based on modified B. G Prasad scale. Current Index of Medical Specialists updated version March 2021 was used for CBA and CEA. Regression analysis was the statistical tool used in the study. Results: A total of 120 participants were included in the study. 57.5% were male and 42.5% were female. 3.33% were pediatrics, 32.5% were young adults, 37.5% were elder adults and 26.67% were geriatrics. Out of 120 samples, 94 participants were prescribed with pantoprazole, other drugs prescribed include domperidone and pantoprazole, rabeprazole, and ranitidine. The CBA revealed ratio of benefits over costs for pantoprazole was 3.86, ranitidine was 9.31, pantoprazole and domperidone was 0.84 and rabeprazole was 0.84. Additional cost of 138.30 Indian Rupee must be spent on pantoprazole over ranitidine to get cost-effective treatment without disease for one whole year. Conclusion: The CBA revealed that maximum patients received benefits for pantoprazole. CEA gives an idea on best effective treatment over two drugs of different class. Our study concludes that pantoprazole is deemed to be superior over other drugs of GPA prescribed among study participants.

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Epidemiological Profile and Antimicrobial Resistance Pattern of Enteric Fever in a Tertiary Care Hospital of North India – a Seven Year Ambispective Study

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2018.130 ◽

2018 ◽

Vol 61 (4) ◽

pp. 125-130 ◽

Cited By ~ 3

Author(s):

Anuradha Makkar ◽

Shilpi Gupta ◽

Inam Danish Khan ◽

Rajiv Mohan Gupta ◽

KS Rajmohan ◽

...

Keyword(s):

Public Health ◽

Enteric Fever ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Public Health Problem ◽

Multidrug Resistant ◽

North India ◽

Major Public Health Problem ◽

Care Hospital ◽

Drug Resistant

Introduction: Enteric-fever is a major public-health problem in developing countries emerging as multidrug-resistant, Nalidixic-acid resistant and extremely drug-resistant Salmonella (Pakistan, 2016), has intensified the use of WHO watch/reserve group antimicrobials such as azithromycin and meropenem. Methods: This ambispective-study was conducted on 782 non-repeat blood-culture isolates of S. Typhi, S. Paratyphi A and S. Paratyphi B obtained from 29,184 blood cultures received at a 1000-bedded tertiary-care hospital of North-India from 2011–2017. Identification and antibiograms were obtained by Vitek-2 compact and Kirby-Bauer’s disc diffusion with resistance to ampicillin, chloramphenicol and cotrimoxazole being labeled as multidrug-resistant. Decreased ciprofloxacin-susceptibility and ciprofloxacin-resistance were defined as MIC 0.125–0.5 and >1 μg/ml. Results: S. Typhi and S. Paratyphi A in a ratio of 3.9:1 were seen between July–September predominantly distributed between 6–45 year age group. Resistance to co-trimoxazole, chloramphenicol, ceftriaxone and azithromycin was 6.1%, 13.8%, 16.1 and 5.78% respectively. Multidrug-resistant S. typhi and S. paratyphi A were 2.73% and 1.91% respectively. Conclusion: Enteric-fever is a major public-health problem in India. Emergence of multidrug-resistant, Nalidixic-acid resistant and extremely-drug resistant Salmonella mandates ongoing surveillance for targeted empirical therapy and containment of spread. Repeated epidemics call for water, sanitation, hygiene and vaccination strategies to sustain herd-immunity.

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Antifungal susceptibility pattern of dermatomycosis in a tertiary care hospital of North India

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20181827 ◽

2018 ◽

Vol 4 (2) ◽

pp. 240

Author(s):

Ravika K. Budhiraja ◽

Saurabh Sharma ◽

Sarbjeet Sharma ◽

Jasleen Kaur ◽

Roopam Bassi

Keyword(s):

Antifungal Agents ◽

Fungal Infections ◽

Treatment Options ◽

Antifungal Susceptibility ◽

Tertiary Care ◽

Public Health Problem ◽

Trichophyton Mentagrophytes ◽

North India ◽

Care Hospital ◽

Microbroth Dilution

Background: Dermatomycoses affect the outer layers of the skin, nails and hair without tissue invasion and are often caused by dermatophytic molds, candida & non dermatophytic molds. Although not dangerous, they are important as a public health problem particularly in the immunocompromised. There are limited studies on the efficacy of antifungal agents against dermatophytes in North India.Methods: This study was conducted to test the efficacy of 5 systemic antifungal agents viz. voriconazole, itraconazole, terbinafine, fluconazole & griseofulvin using Microbroth dilution technique.Results: Three different species of dermatophytes which were isolated from the clinically suspected cases were Trichophyton mentagrophytes, T. rubrum and M. gypseum. According to the obtained results, Itraconazole and Voriconazole showed the lowest MIC range while Fluconazole and Griseofulvin had the highest MIC range for most fungi tested.Conclusions: Despite several treatment options being available for cutaneous fungal infections, due to an inappropriate response, there is an increasing need for determining an antifungal susceptibility profile for specific fungal strains. This will enable the clinician to select an appropriate antifungal agent with minimal side effects to avoid antifungal resistance and treatment failure.

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A clinico-epidemiological study of cutaneous changes in chronic kidney disease

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20164069 ◽

2016 ◽

Vol 2 (4) ◽

pp. 103

Author(s):

Chirag Maheshwari ◽

Ajay Kumar ◽

Sanjeev Gupta

Keyword(s):

Diabetes Mellitus ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Tertiary Care ◽

Public Health Problem ◽

North India ◽

Major Public Health Problem ◽

Care Hospital ◽

Urban Background ◽

Cutaneous Manifestations

Background: Chronic kidney disease (CKD) has emerged as a major public health problem in South Asia. This is attributable to the increase in prevalence of co-morbidities particularly hypertension and diabetes mellitus. Cutaneous manifestations are observed throughout the course of the disease and serve as markers of the disease and its progression. Early diagnosis and treatment is critical in halting the progression of the disease. The objective was to study the prevalence of co-morbidities as well as cutaneous changes in patients with CKD from a rural or semi-urban background in a tertiary care hospital.Methods: A total of 50 patients with CKD aged 18 years or above detected and managed at a tertiary care teaching hospital in North India were included in the study.Results: The age of the patients ranged from 18 to 78 years. 35 patients (70%) had a rural background while 15 patients (30%) had a semi-urban background. 37 patients (74%) had co-morbidities including hypertension, diabetes mellitus or both. 17 patients (34%) were on conservative management while 33 patients (66%) were undergoing haemodialysis. Skin changes included nephrogenic pruritus in 30 patients (60%), xerosis in 25 patients (50%), cutaneous infections and infestations in 25 patients (50%), pallor in 22 patients (44%), acquired perforating disorders in 6 patients (12%), purpura in 5 patients (10%), hyperpigmentation in 4 patients (8%) and yellow skin in 1 patient (2%). Hair changes were observed in 20 patients (40%), nail changes in 24 patients (48%) and mucosal changes in 20 patients (40%). None of the patients were found to have bullous dermatoses, calcific uraemic arteriolopathy or nephrogenic systemic fibrosis. 4 patients (8%) included in the study initially reported to dermatology OPD with a specific dermatosis and were detected to have CKD.Conclusions: The prevalence of co-morbidities including hypertension and diabetes associated with CKD may be lower in rural and semi-urban populations. Nephrogenic pruritus is the most distressing change which impairs the quality of life in these patients. Cutaneous changes may help in early detection and treatment of CKD.

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Antimicrobial Resistance in Typhoidal Salmonellain a Tertiary Care Teaching Centre in North India

JOURNAL OF COMMUNICABLE DISEASES ◽

10.24321/0019.5138.202101 ◽

2021 ◽

Vol 53 (1) ◽

pp. 1-4

Author(s):

Juhi Taneja ◽

Keyword(s):

Antimicrobial Resistance ◽

Blood Culture ◽

Enteric Fever ◽

Clinical Decision Making ◽

Tertiary Care ◽

Herd Immunity ◽

Public Health Problem ◽

North India ◽

Major Public Health Problem ◽

Care Hospital

Introduction: Enteric fever continues to carry a high burden of morbidity and mortality in India. There have been reports of emergence of ceftriaxone resistant typhoidal Salmonella from Asia. Monitoring of antimicrobial resistance trends in typhoidal Salmonella is crucial to support in clinical decision making. Aim: To study the current susceptibility pattern of typhoidal salmonella isolates in our setup. Methods: This retrospective study was conducted on 144 non-repeat blood-culture isolates of S. Typhi, and S. Paratyphi A obtained from 3926 blood cultures received at 510-bedded tertiary-care hospital of North-India from 2017-2019. Identification and antibiograms were obtained by Vitek-2 compact and Kirby-Bauer’s disc diffusion with sensitivity to azithromycin, and chloramphenicol. Result:S. Typhi and S. Paratyphi A in a ratio of 5.2:1 were seen between months of June and July predominantly distributed between 1-10 years age group. S. Typhi resistance to co-trimoxazole, chloramphenicol, ceftriaxone and azithromycin was 21.4%, 25.6%, 12.3% and 28% respectively. S. Paratyphi A resistance to co-trimoxazole, chloramphenicol, ceftriaxone and azithromycin was 4.3%, 17.3%, 34.7% and 21.7% respectively. Conclusion: Enteric-fever is a major public-health problem in India. Emergence of ceftriaxone-resistant Salmonella mandates appropriate investigation of all febrile illnesses with blood culture whenever possible. Provision of safe drinking water, good sanitation, hygiene and vaccination strategies are needed to sustain herd-immunity.

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HOW COST EFFECTIVE IS THE TREATMENT? ARE PRESCRIBERS CONCERNED ?

Journal of Nepal Medical Association ◽

10.31729/jnma.799 ◽

2003 ◽

Vol 42 (146) ◽

pp. 86-88

Author(s):

B P Das ◽

M A Naga Rani ◽

G P Rauniar ◽

H Sangraula

Keyword(s):

Effective Treatment ◽

Antimicrobial Agents ◽

Tertiary Care ◽

Cost Effective ◽

Undergraduate Curriculum ◽

Primary Concern ◽

Care Hospital ◽

Poor Countries ◽

Cost Effective Treatment ◽

Competitive Prices

ABSTRACTCost-effective treatment should be of primary concern to prescribers in poor countries like Nepal. Thepresent study was carried out at a tertiary care hospital in Nepal to find out the perception of prices ofcommonly prescribed drugs among prescribers. The participants selected randomly were directed to writein 10 minutes on a proforma, the generic name(s) and price of the brand preparation of 18 most commonlyused drugs listed under their brand name.The price of the drug was considered correct if the price mentioned was within a range of 20% above orbelow the brand price. Results indicated that the participants were aware of the composition of majority(80%) of the drugs, but were not aware of the prices of 81.80% of the drugs. No single participant mentionedthe correct prices of all the drugs. Among the drug groups studied, the most accurate data was providedabout composition (90.43%) and price (24.47%) of non steroidal anti-inflammatory drugs (NSAIDs). Onlyin 9.22% of brand preparations of antimicrobial agents (AMA), the prices were mentioned correctly. Hence,sensitisation of physicians about cost-effective treatment is of immense importance and to facilitate this,hospital authorities could provide prescribers with regularly updated price lists of commonly prescribeddrugs and competitive prices of various brand preparations. Pharmacoeconomics may be introduced in the undergraduate curriculum which can be reinforced by continuing medical education.Key Words: Cost-effective, Pharmacoeconomics.

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An epidemiological study of poisoning trend in sonipat Haryana region-A one year study

IP International Journal of Forensic Medicine and Toxicological Sciences ◽

10.18231/j.ijfmts.2021.025 ◽

2021 ◽

Vol 6 (3) ◽

pp. 118-121

Author(s):

Yogesh Kumar Vashist ◽

Yogender Malik ◽

Gaurav Sharma ◽

Balraj Sharma ◽

Sunil Kumar ◽

...

Keyword(s):

Tertiary Care ◽

Public Health Problem ◽

Acute Poisoning ◽

The Body ◽

Morbidity And Mortality ◽

North India ◽

Care Hospital ◽

Important Public Health Problem ◽

Effective Prevention ◽

One Year

Poison is a substance that causes damage or injury to the body and endangers one’s life due to its exposure by means of ingestion, inhalation, or contact and it is an important public health problem causing significant morbidity and mortality throughout the world. Hence, this study was done at tertiary care Hospital in north India (Haryana region) from year 2012 to 2013. 59 cases of acute poisoning in adults due to chemicals were included. Data on age, sex, marital status, occupation, locality, type of poison, were recorded and analyzed by descriptive method. Among 120 postmortem cases, 59 cases were of poisoning. Males (40 cases) outnumbered females (19 cases) and 46 cases were married. Peak occurrence was in the age group of 31-40 years (18 cases). Occupation wise poisoning was commonly found among male laborers (25.4%) and farmers (20.3%) followed by house wives (28.1%) and students (6.8%). Organophosphorus was the commonest agent (42.4%). The incidence of poisoning and its morbidity and mortality can be reduced by developing and implementation of effective prevention strategies.

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Prevalence of Pseudomonas aeruginosa in cholesteatoma patients in tertiary care hospital in North India

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20175084 ◽

2017 ◽

Vol 4 (1) ◽

pp. 76 ◽

Cited By ~ 1

Author(s):

Vikram Singh Rathore ◽

Kamlesh Kanwar Shekhawat

Keyword(s):

Pseudomonas Aeruginosa ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cost Effective ◽

Perioperative Period ◽

North India ◽

Klebsiella Pneumonia ◽

Care Hospital ◽

Suppurative Otitis Media ◽

A Prospective Study

Background: Chronic suppurative otitis media (CSOM) is middle ear infection that lasts for more than three months and is accompanied by a perforation of tympanic membrane. Cholesteatoma is a well know complication of CSOM. Prevalence of CSOM varies between racial and socioeconomic groups. The aim of present study was to determine the principal bacteria in ear discharge in patients with cholesteatoma. Methods: This was a prospective study conducted in department of ENT in tertiary care hospital and medical college in north India from March 2017 to May 2017.Total 80 patients attended ENT OPD with complain of ear discharge and deafness during the study period, but only 47 patients were clinically diagnosed unsafe type of CSOM or cholesteatoma. Ear swabs were collected and send for microbiology laboratory for bacteriological process. Results: Out of 80 patients, 47(58.75%) were clinically diagnosed cholesteatoma and of 29(61.70%) were male and 18(38.29%) were female. Most commonly affected age group was between 10 to 20 year (40.42%) followed by 21 to 30 (21.27%). More than 60 Year was less affected by cholesteatoma. Most common isolated organism was Pseudomonas aeruginosa (66.66%) followed by Klebsiella pneumonia (19.44%) and we used Piperacillin tazobactum and amikacin, and ciprofloxacin in all cases in perioperative period and noticed good response and modified radical mastoidectomy was done in all patients. Conclusions: P. aeruginosa was found to be the most common isolate in CSOM with cholesteatoma case and piperacillin-tazobactum, amikacin, and ciprofloxacin was found to be cost effective antibiotics.

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Varied presentations of leptospirosis: experience from a tertiary care hospital in north India

Tropical Doctor ◽

10.1177/0049475516687431 ◽

2017 ◽

Vol 47 (2) ◽

pp. 128-132 ◽

Cited By ~ 1

Author(s):

Rama Chaudhry ◽

Karnika Saigal ◽

Tej Bahadur ◽

Kamla Kant ◽

Bishwanath Chourasia ◽

...

Keyword(s):

Tertiary Care ◽

Public Health Problem ◽

Central India ◽

Febrile Illness ◽

North India ◽

Care Hospital ◽

Global Public Health ◽

Disease Occurrence ◽

Igm Elisa ◽

Curative Action

Leptospirosis has been recognised as an emerging global public health problem. The aim of our study was to explore the epidemiological and clinical pattern of disease occurrence in suspected cases and to search for any existing co-infections. Ours was a retrospective study in patients with acute febrile illness in north India over a period of three years (April 2011 to June 2014). Serological diagnosis of leptospirosis was made using the PanBio IgM ELISA kit. Using modified Faine’s criteria, presumptive and possible diagnosis was made in 57% and 34% cases, respectively. Most of the affected population was resident in north and central India. Nineteen patients showed co-infection with other common pathogens prevailing locally. There is a need to increase awareness and understand the local sero-epidemiological pattern of leptospirosis so that timely preventive and curative action may be taken by healthcare authorities.

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