A PROSPECTIVE STUDY ON CLINICAL PROFILE AND OUTCOME OF PATIENTS WITH TUBERCULOUS MENINGITIS AT A TERTIARY CARE CENTRE IN MAHARASHTRA

2021 ◽  
pp. 7-10
Author(s):  
Nupoor Vaghasia ◽  
Bharatsing D. Rathod ◽  
Vidya Nagar
Keyword(s):  
Tuberculous Meningitis ◽  
Tertiary Care ◽  
Epidemiological Data ◽  
Acute Onset ◽  
P Value ◽  
Western India ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Altered Sensorium ◽  
Low Sensitivity

BACKGROUND: Tuberculous meningitis (TBM) is one of the most fatal forms of tuberculosis, early diagnosis and treatment of which can reduce morbidity and mortality. This study was undertaken to achieve data regarding clinical prole and outcome of patients from western India as epidemiological data is lacking from this region. METHODS: This prospective observational study was conducted on 136 patients admitted in medical ward and critical care unit of a tertiary care hospital in Maharashtra over 18 months. Clinical, biochemical, radiological and microbiological evaluation was done. Data was analyzed using SPSS 22 version software and p value of <0.05 as signicant. RESULTS: The mean age of cases was 35.2 ± 14.69 years, majority from age group of 18 - 40 years. Out of 136 cases, 62 (45.6%) were males and 74 (54.4%) females. Commonest clinical features were fever and headache, followed by altered sensorium and seizure. Symptoms were mostly of acute onset (<14 days). 42 cases (30.9%) were associated with present or past pulmonary tuberculosis and 34 (25%) with retroviral disease. 7 cases (5.2%) had hemiparesis and 3 (2.2%) had ophthalmoplegia. Mean ESR was 56.59 + 22.87. CSF showed lymphocytosis (mean 88.4 + 18.09 %), low glucose percentage (mean 39.57 + 0.2 %) and high protein (mean 146.02 + 106.62 mg/dl). 117 cases (86%) showed positive neuroimaging. Outcome was poor in stage III disease. CONCLUSION: Tuberculous meningitis usually presents as acute onset illness with fever, headache or altered sensorium. CSF Gene Xpert has low sensitivity as compared to neuroimaging. Advanced disease was associated with poor outcome.

scholarly journals Epidemiology of Gall Stone Diseases among Patients attending Surgical Department of a Tertiary Care Hospital in Nepal

2020 ◽  
Vol 8 (1) ◽  
pp. 50-55
Author(s):  
Sanjay Chaudhary
Keyword(s):  
Large Scale ◽  
Gallstone Disease ◽  
Tertiary Care ◽  
Gall Stone ◽  
College Teaching ◽  
P Value ◽  
Cholesterol Stone ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Surgical Department

Background and Objectives: Gallstone disease (GSD) is a chronic disease that consumes a lot of economic and medical resources. It not only affects patients’ life quality, but also is associated with the potential risks of the development of consequences of gallstone diseases. Therefore, the study is aimed to investigate the epidemiology and risk factors of gall stone diseases among patients attending tertiary care centre in Nepal. Material and Methods: A cross sectional study was conducted among patients attending surgical department of Janaki Medical College Teaching Hospital (JMCTH) over a period of one year from January 2019 to December 2019. Chi-square test was applied to show the association between the two groups. P-value < 0.05 was considered statistically significant. Results: In a total of 148 patients, 69.59% had mixed gallstone, 17.57% had cholesterol stone and 12.84% had pigment gallstone. Types of gallstone was found significant for age group (p=0.006), gender (p=0.027) and presence of diabetes (p=0.003) but insignificant with presence of hypertension (p=0.992). Conclusion: Age of the patients, gender and presence of diabetes were found significant for the all types of gall stone. Further large scale research need to be conducted.

scholarly journals Study of magnitude of anaemic problem in rural tertiary care centre in outpatient department

2018 ◽  
Vol 6 (11) ◽  
pp. 3499
Author(s):  
Anjaneya Prasad V. ◽  
Anjani Kumar C. ◽  
Neelima V. ◽  
Sai Prasanth R.
Keyword(s):  
Public Health ◽  
Low Cost ◽  
Tertiary Care ◽  
Outpatient Department ◽  
P Value ◽  
Cost Ratio ◽  
Care Hospital ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Major Health Problem

Background: Prevalence of anaemia is very high in rural tertiary care hospital O.P.D patients. Anemia is the most common morbidity among micronutrients and affects health, education, economy, and productivity of the entire nation. Anemia, like fever, is a manifestation and not a disease per se. The most common group among the causes for anemia is malnutrition and among that group, iron deficiency makes up the bulk of it. Girls are more likely to be a victim due to various reasons. In a family with limited resources, the female child is more likely to be neglected. She is deprived of good food and education and is utilized as an extra working hand to carry out the household chores. The added burden of menstrual blood loss, normal or abnormal, precipitates the crises too often. Anemia can usually be prevented at a low cost, and the benefit/cost ratio of implementing preventive programs is recognized as one of the highest in the realm of public health. This information has equipped everyone in public health to take action against this long-standing problem and to do whatever is needed to be done.Methods: In our study 200 people attending medical outpatient department at a tertiary care centre were enrolled. Assessment of the anaemic problem is worked out.Results: Out of 200 patients, 107 were females and 93 were males. 49 females out of 107 had haemoglobin less than 10 and 9 males out of 93 are having haemoglobin less than 10. Among people with hemoglobin less than 10, 84.5% are females. Significant p value was observed in females (<0.0001).Conclusions:Anemia continues to be a major health problem in developing countries like India, particularly rural India. Despite different strategies and programs have been taken by government of India the growing menace of anaemia is not solved. So newer strategies must be taken.Background: Prevalence of anaemia is very high in rural tertiary care hospital O.P.D patients. Anemia is the most common morbidity among micronutrients and affects health, education, economy, and productivity of the entire nation. Anemia, like fever, is a manifestation and not a disease per se. The most common group among the causes for anemia is malnutrition and among that group, iron deficiency makes up the bulk of it. Girls are more likely to be a victim due to various reasons. In a family with limited resources, the female child is more likely to be neglected. She is deprived of good food and education and is utilized as an extra working hand to carry out the household chores. The added burden of menstrual blood loss, normal or abnormal, precipitates the crises too often. Anemia can usually be prevented at a low cost, and the benefit/cost ratio of implementing preventive programs is recognized as one of the highest in the realm of public health. This information has equipped everyone in public health to take action against this long-standing problem and to do whatever is needed to be done.Methods: In our study 200 people attending medical outpatient department at a tertiary care centre were enrolled. Assessment of the anaemic problem is worked out.Results: Out of 200 patients, 107 were females and 93 were males. 49 females out of 107 had haemoglobin less than 10 and 9 males out of 93 are having haemoglobin less than 10. Among people with hemoglobin less than 10, 84.5% are females. Significant p value was observed in females (<0.0001).Conclusions: Anemia continues to be a major health problem in developing countries like India, particularly rural India. Despite different strategies and programs have been taken by government of India the growing menace of anaemia is not solved. So newer strategies must be taken.

scholarly journals Clinical and investigational study for the aetiological evaluation of patients in nontraumatic altered sensorium and its outcome

2019 ◽  
Vol 7 (4) ◽  
pp. 1113
Author(s):  
Siba Narayan Jali ◽  
Sachida Nanda Nayak ◽  
Biju K. Alexander ◽  
Diptimayee Tripathy ◽  
Bijaya K. Behera
Keyword(s):  
Tertiary Care ◽  
General Medicine ◽  
Diagnostic Methods ◽  
P Value ◽  
Care Hospital ◽  
College Hospital ◽  
Metabolic Encephalopathy ◽  
Altered Sensorium ◽  
Medical College ◽  
Gcs Score

Background: Apart from head injury many patients present to the tertiary care hospital in unconscious state, the etiology of which is obscure in most of the cases. The present study was conducted with on objective to provide insight into the clinical features and diagnostic methods to know the aetiology of patients with non-traumatic cases of altered sensorium and to study the outcome of these patients.Methods: This is an observational study on 100 patients of altered sensorium of non-traumatic origin during the period from October 2012 to September 2014 conducted in the Department of General Medicine, MKCG Medical College Hospital, Berhampur, Odisha, India. All patients were selected for the study based on the inclusion exclusion criteria. Detailed history, clinical evaluation, laboratory investigations like neuroimaging studies etc. were carried out. Statistical data analysis was done using Graph pad Prism 6 and Microsoft Excel. P value <0.0001 was considered statistically extremely significant.Results: Out of 100 patients of altered sensorium, 64 were males and 36 were females. All patients were in the age group of 19 to 89 years. Cerebrovascular accident was the most common aetiology of altered sensorium followed by metabolic encephalopathy and infection. Altered sensorium in patients with CVA carries a high mortality. Metabolic causes and younger age indicated a better prognosis, patients with low (Glasgow Coma Score) GCS score of 3 to 4 had poorer prognosis.Conclusions: The results suggest that clinical assessments yield accurate predictive information about the potential for recovery in cases of altered sensorium. So, this study concludes that empirically based estimates of prognosis in the neurologically severely ill provides great reassurance to those involved in a decision-making process, including patients’ families and physicians.

Profile of secondary bacterial respiratory infections in H1N1 patients admitted in a tertiary care centre – A four-year retrospective study

2021 ◽  
Vol 20 ◽  
Author(s):  
Noorelle Karim Khan ◽  
Suchitra Shenoy M ◽  
Deepak Madi ◽  
Vaman Kulkarni
Keyword(s):  
Bacterial Infection ◽  
Bacterial Infections ◽  
Respiratory Infections ◽  
Indian Subcontinent ◽  
Tertiary Care ◽  
P Value ◽  
Case Report Form ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Secondary Bacterial Infection

Background: H1N1 is known to cause periodic seasonal flu in the Indian subcontinent since 2009. The clinical course and the underlying immunity of the host contribute to the development of secondary bacterial infections in the infected patients. Objectives: This study aims at analyzing the secondary bacterial infections in confirmed H1N1 cases admitted in our hospital (from 2015 to 2018) with respect to the comorbidities, complications, associated bacteria with its antibiotic susceptibility pattern and the outcome of such episodes. Material and methods: Data of 164 patients admitted in a tertiary care hospital with H1N1 was extracted from medical records using a semi-structured case report form. Data was entered and analyzed with SPSS version 17. A p value of <0.05 was considered as statistically significant. Results: Most patients were aged above 40 years with female preponderance. In our study 42% of patients had comorbidities. Only 14 (8.53%) had secondary bacterial infection confirmed by culture. Klebsiella pneumoniae and Acinetobacter baumannii were the most common bacteria that were isolated. They were treated based on the culture reports. There was no mortality in patients with secondary bacterial infection. Conclusion: The early start of the antiviral agents and adherence to the antibiotic policy of the hospital contributed to lower secondary bacterial infections and zero mortality.

scholarly journals The modifications in surgical technique and its impact on short term morbidity in modified radical mastectomy: a tertiary care hospital experience

2019 ◽  
Vol 6 (12) ◽  
pp. 4354
Author(s):  
Arnab Bandyopadhyay ◽  
Rajnish Talwar ◽  
Amol Patel ◽  
Pradeep Jaiswal
Keyword(s):  
Pilot Study ◽  
Tertiary Care ◽  
Radical Mastectomy ◽  
P Value ◽  
Care Hospital ◽  
Flap Necrosis ◽  
Modified Radical Mastectomy ◽  
Tertiary Care Centre ◽  
Shoulder Dysfunction ◽  
Positive Effects

Background: Necrosis of flap margins, postoperative pain and shoulder dysfunction are amongst the main concerns of the breast surgeon performing modified radical mastectomy (MRM). This pilot study is aimed to evaluate the effects of these procedural modifications and whether should it be included as a standard practice.Methods: A total of 150 MRM patients are evaluated in this single arm cohort study in a tertiary care centre over a time period of 2 years (2014-2016). The following modifications are adopted in the usual procedure of the MRM: double skin incision and elective excision of the skin margins, injecting long acting local anesthetic agent (bupivacaine) preoperatively around the nerve pedicles in axilla and postoperative positioning of arm in hyper abduction and early resumption of Shoulder exercisesResults: Flap margin necrosis has reduced considerably (2.6%) in comparison to historical data (15%). Pain relief was significantly less on first post-operative day (mean VAS score 2.93) which encouraged early shoulder mobilisation. Flap necrosis was more in T4 tumours (75% vs 25%) which was significant with a p value of .004. Similarly flap necrosis at 48hrs was more with the patients who received neoadjuvant chemotherapy (NACT) with a p value of 0.047. Higher nodal burden was significantly correlated with flap necrosis with a p value of .002.Conclusions: This pilot study provides preliminary evidence of the positive effects of the proposed modifications on minimising morbidity following MRM further convincing evidence by way of multi-centric randomized control trials, will be required to validate the conclusions of this study.

scholarly journals Clinicoepidemiological study of post burn contractures at a tertiary care centre in western India

2019 ◽  
Vol 6 (6) ◽  
pp. 1896
Author(s):  
Milind A. Mehta ◽  
Vikrant Ranjan ◽  
Abhishek K. Kulkarni ◽  
Pradnya Sarwade
Keyword(s):  
Tertiary Care ◽  
Skin Grafting ◽  
Western India ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Healthcare Facilities ◽  
Rural Background ◽  
Split Skin Grafting ◽  
Split Skin ◽  
Burn Contractures

Background: Burn injuries are one of the commonest form of trauma globally with long term consequences in the form of contractures. The management takes a troll of time, money and stress, despite that the agony remains with the patient only. We intended to study the clinicoepidemiopathological aspects of post burn contractures for a better understanding and management purpose.Methods: This study was conducted from October 2014 to February 2017 in a tertiary care hospital in western India and includes 51 patients.Results: In this study, we observed that the mean age of patients was 21.7 years and females formed 51% of the patient pool. Most of the patients came from a rural background with a mean distance of 77.72 kilometres from the treating hospital. Flame burns contributed to 78% of the cases, with hand (35.7%) being the most commonly involved area, 52.9% patients did not receive splinting or physiotherapy at the initial treatment of burns. Most cases were treated by split skin grafting (64.2%) and the most common complication seen in our study was infection, noted in 15.7% of cases whereas recurrence was seen in only one patient.Conclusions: We observed that young adults were the predominant group of patients with a slight female preponderance. Factors like increased distance from the treating hospital, rural background of patients, poor healthcare facilities with poor rehabilitative facilities and irregular follow up of patients contributed to increased incidence of post burn contractures. We also noted that majority cases can be treated by contracture release with split skin grafting without major complications.

scholarly journals Study of thyroid function in patients admitted in intensive care unit in a tertiary care centre

2018 ◽  
Vol 6 (8) ◽  
pp. 2717
Author(s):  
T. V. D. Sasi Sekhar ◽  
Ramya Appalaneni ◽  
Avinash Jada ◽  
Shalima Pinnamaneni
Keyword(s):  
Intensive Care ◽  
Venous Blood ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Reverse T3 ◽  
Cross Sectional ◽  
Hormone Levels ◽  
Low T3

Background: Thyroid hormones play a key role in the maintenance of body growth by modulating metabolism and the immune system. These alterations in thyroid hormone levels are referred to as “euthyroid sick syndrome” or “non thyroidal illness syndrome” (NTIS), which is characterized by low serum levels of free and total triiodothyronine (T3) and high levels of reverse T3 (rT3) accompanied by normal or low levels of thyroxine (T4) and thyroid-stimulating hormone (TSH). During critical illness, changes in circulating hormone levels are a common phenomenon. These alterations are correlated with the severity of morbidity and the outcomes of patients in ICU.Methods: This study was carried out at a tertiary care hospital. 100 patients of age above 18yrs, both sexes, admitted to intensive care units with following diseases Septicemia, ARF, Respiratory failure, CCF, DKA, Stroke were taken into the cross-sectional study. Relevant hematological and radiological examination are done. Fasting venous blood samples were collected immediately on admission to ICU from all patients and were subjected for hormone analyses. Samples were tested for total T3, total T4, and TSH. The hormone estimation was done by chemiluminescence assay.Results: Patients (59%) had low T3 level, 41(41%) patients had normal T3, 31 patients (31%) had low T4, 69 patients (69%) had normal T4 level and TSH was low in 11 patients (11%), 76 patients (76%) had normal TSH and 14 patients (14%) slightly high. Our study showed low T3 (59%) is the commonest abnormality in ICU admitted patients. There is a significant relation present between T3 and mortality (p value-0.0001) and need for ventilation (p value 0.004).Conclusions: Our study suggests that low T3 is an important marker of mortality in ICU admitted patients. We suggest that in ICU patients T3 levels should be done and used as a prognostic marker for mortality and need for ventilation.

scholarly journals Clinicohematological profile of patients of sepsis admitted in intensive care unit in a tertiary care hospital in Western India

2020 ◽  
Vol 8 (3) ◽  
pp. 1012
Author(s):  
Vipul Patel ◽  
Amit Shah ◽  
Arti Muley
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Medical Condition ◽  
Tertiary Care ◽  
Community Acquired Pneumonia ◽  
Common Source ◽  
Western India ◽  
Care Hospital ◽  
Altered Sensorium

Background: Sepsis is a life-threatening medical condition triggered due to body's response to an infection. If empirical treatment for sepsis and bacteraemia is held up it will increase chances of mortality as well as duration of stay and cost. Hence, there is a need for risk stratification. So, we planned to study the clinicohematological profile of patients of sepsis admitted to this hospital in ICU.Methods: This was an observational study. A total of 50 patients of sepsis were included. All included participants were subject to CBC, RFT, LFT, RBS, Urine RM, ESR, chest X-ray, USG Abdomen.  Laboratory evaluations were performed in the institutional pathology and biochemistry labs. Data was analysed to assess the clinicohematological profile of the patients of sepsis to identify common factors which if taken care of in time can reduce development to sepsis and the morbidity and mortality related to it.Results: Most common presenting complaint was fever (72%), followed by altered sensorium (58%), vomiting (30%), jaundice (30%) and breathlessness (20%). Most noticed signs were pallor (36%), icterus (36%), edema (6%), reduced air entry (34%) and crepitations (26%). Most common source of the infection were abdomen (28%), urinary tract infection (26%) and community acquired pneumonia (24%).Conclusions: Most common presenting complaints were fever, breathlessness, altered sensorium. Most common source of sepsis were urinary tract infection, lung, and abdomen which if adequately treated in time would aid in reducing the number of sepsis patients and thus will control the morbidity, mortality and cost associated with sepsis.

scholarly journals Predictors of mortality in neonatal septicemia in a tertiary care centre

2020 ◽  
Vol 7 (10) ◽  
pp. 2037
Author(s):  
Dhara Gosai ◽  
Bela H. Shah ◽  
Jyothi S.
Keyword(s):  
Neonatal Mortality ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Coagulase Negative Staphylococci ◽  
Neonatal Septicemia ◽  
Mortality And Morbidity ◽  
Laboratory Parameters ◽  
Predictors Of Mortality

Background: Neonatal septicemia continues to be a major cause of mortality and morbidity in new-borns all over the world. Aim and objectives of the study were determining the risk factors for mortality in neonatal septicemia.Methods: A retrospective observational study of the demographics, clinical features and laboratory parameters of 100 neonates admitted in NICU of a tertiary care hospital from September 2019 to March 2020.Results: 67% of neonates delivered outside centre and 33% of neonates delivered at centre were found to have sepsis exclusively based on culture positivity. A significant association was found between very low birth rate (VLBW) (p value<0.001), prematurity (p value<0.01) and high neonatal mortality. Among the different clinical presentations of neonatal sepsis, lethargy (p value<0.02), apnea (p value<0.01) and hypothermia (p value<0.02) were found to be frequently associated with neonatal mortality. Further, C-reactive protein (CRP) positivity (p value<0.003), hyperglycaemia (p value<0.0009) and thrombocytopenia (p value<0.0009) were also associated with high neonatal mortality. Gram positive bacteria were frequently isolated from blood cultures of deceased neonates, Coagulase negative staphylococci (CoNS) (36.1%), being the commonest bacteria followed by B. subtilis (11.1%), Klebsiella spp. (11.1%) and Acinetobacter spp. (8.3%).Conclusion: Demographic factors like VLBW, prematurity, outborn deliveries, clinical and laboratory parameters like lethargy, apnea, hypothermia, thrombocytopenia and hyperglycemia are strong predictors of mortality in neonatal.

scholarly journals Lymphocyte-Neutrophil Ratio in the Diagnosis of Tubercular Pleural Effusion in a Tertiary Care Centre: A Descriptive Cross Sectional Study

2021 ◽  
Vol 6 (2) ◽  
pp. 1517-1521
Author(s):  
Rajneesh Jha ◽  
Ram Kumar Mehata ◽  
Puru Koirala
Keyword(s):  
Pleural Effusion ◽  
Extrapulmonary Tuberculosis ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
P Value ◽  
Care Hospital ◽  
Continuous Variables ◽  
Tertiary Care Centre ◽  
Cross Sectional

Introduction: Tuberculosis is a common infection in our community. Tubercular pleural effusion is the second most common form of extrapulmonary tuberculosis. Among the several causes of exudative pleural effusison tubercular remains the most common form in clinical practice. The aim of this study was to evaluate the significance of lymphocyte-neutrophil ratio(LN ratio) in cases of exudative effusion for diagnosis of tubercular effusion. Methods: This was a hospital based cross sectional studydone in Patients at tertiary care hospital from 1st September 2020 to 1st april 2021after taking ethical clearance from institutional reviw committee. Convienience samplingwas done. Statistical Analysis of data like percentages and frequencies  were used for categorical variables. Mean and SD (standard deviation) were used for describing continuous variables. Inferential statistical tools like Chi-Square test and Student’s t-test were used. P-value of <0.05 was considered statistically significant. Results: out of 200 cases 75% were tubercular pleural effusion and these cases were found have high levels of LN ratio (0.89 ± 0.11 for females and 0.97 ± 0.14 for males) and ADA (137.79 ± 44.61for females and 147.61 ± 51.64 for males) and more than 90% sensitivity and specificity of LN ratio and ADA level. Conclusion: Exudative pleural fluid L/N ratio >0.75 is an efficient means of diagnosing tuberculous pleural effusion and its combination with ADA level gives us more accuracy and surety about the diagnosis of tubercular pleural effusion.

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