RECONSTRUCTION OF FACIAL SKIN DEFECTS BY VARIOUS LOCAL FLAPS IN RURAL INDIA

INTRODUCTION: Face is the index of mind. Facial deformities affect the impression of an individual. For larger defects or in situations where direct suture is neither applicable nor available, facial skin defects in the head and neck can be filled by free grafts, local skin flaps or either pedicled or free tissue transfer. METHODOLOGY: A prospective observational study was conducted to study different facial skin defects, their etiological factors, reconstructive techniques using local flaps and outcome of reconstructed flaps. The study was conducted on 53 patients between 2-70 years, comprising of 30 males and 23 females with facial skin defects due to various etiologies, willing to undergo reconstructive procedure using local flaps presenting at a tertiary care hospital for a duration of 18 months. RESULTS: Reconstruction was done using 18 (33.96%) rhomboid flaps,16 (30.19%) linear advancement flaps, 5 (9.43%) V-Y advancement flaps, 5 (9.43%) cervicofacial advancement flap, 9 (16.98%) nasolabial flaps. After surgery, all patients were assessed on post operative day 1, day 7, 4 weeks and 12 weeks for evaluation of outcome. All flaps survived on postoperative day 1. The ultimate cosmetic outlook at 12 weeks postoperatively is good in rhomboid flap and fair in all other flaps analysed in our study. CONCLUSION: Thus reconstruction by local flaps is an easy and cost effective technique, requires less hospital stay, can be performed even at remote places under local anesthesia with excellent functional and aesthetical results.

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Telemedicine During A Crisis: Challenges, Opportunities & Way Forward At A Tertiary Care Hospital (Preprint)

10.2196/preprints.32861 ◽

2021 ◽

Author(s):

Sadia Masood ◽

Zanaib Samad ◽

Sarah Nadeem ◽

Unzela Ghulam

Keyword(s):

Health Care ◽

Health Care Services ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cost Effective ◽

Successful Implementation ◽

Care Hospital ◽

Quality Health Care ◽

Cross Sectional ◽

Innovative Strategy

BACKGROUND Telemedicine is utilized to deliver health care services remotely. Recently, it is well established due to pandemics because it can help the patients get required supportive care while minimizing their hospital exposure. In the future, it will continue to be used as a convenient, cost-effective patient care modality. OBJECTIVE The objectives were to identify physicians' challenges during teleconsultations and recognize the opportunities and strengths of this modality during the pandemic in a lower-income country. METHODS This cross-sectional study was conducted in a tertiary care hospital. The self-made questionnaire was filled through an online medium and responses were recorded on a five-point Likert scale. RESULTS A total of 83 participants were enrolled in this study. Most of them were Associate professors (29.8%), Assistant professors (26.2%), the ratio of the females was (52.4%) greater than males (,47.6%). 46 (54.8%) have laid between the age group 30-40 years. Pediatricians and senior instructors faced more difficulty in using telemedicine. The ones having clinical experience of fewer than 15 years or categorized in the age of 50-60 years faced challenges while using this modality. CONCLUSIONS During the current pandemic, situation telemedicine is the only glimmer of light to provide better quality health care. Telemedicine is an innovative strategy and it is important to understand the perception of physicians about it. Incomplete and inadequate infrastructure and attitude of the physicians is the main obstacle toward successful implementation of telemedicine. Successful installation and deployment of this technology require a complete grasp of the process among physicians.

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Adverse events following immunization with pentavalent vaccine in a tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20175139 ◽

2017 ◽

Vol 5 (1) ◽

pp. 82

Author(s):

Sharad Bansal

Keyword(s):

Adverse Events ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cost Effective ◽

Care Hospital ◽

Immunization Programs ◽

Global Alliance ◽

Immunization Program ◽

Pentavalent Vaccine ◽

Mild Fever

Background: Immunizations currently save 3 million lives per year throughout the world and is one of the most cost-effective health interventions. The Global Alliance for Vaccines and Immunizations (GAVI) and WHO recommended the use of pentavalent to replace the DPT vaccine in developing countries. Vaccines related most side effects are mild and non-serious. Surveillance of adverse events following immunization will enable us to monitor the safety of immunization programs and thereby contribute to validating the immunization program. The main aim of this study is to analyze all suspected adverse events in children reported for pentavalent vaccination.Methods:A prospective, observational epidemiological study was conducted in the department of Paediatrics OPD at tertiary care teaching institute during October 2016 to December 2016. The study was conducted amongst 190 children attending the department of Paediatrics OPD for the second or third dose of pentavalent vaccine.Results: The study shows the following adverse effects after pentavalent injection 127 (66.8%) children had pain at the site of injection, 103(54.2%) mild fever, Swelling at injection site 84(44.2%) and 55(28.9%) children held their leg back due to pain. In majority 85 (44.7%) of children antipyretic and in 65 (34.2%) children analgesic was given was given to relieve the symptoms. The parents were very positive for completing their children’s immunization schedule even though they have faced few symptoms.Conclusions:It can be concluded that all the adverse events reported were mild and could be managed easily without any complications.

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Supervision and monitoring to assess quality of outreach immunization sessions in a rural area using a checklist

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20202012 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1950

Author(s):

Ambika R. Bhaskar ◽

Mridula Solanki

Keyword(s):

Tertiary Care ◽

Immunization Coverage ◽

Cost Effective ◽

Cross Sectional Study ◽

Care Hospital ◽

Cross Sectional ◽

Effective Interventions ◽

Immunization Services ◽

Timely Fashion ◽

Assess Quality

Background: Immunization is one of the most cost-effective interventions to prevent the suffering that comes from avoidable sickness, disability and death. Outreach immunization services ensure that immunization is available to children who are unable to access a general practice in a timely fashion for their immunization events. Effective supervision and monitoring will help in improving quality and coverage of immunization.Methods: This was an observational cross-sectional study conducted in the rural field practice area of a tertiary care hospital. 50 outreach sessions held in various outdoor places including Anganwadi were supervised and monitored using checklist. 110 mothers and 20 stakeholders were interviewed. Immunization records were assessed.Results: Outreach immunization sessions were found to be of good quality. 89% children were fully immunized. ANMs and ASHAs were of the opinion that outreach session has significantly raised immunization coverage. 75.4% mothers had knowledge about services provided by outreach sessions.Conclusions: There was increase in immunization coverage due to outreach sessions. There is need for adequate supervision on safety injection practices and regular timely incentive to ASHA.

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Assessment of Factors Associated with Dropout for Pentavalent Vaccine in Tertiary Care Hospital of Kathmandu, Nepal

Nepal Medical College Journal ◽

10.3126/nmcj.v22i3.32624 ◽

2020 ◽

Vol 22 (3) ◽

pp. 106-110

Author(s):

Supri Raj Shrestha ◽

B Shakya ◽

R Oli

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

College Teaching ◽

Sampling Technique ◽

Cost Effective ◽

Dropout Rate ◽

Care Hospital ◽

Vaccine Preventable Diseases ◽

Factors Associated ◽

Pentavalent Vaccine

Immunization is one of the most cost-effective public health measures as it has helped in huge reduction of disease, disability and death from different infectious diseases in children by protecting them from vaccine preventable diseases. The current study aimed to study factors associated with dropout for pentavalent vaccine in tertiary care hospital of Kathmandu. A longitudinal observational study using purposive sampling technique was conducted among 196 infants. The information was obtained using self-constructed structured questionnaire from parents visiting Community Medicine OPD of Nepal Medical College Teaching Hospital. The information regarding socioeconomic characteristics of mother, gender of the infant, place of delivery of child, birth order and reasons for dropout of pentavalent third dose were taken. The dropout of third dose pentavalent vaccine was mainly seen in infant of parents living in rented house and according to gender wise, dropout was high among male infants. The different reasons for dropout of vaccine were busy parents, forgotten date, visit to other immunization centres and sick infants. Among these, the main reason for dropout of vaccine was due to infants getting sick during the time of immunization. The dropout rates between first and third dose of pentavalent vaccine were 26.3% and 30.4% respectively for two consecutive months and the overall dropout rate was 28.35%. Also, literacy level of the mother was directly associated with the immunization visit of the infant as, maximum number of infants of illiterate mother were absent for third dose of pentavalent vaccine as opposed to no absentee among master degree holding mothers. Thus, the present study provides valuable information regarding the factors associated with dropout for pentavalent vaccine.

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Study of clinical profile of cervical cancer patients: a hospital based study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174992 ◽

2017 ◽

Vol 6 (11) ◽

pp. 4873

Author(s):

Preeti Umate ◽

Dhuldev S. Thengal ◽

Dhundiraj Kurdukar

Keyword(s):

Early Stage ◽

Past History ◽

Clinical Stage ◽

Tertiary Care ◽

Cost Effective ◽

Educational Status ◽

Clinical Staging ◽

Common Symptom ◽

Care Hospital ◽

Quality Cancer Care

Background: As a consequence of growing and ageing populations, developing countries are disproportionately affected by the increasing number of cancers. Though the situation in India is gradually improving there still exists a disparity between the availability of quality cancer care. With this view, the present study was planned to undertake in this tertiary care institute to find out symptoms, clinical staging, complications and management of cases of carcinoma of cervix.Methods: This was a prospective observational study of carcinoma of cervix carried out at a tertiary care hospital catering services to the people of Maharashtra and neighbouring states. A thorough history including presenting complaints, demographic details, educational status and occupational details, details of menstrual and obstetric history along with any significant past history were recorded on a standard proforma.Results: Most common symptom was per vaginal bleeding which was found in 29 (69.04%). In the present study almost two third of cases i.e. 28 (66.6%) had advanced stage (IIB, III, IV) at the time of admission while the number of cases diagnosed at early stage were only 14 (33.3%). For Wertheim’s hysterectomy, most commonly used approach was transperitoneal 08 (61.53%) while 05 (38.46%) were operated by extraperitoneal approach. Pelvic lymph nodes were positive in 03 (23.07%).Conclusions: A high proportion of patients presented in stages III and IV. This emphasizes the need for early detection of Gynecological cancers in our population. Accordingly, the importance of detection of the pre-clinical stage of the diseases by considering the possibility of initiating cost-effective screening measures needs to be emphasized.

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In Vitro Chloroquine Resistance in Plasmodium falciparum Isolates from Tertiary Care Hospital

Malaria Research and Treatment ◽

10.1155/2012/538481 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Fatima Shujatullah ◽

Haris M. Khan ◽

Abida Khatoon ◽

Parvez A. Khan ◽

Mohammad Ashfaq

Keyword(s):

Tertiary Care ◽

Cost Effective ◽

Diagnostic Techniques ◽

Chloroquine Resistance ◽

Resistance Pattern ◽

Care Hospital ◽

Block Transmission ◽

Development Of Resistance ◽

Diagnostic Modalities

Chloroquine (CQ) has been the mainstay of treatment of malaria for decades. This cost-effective and safe drug has become ineffective for treatment of falciparum malaria in many parts of the world due to development of resistance by the parasite. In addition CQ is not gametocytocidal for P. falciparum and thus cannot block transmission. The extent of problem of chloroquine resistance in P. falciparum is increasing every year. The study was done in period of 2 years. A total of 5653 specimens were examined for malarial infection by employing different diagnostic modalities. Four hundred and thirty-five were found to be positive for P. falciparum by using different diagnostic techniques. All positive specimens were cultured on RPMI 1640 medium; only 108 were found to be culture positive. Sensitivity of isolates to chloroquine was done using Mark III WHO sensitivity plates. The prevalence of malaria infection was found 9.54% in 2010. There were schizont formation at 8 pmol/liter or more of chloroquine concentration in 26 isolates. The emergence of chloroquine (CQ) resistance pattern in Aligarh isolates increases. Antimalarial agents should be used with caution; monotherapies should be avoided.

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Cytohistological correlation of conventional Papanicolaou smears in cervical neoplasia at a tertiary care hospital of Nepal

Journal of Pathology of Nepal ◽

10.3126/jpn.v9i1.23372 ◽

2019 ◽

Vol 9 (1) ◽

pp. 1475-1479

Author(s):

Anuj Poudel ◽

Prahar Dahal

Keyword(s):

Uterine Cervix ◽

Pap Smear ◽

Cervical Screening ◽

Tertiary Care ◽

Cost Effective ◽

Cervical Cytology ◽

Pap Smears ◽

Care Hospital ◽

Cervical Lesions ◽

Cervical Biopsy

Background: Conventional Cervical Cytology is the most widely used cervical cancer screening test. The incidence of cervical carcinoma is incredibly high in developing countries due to lack of proper knowledge. The extensive use of cervical screening with Papanicolau smears had considerably increased the detection of precancerous and cancerous lesion of uterine cervix. Study was conducted to evaluate cytohistological correlation and to calculate concordance and discordance of Pap smear in detection of precancerous and cancerous lesions of uterine cervix. Materials and Methods: A total of 54 samples reported in Pap smear as cervical intraepithelial lesions and suspicious for invasive malignancies were selected and correlated with corresponding histopathological findings. It was an observational study done for a period of 18 months from November 2016 to May 2018 at UCMS-TH. All the statistical evaluation was done by using SPSS version 20. Results: During the study period 54 cases were evaluated. Atypical Squamous Cell of Undetermined Significance was the common abnormal findings in the Pap smear with frequency of 26 (48.1%). Out of total 54 cases of Pap smears, 30 (55.55%) were concordant while discrepancies occurred in 24(44.44%) cases with cervical biopsy. Conclusions: The study revealed a good correlation between cervical cytology and cervical biopsy. We also concluded that conventional Pap smear is a cost effective test for the early detection of precancerous and cancerous cervical lesions.

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Retrospective Analysis of 1230 Patients of Immune Thrombocytopenic Purpura Reporting to a Tertiary Care Hospital in India from 1992–2004.

Blood ◽

10.1182/blood.v104.11.5294.5294 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5294-5294

Author(s):

Dharma R. Choudhary ◽

Rajat Kumar ◽

R. Saxena ◽

Manoranjan Mahapatra ◽

Atul Kotwal ◽

...

Keyword(s):

Developing Countries ◽

Response Rate ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cost Effective ◽

Repeated Measure ◽

Care Hospital ◽

Chronic Itp ◽

Acute Itp

Abstract Background: There is very little published epidemiological data from developing countries regarding ITP and no large series from India. The aim of the study was to analyze the presenting features, response to different therapeutic options and suggest cost effective therapy. Method: The records of hematology department of All India Institute Of Medical Science were analyzed from January 1992 to June 2004. This is a premium tertiary care hospital in India. Diagnosis of ITP was made according to the standard criteria. Response criteria: complete response was defined as a platelet count increase to 100x109 /l or more, for at least 2 months: partial response was defined as doubling of platelet counts from initial levels and > 50x 109/l for at least 2 months; no response included none of the above. Statistical methods: Database was created in MS Access and SPSS ver 11 was used for statistical analysis. Descriptive statistics were calculated and appropriate tests of significance like Chi Square, repeated measure linear model were carried out. Results: During the study period, 1230 patients of ITP were seen in hematology department, with a median age of 19.6 years (range 0.9–80). Females were 51.1% and males 48.9%. Median follow-up was of 9 months (range 0–178). Presenting features were: skin bleed − 91.1%; mucosal bleed − 57.5%; hematuria − 7.2%; gastrointestinal bleed − 12.5% and intracraniall bleed − 2.8%. Per-vaginal bleeding − 31.2 % of females. History of preceding viral fever was seen in 13.1% and palpable spleen in 2.5%. The mean platelet counts at presentation were 34+ 18.3x109/l. There were 595 (48.4%) patients of acute ITP and 635 (51.6%) patients of chronic ITP. Childhood ITP (age ≤ 12 yr) was seen in 46.5% and adult ITP in 53.5%. Response to therapy: Prednisolone was given to 99.6% patients with response of 57.3 %; Intravenous gamma globulin was given to 8.9% with response in 63.6%. Splenectomy was performed in 5% of acute ITP and 15.1% of chronic ITP (p = 0.00). The overall number of splenectomies was 126, with a response rate of 83.3%. Of these 126, acute ITP constituted 23.8% while chronic ITP formed 76.2% of cases. There was no statistically significant difference in response rate in these two groups (p =0.575). Danazole was given to 66 patients with response in 44%. Various other modalities of treatment were given to 24 patients (Anti D-14; Dapsone-2; Cyclosporin-2; Azathioprine-5; and Vincristine with Cyclophosphamide -1 patient), with a response in 25% of patients. The overall response rate with all treatment modalities was 68%: in childhood ITP − 65% and in adult ITP − 70.5%. Childhood ITP did not respond as expected, possibly due to referral bias of more refractory cases being referred to the center. The values of platelets showed a continuous increase during follow up and this increase was statistically significant (P=0.000 for all, Repeated measure model). Conclusion: Pattern of ITP in India is similar to that seen in other centers. In this study Prednisolone was given as first line agent to almost all patients with response in 57.3%; Splenectomy were done in 10.2% of prednisolone refractory or dependent patients with a response in 83.3%. These should form the primary modalities of therapy in developing countries. Significant numbers of patients were refractory to above-mentioned modalities and thus there is a requirement for other cost-effective therapies.

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Haemodynamically Unstable Acute Kidney Injury Patients Treated with Sustained Low Efficiency Dialysis: Outcome in an ICU of Bangladesh

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v42i1.31995 ◽

2017 ◽

Vol 42 (1) ◽

pp. 14-20

Author(s):

Kaniz Fatema ◽

Mohammad Omar Faruq

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

De Novo ◽

Tertiary Care ◽

Kidney Injury ◽

Cost Effective ◽

Apache Ii Score ◽

Care Hospital ◽

Low Efficiency

Acute kidney injury (AKI) is a risk factor for increased mortality in critically ill patients. Sustained low efficiency dialysis (SLED) is a new approach in renal replacement therapy (RRT) and it combines the advantages of continuous renal replacement therapy (CRRT) and intermittent haemodialysis (HD). The study was aimed to evaluate the outcome of the hae-modynamically unstable patients with AKI in Bangladesh who were treated with SLED. So far this is the first reported study on SLED in intensive care unit (ICU) in Bangladesh. This quasi-experimental study was conducted in a 10-bed adult ICU of a tertiary care hospital in Bangladesh from June 2012 to May 2013. A total of 153 sessions of SLED were performed on 43 AKI patients. Mean age of the patients was 60.12 ± 15.57 years with male preponder-ance (67.4% were male). Mean APACHE II score was 26.88 ± 6.25. Fourteen patients (32.55%) had de novo AKI. Twenty nine patients (67.4%) had chronic kidney disease (CKD) with baseline mean serum creatinine 2.56 mg/dl, but did not require any RRT before admis-sion in ICU. After giving SLED, AKI of the study patients were completely resolved in 27.9%. Some forty two percent patients became dialysis dependant and 30.23% patients died. Patients who had AKI on CKD became dialysis dependant more often than the patients with de novo AKI (p <0.01). Mortality rate was significantly higher in patients who were on inotrope support (p= 0.017). Otherwise, there was no relation of 28 day mortality with age, prior renal function and mechanical ventilator requirement (p>0.05). Thus, SLED is an excellent renal replacement therapy for the haemodynamically unstable AKI patients of ICU. It is also cost-effective compared to CRRT.

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Cost of Hemodialysis in a Tertiary Care Hospital in North India

JMS SKIMS ◽

10.33883/jms.v15i1.109 ◽

2012 ◽

Vol 15 (1) ◽

pp. 47-50

Author(s):

Mushtaq Ahmad ◽

Ajaz Mustafa ◽

M Saleem Najar ◽

Farooq Ahmad Jan ◽

Anil Manhas ◽

...

Keyword(s):

Average Cost ◽

Tertiary Care ◽

Public Health Problem ◽

Cost Effective ◽

Chronic Hemodialysis ◽

North India ◽

Care Hospital ◽

Effective Treatment Option ◽

Cost Effective Treatment ◽

Cost Efficient

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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