scholarly journals TO STUDY CLINICAL PROFILE OF ACUTE CONFUSIONAL STATE IN A TERTIARY CARE HOSPITAL IN A HILLY AREA.

2020 ◽  
pp. 1-3
Author(s):  
Rakesh Chauhan ◽  
Subhash Bhunal ◽  
Dalip Gupta ◽  
Ramesh Kumar ◽  
Tarun Sharma
Keyword(s):  
Heart Surgery ◽  
Behavior Pattern ◽  
Medical Condition ◽  
Tertiary Care ◽  
Elderly Persons ◽  
Care Hospital ◽  
Acute Confusional State ◽  
Confusional State ◽  
General Medical Condition ◽  
Increased Risk

Acute confusional state/Delirium is a condition that develops quickly (usually over hours or days) and involves changes in consciousness, attention, cognition (thinking and reasoning), and perception. . Delirium is usually temporary and reversible and does not reflect a persistent psychiatric disorder.1 Delirium may result from a general medical condition, from use of drugs or similar substances, or from withdrawal from these substances. Some researchers suggest that there are two forms of delirium: hyperactive (agitated) and hypoactive (lethargic). If individuals with delirium experience the hyperactive form, they may be more prone to hallucinations, delusions, agitation, and disorientation. The rate is higher in elderly persons, those with cancer, and those with acquired immunodeficiency syndrome (AIDS). Patients who have had an operation (especially heart surgery, hip surgery, and organ transplants), as well as patients with burns, dialysis, or central nervous system lesions, are at increased risk for delirium. It is very common in individuals with terminal illnesses, often occurring just before death.4 we conducted this study to see the aetiological profile of Acute Confusional State in patients admitted in medical wards in IGMC Shimla and to study the behavior pattern of such patients.

scholarly journals Rate of influenza vaccination among patients of rheumatoid arthritis receiving immunosuppressive drugs in Islamabad.

2020 ◽  
Vol 27 (07) ◽  
pp. 1438-1441
Author(s):  
Sajid Naseem ◽  
Ambreen Zahoor ◽  
Zaidan Idrees Choudhary ◽  
Ahmad Bilal Sana
Keyword(s):  
Rheumatoid Arthritis ◽  
Influenza Vaccination ◽  
Medical Condition ◽  
Influenza Infection ◽  
Tertiary Care ◽  
Immunosuppressive Drugs ◽  
Preventive Strategy ◽  
Care Hospital ◽  
Cross Sectional ◽  
Increased Risk

Objectives: Patients of rheumatoid arthritis (RA) receiving immunosuppressive drugs have an increased risk of infections such as influenza and are more likely to develop serious complications. WHO and other leading international health organizations recommend influenza vaccination as the most effective preventive strategy in these patients. The aim of our study was to assess the rates of influenza vaccinations in patients of rheumatoid arthritis receiving immunosuppressive drugs in a tertiary care hospital in Islamabad. Study Design: Cross-sectional study. Setting: Medical outpatient unit of the HBS General Hospital, Islamabad. Period: From October 2018 to January 2019. Material & Methods: Included 108 patients of rheumatoid arthritis selected through nonprobability purposive sampling and Patients with at least one year history of Rheumatoid arthritis currently receiving immunosuppressive therapy were included in the study. Socio-demographic details and vaccination history was collected on a pre-designed performa. Data was analyzed using SPSS version 23. Chi square test was applied to ascertain association. Results: Out of the total 108 patients, 80 were females and 28 were males. Average duration of RA among the study sample was 4.6 years. 34% of the patients reported having co-morbid medical condition(s). Only 3% of the patients had received influenza vaccination. 22% of the patients reported severe influenza infection during the preceding season. Lack of awareness about the importance of vaccination was the main reason for low vaccination rate. Conclusion: The rates of influenza vaccination in patients of rheumatoid arthritis receiving immunosuppressive drugs are extremely low in Islamabad. There is an urgent need to raise awareness on this issue among the patients as well as physicians.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

scholarly journals Predictors of Disseminated Intravascular Coagulation in Patients with Septic Shock

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Diana J. Kelm ◽  
Juan Carlos Valerio-Rojas ◽  
Javier Cabello-Garza ◽  
Ognjen Gajic ◽  
Rodrigo Cartin-Ceba
Keyword(s):  
Septic Shock ◽  
Antiplatelet Therapy ◽  
Disseminated Intravascular Coagulation ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Model ◽  
Care Hospital ◽  
Clinical Predictors ◽  
Intravascular Coagulation ◽  
Early Goal Directed Therapy ◽  
Increased Risk

Purpose. The goal of this study was to identify potential clinical predictors for the development of disseminated intravascular coagulation (DIC) in patients with septic shock. Material and Methods. We performed a retrospective analysis of a cohort of adult (>18 years of age) patients with septic shock admitted to a medical ICU in a tertiary care hospital from July 2005 until September 2007. A multivariate logistic regression model was used to determine the association of risk factors with overt DIC. Results. In this study, a total of 390 patients with septic shock were analyzed, of whom 66 (17%) developed overt DIC. Hospital mortality was significantly greater in patients who developed overt DIC (68% versus 38%, P<0.001). A delay in the timing of antibiotics was associated with an increased risk of the development of overt DIC (P<0.001). Patients on antiplatelet therapy prior to hospital admission and who that received adequate early goal-directed therapy (EGDT) were associated with a decreased risk of overt DIC (P<0.001). Conclusions. In our cohort of patients with septic shock, there was a risk reduction for overt DIC in patients on antiplatelet therapy and adequate EGDT, while there was an increased risk of DIC with antibiotic delay.

scholarly journals Trends and causes of maternal mortality in a tertiary care hospital over five years: 2013-2017

2019 ◽  
Vol 35 (4) ◽  
Author(s):  
Sonia Rafiq ◽  
Wajeeha Syed ◽  
Simi Fayaz Ghaffar
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Creative Commons ◽  
Increased Risk ◽  
Mortality Ratio ◽  
Public Health Challenge

Background and Objective: Maternal death measurement is essential to a country’s wellbeing and development status. In emerging countries like Pakistan, it remains an intimidating and failed public health challenge. Objectives of our audit were to estimate trends and causes of maternal demise in Lady Reading Hospital, Peshawar, Pakistan. Methods: Between January 2013 to December 2017, a retrospective study was carried out at Medical Teaching Institute, Lady Reading Hospital, Peshawar. A structured proforma was used to collect data from the medical records. To detect trends in mother demise maternal mortality ratio was calculated for each year and for all five years, Spss version 23 was used for data analysis. Results: In the five-year periods 134 deaths were recorded. The maternal mortality during the study period was 431/100,000 live births. An unstable trend in mortality with two crowning periods in 2013 and 2017 was observed. Hemorrhage persisted as the foremost cause of maternal death over the five years period, accounting for 47.76% deaths followed by hypertension, accounting for 25.37% deaths. An increased risk of 35.08% was observed among women aged 25-29 years, followed by 26.11% in 20-24 years and 23.88% in >30 years. Conclusion: There is a decreasing trend of maternal death from 2013 to 2016 but a slight increase was noted in 2017. Hemorrhage was the top cause responsible for the maternal death. doi: https://doi.org/10.12669/pjms.35.4.1091 How to cite this:Rafiq S, Syed W, Ghaffar SF. Trends and causes of maternal mortality in a tertiary care hospital over five years: 2013-2017. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.1091 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Study of antimicrobial use in paediatric inpatients in a tertiary care hospital in Ahmedabad, India

2020 ◽  
Vol 8 (1) ◽  
pp. 35
Author(s):  
Hetal N. Jeeyani ◽  
Rutvik H. Parikh ◽  
Sheena Sivanandan ◽  
Harsh J. Muliya ◽  
Shivam N. Badiyani ◽  
...  
Keyword(s):  
Bacterial Resistance ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Care Hospital ◽  
Antimicrobial Drugs ◽  
Prescribing Indicators ◽  
Inappropriate Use ◽  
Increased Risk ◽  
The Mean

Background: Inappropriate use and overuse of antibiotics are important factors leading to increased bacterial resistance apart from increased risk of adverse reactions. The aim of this study was to derive antibiotic use percentage, study its pattern and compare antibiotic prescribing indicators with standard indicators.Methods: This prospective observational study was conducted from 1st August 2018 to 31st July 2019 on paediatric inpatients from 1 month to 14 years. All the relevant data was taken from the case records of patients at the time of discharge. The data included: age, sex, hospital stay, clinical diagnosis and details of antimicrobial treatment.Results: From 989 patients, 85.9% were diagnosed with infectious illness, of which 60.1% had viral and 36.7% had bacterial infection. The use of antimicrobial drugs was 42.7% and antibiotics was 40.4%. The mean number of antibiotics received was 1.13±0.31. 90% patients received single antibiotic. 88.8% drugs were prescribed by generic name and 99% drugs were prescribed from essential drug formulary. 17 different antibiotics were used out of which ceftriaxone (62.5%) was the most commonly used. Groupwise, antibiotic use was cephalosporins (68.4%), penicillin (20.2%), aminoglycosides (4.31%), fluoroquinolones (0.9%) and macrolides (0.22%). The use of higher antibiotics like vancomycin (3.86%) and carbapenems (0.68%) was quite less.Conclusions: The antibiotic use in our hospital was higher than the WHO standard but less as compared to majority of other studies. Use of cephalosporins was more and penicillin was less as compared to other studies. This suggests that there is a need of implementing antibiotic stewardship programs to enhance rational antibiotic prescribing.

scholarly journals Predictors of mortality in adult patients with dengue: a study from South India

2018 ◽  
Vol 6 (5) ◽  
pp. 1605 ◽  
Author(s):  
Vasudeva Acharya ◽  
Mohammed Fahad Khan ◽  
Srinivas Kosuru ◽  
Sneha Mallya
Keyword(s):  
Renal Failure ◽  
Prothrombin Time ◽  
Tertiary Care ◽  
P Value ◽  
Bleeding Tendency ◽  
Care Hospital ◽  
Laboratory Parameters ◽  
Prolonged Prothrombin Time ◽  
Risk Of Death ◽  
Increased Risk

Background: Dengue is one of the important causes of acute febrile illnesses in India. Dengue can be a fatal disease, however there are no reliable markers which can predict mortality among these patients.Methods: A prospective cross sectional study was done in patients who were admitted to a tertiary care hospital with features of dengue fever. A total of 364 patients with IgM dengue serology positive were included in the study. Relevant clinical and laboratory parameters were collected from all patients. Association between clinico-laboratory parameters with mortality was studied using appropriate statistical methods.Results: Among the 364 patients recruited in this study, 14 (3.85%) patients died. Mortality among patients with age group 18-40 years was 2.04%, in patients aged above 40 years was 7.56%. Mortality among patients with hypotension was 42.42% (14 out of 33), bleeding manifestations was 15.38% (8/52), platelets <20,000/mm3 was 10.41% (10/96), ALT >200 was 13.04% (6/46), AST>200 was 12.34% (10/81), prolonged prothrombin time was 60%(12/20), renal failure was 28%(14/50), encephalopathy was 31.57% (6/19), multi organ dysfunction syndrome(MODS) was 43.33% (13/30), acute respiratory distress syndrome (ARDS) was 45.45% (5/11), pleural effusion was 7.5% (6/80).Conclusions: The overall mortality in the present study was 3.85%. Following variables were associated with increased risk of death among the dengue patients: Age >40 years, presence of hypotension, platelets <20000 cells/mm3, ALT>200U/L, AST>200U/L, prolonged prothrombin time, presence of renal failure, encephalopathy, MODS, ARDS and bleeding tendency (p value <0.05). Early identification of factors associated with mortality can help to make appropriate decision on care required.

scholarly journals A study of maternal mortality due to non-obstetric causes

2019 ◽  
Vol 8 (5) ◽  
pp. 2027
Author(s):  
Tejal N. Kansara ◽  
Tushar M. Shah ◽  
Foram R. Lalcheta
Keyword(s):  
Maternal Mortality ◽  
Medical Condition ◽  
Physiological State ◽  
Tertiary Care ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Common Cause ◽  
Medical College ◽  
Study Analyse ◽  
Surgical Condition

Background: Pregnancy, although being considered a physiological state, carries the risk of serious maternal morbidity and at times mortality, due to various complications that may arise during pregnancy, labour or thereafter. The existing medical condition, infection, and surgical condition which is collectively called as non- obstetric cause pre disposes a women for more complication than a non-pregnant women, so much so that it can lead to maternal mortality. Thus, Pregnancy is more vulnerable state and present study was carried out to study, analyse and review various non-obstetrics causes of death of women during pregnancy or within 42 days of termination of pregnancy in Tertiary care centre.Methods: This was an Observational study, conducted in the department of obstetrics and gynaecology, at a tertiary care hospital attached with medical college, from October 2016 to October 2018. The details of maternal deaths were collected from various departments with non- obstetric causes and analyzed.Results: The total number of deliveries in my study period was 15,208. There were 197 maternal mortality in our study period, of which 51 women died of non-obstetric causes. The most common cause of maternal mortality in our study was hepatic cause i.e. 33.33% amongst which viral hepatitis was the most common cause followed by respiratory (19.60%), infectious (15.18%), heamoglobinopathy (13.72%), cardiac (5.88%), neurological (5.88%), surgical (5.88%) causes.Conclusions: Looking into our study, maternal mortality can be reduced by identifying various different indirect medical causes which are preventable by proper pre-pregnancy evaluation for pre-existing comorbid conditions.

What Factors Predict Hospital Readmission after Colorectal Surgery?

2016 ◽  
Vol 82 (5) ◽  
pp. 433-438 ◽  
Author(s):  
Basem Almussallam ◽  
Maurice Joyce ◽  
Peter W. Marcello ◽  
Patricia L. Roberts ◽  
Todd D. Francone ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Hospital Readmission ◽  
Tertiary Care ◽  
Ileoanal Pouch ◽  
Total Proctocolectomy ◽  
Care Hospital ◽  
Stoma Creation ◽  
Increased Risk ◽  
Financial Concern ◽  
High Comorbidity

Readmissions pose a significant hardship for patients and constitute a major quality and financial concern for hospitals. We sought to define risk factors associated with hospital readmission after colorectal surgery at a tertiary care hospital. We evaluated readmission among all patients who underwent a colorectal surgical procedure between July 16, 2007 and June 30, 2011. In a cohort of 4879 operative encounters, 492 (10%) were readmitted to the hospital within 30 days of discharge. Procedures with highest readmissions included stoma creation (22%), ileoanal pouch surgery (22%), and total proctocolectomy (30%). In multivariate analysis, the following variables were associated with risk of readmission: postoperative complication, use of anxiolytics, high comorbidity score, patient setting, alcohol use, and stoma creation. Surgeon of record was not associated with readmission. In conclusion, several patient, procedural, and postoperative factors were associated with an increased risk of readmission. Considerably high rates of readmission were noted after stoma creation, ileoanal pouch procedures, and proctocolectomy. Surgeon of record was not associated with risk of read-mission, indicating little value to this metric as a physician-specific indicator of quality.

Otolaryngology Service Usage in Children With Cleft Palate

2018 ◽  
Vol 55 (5) ◽  
pp. 743-746 ◽  
Author(s):  
Kenneth R. Whittemore ◽  
Jenna M. Dargie ◽  
Briana K. Dornan ◽  
Brian Boudreau
Keyword(s):  
Cleft Palate ◽  
Cleft Lip And Palate ◽  
Tertiary Care ◽  
Case Series ◽  
Upper Airway ◽  
Care Hospital ◽  
Tympanostomy Tube ◽  
Increased Risk ◽  
Tympanostomy Tubes ◽  
Clinic Visits

Objectives: To determine the usage of otolaryngology services by children with cleft palate at a pediatric tertiary care facility. Design: Retrospective case series. Setting: Specialty clinic at a pediatric tertiary care hospital. Patients: Children born between January 1, 1999, and December 31, 2002, with the diagnosis of cleft palate or cleft lip and palate. A total of 41 female and 48 male patients were included. Main Outcome Measures: Total number of otolaryngology clinic visits and total number of otolaryngologic surgeries (tympanostomy tube placements and other otologic or upper airway procedures). Results: In the first 5 years of life, these children utilized an average of 8.2 otolaryngology clinic visits (SD = 5.0; range: 1-22) and underwent 3.3 tympanostomy tube surgeries (SD = 2.0; range: 0-10). Seventy-three had their first tube placed at the time of palate repair, and 4 at the time of lip repair. Fifty-one (57.3%) required other otologic or upper airway procedures, including tonsillectomy and/or adenoidectomy (27 children), removal of tympanostomy tubes (24 children), tympanomastoidectomy (3 children), and tympanoplasty (14 children). Of the children who underwent other procedures, they underwent a mean of 1.67 (SD = 0.84; range: 1-4) surgeries. Conclusions: Children with cleft palate are at increased risk for eustachian tube dysfunction, frequently utilize otolaryngology care, and typically receive multiple sets of tympanostomy tubes. This study found that children with cleft palate receive on average of approximately 3 sets of tympanostomy tubes, and the majority required another otologic or upper airway surgery.

Role of vitamin D and sFlt-1/PlGF ratio in the development of early- and late-onset preeclampsia

2015 ◽  
Vol 53 (7) ◽  
Author(s):  
Indira Álvarez-Fernández ◽  
Belén Prieto ◽  
Verónica Rodríguez ◽  
Yolanda Ruano ◽  
Ana I. Escudero ◽  
...  
Keyword(s):  
Vitamin D ◽  
Late Onset ◽  
Tertiary Care ◽  
Care Hospital ◽  
Hydroxyvitamin D ◽  
Increased Risk ◽  
25 Hydroxyvitamin D ◽  
The Relationship ◽  
Plgf Ratio

AbstractThe imbalanced production of placental biomarkers and vitamin D deficiency have been proposed as risk factors for the development of preeclampsia (PE). However, little is known about the relationship between them and their role in early- versus late-onset PE. The objectives were to assess the role of 25-hydroxyvitamin D [25(OH)D] concentrations and the soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) ratio in the development of early- and late-onset PE; and to evaluate the relationship between 25(OH)D and the biomarkers.A retrospective, full-blinded cohort study was conducted at the Obstetric Emergency Service of a tertiary care hospital. Pregnant women (n=257) attending obstetric triage with suspicion of PE were included. sFlt-1, PlGF and 25(OH)D concentrations were measured by electrochemoluminescence (ECLIA) immunoassay and pregnancy outcome (development of PE) was registered from patients records.PE women showed lower 25(OH)D concentrations at clinical presentation than non-PE women (median: 35.0 nmol/L and 39.6 nmol/L, respectively; p=0.027). Women with 25(OH)D levels <50 nmol/L experienced an increased risk of developing late-onset PE [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.4–15], but no association was found for early-onset PE. However, a sFlt-1/PlGF ratio above the corresponding cutpoints increased the risk of developing both early- and late-onset PE [ORs 58 (95% CI 11–312) and 12 (95% CI 5.0–27), respectively]. No association was found between 25(OH)D levels and sFlt-1/PlGF ratio.Low vitamin D status in women with suspected late-onset PE increases the risk of imminent development of the disease.

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