FACTORS CAUSING DELAY IN TIME TO DOOR AT EMERGENCY DEPARTMENT(ED) IN CASES OF ACUTE STROKE AND IT'S IMPACT ON OUTCOME AT TERTIARY CARE CENTRE

2020 ◽  
pp. 67-70
Author(s):  
Yogender Kumar Yadav ◽  
Dina J Shah ◽  
Jyoti B Sharma ◽  
Nalini Bala Pandey
Keyword(s):  
Acute Stroke ◽  
Average Length ◽  
Tertiary Care ◽  
Onset Time ◽  
Signs And Symptoms ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
End Points ◽  
Exact Test

BACKGROUND: The effectiveness of stroke management is highly dependent on post onset time of treatment. The study hypothesized that perceptual, social and behavioral factors affect delay in seeking help after symptom onset and worsen the outcome and recovery. OBJECTIVE: To look at the causes of delay in arrival to denitive care hospital ED after symptoms of acute stoke and its impact on patient's clinical outcome. METHODS: An observational prospective study conducted on 63 patients with signs and symptoms of acute stroke (CPSS/NIHSS positive) reported to ED. Reasons for delay in arrival to ED observed. Patients divided into two groups, those who came within 4.5 hours of onset of acute stroke symptoms and those who came after 4.5 hours. Impact of delay on patient's outcome studied at time of discharge as primary end-points in terms of average length of stay (ALOS), complications and death. Secondary end-points evaluate in terms of improvement, deterioration and death within 30th day. Statistical analysis using Chi-square or Fisher's exact test applied to compare both the groups. Odds ratio with 95 % condence limit was also calculated. RESULTS: There were multiple overlapping causes of delay; most frequently was “rst went to physician who doesn't treat stroke (8; 38.1%) and non-availability of nearby stroke centre (8; 38.1%)”. Total 21 (33.34%) patients came after window period (4.5hours). Primary endpoints in terms of ALOS (8 days compared to 9 days, p=0.48), complications (OR=1.4, 95%CI:0.2-8.8, p=0.74) and death (OR=3, 95%CI:0.4-19.3, p=0.24) at time of discharge. Secondary endpoints in terms of improvement (OR=2.8, 95%CI:1.0-7.8, p=0.03), deterioration (OR=6.0, 95%CI:1.4-24.5, p=0.01) and death within 30 days (OR=1.2, 95%CI:0.2-5.5, p=0.81). CONCLUSION: Inadequate knowledge of stroke identication and management causes delay in arrival to hospital. This delay can cause signicant impact on patient outcome and recovery

Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia

2021 ◽  
pp. 153857442110225
Author(s):  
Joel Mathew John ◽  
Vimalin Samuel ◽  
Dheepak Selvaraj ◽  
Prabhu Premkumar ◽  
Albert A Kota ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Interventional Procedure ◽  
Tertiary Care ◽  
Arterial Disease ◽  
Multivariable Logistic Regression Analysis ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Exact Test ◽  
Institutional Review ◽  
Chi Square Test

Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.

scholarly journals 2145. Carbapenem-Resistant Enterobacteriaceae infections at the Maharaj Nakorn Chiang Mai Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S727-S727
Author(s):  
Romanee Chaiwarith ◽  
Wisarut Supparatpinyo
Keyword(s):  
Univariate Analysis ◽  
Tertiary Care ◽  
Control Measures ◽  
Fisher Exact Test ◽  
Care Hospital ◽  
Chiang Mai ◽  
Chi Square ◽  
Exact Test ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Nowadays, carbapenem-resistant enterobacteriaceae (CRE) infection has been spreading worldwide in a tertiary care hospital and causing globally health damage. In Thailand, the studies of the epidemiology of CRE are scarce. This study aimed to describe epidemiology, clinical characteristics and treatment outcome of CRE infection. Methods A retrospective cohort study was conducted among patients admitted to the Maharaj Nakorn Chiang Mai Hospital between January 2014 and December 2016 who had clinical diagnosis of CRE infection. Characteristics between groups were compared using Chi-square, Fisher exact test or Student t-test, Mann–Whitney U test. Factors associated with mortality in univariate analysis were analyzed in the logistic regression model. Results Among 241 patients who had clinical specimens grew CRE, 51 had infection. Twenty-five patients (49%) were previously hospitalized within 90 days and 42 patients (82.4%) had exposed to antibiotics before documented CRE infection. The most common sites of clinical isolates were urine (33.3%), sputum (29.4%), and blood (21.6%). The mortality rate was 47.1%, which 17 (33.3%) patients’ death was attributable to CRE infection. Factor associated with mortality was higher body temperature (OR 4.8, P = 0.005) and thrombocytopenia. Conclusion CRE infections cause high mortality. Strategies to prevent emergence through prudent uses of antibiotics and transmission through infection control measures should be implemented in order to reduce mortality. Disclosures All authors: No reported disclosures.

scholarly journals Comparison of intravenous hydralazine and intravenous labetalol in the management of severe hypertensive disorders of pregnancy: a tertiary care centre study

2018 ◽  
Vol 7 (6) ◽  
pp. 2251
Author(s):  
Manvi Verma ◽  
Shashi Gupta ◽  
B. R. Bhagat ◽  
Aakanksha Mahajan ◽  
Baseerat Kaur
Keyword(s):  
Adverse Effects ◽  
Severe Hypertension ◽  
Tertiary Care ◽  
Fetal Outcome ◽  
Categorical Variables ◽  
Tertiary Care Centre ◽  
Low Birth Weight Infants ◽  
Chi Square ◽  
Exact Test ◽  
Student’S T

Background: Severe hypertension in pregnancy (SBP ≥160 mmHg &/or DBP ≥ 110 mmHg) must be treated judiciously to prevent maternal and fetal complications. The study was conducted to compare the efficacy, adverse effects, maternal and fetal outcome between Hydralazine and Labetalol which are the most commonly used drugs for the purpose.Methods: In a prospective study, 130 pregnant patients each with severe hypertension presenting to SMGS Hospital Jammu were randomized in 2 groups and administered hydralazine or labetalol intravenously. The efficacy of the two drugs was measured in terms of number of doses required to obtain target BP and the timing to achieve the same. The incidence of adverse effects, maternal and fetal outcomes were also compared. Comparisons among the two groups was performed by using independent Student’s t test for normally distributed variables, Fishers’ exact test, and Pearson Chi Square test for categorical variables. The level of significance was set at p<0.05 for all analysis.Results: There was no statistical difference between the two drugs in terms of efficacy. Significantly more low-birth weight infants were born in the hydralazine group. Also, the adverse effects were significantly more in the hydralazine group.Conclusions: Both hydralazine and labetalol can be used to treat hypertensive emergencies of pregnancy but hydralazine is associated with more side effects.

scholarly journals Clinical study of patients with trauma to the chest in a tertiary care centre

2020 ◽  
Vol 7 (7) ◽  
pp. 2135
Author(s):  
Vijay D. Potey ◽  
Karan D. Kale ◽  
Vijay B. Kanake
Keyword(s):  
Chest Trauma ◽  
Road Traffic ◽  
Average Length ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Normal Activity ◽  
Common Mechanism ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Intercostal Nerve Block

Background: Chest trauma is one of the serious injuries and also one of the leading causes of death from physical trauma. Current study is designed to study clinical profile, pattern of injuries, complications and treatment modality required in chest trauma management.Methods: A prospective observational study was conducted in Shri Vasantrao Naik Government Medical College, a tertiary care hospital in Yavatmal, Maharashtra, India in 246 patients primarily admitted for chest trauma from 1st March 2018 to 31st August 2019.  All cases were managed in emergency department with history noted, clinical examination performed and initial management done as per ATLS guidelines. Definitive management done according to clinical and radiological investigations. Final outcome (death/discharge) was noted with discharged patients were followed until normal activity regained.Results: Male of 3rd-4th decade constituted most vulnerable group, with mean age of 38.56 years and male:female ratio of 5.31:1. Road traffic accident (RTA) was the commonest cause (71.14%), followed by assault (11.79%) and accidental fall (11.38%). Blunt force was the most common mechanism (93.09%).  Rib fracture was present in 26.83%, lung contusion in 8.13% patients, followed by haemothorax (7.32%), hemopneumothorax (5.70%) and pneumothorax (3.25%). Conservative management suffices in most cases (86.59%), tube thoracostomy in 12.19%, thoracotomy in 1.22% cases. Patients with VAS score of 6 and above required intercostal nerve block (5.31%) or epidural analgesia (2.45%) for satisfactory pain relief. Pneumonia and atelectasis were common complications 2.03% each. Mortality rate was 1.22%. Average length of hospital stay was 4.6 days.Conclusions: Chest trauma commonly affects young males with RTA causing significant morbidity and mortality. Majority of patients can be treated conservatively.    

scholarly journals Patterns and Severity of Injuries in Patients Following Physical Assault– A Medicolegal Aspects

2020 ◽  
Vol 2 (2) ◽  
pp. 16-20
Author(s):  
Archana Chaudhary ◽  
Srijana Kunwar ◽  
Samjhana Ghimire ◽  
Harihar Wasti
Keyword(s):  
Tertiary Care ◽  
Treatment Strategies ◽  
Point Of View ◽  
Physical Assault ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Mortality And Morbidity ◽  
Exact Test ◽  
Young Males ◽  
Far Eastern

Background and purpose: Physical assault (PA) is a common cause of mortality and morbidity throughout the world and the prevalence is still very high in underdeveloped and developing countries. With the objective to see the spectrum of injury following PA from the medico legal point of view, this study was design in a tertiary care centre at far eastern part of Nepal. Material and method: This is a prospective analytical study with non- probability consecutive sampling of physical assault cases presented in the emergency department over the duration of 4 months. All the patients who meet the inclusion criteria were collected in preformed proforma. Gender, types of weapons used for PA, location of external and internal injuries, various treatment strategies, and severity of injuries were presented in frequencies and percentage. Association of different age categories, gender and types of weapons used with severity of injuries were analysed using Chi square/ Fisher’s exact test wherever applicable. Result: There were total 99 patients presented with physical assault during the study period with mean age of presentation 31.69 (SD 13.38) Years with male (70%) predominance. Among various types of weapons used for PA; punches/ kicks were used in 50% of assaults followed by blunt heavy objects (35%) and sharp heavy weapons (14%). Location of the external injuries were more common in head and neck area . Obvious internal injuries were seen in 14% of the assaulted patients. Among all the case of PA, 42% patients needed some sort of surgical intervention during hospital stay. There were 9% cases of grievous injury and 6% had life threatening injuries. Conclusion: Physical assault is a common mode of injuries in eastern Nepal, where young males are more prone to such injuries. Violence are commonly carried out using fists, kicks and blunt objects. Severity of injuries is similar with all the types of weapons used.

scholarly journals Risk factors, bacteriological profile and outcome of surgical site infections following orthopaedic surgery

2021 ◽  
Author(s):  
Shishir Murugharaj Suranigi ◽  
SR Ramya ◽  
C Sheela Devi ◽  
Reba Kanungo ◽  
Syed Najimudeen
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Antimicrobial Prophylaxis ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Care Hospital ◽  
Chi Square ◽  
Exact Test ◽  
Bacteriological Profile ◽  
Superficial Skin

Background and Objectives: Surgical site infection (SSI) is a challenge for the surgeon. Incidence of SSI reported in literature varies from 0.5% to 15%. Severity of SSI ranges from superficial skin infection to life-threatening condition like septicaemia. It is responsible for increased morbidity, mortality, and economic burden to the hospital in general, and the patient in particular. The aim of this study was to assess the risk factors, bacteriological profile, length of hospitalization, and cost due to orthopaedic SSI in patients admitted to a tertiary care hospital. Materials and Methods: This was a prospective case control study. Cases were diagnosed based on CDC definition of nosocomial SSI. All cases were assessed preoperatively, intraoperatively and postoperatively, according to type of surgery, wound class, duration of operation, antimicrobial prophylaxis, use of drain, preoperative hospital stay, causative micro organism, total hospital stay, re-admission rates and cost incurred. Age, sex and surgical procedure matched controls without SSI, were also assessed. Chi- square test and Fisher's exact test were used for analysis. P= <0.05 was considered significant. Results: Out of 1023 patients, 47 cases had SSI, with a rate of 4.6%. Cigarette smoking was a risk factor for SSI (P = 0.0035). The most common etiologic agents were Acinetobacter baumannii and Staphylococcus aureus. Incidence of re- admission among SSI cases was more compared to controls (P= 0.0001). Costs attributable to SSI (Indian Rupees) was Rs 32,542 (17,054 to 87,514) which was significantly more than those without SSI (P= <0.001). Conclusion: Despite latest surgical amenities, meticulous sterilization protocols and pre-operative antibiotic prophylaxis, SSI continues to be present in healthcare settings. The increase in duration of hospital stay due to SSI adds to additional burden to an already resource-constrained healthcare system.

scholarly journals Resection Urethroplasty for Urethral Stricture: Preliminary Findings from a Tertiary Care Hospital of Central Nepal

2019 ◽  
Vol 15 (1) ◽  
pp. 1-4
Author(s):  
Sudeep Raj KC ◽  
Bhusan Raj Timilsina ◽  
Gaurav Devkota ◽  
Sulav Pradhan ◽  
Sabita Lamsal ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Average Length ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Care Hospital ◽  
Central Nepal ◽  
Complete Failure ◽  
End To End ◽  
Tract Infections ◽  
Patients Experience

Background: Urethral stricture is relatively common problem that we encounter in urological practice. As urethral stricture causes progressive narrowing of the urethral lumen, signs and symptoms of urinary  obstruction arise. These patients experience obstructive symptoms like poor stream, straining to urinate, incomplete voiding, end dribbling, urinary retention and recurrent urinary tract infections. Methods: A prospective cohort study was carried out in College of Medical Sciences, Chitwan, Nepal. All the patients who were operated with end to end anastomosis for urethral stricture with stricture length not more than 2.5cm from January 2015 to June 2016 was included in this study. These patients were followed up for two year period for recurrence of the stricture and complications. Results: Mean age of patient in this study was 50.55 years, average length of stricture was 1.3 cm. 66.67% (12 patients) had complete success with no    recurrence of the stricture. 33.33 % (6 patients) had recurrence of stricture. Out of those 6 patients, 3 had  undergone DVIU with no further recurrence of the stricture until the follow up period, one patient was treated with dilatation, two had complete failure and needed re-procedure. Conclusions: End to end anastomosis for short segment stricture had a fairly satisfactory result.

scholarly journals CLINICAL PROFILE OF TYPHOID FEVER IN CHILDREN

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Shaitan Singh Balai
Keyword(s):  
Typhoid Fever ◽  
Enteric Fever ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Clinical Profile ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Main Complaint ◽  
Clinical Signs And Symptoms

Background: The present study describes the clinical presentation of enteric fever at a tertiary care centre. Methods: The study was a hospital based prospective observational study conducted on  children of age 2 -18 years who presented with fever of 5 days or more with clinical signs and symptoms suggestive of typhoid fever and positive Widal test or Typhidot tests were included in the study. The demographic and clinical features of the patients were described. Results: All the children presented with fever as the main complaint (100%). Commonest sign noticed was toxic look (84%) followed by coated tongue (79%) and splenomegaly (61%). Hepatomegaly was also noted in 34% of cases. Conclusion: This study was undertaken to observe the clinical profile of typhoid fever in children admitted in a tertiary care hospital. Typhoid fever remains to be as an endemic disease in this locality. All the signs and symptoms of the disease are nonspecific common with other acute febrile illnesses; a definitive diagnosis of the disease is required for treatment and to prevent transmission. Keywords: Enteric fever, Splenomegaly, Toxic look

scholarly journals Assessment of surgical patients’ knowledge about anaesthesia and anaesthesiologist in a tertiary care teaching institute-a survey

2018 ◽  
Vol 6 (2) ◽  
pp. 486 ◽  
Author(s):  
Vinay Marulasiddappa ◽  
Nethra H. N.
Keyword(s):  
Tertiary Care ◽  
Cross Sectional Study ◽  
Work Place ◽  
Fisher Exact Test ◽  
Care Hospital ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Adequate Knowledge ◽  
Survey Population

Background: Anaesthesia is a speciality, playing a crucial role in the perioperative care of patients. Complex surgeries are facilitated due to the anaesthesiologists catering to the ever-advancing surgical field requirements. Although an important speciality, patients are unaware of the speciality of anaesthesia and anaesthesiologist. Patients are subjecting themselves for surgical procedures without having adequate knowledge of anaesthesia and anaesthesiologist. Hence, the survey was designed with the aim to assess the patients’ knowledge about anaesthesia and anaesthesiologist in surgical patients.Methods: A cross sectional study conducted on four hundred surgical inpatients using predesigned questionnaire containing questions related to the knowledge of anaesthesia and anaesthesiologist. The results were expressed as percentages. Chi-square/ Fisher Exact test was used to find the significance of study parameters.Results: Anaesthesiologists were considered as “doctors” by 60.5% of patients; Thirty three percent of the survey population had “no idea” of Anaesthesia. The survey populations’ knowledge about complications was 32.25%. Awareness about separate consent for anaesthesia was 49%. Anaesthesiologists’ work place was not known to 77.5% of survey population. Anaesthesiologists’ role in operation theatre was known only in 59.5% and remaining 40.5% were unaware of Anaesthesiologists’ role. None of the patients preferred to meet the Anaesthesiologists before surgery.Conclusions: Surgical inpatients in tertiary care hospital have a poor understanding of anaesthesia and poor recognition of the role of anaesthesiologist. The knowledge about anaesthesia and anaesthesiologist is not known in general population. Hence, anaesthesiologists must work towards getting recognition for the speciality of anaesthesiology and the anaesthesiologists.

scholarly journals Antenatal umbilical cord coiling index as a predictor of pregnancy outcome

2021 ◽  
Vol 8 (3) ◽  
pp. 383-387
Author(s):  
Lopamudra B John ◽  
Takkellapati Aanandini ◽  
Setu Rathod
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcome ◽  
Umbilical Cord ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Exact Test ◽  
Fischer Exact Test

: Fetal compromise as a major contributor to neonatal morbidity is of great concern for obstetricians. Antenatal risk assessment profiles are often insufficient in picking up these cases and hence need to be improved. Antenatal Umbilical cord Coiling Index (AUCI) is one such potential predictor which helps in identifying pregnant women who need close antepartum and intrapartum monitoring. It is determined by ultrasonogram antenatally and noted to be fixed throughout the pregnancy. This study aims at determining the association between AUCI and pregnancy outcome.: This was a hospital based prospective analytical study conducted in a tertiary care centre in Pondicherry from January 2019 to May 2020. 207 pregnant women were included in the study and Colour doppler was performed and AUCI was noted. Participants were followed until delivery and pregnancy outcomes were noted.: Chi square and Fischer exact test: In the present study, among 207 subjects, 166 had normal AUCI i.e., 0.41 to 0.61. Hypocoiling was noted in 20 (&#60; 0.41) and hypercoiling in 21(&#62;0.61) subjects. Hypocoiling was associated with hypertension and oligohydramnios in10% cases each. Nonreasssuring fetal (NRFHR) heart rate, meconium stained liquor and low APGAR values were present in 15, 20 and 10% cases respectively. Hypercoiling was associated with diabetes (10%), hypertension (5%), oligohydramnios (10%), polyhydramnios (5%), NRFHR (10%) and meconium stained liquor (5%). However, there was no statistical significance among the above mentioned parameters.

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