scholarly journals Radiological Analysis of Frontal Cells and its Association with Frontal Sinus Mucosal Disease: A Tertiary Care Hospital Based Study

2019 ◽  
Vol 27 (1) ◽  
pp. 1-7
Author(s):  
Bikash Lal Shrestha ◽  
Sameer Karmacharya
Keyword(s):  
Frontal Sinus ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Prospective Longitudinal Study ◽  
Mucosal Disease ◽  
Complex Anatomy ◽  
Prospective Longitudinal

Introduction The frontal sinus and frontal recess both have complex anatomy causing difficulty during endoscopic sinus surgeries. The term frontal cells is currently used to describe a group of anterior ethmoidal cells classified by Kuhn et al into 4 types. Though there are precise descriptions, the frequency of frontal sinus cells (FSCs) varies widely in the literature. The presence of FSCs is responsible for a narrowing of the frontal sinus outflow tract which subsequently causes a partial obstruction of drainage and aeration of the frontal sinus. Our main aim is to the see the distribution of different frontal cells in Nepali population and relation with frontal sinus mucosal disease.   Materials and Methods This prospective, longitudinal study performed in 110 consecutive patients who underwent CT scan of nose and paranasal sinuses. The frontal cells and agger nasi cells were identified and association between the frontal cells and agger nasi cells with frontal sinus mucosal disease was analyzed with chi square test.   Results The agger nasi was present in 83.63% CT scans whereas frontal cells were distributed in 61.82% CT (computed tomogram) scans. There was not statistical significance and any association between the frontal cells and agger nasi cells with frontal sinus mucosal disease.   Conclusion The frontal cells and agger nasi cells distribution in Nepalese population, even though in small sample size, is similar with other studies in the literature. There is also non association of either frontal cells or agger nasi cells with frontal sinus mucosal disease.

scholarly journals Bacteriological profile and antimicrobial susceptibility pattern of endotracheal tube secretion of patients in ICUs of a tertiary care hospital in Punjab

2021 ◽  
Vol 8 (3) ◽  
pp. 224-229
Author(s):  
Kiranjeet Kaur ◽  
Shavetika Jindal
Keyword(s):  
Antimicrobial Susceptibility ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Care Hospital ◽  
Susceptibility Pattern ◽  
Prospective Longitudinal Study ◽  
Antimicrobial Susceptibility Pattern ◽  
Prospective Longitudinal

Healthcare associated pneumonia (HAP)is second most common HCAIs that occur in 27% critically ill patients. Eighty-six percent of HAP are associated with mechanical ventilation and termed as ventilator associated pneumonia (VAP). VAP due to multidrug resistant has also increased in recent past. To isolate and identify the bacterial pathogens in endotracheal tubes aspirates of ICUs patients and study their antimicrobial susceptibility pattern.A prospective longitudinal study was conducted in the Microbiology laboratory of a tertiary care hospital over a period of six months after clearance from institutional Research Committee and Ethical Committee. All the samples of ETT secretions received in Clinical Microbiology lab from ICU patients and fulfilling the criteria for VAP were included in this study. Samples were processed as per standard protocol and organisms were identified on the basis of gram staining, colony characters and biochemical tests. Antibiotic sensitivity was performed by Kirby Bauer disc diffusion method as per CLSI guidelines. : A total of 100 samples of ET secretions were collected and proceeded for culture. Out of 100 samples, 76 (76.0%) were positive for bacterial growth. Among 76 positive cultures, a total 80 bacterial isolates were obtained as some cultures were showing polymicrobial growth. Five (6.26%) isolates were Gram Positive bacteria and 75(93.7%) were Gram negative. The most frequent isolates were 35(43.7%) followed by , isolates were sensitive to colistin while resistant to ampicillin and amoxiclav. isolates were sensitive to colistin and resistant to ampicillin, amoxiclav, ciprofloxacin, cefixime, piperacillin tazobactam. isolates were sensitive to colistin while resistant to ampicillin, amoxiclav, ceftizidime and piperacillin tazobactam. In our study antimicrobial pattern of isolated bacteria shows multidrug resistant pathogens which are associated with VAP and limit therapeutic options.

A long wait: barriers to discharge for long length of stay patients

2018 ◽  
Vol 94 (1116) ◽  
pp. 546-550 ◽  
Author(s):  
Emma Jane Zhao ◽  
Apurva Yeluru ◽  
Lakshman Manjunath ◽  
Lei Ray Zhong ◽  
Hsiao-Tieh Hsu ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chart Review ◽  
Small Sample Size ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Healthcare Staff ◽  
Care Capacity ◽  
Improve Cost

IntroductionReducing long length of stay (LLOS, or inpatient stays lasting over 30 days) is an important way for hospitals to improve cost efficiency, bed availability and health outcomes. Discharge delays can cost hundreds to thousands of dollars per patient, and LLOS represents a burden on bed availability for other potential patients. However, most research studies investigating discharge barriers are not LLOS-specific. Of those that do, nearly all are limited by further patient subpopulation focus or small sample size. To our knowledge, our study is the first to describe LLOS discharge barriers in an entire Department of Medicine.MethodsWe conducted a chart review of 172 LLOS patients in the Department of Medicine at an academic tertiary care hospital and quantified the most frequent causes of delay as well as factors causing the greatest amount of delay time. We also interviewed healthcare staff for their perceptions on barriers to discharge.ResultsDischarge site coordination was the most frequent cause of delay, affecting 56% of patients and accounting for 80% of total non-medical postponement days. Goals of care issues and establishment of follow-up care were the next most frequent contributors to delay.ConclusionTogether with perspectives from interviewed staff, these results highlight multiple different areas of opportunity for reducing LLOS and maximising the care capacity of inpatient hospitals.

scholarly journals Comparison of efficiency of 1% permethrin lotion vs. 0.5% ivermectin shampoo in the treatment of pediculosis capitis

2018 ◽  
Vol 4 (3) ◽  
pp. 357
Author(s):  
B. M. Monisha ◽  
M. Madhumitha ◽  
S. Thilagavathi
Keyword(s):  
Head Louse ◽  
Treatment Options ◽  
Tertiary Care ◽  
Care Hospital ◽  
Louse Infestation ◽  
Pediculosis Capitis ◽  
Prospective Longitudinal Study ◽  
Number Of Patients ◽  
Head Lice Infestation ◽  
Prospective Longitudinal

<p class="abstract"><strong>Background:</strong> Pediculosis or head louse infestation is a common condition and an issue of concern in developing countries. Various treatment options are available for the management of this condition but still needs further research due to drug resistance. This study seeks to compare the efficacy of 1% permethrin lotion and 0.5% ivermectin shampoo in the management of pediculosis capitis.</p><p class="abstract"><strong>Methods:</strong> A prospective longitudinal study was conducted in a tertiary care hospital from September 2013 to June 2015. Patients presenting with pediculosis capitis infestation were divided into two groups of 50 each. They were treated with either topical 1% permethrin lotion or 0.5% ivermectin shampoo. Follow up was done once in 4 weeks on the extent of head lice infestation.<strong></strong></p><p class="abstract"><strong>Results:</strong> After being treated with either topical 1% permethrin or 0.5% ivermectin shampoo, the presence of nits decreased significantly in the ivermectin group. Number of patients either had no nits or less than 5 dead nits in the permethrin group than in the ivermectin group.</p><p class="abstract"><strong>Conclusions:</strong> It is concluded that both 1% permethrin and 0.5% ivermectin have comparable efficacies in managing pediculosis capitis infestation, but permethrin was found to be more effective in treatment. In addition, none of the participants in both the treatment groups experienced any side effects.  This is one of the very few studies exploring the treatment efficacy of topical ivermectin and the potential scope for future studies on the treatment options for pediculosis capitis.</p>

scholarly journals Povidone-iodine irrigation combined with Vancomycin powder lowers infection rates in pediatric deformity surgery

2021 ◽  
Author(s):  
Rolando Figueroa Roberto ◽  
Flynn Andrew Rowan ◽  
Deepak Nallur ◽  
Blythe Durbin-Johnson ◽  
Yashar Javidan ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Povidone Iodine ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Small Sample ◽  
Site Infection ◽  
Infection Rates ◽  
Vancomycin Powder

Abstract Background Surgical site infection is a morbid, devastating complication after spinal procedures. Studies have investigated the effect of wound lavage with 3.5% Povidone-iodine solution or the use of intrawound Vancomycin powder. We examined the effect of Povidone-iodine irrigation, intrawound Vancomycin powder, or a combination of both agents in a tertiary care Pediatric Hospital. Methods We queried our health system database for patients undergoing spinal surgery over an eight-year span between January 2008 and June 2016 and identified patient cohorts who received no intervention, intrawound Vancomycin alone, Povidone-iodine irrigation alone, or a combination of both agents. Infection rates were determined. The effect of treatment on outcome was analyzed using a logistic regression model. Results 475 patients were identified who met study inclusion criteria. 88 non-neuromuscular patients received no intra-operative agent. The surgical site infection (SSI) rate in this group of patients was 10%. For the 194 non-neuromuscular scoliosis patients who received Povidone-iodine and Vancomycin powder, the infection rate was reduced to 0.7%. The SSI rate in the 180 non-neuromuscular patients who were treated with Vancomycin powder alone was 1.4%. 13 patients were treated with Povidone-iodine lavage only, with a small sample size precluding statistical comparison. Infection rate in the 132 neuromuscular disease patients decreased from 14 to 7% overall during this time span: while the odds ratio of infection was reduced in all neuromuscular treatment groups receiving intra-operative measures, statistical significance was not reached in any neuromuscular group studied. Conclusions A protocol using combined 3.5% weight/volume Povidone-iodine and Vancomycin powder was associated with the lowest infection rate in our non-neuromuscular patient population and should be considered as a low cost intervention in pediatric patients undergoing spinal deformity procedures. Level of evidence Level II.

scholarly journals Emotional & Behavioural Problems among Siblings of Children with Chronic Neuromuscular Illnesses

2020 ◽  
pp. 29-37
Author(s):  
Nidhi Garg ◽  
Krishna Moorthi Adhikari
Keyword(s):  
Behavioral Problems ◽  
Assessment Tool ◽  
Small Sample Size ◽  
Tertiary Care ◽  
Small Sample ◽  
Emotional And Behavioral Problems ◽  
Behavioural Problems ◽  
P Value ◽  
Care Hospital ◽  
Significant Difference

Introduction and Objective: To determine the prevalence of emotional and behavioral problems among siblings of children with chronic neuromuscular illnesses by using validated parent completed assessment tool. Method: It is a cross-sectional study conducted in a tertiary care hospital from over a period of 34 months. Siblings of children with chronic neuromuscular illnesses were serially recruited while attending pediatric OPD and IPD. Parents were interviewed and requested to fill the Strength and Difficulty Questionnaire (SDQ) to assess and analyze emotional and behavioral problems among siblings. Results: Study included 171 siblings of children with chronic neuromuscular illnesses. Of 171 siblings, 124 (72.51%) had normal scores, 25 siblings (14.62%) were in borderline range and remaining 22 (12.87%) had abnormal values. The mean ± SD of SDQ score was 12.41 ± 3.6 with median score of 11. There was no significant difference between total SDQ scores of male vs female siblings (p value= 0.229) or between birth order of the sibling or GMFCS class of the affected child to emotional and behavioural problems. Subgroup analysis was not possible because of small sample size.

scholarly journals Trend of Breastfeeding and its Impact on Morbidity in Children in a Tertiary Care Hospital in Kathmandu

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Anwesh Bhatta ◽  
Rydam Basnet
Keyword(s):  
Exclusive Breastfeeding ◽  
Respiratory Infections ◽  
Tertiary Care ◽  
Current Trend ◽  
Acute Otitis Media ◽  
College Teaching ◽  
Care Hospital ◽  
Prospective Longitudinal Study ◽  
Significant Difference ◽  
Prospective Longitudinal

Introduction: WHO advocates for exclusive breastfeeding in infants till six months of age. Exclusive breastfeeding has been estimated to reduce 70% of infection related mortality in children. This study aims to elaborate the current trend of breastfeeding and its impact on common infectious morbidities in children. Methods: This study was a prospective longitudinal study done at Kathmandu Medical College Teaching Hospital with a sample size of 103 infants. Detailed proforma including sociodemographic data, breastfeeding related data and morbidities were collected at one and half months of life. The patients were followed up at 6 months of age again and the same proforma was again filled up. Statistical analysis was done with SPSS 20.0 and  various associations were elucidated.  Results: A total of 103 infants were analyzed. Males were 58 in numbers with mean birth weight of the infants being 3048±537 grams. Breast feeding was initiated within an hour in around 37%. At one and half months of age, 63% reported of exclusive breastfeeding which decreased to 23% at 6 months of age. Breastfeeding for at least 45 days decreased the incidence of Acute Respiratory Infections(ARI), Acute Otitis Media(AOM) and diarrheal diseases although statistically significant difference was found with only ARIs.     Conclusion: Prevalence of exclusive breastfeeding is low in the study. The study has also shown that breastfeeding significantly reduces incidence of common infectious morbidities in infants. 

scholarly journals Prevalence of carriage of community-acquired Methicillin-resistant Staphylococcus aureus among children attending the pediatric OPD at a tertiary care hospital

2018 ◽  
Vol 5 (5) ◽  
pp. 1956 ◽  
Author(s):  
Vishnurajan Radhakrishnan ◽  
Saranya Ravichandran ◽  
Senthamarai Murugaiyan Vadivelu ◽  
Shankar Radhakrishnan
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Tertiary Care ◽  
Control Measures ◽  
Care Hospital ◽  
Prospective Longitudinal Study ◽  
Entire Study ◽  
Methicillin Resistant ◽  
Sensitivity Pattern ◽  
Prospective Longitudinal

Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are commonly recognized in persons without traditional risk factors. Nasal carriage of MRSA is an important risk factor for subsequent MRSA infection and transmission of this pathogen. The aim of this study was to estimate the prevalence of carriage of community acquired MRSA and to describe its antibiotic susceptibility pattern among the pediatric population.Methods: A prospective longitudinal study was conducted in our hospital for a period of 6 months. All pediatric patients age less than 15 years attending the pediatric OPD were included in the study. A total of 325 children were included in the study based on our inclusion and exclusion criteria. Nasal smear was collected by tilting back the child’s head and gently inserting a sterile cotton swabs pre-wetted with sterile saline and slowly rotating against the turbinate of both anterior nares. The following antibiotics were tested for sensitivity pattern: penicillin, pipercillin, erythromycin, clindamycin, cotrimoxazole, vancomycin, linezolid, rifampin, ciprofloxacin and daptomycin. Any S. aureus that is resistant to Cefoxitin was defined as MRSA.Results: The prevalence of Staphylococcus aureus was found to be 26.7% of the entire microorganism detected and 6.4% (n = 21) of the entire study subjects had methicillin resisitant Staphylococcus aureus. Of testing the susceptibility of the various antibiotics vancomycin was the only drug found to be 100% sensitive followed by linezolid and pipericillin (90%). 50% sensitivity was seen with erythromycin and very poor sensitivity was seen in cefuroxime and ciprofloxacin (<50%).Conclusions: CA-MRSA strains tend to replace HA-MRSA in health-care settings, making infection control measures less effective. Hospital based antibiotic policy has to be created and strictly followed to minimize the burden of antibiotic resistance. 

Self-stigma in patients with major depressive disorder: An exploratory study from India

2020 ◽  
pp. 002076402097581
Author(s):  
Bichitra Nanda Patra ◽  
Vaibhav Patil ◽  
Yatan Pal Singh Balhara ◽  
Sudhir K Khandelwal
Keyword(s):  
Mental Health ◽  
Depressive Disorder ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Mental Health Problems ◽  
Small Sample Size ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Unfair Treatment

Background: One of the barriers to effective care in patients with depression is stigma associated with having a mental disorder, which also acts as a barrier to recovery and increases the disability. Aims: To study the stigma and disabilities experienced by the patients with depressive disorders seeking treatment in a tertiary care hospital Methodology: Fifty patients diagnosed to have depressive disorder as per ICD-10 were recruited by convenient sampling. To measure the stigma, the Discrimination and Stigma Scale -12 was applied. The severity of depression was determined by applying Hamilton Depression Rating Scale (HAMD). The disability was calculated by using WHO Disability Assessment Schedule 2.0 Results: Fifty percentages of the participants reported unfair treatment and they experienced discrimination in at least one life domain. There was significant positive correlation between unfair treatment subscale of stigma and disability. Around one fourth of the participants reported to be treated unfairly by their own families. Seventy percent reported to have concealed their mental health problems, 54% have stopped themselves from having a close personal relationship and 32% didn’t apply for work in anticipating discrimination. Experienced and anticipated discrimination were significantly associated with concealing the mental health problem. Conclusion: Stigma due to having depression acts as a barrier to vocational & social integration and functional recovery. Concealment of the diagnosis of depression is itself barrier for help seeking and to receiving appropriate treatment. Small sample size and adopting the purposive sampling method are the limitations of the study.

Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic

2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Faiza Ahmed ◽  
Lubna Abbasi ◽  
Nida Ghouri ◽  
Muhammad Junaid Patel
Keyword(s):  
Gender Differences ◽  
Cardiac Arrest ◽  
Tertiary Care Hospital ◽  
Small Sample Size ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Cross Sectional ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Objectives: To determine epidemiology of in-hospital cardiac arrest (IHCA) in a tertiary care hospital, pre- and during pandemic. Methods: This is a cross-sectional study of inpatients who experienced an in-hospital-cardiac arrest at a tertiary care hospital in Karachi between August 2019 and August 2020. Outcome variables were return of spontaneous circulation (ROSC) and survival to discharge (StD) and analysis was also done comparing pre- and during pandemic period. Results: A total of 77 patients experienced at least one IHCA event during the 1-year study period. Comparing pre- and during pandemic, ROSC for women was higher during the pandemic albeit not significant (43% vs 50%) in comparison to men (54% vs 10%, p<0.001). During the pandemic, women with IHCA were significantly younger than men (μ ± sd; 36.8 ± 15.3 vs 55.9 ± 12.7, p=0.001,) whereas pre-pandemic, there was no gender differences in mean age. Non-shockable rhythm was more common (92.2%) than shockable rhythm (6.5%). Pre- and during pandemic, there were significant differences in the cause of IHCA for 4H4T (87% vs 100%) and cardiac (36% vs 9%). The proportion of hypoxic patients increased from 50% during pre-pandemic to 91% during the pandemic period, whereas hypo/hyperkalemia decreased from 53% to 34%. Conclusion: Despite the limitation of a small sample size, our study has provided important information regarding the epidemiology and outcomes of IHCA pre- and during pandemic in a busy Pakistani tertiary care hospital. Our finding that gender differences exist in survival pre- and during pandemic needs to be explored further with more hospitals doing comparative studies. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5776 How to cite this:Ahmed F, Abbasi L, Ghouri N, Patel MJ. Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic. Pak J Med Sci. 2022;38(2):387-392. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5776 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.

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