scholarly journals COMPARISON OF MICRONIZED PROGESTERONE (CYCLOGEST PESSARY) AND PLACEBO IN PREVENTION OF PRE-TERM BIRTH IN TERTIARY CARE HOSPITAL

2020 ◽  
Vol 70 (6) ◽  
pp. 1859-63
Author(s):  
Nighat Afridi ◽  
Ambreen Fatima ◽  
Amna Fareed ◽  
Saifullah Khan ◽  
Shah Gul Khan
Keyword(s):  
Preterm Birth ◽  
Tertiary Care Hospital ◽  
Positive Impact ◽  
Controlled Trial ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
P Value ◽  
Care Hospital ◽  
Gynecology And Obstetrics ◽  
Micronized Progesterone

Objective: To compare efficacy of micronized per rectal progesterone (cyclogest pessary) and placebo inprevention of preterm birth in tertiary care hospital. Study Design: Randomized controlled trial (RCT). Place and Duration of Study: Study was conducted at department of gynecology and Obstetrics, CombinedMilitary Hospital Nowshera, Khyber Pakhtunkhwa, from Jan 2018 to Jun 2018. Methodology: A sample size of 140 patients was calculated using WHO calculator. Non probability consecutivesampling was used for recruitment of participants. Ethics approval and consent forms were taken. Women weredivided into two groups randomly. Group A was given micronized progesterone (cyclogest pessary) per rectalusage and group B was given placebo. Patients were followed for maternal and neonatal outcomes. Data wasanalyzed using SPSS version 23. Independent t-test was applied. p-value ≤0.05 was considered significant. Results: Total 140 patients were included in study. Mean age of women was 29.4 years ± 4.6SD. Patients in micronized progesterone (cyclogest pessary) was more effective in increasing birth weight (p=0.00), Apgar score maintenance at 1st (p=0.00) and 5th minute (p=0.000) and reduction in length of hospital stay (p=0.000) as compared to placebo. Patients were more satisfied with micronized progesterone (cyclogest pessary) per rectal as compared to placebo (p=0.00). Conclusion: Preterm birth is remained as significant issue in health care system of Pakistan. However, micronized progesterone (cyclogest pessary) per rectal usage had positive impact in improving maternal and neonatal health outcomes. Effective strategies for prevention of preterm birth in Pakistan are required.

scholarly journals Impact of antibiotic stewardship program on usage of higher range of antibiotics in patients of intensive care units in a tertiary care hospital, India

2020 ◽  
Vol 7 (2) ◽  
pp. 287
Author(s):  
Mounamukhar Bhattacharjee ◽  
Vijaya Lakshmi Nag ◽  
Jagdish Prasad Goyal ◽  
Vibhor Tak
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Antibiotic Stewardship ◽  
Tertiary Care Hospital ◽  
Positive Impact ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Stewardship Program ◽  
Definitive Therapy

Background: The aim of the study was to monitor the changes in antimicrobial use after implementation of Antibiotic Stewardship Programmed (ASP) and pattern of use of antimicrobials in the respective ICU’s.Methods: The study was conducted in three ICU’s Adult ICU(AICU), Paediatric ICU (PICU), Neonatal ICU (NICU) -Six bedded each) over a period of six months from September 2018 to February 2019 in a tertiary care hospital. Antibiotics monitored over total 155 patients and antibiotics selected for the study are β-lactam inhibitors, Carbapenem derivatives and ColistinResults: Out of total 155 patients 51% were males and the definitive therapy (Implementation of antibiotics according to the antibiotic policy of the hospital) in the respective ICU’s showed increase from 66.7% to 83.3% after implementation of ASP activity in that particular duration. Antibiotic consumption showed fluctuation in the whole duration of the study (p value <0.05).Conclusions: Analysis of the study shows a positive impact on implementation of ASP programme in intensive care units, brought an effective increase in appropriate use of antimicrobials.

scholarly journals Impact of burnout among surgeons and residents at a Tertiary Care Hospital of Pakistan.

2020 ◽  
Vol 27 (11) ◽  
pp. 2523-2528
Author(s):  
Balakh Sher Zaman ◽  
Raza Gulzar Ghouri ◽  
Muhammad Mohsin Ali ◽  
Raja Mobeen Ahmed
Keyword(s):  
General Surgery ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Working Hours ◽  
High Rate ◽  
Health Improvement ◽  
P Value ◽  
Care Hospital ◽  
Cross Sectional ◽  
Gynecology And Obstetrics

Objectives: To determine frequency and impact of burnout among surgeons and residents of different specialties at a tertiary care hospital in Punjab, Pakistan, over a period of 6 months. Study Design: Observational Cross-sectional study. Setting: Departments of General Surgery and Ophthalmology, Mayo Hospital Lahore and the Department of Gynecology, Lady Willingdon Hospital Lahore. Period: September to November 2019. Material & Methods: Out of 150 invited participants, 124 responded to the questionnaire. Grades of burnout were determined according to the American Public Welfare Association (APWA) inventory. Data analysis was performed using SPSS 26.0, with qualitative statistics determined as frequency and percentages, and quantitative correlations among variables determined by application of chi-square test with p-value ≤ 0.05 as significant. Results: Out of 124 participants, 48.3% were female while the rest were male, mostly in the age group of 26-30 years (75%). Majority (50.8%) belonging to General Surgery; 32.3% were from Gynecology and Obstetrics and 16.9% were from Ophthalmology. Most of the participants (81.4%) were residents, with majority (51.6%) working 60-80 hours per week. There was high rate of burnout, with 46.3% of females and 32.8% of males reporting early burnout, and 36.6% of females along with 25% of males reporting advanced burnout. General surgeons and gynecologists were more prone to advanced burnout, while eye surgeons and residents had an increased propensity towards developing burnout. Conclusion: There is a high rate of burnout among surgical residents and consultants, attributable to increased working hours, less pay, and decreased job satisfaction. Measures should be taken to curb this trend, both for patient safety as well as for personal and mental health improvement of surgeons.

scholarly journals Assessment of adverse drug reaction profile of the disease-modifying anti-rheumatic drugs at the department of orthopaedics in a tertiary care hospital, Silchar, Assam, India

2019 ◽  
Vol 8 (5) ◽  
pp. 1007
Author(s):  
Vijoy S. Kairi ◽  
Pinaki Chakravarty ◽  
Arun Kumar Sipani
Keyword(s):  
Prospective Observational Study ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Case Record ◽  
Medical College ◽  
Disease Modifying ◽  
Reaction Profile

Background: The mainstay of treatment of Rheumatoid Arthritis (RA) is the use of the disease-modifying anti-rheumatic drugs (DMARDs). Methotrexate, sulfasalazine and hydroxychloroquine are some of the DMARDs which are used in combination for the treatment of RA. The current study was undertaken to assess the adverse drug reactions (ADRs) of DMARDs that are commonly encountered with the treatment of RA.Methods: The present study was designed as a prospective, observational study on newly diagnosed patients with RA. Patients diagnosed with RA above 18 years (excluding pregnant women) of either sex who were prescribed DMARDs in combination were included. ADRs reported spontaneously by the patients and also responses obtained in a questionnaire related to likely ADRs from the patients was recorded in the case record form. Statistical analysis was done using graph pad and p value <0.05 was considered to be statistically significant.Results: A total of 47 patients attending the Outpatient Department of Orthopaedics, Silchar Medical College and Hospital, Silchar, Assam, India were screened for the study. ADRs were monitored up to the last visit on 41 patients excluding the patients who were lost and who were not able to adhere to the treatment. A total of 27 ADRs were reported from 19 ADR forms. Gastrointestinal manifestations were the most common adverse effects of combination DMARDs seen in 10 patients (24.39%). Severity assessment done using modified Hartwig and Siegel scale that showed majority of the ADRs were mild (74.07%).Conclusions: Present study showed that DMARDs are well-tolerated and have an acceptable toxicity profile as majority of ADRs seen were mild. It was however difficult to prevent the occurrence of ADRs. Proper monitoring of therapy is needed for early recognition of ADRs.

scholarly journals Visual Outcome of Ocular Trauma Presenting in a Tertiary Care Hospital in Sahiwal

2020 ◽  
Vol 36 (2) ◽  
Author(s):  
Ahmad Zeeshan Jamil ◽  
Muhammad Luqman Ali Bahoo
Keyword(s):  
Visual Acuity ◽  
Ocular Trauma ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Sampling Technique ◽  
Visual Outcome ◽  
P Value ◽  
Care Hospital ◽  
Open Globe ◽  
Patient Reported

Purpose: To find the visual outcome of ocular trauma presenting in a tertiary care hospital in Sahiwal. Study Design: Descriptive observational study. Place and Duration of Study: This study was conducted at District Headquarter Teaching Hospital affiliated with Sahiwal Medical College, Sahiwal from January 2016 to June 2019. Material and Methods:  Four hundred and thirty five patients were included in the study by convenient sampling technique. Patient’s age, gender, occupation, activity at the time of injury, nature of object causing trauma, duration of trauma, visual acuity at the time when patient reported to hospital, the time delay before coming to the hospital were recorded. Ocular injuries were classified according to Birmingham ocular trauma terminology. Detailed ocular examination was performed. Patients were managed and post-management visual acuity at three months was recorded. Results: Mean age of patients was 29.07 ± 12.53 years. There were 219 (50.3%) closed globe and 216 (49.7%) open globe injuries. In 59 (13.6%) cases, cause of injury was metal object. In 146 (33.6%) cases injury was classified as contusion. In 164 (37.7%) cases cornea was involved. Majority of the patients were male. Eighty-seven patients presented within 1 day after trauma. In 154 (35.4%) patients, visual acuity at the time of presentation was 6/12 or better while in 171 (39.3%) cases it was less than 6/60. Chi-square test was used to calculate the difference between pre and post-management visual acuity. This difference was statistically significant with p-value less than 0.05 Conclusion:  Ocular trauma cases, if properly and timely managed, have a statistically significant increase in visual acuity.

Opportunistic infection at the start of antiretroviral therapy and baseline CD4+ count less than 50 cells/mm3 are associated with poor immunological recovery

2019 ◽  
Vol 30 (2) ◽  
pp. 163-171
Author(s):  
Amod Tilak ◽  
Smita Shenoy ◽  
Muralidhar Varma ◽  
Asha Kamath ◽  
Amruta Tripathy ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Opportunistic Infection ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Hiv Positive ◽  
P Value ◽  
Care Hospital ◽  
Long Term Treatment ◽  
Immunological Recovery

AbstractIntroductionThere is a dearth of studies assessing the efficacy and immunological improvement in patients started on antiretroviral therapy (ART) in India. This study was undertaken to assess the 2-year treatment outcomes in HIV-positive patients initiated on ART in a tertiary-care hospital.MethodsAfter approval from the Institutional Ethics Committee, adult HIV-positive patients from a tertiary-care hospital, initiated on ART between January 2013 and February 2015, were included in the study. Data on clinical and immunological parameters were obtained from medical case records over a period of 2 years after initiation of therapy. Intention-to-treat analysis was done using a descriptive approach, using SPSS version 15 (SPSS Inc. Released 2006. SPSS for Windows, Version 15.0. Chicago, SPSS Inc.). A logistic regression analysis was done to assess the predictors for poor outcomes. A p-value <0.05 was considered statistically significant.ResultsART was initiated in 299 adult patients. At 1 and 2 years, the median (interquartile range) change in CD4+cell count was 65 (39, 98) cells/mm3and 160 (95, 245) cells/mm3. The change observed after 2 years of treatment initiation was statistically significant compared with that after 1 year. Three deaths occurred during the study period and 28 were lost to follow-up. Male sex, presence of at least one opportunistic infection at the start of therapy, and baseline CD4+count <50 cells/mm3were associated with poor immunological recovery.ConclusionsWith long-term treatment and regular follow-up, sustained clinical and immunological outcomes can be obtained in resource-limited settings.

Impact of Computerized Prescriber Order Entry on Medication Errors at an Acute Tertiary Care Hospital

2003 ◽  
Vol 38 (3) ◽  
pp. 227-231 ◽  
Author(s):  
Chike Augustine Igboechi ◽  
Carol L. Ng ◽  
Chuiling S. Yang ◽  
Althea N. Buckner
Keyword(s):  
Medication Errors ◽  
Tertiary Care Hospital ◽  
Positive Impact ◽  
Tertiary Care ◽  
Care Hospital ◽  
Order Entry ◽  
Clinical Interventions ◽  
Continuous Quality ◽  
Computerized Prescriber Order Entry ◽  
Drug Therapy Problems

The authors analyzed medication errors documented in a hospital's database of clinical interventions as a continuous quality improvement activity. They compared the number of errors reported prior to and after computerized prescriber order entry (CPOE) was implemented in the hospital. Results indicated that in the first 12 months of CPOE, overall medication errors were reduced by more than 40%, incomplete orders declined by more than 70%, and incorrect orders decreased by at least 45%. Illegible orders were virtually eliminated but the level of medication errors categorized by drug therapy problems remained significantly unchanged. The study underscores the positive impact of CPOE on medication safety and reemphasizes the need for proactive clinical interventions by pharmacists.

scholarly journals Frequency Of Post-operative Hypocalcaemia Following Thyroid Surgery At A Tertiary Care Hospital Of Sindh

2017 ◽  
Vol 08 (01) ◽  
pp. 07-10
Author(s):  
Summaya Qazi ◽  
Khalil ahmed Almani ◽  
Rizwanullah Junaid Bhanbhro ◽  
Diya Ram Khatri
Keyword(s):  
Serum Calcium ◽  
Thyroid Surgery ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
University Hospital ◽  
P Value ◽  
Care Hospital ◽  
Long Duration ◽  
Symptomatic Hypocalcemia ◽  
Laboratory Investigations

Objective: The present study was conducted to determine the frequency of post-operative hypocalcaemia following thyroid surgery at a tertiary care hospital of Sindh Study design: Observational study Place and Duration: Department of surgery, Isra University Hospital from December 2014 to July 2017. Materials and Methods: 100 cases of thyroid swellings were selected according to inclusion and exclusion criteria. Pre- operative patient history, physical examination, thyroid gland examination and laboratory investigations were performed. A serum calcium levels <8 mg/dl was taken as hypocalcemia. Data was analyzed on SPSS 21 version and P value (P< 0.05) was considered significant. Results: Of 100 patients, 67% were female and 33% were male (P=0.0001). Female dominancy was noted with female to male ratio of 2.03:1. Age (mean± SD) was noted as 37.5 ± 9.5 years (19 – 48 years). Frequency of symptomatic hypocalcaemia was noted in 23% subjects post operatively. Mean± SD serum calcium and phosphate in post operative hypocalcemia subjects was noted as 7.31 ± 0.38 mg/dl and 2.95 ± 0.63 mg/dl respectively. Majority of symptomatic hypocalcemia were noted within 72 hours post operatively. Conclusion: The present study reports 23% frequency of post thyroidectomy hypocalcemia noted within 72 hours post operatively. Goiters of long duration, recurrent goiters, hyperthyroidism and goiters with retro sternal extensions were found risk factors for the post thyroidectomy hypocalcemia.

scholarly journals Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Nighat Sultana ◽  
Attia Bari ◽  
Mehwish Faizan ◽  
Muhammad Sarwar
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Neonatal Tetanus ◽  
P Value ◽  
Care Hospital

Objective: To determine the prognostic factors and outcome of tetanus in children of post-neonatal age admitted in the intensive care unit (ICU) of a tertiary care hospital. Methods: This prospective cross sectional study, carried out in the Pediatric ICU of The Children’s Hospital Lahore from Jan 2013 to March 2017. Children of both genders with age range of two months to 16 years diagnosed clinically as tetanus were included. All 132 patients were scrutinized for all possible risk factors, need for mechanical ventilation and outcome. Data was analyzed by SPSS version 20. Results: Mean age of children was 7.5±3.4 years with male predominance (70.5%). Only (38.6%) received three doses of vaccination but none had booster dose. Trauma (43.2%) encompassed maximum predisposing factor followed by ear or nose prick and ear discharge. Mean duration of ICU stay was 20±13.3 days. Mortality rate was (17.4%). Ventilator support was given to (78.8%). Neurological outcome was normal in (82.6%). Trauma, ear or nose prick in girls and ear discharge were significantly associated with poor outcome and death with p-value of <0.001, 0.011 and <0.001 respectively. Other factors associated with poor outcome were need for mechanical ventilation and neurological impairment with p-value of 0.001 and <0.001 respectively. Conclusion: Tetanus is causing our children to suffer from devastating disease. Vaccination status is not satisfactory and along with trauma, ear discharge and ear or nose prick are identifiable risk factors. To combat these issues large scale vaccination and booster doses remains promising option. doi: https://doi.org/10.12669/pjms.35.5.656 How to cite this:Sultana N, Bari A, Faizan M, Sarwar M. Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.656 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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