scholarly journals Brucellosis, Unravelling an Enigma: Eight Years of Experience from a Tertiary Care Hospital in Central Kerala, India

2020 ◽  
Author(s):  
M Ardra ◽  
Chithra Valsan ◽  
KA Sathiavathy
Keyword(s):  
Tertiary Care Hospital ◽  
Demographic Data ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Unknown Origin ◽  
Personal Contact ◽  
Human Brucellosis ◽  
Care Hospital ◽  
Laboratory Findings ◽  
Middle East Countries

Introduction: Various emerging and re-emerging infectious diseases have made the existence of mankind in this world a great challenge. In the midst of these havocs, some important diseases has undermined in the dark. Brucellosis is an endemic zoonotic disease in most of the developing world and it has far-reaching and deleterious effects on humans and animals alike. In humans, brucellosis shows a variety of non-specific clinical signs. To recognise and diagnose this neglected but debilitating disease, the awareness and alertness of medical personnel has to be enhanced. Aim: To determine the prevalence of brucellosis in Tertiary Care Hospital. Materials and Methods: A retrospective study was conducted from June 2011 to May 2019, all culture proven cases of human brucellosis admitted in a Tertiary Care Hospital in central Kerala, India were reviewed. Demographic data, clinical presentations, laboratory parameters, treatment and outcomes of the same were analysed in Microsoft excel sheets as percentages. Results: Of the 12 culture proven Brucella cases, 11 presented as Pyrexia of Unknown Origin (PUO) cases and one was a soft tissue infection. Eleven patients had history of either consumption of unpasteurised milk products or had contact with animals before the symptoms developed. A 75% cases were imported cases from middle-east countries. In one case the route of entry was by close personal contact probably sexual transmission. All the patients complained of fever and malaise (100%), while low backache and arthralgia was noted in 83%. Most common clinical and laboratory findings associated with brucellosis were hepatosplenomegaly (41.7%) and anaemia (66.6%). Oral doxycycline for six weeks combined with either aminoglycoside or rifampicin was used for treatment. There was no death or relapses noted. Conclusion: This study emphasises the close collaboration of an alert clinician and an experienced microbiologist to correctly diagnose and treat an infection with multiple presentations as brucellosis, in endemic areas also.

scholarly journals CLINICAL SPECTRUM OF SCRUB TYPHUS IN A TERTIARY CARE HOSPITAL AT EASTERN INDIA

2018 ◽  
Vol 11 (5) ◽  
pp. 351 ◽  
Author(s):  
Srikant Kumar Dhar ◽  
Sobhitendu Kabi ◽  
Chandan Das ◽  
Swati Samant ◽  
Debasmita Tripathy ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Gastrointestinal Symptoms ◽  
Unknown Origin ◽  
Immunoglobulin M ◽  
Care Hospital ◽  
Diagnostic Features ◽  
Laboratory Findings ◽  
Pyrexia Of Unknown Origin

 Objective: Our hospital, tertiary care hospital in the capital of the state of Odisha, had been witnessing pyrexia of unknown origin, associated with breathlessness, renal, and liver impairment, which did not respond to high antibiotics but to doxycycline; therefore, the present study was undertaken to identify whether scrub typhus is the etiological agent, and thereafter, their characteristic features were further evaluated as an effort in supporting its diagnoses and treating patients accordingly.Methods: A total of 65 adult patients (age >15 years) admitted with pyrexia between April 2015 and October 2017 were evaluated. Immunoglobulin M (IgM) scrub typhus test was done in all these patients. IgM scrub typhus test positive samples were included in the study and various clinical parameters analyzed.Results: Of the 65 patients included in the study, all were found to be positive for IgM antibodies against Orientia tsutsugamushi. The cases were seen mainly in the months between September and November. The common symptoms found were fever, myalgia, breathlessness, rash, and abdominal pain and rarely altered sensorium. The diagnostic features like eschar were found in 23% patients. Nearly, two-thirds of patients had fever more than 7 days and myalgia (76.92%), headache (58.46%). The most common complications were renal failure (20%) followed by pneumonia (10.76%). Laboratory findings of high C-reacting protein (89.23%) and leukocytosis are found in 35.38%.Conclusion: Our results showed that scrub typhus should be considered in the differential diagnosis of pyrexia of unknown origin associated with breathlessness, myalgia, rash, gastrointestinal symptoms, hepatorenal syndrome, or acute respiratory distress syndrome. Empirical treatment with doxycycline may be given in the cases with strong suspicion of scrub typhus.

scholarly journals Solitary thyroid nodule: an overview of one year study at a tertiary care hospital

2019 ◽  
Vol 6 (9) ◽  
pp. 3117
Author(s):  
Shyam Sundar Tandri ◽  
Ayathu V. S. Sai Mahesh
Keyword(s):  
Thyroid Nodule ◽  
Tertiary Care Hospital ◽  
Demographic Data ◽  
Tertiary Care ◽  
Common Finding ◽  
Clinical Approach ◽  
Care Hospital ◽  
Cross Sectional ◽  
Solitary Thyroid Nodule ◽  
One Year

Background: Thyroid nodules are a common finding in general practice. These nodules are either solitary or multinodular. In the present study thorough evaluation of all the cases presenting with a solitary thyroid nodule (STN) is done. The clear overview of prevalence of STN, associated risk factors, its distribution and its percentage of malignancy, clinic-pathological correlation and findings on ultra-sonogram.Methods: A one year cross sectional study at a tertiary care hospital was done after ethical committee approval. All cases of thyroid with solitary thyroid nodule were included and socio demographic data, clinical examination and USG data was noted. Thyroid hormone profile, FNAC and HPE was performed for every case enrolled and data was noted. The data was analyzed using SPSS version 22.Results: 350 cases were enrolled with 44.42% prevalence and 61.43% were females. Maximum age group was 31-40 years with swelling as the most common sign. 81.14% were euthyroid, 6.3% of cases had lymph node involvement. Micro calcification in 69.7% of nodules and 78.65 were solid. 40.3% of the STN were of colloid on FNAC and 6% were malignant. Malignancy on HPE was 14.6% and papillary carcinoma was the most commonest and follicular least.Conclusions: All cases of STN require a thorough clinical approach supported by ultra-sonogram, FNAC and detailed HPE after surgery for evaluation of benign and malignant lesions. Fine needle aspiration cytology has become an invaluable, minimally invasive and reliable tool in the preoperative assessment of patients with suspicion of malignancy.

scholarly journals Prevalence of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital of Gujarat, India

2021 ◽  
Author(s):  
Chirag Manojkumar Modi ◽  
Suman Praveen Singh ◽  
Yagnesh Gajanand Pandya ◽  
Chirag Premjibhai Patel ◽  
Rupal Minesh Patel
Keyword(s):  
Tertiary Care Hospital ◽  
Demographic Data ◽  
Treatment Options ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Defined Daily Dose ◽  
Sample Type ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Introduction: Carbapenem Resistant Enterobacteriaceae (CRE) are major cause of community as well as healthcare associated infections and have limited treatment options. Measuring the magnitude of the problem of CRE, it is important for making strategies to lower its spread. Aim: To assess the incidence and prevalence rate of CRE in a tertiary care hospital of Gujarat, India. Materials and Methods: Retrospective data was collected for a period from 2014 to 2018 using Laboratory Information System (LIS). Prevalence of CRE was determined as number of CRE isolated per 100 Enterobacteriaceae isolated during the study period whereas incidence rate was determined as number of CRE cases per 1000 patient-days. Consumption of Carbapenems was calculated as Defined Daily Dose (DDD) per 1000 patient-days. Demographic data including age, gender, location in the hospital and sample type from which CRE was isolated was also analysed using Microsoft Excel. Results: The incidence of CRE cases per 1000 patient-days in 2014 to 2018 was 1.66, 2.11, 1.90, 2.26 and 1.91, respectively with an overall incidence of 1.99 per 1000 patient-days. The overall prevalence of CRE over a period of five years was found to be 29.07%. Klebsiellasp. was the most common CRE and had the highest percentage of Carbapenem resistance among all Enterobacteriaceae. Conclusion: The rate of CRE in present study was high and worrisome. Screening of the patient for CRE, source isolation and stringent implementation of infection control practices is required to confine the spread of CRE in this institute.

scholarly journals Practice of Informed Consent, Confidentiality and Privacy by Physicians at a Tertiary Care Teaching Hospital

2015 ◽  
Vol 5 (3) ◽  
pp. 1-5
Author(s):  
Zoheb Rafique Rafique ◽  
Urooj Bhatti
Keyword(s):  
Informed Consent ◽  
Medical Ethics ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Laboratory Findings ◽  
Public Sector Hospital ◽  
Privacy And Confidentiality ◽  
Structured Questionnaire

Objective: The aim of this paper was to assess the practice of medical ethics by the physicians at a public sector hospital in Jamshoro Sindh. Material and methods: This survey was conducted at four medical units of tertiary care hospital at jamshoro in the month of august 2014. Participants were randomly selected from patients aged over 18 years. A structured questionnaire was designed and the participants were asked about their demographic profile and their physician’s practice regarding informed consent, maintaining confidentiality, privacy and other treatment formalities. Written consent was taken from all the participants before interview.Results: A total of 100 patients were randomly selected for this study. The majority of patients reported that informed consent was taken from them. The patients also responded that privacy and confidentiality is maintained during their treatment. However, many patients agreed that they were not properly informed about the laboratory findings, role of proposed drugs and also side effects of drugs. Conclusion: There is marked improvement in the practice of medical ethics by physicians of this tertiary care hospital. However, awareness workshops should be conducted to update and improve the knowledge of medical ethics among physicians. This will surely help them translate the knowledge into practice. DOI: http://dx.doi.org/10.3329/bioethics.v5i3.21531 Bangladesh Journal of Bioethics 2014 Vol.5 (3): 1-5.

scholarly journals Anastomotic Leaks after Gastrointestinal Operations- A Prospective Cohort Study

2020 ◽  
Author(s):  
Amit Kumar ◽  
. Sambedna ◽  
Sribatsa Kumar Mahapatra
Keyword(s):  
Anastomotic Leak ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Care Hospital ◽  
Anastomotic Leaks ◽  
Anastomotic Complication ◽  
Intestinal Contents ◽  
Study Population ◽  
Presentation Procedure

Introduction: Anastomotic leak is the release of intestinal contents into the abdomen at the site of surgical stitch line, where two ends of the bowel have been joined for restoration of the gastrointestinal continuity. There are considerable variations in incidence of anastomotic leaks following gastrointestinal operations which have motivated the present study. Aim: To prospectively follow all the patients who underwent gastrointestinal surgeries and look for clinical signs of anastomotic leak in postoperative period. Materials and Methods: Study population comprised of 613 patients who underwent gastrointestinal operation at a Tertiary Care Hospital during the period from September 2011 to September 2013. After taking Institutional Ethical Committee Clearance enrolment in the study was done with written and informed consent. The site of leak, postoperative day of leak was diagnosed and noted based on clinical examination and radiological investigations.It was a prospectively designed descriptive study so no specific tests were applied. Statistical analysis and percentages were calculated using SPSS 16.0 software. Results: Most of the leaks occurred between eighth to ninth postoperative day and most of the obstruction occurred on sixth and seventh postoperative day. Incidence of anastomotic leaks in the study group was 3.26%. Incidence of anastomotic leaks in small bowel anastomosis is 0.489% compared to large bowel leaks reported to be 0.815%. Peritonitis was present in majority of patients presenting with leak. Incidence of obstruction in recto sigmoid anastomosis was 1.957%. Conclusion: The study suggests that as we move distally in Gastrointestinal Tract (GI) the incidence of anastomotic leak increases and it becomes maximum for colorectal surgeries. Anastomotic complication depends on various factors like age, sex, mode of presentation, procedure done, Hb%, dehydration, nutrition, blood sugar, albumin, peritonitis etc.

scholarly journals STUDY OF SPECTRUM OF PYREXIA OF UNKNOWN ORIGIN PATIENTS IN A TERTIARY CARE HOSPITAL IN COASTAL ANDHRA PRADESH

2017 ◽  
Vol 4 (74) ◽  
pp. 4372-4381
Author(s):  
Suryaprakasa Rao Salla ◽  
Prasanth Raghupatruni ◽  
Rakesh Yerra ◽  
Tarun Prudvi Betha
Keyword(s):  
Andhra Pradesh ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Unknown Origin ◽  
Care Hospital ◽  
Pyrexia Of Unknown Origin

scholarly journals Profile of Diabetic Foot Ulcer Patients at Tertiary Care Hospital in Surabaya, Indonesia

2021 ◽  
Vol 9 (3) ◽  
pp. 293
Author(s):  
Arisvia Sukma Hariftyani ◽  
Hermina Novida ◽  
Mouli Edward
Keyword(s):  
Mortality Rate ◽  
Diabetic Foot ◽  
Tertiary Care Hospital ◽  
Demographic Data ◽  
Tertiary Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Care Hospital ◽  
Precipitating Factors ◽  
Medical Histories

Background: Diabetic Foot Ulcer (DFU) has been associated with a high mortality rate of Diabetes Mellitus (DM) patients. Both behavioral and biological factors cause predisposition to DFU. Purpose: This research describes the profile of hospitalized DFU patients at a tertiary care hospital in Surabaya. Methods: A retrospective descriptive study that analyzed medical records of hospitalized T2DM patients with DFU in Dr. Soetomo General Hospital. Sampled respondents were patients ≥ 21 years old who were hospitalized between 2016–2018. Demographic data, clinical characteristics, medical histories, length of hospital stay, laboratory results, precipitating factors, microorganism culture results, treatment, and outcome were analyzed. Descriptive analysis is presented in the form of narratives, tables, and diagrams. Results: 9.08% of hospitalized Type 2 DM (T2DM) cases were related to foot ulcers. The average patient age was 57.00 ± 9.83 years with no gender predominance. DM was poorly controlled (Mean HbA1C 9.78±2.83%; RBG 251.83 ± 158.15 mg/dL). The majority of patients had sepsis (68.26%) and renal function impairment (62.72%). Ulcers with Wagner grades of 4–5 were frequent (41.31%). The highest percentage of sepsis (80.49%) and the average leukocyte level (22.60±11.95 x109/L) were found in gangrenous feet. Anemia was more predominant and severe in ulcers with higher Wagner grades. Trauma and Escherichia coli were the most common precipitating factors and microorganisms isolated, respectively. Amputation was performed for 82.36% of patients who were admitted to hospital with gangrene. The Lower Extremity Amputation (LEA) and mortality rates were 14.11% and 40.93%, respectively. Conclusion: DFUs were found to have a relatively high prevalence among T2DM patients, and must never be neglected due to the high associated mortality rate.

scholarly journals Burden and baseline characteristics of patients with decompensated liver disease in Tertiary Care Hospital Gujrat.

2021 ◽  
Vol 28 (02) ◽  
pp. 165-170
Author(s):  
Irfan Younus ◽  
Muhammad Zahid Ali ◽  
Muhammad Ajmal ◽  
Hina Akhtar ◽  
Javeria Ali ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Decompensated Cirrhosis ◽  
Care Hospital ◽  
Medical Department ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Gi Bleed

Objective: To determine the load, clinical and laboratory findings of the patients with decompensated cirrhosis admitted in medical department of tertiary care hospital and to make plan for the improvement of these patients. Study Design: Cross Sectional study. Setting: Department of medicine of Aziz Bhatti Shaheed Teaching Hospital, Gujrat. Period: from 1st January 2019 to 31st March 2019. Material & Methods: All 964 patients who were admitted included in study, clinical and laboratory features of patients with decompensated cirrhosis were recorded. Results: Male were in majority (53.7%), median age was 39 years. Decompensated cirrhosis was found  in  216 (22.4%), patients due to complication of  Diabetes Mellitus were 170 (17.6%), COPD & Asthma was found in 130 patients(13.5%), Stroke & Hypertension in 126 patients while Gastroenteritis 6% and infectious diseases RTI, UTI, Enteric Fever etc were present in 46 patients. Among 216 patients, one hundred & seventy eight were Hepatitis C Positive, fifteen had Hepatitis B, and eight had history of alcohol consumption. Seven patients were both Hepatitis B and C positive while in 3.6% etiology was other than mentioned above. Ascites was noted in two hundred six patients, 36.5% had variceal bleed while 51 admitted due to encephalopathy. Conclusion: HCV related cirrhosis and its complications like upper GI bleed, encephalopathy, ascites and hepatoma are major burden on our hospitals and need special attention.

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