Serological Characterisation of Auto-antibodies in Patients with Direct Antiglobulin Test Positive Autoimmune Haemolytic Anaemia at a Tertiary Care Teaching Hospital in Tirupati, India

Introduction: Haemolysis in Autoimmune Haemolytic Anaemia (AIHA) is a result of Immunoglobulin G (IgG) or Immunoglobulin M (IgM) auto-antibodies with or without complement components binding to the Red Blood Cell (RBC) surface and initiating its destruction. Serologic evidence is provided by autocontrol or Direct Antiglobulin Test (DAT). Diagnostic work-up is essential as the management depends on the antibody type. Characteristics of the bound antibody and the target antigen determine the degree of haemolysis. Serological characterisation in AIHA helps to differentiate into its various types which help the clinician to decide on the treatment to be given. Aim: To serologically characterise the auto-antibodies in patients with DAT positive AIHA at a tertiary care teaching hospital. Materials and Methods: This cross-sectional study was carried out in the Department of Transfusion Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India, from March 2019 to February 2020. A 40 consecutive patient samples were included in the study. Characterisation of antibody was done using polyspecific Anti-Human Globulin (AHG) reagent followed by mono-specific AHG reagent by gel method. If antibody was of IgG type, then the subclass was determined by a mono specific anti-IgG1 and anti-IgG3 gel card. Association between antibody types, subtype, and strength of DAT with severity of haemolysis were compared using Chi-square/Fisher’s-exact test. A p-value of less than 0.05 was considered statistically significant. Results: The total study population was 40 patients. The mean age of the study population was 45 years (range 13-78). Out of 40 patients, males were 30 (75%) and females were 10 (25%). The primary and secondary causes for AIHA include 4 (10%) and 36 (90%) respectively. Among 40 patients, 22 (55%) patients had IgG antibody alone, 17 (42.5%) patients had IgG antibody with combination of other antibodies and 1 (2.5%) had only complement (C3d). IgG1 was identified in 7 (18%) of patients, combination of IgG1 and IgG3 in 3 (7.7%). There was a significant association with IgG+combination (p-value=0.03), IgG1+IgG3 (p-value=0.029) and strength of reaction (p-value=0.003) with respect to severity of haemolysis. Conclusion: Presence of multiple antibodies, presence of IgG1 and IgG3 and with complement combination and presence of higher grading of reaction in gel column were associated with severity of haemolysis. We recommend that serological characterisation of auto-antibody in AIHA would help the clinician in assessing the severity of haemolysis so that management can be done appropriately.

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STUDY OF POTENTIAL DRUG INTERACTIONS AMONG EIGHT MAJOR DEPARTMENTS-GENERAL MEDICINE, ORTHOPEDICS, GYNECOLOGY, PULMONOLOGY, GENERAL SURGERY, PSYCHIATRY, OTOLARYNGOLOGY AND DERMATOLOGY OF A TERTIARY CARE TEACHING HOSPITAL IN SOUTHERN INDIA

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2020v12i6.37704 ◽

2020 ◽

pp. 59-67

Author(s):

TALHA JABEEN ◽

MOHD ABDUL KHADER ◽

A. V. KISHORE BABU ◽

A. SRINIVASA RAO

Keyword(s):

Drug Interactions ◽

Teaching Hospital ◽

General Surgery ◽

Tertiary Care ◽

General Medicine ◽

Potential Drug ◽

Tertiary Care Teaching Hospital ◽

Care Teaching ◽

Study Population ◽

The Mean

Objective: To identify frequency, type, severity and predictors of potential drug-drug interactions(pDDIs), potential drug-food interactions(pDFIs), potential drug-alcohol interactions(pDAIs) and potential drug-tobacco interactions(pDTIs) and most frequently interacting drug combination pairs in hospitalized patients from departments(depts) of General Medicine(GM), Orthopedic(Ortho), Gynecology(OBG), Pulmonology(Pulmo), General Surgery (GS), Psychiatry (Psych), Otolaryngology(ENT) and Dermatology (Derm) of study population. Methods: A Prospective Observational Study was conducted in eight major dept's of a tertiary care teaching hospital for a period of 6 mo. A sample size of 650 prescriptions reflecting admission no's for each department were used. Results: A total of 650 patients were included in the study. Among them, 282(43.4%) were males and 368(56.6%) were females. The mean age of the study population was 39.67±15.23. A total of 487 pDDIs, 734 pDFIs, 586 pDAIs and 159 pDTIs were found out of 650 hospitalized episodes. OBG showed the highest pDDIs and pDAIs. Highest pDFIs and pDTIs were seen in Pulmo. The majority of DDIs were minor, DFIs and DAIs were moderate and DTIs were of major in severity. Pharmacokinetic types of interactions were seen in the majority of the depts. Logistic regression analysis showed that Polypharmacy was associated with the occurrence of DIs. Most of the DIs repeated several times in particular depts and a list of these combinations was prepared. Conclusion: With the high occurrence of overall DIs and characteristic patterns of DIs combination pairs among different departments of the hospital, the presence of clinical pharmacists in hospitals can play a great role, especially in developing nations like India where their role in hospitalized settings is always controversial.

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APPENDICULAR MASS AND ABSCESS

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.12.1802 ◽

2016 ◽

Vol 23 (12) ◽

pp. 1489-1494

Author(s):

Zubair Ahmed Yousfani ◽

Ahsan Ali Laghari ◽

Jabeen Atta ◽

M. Siddique Khurram ◽

Roohi Bano ◽

...

Keyword(s):

Teaching Hospital ◽

Iliac Fossa ◽

Tertiary Care ◽

University Hospital ◽

P Value ◽

Male Population ◽

Cross Sectional ◽

Tertiary Care Teaching Hospital ◽

Care Teaching ◽

Appendicular Mass

Objectives: To determine the frequency of appendicular mass (tumour) andabscess at tertiary care teaching hospital. Study Design: Cross sectional descriptive study.Period: One year. Setting: Department of Surgery at Liaquat University Hospital Hyderabad /Jamshoro, a tertiary care teaching hospital. Patients and Methods: All the patients presentedwith pain in right iliac fossa were recruited for the study. The detail history was taken; clinicalexamination was done, while all the baseline and specific investigations were advised accordinglyto explore the appendicular lump / abscess whereas the data was saved and analyzed inSPSS version 16 and the consideration for significance was p-value ≤0.05. Results: Duringone year study period total fifty patients were presented as appendicular mass and abscess,seventy percent appendicular mass presented with fever and 60% presented with vomiting.Regarding appendicular abscess 90% presented with fever and 30% presented with vomiting.The appendicular mass and appendicular abscess was identified in 32 (64%) and 18 (36%)cases with male population predominance. Out of thirty two patients of appendicular masswere managed surgically i.e. 16 cases were underwent for surgery immediately whereas restof the 16 subjects were managed by Oschner Scherren regime and later date appendicectomywas performed. All 18 cases of appendicular abscess were managed by antibiotics drainageand these cases of appendicular abscess were nominated for interval appendicectomy6-8 weeks later due to recurrent appendicitis. Conclusion: The appendicular mass andappendicular abscess are common disorders and the management tools varies accordinglyfrom early appendectomy, conservative conventional management to interval appendectomywhile the extraperitoneal drainage and interval appendectomy are useful tool for patients withappendicular abscess

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Inter-hospital obstetric referrals: public versus private sector to a tertiary care teaching hospital in South Kerala, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20185091 ◽

2018 ◽

Vol 8 (1) ◽

pp. 86

Author(s):

Heera Shenoy T. ◽

Sheela Shenoy

Keyword(s):

Public Health ◽

Public Sector ◽

Private Sector ◽

Teaching Hospital ◽

Past History ◽

Tertiary Care ◽

Significant Risk ◽

P Value ◽

Tertiary Care Teaching Hospital ◽

Care Teaching

Background: Inter-hospital Emergency obstetric transfers should be carried out effectively and efficiently to avoid maternal and fetal morbidity and mortality. Authors would like to analyse the determinants ,patterns and reasons for referrals to tertiary hospital for women with obstetric high-risk, complications and obstetric emergencies from both public and private sectors and look into course in hospital and their feto-matermal morbidities.Methods: Descriptive study done at a tertiary care teaching hospital where 124 obstetrical referrals from nearby private and public health sectors were recruited.Results: Infertility treated obstetric referrals were at significant risk of referral (p value-0.002). Public sector referrals had past history of early pregnancy loss which was significant (p value-0.002). Public sector had statistically significant in -labour referrals (p value-0.04). All the obstetric referrals from public health sector reached within half an hour while one third of private sector referrals travelled more than an hour for emergency obstetric care (p value 0.001). Bronchial Asthma caused significant morbidity among public sector referrals (p value-0.001). Public sector referrals <31 weeks were nil while 55 % obstetric referrals were referred <31 weeks from various private hospitals seeked neonatal care with significant p value (0.016). NICU admissions were statistically significant in private sector referrals (p-value 0.001). Mean hospital stay in private sector referrals was 10.17 days and it was 7.62 days in government referrals.Conclusions: Specific guidelines for whom to refer, how to refer, when to refer and where to refer would be helpful in making timely referral. More stringent documentation in the referral slips and more co-ordination between the referral unit and the higher centers are required to build a strong health system.

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A prospective observational study for the safety of Nd-YAG Laster posterior capsulotomy procedure in patients of Posterior Capsular Opacification (PCO) at the ophthalmology outpatient department of a tertiary care teaching hospital in western India

Indian Journal of Clinical and Experimental Ophthalmology ◽

10.18231/j.ijceo.2021.112 ◽

2021 ◽

Vol 7 (3) ◽

pp. 574-578

Author(s):

Rajendra Choudhary ◽

Nishant V Shah ◽

Meet Mashru

Keyword(s):

Observational Study ◽

Teaching Hospital ◽

Prospective Observational Study ◽

Tertiary Care ◽

Posterior Capsular Opacification ◽

P Value ◽

Western India ◽

Yag Laser ◽

Tertiary Care Teaching Hospital ◽

Care Teaching

: Nd YAG laser is preferred method to manage thickened posterior capsule because it is an easy, non-invasive and an OPD basis procedure considering the comfort of the patients.: The present study was carried out with objectives to evaluate the safety profile of Nd-YAG Laser Capsulotomy mainly in terms of rise in intraocular pressure (IOP) and other intra as well as post-operative complications.This prospective observational study was carried out with prior Institutional Ethics Committee (IEC) approval and written informed consent from the participants at Ophthalmology Outpatients Department (OPD) of a tertiary care teaching hospital of western India, for the duration of two years from Oct’2015 to Sept’2017. A detailed ocular, systemic, family history was taken of all the enrolled patients with pre- and post-procedure evaluation of IOP by Goldman’s Applanation Tonometry, Slit lamp examination and Fundus examination by direct and indirect ophthalmoscopy. Capsulotomy was done using VISULAS YAG III laser of Zeiss company.The data was entered and tabulated in Microsoft Excel 2007 and analyzed. Data was analyzed by frequency distribution. The ‘p’ value was determined to finally evaluate and P <0.05 was considered as statistically significant.Acute transient rise of IOP up to 5mmHg or more (P value <0.001) was found in Nine cases which is highly significant compared with pre-procedural stage. Intraocular lens pitting was observed in Four cases. Cystoid macular edema was found in one case. Two patients developed mild iritis. Nd-YAG laser capsulotomy is an easy, practical modality to treat posterior capsular opacities, but is not a completely innocuous procedure. Nd-YAG laser capsulotomy is an easy, practical modality to treat posterior capsular opacities, but is not a completely innocuous procedure. Due precautions should be taken in pre- and post-procedural stages including medications, thorough counselling, proper focusing and steady fixation of the patients to minimise the complication.

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Analysis of caesarean sections according to Robson’s criteria at a tertiary care teaching hospital in central India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204317 ◽

2020 ◽

Vol 9 (10) ◽

pp. 4221

Author(s):

Aparna Wahane ◽

Ashwini S. Ghaisas

Keyword(s):

Teaching Hospital ◽

Tertiary Care ◽

International Standards ◽

Specific Rate ◽

Cross Sectional ◽

Tertiary Care Teaching Hospital ◽

Care Teaching ◽

Study Population ◽

Group 5 ◽

Group 1

Background: The rate of caesarean section (CS) has been skyrocketed globally over the past three decades which makes it utmost essential to be reanalyzed. Hence, the Robson’s classification of international standards has become a need of an hour. This study aimed to analyze the trend of caesarean sections at a tertiary care teaching hospital, by using Robson’s criteria.Methods: This cross-sectional observational study was conducted at Government Medical College in Akola. The data was collected for the women delivered by CS during November 2017 to April 2019 and proportions in various groups as per Robson’s criteria were calculated.Results: The overall CS rate for the study period at our hospital was 63.89%. Robson Group 1 (24.5%) had the greatest representation in the study population followed by Group 5 (21.27%) and 3 (14.18%). While Groups 6 (10.13%) and 9 (0.63%) had the least representation. Group 5 was found to be the highest absolute contributor (20.5%) to overall CS rates followed by Group 1 (16.08%). Group 9 had a least possible share in the study population, but it had 100% CS rate.Conclusions: Robson’s classification must be implemented in all delivery units to avoid unnecessary caesarean sections. Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate and Robson’s criteria is a step forward in the same direction.

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A PROSPECTIVE OBSERVATIONAL STUDY ON THE ASSESSMENT OF POTENTIAL DRUG-DRUG INTERACTIONS AND MANAGEMENT OF POST-COMPLICATIONS IN STROKE PATIENTS AT A TERTIARY CARE TEACHING HOSPITAL

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2021v13i11.42527 ◽

2021 ◽

pp. 8-14

Author(s):

MAHE NAAZ SULTANA ◽

SABA YOUNUS QURESHI ◽

IQRA FATIMA ◽

WAJIDA JABEEN ◽

MOHAMMED OBAID

Keyword(s):

Observational Study ◽

Drug Interactions ◽

Teaching Hospital ◽

Prospective Observational Study ◽

Tertiary Care ◽

Potential Drug ◽

Stroke Patients ◽

Tertiary Care Teaching Hospital ◽

Care Teaching ◽

Study Population

Objective: The objective of the study is to determine the occurrence, frequency, and severity of significant drug-drug interactions in stroke patients, with an emphasis on post complications and their symptomatic management. Methods: A prospective observational study was carried out for 6 mo at Osmania General Hospital, a Tertiary Care Teaching Hospital. The prescriptions taken by stroke patients throughout their hospital stay were analyzed for possible interactions using-Micromedex-2 (Thomson Reuters) × 2.0. Results: A total of 130 prescriptions was analyzed in the study in which 141 drug-drug interactions were found with a male predominance of 85.4%. The majority of interactions were of moderate severity (74.46%) and pharmacokinetics (67.37%) in nature. Among the clinical consequences, decreased atorvastatin efficacy (49.10%) was found to be the highest. The class of drugs most commonly involved in drug-drug interactions was found to be anti-epileptics and statins. 60.15% of the study population were identified with one complication, among which seizures account for 15% of patients. All the complications allied with the condition were treated with drug classes in the study population. Conclusion: This study highlighted the exigency for screening prescriptions of cerebrovascular accident patients for potential drug-drug interactions (pDDIs). Brain edema and seizure were the most accountable complications identified in the study population. The early detection of these problems can improve stroke outcomes and can reduce the mortality or disability rate.

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Factors Associated with Knowledge Regarding Uterine Prolapse among Women Attending Gynecology Outpatient Department of Tertiary Care Teaching Hospital

Global Journal of Medical Research ◽

10.34257/gjmrevol20is6pg9 ◽

2020 ◽

pp. 9-14

Author(s):

Nirmal Raj Marasine ◽

Sabina Sankhi ◽

Rajendra Lamichhane ◽

Sonu Pahari ◽

Sangit Maharjan ◽

...

Keyword(s):

Teaching Hospital ◽

Uterine Prolapse ◽

Tertiary Care ◽

Outpatient Department ◽

Bivariate Analysis ◽

P Value ◽

Tertiary Care Teaching Hospital ◽

Care Teaching ◽

Factors Associated ◽

Validated Questionnaire

Background: Uterine prolapse (UP) is a common reproductive health problem in low-mid-income countries such as Nepal. The current study aimed to explore the factors associated with knowledge regarding UP among women attending the gynecology outpatient department of tertiary care teaching hospital. Methods: A cross-sectional study was conducted among patients visiting the gynecology outpatient department of tertiary care teaching hospital in Nepal from July to September, 2016 using a purposive sampling technique. A suitably designed and validated questionnaire of knowledge consisting of 20 questions was used to determine the knowledge scores. Descriptive statistics and bivariate analysis were used; a p-value <0.05 was taken as significant in multivariate analysis.

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Self-medication amongst pregnant women in a tertiary care teaching hospital in India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205778 ◽

2020 ◽

Vol 10 (1) ◽

pp. 256

Author(s):

Pooja P. Rangwala ◽

Anushka S. Chokshi ◽

Radhe K. Shah ◽

Ayush S. Thakkar ◽

Yash G. Thakker ◽

...

Keyword(s):

Adverse Effects ◽

Pregnant Women ◽

Teaching Hospital ◽

Tertiary Care ◽

Significant Proportion ◽

P Value ◽

Self Medication ◽

Cross Sectional ◽

Tertiary Care Teaching Hospital ◽

Care Teaching

Background: Self-medication is a popular practice in developing countries where there is no strict regulation of drugs sold in local pharmacies. General public is usually unaware of the adverse effects of drugs used for common illness and continue using them without prescription during pregnancy. This study was carried out to know the extent of self-medication practised by pregnant women and various factors associated with it.Methods: A questionnaire based, cross-sectional study of pregnant women visiting the OB GYN-OPD of a tertiary care teaching hospital was conducted. 303 eligible subjects were questioned and statistical analysis was carried out.Results: Total 16.5% women were found to be self-medicating during pregnancy for common conditions like headache (26%), fever (23%) and common cold (19%). Odds Ratio between the self-medicating and non-self-medicating groups for variables like age (<25 years; ≥25 years), education (illiterate; literate) and gestational age (<20 weeks; ≥20 weeks) are 1.6, 2 and 1.73 respectively. Women with a history of self-medicating before pregnancy were significantly more likely to continue doing so during pregnancy (p value <0.00001).Conclusions: A significant proportion of pregnant women have been found to self-medicate without knowing the adverse effects of the drug used. Thus, spreading awareness against this health-predicament is necessary.

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