Assessment of the Anemic Conditions among the Females with Pregnancy at Tertiary Care Hospitals of Sindh Pakistan

Anemia is pathological disorder usually caused by mal nutrition and it was very common among feminine gender during gestational period, number of disease and death are also associated with this type of disorder during pregnancy. The major theme of the study is to evaluate the anemic condition along with prescribed medication among females during the period of pregnancy. Descriptive cross-sectional study was carried out for the period of 9 months at various tertiary care hospitals situated in rural areas of Sindh province. Total 273 females with pregnancy along with anemic condition, were selected by purposive sampling method. From total number of study subjects 71% females were diagnosed as anemic, that were further categorized as mild, moderate and severe, depend on their medical condition. It was observed that anemic condition was more common among infancy pregnant females with ages 20-29 years, the number of patients were 209 (76.5%). females with primary or secondary education had more problem of anemia as compared to females with intermediate or graduation. Anemic females with primary education (126), secondary education (73) whereas anemic female with intermediate (46) and with graduation anemic females were only (28). Females with multipara had severe anemic condition as females with primigravida. Anemic condition becomes more severe among females with second or third trimester. Anemic condition among females with 1st trimester was 37, in second trimester 109 whereas in 3rd trimester 127 anemic females were reported. For management of anemia among females with pregnancy depends upon the medication taking by them, number of females was 142, which were taking 3 or 4 medicine, while females with mono pharmacy were 95 and only 36 females were taking various multi vitamin, intravenous Iron supplement and it was concluded that anemia was more common among females resident of rural area due to unawareness regarding anemia and its associated complication. Another major cause was observed was mal nutrition.

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2019. Multicentric Antimicrobial Point Prevalence Survey in Four Tertiary Care Hospitals in Southern India

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1699 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S677-S678

Author(s):

Shilpa Prakash ◽

Arun Wilson ◽

Anup R Warrier ◽

Rachana Babu ◽

Sonya Joy ◽

...

Keyword(s):

Tertiary Care ◽

Point Prevalence ◽

Antimicrobial Use ◽

Prevalence Survey ◽

Cross Sectional ◽

Resource Limited ◽

Defined Daily Doses ◽

Number Of Patients ◽

Days Of Therapy ◽

Tertiary Care Hospitals

Abstract Background Antibiotic consumption data are scarce in the subcontinent. Defined Daily Doses (Doses) and Days of Therapy (DOT)-based metrics both have inherent disadvantages limiting their application in resource-limited settings primarily in terms of resource hours.. Point Prevalence Study (PPS) offers an offer an initial feasible step for describing antimicrobial use and identifying targets to reduce inappropriate use. Aim of the present study was to use PPS to identify quantitative and qualitative aspects of antimicrobial consumption. Methods A cross-sectional hospital-based PPS was conducted in 4 tertiary care hospitals—Aster Medcity (Kochi, Kerala), Aster MIMS (Calicut, Kerala), Aster Ramesh (Guntur, Andhra Pradesh), and Aster CMI (Bengaluru, Karnataka)—based on a standardized format derived from the GLOBAL-PPS initiative and WHO resources. Results The total number of patients surveyed was 944.42.7% patients had a standing antibiotic order, out of which 19.80%patients were receiving reserve antimicrobials (WHO classification). 76.23% of prescriptions were used empirically, 16.08% were used as prophylaxis meanwhile 7.67% had a culture-based indication. The overall DOT (per 1000 patient-days) for all antimicrobials in the 4 centers were 86.54, 64.19, 93.71 and 85.93 respectively with a cumulative mean DOT of 82.59. Reserve antimicrobials DOT were 26.28, 14.83, 28.08 and 19.61, respectively, with a mean of 22.2. The most common class of antimicrobial prescribed was β lactam -β lactamase inhibitors (BL/BLI) 27.3% while Carbapenems (8.16%) was the most common amongst reserve antimicrobials. Out of all the prescriptions only 7.67% had indications documented. Documented errors of dosing were seen in 8 patients. Adherence to monitoring for ADE was done in 92.57%. Conclusion The study reveals antibiotic use in almost 40% of patients under survey with a DOT of 82.59 per 1000 patient-days. Improving empirical use of antimicrobials, BL/BLI focused intervention and improved documentation has been identified as potential areas for intervention based on this study.The study also highlights the scope of PPS as an effective tool in resource-limited setting to define and refine antimicrobial use and contribute toward antimicrobial stewardship as well as other activities aimed reducing antimicrobial resistance across a range of settings. Disclosures All authors: No reported disclosures.

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Impact of COVID-19 pandemic on non-COVID patient’s management in urology: a public hospital experience in Mumbai

African Journal of Urology ◽

10.1186/s12301-021-00196-0 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Nikhilesh A. Jibhakate ◽

Sujata K. Patwardhan ◽

Ajit S. Sawant ◽

Hemant R. Pathak ◽

Bhushan P. Patil ◽

...

Keyword(s):

Tertiary Care ◽

Stone Disease ◽

Outpatient Clinics ◽

Percentage Decrease ◽

Emergency Procedures ◽

Number Of Patients ◽

Long Term Impact ◽

Tertiary Care Hospitals ◽

The Impact ◽

Near Future

Abstract Background To evaluate the impact of COVID-19 lockdown on non-COVID urological patient’s management in tertiary care urology centres. Methods This is an observational study in which data of patients visiting the urology department of all the MCGM run tertiary care hospitals were recorded for the duration of 1 April 2020 to 31 July 2020 and were compared to data of pre-COVID-19 period of similar duration. Results There was a decrease of 93.86% in indoor admissions of urology patients during the COVID-19 lockdown. Indoor admissions for stone disease, haematuria, malignancy accounted for 53.65%, 15.85%, 9.75%, respectively. Elective surgeries had the highest percentage decrease followed by emergency and semi-emergency procedures. There was a reduction of more than 80% in patients attending outpatient clinics. Stone disease and its consequences were the main reasons for visiting outdoor clinics (39%). A substantial number of patients presented with flank and abdominal pain (14.8%) and benign enlargement of the prostate (10.23%). Malignancy accounted for a very small number of patients visiting outdoor clinics (1.58%). Conclusions COVID-19 pandemic has a profound impact on patient care and education in Urology. There was more than ninety percent reduction in indoor admissions, operative procedures, and outpatient clinics attendance. Once the pandemic is controlled, there will be a large number of patients seeking consultation and management for urological conditions and we should be prepared for it. Surgical training of urology residents needs to be compensated in near future. Long-term impact on urological patient outcome remains to be defined.

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Pediatric Drug-Related Problems in an Indian Tertiary Care Hospital

Applied Drug Research, Clinical Trials and Regulatory Affairs ◽

10.2174/2667337108666211029122255 ◽

2021 ◽

Vol 08 ◽

Author(s):

Qaiser Jahan ◽

K. Pallavi ◽

R. Hamshika ◽

Varun Talla ◽

Jupally Venkateshwar Rao ◽

...

Keyword(s):

Pediatric Patients ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Drug Related Problems ◽

Cross Sectional ◽

Pediatric Department ◽

Root Cause ◽

Patient Morbidity ◽

Tertiary Care Hospitals

Background: Improper drug usages expose patients to drug-related problems (DRPs) and can be the cause of patient morbidity and even mortality, especially frequent in hospitalized patients and pediatric groups. Objective: The objective of the present study was to identify and assess the drug-related problems in the pediatric department of tertiary care hospitals. Methods: The cross-sectional, observational study was carried out for six months included pediatric in-patients of age ≤15 years of either gender in pediatric units of tertiary care hospitals of India. The enrolled pediatric patients were observed for any drug-related problem that were further recorded and classified using the DRP registration format taken from Cipolle et al. The assessment of therapy was done by using positional statements from standard organizations and guidelines. Main outcome measure: Incidences of drug-related problems and their assessment and root cause analysis. Results: A total of 970 DRPs were identified in 296 patients, with an overall incidence of 49.3%. The incidence of DRPs was maximum in the age group of 2-12 years of children (51.2%). Patients who took six or more drugs were around eight (OR:8.41 , 95% CI: 5.22 to 13.55) times more likely to have DRPs compared to those patients who took less than six drugs. The incidences of DRPs were more in patients who were hospitalized for ≥ 7 days. Conclusion: The present study revealed significantly higher incidences of DRPs in hospitalized pediatric patients necessitating the involvement of clinical pharmacists in the pediatric department of tertiary care hospitals.

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Compliance and Adherence to Treatment in Hypertensive Patients in different Tertiary Care Hospitals in Lahore

10.53350/pjmhs211581858 ◽

2021 ◽

Vol 15 (8) ◽

pp. 1858-1860

Author(s):

Junaid Mushtaq ◽

Israr-Ul- Haq ◽

Waqas Mahmood ◽

Mujtaba H. Siddiqui ◽

Atiq Ahmad ◽

...

Keyword(s):

Medical Center ◽

Tertiary Care ◽

Educational Status ◽

Cross Sectional Study ◽

Sectional Study ◽

Adherence To Treatment ◽

Cross Sectional ◽

Hypertensive Patients ◽

Hospital Doctors ◽

Tertiary Care Hospitals

Aim: To determine the factors that affect compliance and adherence to medications of hypertensive patients visiting OPD clinics. Study design: Descriptive-cross sectional study. Place and duration of study: Department of Medicine, Unit 1, Lahore General Hospital, Doctors Hospital & Medical Center and Farooq Hospital Lahore from 1st January 2019 to 31st December 2019. Methodology: One hundred and sixty five patients with hypertension were handed over questionnaire socio-demographic, compliance and adherence were recorded. Results: Patients who maintained BP charting were only 13(7.9%) and those without BP charting were 152(92.1%). Patients taking regular medications were only 20(12.1%). Forgetfulness in taking medications was found in 47.3% of patients. 20.6% of patients were unable to purchase medicines because of financial reasons. Thirty two patients (19.4%) thought that they should not take medicines as they were not having any symptoms. Conclusion: Major causes of non-adherence were expense of medications, lack of symptoms, lack of money, forgetfulness, lack of awareness due to poor educational status and nature of job. Keywords: Compliance, Adherence, Medications, Hypertension, Forgetfulness

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Management Strategy of Patients Attending at Epilepsy Clinic in a Tertiary Care Hospital of Bangladesh

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v6i1.48005 ◽

2020 ◽

Vol 6 (1) ◽

pp. 3-8

Author(s):

Mohammad Sayeed Hassan ◽

Md Shafikul Islam Khan ◽

Paritosh Kumar Sarkar ◽

Anwar Israil ◽

Ferdous Ara ◽

...

Keyword(s):

Partial Seizure ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Partial Epilepsy ◽

Absence Seizure ◽

Care Hospital ◽

Cross Sectional ◽

Tonic Seizure ◽

Number Of Patients ◽

Generalized Epilepsy

Background: Epilepsy is a neuronal disorder that is observed globally but still it is not explored very well in most parts of the world. Objective: The aim of our study was to determine the types of epilepsies along with their treatment strategies among patients attending the outdoor epilepsy clinic in a referral tertiary care hospital. Methodology: This cross sectional study was carried out from the records of weekly epilepsy clinic of Department of Neurology at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from January 2018 to August 2019. Data were collected through a predesigned questionnaire containing information about demography, clinical features, EEG and imaging findings and treatment of patients. Results: A total number of 1832 patients were recruited. There was a male (55.3%) and urban (61.1%) predominance. Most (75.1%) of the patients were young (age range from 10 to 29 years). A large number of patients were student (44.4%) and 24.2% were unemployed. The duration of epilepsy in most patients were less than 5 years (40.7%). 58.3% patients took various forms of indigenous treatment prior to attending this clinic. 54.7% patients had no comorbid illness. EEG was abnormal in 34.5% patients of which 24.4% had focal abnormality and 10.1% had generalized epileptic discharge. In brain imaging (CT/MRI) only 16.4% showed abnormal findings. 49.5% patients were suffering from generalized epilepsy whereas 44.6% had partial epilepsy. Among the generalized epilepsy group, most of them had generalized tonic clonic seizure (GTCS) (75.4%), while 8.9% had absence seizure and 7.9% had tonic seizure. In partial epilepsy group, the majority were secondary generalized seizure (74.7%), followed by complex partial seizure (CPS) (18.7%) and simple partial seizure (6.6%).42.7% patients got single antiepileptic drug whereas 37.4% patients received dual drug. Polytherapy (three or more drugs) were prescribed in 14% patients. Valproic acid was the highest prescribed drug (29.3%) either as monotherapy or in combination. Carbamazepine (27.4%) was the second common drug followed by Levetiracetam (15.1%). Conclusion: Epilepsy affects almost all groups of the society. Most of the patients remain seizure-free with judicious anti-epileptic drugs. Therefore, more effort is needed for early accurate diagnosis and appropriate treatment of epilepsy Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 3-8

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Regional differences in reasons for consultation and general practitioners’ spectrum of services in Northern Germany – Results of a cross-sectional observational study

10.21203/rs.2.16496/v3 ◽

2019 ◽

Author(s):

Ingmar Schäfer ◽

Heike Hansen ◽

Thomas Ruppel ◽

Dagmar Lühmann ◽

Hans-Otto Wagner ◽

...

Keyword(s):

Observational Study ◽

Rural Areas ◽

Urban Areas ◽

Medical Training ◽

Practice Trial ◽

Cross Sectional ◽

Federal States ◽

German Federal States ◽

Number Of Patients ◽

Individual Consultation

Abstract Background Among other factors, the patients’ consultation reasons and GPs’ spectrum of services determine the process and outcome of the medical treatment. So far, however, there has been little information on differences in reasons for consultation and GPs’ services between urban and rural areas. Our study’s goal was thus to investigate these factors in relation to the regional location of GPs’ practices. Methods We conducted a cross-sectional observational study based on standardised GP interviews in a quota sampling design. All counties and independent cities within a radius of 120 km around Hamburg were divided into three regional categories (urban area, environs, rural area) and stratified proportionally to the population size. Differences in the number of reasons for consultation and services were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the German federal states and administrative districts. Differences in individual consultation reasons and services were identified by logistic regression via stepwise forward and backward selection. Results Primary care practices in 34 of the 37 selected administrative districts (91.9%) were represented in the dataset. In total, 211 GPs were personally interviewed. On average, GPs saw 344 patients per month with a slightly higher number of patients in rural areas. They reported 59.1 ± 15.4 different reasons for consultation and 30.3 + 3.9 different services. There was no statistically significant regional variation in the number of different consultation reasons, but there was a broader service spectrum by rural GPs (ß=-1.42; 95% confidence interval -2.75/-0.08; p=0.038) which was statistically explained by a higher level of medical training. Additionally, there were differences in the frequency of individual consultation reasons and services between rural and urban areas. Conclusion GPs in rural areas performed more frequently services usually provided by medical specialists in urban areas. This might be caused by a low availability of specialists in rural areas. The association between medical training and service spectrum might imply that GPs compensate the specific needs of their patients by completing advanced medical training before or after setting up a medical practice. Trial registration The study was registered in ClinicalTrials.gov (NCT02558322).

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Metabolic syndrome in alopecia areata: an observational study at a tertiary care center

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20213338 ◽

2021 ◽

Vol 7 (5) ◽

pp. 647

Author(s):

Subrata Kumar Das ◽

Saptadipa Das

Keyword(s):

Metabolic Syndrome ◽

Observational Study ◽

Alopecia Areata ◽

Care Center ◽

Tertiary Care ◽

Age Group ◽

Tertiary Care Center ◽

Cross Sectional ◽

Laboratory Parameters ◽

Number Of Patients

Background: The aim was to evaluate the parameters of metabolic syndrome (MS) in patients of alopecia areata and to investigate the possibility of an existing relationship between MS and alopecia areata (AA).Methods: This cross-sectional observational study included 50 patients with AA who attended OPD of department of dermatology at a tertiary care center during a period of 1 year. Clinical and laboratory parameters were noted in each patient.Results: This study included 50 patients with AA (33 males and 17 females). In the present study maximum number of patients belonged to the age group 20-30 years with 23 patients, followed by 30-40 years with 17 patients. Most of the study subjects, 17 were college students and number of employees were 15. Out of 50 patients 44 had patch(es) and 2 patient had alopecia totalis. In this study out of 50 patients, 38 had mild AA, 7 had AA and 5 patients had severe AA. No significant derangement of clinical and laboratory parameters of MS observed in patients of AA.Conclusions: In the present study we did not observe any significant derangement of clinical and laboratory parameters of MS in patients of alopecia areata.

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Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.1.237 ◽

2018 ◽

Vol 35 (1) ◽

Author(s):

Iqra Arshad ◽

Sara Mohsin ◽

Sana Iftikhar ◽

Tahseen Kazmi ◽

Luqman F. Nagi

Keyword(s):

Insulin Therapy ◽

Tertiary Care ◽

Cross Sectional Study ◽

Early Initiation ◽

P Value ◽

Diabetic Patients ◽

Cross Sectional ◽

Creative Commons ◽

Oral Medications ◽

Tertiary Care Hospitals

Background and Objective: Initiation of Insulin therapy during earlier stages has proved to significantly improve health outcomes among diabetics in comparison to oral medications. Not only patients but physicians are also often resistant to early initiation of insulin therapy. The objective was to assess misconceptions and barriers to early initiation of insulin therapy among diabetic patients coming to a diabetic clinic. Methods: This cross sectional study was conducted on 300 patients selected by convenience sampling arriving in Diabetes Outdoor Clinics of Mayo and Services Hospitals, Lahore during August 2017 to May 2018. The data was entered and analyzed by using SPSS version 17. Results: Out of 300 patients included in study, 39% (n= 117) were males and 61% (n=183) were females. The mean age of the participants at presentation was 48.46±13.15 years with a range of 13 to 80 years. Study participants considered it embarrassing to inject insulin in public place (p-value 0.01). The fear associated with lifelong commitment to insulin therapy once it is started, was also found statistically significant (p-value 0.001)particularly in subjects who have long duration of DM (>5 years). Conclusion: Perceptions of diabetic patients about insulin therapy are still barriers to early initiation of therapy and tend to prevail in Pakistan and around the globe. How to cite this:Arshad I, Mohsin S, Iftikhar S, Kazmi T, Nagi LF. Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.237 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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COVID-19: An Experience from a Tertiary Care Hospital of Nowshera

Journal of Rawalpindi Medical College ◽

10.37939/jrmc.v24i2.1376 ◽

2020 ◽

Vol 24 (2) ◽

pp. 149-155

Author(s):

Hamzullah Khan ◽

Mohammad Zahid Khan ◽

Mian Mohammad Naveed

Keyword(s):

Tertiary Care ◽

Relevant Information ◽

Cross Sectional Study ◽

Care Hospital ◽

Cross Sectional ◽

Number Of Patients ◽

Epidemic Area ◽

History Of ◽

Severity Of The Disease ◽

Age Range

Objective: To determine the frequency of COVID-19 and characteristics of patients presenting to the COVID-19 clinic at Qazi Hussain Ahmed Medical Complex (QHAMC) Nowshera. Methodology: This cross-sectional study was conducted from 21st Feb 2019 to April 8, 2020, in QHAMC Nowshera. Relevant information was collected on a pre-designed Performa prepared following the objectives of the study. Results: Out of 220 patients, 165(75%) were males, and 55(25%) females. 96(43.6%) of the patients were in the age range 18-30 years followed by 52(23.6%) in age range 31-45years and 17(7.7%) with age>60 years etc. Out of total the nasopharyngeal swabs of 26(11.6%) strong suspects were sent for PCR testing. 208(94.5%) were sent home while 12(5.5%) were advised quarantine. Forty-seven (21.4%) had a travel history to an epidemic area in the last 14 days. 51(23.2%) had a positive history of contact. Eighty-five (38.6%) had a fever and sore throat followed by 27(12.3%) with (fever & cough), 24(10.9%) with (cough and shortness of breath/dyspnea) and 14(6.4%) with a simple flue, etc. Out of 26 cases, 6(2.7%) were COVID-19 Positive, 12(5.5%) were negative and results of 8(3.6%) were still awaited. The PCR repeated the test for confirmed cases showed; 4(1.8%) negative, one died and one was refractory positive. A positive correlation (p=0.03, r=0.4) of an increase in age with the severity of the disease/outcome was recorded. Conclusion: The frequency of infectivity with COVID-19 was 2.6%. A higher number of patients with mild symptoms attend the COVID clinic. The rate of infection and mortality was higher in age> 60 years.

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A Survey of Factors Influencing Drug Choice and the Prescribing Attitudes Among Junior Doctors of Two Major Tertiary Care Hospitals in Chittagong City

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v17i1.39437 ◽

2018 ◽

Vol 17 (1) ◽

pp. 17-22

Author(s):

Jannatul Ferdoush ◽

Abhijit Chowdhury ◽

Kohinoor Parveen ◽

Maliha Ata ◽

Sefa Sarwath Alam ◽

...

Keyword(s):

Tertiary Care ◽

Complete Response ◽

Continuous Medical Education ◽

Junior Doctors ◽

College Hospital ◽

Cross Sectional ◽

Medical College ◽

Factors Influencing ◽

Drug Choice ◽

Tertiary Care Hospitals

Background: The magnitude of rational prescribing is well known but the irrationalities and errors in prescriptions are seen worldwide as the training of future doctors is still not up to the mark. This study aimed to find out the factors influencing drug choice and the prescribing attitudes among junior doctors of two major tertiary care hospitals in Chittagong city. Methods: A cross-sectional questionnaire survey was conducted among the junior doctors of Chittagong Medical College Hospital (CMCH) and Chattagram Maa -O- Shishu Hospital Medical College (CMOSHMC) to assess the factors influencing drug choice and the prescribing attitudes among junior doctors during August 2016. Results: The questionnaires were provided to 220 participants of whom 162 (73.63%) participants provided a complete response to the survey. The response rate was 75.89% in CMOSHMCH and 71.29% in CMCH. The majority (87.03%) of junior doctors mentioned that they are highly influenced by their supervising senior doctors’ patterns of prescriptions. About 79.01% of them took the cost of drugs into consideration while prescribing. 58.64% of the prescribers reported their confidence while prescribing without supervision. On the otherhand, 33.33% doctors mentioned that side effects of the drug changed their patterns of prescriptions. Only one-third (33.95%) of the junior doctors opined that the pharmaceutical promotional offers never influence them. Conclusion: Junior doctors decide their drug of choice mainly by copying their supervising senior doctors’ prescriptions without knowing how to choose, and they feel less confident while prescribing. Issues of drug cost, adverse drug reactions concerned the majority of the participants, but they do not have the clear ideas on how to deal with these practice behaviours. Moreover, pharmaceutical promotional offers significantly persuaded the junior doctors’ prescription patterns. So, there is a need for the continuous medical education programs in hospital settings to train the junior doctors for building capacities and competencies while prescribing. Chatt Maa Shi Hosp Med Coll J; Vol.17 (1); Jan 2018; Page 17-22

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