Violence against resident doctors, its psychological impact and associated factors in accident & emergency department in a tertiary care institute of Haryana

Background: Violence in the healthcare setting is very common with the emergency department (ED) having the highest rate of violence in the hospital. While on one hand, the physical violence at the workplace has always been well recognized, the existence of psychological violence has been long underestimated. Materials and Methods: The study was a descriptive type of cross-sectional study conducted in 6 months in a tertiary care center of Haryana among doctors in Emergency and casualty Department. Study subjects were junior residents and senior residents posted in the emergency department. The questionnaire is a predesigned survey questionnaire formulated by ILO/ ICN/ WHO/ PSI Joint. Results: Most of the physical violence was seen in Surgery & Orthopaedics department with respective frequency of 44% & 39% respectively; while most of the verbal abuse reported in Medicine department with frequency of 33%. Most of the physical violence and verbal abuse occurred in age group of 25-29; males were more predisposed to both physical and psychological violence. Only 63% of the subjects knew about the procedures of reporting existing in the health facility. Conclusion: The study concludes that physical violence and verbal abuse are high in our institute, but majority of doctors did not know about the procedures of reporting.

Comparison of Treatment of Salmeterol and Formoterol with Fluticasone on Quality of Life (QOL) of Patients Suffering from Chronic Obstructive Pulmonary Disease (COPD)

Background: Chronic obstructive pulmonary disease (COPD) is characterized by symptoms of dyspnoea, paroxysmal coughing, fatigue, and insomnia associated with considerable impact on quality of life of patients. Inhaled corticosteroid/long-acting β2-agonist combinations (ICS/LABA) are endorsed for maintenance therapy for COPD.  So, we designed this study to compare the treatment of combination of salmeterol or formoterol with fluticasone on Quality of life (QOL) of patients suffering from chronic obstructive pulmonary disease (COPD). Methods: This prospective, randomized, parallel group study was conducted 45 patients suffering from COPD were enrolled in the study after they signed a written informed consent. The patients were divided in two groups based on the treatment in two groups. Group 1 was on treatment with salmeterol with fluticasone whereas group 2 was on treatment with formoterol with fluticasone; they were assessed at baseline and 4weeks. Patients were subjected to St George Respiratory Questionnaire (SGRQ) and WHO – Quality of life (WHO-QOL Bref) Questionnaire. Results: A total of 24 patients in group 1 and 21 patients in group 2 completed the study. The demographic profile of patients was comparable at baseline. Patients in both groups had showed a statistically significant improvement in symptoms score as compared to baseline as is evident by lower scores in SGRQ and high scores in WHO-QOL Bref score Patients on formoterol and fluticasone had slightly better scores as compared to the other group though it was not statistically significant. Conclusions: Both the treatment showed significant improvement in symptoms as well as quality of life as compared to baseline and a combination of formoterol and fluticasone was slightly better as compared to combination of salmeterol and fluticasone.

Pandemic influenza A (H1N1) 2009 vaccine: An update.

The world witnessed a the first influenza pandemic in this century and fourth overall since first flu pandemic was reported during the World War I. The past experiences with influenza viruses and this pandemic of H1N1 place a consider­able strain on health services and resulted in serious illnesses and a large number of deaths. Develop­ing countries were declared more likely to be at risk from the pandemic effects, as they faced the dual problem of highly vulnerable populations and limited resources to respond H1N1. The public health experts agreed that vaccination is the most effective ways to mitigate the negative effects of the pandemic. The vaccines for H1N1 virus have been used in over 40 coun­tries and administered to over 200 million people helped in a great way and on August 10, 2010, World Health Organization (WHO) announced H1N1 to be in postpandemic period. But based on knowledge about past pandemics, the H1N1 (2009) virus is expected to continue to circulate as a seasonal virus and may undergo some agenic-variation. As WHO strongly recommends vaccination, vigilance for regular updating of the composition of influenza vaccines, based on an assessment of the future impact of circulating viruses along with safety surveillance of the vaccines is necessary. This review has been done to take a stock of the currently available H1N1 vaccines and their possible use as public health intervention in the postpandemic period.

Outcome predictors for non-invasive positive pressure ventilation in acute respiratory failure.

BACKGROUND: Noninvasive positive pressure ventilation (NIPPV) has emerged as a significant advancement in the management of acute respiratory failure. OBJECTIVE: To identify factors, based on clinical and laboratory parameters, for predicting the outcome of NIPPV in patients with acute respiratory failure. MATERIALS AND METHODS: Fifty patients were included in the study. Inclusion criteria were RR>30 breaths/ min, PaO2<60mmHg, PaO2/FiO2<300, pCO2< or = 45mmHg and signs of increased work of breathing. Baseline clinical parameters and arterial blood gas (ABG) were recorded before initiating NIPPV. Clinical parameters including heart rate, respiratory rate, oxygen saturation and ABG was revaluated at 1, 4, 12, 24 hrs after initiation of NIPPV. Change in these parameters and need for intubation was evaluated. RESULTS: Of the 50 patients, 37 (74%) showed clinical and ABG improvement. Out of 13 (26%) patients who failed to respond, 7 (52%) needed endotracheal intubation within 1 hr. There was significant improvement in clinical and ABG parameters within 1st hr in success group and these parameters continues to improve even after 4 hrs of NIPPV treatment (p<0.05). Failure group had higher baseline heart rate than success group (p<0.05). CONCLUSION: Determination of baseline clinical factors such as heart rate and respiratory rate, available at the time of initiation and after a short period, can predict the likelihood of success or failure of NIPPV. As a result, delay in intubation can be avoided which itself is associated with significant mortality.

Virtual cystoscopy: reality in imaging of bladder tuberculosis.

We present a case of urinary tuberculosis investigated initially by ultrasound and multidetector computed tomography (MDCT). The MDCT-derived volumetric data were used to generate virtual cystoscopy (VC) images, which revealed a bladder ulcer. The presence of this ulcer was confirmed by conventional cystoscopy-guided biopsy and there was good agreement regarding various features of the ulcer, such as the site, size and shape, as detected by virtual and conventional cystoscopies. VC, a result of simple postprocessing of preacquired MDCT data, proved valuable in the characterization of the bladder lesion in conjunction with CT and ultrasound images. Although a larger study is warranted, in our case these en face VC representations of the ulcer served as useful precursors to conventional cystoscopic biopsy.

Ultrafast MRI in the prenatal diagnosis of Bourneville's tuberous sclerosis.

The purpose of this report is to highlight the utility of prenatal MRI as an adjunctive imaging modality in the diagnosis and prognosis of Tuberous Sclerosis (TS) (Bourneville's disease). We report a case of TS detected in utero at 30 weeks gestation. A routine ultrasonography at 26 weeks in a 28-year-old primigravida was followed by an ultrafast MRI examination at 30 weeks gestation. Ultrasound raised the possibility of TS based on the detection of multiple cardiac rhabdomyomas. Fetal MRI, subsequently performed, showed the presence of cortical tubers and subependymal nodules establishing the diagnosis. Fetal MRI in the appropriate clinical setting can be potentially invaluable and can have important prognostic implications.

Magnetic resonance urography (MRU) versus intravenous urography (IVU) in obstructive uropathy: a prospective study of 30 cases.

AIM: Intravenous Urography (IVU) as a diagnostic modality has limitations in patients of obstructive uropathy with impaired renal function. Our aim was to study the technique and diagnostic accuracy of Magnetic Resonance Urography (MRU) in obstructive uropathy and to correlate the findings with IVU. METHODOLOGY: Forty-eight patients, selected over a six-month period, based on mild to severe pelvicalyceal dilatation on screening ultrasonography, underwent an IVU; those having non-obstructive dilatation were excluded (18 patients). Thirty patients (age range 10 to 75 years) with definite obstructive dilatation underwent MRU. These were obtained using an open MRI unit (Siemens Magnetom Open Viva) with low-dose gadolinium-DTPA (0.01 mmol/kg body weight) using various MRI sequences. MRU studies were classified as 'excellent' or 'diagnostic' and data generated was compared with that of IVU. RESULTS: MRU studies were 'excellent' in twelve and 'diagnostic' in eighteen patients. Of the sixty pelvicalyceal systems (PCS) evaluated in thirty patients, there were thirty-seven calculi, nine pelvi-ureteric junction (PUJ) obstructions, six with impaired renal function, four malrotated kidneys and one each of horseshoe kidney, pancake kidney, pelvic mass (endometriomas), duplex moieties, ureterocele and vesico-ureteric reflux. MRU better depicted moderate-severe PCS dilatation, staghorn and urethral calculi, impaired renal function, extrinsic ureteric and PUJ obstruction. IVU better depicted small calculi and mild PCS dilatation. CONCLUSIONS: In these thirty patients of obstructive uropathy, low magnetic field, open MRI units and low-dose Gd-DTPA provided cost-effective MRU studies with excellent diagnostic utility. MRU scored over IVU in patients with moderate-severe dilatation, staghorn and urethral calculi, impaired renal function, extrinsic ureteric and PUJ obstruction.

Role of multidetector CT virtual bronchoscopy in the evaluation of post-tracheostomy tracheal stenosis--a preliminary study.

AIM: To study the technique and utility of virtual bronchoscopy (virtual reality endobronchial simulation, VRES) as a tool to evaluate post-tracheostomy tracheal stenoses and to correlate the findings of virtual and invasive bronchoscopy and to follow-up treated lesions or those currently under treatment that were initially diagnosed with VRES. METHODOLOGY: This prospective study comprised nine patients in the age group 13 to 65 years presenting with breathlessness and stridor following one or multiple tracheostomies. They underwent plain CT using a multidetector CT (MDCT) scanner (Siemens Volume Zoom) using narrow (1 mm) collimation. These thin slice images were post-processed using an Irix-based workstation with a 'Fly-Through' endoscopy application. These patients also underwent a rigid (three patients) or fiberoptic (six patients) bronchoscopy. RESULTS: Of the nine patients that underwent VRES, five were found to have stenoses, three had obstructing granulation tissue, one had an obstructing membrane and one had synechiae. The invasive bronchoscopic findings supported the VRES diagnosis in all but one case of stenosis, one of granulation tissue and the case with synechiae. Membranes and synechiae were relatively difficult to diagnose without the corresponding axial and multiplanar images. VRES achieved a higher sensitivity, while invasive bronchoscopy a higher specificity. CONCLUSIONS: VRES proved to be comparable to invasive bronchoscopy in the depiction of post-tracheostomy tracheal stenoses, with a notable advantage in critical stenoses in that the airway distal to the stenosis could be assessed with VRES but not with invasive bronchoscopy. A preliminary VRES was found to be of assistance in the selection of patients for the more invasive therapeutic procedures such as laser ablation of granulation tissue and its follow-up.

Participatory health communication and action through women groups in rural areas.

Twelve women groups in 10 villages of block Beri were identified and activized through participatory health communication actions for mother and child development. Women could undertaken responsibilities on key health problems concerning mothers and children. In these villages over 58% of antenatal mothers now used home made clean packets for delivery and chose right place for delivery. Most of them (60%) now initiate breast feeding immediately after delivery as against 23% in the year 1988. Over 54% of women now drink chlorinated water and almost same proportion used sugar salt solution in diarrheal diseases. Thus women have become self reliant in chlorination of wells and pots as also in diarrheal diseases management. Practice of hand washing has been almost universalized.

Empowering young girls for health and development.

Yuvati Vikas Kendra (YVK) model of empowering young girls in the age bracket of 7-19 years could raise the level of awareness and generate self-esteem and self-confidence in over 50% of young girls over a period of six months of operation. The YVK model was utilised by 37-55% of enrolled girls in different age brackets; thus these centres functioned well below their installed capacity. Functional inter-sectoral linkages have to be developed for better impact and better coverage. Data based information from other models of empowerment such as schools, non-formal system of education and Integrated Child Development Services Scheme, is called for to choose different alternatives for our country, as no uniform system can succeed in this vast country. Diversified modes and approaches for empowerment of young girls are needed.

Enterotoxigenic Escherichia coli from an outbreak with cholerigenic syndromes of gastroenteritis.

In an outbreak of food-poisoning, 76 out of 200 students who had dined in an Institute mess experienced acute cholerigenic syndromes of gastroenteritis. Processing of the seven stool samples of affected students and remnants of 4 out of 5 type of food for isolation of bacterial pathogen(s) revealed only the presence of Escherichia coli which were serotyped as 020, 026, 045, 053 and one untypable (UT). Enterotoxigenicity testing of these isolates revealed serotypes 020, 026 of E. coli to be heat-labile enterotoxin producer when subjected to Biken test, Latex agglutination test and co-agglutination test. Based on the laboratory findings there are good reasons to believe that serotype 020 was responsible for this episode.