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Background: Critical congenital heart disease (CCHD) comprise a group of morphologically heterogeneous disorders which have one thing in common that early surgical or catheter interventional therapy is mandatory to achieve survival. Our aim in this study was to look for pattern of Critical congenital heart disease in a tertiary centre in Northern India.Methods: Our study was a hospital based prospective study conducted on all patients with suspected congenital heart disease who were brought to neonatology section of a tertiary care hospital. The methods employed for case detection used were clinical examination, pulse oximetry, chest radiograph, electrocardiogram and echocardiography.Results: Forty two neonates with suspected congenital heart disease were admitted in our NICU (Neonatal intensive care unit) and nine cases of CCHD were diagnosed. Twenty seven cases were having Non Critical cardiac lesions whereas six cases had respiratory illness. Out of nine cases of CCHD seven patients died while two are alive.Conclusions: With the advent of more screening tools the prevalence of CCHD has increased and the mortality associated with this condition is also very high. It is thus imperative to go for early surgical correction to achieve survival.
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Background: To quantify the extent of emergency department overcrowding in a tertiary care hospital and to identify possible solutions.Methods: A retrospective hospital record-based study was conducted at Government Medical College Jammu, Jammu and Kashmir, India from the Department of Pediaterics and comprised data of all the patients presenting to the emergency department between 1st January 2018 to 31st December 2018. Demographic characteristics, length of stay (LOS), revisit frequency and consultation status of the patients were determined.Results: Of the 1,17,035 patients, 25,223 (43.89%) were discharged straight away while 24,113 (41.95%) were admitted to different wards and subspecialties. Besides, 6464 (11.25%) patients left the department against medical advice, 861 (1.5%) expired, 741 (1.29%) were referred to other hospitals and 67 (0.12%) were dead on arrival. Of those who were admitted, 1,4498 (60.13%) patients stayed for more than 10 hours before getting the main hospital bed. Mostly, the delays observed were due to delay in getting lab reports, already preoccupied ventilators and incubators in pediatric and neonatal intensive care units, not using checklist for proper reassessment of patients and early discharge, overburdened by patients coming in just for nebulization and intravenous or intramuscular medications, the admitting residents detain the unstable patient longer in emergency department before admission to wards.Conclusions: In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments.
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Background: The increasing clinical incidence of antibiotic-resistant bacteria is a major global health care issue. Among MDR pathogens, Klebsiella pneumoniae (KP) is one of the world's most dangerous superbugs; and becoming resistant to virtually every antibiotic available today. The objective were to study the clinical characteristics of neonatal sepsis caused by KP and the antibiotic sensitivity pattern of Klebsiella pneumoniae in a neonatal intensive care unit (NICU) in northern india.Methods: This observational study was conducted with neonates who were admitted in NICU of Government Medical College (GMC) Jammu (Jammu and Kashmir) India and whose blood culture showed growth of KP in a study period of 1 year between 1st January 2018 to 31st December 2018. The data was entered into a register and presented by descriptive statistics.Results: Twenty four neonates were included in the study. The clinical presentations include refusal of feed (83.3%), lethargy (79.2%), respiratory distress (70.8%), shock (70.8%), fever (37.5%) or hypothermia (58.3%), apnea (29.2%) and abdominal distension (33.3%). Most common perinatal risk factor was prolonged labor (>24 h) seen in 79.2% of cases. C-reactive protein (CRP) level was positive in 95% of the cases. The mortality was 25%. KP strains were sensitive to colistin, polymyxin B, cotrimoxazole and tetracyclines.Conclusions: The clinical manifestations of neonatal sepsis caused by KP are usually non-specific. CRP detection is valuable for early diagnosis of sepsis. Neonatal sepsis persists as a cause of mortality in this region. Regular antimicrobial surveillance for empirical treatment remains an important component of neonatal care.
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Background: Neonatal hypothermia is increasingly recognized as a risk factor for newborn survival. World Health Organization (WHO) recommends maintaining a warm chain and skin-to-skin care for thermo-protection of newborn children. Since little is known about practices related to newborn hypothermia, this study’s goal was to assess the knowledge of mothers of newborns especially LBW babies on prevention of hypothermia and to provide them the knowledge of cost-effective thermal protection measures.Methods: It was a cross-sectional study using pre-tested, pre-structured questionnaire. 108 postnatal mothers having LBW babies admitted in postnatal wards of Government Medical College, Jammu, Jammu and Kashmir, India were included in the study and analysed using SPSS version 20.Results: Out of 108 mothers, maximum mothers were of age less than 25 years (51%), 60% were from rural area, residing in nuclear family were 62%. Mothers attended hospital for confinement were 95% and 85% started breast feeding their babies. 45% had knowledge of keeping the baby warm by immediately wiping the baby and only 3% mothers had knowledge of Kangaroo Mother Care (KMC).Conclusions: Understanding and addressing community-based practices on hypothermia, prevention and management might help to improve newborn survival in resource-limited settings. Possible interventions include the implementation of skin-to-skin care in rural areas and the use of appropriate, low-cost newborn warmers to prevent hypothermia and support families in their provision of newborn thermal protection. Training family members to support mothers in the provision of thermo-protection for their newborns could facilitate these practices. Those who fail to fully attend antenatal clinics should be targeted for newborn care education.
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Background: India with 1.35 billion people is the second most populated country in the world next to China. Total fertility rate of India is 2.2 and the current total fertility rate of Jammu and Kashmir is 1.7 which is still lagging behind various states. This study was conducted to investigate the knowledge, attitude and practices of contraception in women of reproductive age in this set up.Methods: The present cross-sectional study was carried out in patients attending OPD (outpatient department) of Obstetrics and Gynecology at ASCOMS, Jammu, Jammu and Kashmir, India from 1st September 2017 to 31st August 2018. 200 married women aged between 18-49 years were included in this study. Socio-demographic characteristics of the women, their knowledge, attitude and practices on contraception were evaluated with the help of predesigned questionnaire.Results: Out of 200 women, maximum respondents belong to age group of 21-25 years (75.6%). Most of the contraceptive non-users belongs to age below 20 years (62.5%). Majority of respondents were Hindu (70.37%), maximum studied up to secondary level education (84.61%), 70.30% were housewives and 56.58% belongs to middle class. In 45% of respondents, media was the main source of information. Preferred spacing method was condom in 85% of cases. 68% women had knowledge of female sterilization. According to most women, family planning methods are meant for limitations of birth (43%) and 36% meant for spacing of birth. 80% women had positive attitude towards contraceptive usage. 50% experienced side effects with the use of contraceptives. The most common side effect was menstrual irregularities in 25% of cases. Most common reason for not using contraceptive methods among non-respondents were lack of knowledge in 50% of cases.Conclusions: The study showed that inspite of having good knowledge, utilization of contraceptives were less because of large family norm, religious myth, cultural and political barriers. Ignorance regarding use and side effects of various contraceptive methods is another reason for inadequate practice of family planning methods.
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Background: The objective of this study is to determine the trends of patients presenting in Obstetrics and Gynecology emergency department and to identify possible solutions.Methods: This retrospective hospital record-based study was conducted at Government Medical College Jammu, Jammu and Kashmir, India from the department of Gynecology and Obstetrics and comprised data of all patients presenting to the emergency department between 1st January 2018 to 31st December 2018. Patients were assessed in terms of demographic features, presenting complaints, admission types (urgent, non-urgent), referral from other hospitals or coming from home. The total number of patients admitted and the number of patients sent home was also recorded.Results: A total of 1,46,366 patients were analyzed retrospectively. Out of which 63,004 (43.05%) were send home from the OPD while 83,362 (56.95%) presented to the emergency department. Of them, 49,383 (59.24%) were discharged straight away from the ED after emergency treatment and care while 339,79 (40.76%) were admitted. Out of 339,79 patients, 24,932 (73.37%) stayed in the emergency whereas 9047 (26.63%) admitted into different wards for elective procedures. Majority of the patients 26,098 (89.92%) came from home and 2927 patients (10.08%) were referred from other hospitals. Labour pains 7833 (31.42%) was the most common presentation. Trauma was the reason for admission in 112 (0.45%) patients out of 29025. 971 (3.89%) patients presented with gynecological problems. 4093 (14.10%) patients presented with non-urgent indications. Rest of all patients presented with indications which were categorized as urgent and were admitted. All data was analysed using SPSS version 20.Conclusions: To reduce the overcrowding in the emergency department and improve quality of obstetrics and gynecological services, Inpatients and Outpatient departments at primary and secondary care levels need to be strengthened. Patients with non-urgent problems should be provided adequate care at primary and secondary health care centers.