An observational study of role of medical record department in tertiary care teaching hospital

Background: Medical record document explains all the details about the patient’s history, clinical findings, diagnostic test results, pre- and post-operative care, patient’s progress, and medication given. If written correctly, notes will support the doctor about the correctness of treatment. Aim and Objectives: Our objective was to study effectiveness and utility of medical record department at our medical college affiliated tertiary care institution. Materials and Methods: We did an observational study to determine various parameters of medical records such as consent, history and examination findings, pre-operative and intraoperative records, investigation documentation, nursing care chart, and concerned medical person’s signature. The study included 300 files. A medical record checklist was used as a tool for data collection. The study was conducted between January 2021 and January 2022. Data were collected, entered in Microsoft Excel spread sheet, and analyzed using percentage. Results: Out of the 300 files, 186 files belonged to different surgical specialties while the rest were of non-surgical fields. It was found that nursing assessment document was present in 78%, while discharged card copy was found attached in 75.33% files. Furthermore, surgical safety checklist was found in 89.24%, while signature of faculty was absent in 38.3% files. Conclusion: Medical record maintaining and keeping is an essential and vital part of health-care infrastructure, not only for data collection but also for calculating use of resources needed for better delivery of quality services to patients.

Effectiveness Of Homoeopathic Medicines In Increasing Haemoglobin Level In Pregnant Anaemic Women

Background:Anaemia is prevalent in society as leading disorder is for dissertationwhich starts usually since birth and it is seen at any age during life time irrespective of sex, area, community or life style. It seems to be difficult to treat or prevent the occurrences by the government because it is multi facet illness, in the sense that there are several types of anaemia and with different causative factors, the line of treatment varies with each and every group of patient with same causative factor or similar symptoms totality. Aim:To evaluate the efficacy of Homoeopathic medicines and Homoeopathic Approach in Increasing Haemoglobin Level in Pregnant Anaemic Women. Material And Methods:Number of cases:60, Duration of study: 24 months. Result:Laboratory Findings: Haemoglobin levels before and after the treatment, Case record form is especially modified to take the historyof Anaemia, Inclusion criteria: Only pregnant anaemic women of child bearing age are included in the study.Conclusion:As per the totality of case the most similar remedy were chosen to satisfy Susceptibility. And the Indicated Constitutional Dynamic Medicine was administered to establish a state of Health and in few cases, Biochemic Medicines were also been prescribed, depending on the deficiency of concerned salts.

Efficacy Of Homeopathic Medicines In Dysmenorrhoea

Background:The study aims to prove the efficacy of Homoeopathic Medicines in Dysmenorrhoea was conducted for 1½ year in the age of 14-45 years. Dysmenorrhoea is commonest complaint in females affecting half of females in the age of 11-45 years. It is one of the leading causes of periodic absentee in colleges and school. It incapacitates women in her day to day life1. It is defined as painful menstruation of uterine origin and is divided in two categories Primary and secondary. Primary begins typically during adolescences and there is no pelvic cause while secondary is uncommon during adolescences and results from pelvic origin. This article focuses on classification, pathology, clinical type and efficacy of homoeopathic medicines. The aim is to give a pain free menstruation to female thus improving quality of life in women. Material And Methods:A total of 20 patient were selected who complained of moderate to severe dysmenorrhoea for 1½ year with holistic approach according to model case proforma. Result:The study shows that in majority of cases there was no major cause for dysmenorrhoea 90% of cases responded well with Homoeopathic medicines where majority cases required PULSATILLA as a constitutional medicine, Mag Phosphoricum as an acute and Tuberculinum as intercurrent remedy. Among these,constitutional medicine acts more effectively.Conclusion:Thus it can be concluded that Homoeopathic medicines prove effective along with change in lifestyle, food habits and distress. Acute exacerbation can be controlled with acute medicines and anti miasmatic are required in stands still conditions. Potency can be 30 or 200 depending on susceptibility.

The Utility Of Boger Boenninghausens Characteristics And Repertory In Cases Of Upper Respiratory Tract Infection

Background:In today’s era cases of Upper Respiratory Tract Infection are increasing all over the world. The present study shows the efficacy of BBCR in cases of upper respiratory tract infection Objective: To ascertain the role of BBCR Management of Upper respiratory tract infections. Material And Methods:Purposive Sampling for research purpose will be done. Selection of the medicine will be according to concept of Method of Repertorisation given by Dr. Boger. Selection of the potency and repetition was based on laws of Homeopathic Posology which is described in Organon of medicine. Result:In study mostly adults are more affected and acute cases are more present. Mostly higher potency was used. Conclusion:Our study has concluded theGreat utility of BBCR in finding the indicated medicines for cases of URTI.

Effectiveness Of Homoeopatic Medicine In Cases Of Generalized Anxiety Disorders

Background:In today’s era cases of Anxiety Disorders are increasing all over the world. The present study shows the efficacy of Homoeopathic Medicine in cases of Generalized Anxiety Disorders.Objective: To ascertain the Role of Homoeopathic Medicine in Management of Generalized Anxiety Disorders. Material And Methods:Purposive Sampling for research purpose will be done. Selection of the medicine will be according to concept of Method of Repertorisation. Selection of the potency and repetition was based on laws of Homeopathic Posology which is described in Organon of medicine. Result:In study mostly adults are more affected and acute cases are more present. Mostly higher potency was used. Conclusion:Our study has concluded theGreat utility of Homoeopathic Medicine in finding the indicated medicines for cases of Anxiety Disorder.

Role Of Sulphur In Haemorrhoids

Background:As there is controversy and disagreement with respect to treatment of Haemorrhoids adopted by conventional method due to inefficacy, relapse and complications are seen. It is most prevalent ailments and impacts the quality of life significantly. Haemorrhoids are enlarged, swollen veins around the anus externally or in lower rectum1. This study aim to access Role of Sulphur in Cases of Haemorrhoids as a constitutional2,3, medicine follow well2,3, anti miasmatic5,6. The Study showed near about 100% of cases responded to Sulphur4,5, thus proving effective role of Sulphur in Haemorrhoids. The study aim role of Sulphur in Haemorrhoids.Aminimum of 1 year and 15 to 70 yrs of age and six matched controls were included in the study. As there is controversy and disagreement with respect to treatment of Hamorrhoids adopted by conventional method due to inefficacy relapse and complications are seen. It is most prevalent ailments and impacts the quality of life significantly. Haemorrhoids are enlarged, swollen veins around the anus externally or in lower rectum1. Material And Methods:Here patients were subjected on clinical presentation and examination using standard scales measuring severity andanoscopy. The entire process was done using standard case research record with a follow up of minimum 3 months period. Result:Out of 30 patients screened, it was observed that 66.6% of affected patient were in age group of 25-40, 16.7% in 41-54. Males prevalency was present and in that 26.6% were service class, driver 13.3% and mechanics 13.3%. Showing occupation played a significant role. The study should 100% of cases responded to sulphur as a constitutional medicine in 23.3% cases, as a follows well cases in 60%. Conclusion:Hence we conclude that along with Homoeopthic medication used asconstitutional, follow well, Dietary corrections, correction of sedentary habits by exercise etc. Which are the predisposing factorsis alsomandatory.

Proving Of Bacopa Monniera (BRAHMI)

Background:Brahmi has been used by Ayurvedic medical practitioners in India for almost 3000 years. The earliest chronicled mention is in the Ayurvedic treatise, the Charaka Samhita (100 A.D.), in which Brahmi is recommended in formulations for the management of a range of mental conditions including anxiety, poor cognition and lack of concentration. According to the Charaka, Brahmi acts as an effective braintonic that boostsone's capabilities to think and reason. The Sushruta Samhita 6 (200 A.D.) attributes the plant with efficacy in maintaining acuity of intellect and memory. The Bhavprakasha Nighantu, commonly known as the Indian Materia Medica (1500 A.D.),cites the plant as a brain tonic that is effective in maintaining vigor and intellect. Material And Methods:Method for the study has been selected as placebo controlled “Double Blind Method”.Result:In drug proving out of seventeen provers sixteen manifested the symptoms consequent upon the administration of drug. There is a drop of one prover due to death of near one on the 5thday of phase-I. One prover got the typhoid fever so he was continued on abstinence of medicine because of the symptoms persisted till the completion of phase-II.Conclusion:This drug is initially use d clinically in mother tincture form and not proved completely on the principles laid down in Organon of medicine. I have taken this drug to prove it in 30c & 200c potency. For the study placebo control “Double blind method” is been selected.

Utility Of Boswellia Serrata Q in Rheumatoid Arthritis (RA)

Boswellia Serrata Mother Tincture knownas Indian Frankincenses (gugle),is an herbal extract taken from the Boswellia Serrata tree.it is use in treatment of chronic Inflammatory changes as well as a number of other illness. Studies show that boswellia may reduce inflammation. Because boswellia is an effective anti-inflammatory, it can be an effective painkiller and may prevent the loss of cartilage. Here is an attempt made to determine the efficacy of Homeopathic Mother Tincture to bring about desired result in Rheumatoid Arthritis cases.

A Study Of Solanaceae Family Of Homoeopathic Materia Medica

Background:One of the best method ofobtaining an idea of the action of any drug is to Study from the Source of the drug, its habitat, how it exists and acts in nature and what does that says for the type of symptoms and type of person that it will help to cure..Objectives:1.To Study the nfeatures of Solanaceae family.2.To determine their utility in clinical Practice. 3.To utilize the above understanding for helping mankind in enjoying a healthy life, free from disease manifestations on mental and physical level. Material & Method:Study of Homoeopathic medicines in Solanaceae in Materia Medica point of view and also through case study after definining, analyzing then further testing data for accuracy.Purposive Sampling for research purpose will be done. Selection of the medicine will be according to concept of individualization. Result:Observed results will be discussed on study of cases in which the efficacy of the Solanacae in various disease conditions shall be present positive and negative points and compare, with the findings in theliterature.Conclusion:Understanding of Solanaceae family from dimensions of Materia Medica, natural habitat helps to understand totality of group and thereby making our knowledge of Materia Medica more complete and precise.

A Study Of Efficacy Of Homeopathic Management Of Chikungunya

Background:In today’s era viral infections are increasing all over the world. One of the viral infection which demandsstudy is Chikungunya. The present study shows the efficacy of Homoeopathic Medcines in Chikungunya. Objective:To ascertain the role of Homeopathic medicine in Management of Chikungunya. Material & Method: Purposive Sampling for research purpose will be done. Selection of the medicine will be according to concept of individualization. Selection of the potency and repeatation was based on laws of homeopathic Posology which is described in organon of medicine. Result:In study mostly adults are more affected and acute cases are more present. Mostly higher potency was used. Conclusion:Our study has concluded that homeopathic Medicine has shown the efficacy in treatmentof chikungunya. Cases were under the supervision of Homoeopathic Physician (Dr.Vipul Shastri)

Utility Of Pulsatilla Nigrican And Sepia In Leucorrhoea

Now a day with modern civilized life a report suggests that women are probably dying because incidence is increasing due to change of life style. Women’s health is compromised at practically in every step.The statement has been amplified to include the ability to lead a ‘socially and economically productive life’. Among the people the health of women requires high attention. There are several medical disorders from which women suffer, from puberty to till after menopause like leucorrhoea, painful menses, menstrual irregularities; dysfunction uterine bleeding, cancer of genital organ, cervical and endometrial polyposis etc are chief problems. Many of victims suffer from among all this, but leucorrhoea is universal problem of all women. Material & Methods:Type of study: Comparative study& Prospective study.Type of sampling: random sampling Conclusion:These prove when homoeopathic medicine selected on bases of Totality of symptoms, causation, constitutionally and on bases of individualization, it gives permanent improvement without recurrences.

Understand The Role Of Susceptibility In Acute Disease

Day in and dayout we come across acute diseases in our practice. It is observed in clinic practice of almost all physicians that majority of the cases are of acute origin and the rest are chronic in nature. Usually acute disease presents to us with distinct characteristic form which suggest acute remedy. In order to treat as early as possible acute cases becomes the prime need of the physician. We have noted that an organism is constantly required to adapt itself to its environmental conditions so that harmony is maintained. This process of adaptation can take lace on account of the susceptibility. To undertake such study we need to examine acute diseases. We need to understand the role of susceptibility and miasm in every case. In developing countries like India, infectious diseases are the commonest cause of mortality. Especially diseases like Typhoid fever, Acute Viral Hepatitis and Pneumonia are very frequent cause of admission and also a frequent enemy to encounter in O.P.D.

Homeopathic Approach In Iron Deficiency Anaemia

In present global worming most common disease in women is anaemia.This condition also seen in during pregnancy also. In my study also find out which miasmas are more prominent during pregnancy may be responsible for iron deficiency anaemia.

A Prospective Observational Study to Ascertain the Role of Homoeopathic Therapy in Management of Rheumatology

On day to day practice most problems in all over the world is joint pain. Especially in female joint pain more common after climacteric period and old age. On these base my study of homeopathic therapeutic effect on joint pain. In my study use homeopathic medicines which are regularly use and easy availability for patient, and benefit to relive the complaint but not completely cure all joint pain. With help of homeopathic medicine improved his/her daily routine work and enjoy his/her life without pain in joint.

Age-related changes in macular vessels and their perfusion densities on optical coherence tomography angiography

Purpose: To evaluate age-related changes in macular vessels and their perfusion densities using optical coherence tomography angiography (OCTA). Methods: A total of 108 eyes of 54 healthy subjects between the age group of 11 to 60 years having unaided visual acuity of 20/20 were studied on spectral domain OCTS using 3 * 3 mm macula protocol. These subjects were divided into 5 groups; Group 1: 11–20 years, Group 2: 21–30 years, Group 3: 31–40 years, Group 4: 41–50 years, and Group 5: 51–60 years. An early treatment diabetic retinopathy study (ETDRS) grid overlay at the macula was used to calculate changes in different quadrants of the superficial retinal plexus. Results: A total of 98 eyes of 49 patients were considered for the final analysis. The vessel density values decreased from the second to the sixth decade in all four quadrants (except the third decade, where a slight increase was noted). The total vessel density decreased from 168 ± 78 mm-1 (group 1) to 131.47 ± 18.32 mm-1 (group 5). A similar reduction pattern in perfusion density was seen in each quadrant from the second to the sixth decade. The total perfusion density reduced from 309 ± 15.63% (group 1) to 283.05 ± 45.23% (group 5). The foveal avascular zone area was 0.18 ± 0.09 mm2 in group 1, 0.33 ± 0.13 mm2 in group 2, 0.30 ± 0.10 mm2 in group 3, 0.38 ± 0.05 mm2 in group 4, and 0.46 ± 0.06 mm2 in group 5. Conclusion: In our population, macular vessel density appears to decrease noticeably from the fourth decade onwards but a statistically significant decrease was observed only from the fifth decade onwards. However, it was not uniform along with all the quadrants. Similarly, the percentage of perfusion density dropped from the fourth decade but these values also varied among the different quadrants.

Validation of Deep Convolutional Neural Network-based algorithm for detection of diabetic retinopathy – Artificial intelligence versus clinician for screening

Purpose: Deep learning is a newer and advanced subfield in artificial intelligence (AI). The aim of our study is to validate a machine-based algorithm developed based on deep convolutional neural networks as a tool for screening to detect referable diabetic retinopathy (DR). Methods: An AI algorithm to detect DR was validated at our hospital using an internal dataset consisting of 1,533 macula-centered fundus images collected retrospectively and an external validation set using Methods to Evaluate Segmentation and Indexing Techniques in the field of Retinal Ophthalmology (MESSIDOR) dataset. Images were graded by two retina specialists as any DR, prompt referral (moderate nonproliferative diabetic retinopathy (NPDR) or above or presence of macular edema) and sight-threatening DR/STDR (severe NPDR or above) and compared with AI results. Sensitivity, specificity, and area under curve (AUC) for both internal and external validation sets for any DR detection, prompt referral, and STDR were calculated. Interobserver agreement using kappa value was calculated for both the sets and two out of three agreements for DR grading was considered as ground truth to compare with AI results. Results: In the internal validation set, the overall sensitivity and specificity was 99.7% and 98.5% for Any DR detection and 98.9% and 94.84%for Prompt referral respectively. The AUC was 0.991 and 0.969 for any DR detection and prompt referral respectively. The agreement between two observers was 99.5% and 99.2% for any DR detection and prompt referral with a kappa value of 0.94 and 0.96, respectively. In the external validation set (MESSIDOR 1), the overall sensitivity and specificity was 90.4% and 91.0% for any DR detection and 94.7% and 97.4% for prompt referral, respectively. The AUC was. 907 and. 960 for any DR detection and prompt referral, respectively. The agreement between two observers was 98.5% and 97.8% for any DR detection and prompt referral with a kappa value of 0.971 and 0.980, respectively. Conclusion: With increasing diabetic population and growing demand supply gap in trained resources, AI is the future for early identification of DR and reducing blindness. This can revolutionize telescreening in ophthalmology, especially where people do not have access to specialized health care.

Related Impurities High-Performance Liquid Chromatography Method Development And Validation For Drug Combinations: Olmesartan Medoxomil, Chlorthalidone And Cilnidipine

The liquid chromatography mass spectrometry (LC-MS) compatible, stability-indicating, specific, linear, accurate, sensitive with less run-time related impurities reversed phase high-performance liquid chromatography (RP-HPLC) related impurities method has been developed for olmesartan medoxomil (OLM), chlorthalidone (CHLR), and cilnidipine (CIL) drug combinations, and the method has been validated according to ICH and US-FDA guidelines. The chromatographic separation was performed by using Hypersil-BDS Thermo-Scientific, C18 (12.5 cm, 4.6 mm, 5 microns particle size) column. Mobile phase-A was prepared by mixing 3.85 gm ammonium acetate in HPLC water and adjust pH 5.0 by using diluted acetic acid. Acetonitrile was taken as mobile phase-B. Initial mobile phase ratio (55:45 v/v) was adjusted for mobile phase-A: mobile phase-B followed by gradient program. Other chromatographic conditions such as column temperature 25 degrees, flow rate 1.0 mL/minutes with the detection wavelength at 260 nm. The retention time for CHLR impurity A, olmesartan (OL), OLM impurity A, were found about 2.7, 3.3, and 7.2 minutes respectively, with a total run time of 18.0 minutes. The linearity calibration plot was performed and found linear relationship over the concentration range of 1.25 limit of quantitation (LoQ)–18.75 μg/mL, 3.6 LoQ–60.0 μg/mL, 3.6 LoQ– 60.0 μg/mL respectively for CHLR impurity A, OL and OLM impurity A respectively. The limit of detection (LoD) and LoQ were found 0.4 ppm (μg/mL) and 1.2 ppm (μg/mL), 1.2 ppm (μg/mL) and 3.5 ppm (μg/mL), 1.1 ppm (μg/mL) and 3.3 ppm (μg/mL) for CHLR impurity A, OL and OLM impurity A respectively. The accuracy was determined by recovery studies and was found between 90.0–110.0%. The developed analytical method has been validated for LoD-LoQ, specificity, linearity, accuracy, precision, robustness, and ruggedness, which were well within the acceptance limit as per ICH guidelines. All the degradation products generated by stress conditions were found to be well separated from one another (all drug components and impurities). The developed method with shorter runtime was successfully implemented for routine quality control and stability analysis to check the quality of OLM, CHLR, and CIL drug combinations.

Surgical outcomes of microincision vitrectomy surgery in eyes with retinal detachment secondary to retinopathy of prematurity in Indian population

Purpose: To analyze and report outcomes of microincision vitrectomy surgery (MIVS) for Stage 4 and 5 retinopathy of prematurity (ROP). Methods: Medical records of 202 eyes of 129 premature children undergoing MIVS for Stage 4/Stage 5 ROP between January 2012 and April 2015 were evaluated. The primary outcome measure was the proportion of eyes with anatomical success (defined as attached retina at the posterior pole at last follow-up). Complications associated with MIVS were noted and analysis of risk factors associated with poor anatomical outcome was also done using logistic regression. Results: Mean age of presentation of babies with Stage 4 ROP (2.9 ± 1.75 months) was lower than those with stage 5 disease (5.62 ± 2.55 months) (P < 0.005). One hundred seventeen eyes (56% or 58%) had Stage 5, 38 (19%) had Stage 4a, and 47 (23%) Stage 4b. Ninety-four eyes (47%) had received prior treatment (laser and/or anti-vascular endothelial growth factors [VEGF]). Lens-sparing vitrectomy (LSV) was performed in 58 (29%) eyes while lensectomy with vitrectomy (LV) was performed in 144 (71%) eyes. At a mean follow-up of 32.5 weeks, 102 (50.5%) eyes achieved anatomical success, including 74% eyes in Stage 4a and 4b and 33% in Stage 5. Complications included intraoperative break formation (19%), postoperative vitreous hemorrhage (28%), raised intraocular pressure (12.7%), and cataract progression (2.4%). Factors significantly associated with favorable anatomical outcome were Stage 4 disease (vs. Stage 5) (odds ratio [OR] 5.8; confidence interval [CI] =2.6–13.8, P < 0.005), prior treatment (laser ± anti-VEGF) (OR 2.5; CI 1.4–4.7, P < 0.005) surgery with 25G MIVS (vs. 23G) (OR: 1.7; CI = 0.98–3.00, P = 0.05) and LSV (vs. LV) (OR 7; CI = 3.4–14.6, P < 0.005). Retinal break was significantly associated with poor anatomical outcome (OR 0.21; CI = 0.09–0.5, P < 0.005). Conclusion: MIVS along with wide angle viewing systems allow surgeons to effectively manage ROP surgeries while at the same time reducing complication rate in these eyes which have complex pathoanatomy and otherwise grim prognosis.

Nutritional status at presentation, comparison of assessment tools, and importance of arm anthropometry in children with cancer in India.

BACKGROUND: In India, approximately 40,000 new cases of cancer in children are diagnosed each year. However, there are no good studies analyzing their nutritional status. Also, since accurate and sensitive nutritional assessment is critical for optimal clinical outcomes through timely remediation of malnutrition, it is important to assess the relative sensitivity and feasibility of commonly used nutritional screening tools. METHODS: This observational study analyzed height/length (cm), weight (kg), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSFT) as well as their Z-scores or percentiles, albumin levels and history of weight loss at diagnosis in children aged 2–15 years being treated for cancer between November 2008 to December 2013. Body mass index (BMI) and arm muscle circumference (AMC) were calculated respectively from height and weight, and MUAC and TSFT. RESULTS: A total of 1693 new patients were enrolled; 1187 had all anthropometric measurements performed. The prevalence of malnutrition was 38%, 57%, 76%, 69% and 81% on the basis of BMI, TSFT, MUAC, AMC, and arm TSFT + MUAC respectively with the highest prevalence in solid abdominal tumours. Addition of BMI and serum albumin to arm anthropometry increased the proportion classified as severely nutritionally depleted by a mere 2% & 1.5% respectively. Positive history of significant weight loss additionally identified 16.5% at nutritional risk over arm anthropometry. CONCLUSIONS: The prevalence of malnutrition in Indian children with cancer at presentation is very high ranging from 40% and 80% depending on the method used for assessment, being higher with MUAC and lowest with BMI. Either MUAC alone or TSFT + MUAC (wherever feasible) should be used for screening for malnutrition in children with cancer at diagnosis to plan timely nutritional interventions, reduce the treatment-related morbidity and optimise their chance of long-term cure.