Challenges Faced in Biomedical Waste Management by Waste Handlers amidstthe COVID-19 Pandemic in a Tertiary Care Hospital: A Qualitative Study

Introduction :Coronavirus disease 2019(COVID-19) saw an overhaul in the biomedical waste management (BMWM) practices. Waste handlers were at the brunt of these changes. If the challenges pertaining to BMWM at the ground level are better understood, more effective measures to overcome them can be formulated. 1. To identify myths and concerns regarding BMWM in the context of COVID-Objectives: 19 pandemic. 2. To explore the challenges faced in BMWM amidst the COVID-19 pandemic. 3.To explore opportunities and future perspectives of BMWM. In-depth interviews were conducted among 17Method: purposively selected Class IV health care workers during August to November 2021 in a tertiary care institute in Mumbai. Data was reported using thematic analysis. Three major themes - challengesResults: and concerns faced by BMW handlers, enablers/ motivators, opportunities and future practices were generated from the transcripts. Various challenges faced by waste handlers were- difficulties in segregation and transport of BMW, exhaustion from PPE usage and fear of acquiring and spreading COVID-19 from work, stigma faced from public, and handling COVID-19 deaths. Support from family and colleagues, incentives and a positive change in public perception enabled them to work. Forming redressal committees, addressing job security concerns and timely provision of good quality equipment can improve hospital waste management measures in the future. It is of utmost importance to address challenges faced byConclusion: waste handlers in BMWM. Onus should also be on periodic training in BMWM

Clinical Study on Assessment of Post-Surgical Complications According to Clavien–Dindo Classification after Major Abdominal Surgery

Aims and Objectives: Surgical complications occur in every surgical department. The absence of a definition and a widely accepted ranking system to classify surgical complications has hampered proper interpretation of the surgical outcome. This study aimed to define a simple and reproducible classification of complications following abdominal surgery based on a therapy-oriented severity grading system and to validate the Clavien–Dindo grades and categorize complications in elective major abdominal surgeries. Materials and Methods: This is a prospective study of 80 patients, who were diagnosed and admitted for major elective abdominal surgery in KIMS hospital, Hubli, from December 2012 to May 2014. Patients underwent definitive treatment. Data related to the objectives of the study were collected and post-operative complications were classified according to Clavien–Dindo grades and managed. Results: Ages between 30 and 39 years were the most common in our present study; there were 46 male patients and 34 female patients. Of 80 cases, 24 cases were cholelithiasis cases (predominate group) among which 17 were free of complications and 7 developed complications, 21.25% developed wound complications in the form of superficial surgical site infection followed by basal atelectasis (18.75%). 46 cases (57.5%) had complications in their post-operative course, among which Grade 1 constitutes 25 cases (31.25%), Grade 2 constitutes 12 cases (15%), Grade 3 A constitutes 2 cases (2.5%), Grade 3 B constitutes 2 cases (2.5%), Grade 4 A constitutes 1 case (1.25%), Grade 4 B constitutes 1 case (1.25%), and Grade 5 constitutes 3 cases (3.75%), and rest of 34 cases (42.5%) were free of complications and had normal post-operative course. In our study, Grade 1 complications were the most common complications. Conclusion: We conclude that the Clavien–Dindo classification is based on the therapeutic consequences of complications constitutes a simple, objective, and reproducible approach for comprehensive surgical outcome assessment. In this study, Clavien–Dindo Grade 1 complication is the most common complication.

Comparative Study on Prediction of Clinical Outcome of the Patients Presenting with Upper Gastrointestinal Bleeding Using Glasgow-Blatchford Score and Full Rockall Score Systems in Tertiary Care Center

Introduction and Objectives: Upper gastrointestinal bleeding (UGIB) is a potential life-threatening bleeding condition requiring accurate, prompt, and appropriate patient evaluation management. Early resuscitation and surgical intervention play a vital role in deciding the mortality and morbidity. Considerable advances have been made in endoscopic, surgical, and pharmacological therapy. The present study is aimed at the prediction of clinical outcome of the patients presenting to with UGIB using full Rockall score (RS) and the Glasgow-Blatchford score (GBS) systems. Materials and Methods: This was a prospective study where 118 patients who presented to the casualty with UGIB were studied. The data regarding the clinical profile, comorbidities, and course in the hospital were recorded. The GBS and full RS systems were calculated for every patient. The clinical course and outcome of each patient during the hospital stay were recorded. The patients were followed up for 1 month post-discharge for the complications such as rebleeding and mortality. Results: Follow-up was not done in 27 patients due to poor compliance. 11 patients had rebleeding (rebleeding rate - 12%) and 15 patients succumbed to the illness (mortality rate -16.5%) during 1-month follow-up period. During our study, it was found that GBS was more accurate in terms of detecting transfusion need, rebleeding rate, intensive care unit admission rate, and endoscopic intervention rate. Our study concluded that full RS was better than GBS in the prediction of 1-month mortality rate. Conclusion: The present study found that full RS system is better for the prediction of 1-month mortality, while GBS system is better for the prediction of other outcomes. Familiarity with the above scoring system can be a tool in the approach of the patient with UGIB.

Incidence of Significant Bacteriuria among Pregnant Women in a Teaching Hospital of Rural Setup

Aim This study was carried out to determine the prevalence of asymptomatic bacteriuria in pregnant women attending a teaching hospital in rural setup. Materials and Methods A total of 600 women were recruited for this study. A total of 200 antenatal women were clinically identified to have no signs and symptoms of UTI, 200 antenatal women were having signs and symptoms of UTI, and 200 were non-pregnant women that were studied as controls. Clean catch midstream urine samples were collected from each patient into a sterile universal container from Gynecology and obstetrics department and general medicine department. The urine samples were examined microscopically and by the cultural method. Identification of isolates was carried out by a standard microbiological technique. Result A total of 272 (45.3%) were positive for significant bacteriuria. There was a significant difference in the prevalence of asymptomatic bacteriuria with respect to age (P< 0.0001). Trimester did not show any significant difference (P = 0.2006) in the prevalence of asymptomatic bacteriuria. Escherichia coli was the most predominant organism followed closely by Klebsiella species. Nitrofurantoin, ampicillin, and levofloxacin were mostly used antibiotics. Conclusion Asymptomatic bacteriuria is not uncommon among antenatal patients in the population studied. Routine urine cultural test should be carried out on all antenatal patients in order to identify any unsuspecting infection. This measure will go a long way in reducing maternal and obstetric complications associated with pregnancy.

Play therapy: a window into the child's world

Play therapy is a developmentally responsive modality uniquely suited for children to help prevent or resolvepsychosocial difficulties and achieve optimal grow th and development. Developmentally, children lack thecognitive ability to meaningfully communicate their thoughts, feelings, and experiences through the abstractmeans of verbal language. The concrete objects (toys, art, etc.) and other play-based experiences provided inplay therapy afford children an age-appropriate and emotionally safe means to express their difficult experiences.

Brain tumours in children.

A 10 years old, female patient presented with symptoms of abnormal movement of the body for 5 years, deviation of mouth to left side for 12 days and difficulty in walking for 12 days. We report a very rare case of Brain Stem gliomas. Clinical and imaging findings were suggestive of brain stem gliomas.