IMJ Health : October 2015

Medical Journal, International Journal

Role of Spiritual Health in Patient Care: A Review

Abstract Spiritual or compassionate care involves serving the whole person i.e. physical, emotional, social, spiritual etc dimensions of health. Spirituality has now been identified globally as an important aspect for providing answers to many questions related to health and happiness. The World Health Organization is also looking beyond physical, mental and social dimensions of the health i.e. the spiritual health and its impact on the overall health and happiness of an individual. Spiritual commitment tends to enhance recovery from illness and surgery also. Spiritually is transpired both in order to comfort the dying and to broaden one’s own understanding of life at its ending. Spiritual beliefs can help patients cope with disease and face death. So it should be necessarily be add-on in critical stage of disease. Nowadays in some of medical schools in developed countries has included as a curreculam of patient care. Now it is the time that all Medical Colleges should include educating their students about spiritual health care in comprehensive patient care. Medical Council of India should also take some action in this direction.

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Bacteriological Profile of Burn Wound Infection in a Tertiary Care Hospital in North India with Special Reference to Methicillin Resistant Staphylococcus aureus

Abstract Methicillin-resistant Staphylococcus aureus (MRSA) poses a great risk to burn patients with potential to cause significant morbidity and mortality. This study aimed to find out the prevalence of MRSA and its susceptibility, in burn wound infection/colonization in a Tertiary Care Hospital in North India. A retrospective study was conducted among patients admitted in burn ward of our hospital, between January to December 2012. All the patients irrespective of age, sex, duration of hospital stay, percentage and degree of burn were included in our study. Wound swabs from 1294 patients hospitalized in burn ward were analysed for bacteriological examination. Swabs were inoculated on Blood agar, MacConkey agar and Brain heart infusion broth. Isolates were examined for colony characteristics, Gram staining and biochemical tests. Antimicrobial susceptibility testing was done by modified Stokes disc diffusion method. Detection of MRSA was done by cefoxitin (30mg) disc diffusion method. Among the Staphylococcus aureus (S.aureus) isolates, 56.7% (80/141) were found to be MRSA while 43.3% (61/141) were Methicillin Susceptible S.aureus (MSSA). All the MRSA isolates were resistant to penicillin, cephalexin and cefazolin. Resistance to erythromycin, clindamycin, ofloxacin, ciprofloxacin, gentamicin, amikacin, rifampicin, chloramphenicol was found to be 74%, 97.4%, 96%, 100%, 97.4%, 84.6%, 11.5%, 10.3%. All MRSA isolates were found to be sensitive to vancomycin and teicoplanin while 1.3% were resistant to linezolid. Although survival rates for burn patients have improved substantially over the years, nosocomial infections still remain a major challenge in burn care. This concludes that there is high prevalence of nosocomial infections specially the presence of multidrug resistant bacteria like Methicillin Resistant Staphylococcus aureus among burn patients suggest continuous surveillance of burn wound infections and development and stringent implementation of antibiotic policy.

Key-words: Methicillin Resistant Staphylococcus aureus (MRSA), Methicillin Susceptible Staphylococcus aureus (MSSA), Antimicrobial susceptibility testing, burn wound infection.

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Etiological pattern of Lymphadenopathies and Role of Fine Needle Aspiration Cytology (FNAC) in its Diagnosis

Abstract—Lymphadenopathy is one of the commonest presentation in inflammatory and neoplastic cases. Pathological diagnosis of enlarged lymph nodes is crucial in further management of patients. Fine Needle Aspiration cytology (FNAC) is quick and cost effective OPD procedure for establishing etiology of enlarged lymph nodes. This study was aimed to observed the pattern of lymphadenopathy as per FNAC and its diagnostic accuracy assuming histopathology as gold standard. This study was conducted on two hundred and thirty one consecutive enlarged lymph nodes attended for FNAC in a secondary care level Government Hospital, Gandhi Nagar, Jammu in a study period of two and a half years. Lymph nodes of these cases were aspirated and subjected to cytomorphological evaluation with Papanicolaou (PAP) and Giemsa stain. After that histopathological examination was done of excised biopsies. Then pattern of lymphadenopathy as per FNAC was observed and its diagnostic accuracy was found out assuming histopathology as gold standard. Maximum number of patients was in the age group of 21-30 years age group with male to female ratio 1.2:1. Out of 231 lymphadenopathy cases 4 remain inconclusisve whereas 200 (88.11%)cases were benign and 27 (11.89%) were malignant including 14 (6.1%) cases of metastatic tumors. Among benign cases, majority had non specific reactive lymphadenitis (42.29%) followed by tubercular lymphadenitis. And among malignant tumors, metastatic tumors (6.1%). were most common. Diagnostic accuracy of FNAC was observed as fairly good i.e. ranging from 100% to 83.3% in various type of lymphadenopathies. So it can be depicted that FNAC is very useful first line investigation in patients presenting with enlarged lymph nodes especially in secondary level health care hospitals/centers where advanced diagnostic modalities are not available. The suspicious cases can always be referred for further evaluation.

Keywords Fine Needle Aspiration cytology (FNAC), Lymphadenopathy, Metastatic tumours, Lymphadenitis, Diagnostic Accuracy

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Non-alcoholic Fatty Liver Disease (NAFLD) and its association with metabolic syndrome and cardiovascular diseases

Abstract Non Alcoholic Fatty Liver Disease is also becoming public health impotance nowadays. So this study was aimed to determine the association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. This study includes a total of 222 subjects were enrolled as per the inclusion/exclusion criteria, out of which 110 cases who had NAFLD with hepatic steatosis on ultrasonography and 112 subjects who did not have NAFLD were considered control. These cases and controls were interrogated and investigated further. Observations were recorded and association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. Statistical methods used were unpaired student’s t-test for continuous variables, Fischer’s and chi-sq test for categorical variables using bivariate analysis by Graph Pad Instat Version 3.10. Risk was assessed in terms of Odd’s Ratio. The patients with MS and NAFLD had a higher proportion of CVD compared with those who did not have NAFLD (29.1 vs 18.1 %). This study concludes that NAFLD is significantly associated with MS; most significant with WC, followed by TG and FBS and thus can be considered as hepatic component of MS. This needs more research with large multi-centric prospective studies to evaluate NAFLD as an independent risk factor for CVD.

KeywordsCVD: Cardio Vascular Disease, MS: Metabolic Syndrome, NAFLD: Non-Alcoholic Fatty Liver Disease, NASH: Non-Alcoholic Steato Hepatitis

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Health Status of Geriatric Population of a Metropolitan City with their inclination towards Indigenous Medicine System

Abstract: Geriatric population is increasing as life expectancy is increasing. This population is susceptible for many health problems which have a significant impact on their quality of life. So this cross-sectional study was carried out from September 2009 to August 2010 on 1620 elderly residing in Municipal corporation area of Jaipur city with the aim to study the health status of geriatric population and their inclination towards Indigenous medicine system. Study population consist of 1620 elderly with M:F ratio 0.95. Mean age of elderly was 66.08 years with slight female predominance i.e. 1048 females for 1000 males in Jaipur city. Only 285 (17.59%) elderly who were not having and type of morbidity otherwise a sizable count i.e. 573 (35.36%) were having even 4 or more type of co morbidity. Commonest reported morbidity in present study was Psychiatric morbidity (54.32%) followed by Musculo-Skeletal problems, Cataract, Hypertension, Dental problems etc. About one third were having 2 or more episodes of acute illness episodes in last month. Although 805 (49.69%) were not having any limiting condition in last one year but 382 (23.58%) were hospitalized, 171 (10.56%) got some domestic accidents, 139 (8.59%) had some surgery and 123 (7.59%) had fractures in last one year. It was also found that 53.08% of elderly were able to perform their daily activity without difficulty and only 5.3% of elderly required help for daily activity. In daily activity of life of these elderly face highest difficulty in ADL /required help in use of stair followed by mobility, bowel/bladder activity and nails manicure. Majority (1349 i.e. 82.77%) of elderly followed Allopathy but others were following other type of Indigenous system of medicine. Among males were next to majority were following Homeopathy whereas in females Ayurveda. Among Ayurveda followers females predominate over males (10.49% v/s 7.33%).

Key words- Health Status, Elderly, Geriatric, Metropolitan City, Urban Area.

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Integrated Disease Surveillance Programme (IDSP) Disease Pattern and its Load on a tertiary level Hospital: A Cross-Sectional Study

AbstractTo strengthen the surveillance system in India, Integrated Disease Surveillance Program (IDSP) was launched in 2004. The frequent occurrence of epidemics even after the launching of the IDSP was an indication toward inadequacy of the system. The aim of the this study was to find out the IDSP disease pattern and load on a tertiary hospital. It was cross-sectional study carried out in hospitals attached to SMS medical College, Jaipur (Rajasthan) India. Weekly report of IDSP in ‘P’ Form was collected from SMS Medical College, Hospitals. Data related to IDSP diseases were gathered from these reports. These reports were analysed in percentage and proportion. It was observed in this study that among IDSP diseases most common was fever of unknown origin accounting total 93 (23.97%) cases followed by Acute Diarrheal including Ac. Gastroenteritis, Acute Respiratory Infection (ARI) Influenza like illness (ILI), Pneumonia, Malaria, Viral hepatitis etc. Distribution of various IDSP diseases were with significant variation in pediatric and adult population. Among pediatric population ADD was most common whereas in adult population ARIs were most common. Even after launching of more than a decade, a sizable burden of IDSP diseases is there at tertiary level hospital, who could be treated at peripheral health institutes like Sub centre and Primary health centre. So there is a strong need for IDSP disease and its toll free no awareness.

Key words: Integrated Diseases Survillance Programme (IDSP), Communicable Diseases, Survillance

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