Prevalence of HIV seropositivity among the patients attending tertiary care hospital at Puducherry, India

Background: HIV/AIDS has been globally increasing since its first identification and reached 36.9 million by the end of 2014. It is more prevalent in underdeveloped countries. India with about 2.1 million HIV/AIDS affected people is placed third on the table followed by South Africa and Nigeria. In the present study, we aim to report the prevalence of HIV/AIDS among the patients attending our hospital in and around Puducherry, India.Methods: A total of 18903 patients attending various departments of our hospital from November 2012 to October 2015 were included in this study. HIV screening was done by rapid card test and ELISA for the detection of antibodies against HIV.Results: Out of the total study population, 259 (1.37%) were positive for HIV/AIDS. An increasing prevalence was observed in each successive year of our study. Male (1.94%) population was predominantly affected by HIV/AIDS than the females (0.90%) and is more prevalent in the 41-50 year age group.  Conclusions: Continuous monitoring, testing and counseling for HIV/AIDS would help to keep the disease under control. Special awareness and education programs are to be conducted in areas in which an increasing prevalence of HIV/AIDS is reported

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

An analysis of the predictors of mortality and morbidity in patients admitted after suicidal hanging to an Indian multidisciplinary Intensive Care Unit

Background and Aims: Hanging is a frequently used method to attempt suicide in India. There is a lack of data in the Indian population regarding clinical features and outcomes of suicidal hanging. The purpose of this study was to evaluate the factors affecting mortality and morbidity in patients admitted with suicidal hanging to the Intensive Care Unit (ICU). Methods: A 6-year retrospective study of adult patients admitted to the ICU with suicidal hanging was analysed for demographics, mode of hanging, lead time to emergency room (ER) admission, clinical presentation, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, admission Glasgow coma scale (GCS) and neurological outcomes. The primary outcome was in-hospital mortality rate. Secondary outcomes were hospital length of stay (LOS), ICU-LOS, time for neurological recovery, organ support and duration of mechanical ventilation. Statistical analysis was performed using the Student's t-test for continuous variables and Chi-square test for categorical variables. Results: We analysed data of 106 patients. The median age was 27 years [Interquartile Range (IQR) (22–34)]. The median lead time to ER admission was 1 h [IQR (0.5–1.4)] with median ICU stay of 3 days [IQR (2–4)]. Vasopressors were administered to 27.4% patients. GCS was ≤7 in 65% patients, and 84.9% patients received mechanical ventilation. Mortality rate was 10.3%. Survivors recovered with normal organ function. Conclusion: Suicidal hanging is associated with significant mortality. Admission GCS, APACHE II and 48 h SOFA score were predictors of poor outcome

Eulophia pulchra - an interesting orchid from the Siruvani Hills, Western Ghats, India

An interesting orchid, Eulophia pulchra (Thouars) Lindl., was collected from the Siruvani Hills, Coimbatore District, Tamilnadu, India. A short description and photographs taken in the field are provided for easy identification. The species was recollected after a lapse of 40 years from Tamil Nadu. The present article also reports the extended distributional range of this interesting orchid.</p

Eulophia pulchra - an interesting orchid from the Siruvani Hills, Western Ghats, India

An interesting orchid, Eulophia pulchra (Thouars) Lindl., was collected from the Siruvani Hills, Coimbatore District, Tamilnadu, India. A short description and photographs taken in the field are provided for easy identification. The species was recollected after a lapse of 40 years from Tamil Nadu. The present article also reports the extended distributional range of this interesting orchid.</p

Comparison of acute physiology and chronic health evaluation II (APACHE II) and acute physiology and chronic health evaluation IV (APACHE IV) severity of illness scoring systems, in a multidisciplinary ICU

Background and Aims: Outcome prediction of critically ill patients is an integral part of care in an Intensive Care Unit (ICU). Acute Physiology and Chronic Health Evaluation (APACHE) scoring systems provide an objective means of mortality prediction in ICU. The aim of this study was to compare the performance of APACHE II and IV scoring system in our ICU. Material and Methods: All patients admitted to the ICU between January and June 2014 and who met the inclusion criteria were evaluated. APACHE II and IV score were calculated during the first 24 h of ICU stay based on the worst values. All patients were followed up till discharge from the hospital or death. Statistical analysis was performed using SPSS version 19.0. Discrimination of the model for mortality was assessed using receiver operating characteristic curve and calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test. Results: Of a total 1268, 1003 patients were included in this study. The mean (±standard deviation) admission APACHE II score was 19.4 ± 8.9, and APACHE IV score was 59.1 ± 27.2. The APACHE scores were significantly higher among nonsurvivors than survivors (P < 0.001). The overall crude hospital mortality rate was 17.6%. APACHE IV had better discriminative power area under the ROC curve ([AUC] –0.82) than APACHE II (AUC-0.75). Both APACHE II and APACHE IV had poor calibration. Conclusions: APACHE IV showed better discrimination compared to APACHE II in our ICU population. Both APACHE II and APACHE IV had poor calibration. However, APACHE II calibrated better compared to APACHE IV

Laser depilation as an adjuvant therapy in prevention of recurrence of pilonidal sinus disease: Initial experience of a district general hospital in the UK

INTRODUCTIONPilonidal sinus disease (PD) is a chronic debilitating illness involving the sacrococcygeal area. It commonly affects economically productive age groups and carries a significant effect on social activities and quality of life. Despite the availability of many surgical options, recurrence continues to be a major issue. Laser depilation therapy (LDT) has been proposed as an adjunct to surgery in PD and shown promising results in minimising recurrence. We present our initial experience in adjuvant LDT in patients with PD in a district general hospital.METHODSProspectively maintained database of patients with PD who have had Laser-induced hair removal after surgical therapy from 01/06/2013 to 01/06/2018 were analysed. Patients were offered a minimum of two sessions of LDT and all Fitzpatrick skin types were enrolled. Follow up data were available until 01/06/2019. Persistent symptoms of PD after 1 year from the date of last surgical intervention were recognised as recurrent disease. Data are presented as median.RESULTSSixty-seven (67) patients underwent LDT, although 60 patients were eligible for final analysis. Fifty-seven of them were males (57:3) and the median age was 23 (16-46) years. 15% of patients were smokers and 13% had their BMI over 30. The majority (64%) of patients received 6 cycles of LDT. There were no complications related to Laser treatments. Overall, our recurrence rate after LDT was 13% at a median follow up of 172 weeks. A subset of patients who had Laser hair removal after EPSiT demonstrated the lowest recurrence rate of 6%. CONCLUSIONLDT is a safe and effective adjunct to surgery in reducing the recurrence of PD. Patients after EPSiT may have greater benefits of LDT. High quality randomised control trials are required to prove its efficacy and safety further