Knowledge and awareness among female patients attending cardiac outpatient department in a super speciality hospital

Background: Cardiovascular disease is the leading cause of mortality not only in males but also in females and knowledge about the disease is poor among them. Objective of the study was to assess the knowledge and awareness among female cardiac patients.Methods: This cross-sectional study was conducted in outpatient department of cardiology in a super specialty hospital of government medical college Jammu, Jammu and Kashmir, for a period of three month from 1st March to 31st May 2017. Female patients were given a questionnaire regarding socio demographic profile, knowledge and awareness were recorded and analyzed in percentage.Results: There were 216 female patients, out of which 56.9% were in age group of 41-60 years, 86.1% were housewives, 87.5% were married, 54.1% having education up to 10th standard and maximum were living in joint family and 52.7% having monthly family income above 20,000. 44.4% were suffering from hypertension. Maximum females 59.7% consider themselves as bulky, 83% have changed their eating habits, 66.6% have started work out after the onset of disease, 61%-62% were having awareness about the cardiac symptoms and 97.2% were following allopathic drug therapy.Conclusions: Overall knowledge and awareness about disease and risk factors among these females was good as these patients were already diagnosed patients and were coming for follow up. There is need of educational programme by involving primary health care workers and utilization of CVD guidelines as a better preventive strategy

AWARENESS, STRESS, ANXIETY, AND DEPRESSION AMONG HYPERTENSIVE PATIENTS ATTENDING CARDIAC OUTPATIENT DEPARTMENT IN A SUPER SPECIALTY HOSPITAL

Objective: Hypertension is a major risk factor for cardiovascular disease and its association with negative emotions may increase their risk forthe development of mental health disorders. The main objective of the study was to assess the awareness, stress, anxiety, and depression amonghypertensive patients attending cardiac outpatient department (OPD).Methods: This study was conducted in cardiac OPD of Super Speciality Hospital associated with Government Medical College, Jammu, for a period of1-month commencing from 1st October to 31st October 2015. Hypertensive patients were given a questionnaire regarding socio-demographic profile,risk factors, and awareness for high blood pressure, and prevalence of stress, anxiety, and depression was assessed using a structured validatedquestionnaire DASS-21 [depression, anxiety, and stress scale-21].Results: It was observed that most (72.5%) of the patients were aware of symptoms and its complications and regarding psychological symptomsmild to severe depressive symptoms were present in 10%, anxiety in 70%, and stress in 10% of patients.Conclusion: There is need of psychiatric evaluation and counseling in these patients and support services to be made available to these patients.Keywords: Hypertension, Awareness, Stress, Anxiety, Depression, Depression; anxiety and stress scale-21

A retrospective study of emergency obstetric hysterectomy in a tertiary care center for a period of 5 years

Background: The study was conducted to determine the frequency, demographic characteristics, indication and fetomaternal outcome associated with emergency obstetric hysterectomy in a tertiary care center.Methods: Thirty cases of emergency obstetric hysterectomy performed during the five-year period from April 2011 to April 2016 were analyzed in the dept. of Gynae and obs. in Shri Guru Ram Rai Institute of Medical Sciences in Dehradun.Results: During the study period there were 30 cases of obstetric hysterectomy out of 8084 deliveries giving an incidence of 0.37%. Majority of the patients (60%) were unbooked and were in the age group of 26-30 (43.3%). Common parity group were 3, 4 and 5. Morbid adherent placenta was the most common indication contributing to 40% of the cases. There were four maternal deaths in the study. All were unbooked and three of them died of hypovolemic shock with cardiopulmonary arrest and one died of septicemia. Whereas there were 60% perinatal mortality and 26.66% NICU admissions.Conclusions: Emergency obstetric hysterectomy is a potentially lifesaving procedure which often puts obstetrician in dilemma at the time of decision making

A prospective study of immediate postpartum intra uterine device insertion in a tertiary level hospital

Background:In India there is an unmet need for contraception. Intrauterine device is a long acting reversible method. This study was done to determine the efficacy and safety of immediate Post-Partum Intrauterine Device (PPIUD) and to compare the outcome of PPIUD insertion after vaginal delivery and caesarean section.  Methods:A total of 113 women who underwent PPIUD insertion were followed up at 6 weeks and 6 months post-partum. Outcome in term of side effects, removal and expulsion was compared in vaginal delivery and caesarean section insertions.Results:In 61.45% women there was no complaint. Menstrual disturbances were found in 16.66% women and pelvic pain in 13.54% women. The expulsion rate was 5.20% and IUD removal was done in 13.54% women. Incidence of removal was more in vaginal insertions than in caesarean insertions and this difference was statistically significant. Continuation rate at 6 months was 81.25%.  Conclusion:Immediate postpartum IUD insertion is a safe, convenient and effective method

A six year appraisal of caesarean delivery at a teaching hospital in Uttarakhand

Background: Caesarean section is one of the commonest surgical procedures worldwide. Its upward trend and its indications in low resource setting makes regular appraisal of the practice necessary.Methods: A retrospective study. Labour ward logbook and case records were looked into, and all information extracted.Results: The prevalence of caesarean section in the study population was 32.18%. The most common indication of caesarean section was previous caesarean section (33%) followed by fetal distress (26.2%).Conclusions: Risk appraisal and all efforts must be geared towards reducing caesarean section rate. Certain measures have been recommended.

Evaluation of simple International ovarian tumor analysis ultra sound rules in differentiating between benign and malignant ovarian tumors and their histopathological correlation

Background: IOTA (International ovarian tumor analysis) study is considered one of the largest studies on ultrasound diagnosis of ovarian pathology conducted in literature till date. It was started in 1999 and included nine European countries. It is a standardized technique for preoperative classification of ovarian pathology defined by IOTA group.Methods: A retrospective study was analyzed from a period of January 2016 to December 2017 (2-year period). The records of all the patients operated for benign and malignant ovarian pathology in the gynae department of hospital were retrieved from medical record sections. USG findings were redefined as per IOTA simple rules by sonologist and its histopathological correlation was done using kappa statistical method.Results: In the present study, out of 61 patients IOTA was applicable to 57 patients. The sensitivity where IOTA simple rules were applicable was 92.8% and the specificity was 93%. The accuracy turned out to be 92.9%. If inconclusive results were taken as malignant then sensitivity increased to 94% and specificity decreased to 87%. Good level of agreement was found between sonological and histopathological findings with Kappa statistics application (K = 0.59).Conclusions: The IOTA simple rules can be considered as an important diagnostic modality in differentiation of benign and malignant ovarian tumors, it has an added advantage of abolishing the subjectivity of routine ultrasound. However inconclusive results demand further expertise in the field and need to be taken care of before interpretation of ovarian pathologies

A case report of tubo-ovarian torsion in 4 years old girl

Tubo-ovarian torsion is infrequent diagnosis, clinical picture is nonspecific and children cannot articulate their symptoms which make diagnosis as a challenge. High index of suspicious and early intervention prevents damage to adnexal tissue.

How Many Simultaneous Audit Committee Memberships Are Too Many?

Recent research by Sharma, Sharma, Tanyi, and Cheng (2020) provides new insight into directors serving on multiple public company audit committees. Specifically, they investigate how an individual audit committee director serving on multiple audit committees is related to companies’ cost of equity capital. Their evidence suggests that serving on multiple audit committees is viewed positively by investors up to a certain point, but beyond that point investors become concerned. This turning point, on average, is 3.5 audit committees for retired directors and 1.5 audit committees for directors in full-time employment. These results have implications for numerous stakeholders including investors, proxy advisors, boards, nominating committees, stock exchanges, and policymakers. They also have implications for future research

Seizure disorders in pregnancy: an insight beyond eclampsia and epilepsy

Background: Seizures in pregnancy contribute to poor maternal and perinatal outcome. Though eclampsia and epilepsy are common causes of seizures in pregnancy but there are several other conditions apart from eclampsia and epilepsy which give rise to convulsions. Objective of this study was to evaluate fetomaternal outcome in patients with seizure disorders as well as to analyze the other causes of seizures in pregnancy apart from eclampsia and epilepsy.Methods: This prospective study was conducted in Shri. Guru Ram Rai institute of medical and health sciences, Dehradun, India over a period of 39 months from January 2017to March 2020, in all pregnant women with seizure disorders delivered in this hospital. In all cases demographic characteristics, causes of seizure with special attention on noneclamptic, non-epileptic conditions, maternal complications, mode of delivery and fetal outcome were noted.Results: Total 97 cases with seizure disorders were included in the study. Mostly seizures were due to eclampsia and epilepsy in 91.75% cases. Among other causes neurocysticercosis, cerebral malformation, posterior reversible encephalopathy syndrome, brain tumor, and cerebral infarcts contributed to seizures in pregnancy in 8.25%cases. Maternal complications were premature rupture of membranes, gestational diabetes mellitus, hypothyroidism, anaemia, jaundice and abruption observed in37.11% cases. Live birth rate was 76.28%, prematurity was present in 27.83% cases and fetal growth restriction was seen in 7.21% neonates. There were 5 (5.15 %) neonatal deaths.Conclusions: Seizure disorders in pregnancy are associated with significant increase in maternal and fetal risk. Maternal complications, cesarean section rate and neonatal complications are increased. Several other conditions apart from eclampsia, need to be considered in patients without epilepsy presenting with convulsions in pregnancy.

Exploring the Disproportionate Impact of COVID-19 in Older Adults in Canada

Background – Why are older Adults are Higher Risk? The majority of older adults have comorbid conditions, which are associated with a higher risk for COVID-19. Many live in residential care homes, which have seen the highest number of covid-19 cases due to tightly shared living spaces. With weakened immune systems, older adults living in poverty face additional challenges in protecting themselves from the virus, as it is difficult for them to comply with public health measures such as social distancing. 5% of individuals in the lowest income quartile were hospitalized due to covid19, compared to only 11.4% of individuals from the highest income quartile.   Methods – The data was retrieved from the Canadian MIS Database (CMDB) and the discharge abstract database (DAD). The CMDB contains financial and statistical operations information on public hospitals and regional health authorities across Canada. Case selection is based on COVID-19 diagnosis codes available in the International Statistical Classification of Diseases and Related Health Problems.   Results – Elderly faced higher rates of hospitalization during the pandemic. The average length of hospital stay was also higher for older adults—hospitalizations of individuals under age 65 without comorbidity 41,707 with comorbidity 12,372. Hospitalizations of individuals 65 and older without comorbidity were 22,221 with comorbidity 24,731. Higher Hospitalization rates and issues of inequality in the healthcare system globally. As the pandemic progressed, hospitalization increased in number significantly. The average length of stay for individuals younger than age 65 without comorbidity is 7.7 days compared to 17.0 days in patients with comorbidity. The average full length of stay for individuals 65 and older without comorbidity was 13.2 days, While in patients with comorbidity 19.2 days. Older adults had higher in-facility death rates due to COVID-19 hospitalization. The in-facility death rate of individuals younger than 65 without comorbidity is 2.5%, With comorbidity at 12.9%. In-facility death rate of individuals 65 and older without comorbidity is 14.4%, with comorbidity at 23.2%.   Conclusion – By analyzing and comparing various hospitalization rates for Canada, the precise data indicate that older adults have been disproportionatelyimpacted by COVID-19. It is now important to determine the underlying structural issues that have caused this inequality to prioritize healthy aging.   &nbsp