The World Health Organization (WHO) Labour Care Guide (LCG) is a paper-based labour monitoring tool designed to facilitate the implementation of WHO's latest guidelines for effective, respectful care ...during labour and childbirth. Implementing the LCG into routine intrapartum care requires a strategy that improves healthcare provider practices during labour and childbirth. Such a strategy might optimize the use of Caesarean section (CS), along with potential benefits on the use of other obstetric interventions, maternal and perinatal health outcomes, and women's experience of care. However, the effects of a strategy to implement the LCG have not been evaluated in a randomised trial. This study aims to: (1) develop and optimise a strategy for implementing the LCG (formative phase); and (2) To evaluate the implementation of the LCG strategy compared with usual care (trial phase).
In the formative phase, we will co-design the LCG strategy with key stakeholders informed by facility assessments and provider surveys, which will be field tested in one hospital. The LCG strategy includes a LCG training program, ongoing supportive supervision from senior clinical staff, and audit and feedback using the Robson Classification. We will then conduct a stepped-wedge, cluster-randomized pilot trial in four public hospitals in India, to evaluate the effect of the LCG strategy intervention compared to usual care (simplified WHO partograph). The primary outcome is the CS rate in nulliparous women with singleton, term, cephalic pregnancies in spontaneous labour (Robson Group 1). Secondary outcomes include clinical and process of care outcomes, as well as women's experience of care outcomes. We will also conduct a process evaluation during the trial, using standardized facility assessments, in-depth interviews and surveys with providers, audits of completed LCGs, labour ward observations and document reviews. An economic evaluation will consider implementation costs and cost-effectiveness.
Findings of this trial will guide clinicians, administrators and policymakers on how to effectively implement the LCG, and what (if any) effects the LCG strategy has on process of care, health and experience outcomes. The trial findings will inform the rollout of LCG internationally.
CTRI/2021/01/030695 (Protocol version 1.4, 25 April 2022).
Background: Antiretroviral therapy (ART) significantly delays the progression from HIV to AIDS. Adherence to ART is the second strongest predictor of progression to AIDS and death, after CD4 count. A ...very high level of adherence (≥95%) is required for ART to be effective on a long term and to prevent the emergence of resistant viral strains and prevent comorbidities. Methods: A case series study was undertaken at an ART center for a period of 6 months. Non-probability purposive sampling was adapted to select HIV-positive subjects aged >15 years on ART for more than 6 months. A predesigned semi-structured questionnaire was used to obtain the data. Treatment compliance was assessed by self-reported 1-week recall method. Results: A total of 536 HIV-positive people were interviewed, among which 315 (58.8%) of them were males and 214 (39.9%) were females. Nearly two third of the participants (359, 67.0%) reported ≥95% adherence to treatment. Personal commitments (51, 28.8%) and working time inconvenience (42, 23.7%) were the common reasons for less adherence. On bivariate analysis, married people (OR: 1.586, CI: 1.097-2.292), participants residing in rural area (OR: 1.628, CI: 1.130-2.345), participants not having side effects of drugs (OR: 5.324, CI: 3.491-8.181), participants equipped with better knowledge about ART (OR: 2.019, CI: 1.377-2.961), and participants having support of friends and family members (OR: 1.612, CI: 1.019-2.540) showed a higher level of adherence to ART. Conclusions: Demographic factors such as marital status, residing in rural area, and other personal factors like having good knowledge about ART, without side effects to drugs, and having support of friends and family members were found to show a high level of adherence to ART.
Background: The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic has caused a re-emergence of tuberculosis (TB). In persons infected with both HIV and TB, the ...lifetime risk of developing TB disease is 50-70% compared to 10% in HIV-negative individuals. India has world's 3rd highest HIV burden and is also one of the countries endemic for TB, so the country faces a dual epidemic of HIV and TB. Objectives: To find out the proportion and determinants of TB in HIV-positive subjects. Subjects and Methods: This study was undertaken at the ART center from June 01, 2012, to May 31, 2013. HIV-positive subjects aged above 15 years who had been on antiretroviral therapy (ART) for more than 6 months were included in the study. Nonprobability purposive sampling was adopted. A predesigned semi-structured questionnaire was used to obtain data.
Results: A total of 536 HIV-positive people were interviewed, 58.8% of whom were males, 79.1% were Hindu, 61.0% had up to high school education, and 57% were unskilled laborers. About 63% were married, 40% were from the upper lower class, and 60% were from urban areas. For the majority (89.1%), the probable mode of transmission of HIV was by the heterosexual route. TB co-infection was present in 38.4% subjects. The most common form of TB was extra-pulmonary in subjects on antituberculous treatment (47.3%) and among old cases (57.6%). On bivariate analysis, 136 (42.4%) married subjects and those from rural areas were more commonly affected by TB compared to subjects who were unmarried and from urban areas with odds ratio (OR): 1.555, confidence interval (CI): 1.077-2.246 and OR: 1.523, CI: 1.061-2.185, respectively. The proportion of TB was high among subjects who lived in overcrowded houses 130 (44.2%), and who had a habit of alcohol use compared to others with OR: 1.731, CI: 1.734-2.179 and OR: 1.524, CI: 1.045-2.223, respectively. Logistic regression analysis showed that TB among people living with HIV/AIDS was highest in persons living in overcrowded houses (OR: 1.706, CI: 1.185-2.458) and those who consumed alcohol (OR: 1.605, CI: 1.090-2.362). Conclusions: Demographic factors like male gender, middle age, living in the rural areas, consumption of alcohol, and living in overcrowded houses were found with a higher proportion of TB. The use of highly active ART appeared to progressively decrease but did not completely eliminate the risk of TB.
Cesarean section rates worldwide are rising, driven by medically unnecessary cesarean use. The new World Health Organization Labour Care Guide (LCG) aims to improve the quality of care for women ...during labor and childbirth. Using the LCG might reduce overuse of cesarean; however, its effects have not been evaluated in randomized trials. We conducted a stepped-wedge, cluster-randomized pilot trial in four hospitals in India to evaluate the implementation of an LCG strategy intervention, compared with routine care. We performed this trial to pilot the intervention and obtain preliminary effectiveness data, informing future research. Eligible clusters were four hospitals with >4,000 births annually and cesarean rates ≥30%. Eligible women were those giving birth at ≥20 weeks' gestation. One hospital transitioned to intervention every 2 months, according to a random sequence. The primary outcome was the cesarean rate among women in Robson Group 1 (that is, those who were nulliparous and gave birth to a singleton, term pregnancy in cephalic presentation and in spontaneous labor). A total of 26,331 participants gave birth. A 5.5% crude absolute reduction in the primary outcome was observed (45.2% versus 39.7%; relative risk 0.85, 95% confidence interval 0.54-1.33). Maternal process-of-care outcomes were not significantly different, though labor augmentation with oxytocin was 18.0% lower with the LCG strategy. No differences were observed for other health outcomes or women's birth experiences. These findings can guide future definitive effectiveness trials, particularly in settings where urgent reversal of rising cesarean section rates is needed. Clinical Trials Registry India number: CTRI/2021/01/030695 .
The growth and development of child is a strong reflection of country's growth and development. Being most vulnerable segment of the society the preschoolers are at greatest risk of malnutrition for ...it is their growing period that demands high intake of protein and calories.
To find out the prevalence of undernutrition among 1-5 years children in Urban Ballari.
This is a cross-sectional study conducted from January 2018 to June 2018 which included 700 children in the age group of 1-5 years residing in Ballari urban.
Of total 700 study subjects, boys constituted 49.7% and girls 50.3%. The overall prevalence of under nutrition among the study subjects based on weight for age parameter was found to be 40.6%. (Normal- 59.4%, Moderate under nutrition- 22%, Severe under nutrition - 18.6%). Prevalence of stunting and wasting was 43.2% and 23.9% respectively.
The result of the study is indicative of high prevalence of undernutrition among children in the age group of 1-5 years in Ballari City.
Background Secondary peritonitis presents common life-threatening conditions associated with high mortality and morbidity. Management of perforative peritonitis poses significant challenges to the ...treating surgeons with respect to surgical outcome thereby demanding thorough evaluation and appropriate management in such cases. Objectives To study the clinical profile, management of perforative peritonitis and its surgical outcomes. Methodology A case series study of 513 patients with Perforative Peritonitis was studied in setting of tertiary care hospital in the department of general surgery at Vijayanagara Institute of Medical Sciences, Ballari, Karnataka during the period of June 2015 to January 2018. Among the selected patients the clinical profile, etiological profile and the surgical interventions were undertaken and the outcome were noted. Appropriate descriptive statistics were used to analyse the findings and to draw the inferences. Results There were 390 males and 123 females. The mean age of patients was 35.95 ± 24.87 years. Common cause of perforative peritonitis were acid peptic disease (35.7%), infectious disease (23%), trauma (13%) and malignancy (2.3%). Complication rate and mortality among the patients was 47.2% and 9.6% respectively. Elderly age, comorbid condition, infectious disease etiology and malignancy and site of perforation were the important determinants of mortality among the patients. Conclusion GI perforations are one of the most common surgical emergencies. Mortality depends on the age and general condition of the patient, associated pre-operative co-morbidities, site of perforation and etiology.
Background: Awareness regarding dengue through health education is one of the important components of Integrated vector control which can bring about reduction in mosquito density and thereby ...reduction in morbidity and mortality. The objectives of this study to assess the impact of health education on larval indices in the study area.Methods: This was a community based interventional study was conducted between August to September 2017 at rural field practice area of Vijayanagar Institute of Medical Sciences, Ballari. Three villages with a population of more than 2000 were selected randomly. A total of 100 households were surveyed for Aedes larvae in all the three villages. Baseline information and larval indices like house index (HI), container index (CI) and Breteau index (BI) were calculated as per the procedure of WHO. Health education regarding potential breeding sites of Aedes mosquito and importance and methods of eliminating them through demonstration at household level and street play at community level was done. Post intervention larval survey was done.Results: There was 31.7% reduction in container index (pre-CI: 14.2% to post-CI: 9.7%) and 40.1% reduction in Breteau index (pre-BI: 76.3 to post-BI: 45.7%) and this reduction in the larval indices was found to be statistically significant.Conclusions: Based on the high larval indices, the study areas were prone for dengue transmission. There was significant reduction in the larval indices after the educational intervention.
ABSTRACT
Introduction
The aim of this study is to study the clinical profile and outcome of primary and secondary intracerebral hemorrhage (ICH) and to study the different parameters that affect the ...outcome.
Materials and methods
A total of 40 patients who were diagnosed to have ICH, both primary and secondary, by computed tomography scan were included in the study. Among the selected patients, the clinical profile, radiological profile, and the modality of treatment undertaken and the outcome were noted. Outcome variables included survived improvement in the Glasgow Coma Scale (GCS), death, and vegetative state. The outcome variable was compared with respect to age, sex, GCS, etiology, location of the hematoma, and the modality of treatment to find out any statistically significant difference in the rate of outcomes.
Results
The mean age of the patients was 36.78 ± 18.5 years; mean GCS at the time of presentation was 9.05 ± 1.82. Common causes of ICH were trauma (57.5%) and hypertension (25%). Significant association was found between outcome and age group, GCS, etiology of ICH, and location of the bleed. Poor outcome was associated with GCS ≤ 8 (40%), >50 years of age (45.5%), hypertension (50%), and basal ganglia bleed (50%). Best outcome was seen in patients with GCS ≥9, a lobar bleed, and trauma as the cause of ICH where the patient survival was 90%.
Conclusion
In case of ICH depending upon the clinical and radiological profile, the treatment should be individualized. The rates of survival and favorable outcome are better in patients with GCS ≥ 9, a lobar bleed, and trauma as the cause of ICH.
How to cite this article
Sidram V, Kumar PCC, Raghavendra B. A Study of Clinical Profile of Intracerebral Hemorrhage and ENT Manifestations and its Surgical Outcome. Int J Head Neck Surg 2017;8(1):5-10.
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