Journal of Medical Research and Innovation (JMRI)
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A study of patient satisfaction level in inpatient spine department of a tertiary care multi-speciality hospital
Full text linkBackground: Patient satisfaction at spine surgery centers is a matter of concern. In specialized surgeries like spine, the satisfaction of a patient is not merely because of surgical outcomes but also empathy of doctor, rehabilitation programs and friendliness of the hospital.
Aims and Objectives: This study aims to investigate the prognosis and satisfaction level of patients/relatives operated with spinal surgery. This shall not only help the spinal hospitals to know the ways to improve the patient outcome but methods to provide better services.
Material and methods: The study was conducted by carrying out survey amongst 39 patients and their relatives at inpatient department of spine surgical unit by using structured questionnaire and analysing the data using SPSS software. The patients were examined before and after surgery and their VAS (Visual Analogue Score) and ODI (Oswestry Disability Index) were also documented. The SERVQUAL methodology was also studied to understand if it could be implemented in the study to understand better and make the study more conclusive.
Results: The study composed of 39 individuals with an average age of 75.6 +-10.2 years.39 percent of the study group were females and 61 percent males. The ODI score in post-operative stage (18.97+_12.97) was significantly reduced as compared to pre-operative stage (76.66+-17.23) (p<0.05). The VAS score in post-operative stage (1.48 +-1.8) was also significantly reduced as compared to pre-operative stage ( 9.51 +- 0.22) (p<0.05). Ninety-Two percent people were satisfied with the housekeeping services while Ninety-Eight percentage were satisfied with the medical care provided. Ninety-five percentage of people were satisfied by the behaviour of staff and nurses. The nursing department, cleanliness and behaviour of the doctor satisfied 90 percent, 87 and 84.59 percent. The admission and reception satisfied only 66 percentage . The SERVQUAL study was not incorporated because the questionnaire designed through this methodology requires to be administrated by face to face interviews along with moderate to large sample size for statistical reliability.
Conclusion: This study has clearly shown that satisfactory results are obtained after spine surgery. However, the results are better when performed by a fellowship trained surgeon. Moreover, doctors who spend time in explaining the ailments and possible outcomes to the patients have more satisfactory results. A caring attitude of the staff and empathy in interaction makes a lot of difference in the success of the practice of a surgeon
Clinical Profile of Ascites Based on Presentation and Laboratory Findings: An institutional experience from Kathmandu, Nepal
Full text linkIntroduction: Ascites is the fluid collection in the potential space of the peritoneal cavity. Alcoholic liver disease and intra-abdominal malignancy are two major etiologies behind it. Also, diagnosis of tuberculous ascites should be thought of due to endemicity. Cirrhotic patients at any time during the course of disease, invariably present with ascites which is one of the marker of decompensation. In our context, etiology behind ascites and its correlation with symptoms and clinical findings not yet studied, so present study is conceptualized.
Methods:This is a cross-sectional retrospective descriptive hospital based record review of patients presented with ascites in a tertiary center of Kathmandu. One hundred fourteen patients with ascites under regular follow up of Shree Birendra Hospital (SBH) were reviewed. Data regarding presenting complaints, examination findings, relevant investigations during first visit and final diagnosis were retrieved from our own record keeping and recorded information were then evaluated.
Results: Patients having ascites have myriad of symptoms and signs, commonest clinical feature being icterus (74, 64.9%). Most of them were anemic at presentation. Forty-two (36.8%) had high blood urea and 36 (31.5%) with high creatinine suggesting approximately 30-40% cases presented with deranged renal function test. Ninety-three (81.5%) had raised total serum bilirubin. Similarly, PT/INR derangements were in 74 (64.9%) and 57 (50%) suggesting deranged liver function. Serum albumin was less than 3.5 gram/deciliter in 83(72.8%) cases. Among the patients studied, 80 (70.1%) had high Serum-Ascites Abumin Gradient (SAAG) suggesting transudative type of ascites and rest 34 had low SAAG suggesting exudative type of ascites. Overall assessment revealed, majority of patients (71.05%) had Chronic liver disease (CLD) as the cause of ascites.
Conclusions: Ascites due to chronic liver disease was the main finding with etiology supported by laboratory findings. Significant numbers of the patients had deranged renal function on top of liver function derangement, so these parameters need to be properly taken care of.
Key Words: Ascites, liver cirrhosis, serum ascetic albumin gradient
Presentation with Personality changes and Tinnitus to a Vascular Intervention: Rare case of Carotid Body Paraganglioma
Full text linkBackground: Carotid body paragangliomas are rare neuroendocrine neoplasms of chromaffin negative glomus cells. This case report explains an atypical case with unusual presentation and treatment.
Case Report: A healthy smoker technician by profession was brought to the emergency room (ER) with coprolalia. The general physical exam did not reveal any information. His history revealed unilateral tinnitus and odynophagia leading to a consultation by the neurologist with head imaging. Acoustic neuroma was ruled out and the caregiver was asked to elaborate the events mentioned in the history and a psychiatric examination was done. The personality changes were evaluated by the psychiatrist that showed overlapping of delirium and depression. The patient was further examined by a vascular surgeon. After careful revisiting of the history, examination and indication of tender mass in the neck by the patient's vascular surgeon, the diagnosis of carotid body paraganglioma was made which was followed by surgical resection for treatment.
Conclusion: Carotid Body Paragangliomas are very vascular structures and their manipulation in a surgery setting requires expertise. This case presented with personality changes and tinnitus, a very less likely event to occur in a carotid body tumor. The present care report, thus adds on to the literature of carotid body tumors and its presenting symptoms
Hydroelectrophoresis for Transdermal Administration of Verapamil or of Hyaluronic Acid in Peyronie's Disease: A Prospective, Open Label, Multicenter Study
Full text linkAim & Objective: To assess the efficacy of a new electromotive system for the transcutaneous delivery of verapamil or of hyaluronic acid to improve the symptoms of Peyronie' s disease (PD) in patients with a curvature deformity of < 30° at the beginning of therapy.
Methods & Materials: Sixty-one PD patients were studied. Thirty were randomly assigned to receive verapamil 10 mg/session (Isoptin®, BGP Products, Rome-Italy), (Group 1, median age 56 years, range 49-62), and 31 were randomly assigned to receive hyaluronic acid 8 mg/session (Sinovial®, IBSA, Lodi-Italy) (Group 2, median age 58 years, range 51-56). There were ten sessions, 2 sessions/week for each drug. Each drug was transdermally administered using the hydroelectrophoresis technique and carried out using a Hydro4and apparatus (Swiss4Med SA, Morbio Inferiore, Switzerland). With respect to the efficacy of the drugs studied, the endpoints were: side effects, pain, erectile function, penile deviations and plaque area (cm2) before, and 3 and 6 months after drug administration. The differences were assessed using the Mann-Whitney Rank test (unmatched groups) or using the Wilcoxon Signed Rank test (matched groups). The differences between the groups in terms of side effects were assessed using the chi-square test.
Results: No significant difference emerged among the baseline values of the two groups. Pain, erectile function, plaque area and penile deformity significantly improved in both groups after treatment, but a notably higher improvement occurred in the patients in whom hyaluronic acid was administered. Only a few negligible side effects occurred in the Group 1 patients treated with Verapamil, with no significant difference between the groups.
Conclusion: Administration of both hyaluronic acid and verapamil using the Hydro4and apparatus is a safe and efficient method for PD therapy
Ayushman Bharat Initiative: India’s Answer to Universal Health-Care
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Valproic Acid-Induced Hyperammonemia with Encephalopathy (VIHE): A Case Report
Full text linkValproic acid (VPA) is a wide spectrum antiepileptic medication indicated for seizure prophylaxis across the spectrum of epilepsy. Since coming into clinical use, VPA has also been recommended for the management of a variety of other pathologies, including, most notably, mood stabilization in the manic patient. VPA’s common adverse effects include gastrointestinal, influenza-like symptoms, headache, and difficulties with sleep; nonetheless, in rare instances, VPA has been noted to cause the severe and potentially lethal condition of hyperammonemia with encephalopathy (VIHE). VIHE is the result of a dose-independent increase in ammonia levels. Often the patient is asymptomatic; if symptoms reach clinical threshold, lethargy is most common, though seizures, focal neurologic deficits and even coma are possible. VIHE can occur in patients despite normal hepatic function, normal loading doses, chronic stable doses and normal free serum drug levels. Once the diagnosis is confirmed, the first approach for symptomatic patients is to discontinue VPA, start alternative mood stabilizer as indicated, and supplement hyperammonemia treatment with lactulose, carnitine or carglumic acid. Below is a case report of VIHE that developed in an adolescent girl with a history of Bipolar I Disorder who was hospitalized in our facility for stabilization of mania. As demonstrated below, early diagnosis of VIHE is pivotal in reducing morbidity and ultimately can be life-saving
Editors and Reviewers Acknowledgement, 2(2), July-December, 2018
No full textThe Journal of Medical Research and Innovation would like to thank each and every one who has helped us to review and edit the articles. As a small token of appreciation, we would like to mention the names of all the editors and reviewers in random order here who have edited or reviewed the articles for the July, 2018 issue. The list will be updated as when more reviewers review the articles.
Editors
1) Varshil Mehta2) Shakti Goel3) Krutarth Shah
4) Sergey Kozhukhov
Reviewers
1) Shakti Goel
2) Varshil Mehta
3) Mykola Khaitovych
4) Rahul Kotian
5) Hira Lal
6) Prashant Pradhan
7) Pravin Padalkar
8) Saumya Agarwal
9) Mathew Asare
10) Edith Claros
11) Surya Parajuli
12) Rajesh Sharawat
13) Nishu Tyagi
14) Pradosh Sarangi
15) Deepak Jain
16) Hamsini C
17) Vicky Varghese
18) Nishtha Agarwal
19) Ishpreet Biji
20) Tushar Kunder
21) Rushi Solanki
22) Suvendu Maji
23) Sergey Kozhukhov
24) Shaunak Ajinky
Proposing the concept of Perfection Quotient (PQ) as a measure of readiness for health behavior change
Full text linkIntelligence Quotient (IQ) has been used for a long time to test for readiness of individuals with regard to their learning abilities. It offers limited utility in ascertaining readiness toward health behavior change. Work on emotional quotient (EQ) and X quotient (XQ) has been done in recent years but has not been applied for determining readiness toward health behavior change through health education and health promotion interventions. The purpose of this editorial is to propose a novel concept of perfection quotient (PQ) that integrates IQ, EQ and XQ for ascertaining the readiness for health behavior change through health education and health promotion interventions in a variety of target populations. Such measure will be invaluable in ameliorating the impact of health education and health promotion interventions
Editors and Reviewers Acknowledgement, 2(1), January-June, 2018
No full textThe Journal of Medical Research and Innovation would like to thank each and every one who has helped us to review and edit the articles. As a small token of appreciation, we would like to mention the names of all the editors and reviewers in random order here who have edited or reviewed the articles for the January-June, 2018 issue. The list will be updated as when more reviewers review the articles.
Editors
1) Varshil Mehta2) Shakti Goel3) Surya Parajuli4) Nikhil Nalluri5) Vitaliy Bezsheiko
Reviewers
1) Shakti Goel
2) Assad Mughal
3) Harsha Makwana
4) Megha Patel
5) Ishpreet Biji
6) Surya Parajuli
7) Varshil Mehta
8) Heera KC
9) Prem Bhattarai
10) Tushar Kunder
11) Akshay Avula
12) Mykola Khaitovych
13) K Bedmutha
14) Mayank Jain
15) Joseph Bell
16) Vitaliy Bezsheiko
17) Ahmad Farrokhi
18) N. Kuma