Point prevalence & risk factor assessment for hospital-acquired infections in a tertiary care hospital in Pune, India.

BACKGROUND & OBJECTIVES: Hospital-acquired infections (HAIs) are a major challenge to patient safety and have serious public health implications by changing the quality of life of patients and sometimes causing disability or even death. The true burden of HAI remains unknown, particularly in developing countries. The objective of this study was to estimate point prevalence of HAI and study the associated risk factors in a tertiary care hospital in Pune, India. METHODS: A series of four cross-sectional point prevalence surveys were carried out between March and August 2014. Data of each patient admitted were collected using a structured data entry form. Centers for Disease Control and Prevention guidelines were used to identify and diagnose patients with HAI. RESULTS: Overall prevalence of HAI was 3.76 per cent. Surgical Intensive Care Unit (ICU) (25%), medical ICU (20%), burns ward (20%) and paediatric ward (12.17%) were identified to have significant association with HAI. Prolonged hospital stay [odds ratio (OR=2.81), mechanical ventilation (OR=18.57), use of urinary catheter (OR=7.89) and exposure to central air-conditioning (OR=8.59) had higher odds of acquiring HAI (P<0.05). INTERPRETATION & CONCLUSIONS: HAI prevalence showed a progressive reduction over successive rounds of survey. Conscious effort needs to be taken by all concerned to reduce the duration of hospital stay. Use of medical devices should be minimized and used judiciously. Healthcare infection control should be a priority of every healthcare provider. Such surveys should be done in different healthcare settings to plan a response to reducing HAI.

Dermoid tumors of the ovary: evaluation of the gasless lift-laparoscopic approach.

Laparoscopic removal is widely accepted as the treatment of choice for dermoid tumors. However, the spillage of dermoid content with the laparoscopic approach is very high compared to laparotomy. The potential malignancy of dermoid tumors and the rare, but difficult to treat, chemical peritonitis in cases of spillage of dermoid content should lead to an adaptation of procedures during an endoscopic operation on a dermoid tumor to comply with the precautions of the "open" technique. Lift-laparoscopy combines laparoscopy with the standard procedures of laparotomy and thus may help reduce the spillage of dermoid contents. In a retrospective study of 108 patients with dermoid tumors, the frequency of the rupture of a dermoid tumor during a lift-laparoscopic operation was examined. Among the 79 cases of organ-preserving treatment, there were only three cases (3.8%) where a rupture of the dermoid capsule occurred. Even in cases of ruptures, it was possible to avoid spillage by closing the lesion with a clamp and continue the enucleation of the dermoid tumor during a lift-laparascopic operation. After thorough abdominal cavity lavage, none of these three cases showed a cytological contamination of the abdominal cavity with dermoid cells. None of the ovariectomy or adnexectomy cases showed a rupture. Histologically, there was also no carcinoma in any of the examined dermoid tumors. By adapting the endoscopic dermoid surgery to the precautions established in an open surgery technique using gasless lift-laparoscopy, ruptures and cell spilling can be avoided to a large extent but not completely excluded. Compared with other methods, the number of ruptures and spillage of dermoids by organ-preserving treatment as well as ovariectomy is lowest using a lift-laparoscopic procedure.

Efficacy of Use of Long-Term, Low-Dose Mifepristone for the Treatment of Fibroids.

BACKGROUND: Fibroid or myoma is the commonest reported tumor of uterus, and is one of the important reasons for hysterectomy in our setting. Different drugs are available for medical management of fibroid uterus including mifepristone, a progesterone antagonist. Varying dosage regimen for mifepristone was studied as medical management of fibroid uterus. The aim of the project was to study the effect of mifepristone on the symptoms and size of fibroids, especially using a low-dose regimen for 6 months. In addition, any symptomatic improvement of menorrhagia and dysmenorrhea was also studied. METHODS: The study was designed as an observational prospective "before-after" study. Women diagnosed with uterine fibroids attending OPD of a tertiary care hospital were selected according to the inclusion criteria. A total of 36 patients were enrolled in the study. Sample size was calculated to study changes in various parameters after 6 months treatment with mifepristone 50 mg once a week. Baseline investigations were performed and menstrual blood loss was assessed using pictorial blood assessment charts. Fifty milligrams of mifepristone weekly was used, and patient assessed at 1 and 6 month. They were also further followed up till 3 months after stopping the drug to observe the changes in menstrual pattern, fibroid volume, hemoglobin and liver function tests. Baseline endometrial biopsy and another at 6 month on cessation of drug therapy were done for all patients. RESULTS: Majority of the study population comprised of perimenopausal women, i.e., 41-45 years (44 %). Fifty percent of the patients were Para 2 and belonged to the perimenopausal age-group (18 out of 36). The dominant presenting symptom was menorrhagia associated with dysmenorrhea and pelvic pain. After 6 months of treatment with mifepristone, the mean fibroid volume reduced from 204.33 to 113.16 cm(3) (n = 33); p ≤ 0.001, and the percentage mean volume reduction of the fibroid in the study population was 44.57 % (range 1.10-100 %). Immediate reduction in bleeding PV was observed in 100 %, and 88.89 % (32/36) patients attained amenorrhea. The mean hemoglobin increased from 9.18 to 10.82 g/dl (p = 0.001). There was a transient rise in mean transaminases (AST/ALT) levels at 6 months which reverted to normal at 9 months follow-up. CONCLUSION: To conclude, 6 months therapy with 50 mg of mifepristone given weekly is efficacious and acceptable for the treatment of symptomatic leiomyoma, especially in a select group of patients. Although its use as a primary medical therapy is limited due to recurrence of fibroid after stopping treatment, it is useful for perimenopausal women whose myoma would regress after menopause, and younger infertile patients with small-size deep intramural myomas not easily accessible to either hysteroscopic or laparoscopic surgery. It is also beneficial as a preoperative adjunct, in patients with preoperative severe anemia and large fibroids where surgery is technically difficult. Mode of surgery can be changed to a less-invasive vaginal hysterectomy rather than an abdominal procedure.

Lift-laparoscopic total hysterectomy as a routine procedure.

In this study, laparoscopic hysterectomy was done with a special lift system that elevates the abdominal wall without carbon dioxide (CO2) insufflation. During this procedure, bipolar diathermy scissors also were used, which disconnected the uterus from its vessels and ligaments. The uterus was then removed through the vagina. In 403 cases, variables including operation time, complication rate, blood loss, postoperative pain, hospital stay, vaginal discharge, and convalescence time were examined. Compared with other laparoscopic methods [laparoscopic-assisted vaginal hysterectomy (LAVH), supracervical hysterectomy, and total laparoscopic hysterectomy], all those examined showed better results. Further advantages of the gasless Lift-laparoscopic total hysterectomy are lower costs and an effective "learning curve." Use of this method routinely could decrease the number of conventional-surgical hysterectomies that result in additional complications.

Endometrial ablation with a new thermal balloon system.

STUDY OBJECTIVE: To assess the efficacy of Thermablate EAS, a new, simple, hand-held, portable endometrial ablation instrument, in the treatment of menorrhagia. DESIGN: Retrospective observational study (Canadian Task Force classification II-1). SETTING: Urban hospital and private clinic facilities in Bombay, India. PATIENTS: Sixteen women with menorrhagia. INTERVENTION: Endometrial ablation with the Thermablate EAS. MEASUREMENTS AND MAIN RESULTS: Follow-up at 6 months showed eight patients (50%) to have amenorrhea and six (38%) hypomenorrhea. The only failure was in a patient with cystic hyperplasia. No complications occurred. CONCLUSIONS: Thermablate EAS is a promising instrument for endometrial ablation.