A Study to Develop and Evaluate the Effectiveness of a Mobile App: Samrudheart on Self-Care Management of a Patient with Heart Failure in Terms of Knowledge, Practice, and Adherence to Treatment among Heart Failure Patients in Safdarjung Hospital, New Delhi

Topic: A study to develop and evaluate the effectiveness of mobile app: Samrudheart on self-care management of patient with heart failure in terms of knowledge, practice, and adherence to treatment among heart failure patients in Safdarjung Hospital, New Delhi. Objectives: The objectives of the study were to develop and evaluate the effectiveness of mobile app: Samrudheart on self-care management of patient with heart failure, to assess and evaluate the knowledge, practice, and adherence to the treatment of heart failure patients, to find the relationship between knowledge, practice, and adherence to treatment after the administration of mobile app, on heart failure patients, to find the association between knowledge, practice, and adherence to treatment of heart failure patients after the administration of mobile app on selfcare management of heart failure with selected variables like age, sex, education status, family income, BMI, duration of illness, smoking, tobacco use, alcohol intake, lifestyle, diet, regular follow-up. Methodology: The research approach was the quasi-experimental approach. The Research design was one group pre-test and post-test control group design. The research setting selected for the study was cardiology OPD of VMMC and Safdarjung Hospital, New Delhi. The sample was comprised of (60) Heart Failure patients attending cardiology OPD. The independent variable in the study was a mobile app: Samrudheart and reminder call for adherence to treatment on self-care management of a patient with heart failure and the dependent variable was knowledge, practice, and adherence to treatment on self-care management of heart failure. The tool used for data collection were demographic data of sample characteristics, health determinant data of sample characteristics, structured knowledge questionnaire, structured practice checklist, structured adherence to the treatment rating scale, and structured opinionnaire. The KR-20, inter-observer and cronbach alpha formula was used to assess the reliability of tools. Results: Major findings of the study revealed that initially, the heart failure patients had poor knowledge, practice, and adherence to treatment on self-care management of heart failure. The mobile app was found to be effective in improving the knowledge, practice, and adherence to treatment of heart failure patients. There was no significant association between the knowledge, treatment adherence and not influenced by the selected variables except the practice scores are influenced by the regular follow up. Conclusion: Findings revealed that the mobile app: Samrudheart was found to be an effective strategy in improving the knowledge, practice, and adherence to treatment on self-care management of a patient with heart failure. Key words: Mobile App, Self-care management, Knowledge, Practice, Adherence, Heart Failure Patients.

PREVALENCE OF INTESTINAL TUBERCULOSIS IN CASES OF ACUTE ABDOMEN AT VMMC & SAFDARJUNG HOSPITAL, NEW DELHI

Objective: To determine the prevalence of Intestinal Tuberculosis in cases of Acute abdomen. Design & Duration: A randomized prospective study from August 2019 to July 2020. Setting: Department of Surgery, VMMC & Safdarjung Hospital, New Delhi. Patients: A total number of 200 patients with Acute Abdomen, who presented as intestinal obstruction or peritonitis. Methodology: Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome and histopathology was entered on a specially designed proforma, compiled and analyzed. Results: Among the 200 patients with acute abdomen, 32 (16%) had Intestinal Tuberculosis on the basis of operative findings and histopatholoigcal reports. Age of the patients ranged between 15 to 65 years; majority (75%) were in the age group of 20 to 40 years. Male to female ratio was 1:0.45. Twelve (37.5%) patients had evidence of Pulmonary Tuberculosis as well on X-ray chest. The commonest operative findings were hyperplastic ileocaecal tuberculosis (34.3%), followed by strictures (25%), and perforations (25%). The overall mortality in cases of acute abdomen was 6% and among tubercular patients 9.3%. Conclusion: Intestinal Tuberculosis is a common problem presenting to general surgical units in the developing countries, often in an acute form. A high index of suspicion, proper evaluation and therapeutic trial in suspected patients is essential for an early diagnosis, in order to minimize complications.

A COMPARATIVE STUDY ON OUTCOME OF ILEAL PERFORATION AFTER PRIMARY PERFORATION CLOSURE AND RESECTION AND ILEOSTOMY AT VMMC & SAFDARJUNG HOSPITAL, NEW DELHI

Background: Ileal perforations are a common occurrence in our hospital setup with a majority of cases having an etiology of typhoid. The presentation and management of ileal perforation with special reference to typhoid, nonspecific and traumatic perforations and the outcomes in these patients and the factors affecting prognosis are important. Aims and objectives of the study were to study the management of Ileal perforation. To compare the outcome of two different types of treatment for Ileal perforation i.e. Primary Closure (vs) Resection and Ileostomy. Methods: This is a randomized comparative observational study conducted in Surgery Department of VMMC & Safdarjung Hospital, New Delhi between October 2019 to July 2020. A Minimum of 28 patients was included in the study. Diagnosis was made on the basis of the X-ray erect abdomen, ultrasound abdomen, Widal test and intra-operative findings. Results: The common age groups affected was 41-50 years age group (5 patients) and 61-70 years age groups (5 patients). The least affected were 1-10years age group (one patient). The incidence in males was slightly greater than females. Male to female ratio was 2.5:1. Typhoid perforation is the most common case of ileal perforation followed by non-specific perforation. Post-operative complications are more in the primary closure group with 32.14% (9 patients) which is lower when compared to ileostomy group 17.85% (5 patients). Complications of primary closure were wound infection (2 patients), burst abdomen (3 patients), faecal fistula (1 patient), respiratory complications (3 patients). Complications in ileostomy group were wound infection (4 patients) and respiratory complications (one patient). Conclusions: Mortality was more in primary closure group with 21.42% (6 patients) and mortality was less in ileostomy group with 7.14% (2 patients). This study proposes that ileostomy may be given priority over other surgical options in moribund patients.

Clinico-epidemiological profile of patients admitted with Plasmodium vivax malaria in a tertiary care hospital, Delhi

Background: Malaria is an important public health problem in India. Severe and complicated forms of malaria are usually associated with Plasmodium falciparum species. But recently published literature suggests that Plasmodium vivax infection also presents as severe malaria. The objective was to study clinical and epidemiological profile of patients with P. vivax malaria admitted in Safdarjung hospital.Methods: A record based retrospective study was conducted in Vardhman Mahavir Medical College & Safdarjung Hospital, a tertiary care hospital in Delhi. Data were collected from all case records with ICD 10 codes for Malaria (B50-B54) for the year 2011 obtained from Medical Records Department, Safdarjung Hospital and analyzed using SPSS 21.0.Results: A total of 147 case records which had information about the test results for type of malaria infection were reviewed. Out of 147, 89 (60.5%) had P. vivax malaria. Of the 89 patients with P. vivax malaria, 47 (53%) were children and 63 (70.7%) were males. A peak in the number of inpatients was seen in September with median duration of hospital stay of 4 days and case fatality rate of 9%. A total of 56 (63%) patients had one or more severe manifestations of malaria as per WHO criteria. The most common severe manifestation was bleeding 27 (30%) followed by impaired consciousness 18 (20%).Conclusions: In more than half of the malaria patients admitted at the tertiary care centre the diagnosis was P. vivax malaria. Of them 63% patients had severe malaria as per WHO criteria.

Metastatic gestational trophoblastic neoplasia presenting after a normal pregnancy

Gestational Trophoblastic Neoplasia presenting after a normal delivery is very rare & seen in 1 in 1,60,000 pregnancies and is associated with a poor outcome due to delay in diagnosis. Only three cases have been reported in the literature till date. A 27 year old lady, P2L1 delivered a stillborn baby in some peripheral hospital. Intrapartumand post-partum period were uneventful. After a period of 2 months, in view of persistent bleeding pervaginumshe underwent dilatation & evacuation in the same hospital. Ultrasonography showed circumscribed lesion 4.1 x 3.6 cm in lower uterine segment indenting the endometrium. MRI showed a heterogeneous space (4.2 x 3.2 x 3.3 cm) occupying lesion extending to involve the anterior myometrium. She was discharged on single dose of methotrexate 50 mg intramuscular injection. After one month, she again had an episode of heavy bleeding pervaginum leading to shock, for which she was referred to Safdarjung Hospital for further management. At Safdarjung Hospital an emergency hysterectomy was performed as a lifesaving measure. Preoperative serum Bhcg was >1 lac mIU/ml. later it was reported as gestational choriocarcinoma by histopathology. Metastatic workup showed cannonball lesions in lungs. On the 10th post-op day, she had severe episode of headache followed by right sided hemiplegia. NCCT head showed multiple haemorrhagiclesion in bilateral parietal and right frontal region suggestive of brain metastasis. She was started on the EMA/CO regimen. Conclusion: The main modality of treatment of choriocarcinoma is multiagent chemotherapy. Hysterectomy is generally reserved for those gestational trophoblasticneoplasia where it is chemotherapy resistant. Although in exceptional circumstances of heavy uncontrolled bleeding per vaginum hysterectomy is a lifesaving procedure, it is not curative to the other metastatic manifestations.

Sample survey of cancer awareness in health care workers

Objective: To see the awareness about cancer in women among ASHA workers. Place of Study: Awareness Sessions at Safdarjung Hospital, New Delhi. Background: ASHA workers are the first point of contact for women in the community & bridge the back between the hospital and women. They have been instrumental in the success of the family planning programme & polio eradication program in India. Materials and Methods: A questionnaire about educational status, awareness about breast & cervical cancer statistics, methods of screening and diagnosis was distributed to Accredited Social Health Activists appointed by the government at two educational sessions organized at Safdarjung hospital. Results: Of the 200 ASHA workers attending, 188 completed the questionnaire. Their educational status ranged from 7th standard to post-graduate, majority had studied up to 10th standard. Their sources of information were mostly television and mobile phones, 23% had knowledge about internet, 36% were using Whats app. Only 28% knew about the commonest cancer in Indian women. Regarding breast cancer, 63% were aware of self examination of breasts, 41% knew the frequency of self examination; awareness about symptoms of breast cancer was prevalent in 46%, 24% knew about risk factors of breast cancer. Regarding Cervical Cancer, 28% knew about risk factors, 22% knew about symptoms of cervical cancer; 19% knew about screening methods for cervical cancer, 9.5% knew the screening intervals. Conclusion: Health education about cancer prevention should start at the primary school level. Special educational & motivational sessions for ASHA workers could help in cancer prevention programs.