The History of a Hospital Merger: The Wilmington Medical Center 1965-1985

Importance: This is the first reported case of acute exudative paraneoplastic polymorphous vitelliform maculopathy (AEPPVM) in a patient with thymoma, accompanied by myasthenia gravis (MG) and polymyositis. Objective: To examine the pathogenesis of ocular disease in a patient with yolk-like fundus lesions and thymoma, MG, and polymyositis throughout the body based on clinical manifestations, diagnosis, differential diagnosis, and genetic testing to determine the appropriate treatment course. Design, setting, and participants: We describe a 63-year-old woman who presented to our tertiary medical center with a 3-month history of reduced visual acuity in both eyes. Concurrent fundoscopy revealed a 2.0 × 1.7-mm, unifocal, yellow, round vitelliform lesion in the macular region, surrounded by multifocal, shallow, yellow-white pockets of subretinal fluid. The patient’s medical history included thymoma with thymectomy treatment, combined with pericardiectomy and postoperative radiotherapy (20 years prior), followed by a diagnosis of MG with suspect thymic association (15 years prior). Three years prior, the patient had been diagnosed with polymyositis related to paraneoplastic syndrome; 1 year prior, she had been examined for pleural thickening due to suspected metastatic tumor. Results: On her most recent follow-up visit at 3 months after initial diagnosis, the patient was stable with no clinically significant progression in ocular or systemic conditions.

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Sex, Race, Insurance, and Pain: Do Patient Sociodemographics Influence Postoperative Opioid Prescriptions Among Hand Surgeons?

Hand ◽

10.1177/1558944721998020 ◽

2021 ◽

pp. 155894472199802

Author(s):

Connor J. Peck ◽

Martin Carney ◽

Alexander Chiu ◽

Kitae E. Park ◽

Alexandre Prassinos ◽

...

Keyword(s):

Chronic Pain ◽

Medical Center ◽

Carpal Tunnel Release ◽

Private Insurance ◽

Academic Medical Center ◽

Age Groups ◽

Postoperative Pain Management ◽

Patient Treatment ◽

Opioid Prescription ◽

History Of

Background: Social and demographic factors may influence patient treatment by physicians. This study analyzes the influence of patient sociodemographics on prescription practices among hand surgeons. Methods: We performed a retrospective analysis of all hand surgeries (N = 5278) at a single academic medical center from January 2016 to September 2018. The average morphine milligram equivalent (MME) prescribed following each surgery was calculated and then classified by age, race, sex, type of insurance, and history of substance use or chronic pain. Multivariate linear regression was used to compare MME among groups. Results: Overall, patients with a history of substance abuse were prescribed 31.2 MME more than those without ( P < .0001), and patients with a history of chronic pain were prescribed 36.7 MME more than those without ( P < .0001). After adjusting for these variables and the type of procedure performed, women were prescribed 11.2 MME less than men ( P = .0048), and Hispanics were prescribed 16.6 MME more than whites ( P = .0091) overall. Both Hispanic and black patients were also prescribed more than whites following carpal tunnel release (+19.0 and + 20.0 MME, respectively; P < .001). Patients with private insurance were prescribed 24.5 MME more than those with Medicare ( P < .0001), but 25.0 MME less than those with Medicaid ( P < .0001). There were no differences across age groups. Conclusions: Numerous sociodemographic factors influenced postoperative opioid prescription among hand surgeons at our institution. These findings highlight the importance of establishing more uniform, evidence-based guidelines for postoperative pain management, which may help minimize subjectivity and prevent the overtreatment or undertreatment of pain in certain patient populations.

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Differences in transitions of care among cancer patients with and without venous thromboembolism (VTE) events.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18636 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18636-e18636

Author(s):

Cinduja Nathan

Keyword(s):

Venous Thromboembolism ◽

Patient Care ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Medical Center ◽

Survival Rates ◽

Transitions Of Care ◽

Office Visits ◽

Oncology Patient ◽

History Of

e18636 Background: Transitions of care are an important part of medical care, as they provide opportunities to address patient concerns, refine goals to match current needs and prevent unforeseen complications and comorbidities. One such common and prevalent comorbidity amongst cancer patients is venous thromboembolism (VTE) events. Common VTE events include the occurrence of pulmonary embolism (PE), deep vein thrombosis (DVT) or both at the time of diagnosis or any time thereafter. It is estimated that approximately 4–20% of cancer patients will experience a VTE. Cancer patients developing VTE is a serious concern as it can adversely affect the patients’ quality of life and reduce overall survival rates and prognosis. Methods: This study is designed as a case control study. The subject group consists of 87 cancer patients who had one or several VTE events after their cancer diagnosis. Patients were selected from the UVM Medical Center electronic health record database. The goal of this project was to quantify and compare the average number of transitions of care in cancer patients with and without venous thromboembolism (VTE) events. This was achieved by reviewing the patients charts three months following a VTE event and evaluating whether these patients had a greater number of transitions compared to the three months prior to their VTE event. Transitions of care in our study were defined as office visits, ED visits, and inpatient admissions related to their VTE. Results: Initial evaluation of the results showed that there were more transitions of care amongst cancer patients with a VTE than without. Preliminary data of the 87 patients shows that patients who developed a VTE event after their cancer diagnosis had on average 1.3 more transitions of care within the three months following their VTE event compared to cancer patients without a VTE event. A t test will be used to determine whether the difference between the means (number of transitions of care) of the two groups (cancer patients with VTE and those without VTE) is significant. Conclusions: The implications of having greater transitions of care amongst cancer patients with VTE events are profound. Having more transitions of care exemplifies better implementation, patient care and involvement of health care teams given a history of VTE. Furthermore, the results of this study will provide further insight on ways to improve clinical outcomes and oncology patient care given a history of VTE.

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Paroxysmal Stabbing Headache in The Multiple Dermatomes of The Head and Neck: A Variant of Primary Stabbing Headache or Occipital Neuralgia?

Cephalalgia ◽

10.1111/j.1468-2982.2007.01395.x ◽

2007 ◽

Vol 27 (10) ◽

pp. 1101-1108 ◽

Cited By ~ 10

Author(s):

JH Shin ◽

HK Song ◽

JH Lee ◽

WK Kim ◽

MK Chu

Keyword(s):

Medical Center ◽

Previous History ◽

Headache Disorder ◽

Acute Onset ◽

Occipital Neuralgia ◽

Cervical Nerve ◽

Primary Stabbing Headache ◽

History Of ◽

Stabbing Headache

A paroxysmal stabbing or icepick-like headache in the multiple nerve dermatomes, especially involving both trigeminal and cervical nerves, has not been fully explained or classified by the International Classification of Headache Disorder, 2nd Edition (ICHD-II). Of patients with acute-onset paroxysmal stabbing headache who had visited the Hallym University Medical Center during the last four years, 28 subjects with a repeated stabbing headache involving multiple dermatomes at the initial presentation or during the course were prospectively enrolled. All patients were neurologically and otologically symptom free. A coincidental involvement of both trigeminal and cervical nerve dermatomes included seven cases. Six cases involved initially the trigeminal and then cervical nerve dermatomes. Five cases showed an involvement of the cervical and then trigeminal nerve dermatomes. The remaining patients involved multiple cervical nerve branches (the lesser occipital, greater occipital and greater auricular). Pain lasted very shortly and a previous history of headache with the same nature was reported in 13 cases. Preceding symptom of an infection and physical and/or mental stress were manifested in seven and six subjects, respectively. All patients showed a self-limited benign course and completely recovered within a few hours to 30 days. Interestingly, a seasonal gradient in occurrence of a stabbing headache was found in this study. A paroxysmal stabbing headache manifested on multiple dermatomes can be explained by the characteristics of pain referral, and may be considered to be a variant of primary stabbing headache or occipital neuralgia.

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EPIDEMIOLOGICAL STUDY OF PERIORBITAL HYPERMELANOSIS

10.36106/ijsr/3523105 ◽

2020 ◽

pp. 1-4

Author(s):

Sonal Khade Ahuja ◽

Ashish Deshmukh ◽

Sanmitra Aiholli ◽

Omkar Kulkarni

Keyword(s):

Quantitative Assessment ◽

Medical Center ◽

Sun Exposure ◽

Age Group ◽

Single Patient ◽

Psychosocial Consequences ◽

History Of ◽

Grade 3 ◽

Almost All ◽

Sleeping Habits

Background: Periorbital hypermelanosis also called dark circles form the major percentage of dermatology consultations. Importance of these disorders is growing as they cause easy visible cosmetic disfigurement and significant psychosocial consequences. Aims: To assess the patients of POH disorders for demographic, etiological and clinical profile. Methods: This prospective hospital-based clinical study, conducted in a tertiary medical center over a period of two years, involved 200 patients with POH disorders, assessed using detailed history taking and clinical examination for demographic, etiological and clinical data. Data is statistically described in frequencies (number of cases) and percentages(%) . Results: Majority of patients were in age group 18-40 years. Females dominated the study with a number of 169 (84.5%) , only 31 (15.5%) were males. Most of the patients belonged to Grade 2 (53%), grade 3 was seen in 27% patients followed by grade 1 (16.5% ) and grade 4 (3.5% ) POH. Family history was positive in 81.5% patients. POH was observed mostly in housewives 93 (46.5%) and patients with indoor occupation 69 (34.5%) and less commonly in patients with outdoor occupation 29 (14.5%). Almost all cases of POH gave history of exacerbation following sun exposure. Not a single patient showed hepatic, renal complaints, hypothyroidism or ecchymosis. Majority of patients (86.5%) had altered Sleeping habits. Alcohol and smoking did not have a significant co-relation with POH. It was found that only five percent females on oral contraceptives developed POH and there was no change in Pigmentation of POH in relation to menstrual cycle in any of the females. Limitations: The quantitative assessment of melanin by specialized instrument ( mexameter) could not be done because of lack of resources.

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P525 Patients’ Perception of Risks of biologic therapy During Covid-19 Pandemic in Israel Orly Lior, Ilia Sergeev, Nahum Ruhimovich, Michal Openheim, Fabiana Benjaminov, Dan Feldman, Yehuda Ringel, Timna Naftali Division of Gastroenterology and Liver Diseases, Meir Medical Center, Kfar Saba, Israel

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.647 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S501-S501

Author(s):

O Lior ◽

I Sergeev ◽

N Ruhimovich ◽

M Openheim ◽

F Benjaminov ◽

...

Keyword(s):

Medical Center ◽

Severe Disease ◽

Treatment Decision ◽

Mild Disease ◽

Treatment Decision Making ◽

Increased Risk ◽

Increase Risk ◽

History Of ◽

Stopping Treatment ◽

Theoretical Question

Abstract Background Current inflammatory bowel disease (IBD) therapies are highly effective. However, compliance with treatment is influenced by patients’ perception of benefits versus risks. Understanding these perceptions and their influence on patients’ treatment decision-making is crucial for achieving compliance, especially during Covid-19 pandemic. Aim: to assess patients’ perception of risks of IBD exacerbation and SARS-CoV-2 infection, and their influence on patients’ decisions regarding biologic and immunosuppressive treatments during Covid-19 pandemic in Israel. Methods A prospective internet-based survey among Meir Medical Center, IBD clinic patients. Results 116 patients have responded. Mean age 42 (18–84), 44 (38%) males, 75 (64%) Crohn’s disease, 38 (32%) ulcerative colitis, 34 (29%) with history of abdominal surgery, 47 (40%) were in remission and 9(7.5%) with severe disease. 18 (15%) patients were on Immunosuppressive and 76 (66%) on biologic treatments. Concerns of contracting SARS-CoV-2 infection: 56 (48%) patients considered their risk as equal to that of the general population whereas 53 (46%) considered it to be increased. 55% of the patients related the increase risk of COVID-19 infection to their IBD treatment, whereas 47% related it to having IBD. Patients treated with biologics were more concerned of becoming infected with SARS-CoV-2 then those who were not. There was also a significant association between depression and anxiety levels and the fear of becoming infected (r= 0.3 for depression and 0.4 for anxiety). Adherence to IBD treatment: Only 8 (7.5%) patients considered stopping their IBD treatment, and only 4 (3.7%) patients actually stopped their treatment. Patients with more severe disease were more inclined to stop their treatment compared to those with mild disease. Reasons for not stopping treatment were fear of disease exacerbation in 37 (32%) patients, and reassuring information received from medical providers, in 25 (21.5%) patients. When faced with a theoretical question of trading long-term remission versus risk of SARS-CoV-2infection, 34 (29%) patients were willing to accept a 10% infection risk for a 10-year remission Conclusion Significant portion of the patients with IBD believe that they are at increased risk of contracting SARS-CoV-2 infection, and more than half of them related the increase risk to their IBD treatment. However, despite their fear most patients felt safe enough to continue their treatment. Patients with more severe disease and treated with biologics experienced higher levels of anxiety, depression and fear of COVID-19 infection. Identifying and addressing these fears early might increase patient’s adherence to treatment and prevent the hazardous effects of discontinuation of treatment.

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CHRONIC ANAL FISSURE

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.04.2576 ◽

2011 ◽

Vol 18 (04) ◽

pp. 562-565

Author(s):

ABID HUSSAIN ◽

KISHWAR NAHEED

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Medical Center ◽

Anal Verge ◽

Symptomatic Relief ◽

First Line ◽

Detailed History ◽

History Of ◽

First Line Treatment

Objective: To determine the role of chemical syphincterotomy as non surgical management of chronic anal fissure. Study Design: Descriptive. Setting: This study was conducted at Margalla teaching Hospital and United Medical center .Rawalpndi. Period: 1½ years. Patients & Methods: This study included 70 patients of either sex. A personal bio data and detailed history of dietary and bowel habits were registered. Topical 0.2% GTN (Gylciryltrinitrate) was applied to anal verge 2 times per day for the period of two months and its effects were noted. Result: 58 patients (83%) got symptomatic relief and 12 patients (17%) did not get improvement. Conclusions: Chemical syphincterotomy heals majority of the fissure . Topical 0.2% GNT ointment is widely used as a first line treatment in U.K . It is generally accepted as an effective treatment for chronic fissure .

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High incidence of asymptomatic SARS-CoV-2 infection, Chongqing, China

10.1101/2020.03.16.20037259 ◽

2020 ◽

Cited By ~ 4

Author(s):

Yang Tao ◽

Panke Cheng ◽

Wen Chen ◽

Peng Wan ◽

Yaokai Chen ◽

...

Keyword(s):

Asymptomatic Patient ◽

Medical Center ◽

Age Groups ◽

The Elderly ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Asymptomatic Patients ◽

Imported Cases ◽

History Of ◽

Epidemiological Characteristics

SummaryBackgroundSARS-CoV-2 has been a global pandemic, but the emergence of asymptomatic patients has caused difficulties in the prevention of the epidemic. Therefore, it is significant to understand the epidemiological characteristics of asymptomatic patients with SARS-CoV-2 infection.MethodsIn this single-center, retrospective and observational study, we collected data from 167 patients with SARS-CoV-2 infection treated in Chongqing Public Health Medical Center (Chongqing, China) from January to March 2020. The epidemiological characteristics and variable of these patients were collected and analyzed.Findings82.04% of the SARS-CoV-2 infected patients had a travel history in Wuhan or a history of contact with returnees from Wuhan, showing typical characteristics of imported cases, and the proportion of severe Covid-19 patients was 13.2%, of which 59% were imported from Wuhan. For the patients who was returnees from Wuhan, 18.1% was asymptomatic patients. In different infection periods, compared with the proportion after 1/31/2020, the proportion of asymptomatic patient among SARS-CoV-2 infected patient was higher(19% VS 1.5%). In different age groups, the proportion of asymptomatic patient was the highest(28.6%) in children group under 14, next in elder group over 70 (27.3%). Compared with mild and common Covid-19 patients, the mean latency of asymptomatic was longer (11.25 days VS 8.86 days), but the hospital length of stay was shorter (14.3 days VS 16.96 days).ConclusionThe SARS-CoV-2 prevention needs to focus on the screening of asymptomatic patients in the community with a history of contact with the imported population, especially for children and the elderly population.

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Historical perspective of neurology in Iran

Iranian Journal of Neurology ◽

10.18502/ijnl.v18i1.943 ◽

2019 ◽

Author(s):

Shri Kant-Mishra ◽

Hadi Mohammad Khanli ◽

Golnoush Akhlaghipour ◽

Ghazaleh Ahmadi Jazi ◽

Shaweta Khosa1

Keyword(s):

Historical Perspective ◽

Medical Center ◽

Medical Science ◽

Early Period ◽

Medieval Period ◽

Neurologic Diseases ◽

The Past ◽

Modern Period ◽

History Of ◽

Modern Era

Iran is an ancient country, known as the cradle of civilization. The history of medicine in Iran goes back to the existence of a human in this country, divided into three periods: pre-Islamic, medieval, and modern period. There are records of different neurologic terms from the early period, while Zoroastrian (religious) prescription was mainly used until the foundation of the first medical center (Gondishapur). In the medieval period, with the conquest of Islam, prominent scientists were taught in Baghdad, like Avicenna, who referred to different neurologic diseases including stroke, paralysis, tremor, and meningitis. Several outstanding scientists developed the medical science of neurology in Iran, the work of whom has been used by other countries in the past and present. In the modern era, the Iranian Neurological Association was established with the efforts of Professor Jalal Barimani in 1991.

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Case-control Analysis ofClostridium difficile—Associated Diarrhea on a Gynecologic Oncology Service

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/s1064744994000578 ◽

1994 ◽

Vol 2 (4) ◽

pp. 154-161 ◽

Cited By ~ 2

Author(s):

Steven E. Waggoner ◽

James Barter ◽

Gregorio Delgado ◽

Willard Barnes

Keyword(s):

Kansas City ◽

Medical Center ◽

Gynecologic Oncology ◽

Case Control ◽

Latex Agglutination ◽

Control Analysis ◽

Oncology Patients ◽

Ofclostridium Difficile ◽

History Of ◽

Case Control Analysis

Objective:The incidence, morbidity, and risk factors associated withClostridium difficile-associated diarrhea (CDAD) were studied in a group of gynecologic oncology patients.Methods:A case-control analysis of gynecologic oncology patients with CDAD was carried out from August 1986 through January 1989 in a university medical center.Results:One hundred twenty-three stool samples were tested forC. difficileusing the CDT latex agglutination test (Marion Diagnostics, Kansas City, MO). Thirty episodes of CDAD developed in 23 patients. From August 1986 through July 1988, the incidence was stable at 1.5 episodes/100 admissions. From August 1988 through January 1989, the incidence increased to 9.9 episodes/100 admissions (P= 0.005). Compared with patients with nonspecific antibiotic-associated diarrhea, the study patients were hospitalized longer prior to the development of symptoms (mean 15.2 vs. 9.2 days,P= 0.006) and were admitted more frequently with diarrhea (37% vs. 11%,P= 0.015). The rates of surgery, chemotherapy, and radiation therapy were similar. Fever (57% vs. 14%,P< 0.001), abdominal pain (40% vs. 6%,P< 0.001), bloody stools (27% vs. 3%,P= 0.006), and leukocytosis (64% vs. 26%,P= 0.011) were more common among the study cases. The duration, indication, and number of antibiotics administered were similar, though once started, the mean time to symptoms was longer in the study cases (13.7 vs. 6.1 days,P= 0.004). Seven relapses, 1 death, and 1 unplanned colostomy occurred among women with CDAD.Conclusions: C. difficileis a serious cause of nosocomial morbidity in gynecologic oncology patients. Diarrhea developing after antibiotic exposure is more likely to be associated withC. difficilein patients whose symptoms develop several days after completing antibiotics and in patients with a history of CDAD.

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