Coronavirus Disease 2019 (COVID-19) Admission Screening at a Tertiary-Care Center, Iowa 2020

Background: Hospitalized patients may unknowingly carry severe acute respiratory coronavirus virus 2 (SARS-CoV-2), even if they are admitted for other reasons. Because SARS-CoV-2 may remain positive by reverse-transcriptase polymerase chain reaction (RT-PCR) for months after infection, patients with a positive result may not necessarily be infectious. We aimed to determine the frequency of SARS-CoV-2 infections in patients admitted for reasons unrelated to coronavirus disease 2019 (COVID-19). Methods: The University of Iowa Hospitals and Clinics is an 811-bed tertiary-care center. We use a nasopharyngeal SARS-CoV-2 RT-PCR to screen admitted patients without signs or symptoms compatible with COVID-19. Patients with positive tests undergo a repeat test to assess cycle threshold (Ct) value kinetics. We reviewed records for patients with positive RT-PCR screening admitted during July–October 2020. We used a combination of history, serologies, and RT-PCR Ct values to assess and qualify likelihood of infectiousness: (1) likely infectious, if Ct values were <29, or (2) likely not infectious, if 1 or both samples had Cts <30 with or without a positive SARS-CoV-2 antinucleocapsid IgG/IgM test or history of a positive result in the past 90 days. Contact tracing was only conducted for patients likely to be infectious. We describe the isolation duration and contact tracing data. Results: In total, 6,447 patients were tested on hospital admission for any reason (persons under investigation or admitted for reasons other than COVID-19). Of these, 240 (4%) had positive results, but 65 (27%) of these were admitted for reasons other than COVID-19. In total, 55 patients had Ct values available and were included in this analysis. The median age was 56 years (range, 0–91), 28 (51%) were male, and 12 (5%) were children. The most frequent admission syndromes were neurological (36%), gastrointestinal (16%), and trauma (16%). Our assessment revealed 23 likely infections (42%; 14 definite, 9 possible) and 32 cases likely not infectious (58%). The mean Ct for patients who were likely infectious was 22; it was 34 for patients who were likely not infectious. Mean duration of in-hospital isolation was 6 days for those who were likely infectious and 2 days for those who were likely not infectious. We detected 8 individuals (1 healthcare worker and 7 patients) who were exposed to a likely infectious patient. Conclusions: SARS-CoV-2 infection in patients hospitalized for other reasons was infrequent. An assessment of the likelihood of infectiousness including history, RT-PCR Cts, and serology may help prioritize patients in need of isolation and contact investigations.Funding: NoDisclosures: None

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ANALYSIS AND INTERPRETATION OF SPIROMETRY OF PATIENTS ATTENDING RESPIRATORY MEDICINE OPD IN A TERTIARY CARE CENTER: A RETROSPECTIVE STUDY

10.36106/ijsr/0507201 ◽

2021 ◽

pp. 39-41

Author(s):

Vidhi Jobanputra ◽

Hafiz Deshmukh ◽

Ashish Deshmukh ◽

Sunil Jadhav ◽

Shivprasad Kasat ◽

...

Keyword(s):

Retrospective Study ◽

Bronchial Asthma ◽

Lung Diseases ◽

Care Center ◽

Tertiary Care ◽

Respiratory Medicine ◽

Smoking History ◽

Tertiary Care Center ◽

Operative Evaluation ◽

History Of

OBJECTIVE: To study the various spirometry ndings and look for its association with smoking history and use of biomass fuels. METHODS: Spirometry ndings of 375 patients who attend Respiratory medicine OPD from year 2017- 2019 were studied. RESULTS: Out of 375 patients, 95 patients were diagnosed as COPD, 62 as bronchial asthma, 149 had normal spirometry and 69 had restriction. CONCLUSION: In this study we concluded that spirometry plays an intergral role in the diagnosis of bronchial asthma, COPD and restrictive lung diseases. It gives an overview of the decline of lung function with increasing age, smokers, occupational lung exposures, family history of bronchial asthma. Restrictive patterns were most commonly seen in patients who came for pre operative evaluation.

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COVID-19 Conversion after Exposure in a Semiprivate Room at a Tertiary Care Center in Iowa, July–December 2020

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.37 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s20-s21

Author(s):

Alexandra Trannel ◽

Takaaki Kobayashi ◽

Oluchi Abosi ◽

Kyle Jenn ◽

Holly Meacham ◽

...

Keyword(s):

Exposure Time ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

University Of Iowa ◽

Subsequent Conversion ◽

Risk Of Exposure ◽

Polymerase Chain ◽

The University

Background: Hospital semiprivate rooms may lead to coronavirus disease 2019 (COVID-19) patient exposures. We investigated the risk of COVID-19 patient-to-patient exposure in semiprivate rooms and the subsequent risk of acquiring COVID-19. Methods: The University of Iowa Hospitals & Clinics is an 811-bed tertiary care center. Overall, 16% of patient days are spent in semiprivate rooms. Most patients do not wear masks while in semiprivate rooms. Active COVID-19 surveillance included admission and every 5 days nasopharyngeal SARS-CoV-2 polymerase chain reaction (PCR) testing. We identified inpatients with COVID-19 who were in semiprivate rooms during their infectious periods during July–December 2020. Testing was repeated 24 hours after the first positive test. Cycle threshold (Ct) values of the two tests (average Ct <30), SARS-CoV-2 serology results, clinical assessment, and COVID-19 history were used to determine patient infectiousness. Roommates were considered exposed if in the same semiprivate room with an infectious patient. Exposed patients were notified, quarantined (private room), and follow-up testing was arranged (median seven days). Conversion was defined as having a negative test followed by a subsequent positive within 14 days after exposure. We calculated the risk of exposure: number of infectious patients in semiprivate rooms/number of semiprivate patient-days (hospitalization days in semiprivate rooms). Results: There were 16,427 semiprivate patient days during July–December 2020. We identified 43 COVID-19 inpatients who roommates during their infectious periods. Most infectious patients (77%) were male; the median age was 67 years; and 22 (51%) were symptomatic. Most were detected during active surveillance: admission testing (51%) and serial testing (28%). There were 57 exposed roommates. The risk of exposure was 3 of 1,000 semiprivate patient days. In total, 16 roommates (28%) did not complete follow-up testing. Of 41 exposed patients with follow-up data, 8 (20%) converted following their exposure. Median time to conversion was 5 days. The risk of exposure and subsequent conversion was 0.7 of 1,000 semiprivate patient days. Median Ct value of the source patient was 20 for those who converted and 23 for those who did not convert. Median exposure time was 45 hours (range, 3–73) for those who converted and 12 hours (range, 1–75) for those who did not convert. Conclusions: The overall risk of exposure in semiprivate rooms was low. The conversion rate was comparable to that reported for household exposures. Lower Ct values and lengthier exposures may be associated with conversion. Active COVID-19 surveillance helps early detection and decreases exposure time.Funding: NoDisclosures: None

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Self-reported natural history of recurrent prolapse among women presenting to a tertiary care center

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2012.07.024 ◽

2012 ◽

Vol 120 (1) ◽

pp. 53-56 ◽

Cited By ~ 7

Author(s):

Payton Johnson ◽

Kindra A. Larson ◽

Yvonne Hsu ◽

Dee E. Fenner ◽

Daniel Morgan ◽

...

Keyword(s):

Natural History ◽

Care Center ◽

Tertiary Care ◽

Recurrent Prolapse ◽

Tertiary Care Center ◽

History Of

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Incidence and natural history of intravenous immunoglobulin-induced aseptic meningitis: a retrospective review at a single tertiary care center

Transfusion ◽

10.1111/trf.13200 ◽

2015 ◽

Vol 55 (11) ◽

pp. 2597-2605 ◽

Cited By ~ 21

Author(s):

Vighnesh Bharath ◽

Kathleen Eckert ◽

Matthew Kang ◽

Ian H. Chin-Yee ◽

Cyrus C. Hsia

Keyword(s):

Natural History ◽

Intravenous Immunoglobulin ◽

Aseptic Meningitis ◽

Retrospective Review ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

History Of

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Spike in Rhino-Orbital-Cerebral Mucormycosis Cases Presenting to a Tertiary Care Center During the COVID-19 Pandemic

Frontiers in Medicine ◽

10.3389/fmed.2021.645270 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yousef A. Fouad ◽

Tougan Taha Abdelaziz ◽

Anas Askoura ◽

Mohamed Ibrahim Saleh ◽

Mohammad S. Mahmoud ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Test Results ◽

Rt Pcr ◽

Reverse Transcription Pcr ◽

Microbiological Criteria ◽

Criteria For Diagnosis ◽

Test Result ◽

Orbital Invasion

Objective: To determine if there was an increase in the rate of cases presenting with rhino-orbital-cerebral mucormycosis (ROCM) to a tertiary care center during the first wave of the coronavirus disease 2019 (COVID-19) pandemic and the characteristics of the presenting cases.Methods: Retrospective observational study reviewing ROCM cases presenting from March 25 until September 25, 2020. Cases fulfilling the clinical, radiological, and pathological/microbiological criteria for diagnosis with ROCM were included. The number of cases presenting during the designated interval, their COVID-19 status, comorbidities, and clinical presentation were analyzed. The number of cases during the corresponding interval in the previous 3 years was used as reference to detect if there was a recent spike.Results: Of the 12 ROCM cases identified, 5 had a concurrent positive reverse transcription PCR (RT-PCR) test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 1 had a prior positive result, and 6 did not have concurrent nor prior positive test results. Nine of the 12 cases had poorly controlled diabetes mellitus, and 2 cases had a hematological malignancy. All cases had orbital invasion, and eight cases had cerebral invasion. The number of cases identified during the interval is much higher than the numbers presenting in the prior 3 years during equivalent intervals (range, one to two cases) than those reported in the literature in different settings in the pre-pandemic era.Conclusions: There is an increased rate of ROCM cases presenting to our center during the first wave of the COVID-19 pandemic. This is a preliminary report, and further studies are needed to corroborate the findings and explain possible underlying links.

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Case report on fatal human rabies infection in central India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20215016 ◽

2021 ◽

Vol 9 (1) ◽

pp. 324

Author(s):

Pratik Kumar ◽

Vijay Domple ◽

Gautam Khakse

Keyword(s):

Public Awareness ◽

Care Center ◽

Tertiary Care ◽

Clinical Signs ◽

Human Rabies ◽

Tertiary Care Center ◽

Unusual Behavior ◽

Probable Case ◽

Health Care Center ◽

History Of

Rabies is a zoonotic disease that affects the central nervous system of mammals and has a high mortality rate. It is a viral disease that can be prevented by vaccination. Dogs are the leading cause of human rabies deaths, accounting for up to 99% of all human rabies transmissions. On 15th December 2019 an 8 years old male child was bitten by a stray dog outside of his house. The patient visited with his parents to a nearby primary health care center on same day where his wound was washed with water. He received first dose of anti-rabies vaccine and was referred to a tertiary care center for immunoglobulin because of a history of wound bleeding. They did not visit tertiary care center for immunoglobulin as advised. 15 days after exposure on 1st January 2021 the patient presented with unusual behavior like fear of water and tremor. On examination his pupils were found dilated and he was referred to isolation ward of tertiary care center. Based on the history of animal bites and clinical signs, the patient was diagnosed as probable case of rabies. The patient eventually died within 24 hours of admission. Such kind of incident shows that there is lack of awareness regarding rabies in community. In this case, if the patient had completed the anti-rabies vaccination schedule and visited a higher centre on time for immunoglobulin, death could have been avoided. Mortality due to rabies can be prevented by raising public awareness about immunization.

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Clinical Spectrum of COVID-19 in a Pediatric Mexican Population

10.21203/rs.3.rs-81586/v3 ◽

2020 ◽

Author(s):

Edgar Bustos-Cordova ◽

Daniela Castillo-García ◽

Magdalena Cerón-Rodriguez ◽

Nadia Soler-Quiñones

Keyword(s):

Emergency Department ◽

Pediatric Patients ◽

Care Center ◽

Tertiary Care ◽

Signs And Symptoms ◽

Clinical Spectrum ◽

Tertiary Care Center ◽

Rt Pcr ◽

Excessive Crying ◽

Pcr Test

Abstract ObjectiveFrom the beginning of the COVID-19 pandemic, it has become evident that the spectrum of manifestations in children is different from those seen in adults. In this study, we aimed to describe a broader clinical spectrum of COVID-19 in children.MethodsIn this descriptive, prospective study, we included confirmed pediatric patients with COVID-19 who presented to the emergency department of a pediatric tertiary care center from April to July 2020. All patients were confirmed by the SARS-CoV-2 RT-PCR test, and we analyzed 24 symptoms and 25 signs.ResultsWe analyzed 50 patients with COVID-19. From the evaluated signs and symptoms, the most common symptoms were fever, excessive crying and dry cough, digestive symptoms were frequently found (24%), and the most common signs were pharyngeal erythema and irritability.ConclusionClinicians should recognize that the clinical spectrum of COVID-19 in children is wider than previously described, often with nonspecific signs and symptoms, and digestive symptoms should raise suspicion.

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Prevalence of pre-gestational diabetes among the antenatal women attending a tertiary care center

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170466 ◽

2017 ◽

Vol 6 (3) ◽

pp. 797 ◽

Cited By ~ 1

Author(s):

Renji S. R. ◽

Sujatha Thankappan Lekshmi ◽

Nirmala Chellamma

Keyword(s):

Gestational Diabetes ◽

Pregnant Women ◽

Statistical Tests ◽

Care Center ◽

Tertiary Care ◽

First Trimester ◽

Adverse Outcomes ◽

Tertiary Care Center ◽

Family History Of Diabetes ◽

History Of

Background: Number of pregnant women with preexisting diabetes is increasing. Hence the detection and management of diabetes from the beginning of pregnancy itself will help to improve the fetal and maternal outcome. Aim of the study was to determine the prevalence of pre-gestational diabetes among the antenatal women attending a tertiary care center and to study the associated factors.Methods: This was a cross sectional study conducted in SAT hospital, Government Medical College, Trivandrum, Kerala, India for one year. HbA1C was the test used to diagnose diabetes. 400 women attending the OP in their first trimester were selected after informed consent. Socio demographic factors assessed by a structured questionnaire. Blood samples were taken for HbA1C. Diagnosis of diabetes was made at levels of HbA1C ≥6.5%. Statistical tests used were mean, standard deviation, chi-square and odds ratio.Results: Prevalence of pre-gestational diabetes was 3.8%.in our study. Main associations were age more than 25 years, body mass index, family history of diabetes, history of intra uterine death, gestational diabetes in previous pregnancy, candidiasis and thyroid disease.Conclusions: Screening of all pregnant women in first trimester itself for diabetes will help in early detection of pre-gestational diabetes, so that anticipation of adverse outcomes and proper management can be done in such cases.

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Epidemiological and clinical profile of various plant poisons in a tertiary care center in South Tamilnadu, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20193939 ◽

2019 ◽

Vol 7 (9) ◽

pp. 3517

Author(s):

Meena Kumari ◽

Pattu Swarna Latha ◽

Kalyanasundaram .

Keyword(s):

Care Center ◽

Tertiary Care ◽

Clinical Manifestations ◽

Tertiary Care Center ◽

Active Components ◽

Medical College ◽

Suicidal Intention ◽

History Of ◽

Plant Constituents ◽

Plant Poisoning

Background: Plant poisoning is a common scenario in a toxicology unit . Some of the plants contain active components used as medicines. However, some of the plant constituents are poisonous with wide variety of clinical manifestations. Authors aimed to study the pattern of various types of plant poisons and clinical presentations and complications of various plant poisons admitted in our toxicological unit.Methods: A total of 87 patients admitted with history of plant poison ingestion, in toxicological unit of Tirunelveli medical college were studied . It was a retrospective observational study and was done over a period of one year.Results: Out of 87 cases studied, 92%were due to consumption with suicidal intention. Plant poisoning ranks second only to pesticide poisoning . among the plant poisons encountered 66.6% were due to Oleander poison, followed by Datura (8%) and Glory lily(5.7%). Common parts of plant consumed by patients include seeds and plant oils . Vomiting and abdominal pain were the commonest presentations. Encephalopathy, dyselectrolytemia and arrhythmias were the notable complications in our study.Conclusions: Early admission and prompt first aid and monitoring at tertiary care center are key to the reduced mortality. The study throws light on various manifestations, toxic parts and complications of plant poisons.

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