scholarly journals Secondary Abnormal CSF Neurotransmitter Metabolite Profiles in a Pediatric Tertiary Care Centre

2017 ◽  
Vol 45 (2) ◽  
pp. 206-213 ◽  
Author(s):  
Clara D.M. van Karnebeek ◽  
Mary Dunbar ◽  
Csilla Egri ◽  
Bryan Sayson ◽  
Janetta Milea ◽  
...  
Keyword(s):  
Movement Disorders ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Epileptic Encephalopathy ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
Chi Square ◽  
Number Of Patients ◽  
Patients With Epilepsy

AbstractBackground:Secondary neurotransmitter deficiencies have been reported in several reviews. Our primary aim was to assess the relationship among epilepsy, antiseizure medications, and specific neurotransmitter abnormalities. We also evaluated movement disorders and brain abnormalities via magnetic resonance imaging scans in patients with secondary neurotransmitter defects.Methods:This is a retrospective case series of 376 patients who underwent neurotransmitter analysis at BC Children’s Hospital between 2009 and 2013, for a variety of neurological presentations. The biochemical genetics laboratory database was interrogated for results of cerebrospinal fluid neurotransmitter analyses. Clinical data for patients with abnormal results were collected from the hospital charts. Statistical analysis included one-way analysis of variance, chi-square, and a two-way contingency table.Results:Abnormal neurotransmitter values were identified in 67 (17.8%) patients, two (0.53%) of which were attributable to a congenital neurotransmitter disorder and 11 (16.9%) secondary to other genetic diagnoses. Of 64 patients with secondary abnormal neurotransmitter values, 38 (59%) presented with epilepsy and 20 (31%) with movement disorders. A combination of epilepsy and movement disorder was less frequent.Discussion:Acknowledging the limitations of this retrospective chart review, we conclude that, in our cohort, in addition to patients with movement disorders, a considerable number of patients with epilepsy and epileptic encephalopathy also showed secondary neurotransmitter mono-amine abnormalities. There is no clear relation, however, between clinical phenotype and type of neurotransmitter affected. In addition, no association was identified between the type of antiseizure medications and affected neurotransmitter type. We outline the need for prospective studies to further enrich our understanding of the relation between epilepsy and neurotransmitters with a focus on improving treatments and patient outcomes.

scholarly journals Peripartum hysterectomy: a five year review at a tertiary care centre

2017 ◽  
Vol 6 (8) ◽  
pp. 3590
Author(s):  
Deepak A. V. ◽  
K. J. Jacob ◽  
Sumi P. Maria
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Case Fatality ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
College Hospital ◽  
Peripartum Hysterectomy ◽  
Medical College ◽  
Obstetric Haemorrhage ◽  
Suboptimal Care

Background: Peripartum hysterectomy is a life-saving procedure resorted to when conservative measures fail to control obstetric haemorrhage. Several predisposing factors, suboptimal care and lack of infrastructure may lead to this emergency procedure. We wanted to find out factors associated with peripartum hysterectomy and the adverse maternal outcomes at our centre.Methods: A retrospective case series analysis of 40 cases of peripartum hysterectomy performed over a period of 5 years from January 2010 to December 2014 at Government Medical College Hospital, Thrissur, Kerala was done.Results: The incidence of peripartum hysterectomy was 0.29%. The most common indication for peripartum hysterectomy was hysterectomy was uterine atony (50%). Thirty-five women (88%) were between 20 and 35 years. Most of the subjects were unbooked. There were two maternal deaths (case fatality rate of 5%) following peripartum hysterectomy during this period. All the subjects required blood transfusion.Conclusions: Prompt performance hysterectomy before the patient’s clinical condition deteriorates is the key to success. The incidence of adherent placenta is increasing, so every effort should be taken to reduce the caesarean section rates globally. 

Management and Outcomes of Interstitial Ectopic Pregnancies at a Tertiary Care Centre: a Retrospective Case Series

2018 ◽  
Vol 40 (6) ◽  
pp. 852
Author(s):  
Angel Shan ◽  
Mary Ellen Conway ◽  
Lindsay Machan ◽  
Laura Cormack ◽  
Nadia Branco ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Ectopic Pregnancies

Concurrent surgeries in ENT: a cost-effective and safe approach in patients requiring multiple definitive procedures

2004 ◽  
Vol 118 (1) ◽  
pp. 31-33 ◽  
Author(s):  
Achamma Balraj ◽  
Mary Kurien ◽  
Anand Job
Keyword(s):  
Surgical Procedures ◽  
Tertiary Care ◽  
Case Series ◽  
Cost Effective ◽  
Definitive Treatment ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
Average Hospital ◽  
Duration Of Surgery

Treatment of the predisposing factors that are identified in the nose and throat in several ENT diseases is mandatory prior to the definitive management of the latter. When surgical management is indicated it has been traditional to use staged procedures. This study was undertaken to assess the role of concurrent surgical procedures in ENT and evaluate their cost-effectiveness compared to similar staged procedures. This was a retrospective case series of 100 consecutive patients undergoing concurrent and similar staged ENT surgical procedures. On analysis, it was noted that the average duration of surgery, anaesthesia and hospital stay was significantly less in the concurrent procedures group than in the staged procedures (2.35/3.1.hours; 3.05/3.30.hours and 2.5/6.5 days, respectively). The average hospital bill for the concurrent procedures was also lower than for the staged procedures. Hence, in patients requiring multiple ENT surgical procedures for definitive treatment, concurrent procedures are more cost-effective than staged procedures and should be considered the treatment of choice in a tertiary care centre.

scholarly journals Neurocysticercosis – A Window to Intraocular Involvement

2016 ◽  
Vol 7 (2) ◽  
pp. 135-141
Author(s):  
BN Kalpana ◽  
HR Samhitha ◽  
Kailash P Chhabria ◽  
Sonali Muralidhar ◽  
Kirti Raj
Keyword(s):  
Retinal Detachment ◽  
South India ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Case Series ◽  
Positive Association ◽  
Care Hospital ◽  
Retrospective Case ◽  
Tractional Retinal Detachment ◽  
Number Of Patients

Objective : To analyse the clinical characteristics of intraocular cysticercosis and the association of neurocysticercosis with intraocular involvement in these patientsMaterials and methods: Retrospective case series of records of patients managed at a Tertiary Care Hospital in South India. Case records of patients managed at a Tertiary Care Hospital in South India over two years (October 2012 – October 2014) were reviewed and cases reported with intraocular cysticercosis were included in the study and results analyzed.Results: Five (5) patients of intraocular cysticercosis were diagnosed in a two year period at our centre, 60% being bilateral. Eight (8) eyes of five (5) patients had intraocular cysts documented by clinical examination and B mode ultrasonography (75% eyes with active cysts, 25% eyes inactive) .Visual acuity at presentation of eyes with active cysts ranged from perception of light to counting finger 4m. The 75% eyes had tractional retinal detachment at presentation. Neurocysticercosis was documented in 80% of the cases oncomputed tomography / magnetic resonance imaging . Six (6) eyes with active cysts underwent parsplanavitrectomy with cyst removal using vitreous cutter with concurrent management of tractional retinal detachment in five (5) eyes. Postoperative visual recovery was poor in eyes with associated tractional retinal detachment while good anatomical outcome was achieved in all six (6) cases.Conclusion: Intraocular cysticercosis can be associated with cysts in other areas. High number of patients with neurocysticercosis (80%) in those with intraocular cysticercosis in our study may indicate positive association between the two which needs further investigation.

Local incidence of Jarisch–Herxheimer reaction in pregnancy following penicillin treatment for syphilis: A case series

2021 ◽  
pp. e20210001
Author(s):  
Amreet Dhaliwal ◽  
Alison A Lopez ◽  
Jared Bullard ◽  
Vanessa Poliquin
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Gestational Age ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Antimicrobial Treatment ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Gestational Age At Delivery

Background: The literature suggests that the Jarisch–Herxheimer (J-H) reaction following antimicrobial treatment of syphilis is common and may precipitate uterine activity. Local practice is to transfer syphilitic parturients beyond gestational age of viability from rural locations to a tertiary care centre for treatment. Study objectives were to delineate local incidence and risk factors for the J-H reaction among pregnant women receiving treatment for syphilis. Methods: A retrospective chart review was conducted on pregnant women diagnosed with syphilis and treated during pregnancy at a tertiary care centre between 2012 and 2018. J-H reaction was defined as having ≥1 of the following symptoms within 24 hours of antibiotic treatment: fever (temperature ≥38°C), clinical description of a painful or itchy skin lesion, headache, hypotension (systolic BP <90), uterine contractions, or fetal heart rate decelerations. Descriptive statistical analysis was performed with mean and median used as measures of central tendency for continuous and categorical data, respectively. Results: Fifty-eight charts were eligible for inclusion. Mean maternal age was 25.1 (SD 5.6) years, and mean gestational age was 20.4 (SD 9.5) weeks when syphilis was diagnosed. One patient (1/58, 1.7%) met J-H reaction criteria. Mean gestational age at delivery was 37.1 (SD 3.4) weeks. One stillbirth (1.7%) was identified. Conclusions: The J-H reaction is less common at our centre than the literature suggests. Further research is important to identify risk factors associated with J-H reaction to optimize resource allocation in the context of treatment of syphilis during pregnancy.

scholarly journals Observational Study on Clinical Features, Treatment and Outcome of COVID 19 in a tertiary care Centre in India- a retrospective case series

2020 ◽  
Author(s):  
Raja Bhattacharya ◽  
Rohini Ghosh ◽  
Manish Kulshrestha ◽  
Sampurna Chowdhury ◽  
Rishav Mukherjee ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Tertiary Care ◽  
Case Series ◽  
Case Fatality ◽  
Standard Of Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
Demographic Profile ◽  
Acetyl Cysteine

ABSTRACT Objective: This study will attempt to explore the demographic profile and outcome in the patients receiving multidisciplinary, personalised approach including use of Broad Spectrum Antivirals - Ivermectin, anti-inflammatory and antioxidants roles of Statins and N-acetyl-cysteine along with Standard of Care (SOC) in hospitalised COVID19 patients in a tertiary care centre. Setting: Inpatient department Participants: 191 COVID-19 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the year 2020 between June 14- 28, 2020 Main outcome measures: The outcome of Interests are : Studying the demographic profile of COVID 19 cases Study the treatment outcomes in terms of death or discharge in patients receiving Ivermectin+N-acetyl-cysteine+Statin along with Standard of care. Results: 148 patients were included in the study. All of them had confirmed COVID19 infection by the rtPCR method. Average age of the patients was 57.57 years ( Range = 17 - 88), 49% were male, 51% female. 81% of the patients had at least one or more comorbidities. Most common comorbidities included diabetes( 32%), Hypertension (27%),Ischaemic Heart Disease (8%). More comorbidities. The in hospital, Case Fatality Rate was therefore, 1.35 %. The remaining 144 were discharged from the facility after an average 12 days duration of stay. Conclusions: Triple therapy with ivermectin + atorvastatin + N-acetylcysteine can be an useful adjunct to standard of care. Keywords: SARS-CoV-2, COVID-19, outpatients, treatment, zinc, hydroxychloroquine, azithromycin

scholarly journals High Impedance Alerts with Pulse Generator -- Lead Mismatch

2021 ◽  
Author(s):  
Simon Christie ◽  
Nada El Tobgy ◽  
Colette Seifer ◽  
Clarence Khoo
Keyword(s):  
Primary Outcome ◽  
Pulse Generator ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Boston Scientific ◽  
Implantable Cardioverter Defibrillators ◽  
Tertiary Care Centre ◽  
Cardiac Implantable Electronic Devices ◽  
High Impedance

Background: Cardiac Implantable Electronic Devices (CIED) include pulse generators and leads. In some implanting centres, it is common practice to combine devices with leads from different companies. Case series have reported episodic high-impedance changes in Boston Scientific CIEDs with competitor leads. We investigated the incidence of high-impedance abnormalities in matched vs. mismatched Boston Scientific CIEDs. Methods: Retrospective chart review identified all consecutive Boston Scientific Accolade pacemakers and Autogen implantable cardioverter defibrillators (ICD) implanted between January 2017 and June 2019 at a Canadian tertiary care centre. The primary outcome was the occurrence of transient, high-impedance changes which resulted in a switch to unipolar pacing / sensing in the absence of any other identifiable lead issue. Fisher exact tests (two-tailed, α = 0.05) were used to compare the incidence of outcomes in matched vs. mismatched systems. Results: 564 Boston Scientific CIEDs were identified associated with 969 individual leads. The primary outcome occurred with 22 leads (21 Medtronic and 1 Abbott), associated with occasional pacing inhibition, syncope, and/or early surgical revision. Mismatched systems were significantly associated with CIED malfunction compared to matched systems (3.4% vs. 0%, P = 0.0001). Median time from implant to unipolar safety switch was 19.3 months. Median follow-up time was 21.6 months. Conclusion: Use of mismatched leads with a Boston Scientific Accolade or Autogen device was associated with increased system malfunction and adverse clinical outcomes. Awareness of this interaction can allow for institution of appropriate programming remedies and may increase scrutiny of the use of mismatched CIED systems.

scholarly journals Cannabinoid hyperemesis syndrome presentation to the emergency department: A two-year multicentre retrospective chart review in a major urban area

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 550-555 ◽  
Author(s):  
Jeremy M. Hernandez ◽  
Jared Paty ◽  
Ira M. Price
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Kappa Statistic ◽  
Cannabis Use ◽  
Urgent Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Cannabinoid Hyperemesis Syndrome

AbstractObjectiveCannabinoid hyperemesis syndrome (CHS) is a paradoxical side effect of cannabis use. Patients with CHS often present multiple times to the emergency department (ED) with cyclical nausea, vomiting, and abdominal pain, and are discharged with various misdiagnoses. CHS studies to date are limited to case series. The objective was to examine the epidemiology of CHS cases presenting to two major urban tertiary care centre EDs and one urgent care centre over a 2-year period.MethodsUsing explicit variables, trained abstractors, and standardized abstraction forms, we abstracted data for all adults (ages 18 to 55 years) with a presenting complaint of vomiting and/or a discharge diagnosis of vomiting and/or cyclical vomiting, during a 2-year period. The inter-rater agreement was measured using a kappa statistic.ResultsWe identified 494 cases: mean age 31 (+/-11) years; 36% male; and 19.4% of charts specifically reported cannabis use. Among the regular cannabis users (>three times per week), 43% had repeat ED visits for similar complaints. Moreover, of these patients, 92% had bloodwork done in the ED, 92% received intravenous fluids, 89% received antiemetics, 27% received opiates, 19% underwent imaging, 8% were admitted to hospital, and 8% were referred to the gastroenterology service. The inter-rater reliability for data abstraction was kappa=1.ConclusionsThis study suggests that CHS may be an overlooked diagnosis for nausea and vomiting, a factor that can possibly contribute to unnecessary investigations and treatment in the ED. Additionally, this indicates a lack of screening for CHS on ED history, especially in quantifying cannabis use and eliciting associated symptoms of CHS.

Autoimmune Movement Disorders: A Video-Based Case Series of 11 Patients

2021 ◽  
pp. 1-5
Author(s):  
Anjali Chouksey ◽  
Sanjay Pandey
Keyword(s):  
Movement Disorder ◽  
Movement Disorders ◽  
Clinical Symptoms ◽  
Tertiary Care ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Intravenous Immunoglobulins ◽  
Thyroid Peroxidase ◽  
Tertiary Care Centre ◽  
Abnormal Movements

Autoimmune encephalitis (AIE) constitutes an important treatable cause of movement disorders. We aimed to highlight the spectrum of movement disorder and other salient features of AIE patients diagnosed at our tertiary care centre and describe their clinical symptoms, diagnostic approach, treatment, and outcome. We evaluated 11 patients who presented with movement disorder in association with AIE at our centre. Various abnormal movements observed were tremor, dyskinesias, stereotypy, dystonia, ataxia, asterixis, myoclonus, and parkinsonism. Antibodies were detected against NMDAR (n = 3), LGI-1 (n = 2), GAD-65 (n = 1), CASPR-2 (n = 1), Sox-1 (n = 1), Yo (n = 1), and thyroid peroxidase (n = 1). One patient was diagnosed with opsoclonus myoclonus syndrome associated with the suspected neuroblastic tumour. Six patients responded well to first-line immunotherapy (intravenous immunoglobulins or steroid or both). Three patients with anti-NMDAR antibodies received second-line therapy consisting of rituximab. Movement disorder is one of the most consistent features of AIE. Understanding of the ever-expanding spectrum of antibodies associated with movement disorders helps in the early diagnosis and better management of patients of autoimmune movement disorder.

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