scholarly journals Cerebrovascular Injury Following Scorpion Sting and Snake Envenomation: A Case Series

2018 ◽  
Vol 45 (6) ◽  
pp. 669-674 ◽  
Author(s):  
Ajay Mishra ◽  
Aditya Binu ◽  
George Abraham ◽  
Harshad Vanjare ◽  
Tina George ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Neurological Complications ◽  
Neurological Deficits ◽  
Neurological Involvement ◽  
Scorpion Sting ◽  
Male Predominance ◽  
Cerebrovascular Injury ◽  
Snake Envenomation

AbstractBackgroundNeurological complications following snake and scorpion bite are diverse. Literature regarding patterns of cerebrovascular injury (CVI) and outcomes among these patients is scarce. This is a descriptive study of the clinical profile, brain imaging findings, mechanisms of injury, vascular territory involvement and outcomes of CVI following scorpion and snake envenomation, in a tertiary care center in South India.MethodologyPatients with scorpion sting- and snake envenomation-related complications were retrospectively enrolled. Neuroimaging was performed on five patients with each envenomation, and they were found to have neurological involvement. On imaging, three patients were found to have a CVI. Clinical, radiological parameters and outcomes of these patients were studied. We also performed a review of the literature and analyzed the finding of all the cases.ResultIn all, three patients each had evidence of CVI in imaging. An additional 32 reports of scorpion sting-related CVI and 35 reports of snake envenomation-related CVI were identified from the literature. There was a male predominance among these patients. Mean age of the patients with scorpion sting was 42.8 years as compared with 33 years for the patients with snake envenomation. Features of severe envenomation were present in all patients. Persistently depressed sensorium and new-onset focal neurological deficits were seen in 70% of all patients. Infarcts were seen in 88% of patients with snake envenomation and 53% of patients with a scorpion sting. Mortality was 28% among patients with a scorpion sting as compared with 8% with snake envenomation.ConclusionCerebrovascular injuries are uncommon neurological manifestations following scorpion and snake envenomation. These tend to occur in younger patients. Infarcts are more common than bleeds.

scholarly journals 713. Coccidioidal Meningitis Among Children: A Case Series and Single Center Experience In Central California

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S456-S456
Author(s):  
Fouzia Naeem ◽  
Linda Giglio ◽  
Julia Sharma ◽  
Patricia Clerkin ◽  
Frederick Laningham ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Case Series ◽  
Neurological Complications ◽  
Communicating Hydrocephalus ◽  
Case Review ◽  
Endemic Region ◽  
Retrospective Case

Abstract Background Coccidioidal meningitis is a severe form of coccidioidomycosis associated with significant morbidity and mortality. Published literature in the pediatric population is limited, particularly on coccidioidal meningitis. Here we describe a large case series of pediatric coccidioidal meningitis followed at a tertiary care center in an endemic region. Methods We performed a retrospective case review of patients ≤21 years old followed at our facility with a diagnosis of coccidioidal meningitis from January 1, 2000, to December 31, 2018. Results Overall, 30 patients were identified during the study period. The median age was 10.8 years (IQR: 4.6-15). The majority of patients were previously healthy (93%) and all required hospitalization. Fever (90%), headache (70%), vomiting (53%), and fatigue (57%) were the most common clinical manifestations. More than one-third (40%) had concurrent pulmonary disease. Only 20 patients (67%) had initial Coccidioides complement fixation (CF) titers >=1:16. The majority had extra-axial brain involvement (60%) and seven (23%) had associated spinal canal disease. Over two-third required shunt placement (70%) and almost half of them (43%) underwent revision. Neurological complications including paresis/paralysis, stroke, neuropathy, seizures, and cognitive delay were observed in 20% of patients. Two-thirds (73%) of patients received fluconazole as the initial drug. However, 37% of those had fluconazole failure, requiring alternative treatment. Due to refractory disease, two patients required a novel triazole, isavuconazole, while adjunctive therapy with steroids and interferon-gamma (IFNγ) was used in 20% of patients. Most cases (83%) stabilized, 13% experienced relapses and/or progressive disease, and 3% were fatal. Conclusion Pediatric coccidioidal meningitis is an uncommon and sometimes devastating complication of disseminated coccidioidomycosis. Many patients present with relatively low CF titers, and communicating hydrocephalus and long term neurologic complications are common. Fluconazole treatment failures are common, and management remains difficult despite recent advances in therapy. Most patients do well once the disease is stabilized and require lifelong therapy. Newer therapeutic agents are needed. Disclosures All Authors: No reported disclosures

scholarly journals Gastrointestinal duplication cysts: experience from a tertiary care center in North India and review of literature

2020 ◽  
Vol 8 (1) ◽  
pp. 180
Author(s):  
Divya Aggarwal ◽  
Kim Vaiphei
Keyword(s):  
Congenital Malformations ◽  
Clinical Presentation ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Case Series ◽  
North India ◽  
Male Predominance ◽  
High Index Of Suspicion ◽  
Age Range

Background: Duplication cysts (DC) are uncommon congenital malformations which predominantly present in infants and young children. Owing to their variable clinical presentation, radiology and/or histopathology are often required to clinch the diagnosis. We present a case series of 66 patients, which is the largest series reported so far.Methods: A search of prospectively maintained institutional database was carried out to identify patients who were diagnosed and operated for gastrointestinal DC between January 2013 and August 2018. For all cases, the demographic data, site of DC, details of clinical presentation, associated conditions and histopathology findings were recorded. The slides of all cases were retrieved and re-examined.Results: The age range was 1 day to 47 years, with a slight male predominance (1.3:1). Ileum was the most common site followed by jejunum. Ectopic mucosae noted were gastric, pancreatic, biliary and respiratory. One case showed glial heterotopia. Perforation, gangrene and intussusception were among the co-existing pathologies noted.Conclusions: Duplication cysts are rare congenital malformations. The variability in clinical presentation makes the diagnosis elusive. Timely diagnosis and appropriate management require a high index of suspicion and a holistic diagnostic approach with clinical, radiological and histopathological inputs. 

scholarly journals Clinical and epidemiological spectrum of coronavirus disease 2019 in Central Kerala: a retrospective case series

2021 ◽  
Vol 8 (3) ◽  
pp. 1503
Author(s):  
Ronnie Thomas ◽  
Bins M. John ◽  
Joe Thomas Koothapally ◽  
Sanjeev Kumar ◽  
Supriya Adiody ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Care Center ◽  
Laboratory Finding ◽  
Tertiary Care ◽  
Case Series ◽  
Mitigation Measures ◽  
Retrospective Case ◽  
Male Predominance ◽  
Retrospective Case Series ◽  
Asymptomatic Patients

Kerala state in India was known for its early response to the Covid-19 pandemic by public health mitigation measures through science-based advocacy. The objective of this study was to analyze epidemiological and clinical characteristics of COVID-19 patients admitted to a tertiary care center in central Kerala. This retrospective case series was undertaken by reviewing the medical records and extracting the epidemiological data, clinical symptoms and laboratory findings of consecutive patients admitted between April 1st and September 31, 2020. Clinical and demographic parameters of hospitalized patients were analyzed regarding their association with the severity of disease. The mean age of the patients was 35.8 years with significant male predominance. Shopkeepers represented 15.6% of the patients and healthcare workers represented 12.5%. Primary contact with a known case was documented in 62.5% of the patients. Asymptomatic patients constituted 25% of the patients and the most commonly experienced symptoms were fever, cough, breathlessness and diarrhea. Three patients had atypical presentations in the form of generalized seizures, intussusception and generalized anxiety with suicidal ideation. Neutrophilia and Lymphopenia were the most dominant laboratory finding. The clinical spectrum of COVID-19 in the study population is wider than previously described in literature.

scholarly journals Vitamin C Deficiency in Inflammatory Bowel Disease: The Forgotten Micronutrient

2021 ◽  
Author(s):  
Katie A Dunleavy ◽  
Ryan C Ungaro ◽  
Laura Manning ◽  
Stephanie Gold ◽  
Joshua Novak ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Vitamin C ◽  
Bowel Disease ◽  
Fruits And Vegetables ◽  
Nutritional Assessment ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Vitamin C Deficiency ◽  
Inflammatory Bowel

Abstract Background Micronutrient deficiencies are common in patients with inflammatory bowel disease (IBD). To date, the literature has focused on vitamin D, vitamin B12, and iron deficiencies. Methods We report a case series of 20 patients with IBD and vitamin C deficiency treated at a single tertiary care center. Results Sixteen (80%) patients had symptoms of clinical scurvy, including arthralgia, dry brittle hair, pigmented rash, gingivitis, easy bruising and/or brittle nails. Eighteen patients underwent a nutritional assessment, 10 (56%) patients reported complete avoidance of fruits and vegetables, and 3 (17%) reported reduced intake of fruits and vegetables. Conclusions Vitamin C deficiency should be considered in IBD patients, particularly those with reduced fruit/vegetable intake, as it can lead to significant signs and symptoms.

scholarly journals Accidental tramadol ingestion in children admitted in tertiary care centre

2019 ◽  
Vol 8 (12) ◽  
pp. 2661
Author(s):  
Vadlakonda Sruthi ◽  
Annaladasu Narendra
Keyword(s):  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Hemodynamic Instability ◽  
Tertiary Care Centre ◽  
Medical College ◽  
History Of

Background: Tramadol use has been increasing in the adult and pediatric population. Practitioners must be alert because Tramadol misuse can lead to severe intoxication in which respiratory failure and seizures are frequent. Overdoses can lead to death. We report 47 pediatric cases with history of accidental tramadol exposure in children.Methods: An observational, retrospective, single center case -series of children with a history of accidental tramadol exposure in children admitted in pediatric intensive care unit of tertiary care center, Niloufer Hospital (Osmania Medical College) Hyderabad, Telangana India.Results: Of 47 children, 22 (47%) are male and 25 (53%) were female. At presentation 11 (23%) had loss of consciousness, 14 (29%) seizures, 17 (36%) hypotonia was noted. Pupils were miotic in 22 (47%) mydriatic in 2 (4.2%) normal in rest of children. Hemodynamic instability noted in 13 (27.6%). Serotonin syndrome (tachycardia, hyperthermia, hypertension, hyper reflex, clonus) was noted on 5 (10.6%) children. Respiratory depression was seen in 4 (8%) children who needed ventilatory support. Antidote Naloxone was given in 7 children. No adverse reaction was noted with Naloxone. All 47 children were successfully discharged.Conclusions: Overdoses can lead to death and practitioners must be alert because of the increasing use of tramadol in the adult and pediatric population. The handling of the tramadol should be explained to parents and general population and naloxone could be efficient when opioid toxicity signs are present.

Disseminated Tuberculosis: A 3-Year Case-Series Experience in a Tertiary Care Center

2021 ◽  
Vol 22 (5) ◽  
pp. 358-363
Author(s):  
Canan Gunduz Gurkan ◽  
◽  
Hamide Sekerbay ◽  
Aylin Babalik ◽  
◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Tertiary Care Center ◽  
Disseminated Tuberculosis

scholarly journals Postoperative Neurological Complications after a Cranial Surgery: A Multicentre Prospective Observational Study

2020 ◽  
Author(s):  
Ramesh J. Venkatapura ◽  
Surya K. Dubey ◽  
Nidhi Panda ◽  
Dhritiman Chakrabarti ◽  
Sudhir Venkataramaiah ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Tertiary Care ◽  
Neurological Complications ◽  
Vascular Pathology ◽  
Neurological Deficits ◽  
Motor Deficit ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Exact Test ◽  
Cranial Surgery

Abstract Background  Cranial surgery is associated with multiple postoperative complications varying from simple nausea and vomiting to devastating complications such as stroke and death. This multicentre collaborative effort was envisioned to collect observational data regarding postoperative complications in cranial surgeries among the Indian population. The aim of this study was to describe the postoperative neurological complications occurring within the first 24 hours after surgery and to identify the predictive factors. Methods Data was collected from three participating tertiary care academic institutions. The study was prospective, observational, multicentre design with data collected over a period of two months or 100 cases, whichever is earlier, from each participating institute. A predesigned Microsoft excel sheet was distributed among all three centers to maintain uniformity. All patients aged 18 years and above of both sexes undergoing elective or emergency craniotomies were included in the study. The postoperative neurological complications (within 24 hours) assessed were: (1) Neurological deficit (ND) defined as new focal neurological motor deficit relative to preoperative status. (2) Sensorium deterioration (SD) defined as reduction in Glasgow coma score (GCS) by 2 or more points compared with preoperative GCS. (4) Postoperative seizures (SZs) defined as any seizure activity. All possible variables associated with the above neurological complications were tested using Chi-square/Fisher exact test or Mann–Whitney U test. The predictors, which were statistically significant at p < 0.2, were entered into a multiple logistic regression model. Alpha error of 5% was taken as significant. Results Data from three institutions was collected with a total of 279 cases. In total, there were 53 (19%) neurological complications. There were 28 patients with new postoperative NDs (10.04%), 24 patients had SD (8.6%), and 17 patients had seizures (6.1%). Neurological deficits were significantly less in institution 2. Diagnosis of traumatic brain injury (TBI) was associated with very low risk of ND, and vascular pathology was associated with higher chance of a ND. The duration of anesthesia was found to be significantly predictive of SD (OR/CI = 1.01 / 1–1.02). None of the factors were predictive of PS. Conclusion The incidences of postoperative ND, SD and postoperative seizures were 10%, 8.6%, and 6.1%, respectively. Studies with a much larger sample size are required for a better and detailed analysis of these complications.

scholarly journals Outcome of Primary Intracerebral Hemorrhage: A Study in Tertiary Care Center

2020 ◽  
Vol 2 (2) ◽  
pp. 35-40
Author(s):  
Jagat Narayan Rajbanshi ◽  
Pankaj Raj Nepal
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Systolic Blood Pressure ◽  
Care Center ◽  
Tertiary Care ◽  
Brain Parenchyma ◽  
Chronic Hypertension ◽  
Midline Shift ◽  
Male Predominance ◽  
The Mean

 Background: Intracerebral hemorrhage (ICH) is an irreversible phenomenon inside the brain parenchyma resulting in mild to severe neurological deficit. Based on etiology it is broadly divided into primary and secondary. Primary ICH is usually due to the rupture of Charcot-Bouchard aneurysm and chronic hypertension. Charcot – Bouchard aneurysms are supposed to get formed due to lipohyalinosis. With the aim to evaluate the outcome of primary ICH admitted to our institute this study is performed. Materials and methods: This is a prospective analytical study, where all the consecutive patients of the primary ICH were collected. Quantitative variables like age, the volume of hematoma, midline shift, GCS, and systolic blood pressure (SBP) were presented as mean and standard deviation (S.D). Whereas, qualitative variables like gender, site, and side of hematoma, type of treatment, best motor response were presented in frequency and percentage. The outcome of the patient was measured using the Glasgow outcome scale (GOS) and the association between qualitative/quantitative variables and GOS was done using the chi-square test or Fischer exact test whenever applicable in SPSS20. Results: There were a total of 31 patients with a mean age of 59.81(S. D 15.8) year and male predominance (74%). The mean volume of hematoma was 40 ml. Similarly, midline shift ranged from zero to 14 mm. The majority of primary ICH were located in basal ganglia (35%) and on the right side (52%). The mean GCS at presentation was 12.1 (S.D 2.166). Mean Systolic blood pressure was 163.77 mmHg (S.D 34.6 mmHg) with maximum SBP up to 240mmHg. There was a 14% mortality in this study group with favorable outcome (GOS 4 and 5) in 82%. GOS was significantly associated with the volume of hematoma and midline shift. Conclusion: The outcome of primary ICH is strongly associated with the volume of hematoma and midline shift. They were generally associated with hypertension with a mean systolic blood pressure of >160 mm Hg.

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