scholarly journals Providing safe care for patients in the coronavirus disease 2019 (COVID-19) era: A case series evaluating risk for hospital-associated COVID-19

2021 ◽  
pp. 1-7
Author(s):  
Elizabeth B. Habermann ◽  
Aaron J. Tande ◽  
Benjamin D. Pollock ◽  
Matthew R. Neville ◽  
Henry H. Ting ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Case Series ◽  
Adult Patients ◽  
Care Hospital ◽  
Strict Adherence ◽  
Large Tertiary Care ◽  
Healthcare Associated ◽  
Serology Testing ◽  
Pcr Test

Abstract Objective: We evaluated the risk of patients contracting coronavirus disease 2019 (COVID-19) during their hospital stay to inform the safety of hospitalization for a non–COVID-19 indication during this pandemic. Methods: A case series of adult patients hospitalized for 2 or more nights from May 15 to June 15, 2020 at large tertiary-care hospital in the midwestern United States was reviewed. All patients were screened at admission with the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test. Selected adult patients were also tested by IgG serology. After dismissal, patients with negative serology and PCR at admission were asked to undergo repeat serologic testing at 14–21 days after discharge. The primary outcome was healthcare-associated COVID-19 defined as a new positive SARS-CoV-2 PCR test on or after day 4 of hospital stay or within 7 days of hospital dismissal, or seroconversion in patients previously established as seronegative. Results: Of the 2,068 eligible adult patients, 1,778 (86.0%) completed admission PCR testing, while 1,339 (64.7%) also completed admission serology testing. Of the 1,310 (97.8%) who were both PCR and seronegative, 445 (34.0%) repeated postdischarge serology testing. No healthcare-associated COVID-19 cases were detected during the study period. Of 1,310 eligible PCR and seronegative adults, no patients tested PCR positive during hospital admission (95% confidence interval [CI], 0.0%–0.3%). Of the 445 (34.0%) who completed postdischarge serology testing, no patients seroconverted (0.0%; 95% CI, 0.0%–0.9%). Conclusion: We found low likelihood of hospital-associated COVID-19 with strict adherence to universal masking, physical distancing, and hand hygiene along with limited visitors and screening of admissions with PCR.

Laparoscopic Surgical Management of Rectal Cancer at Tertiary Care Hospital

2021 ◽  
Vol 15 (11) ◽  
pp. 3285-3287
Author(s):  
Zubair Yousfani ◽  
Jabeen Atta ◽  
Khenpal Das ◽  
Madhu Bala ◽  
Shagufta Magsi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Case Series ◽  
Operation Time ◽  
Health Sciences ◽  
Care Hospital ◽  
Average Hospital ◽  
Case Series Study

Objective: To evaluate the consequent outcomes in the patients with rectal cancer endured laparoscopic surgical excision at Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro, Hyderabad and to review their curative resection and recurrence rates, postoperative morbidities and complete survival. Methods: This prospective case series study was done at the Department of General Surgery of Liaquat University of Medical & Health Sciences, Jamshoro, Sindh, Pakistan. All patients of 30-65 years ages with rectal cancer and underwent diagnostic laparoscopy either of gender were included. After removing the tumor, the specimen pinned out on a flat surface and placed in fixative solution to allow the orientation of the specimen and assessments of the exact margins. As the specimens had acceptable clear margins and limited invasion to the submucosa, no further surgical procedure was proceeded. Data was collected via study proforma. Results: A total of 40 patients were studied. Patients in the laparoscopic operation lost less blood with an amount of only 200mL during 190 minutes average operation time. The bowel functioning returned in 2 days averagely with 8 days average hospital stay. Conclusion: It is concluded that laparoscopic surgery for rectal cancer is an effective, safe and feasible approach in terms of less post-operative complications and recovery time as well as Hospital stay. Key words: Rectal Cancer, laparoscopic surgery

scholarly journals Subcutaneous emphysema and pneumomediastinum in patients with COVID-19 disease; case series from a tertiary care hospital in Pakistan

2021 ◽  
Vol 149 ◽  
Author(s):  
S. M. Sethi ◽  
A. S. Ahmed ◽  
S. Hanif ◽  
M. Aqeel ◽  
A. B. S. Zubairi
Keyword(s):  
Hospital Stay ◽  
Subcutaneous Emphysema ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Case Series ◽  
Positive Pressure ◽  
Care Hospital ◽  
Spontaneous Pneumomediastinum ◽  
Disease Case

Abstract Since December 2019, the clinical symptoms of coronavirus disease 2019 (COVID-19) and its complications are evolving. As the number of COVID patients requiring positive pressure ventilation is increasing, so is the incidence of subcutaneous emphysema (SE). We report 10 patients of COVID-19, with SE and pneumomediastinum. The mean age of the patients was 59 ± 8 years (range, 23–75). Majority of them were men (80%), and common symptoms were dyspnoea (100%), fever (80%) and cough (80%). None of them had any underlying lung disorder. All patients had acute respiratory distress syndrome on admission, with a median PaO2/FiO2 ratio of 122.5. Eight out of ten patients had spontaneous pneumomediastinum on their initial chest x-ray in the emergency department. The median duration of assisted ventilation before the development of SE was 5.5 days (interquartile range, 5–10 days). The highest positive end-expiratory pressure (PEEP) was 10 cmH2O for patients recieving invasive mechanical ventilation, while 8 cmH2O was the average PEEP in patients who had developed subcutaneous emphysema on non-invasive ventilation. All patients received corticosteroids while six also received tocilizumab, and seven received convalescent plasma therapy, respectively. Seven patients died during their hospital stay. All patients either survivor or non-survivor had prolonged hospital stay with an average of 14 days (range 8−25 days). Our findings suggest that it is lung damage secondary to inflammatory response due to COVID-19 triggered by the use of positive pressure ventilation which resulted in this complication. We conclude that the development of spontaneous pneumomediastinum and SE whenever present, is associated with poor outcome in critically ill COVID-19 ARDS patients.

scholarly journals Healthcare-Associated Pneumonia in a Mexican Tertiary Care Center Micro to Systemic Analysis: A 2017–2019 Case Series Study

2020 ◽  
Vol 41 (S1) ◽  
pp. s247-s248
Author(s):  
Miguel Ángel García Salcido ◽  
Roxana Trejo González ◽  
Lucio Antonio Hernández González
Keyword(s):  
Mechanical Ventilation ◽  
Incidence Rate ◽  
Tertiary Care ◽  
Case Series ◽  
Care Hospital ◽  
Age Group ◽  
Data Set ◽  
Case Series Study ◽  
Healthcare Associated ◽  
Series Study

Objectives: The aim of this study was to identify the biological, microbiological, and healthcare factors related to the occurrence of nosocomial pneumonia in our confirmed cases during 2017–2019. Methods: We conducted a case series study. For the selection of the cases we used the CDC criteria for hospital-acquired pneumonia, we collected cases from the data set for healthcare-associated infections from a tertiary-care hospital in Mexico City. For the quantitative analysis, we used Stata v14 software, and we obtained frequencies, proportions, accumulated incidence rate, lethality rate, central tendency, and dispersion metrics. This study was a secondary data set analysis; we obtained signed authorization for the use of the data from the Epidemiological Surveillance Unit. Results: During our analysis period (January 2017 to June 2019), we identified 107 cases that fulfilled the CDC criteria: 47 cases (43.93%) from 2017, 38 cases (35.51%) from 2018, and 20.56% from 2019. The month that reported the highest frequency was February, with 17 cases (15.89%). The median age was 63 years (range, 0–97 years; IQR, 36). The most affected age group was 65 years (48.60%), and the most affected 5-year age group was 75–79 years (13.08%). Moreover, 60 cases (56.07%) were men and 47 (43.93%) were women. Regarding the reason for discharge, 71% were discharged due to improvement, 27% died, and 2% were transferred to another healthcare facility. Also, 17 patients (15.89%) required readmission due to respiratory illness within 72 hours of previous discharge. The most common diagnosis was a solid malignant neoplasm (20.19%), followed by heart or vascular malformation or anomaly (12.50%). The mean inpatient hospital stay was 39.95 days (46.40; median, 27 days, range, 2–317 days; IQR 35 days). The median time elapsed until detection was 14 days. The hospitalization area with the most cases was the intensive care unit, with 24 cases (22.43%); the service with most cases was oncology with 21 cases (20.56%). The most isolated pathogen was Pseudomonas aeruginosa (14%). Moreover, 59% were gram-negative, 36% were gram-positive, 19.67% were viruses, and 14.75% were fungi. Our accumulated-incidence-rate was 0.58 cases per 1,000 patient days and our case-fatality-rate was 25.23%. Furthermore, 41% of cases required invasive mechanical ventilation, 52.34% required noninvasive mechanical ventilation, 5% cases had an endo-pleural tube, 9.35% had a nasogastric tube, and 41.12% had a central venous catheter. The most-prescribed antimicrobial was meropenem (33.33%), and meropenem-resistance was 61.54%. Conclusions: Infection prevention efforts should target oncological patients, critical-care units, and the elderly. We must reinforce our antimicrobial policy due to our overprescription of carbapenems. Early detection is needed to reduce mortality.Funding: NoneDisclosures: None

scholarly journals Neuroimaging Findings of Hospitalized Covid-19 Patients: A Canadian Retrospective Observational Study

2021 ◽  
pp. 084653712110028
Author(s):  
Vibeeshan Jegatheeswaran ◽  
Michael W. K. Chan ◽  
Sumon Chakrabarti ◽  
Adrian Fawcett ◽  
Yingming Amy Chen
Keyword(s):  
Observational Study ◽  
Clinical Status ◽  
Tertiary Care ◽  
Case Series ◽  
Tertiary Hospital ◽  
Adult Patients ◽  
Retrospective Observational Study ◽  
Acute Ischemia ◽  
Care Hospital ◽  
Icu Patients

Purpose: Coronavirus disease (COVID-19) has been associated with neurologic sequelae and neuroimaging abnormalities in several case series previously. In this study, the neuroimaging findings and clinical course of adult patients admitted with COVID-19 to a tertiary care hospital network in Canada were characterized. Methods: This is a retrospective observational study conducted at a tertiary hospital network in Ontario, Canada. All adult patients with PCR-confirmed COVID-19 admitted from February 1, 2020 to July 22, 2020 who received neuroimaging related to their COVID-19 admission were included. CT and MR images were reviewed and categorized by fellowship-trained neuroradiologists. Demographic and clinical data were collected and correlated with imaging findings. Results: We identified 422 patients admitted with COVID-19 during the study period. 103 (24.4%) met the inclusion criteria and were included: 30 ICU patients (29.1%) and 73 non-ICU patients (70.9%). A total of 198 neuroimaging studies were performed: 177 CTs and 21 MRIs. 17 out of 103 imaged patients (16.8%) had acute abnormalities on neuroimaging: 10 had macrohemorrhages (58.8%), 9 had acute ischemia (52.9%), 4 had SWI abnormalities (23.5%), and 1 had asymmetric sulcal effacement suggesting possible focal encephalitis (5.8%). ICU patients were more likely to have positive neuroimaging findings, more specifically acute ischemia and macrohemorrhages ( P < 0.05). Macrohemorrhages were associated with increased mortality ( P < 0.05). Conclusion: Macrohemorrhages, acute ischemia and SWI abnormalities were the main neuroimaging abnormalities in our cohort of hospitalized COVID-19 patients. Acute ischemia and hemorrhage were associated with worse clinical status.

Healthcare associated infections caused by non-fermenting Gram negative rods (NFGNR): six years of experience of a tertiary hospital

2013 ◽  
Vol 7 (2) ◽  
pp. 06-12
Author(s):  
Zahidul Hasan ◽  
Md. Kamrul Islam ◽  
Arifa Hossain
Keyword(s):  
Blood Stream Infection ◽  
Tertiary Care ◽  
Blood Stream ◽  
Tertiary Hospital ◽  
Healthcare Associated Infections ◽  
Care Hospital ◽  
Gram Negative ◽  
Acinetobacter Spp ◽  
Tract Infections ◽  
Healthcare Associated

Recently non-fermenting Gram negative rods (NFGNR) are playing an important role in healthcare associated infections. This observational study in a tertiary care hospital of Dhaka city conducted during 01August 2007 to 30 June 2013 found that 34.8% isolated organisms from patients with healthcare associated infections were NFGNR. Majority (74.3 %) of these infections were occurring inside critical care areas. Pseudomonas and Acinetobacter together constituted 79.6% of the total NFGNR whereas Burkholderia cephacia complex (15.4%), Stenotrophomonas (4.3%) and Chryseobacterium species (0.7%) combined constituted remaining 20.4%. Out of total NFGNRs, Pseudomonas was responsible for highest number of catheter associated urinary tract infections (55.6%), ventilator associated pneumonia (46.3%), respiratory tract infection (65.8%) and surgical site infection (70.6%). Blood stream infection was predominantly caused by Burkholderia cephacia complex (33.5%) and Acinetobacter spp. (39.5%). Other than colistin most of the organisms were resistant to antibiotics commonly recommended for NFGNR.DOI: http://dx.doi.org/10.3329/bjmm.v7i2.19326 Bangladesh J Med Microbiol 2013; 07(02): 6-12

scholarly journals A Study of Factors Affecting the Length of Hospital Stay of COVID-19 Patients by Cox-Proportional Hazard Model in a South Indian Tertiary Care Hospital

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
Gayathri Thiruvengadam ◽  
Marappa Lakshmi ◽  
Ravanan Ramanujam
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Hazard Model ◽  
Cox Proportional Hazard Model ◽  
Care Hospital ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
South Indian

Background: The objective of the study was to identify the factors that alter the length of hospital stay of COVID-19 patients so we have an estimate of the duration of hospitalization of patients. To achieve this, we used a time to event analysis to arrive at factors that could alter the length of hospital stay, aiding in planning additional beds for any future rise in cases. Methods: Information about COVID-19 patients was collected between June and August 2020. The response variable was the time from admission to discharge of patients. Cox proportional hazard model was used to identify the factors that were associated with the length of hospital stay. Results: A total of 730 COVID-19 patients were included, of which 675 (92.5%) recovered and 55 (7.5%) were considered to be right-censored, that is, the patient died or was discharged against medical advice. The median length of hospital stay of COVID-19 patients who were hospitalized was found to be 7 days by the Kaplan Meier curve. The covariates that prolonged the length of hospital stay were found to be abnormalities in oxygen saturation (HR = 0.446, P < .001), neutrophil-lymphocyte ratio (HR = 0.742, P = .003), levels of D-dimer (HR = 0.60, P = .002), lactate dehydrogenase (HR = 0.717, P = .002), and ferritin (HR = 0.763, P = .037). Also, patients who had more than 2 chronic diseases had a significantly longer length of stay (HR = 0.586, P = .008) compared to those with no comorbidities. Conclusion: Factors that are associated with prolonged length of hospital stay of patients need to be considered in planning bed strength on a contingency basis.

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

Sign in / Sign up

Export Citation Format

Share Document