Management of Mesenteric Cysts in Pediatric Population: Five-year Experience in Tertiary Care Center

Abstract Introduction To study the clinical features, diagnosis and treatment of mesenteric cysts in pediatric age group (< 15 years). Materials and Methods This was a retrospective analysis which inculded 35 children diagnosed and treated for mesenteric cysts in the pediatric surgery department from January 2014 to January 2019. Patient’s data were retrieved from case sheets and analyzed. Patients with atleast one year follow-up were included in the study. Results Thirty-five patients were included in the study. Twenty-one (60%) were males and fourteen (40%) were females. Mean age of presentation and surgery was 24 months. Twenty-six (74.2%) patients were managed by bowel resection, while 9 (25.7%) were managed by simple cystectomy. The average size of the cyst was 15 cm (ranging from 5 to 25 cm). Content of cysts was mostly chylous (82.9% cases). No recurrence was found throughout the follow-up period (1–2 years). Conclusion Mesenteric cyst should be considered as a differential diagnosis in pediatric patients with acute or subacute intestinal obstruction and with or without a palpable lump in the abdomen. Mesenteric cysts can be managed surgically with favorable outcomes.

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Profile and outcome of pediatric intussusception: a 5-year experience in a tertiary care center

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00097-5 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Aqeela J. Madan ◽

Fayza Haider ◽

Saeed Alhindi

Keyword(s):

Seasonal Variation ◽

Success Rate ◽

Pediatric Population ◽

Care Center ◽

Tertiary Care ◽

Operative Intervention ◽

Secondary Outcome ◽

Lead Point ◽

Pneumatic Reduction ◽

Tertiary Center

Abstract Background Intussusception is the most frequent cause of bowel obstruction in infants and toddlers; idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years; the highest incidence occurs in infants between 4 and 9 months; the gold standard for treatment of intussusception is non-operative reduction. This research will tackle the problem of pediatric intussusception in our center which is the largest tertiary center in our region. The primary outcome is to study the profile of intussusception; the secondary outcome is to assess the success rate of pneumatic reduction in the center’s pediatric population as well as to study the seasonal variation if present. Results During the study period, eighty-six (N=86) cases were identified, from which 10 cases were recurrent intussusception. Seventy-six (N=76) cases were included from the study period. N=68 (89%) were less than 3 years of age, and only N=2 (3%) were above 6 years. Seasonal variation was not significant; N=69 (91%) patients had successful pneumatic reduction under fluoroscopy while thirteen patients N=13 (17%) needed operative intervention. Conclusion Ileocolic intussusception is one of the most common pediatric surgical emergencies that can be successfully managed non-operatively in our institute; 89% of the cases were below 3 years of age, and no seasonal variation was demonstrated. Operative intervention was required in 13 cases with the main reason being lead point. The fact that the pediatric surgeon performs the reduction might have contributed to a high success rate reaching 91% in our center. This study provides a valuable opportunity for future regional data comparisons and pooled data analyses.

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Evaluation of the Anxiety Level of Mothers of Children with Epilepsy during the COVID-19 Pandemic Period

European Neurology ◽

10.1159/000514826 ◽

2021 ◽

pp. 1-8

Author(s):

Halil Celik ◽

Sadettin Burak Acikel ◽

Fatih Mehmet Akif Ozdemir ◽

Erhan Aksoy ◽

Ulkuhan Oztoprak ◽

...

Keyword(s):

Neurological Disease ◽

Chronic Conditions ◽

Care Center ◽

Tertiary Care ◽

Anxiety Level ◽

Childhood And Adolescence ◽

Routine Examination ◽

Significant Difference ◽

Anxiety Levels

Background and Aim: Although anyone can be affected by the COVID-19 pandemic, it may cause additional concern for people with chronic conditions. Epilepsy is the most common neurological disease in childhood and adolescence. The aim of this study was to determine anxiety levels among the mothers of children under follow-up for epilepsy in our clinic during the COVID-19 pandemic. Methods: The study group consisted of the mothers of epilepsy patients who were under follow-up in the pediatric neurology outpatient clinic of the tertiary care center and were scheduled for a routine examination during the COVID-19 pandemic. The mothers’ anxiety levels according to the Beck Anxiety Inventory and their opinions about COVID-19 in relation to their child were assessed and compared based on whether the mother/patient attended their appointments in person and whether the child had frequent or infrequent seizures. Results: There was no statistically significant difference in anxiety level between the mothers of 64 children with epilepsy who attended their appointment during the pandemic and those of the mothers of 52 who did not attend their appointment. However, the mothers of children with frequent seizures had significantly higher anxiety levels. Conclusion: Anxiety level of mothers whose children have frequent seizures was significantly higher compared to mothers whose children have infrequent seizures. It is important to be aware about this point and using telemedicine approach in suitable population and postpone routine outpatient follow-up appointments as much as possible.

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Nephrocalcinosis, Renal Dysfunction, and Calculi in Patients With Primary Hypoparathyroidism on Long-Term Conventional Therapy

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz319 ◽

2020 ◽

Vol 105 (4) ◽

pp. e1215-e1224 ◽

Cited By ~ 2

Author(s):

Soma Saha ◽

Devasenathipathy Kandasamy ◽

Raju Sharma ◽

Chandrasekhar Bal ◽

Vishnubhatla Sreenivas ◽

...

Keyword(s):

Renal Dysfunction ◽

Conventional Therapy ◽

Care Center ◽

Tertiary Care ◽

Fractional Excretion ◽

Renal Calculi ◽

Serum Total Calcium ◽

Calcium Phosphorus

Abstract Context There are concerns about the long-term safety of conventional therapy on renal health in patients with hypoparathyroidism. Careful audit of these would help comparisons with upcoming parathyroid hormone therapy. Objective We investigated nephrocalcinosis, renal dysfunction, and calculi, their predictors and progression over long-term follow-up in patients with primary hypoparathyroidism (PH). Design and Setting An observational study at a tertiary care center was conducted. Participants and Methods A total of 165 PH patients receiving conventional therapy were evaluated by radiographs, ultrasonography, and computed tomography. Their glomerular filtration rate (GFR) was measured by Tc-99m-diethylenetriamine penta-acetic acid clearance. Clinical characteristics, serum total calcium, phosphorus, creatinine, hypercalciuria, and fractional excretion of phosphorus (FEPh) at presentation and during follow-up were analyzed as possible predictors of renal complications. Controls were 165 apparently healthy individuals. Results Nephrocalcinosis was present in 6.7% of PH patients but not in controls. Patients younger than 15 years at presentation and with higher serum calcium-phosphorus product were at higher risk. Nephrocalcinosis showed no significant association with cataract and intracranial calcification. Prevalence of renal calculi was comparable between hypoparathyroid patients and controls (5% vs 3.6%, P = .58). Fourteen percent of patients had a GFR less than 60 mL/min/1.73 m2. Increased FEPh during follow-up was the significant predictor of low GFR. Nephrocalcinosis developed in 9% of patients over 10 years of conventional therapy. Conclusion A total of 6.7% of PH patients had nephrocalcinosis, and 14% showed renal dysfunction. Prevalence of renal calculi was similar in patients and controls. Nine percent of patients developed nephrocalcinosis over 10 years of conventional therapy.

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Postpartum follow up of gestational diabetes in a Tertiary Care Center

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-017-0303-4 ◽

2018 ◽

Vol 10 (1) ◽

Cited By ~ 5

Author(s):

C. A. Cabizuca ◽

P. S. Rocha ◽

J. V. Marques ◽

T. F. L. R. Costa ◽

A. S. N. Santos ◽

...

Keyword(s):

Gestational Diabetes ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center

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Effectiveness of Transjugular Intrahepatic Portosystemic Shunt in Variceal Bleeding: An Audit from a Tertiary Care Center in North India

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0037-1603888 ◽

2017 ◽

Vol 01 (03) ◽

pp. 150-155

Author(s):

Arun Gupta ◽

Ajay Mehta ◽

Nitin Mishra ◽

Rajendra Bansal ◽

Ajit Yadav

Keyword(s):

Variceal Bleeding ◽

Patency Rate ◽

Care Center ◽

Tertiary Care ◽

Portosystemic Shunt ◽

North India ◽

Related Complication ◽

Variceal Bleed ◽

Intrahepatic Portosystemic Shunt

AbstractVariceal bleeding is one of the most feared complications of cirrhosis and portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective minimally invasive option to achieve adequate decompression of the portal system. The aim of the study was to assess the efficacy and complications of TIPS in patients presenting with variceal bleed. It was a retrospective study done in a tertiary care center in North India in cirrhotic patients with acute or recurrent variceal bleed who underwent TIPS from April 2010 to October 2013. All the patients were followed up till April 2014. We could successfully implant TIPS in 100% of our patients with 100% success rate in controlling variceal bleeding immediately and during the follow-up period. Our primary patency rate was 94.5% and overall patency rate was 100%. Major TIPS-related complication was hepatic encephalopathy in 20% of patients; 7 of 22 patients died during the follow-up period. TIPS is a safe and effective procedure for control of acute or recurrent variceal bleed. Emerging evidence in favor of early TIPS is further going to expand its indication in variceal bleed. Hepatic encephalopathy was the major procedure-related complication in our study consistent with previous literature reports.

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Clinical and laboratory follow-up after hospitalization for COVID-19 at an Italian tertiary care center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab049 ◽

2021 ◽

Author(s):

Michele Spinicci ◽

Iacopo Vellere ◽

Lucia Graziani ◽

Marta Tilli ◽

Beatrice Borchi ◽

...

Keyword(s):

Infectious Diseases ◽

Care Center ◽

Tertiary Care ◽

University Hospital ◽

Tertiary Care Center ◽

Persistent Symptom ◽

Post Discharge

Abstract We evaluated 100 post-acute COVID-19 patients, a median of 60 days (IQR 48-67) after discharge from the Careggi University Hospital, Italy. Eighty-four (84%) had at least one persistent symptom, irrespective of COVID-19 severity. A considerable number of hospital re-admission (10%) and/or infectious diseases (14%) during the post-discharge period was reported.

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Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: A retrospective cohort study with follow-up from Mumbai, India

10.21203/rs.3.rs-88185/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

YOJANA Gokhale ◽

Rakshita Mehta ◽

Uday Kulkarni ◽

Nitin Karnik ◽

Sushant Gokhale B.Tech ◽

...

Keyword(s):

Regression Analysis ◽

Retrospective Cohort ◽

Cox Regression ◽

Virus Disease ◽

Care Center ◽

Tertiary Care ◽

Supplemental Oxygen ◽

Cytokine Storm ◽

Cox Regression Analysis

Abstract Background: Cytokine storm triggered by Severe Corona Virus Disease 2019 (COVID-19) is associated with high mortality. With high ‘Interlukin -6’ (IL-6) levels reported in COVID-19 deaths in China1, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. Aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm.Method: This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls i.e consecutive COVID-19 patients with persistent hypoxia, defined as above (N=118, from our first COVID-19 admission on 31st March to 12th May 2020 ie till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26.Results: On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427-0.903, P 0.013) and higher oxygen saturation.Conclusion: Tocilizumab improved survival in severe COVID-19 pneumonia with persistent hypoxia

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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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A Prospective Study to Observe the Results and Complications of Lateral Internal Sphincterotomy in Anal Fissure

MVP Journal of Medical Sciences ◽

10.18311/mvpjms/2015/v2/i2/779 ◽

2015 ◽

Vol 2 (2) ◽

pp. 81

Author(s):

Sandesh Pawar ◽

Sudhir D. Bhamre ◽

Vijay Malpathak ◽

Yamini Sorate

Keyword(s):

Anal Fissure ◽

Care Center ◽

Time Frame ◽

Lateral Internal Sphincterotomy ◽

Health Care Center ◽

Internal Sphincterotomy ◽

Medical College ◽

A Prospective Study ◽

Surgery Department

Aim: To observe the results and complications of lateral internal sphincterotomy in anal fissure. Materials&Methods: The study was carried out as a prospective observational study of 40 patients at surgery department of a medical college&tertiary health care center, over a period of two years that included cases of anal fissure in the age group of 16 years and above for conservative&surgical management. Results: The recovery of the patient after this marvellous operation was fast and the pain relief was dramatic. On follow-up at 2 weeks post-operatively pain and other symptoms were present only in 11 patients (27.5%). On follow-up at 8 weeks post-operatively all 40 patients (100%) were symptom-free in this study. The complications that were observed within time frame of this study were Soiling in 4 patients (10%) and incontinence to flatus in 1 patient (2.5%). There was no recurrence of anal fissure observed in this study group within the time frame of this study. Conclusion: It is very evident from the above study that 'Lateral Internal Sphincterotomy' is by far the best operation for an indolent anal fissure.

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Accidental tramadol ingestion in children admitted in tertiary care centre

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20195200 ◽

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.

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