scholarly journals 264. A 20-year Study of Intracranial Pyogenic Complications of Sinusitis in Children

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S238-S238
Author(s):  
Jennifer Tat ◽  
Mina Smiljkovic ◽  
Susan E Richardson ◽  
Aaron Campigotto ◽  
Sharon Cushing ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Retrospective Chart Review ◽  
International Classification Of Diseases ◽  
Symptom Duration ◽  
Upper Respiratory Tract ◽  
Streptococcus Anginosus ◽  
Presenting Symptoms ◽  
Pott’S Puffy Tumor ◽  
Classification Of Diseases ◽  
Intracranial Complications

Abstract Background Intracranial pyogenic complications of sinusitis in children are relatively uncommon but can lead to serious sequelae. The objective of this study was to characterize the clinical, epidemiologic and microbiologic characteristics of children with such complications over a 20-year period (2000- 2019). Methods Single-center retrospective chart review. Cases were identified based on International Classification of Diseases (ICD)-10 diagnostic codes (intracranial abscess or granuloma, extradural and subdural abscess, Pott’s puffy tumor, acute or chronic sinusitis) and by reviewing all microbiological samples of intracranial pus, tissue or fluid. Results 108 cases of clinically and/or radiologically diagnosed sinusitis were included after review of 1591 charts. The majority were adolescents (median age 12, IQR 9-14); 72 were male (67%). The most common presenting symptoms were fever (84%), headache (87%) and symptoms of upper respiratory tract infection (57%). Median symptom duration was 10 days (IQR 5-21) and 55 cases (51%) received oral antibiotics prior to admission. The most frequent complications were epidural empyema (n=50, 46%), subdural empyema (n=46, 43%) and Pott’s puffy tumor (n= 31, 29%). 50% (n=54) underwent neurosurgery, of which 20% (n=11) required multiple craniectomies. 38% (n=41) underwent otolaryngological surgery. Microbiological data from sterile specimens demonstrated single organisms in 36 cases (59%) and polymicrobial growth in 25 cases (41%). The most frequently identified pathogens were Streptococcus anginosus (n=40, 66%) followed by Fusobacterium species (n=10, 16%) and Prevotella species (n=10,16%). Most cases were treated with combination antibiotic therapy (n=68, 63%) and 14% (n=15) with a carbapenem. The median duration of intravenous antibiotic therapy was 51 days (IQR 42-80). One child died and 23% (n=25) suffered neurological sequelae (median follow-up 344 days). 48 cases (44%) occurred between 2014-2019. Conclusion Intracranial complications of sinusitis continue to cause significant morbidity in children. The predominant causative pathogen was Streptococcus anginosus. Polymicrobial infections are common, confirming the need for prolonged broad-spectrum antibiotic treatment. Disclosures Sharon Cushing, MD, MSc, FRCSC, Cochlear Corporation (Research Grant or Support)Cochlear Corporation (Speaker’s Bureau)Interacoustics (Speaker’s Bureau)Plural publishing (Other Financial or Material Support, Royalties: editor: manual of pediatric balance disorders)

Clinical manifestations in patients with acute and transient psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. S363-S364
Author(s):  
Á. López Díaz ◽  
A. Soler Iborte ◽  
S. Galiano Rus ◽  
J.L. Fernández González ◽  
J.I. Aznarte López
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Clinical Manifestations ◽  
Retrospective Chart Review ◽  
International Classification Of Diseases ◽  
Exact Test ◽  
Chi Squared ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Competing Interest

IntroductionThe term, acute and transient psychosis, is comprehended as a heterogeneous group of disorders, which share, as a common feature, the abrupt and brief deployment of typical psychotic behaviour, either polymorph, delusional, or schizophreniform. This diversity of symptoms may also be present in other psychotic disorders, for which, some authors question its reliability.ObjetiveTo analyse the clinical manifestations present in acute and transient psychotic disorders (ATPD), and determine the differences between its different subcategories.MethodRetrospective chart review study of adult patients admitted in our psychiatric unit between 2011 and 2015, with a mean diagnosis of ATPD at hospital discharge. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Symptoms were divided under operative procedures, as set out in psychopatologic descriptions. For methodological reasons, statistical analysis was conducted between polymorphic features group (PM) and nonpolymorphic group (NPM). Chi-squared test and Fisher's exact test (as appropriate) were performed, using MedCalc software.ResultsThirty-nine patients met the inclusion criteria. Acute polymorphic psychotic disorder with and without symptoms of schizophrenia (39%), acute schizophrenia-like psychotic disorder (20%), acute predominantly delusional psychotic disorder (23%), other and NOS (18%). There were statistically significant differences between PM and NPM groups in emotional turmoil (>PM, P = 0.0006), grossly disorganized or abnormal motor behaviour (>PM, P = 0.0038), and type of onset (sudden >PM, P = 0.0145).ConclusionCurrently, the same concept encompasses two categories (PM and NPM) to be differentiated. The ATPD construct is under review, due its long-term instability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Analysis of the primary incidence of conscript military personnel of the Navy and Russian Ground Forces over the last 10 years (2010–2019)

2021 ◽  
Vol 6 (4) ◽  
pp. 63-72
Author(s):  
V. I. Evdokimov ◽  
P. P. Sivashchenko
Keyword(s):  
Respiratory Tract ◽  
Military Personnel ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Subcutaneous Tissue ◽  
International Classification Of Diseases ◽  
Upper Respiratory Tract ◽  
Total Contribution ◽  
Classification Of Diseases ◽  
Icd 10

The purpose of the study is to analyze the primary incidence of conscript military personnel of the Navy and Ground Forces over the last 10 years from 2010–2019.Methodology. We conducted a selective statistical analysis of medical reports on the health status of personnel and the activities of the medical service in the form of 3/MED of military units, in which served about 80% of the total number of conscript military personnel of the Navy and Russian Ground Forces. The primary incidence of conscript military personnel was correlated with the chapters of the International Classification of Diseases, 10 th revision (ICD-10).Results and their discussion. The average annual incidence rate of conscript military personnel for the Navy amounted to 1143,4–59,1‰, of the Ground Forces was higher at the level of trends — 1345,9–86,1‰. The dynamics of the primary incidence of conscript military personnel of the Navy showed a decrease in data, the Ground Forces — resembled an inverted U-curve with maximum rates in 2013–2014. The leading chapters of diseases of the primary incidence of the Russian Navy and the Army were respiratory diseases (X chapter), skin and subcutaneous tissue diseases (XII chapter), some infectious and parasitic diseases (chapter I), digestive diseases (XI chapter) and bone disease -muscular system and connective tissue (XIII chapter). The total contribution of these classes to the structure was 83,9 and 84,5%, respectively. Indicators of primary morbidity of acute respiratory infections of the upper respiratory tract (J00–J06), infections of the skin and subcutaneous tissue (L00–L08), and other acute lower respiratory infections were of a different significance for the conscripts of the Russian Navy and the Ground Forces of rank 1–6 respiratory tract (J20–J22), flu and pneumonia (J10–J18), diseases of the esophagus, stomach and duodenum (K20–K31) and viral infections characterized by lesions of the skin and mucous membranes (B00–B09). The distinctive features of the primary morbidity of military personnel of the Navy and Ground Forces by disease classes and leading nosologies are revealed. The total contribution of the listed nosologies (groups in chapters) to the structure was 71,3 and 73,2%, respectively.

Current State of Psychiatric Nosology

2016 ◽  
Author(s):  
Michael B. First
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Health Care Professionals ◽  
International Classification Of Diseases ◽  
Presenting Symptoms ◽  
Current State ◽  
Effective Interventions ◽  
Classification Of Diseases ◽  
Psychiatric Conditions

Psychiatric classifications categorize how patients present to mental health care professionals and are necessarily utilitarian. From the clinician’s perspective, the most important goal of a psychiatric classification is to assist them in managing their patients’ psychiatric conditions by facilitating the selection of effective interventions and predicting management needs and outcomes. Due to the field’s lack of understanding of the neurobiological mechanisms underlying the psychiatric disorders in both the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), diagnosis and treatment are only loosely related, thus limiting clinical utility. Both DSM and the chapter on mental and behavioral disorders in ICD adopted a descriptive atheoretical categorical approach that defines mental disorders according to syndromal patterns of presenting symptoms. This chapter discusses the fundamental challenges that underlie this decision. It then reviews the Research Domain Criteria (RDoC) project, a research framework established by the U.S. National Institute of Mental Health (NIMH) to assist researchers in relating the fundamental domains of behavioral functioning to their underlying neurobiological components. Designed to support the acquisition of knowledge of causal mechanisms underlying mental disorders, RDoC may facilitate a future paradigm shift in the classification of mental disorder.

Clinical Outcomes Utilizing a “Modified Latham” Appliance for Presurgical Infant Orthopedics in Patients With Unilateral Complete Cleft Lip and Palate

2018 ◽  
Vol 56 (7) ◽  
pp. 929-935 ◽  
Author(s):  
Diana S. Jodeh ◽  
Stephen Ruso ◽  
Randy Feldman ◽  
Ernesto Ruas ◽  
S. Alex Rottgers
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Retrospective Chart Review ◽  
International Classification Of Diseases ◽  
Average Hospital ◽  
Classification Of Diseases ◽  
Cleft Lip Palate ◽  
Direct Approximation ◽  
Infant Orthopedics

Presurgical infant orthopedic manipulation is utilized prior to cleft lip/nasal repair to facilitate a gingivoperiosteoplasty (GPP) and primary nasolabial repairs. The Latham dentomaxillary advancement appliance uses a screw that must be tightened daily to approximate the cleft segments in unilateral complete clefts. Our cleft center has been utilizing a “modified Latham” appliance since 1987, including an orthodontic elastic power chain to close the gap in a shorter amount of time. We performed a retrospective chart review of all patients undergoing treatment at Johns Hopkins All Children's Hospital (JHACH) with a unilateral complete cleft lip and palate between 1987 and 2017. Patients were identified by the International Classification of Diseases, Ninth Revision code (749.21). The majority of the patients represent the experience of the senior authors (E.R. and R.F.). Two hundred and eighty-one patients with unilateral complete cleft lip/palate were identified. Seventy-five patients were treated with a “modified Latham” appliance prior to their lip repair. The “modified Latham” appliance remained in place on average 20.6 days (range: 4-82), and average hospital stay after placement was 1.18 days. Nearly 96% of patients underwent a successful GPP at the time of nasolabial repair. Modification of the Latham appliance by utilizing an elastic power chain and eliminating the screw allows rapid closure of the alveolar cleft with limited need for adjustments and outpatient visits. Direct approximation of the palatal segments allows successful completion of a GPP in 95.9% of patients with limited dissection.

Hospitalizations in Patients with Systemic Lupus Erythematosus in an Academic Health Science Center

2017 ◽  
Vol 44 (8) ◽  
pp. 1173-1178 ◽  
Author(s):  
Kaien Gu ◽  
Dafna D. Gladman ◽  
Jiandong Su ◽  
Murray B. Urowitz
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Length Of Stay ◽  
Lupus Erythematosus ◽  
Retrospective Chart Review ◽  
International Classification Of Diseases ◽  
Health Science ◽  
Science Center ◽  
Systemic Lupus ◽  
Short Period ◽  
Classification Of Diseases

Objective.Hospitalization occurs in about 10% of patients with systemic lupus erythematosus (SLE) each year and accounts for most of the direct cost of SLE patient care. We aimed to determine the frequency of admissions of patients with SLE and describe their causes and outcomes.Methods.We identified all hospitalizations at University Health Network in the periods 2011–2012 and 2013–2015 with an International Classification of Diseases, 10th ed. code of M32 (SLE). A retrospective chart review of these patients categorized them based on SLE care provider and cause of admission. Frequency of emergency room visits and duration of hospitalization were ascertained. Poisson and linear regressions were performed to determine factors associated with frequency and duration of hospitalizations.Results.There were 247 unique patients with SLE who were hospitalized a total of 491 times: 87.4% were women, average age of 43.9 ± 17.9 years, and disease duration 13.7 ± 12.3 years. Incidental causes were most common (35.6%); 21.4% and 22.4% of admissions were because of active SLE and infection, respectively. The patients with SLE averaged 1.6 hospitalizations lasting 8.5 days. Thirteen percent of hospitalizations resulted in intensive care unit admission, and 2.8% of hospitalizations resulted in death. Patient employment was associated with fewer hospitalizations during 2011–2015. Antimalarial use was associated with fewer hospitalizations as well as shorter length of stay during 2011–2012. The presence of damage correlated with increased hospitalizations. Higher educational level and antimalarial use correlated with shorter length of stay.Conclusion.Patients with SLE are frequently hospitalized, often because of active SLE or infection, and re-hospitalized within a short period of time.

General provisions and features of statistical records of the upper respiratory tract diseases, ear and mastoid process in children

2020 ◽  
Vol 40 (4) ◽  
pp. 61-69
Author(s):  
S. O. Samusenko ◽  
◽  
O. I. Serdyuk ◽  
I. V. Filatova ◽  
◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Age Groups ◽  
International Classification Of Diseases ◽  
Mastoid Process ◽  
Upper Respiratory Tract ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Upper Respiratory ◽  
Statistical Trends

The formation of medical statistical information and the effectiveness of statistical records of diseases of the upper respiratory tract, ear and mastoid process in children on the basis of the current International Classification of Diseases, 10th revision (ICD-10). The relevance of the analysis of the completeness and effectiveness of statistical records of the incidence of diseases of the upper respiratory tract, ear and mastoid process is substantiated. It is established that the reporting of the incidence of the child population on upper respiratory tract, ear and mastoid process is carried out in accordance with the headings of the ICD-10 revision. The requirements of the ICD-11 revision do not make significant changes in the statistical records. Features of statistical records of diseases of the upper respiratory tract, ear and mastoid process on the basis of the modern classifier of diseases — ICD-10 are shown and characterized. The shortcomings of statistical records of diseases of the ear and mastoid process in children in terms of clinical assessment of cases. The reasons of probable underestimation of statistical indicators of incidence of diseases of the upper respiratory tract in this category of patients are analyzed. The presence of differences in the formation of groups of statistical accounting of the incidence of the ear, nose and throat organs in children during the analysis of statistical trends has been proved. It is concluded that this contributes to the inaccuracy of accounting and data analysis, which hinders the development of adequate management decisions. It is shown the expediency of developing indicators, bringing into line the criteria for the formation of age groups for statistical records and creating a single register of nosology for such records at different levels.

scholarly journals Implication and Management of Incidental Oropharyngeal Papillomas—A Retrospective Case Series Review

2019 ◽  
pp. 014556131987122
Author(s):  
Daniel Kim ◽  
Justin Siegel ◽  
Robert J. Chouake ◽  
Jan Geliebter ◽  
Craig H. Zalvan
Keyword(s):  
Case Series ◽  
Operative Management ◽  
International Classification Of Diseases ◽  
Pathology Report ◽  
Ktp Laser ◽  
Retrospective Case ◽  
Ablation Therapy ◽  
Presenting Symptoms ◽  
Classification Of Diseases

Introduction: Incidental papillomas of the pharynx can be found while examining the nasopharynx, oropharynx, and hypopharynx for other disorders of the head and neck. Purpose of the study is to explore the location, biopsy protocol, and decision to perform office-based versus operative management via potassium titanyl phosphate (KTP) laser when an oropharyngeal papilloma is discovered incidentally. Methods: A retrospective review of the senior author’s patient population was performed using Current Procedural Terminology and/or International Classification of Diseases codes to identify patients who had KTP laser removal of incidental oropharyngeal papillomas. Patients were included based on the incidental nature of the papilloma and confirmed pathology report of squamous papilloma. Demographics, presenting complaint, lesion location, pathological analysis, type of intervention, and outcomes were recorded. When available, human papillomavirus (HPV) subtype was noted. Results: A total of 26 cases were identified, 13 females and 13 males. The median age at time of surgery was 58 years (range: 21-77). The most common presenting symptoms were difficulty swallowing and throat pain. The most common locations were the base of tongue, uvula, tonsils, and the soft palate. Of the 26 patients, 23 patients received KTP laser ablation therapy as an office-based procedure, while the remaining 3 were performed under general anesthesia in the operating room. Only 5 patients had a recorded recurrence that required reoperation. There were no operative or postoperative complications. There were 16 biopsy samples tested for HPV, where 12 were negative for HPV and 4 were positive for HPV. Conclusion: Oropharyngeal papillomas, when present, can be found incidentally during examination of the oropharynx for other symptoms. Office-based biopsy and KTP laser is a safe and efficient means of identifying and removing most oropharyngeal papillomas.

scholarly journals Management of Breast Cancer during Pregnancy: Are We Compliant with Current Guidelines?

2017 ◽  
Vol 07 (01) ◽  
pp. e39-e43 ◽  
Author(s):  
Victoria Shlensky ◽  
Sigrun Hallmeyer ◽  
Lourdes Juarez ◽  
Barbara Parilla
Keyword(s):  
Breast Cancer ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
International Classification Of Diseases ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Classification Of Diseases ◽  
Cancer In Pregnancy ◽  
In Pregnancy

Introduction The purpose of this study was to evaluate the management of patients with breast cancer in pregnancy treated at the Advocate Health Care, to determine whether these patients were treated according to guidelines for pregnant patients, which aim to maximize both fetal and maternal outcomes. Methods A retrospective chart review was performed at the Advocate Lutheran General Hospital, Christ Medical Center, and Illinois Masonic Medical Center from 2002 to 2012 on patients diagnosed with breast cancer during pregnancy using ICD-9 (International Classification of Diseases - 9th version) codes. Results Eleven patients between 12 and 37 weeks' gestation matched the search criteria. One patient terminated the pregnancy. Patients in our study were treated appropriately according to guidelines with the following exceptions. Trastuzumab was used in one patient during pregnancy which likely caused the oligohydramnios resulting in an induction of labor at 33 weeks. Three patients were delivered preterm between 34 and 36 weeks without an obstetric indication. Two patients underwent sentinel node biopsy. Conclusion The diagnosis of breast cancer in pregnancy is an infrequent but devastating diagnosis that is likely to increase. Although sentinel lymph node biopsy is not generally recommended in pregnancy, this may be an outdated guideline as using a low-dose lymphoscintigraphic technique appears to be safe in pregnancy.

Prevalence and Management of Gastrointestinal Stromal Tumors

2009 ◽  
Vol 75 (1) ◽  
pp. 55-60 ◽  
Author(s):  
David Machado-Aranda ◽  
Matthew Malamet ◽  
Yeon-Jeen Chang ◽  
Michael J. Jacobs ◽  
Lorenzo Ferguson ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Retrospective Chart Review ◽  
International Classification Of Diseases ◽  
Vaginal Septum ◽  
Curative Therapy ◽  
Telephone Interviews ◽  
Classification Of Diseases ◽  
Common Clinical Presentation ◽  
Pathology Reports ◽  
Immunohistochemical Techniques

The prevalence and characteristics of patients with confirmed gastrointestinal stromal tumor (GIST) in a community hospital over a 6-year period are described. Our objective was to communicate our experience managing this rare tumor of the gastrointestinal tract. A retrospective chart review was performed. Patients were selected based on International Classification of Diseases, 9th Revision codes in correlation with their respective confirmational pathology. Patients with a diagnosis of GIST, cells of Cajal tumor, and/or different varieties of gastrointestinal sarcoma were included in this study. These tumors had to have a positive C-kit on immunohistochemistry. Demographic and clinical data were collected from medical records as well as pathology reports. Follow up from attendings’ office records and telephone interviews complemented our data. A total of 61 patients was identified in our institution (averaging 10 patients per year). Females represented 63 per cent of our series. The average ages were 70.2 ± 19.1 years for females and 59.4 ± 13.5 years for males ( P < 0.01). The most common clinical presentation was an intra-abdominal nonobstructing mass followed by an endoscopically detected mass or incidental tumors found during unrelated surgery. Surgical emergencies such as acute abdomen and gastrointestinal bleed were rare. Over half of these tumors were located in the stomach. Other sites were the small intestine, colon, esophagus, and rectal–vaginal septum. Opened surgical resection was performed in two-thirds of treated cases, whereas laparoscopic resection was done in the remainder. Only 18 per cent of these tumors were considered benign, whereas 35 per cent were considered to have some malignant potential and 47 per cent were of undetermined potential. In surgically resected tumors, we found a 42 per cent recurrence rate with a median average time of recurrence of 22 months. Pathologic grading and type of surgery were not predictors of rate and timing of recurrence. However, the disease tended to be more aggressive in white males and age older than 70 years. Imatinib was used mainly in attempts to downstage, control recurrent disease, and make surgery possible. With the improvement of immunohistochemical techniques, the diagnosis of GIST is increasing. Preoperative diagnosis is highly uncertain and dependent on clinical suspicion. Surgical resection is still the main form of curative therapy. Our experience is similar to large-volume centers. GIST, once recognized, can be treated in community hospitals without compromise of their care.

scholarly journals Management of delirium at an academic medical center: Plans for antipsychotic prescribing upon discharge

2020 ◽  
Vol 10 (1) ◽  
pp. 25-29
Author(s):  
Lauren Halavonich ◽  
Sophie Robert ◽  
Dan McGraw ◽  
Erin Weeda ◽  
Kristen Mullinax ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Positive Association ◽  
International Classification Of Diseases ◽  
Discharge Instructions ◽  
Academic Medical ◽  
Classification Of Diseases ◽  
Antipsychotic Prescribing

Abstract Introduction Delirium is an acute, fluctuating change in mental status, often associated with behavioral manifestations such as agitation. Literature suggests that many patients who continue on antipsychotics for extended management of delirium are not provided instructions for discontinuation. However, there is a positive correlation between consult services and instructions for discontinuation. The objective of this study was to determine the frequency at which patients with delirium were prescribed an antipsychotic at hospital discharge and to characterize discharge antipsychotic prescribing for psychiatric consult and nonconsult cohorts. Methods This study was a retrospective chart review of adult patients with an International Classification of Diseases 10th revision code of delirium who received at least 1 dose of antipsychotic during their admission. Inclusion criteria were all patients aged 18 years or older with a diagnosis of or relating to delirium who were administered antipsychotics during their admission. Results A total of 152 patients were included, of which 43 received a psychiatric consult. Antipsychotics were prescribed at discharge for management of delirium for 52 (34.2%) of 152 total patients. More patients in the psychiatric consult cohort were discharged with an antipsychotic as compared to those in the nonconsult cohort (53.3% vs 26.6%, P =  .02). Discussion Compared to previous studies, patients in this retrospective review were more likely to be discharged on an antipsychotic that was initiated during admission for management of delirium. Findings from this study also align with prior research demonstrating a positive association between antipsychotic discharge instructions and specialty consult recommendations.

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