Sonographically Guided Percutaneous Sectioning of the Coracohumeral Ligament for the Treatment of Refractory Adhesive Capsulitis: Proof of Concept

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3314-3319 ◽  
Author(s):  
Sayed Wahezi ◽  
Sandeep Yerra ◽  
Yulia Rivelis ◽  
Kishan Sitapara ◽  
David Gonzalez ◽  
...  
Keyword(s):  
Adhesive Capsulitis ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Surrounding Tissue ◽  
Proof Of Concept ◽  
Ultrasonic Probe ◽  
Coracohumeral Ligament ◽  
Percutaneous Tenotomy ◽  
Number Of Passes

Abstract Introduction Treatment options are limited for nonsurgical chronic refractory cases of adhesive capsulitis. We describe a novel percutaneous tenotomy technique for coracohumeral ligament interruption with cadaveric validation. Objective The objective of this study was to describe and validate a novel technique for percutaneous interruption of the coracohumeral ligament. Design Cadaveric study. Setting Academic tertiary care center. Methods Eight cadavers underwent ultrasound (US)-guided percutaneous incision of the coracohumeral (CHL) ligament. Performance of the procedure requires that the practitioner make oscillatory motions with a needle that uses ultrasound energy to cut through tissue. Each pass removes a pinhead-sized amount of tissue. The number of passes and the cutting time are recorded during the procedure. As a standard for this procedure does not exist, the authors created their own based on the preclinical information presented here. Postprocedure dissection was performed to assess the extent of CHL interruption and injury to surrounding tissue. Results The average resection time was seven minutes, requiring 500 passes. The technique described in this paper completely interrupted the CHL in all subjects. Cadaveric analysis demonstrated interruption of the CHL with respect to control shoulders requiring an average of seven minutes of cutting time and ∼500 micro-perforations. Conclusion US-guided percutaneous CHL ligament sectioning is possible with a commercially available ultrasonic probe.

scholarly journals Trichotillomania in Children and the Different Approaches between Dermatological and Behavioral Health Professionals at an Urban Tertiary Care Center

2020 ◽  
pp. 1-7
Author(s):  
Sneha Rangu ◽  
Leslie Castelo-Soccio
Keyword(s):  
Behavioral Health ◽  
Chart Review ◽  
Complex Disease ◽  
Behavioral Therapy ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Psychosocial Impairment ◽  
Epidemiologic Features

<b><i>Background:</i></b> Trichotillomania (TTM) is a complex disease with varying clinical characteristics, and psychosocial impairment is noted in many TTM patients. Despite its prevalence in childhood, there is limited research on pediatric TTM. <b><i>Objective:</i></b> To analyze the clinical and epidemiologic features of TTM in children evaluated by dermatologists and behavioral health specialists. <b><i>Method:</i></b> We performed a retrospective chart review of 137 pediatric patients seen at the Children’s Hospital of Philadelphia with initial presentation of TTM at age 17 or younger. Patients were treated by dermatology or behavioral health. <b><i>Results:</i></b> The majority of the patients were females, with an average diagnosis age around 8 years. Over half had a psychiatric comorbidity, and over a quarter had a skin disorder. Skin disorders were more commonly present in those evaluated by dermatology, and psychiatric comorbidities were more commonly present in those evaluated by behavioral health. The most common form of treatment was behavioral therapy, with medications prescribed more often by dermatologists. <b><i>Conclusions:</i></b> TTM patients choose to present to behavioral health or dermatology; however, there are distinctive differences between the two cohorts. With behavioral and pharmacologic treatment options, a relationship between dermatologists and behavioral health specialists is necessary for multifactorial management of TTM.

Gastrointestinal stromal tumors: Immune protein expression and clinical outcomes.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 124-124
Author(s):  
Andrew M. Blakely ◽  
Andres Matoso ◽  
Thomas J. Miner
Keyword(s):  
Clinical Outcomes ◽  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Tumor Biology ◽  
Benign Tumors ◽  
Stromal Tumors ◽  
Significant Difference

124 Background: The immune microenvironment is emerging as an important prognostic factor with potential therapeutic targets for various malignancies. Although programmed death-ligand 1 (PD-L1) and indoleamine 2,3-dioxygenase (IDO) have been studied in some tumor types, significance of their expression in gastrointestinal stromal tumors (GISTs) is largely unknown. Methods: Tissue microarrays at an academic tertiary care center were constructed from pathology files from 1996 to 2016. Immunohistochemistry for PD-L1 and IDO was performed and correlated with tumor size, mitoses, and clinical outcomes. Tumor infiltrating lymphocytes (TILs) were counted using image analysis software. Results: 131 GISTs were analyzed. Median patient age was 64 years (range 30-89); 51.1% were male. Tumor location included 89 stomach (67.9%), 34 small bowel (26.0%), 4 colorectal (3.1%), and 4 other (3.1%). Median follow-up was 58 months. Mean tumor size was 5.6±4.5cm, range 0.5 to 24; mean mitoses were 7.2/50HPF. 19 (14.5%) metastasized to mesentery (n = 8), liver (n = 6), and elsewhere (n = 5). Mean survival was 61 months (range 7-127); 5 patients died of disease (3.8%). PD-L1 immunostain was positive in 89 (67.9%), including 11 of 19 (57.9%) malignant and 78 of 112 (69.6%) benign tumors (p = 0.4). PD-L1 positive tumors were larger (6.3±4.4 vs. 4.4±3.4 cm; p = 0.02) and had more mitoses/50HPF (8.9±5.4 vs. 3.9±3.5; p = 0.006) than PD-L1 negative tumors. IDO immunostain was positive in 116 (88.5%), including 14 of 19 (73.7%) malignant and 102 of 112 (91.1%) benign tumors (p = 0.07). There was no significant difference in size or mitotic count between IDO positive and negative tumors. Mean number of CD8-positive TILs was 168±35/mm2 and mean number of PD-L1 positive TILs was 147±28/mm2 in PD-L1 positive tumors. PD-L1 positive tumors had significantly more TILs than PD-L1 negative tumors (113±21 vs. 104±18; p < 0.001). Conclusions: The majority of GISTs express PD-L1 and IDO. Expression of PD-L1 was associated with increased tumor size and higher mitotic activity. PD-L1 and IDO could play a significant role in the tumor biology of GISTs; immunotherapy targeting one or both may provide novel treatment options.

scholarly journals RECENT INCREASE IN COLISTIN-RESISTANT EXTENSIVELY DRUG RESISTANT ACINETOBACTER INFECTIONS AT A TERTIARY CARE CENTER IN PAKISTAN

2019 ◽  
Author(s):  
Nosheen Nasir ◽  
Fatima Sharif ◽  
Rubab Mansoor ◽  
Shehryar Ahmed ◽  
Bushra Jamil ◽  
...  
Keyword(s):  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Antimicrobial Treatment ◽  
Common Diagnosis ◽  
Resistant Strains ◽  
Treat All

Abstract Background Acinetobacter is an important nosocomial pathogen and a major cause of morbidity and mortality in hospitalized patients. Recently, colistin resistant strains of Acinetobacter were reported from different parts of the world. We are describing a case series of 18 patients with colistin resistant Acinetobacter over a span of 4 years. Methods Patients with any clinical specimen positive for colistin resistant Acinetobacter from 2014 to 2017 were identified from the hospital records. Three cases were isolated between 2014 and 2015, six cases in 2016 and 9 cases in 2017. Data on patients’ demographics as well as clinical data was collected retrospectively on a structured proforma from the hospital medical records. Results Mean age of the patients was 50 ± 18 years. Fifteen (83.3%) out of the 18 patients were male. Acinetobacter Pneumonia was the most common diagnosis in n=13(72.2% of the patients). Nine (50%) of the patients developed sepsis. In addition to Colistin resistance, carbapenem and amikacin resistance was documented to be 94% and 61% respectively. Colistin and carbapenem based combinations were used to treat all patients with a mean antibiotic duration of 20 ± 10 days. Median length of hospital stay was 25 days (range 8 - 61), with 14 patients (77.8%) requiring ICU admission. Eight (44.4%) of the patients expired and only 6 (33.3%) achieved microbiological eradication. Conclusion Infections due to Colistin resistant strains of Acinetobacter are rapidly increasing, have limited antimicrobial treatment options and are associated with poor outcomes.

Alfacalcidol versus calcitriol in the management of patient with hypoparathyroidism: a randomized control trial

2021 ◽  
Author(s):  
Soma Saha ◽  
Sreenivas Vishnubhatla ◽  
Ravinder Goswami
Keyword(s):  
Serum Calcium ◽  
Controlled Trial ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
High Serum ◽  
Serum Phosphate ◽  
Calcium Excretion ◽  
Open Label

Abstract Context Alfacalcidol and calcitriol are commonly used for managing hypoparathyroidism. Their relative merits have not been systematically assessed. Objective We compared the effect of alfacalcidol and calcitriol on phosphatemic control, hypercalciuria and associated factors in idiopathic-hypoparathyroidism (IH). Design and Setting Open label randomized-controlled-trial, tertiary-care-center. Subjects and Methods IH patients with optimal calcemic control on alfacalcidol were continued on the same (n=20) or switched to calcitriol (n=25) at half of the ongoing alfacalcidol dose. The dose was adjusted during follow-up to maintain serum total calcium between 8.0-9.5 mg/dL. Serum calcium, phosphorus, 25-hydroxyvitamin-D, 1,25-dihydroxyvitamin-D, 24-hr urine calcium-to-creatinine ratio, fractional-excretion-of-phosphorus (FEPh) were measured at baseline and six-months. Plasma intact-FGF23 was measured at final follow-up. Result Patients receiving alfacalcidol and calcitriol had comparable serum calcium at six-months (8.7 ± 0.4 vs. 8.9 ± 0.4 mg/dL, P = 0.13). Their median (IQR) dose at six-months was 2.0 (1.0-2.5) and 0.75 (0.5-1.0) µg/d, respectively. Serum 1,25(OH)2D levels were physiological in both (35.3 ± 11.6 and 32.3 ± 16.9 pg/ml). Serum phosphate and calcium-excretion were comparable in two arms. Majority had hyperphosphatemia (75% vs. 76%), hypercalciuria (75% vs. 72%) and elevated FGF23 (116 ± 68 and 113 ± 57 pg/mL). Age showed significant independent association with plasma FGF23 (β = 1.9, P = 0.001). Average FEPh was low despite high FGF23. Conclusion At optimal calcium control both alfacalcidol and calcitriol lead to comparable but high serum phosphate levels, hypercalciuria, physiological circulating 1,25(OH)2D and elevated FGF23. Further studies are required to systematically investigate other treatment options.

scholarly journals Efficacy of colistin in multidrug-resistant neonatal sepsis: experience from a tertiary care center in Karachi, Pakistan

2020 ◽  
Vol 105 (9) ◽  
pp. 830-836 ◽  
Author(s):  
Gul Ambreen ◽  
Muhammad Sohail Salat ◽  
Kashif Hussain ◽  
Syed Shamim Raza ◽  
Umer Ali ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Electrolyte Imbalance ◽  
High Morbidity ◽  
Gram Negative Bacteria ◽  
Record Review

ObjectiveInfections with multidrug-resistant organisms (MDROs) such as Gram-negative bacteria have high morbidity and mortality with limited treatment options. Colistin, an antibiotic active against MDRO, was rarely used due to frequent adverse effects, but its use has now been recommended among adults. In this study, we determined the efficacy of colistin for the treatment of sepsis in neonates.Design/setting/patients/outcomesWe conducted a retrospective record review of all neonates admitted to the neonatal intensive care unit of Aga Khan University Hospital, Karachi, Pakistan, between June 2015 and June 2018, who had sepsis and received colistin by intravenous, inhalation and/or intrathecal routes. Predictors of colistin efficacy, for neonatal survival and microbial clearance, were assessed using multiple logistic regression.Results153 neonates received colistin; 120 had culture-proven sepsis; and 93 had MDR-GNB (84 colistin-sensitive). 111 (72.5%) neonates survived and were discharged from hospital; 82.6% had microbial clearance. Neonates with colistin-sensitive bacteria (adjusted OR (AOR)=3.2, 95% CI 2.8 to 4.0), and those in which colistin therapy started early (AOR=7.2, 95% CI 3.5 to 13.6) were more likely to survive. Neonates with increased gestational age (AOR=1.9, 95% CI 1.5 to 3.0), higher weight (AOR=5.4, 95% CI 3.3 to 11.8) and later onset of sepsis (AOR=4.3, 95% CI 2.0 to 9.0) had higher survival. Adverse events included nephrotoxicity in 5.2%; 13.7% developed seizures and 18.3% had electrolyte imbalance.ConclusionsColistin therapy was associated with survival among neonates suffering from MDR-GNB sepsis. The frequency of side effects was moderate.

scholarly journals Inducible and constitutive clindamycin resistance in Staphylococcus aureus in a northeastern Indian tertiary care hospital

2015 ◽  
Vol 9 (07) ◽  
pp. 725-731 ◽  
Author(s):  
Amit Banik ◽  
Annie Bakorlin Khyriem ◽  
Jeetendra Gurung ◽  
Valarie Wihiwot Lyngdoh
Keyword(s):  
Staphylococcus Aureus ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Care Hospital ◽  
Sensitivity Testing ◽  
In Vitro Susceptibility ◽  
Routine Identification

Introduction: Staphylococcus aureus is one of the most common pyogenic bacteria. They are notorious for developing prompt resistance to newer antimicrobials. With increasing incidence of methicillin-resistant S. aureus (MRSA) isolates, the treatment options are also becoming limited. Clindamycin is an excellent drug for skin and soft tissue infections, but resistance mediated by the inducible phenotype (iMLSB) leads to in vivo therapeutic failure even though there may be in vitro susceptibility. The double disk approximation test (D-test) can reliably detect the presence of such isolates. This study was aimed to detect and report the prevalence of the iMLSB phenotype in NEIGRIHMS, a tertiary care center in Northeast India. Methodology: A total of 243 consecutive isolates were subjected to routine identification tests followed by antimicrobial sensitivity testing. Erythromycin-resistant isolates were tested for inducible resistance phenotype by the D-test. Results: Among strains tested, 95 (39%) were erythromycin resistant. Twenty-six (10.7%) isolates were D-test positive (iMLSB phenotype), 41 (16.88%) were constitutively resistant (cMLSB phenotype), and 28 isolates (11.52%) were found to be negative by D-test. The incidence of both inducible and constitutive phenotypes was higher in MRSA isolates compared to methicillin-sensitive S. aureus (MSSA) isolates. Conclusions: This study revealed a moderate prevalence of the inducible clindamycin phenotype in the staphylococcal isolates tested. Clinical microbiology laboratories in areas of high MRSA prevalence should consider performing the D-test routinely. This will help prevent prescription of drug(s) whose therapeutic efficacy is doubtful.

scholarly journals An audit of hysterectomies: indications, complications and clinico pathological analysis of hysterectomy specimens in a tertiary care center

2018 ◽  
Vol 7 (9) ◽  
pp. 3689
Author(s):  
Vanithamani Sivapragasam ◽  
Chellammal K. Rengasamy ◽  
Aruna B. Patil
Keyword(s):  
Clinical Diagnosis ◽  
Surgical Procedure ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Abnormal Uterine Bleeding ◽  
Bladder Injury ◽  
Histopathological Diagnosis ◽  
Invasive Treatment ◽  
Effective Treatment Option

Background: Hysterectomy is the commonest major surgical procedure performed in gynecology. It is an effective treatment option for many gynecological conditions. Aim and objective of the study was to analyse the indications, complications of hysterectomies and to see whether preoperative clinical diagnosis was confirmed by histopathology.Methods: Authors present a retrospective study of 198 hysterectomised cases over a period of one year from January 2016 to December 2016. The data regarding patients age, parity, indication for hysterectomy, type of hysterectomy, complications during and after surgery and final histopathological diagnosis were collected from the records and analysed.Results: A total of 198 cases of hysterectomies were studied. Hysterectomies were distributed over a wide age ranging from 32 years to 75 years. Most common age group was 41-50 years. Majority were done through abdominal route 162 cases (81%). Most common indication was abnormal uterine bleeding 56 (28%) and fibroid 41 (21%). One case of accidental bladder injury was noted. Most common postoperative complication was fever (23%). Most common histopathological lesion was fibroid 101 (51%). In three cases preoperative clinical diagnosis did not correlate with final histopathological diagnosis.Conclusions: As any surgical procedure, hysterectomy is also associated with risk of complications. Hence the indication should be carefully evaluated. Reporting of all hysterectomies should be made mandatory and audit results should be used for improvement of quality of health service. Newer and less invasive treatment options should be offered to women with benign pathologies. This will further reduce the incidence of hysterectomy.

scholarly journals Cervical myelopathy treatment options at BPKIHS-A tertiary care center

2017 ◽  
Vol 3 (1i) ◽  
pp. 587-590
Author(s):  
Chaudhary P ◽  
Khanal GP ◽  
Rijal R ◽  
Maharjan R ◽  
Paneru S ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Tertiary Care Center

Outcomes of scleral buckle technique performed by trainee doctors in retinal detachment

2021 ◽  
Vol 2 (3) ◽  
pp. 159-163
Author(s):  
Aalok Kumar ◽  
◽  
Sanjiv Kumar Gupta ◽  
Keyword(s):  
Retinal Detachment ◽  
Success Rate ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Case Series ◽  
Complication Rates ◽  
Scleral Buckle ◽  
Retrospective Case ◽  
Anatomical Success

AIM: To evaluate the outcomes of patients operated for retinal detachment by scleral buckle technique done by trainee doctors pursuing postgraduate course in ophthalmology. METHODS: This study was a non-comparative retrospective case series to evaluate the demography, clinical features and outcomes of patients underwent rhegmatogenous retinal detachment (RRD) repaired by scleral buckle technique from July 2017 to February 2018 at a tertiary care center in India. Records of all these patients were screened. Statistical analyses were performed and using Fisher's exact test, Mann-Whitney test and Nominal Logistic regression. RESULTS: Totally of 41 patients were included out of which, 32 (78.04%) were males and 9 (21.95%) were females. In our study primary anatomical success rate was 95.12%, with significant visual gain. Postoperative complications were raised intraocular pressure (n=2), new breaks (n=2) and re-detachment in 2 patients which was successfully managed by pars plana vitrectomy (PPV) with internal tamponade and laser. CONCLUSION: The study showed that scleral buckle surgeries done by trainee doctors under supervision can achieve a high success rate in patients of RRD both in terms of postoperative anatomical success, visual acuity and complication rates. Thus, scleral buckle surgery can be an acceptable primary procedure for trainee doctors for management of RRD in selected cases despite the various treatment options now available.

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