Novel Adaptive T-Cell Oncological Treatments Lead to New Challenges for Medical Emergency Teams: A 2-Year Experience From a Tertiary-Care Hospital in Switzerland

Cerebral malaria (CM) is the most severe neurological presentation of acute falciparum malaria. It is a medical emergency, the hallmark of which is the presence of coma probably due to diffuse encephalopathy. A compromised microcirculation with sequestration of parasitized erythrocytes is central to the pathogenesis of cerebral malaria. The death is unacceptably high even with effective antimalarials in tertiary care hospital. The mainstay of treatment of cerebral malaria include prompt diagnosis and early institution of effective antimalarial therapy, recognition of complications, and appropriate supportive management in an ICU. Neurological sequlae are increasingly recognized, but further research on the pathogenesis of coma and neurological damage is required to develop other ancillary treatmentsNorthern International Medical College Journal Vol.6(2) 2015: 45-47

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Success Rate of Endoscopic Sphenopalatine Artery Ligation for the Management of Refractory Posterior Epistaxis Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.5855 ◽

2020 ◽

Vol 58 (232) ◽

Author(s):

Meenakshi Basnet ◽

Bibek Ghimire ◽

Akriti Shrestha ◽

Gyan Raj Aryal

Keyword(s):

Success Rate ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Medical Emergency ◽

Care Hospital ◽

Sectional Study ◽

Artery Ligation ◽

Cross Sectional ◽

Sphenopalatine Artery

Introduction: Epistaxis is a common medical emergency with 5% to 15% of patients admitted for epistaxis will require surgical management as nasal packing has high failure rates. A modern endoscopic technique like Endoscopic Sphenopalatine Artery Ligation has increased in popularity for managing intractable posterior epistaxis. It has less complication and a high success rate. The study conducted to estimate the success rate of Endoscopic Sphenopalatine Artery Ligation of refractory posterior epistaxis among admitted patients in a tertiary care hospital. Methods: This is a descriptive cross-sectional study conducted from June 2019 to June 2020 at the Department of Otorhinolaryngology, Nobel Medical College and Teaching Hospital among the patient with refractory posterior epistaxis with the help of retrospective data. A convenient sampling method was used. These patients underwent endoscopic sphenopalatine artery cauterization for recurrent/intractable posterior epistaxis. Ethical clearance was taken from the Institutional Review Board. Data were analyzed in Statistical Package for the Social Sciences. Results: Out of the total patient with refractory posterior epistaxis who underwent Endoscopic Sphenopalatine Artery Ligation, the overall success rate was 39 (95.12%). Among them, 25 (60.97%) males and 16 (39.02%) females underwent endoscopic sphenopalatine artery ligation. Twenty (48.78%) of them were unilateral whilst 21 (51.21%) were bilateral disease. About 2 (4.8%) cases had re-bleeding within 48 hours which was managed conservatively. Hypertension was found to be the most common comorbid condition followed by diabetes, chronic kidney. Conclusions: From our study, we conclude that the success rate for Endoscopic Sphenopalatine Artery Ligation in a patient with refractory posterior epistaxis was high.

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Impact of a Local Low-Cost Ward-Based Response System in a Canadian Tertiary Care Hospital

Critical Care Research and Practice ◽

10.1155/2016/1518760 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8

Author(s):

Andrea Blotsky ◽

Louay Mardini ◽

Dev Jayaraman

Keyword(s):

Clinical Teaching ◽

Tertiary Care Hospital ◽

Low Cost ◽

Tertiary Care ◽

Medical Emergency ◽

Care Hospital ◽

Response System ◽

Code Blue ◽

Initial Intervention ◽

Teaching Unit

Background. Medical emergency teams (METs) or rapid response teams (RRTs) facilitate early intervention for clinically deteriorating hospitalized patients. In healthcare systems where financial resources and intensivist availability are limited, the establishment of such teams can prove challenging.Objectives. A low-cost, ward-based response system was implemented on a medical clinical teaching unit in a Montreal tertiary care hospital. A prospective before/after study was undertaken to examine the system’s impact on time to intervention, code blue rates, and ICU transfer rates.Results. Ninety-five calls were placed for 82 patients. Median time from patient decompensation to intervention was 5 min (IQR 1–10), compared to 3.4 hours (IQR 0.6–12.4) before system implementation (p<0.001). Total number of ICU admissions from the CTU was reduced from 4.8/1000 patient days (±2.2) before intervention to 3.3/1000 patient days (±1.4) after intervention (IRR: 0.82,p=0.04(CI 95%: 0.69–0.99)). CTU code blue rates decreased from 2.2/1000 patient days (±1.6) before intervention to 1.2/1000 patient days (±1.3) after intervention (IRR: 0.51,p=0.02(CI 95%: 0.30–0.89)).Conclusion. Our local ward-based response system achieved a significant reduction in the time of patient decompensation to initial intervention, in CTU code blue rates, and in CTU to ICU transfers without necessitating additional usage of financial or human resources.

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Comparison of outcome of milwaukee regimen and 48 hours regimen in diabetic ketoacidosis in a tertiary care hospital in Chitradurga, Karnataka, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20201651 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1123

Author(s):

Basavanthappa S. P. ◽

Srinivasa V. ◽

Sivachand T.

Keyword(s):

Diabetic Ketoacidosis ◽

Tertiary Care Hospital ◽

Average Length ◽

Venous Blood ◽

Tertiary Care ◽

Medical Emergency ◽

Care Hospital ◽

Mortality And Morbidity ◽

Pediatric Age Group

Background: Diabetic ketoacidosis (DKA) is an acute life threatening and a medical emergency that accounts for the majority of diabetes related mortality and morbidity in the pediatric age group who are suffering from type 1 Diabetes Mellitus (DM). Objective of this study was to compare the clinical outcome in a patient with DKA who are been treated with Milwaukee regimen (24hours) and 48 hours regimen.Methods: A retrospective study was conducted in PICU of tertiary care hospital in Chitradurga, Karnataka. Data was collected from 2015 to May 2018. Diagnosis of DKA was made by plasma glucose level higher than 200mg/dl, venous blood PH of <7.3 and /or bicarbonate <15 mmol/L, presence of ketonuria. Among 56 cases, 36 cases were treated with 48 hours regimen and 20 cases were treated with Milwaukee regimen and results were compared.Results: The median age of presentation was 7.52 years (Range: 2-14 years) with female: male ratio of 1:1.3. Newly diagnosed type 1 DM cases constituted 80.7%. The most common presenting complaints were hurried breathing and altered sensorium. The average length of stay in the ICU was 3.5 days for 48 hours regimen and 4.5 days for Milwaukee regimen. The mortality rate was 10.71 % (6 cases), among which 15% (3 cases) were patients treated with Milwaukee and 8.3% (3 cases) were patients treated with 48 hours regimen. Cerebral edema was found to be the commonest cause of fatality.Conclusions: There is lack of awareness regarding dog bite and its management among the rural population.

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Evaluation of Baseline CD4 + T Cell Counts and ART Requirement in Newly Diagnosed HIV Seropositive Individuals in a Tertiary Care Hospital of Northern India

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2016/21595.8915 ◽

2016 ◽

Author(s):

Sonali Bhattar

Keyword(s):

T Cell ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cd4 T Cell ◽

Care Hospital ◽

Newly Diagnosed ◽

Northern India ◽

Cell Counts ◽

Hiv Seropositive

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1475. Etiology and Outcome of Fever and Respiratory Distress in Adult Patients Presenting to Medical Emergency in a Tertiary Care Hospital in North India

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1304 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S456-S457

Author(s):

Vikas Suri ◽

Harshit R Rao ◽

Ashish Bhalla ◽

Inderpaul Singh ◽

Manisha Biswal ◽

...

Keyword(s):

Respiratory Distress ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Adult Patients ◽

North India ◽

Medical Emergency ◽

Care Hospital

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Cryptococcal Antigenemia in HIV-Infected Patients with CD4+ T-cell Count ≤ 200 cells/μl: A study from a tertiary care hospital

International Journal of Contemporary Medical Research [IJCMR] ◽

10.21276/ijcmr.2020.7.2.11 ◽

2020 ◽

Vol 7 (2) ◽

Cited By ~ 1

Author(s):

Surabhi Pujari ◽

Vidya Arjunwadkar ◽

Shashikala Sangle ◽

Anju Kagal ◽

Renu Bharadwaj ◽

...

Keyword(s):

T Cell ◽

Cell Count ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cd4 T Cell ◽

Care Hospital ◽

Cd4 T Cell Count

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Frequency of electro-cardiographic changes in patients of acute organophosphate poisoning at tertiary care hospital Larkana, Pakistan

Nepalese Heart Journal ◽

10.3126/njh.v14i2.18495 ◽

2017 ◽

Vol 14 (2) ◽

pp. 5-8

Author(s):

Munawar Hussain Soomro ◽

Mansoor Magsi ◽

Rahim Baig ◽

Mohammad Aslam Soomro

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

University Hospital ◽

Electrolyte Imbalance ◽

Medical Emergency ◽

Organophosphate Poisoning ◽

Qtc Interval ◽

Care Hospital ◽

Ecg Changes ◽

History Of

Background and Aims: The organophosphate (OP) poisoning is one of the important preventable public health problems in developing countries. It is estimated that OP pesticide self-poisoning kills around 200,000 people every year. The aim of the study was to determine the frequency of electrocardiographic (ECG) changes in acute OP poisoning at tertiary care hospital Larkana, Pakistan.Methods: It was an observational retrospective study of the patients who were diagnosed with acute OP poisoning during the period of four years January 2012 to December 2015 at medical emergency department, Shaheed Mohtarma Benzir Bhutto Medical University Hospital Larkana, Pakistan. A sample of 223 patients between 16-45 years with definite history of OP ingestion, were included in study. Patients with the history of cardiac disease, diabetes mellitus, hypertension, chronic renal failure and electrolyte imbalance were excluded.Results: Mean age was 29.61 ± 8.656 years with range of 16-45 years. Duration of OP ingestion ranged from 30 to 300 minutes with mean of 167.53 ± 45.26 minutes. Sixty five percent patients were in their 3rd and 4th decades of life. Males were 122 (54.71%) while 101 (45.29%) were females. ECG changes found in 145 (65.02%) with tachycardia and bradycardia was 85 (38.1%) and 60 (26.9%) respectively. The ST elevation was noted in 59 (26.5%), depression in 50 (22.4%), T wave changes observed in 51 (22.9%) patients. QTc interval was prolonged in 129 (57.85%).Conclusion: ECG changes are frequent in OP patients. QTc interval followed by sinus arrhythmias were most common changes observed. ECG should be done in all the patients who present with OP poisoning.Nepalese Heart Journal 2017; Vol 14(2), 5-8

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Bacteriological Surveillance of Ambulance Vehicles from a Tertiary Care Hospital of North India

Journal of Laboratory Physicians ◽

10.1055/s-0041-1730848 ◽

2021 ◽

Author(s):

Shiwani Sharma ◽

Priya Datta ◽

Varsha Gupta ◽

Dipanshu Vasesi ◽

Jagdish Chander

Keyword(s):

Pathogenic Bacteria ◽

Bacterial Contamination ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Control Policy ◽

North India ◽

Medical Emergency ◽

Contamination Rate ◽

Care Hospital ◽

Frequency Of Contact

Abstract Objective An ambulance is a medically equipped vehicle which is used in case of any medical emergency for the transport of patients to treatment facilities. The ambulances help in the transportation of thousands of patients per year, and such patients may carry infectious microorganisms which pose a major threat to the treatment of such patients. In this study, we analyzed the extent of bacterial contamination in our ambulance vehicles and measured the degree of antimicrobial resistance among isolated pathogens. Material and Method This study included five ambulances of our tertiary care hospital and different random sites were swabbed in each vehicle. These were selected based on their well-known high frequency of contact by emergency personnel and patients. Swabs were inserted into sterile test tubes containing normal saline and immediately transferred to our microbiology laboratory to identify bacterial contaminants utilizing standard microbiological procedures. Result A total of 198 swab samples were collected from all the five ambulances, out of which 170 (85.8%) swabs were sterile and 28 (14.2%) swabs yielded potentially pathogenic bacterial isolates. The highest contamination rate with pathogenic bacteria was detected in the oxygen flow meter knob (60%), suction machine tubing (60%), and stethoscope (40%). Staphylococcus aureus (32%) was the most frequently detected microorganism. Conclusion Our study showed low prevalence of bacterial contamination in ambulances because of good infection control policy of our hospital, however, some areas still need improvement and require proper standard operating procedures of disinfection policies of these emergency vehicles.

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