scholarly journals Pre-endoscopy SARS-CoV-2 testing strategy during COVID-19 pandemic: The care must go on

2020 ◽  
Author(s):  
M Casper ◽  
MC Reichert ◽  
J Rissland ◽  
S Smola ◽  
F Lammert ◽  
...  
Keyword(s):  
Medical Center ◽  
Intermediate Frequency ◽  
Testing Strategy ◽  
Endoscopic Procedures ◽  
Single Center Experience ◽  
Gastrointestinal Conditions ◽  
Clinically Significant ◽  
Program Reduction ◽  
New Strategies ◽  
Hospital Capacities

ABSTRACTBackgroundIn response to the COVID-19 pandemic, endoscopic societies have recommended reduction of endoscopic procedures. In particular non-urgent endoscopies should be postponed. However, this might lead to unnecessary delay in diagnosing gastrointestinal conditions.MethodsRetrospectively we analysed the gastrointestinal endoscopies performed at the Central Endoscopy Unit of Saarland University Medical Center during seven weeks from 23 March to 10 May 2020 and present our real-world single-center experience with an individualized rtPCR-based pre-endoscopy SARS-CoV-2 testing (“PECo”) strategy.ResultsAltogether 359 gastrointestinal endoscopies were performed. The PECo strategy enabled us to conservatively handle endoscopy program reduction (44% reduction as compared 2019). The results of COVID-19 rtPCR from nasopharyngeal swabs were available in 89% of patients prior to endoscopies. Apart from six patients with known COVID-19, all other tested patients were negative. The frequencies of endoscopic therapies and clinically significant findings did not differ between patients with or without SARS-CoV-2 tests.ConclusionA reasonable reduction of the endoscopy program in the setting of structured SARS-CoV-2 testing is feasible and safe. The PECo strategy allows continuation of endoscopic procedures in a region with intermediate frequency of COVID-19 when hospital capacities are not overwhelmed by the pandemic. Thus, the study might help to develop new strategies during future waves of COVID-19 or local outbreaks.

scholarly journals Couples’ experiences with expanded carrier screening: evaluation of a university hospital screening offer

2021 ◽  
Author(s):  
Ivy van Dijke ◽  
Phillis Lakeman ◽  
Naoual Sabiri ◽  
Hanna Rusticus ◽  
Cecile P. E. Ottenheim ◽  
...  
Keyword(s):  
High Risk ◽  
Medical Center ◽  
Informed Choice ◽  
Carrier Screening ◽  
University Hospital ◽  
Structured Interviews ◽  
Expanded Carrier Screening ◽  
Post Test ◽  
Future Child ◽  
Clinically Significant

AbstractPreconception carrier screening offers couples the possibility to receive information about the risk of having a child with a recessive disorder. Since 2016, an expanded carrier screening (ECS) test for 50 severe autosomal recessive disorders has been available at Amsterdam Medical Center, a Dutch university hospital. This mixed-methods study evaluated the experiences of couples that participated in the carrier screening offer, including high-risk participants, as well as participants with a general population risk. All participants received genetic counselling, and pre- (n = 132) and post-test (n = 86) questionnaires and semi-structured interviews (n = 16) were administered. The most important reason to have ECS was to spare a future child a life with a severe disorder (47%). The majority of survey respondents made an informed decision (86%), as assessed by the Multidimensional Measure of Informed Choice. Among the 86 respondents, 27 individual carriers and no new carrier couples were identified. Turn-around time of the test results was considered too long and costs were perceived as too high. Overall, mean levels of anxiety were not clinically elevated. High-risk respondents (n = 89) and pregnant respondents (n = 13) experienced higher levels of anxiety before testing, which decreased after receiving the test result. Although not clinically significant, distress was on average higher for carriers compared to non-carriers (p < 0.0001). All respondents would opt for the test again, and 80.2% would recommend it to others. The results suggest that ECS should ideally be offered before pregnancy, to minimise anxiety. This study could inform current and future implementation initiatives of preconception ECS.

Acute exudative paraneoplastic polymorphous vitelliform maculopathy in a patient with thymoma, myasthenia gravis, and polymyositis

2021 ◽  
pp. 112067212199404
Author(s):  
He Yu ◽  
Xinyu Ma ◽  
Nianting Tong ◽  
Zhanyu Zhou ◽  
Yu Zhang
Keyword(s):  
Myasthenia Gravis ◽  
Medical Center ◽  
Postoperative Radiotherapy ◽  
Clinical Manifestations ◽  
Subretinal Fluid ◽  
Metastatic Tumor ◽  
The Body ◽  
Pleural Thickening ◽  
History Of ◽  
Clinically Significant

Importance: This is the first reported case of acute exudative paraneoplastic polymorphous vitelliform maculopathy (AEPPVM) in a patient with thymoma, accompanied by myasthenia gravis (MG) and polymyositis. Objective: To examine the pathogenesis of ocular disease in a patient with yolk-like fundus lesions and thymoma, MG, and polymyositis throughout the body based on clinical manifestations, diagnosis, differential diagnosis, and genetic testing to determine the appropriate treatment course. Design, setting, and participants: We describe a 63-year-old woman who presented to our tertiary medical center with a 3-month history of reduced visual acuity in both eyes. Concurrent fundoscopy revealed a 2.0 × 1.7-mm, unifocal, yellow, round vitelliform lesion in the macular region, surrounded by multifocal, shallow, yellow-white pockets of subretinal fluid. The patient’s medical history included thymoma with thymectomy treatment, combined with pericardiectomy and postoperative radiotherapy (20 years prior), followed by a diagnosis of MG with suspect thymic association (15 years prior). Three years prior, the patient had been diagnosed with polymyositis related to paraneoplastic syndrome; 1 year prior, she had been examined for pleural thickening due to suspected metastatic tumor. Results: On her most recent follow-up visit at 3 months after initial diagnosis, the patient was stable with no clinically significant progression in ocular or systemic conditions.

scholarly journals The Diagnostic Yield of Magnetic Resonance Cholangiopancreatography in the Setting of Acute Pancreaticobiliary Disease — A Single Center Experience

2021 ◽  
pp. 084653712110137
Author(s):  
Sultan Yahya ◽  
Abdullah Alabousi ◽  
Peri Abdullah ◽  
Milita Ramonas
Keyword(s):  
Magnetic Resonance ◽  
Diagnostic Yield ◽  
Binary Logistic Regression ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Significant Discrepancy ◽  
Logistic Regression Models ◽  
Single Center Experience ◽  
New Information ◽  
Clinically Significant ◽  
Enzyme Elevation

Purpose: To discern whether preceding ultrasound (US) results, patient demographics and biochemical markers can be implemented as predictors of an abnormal Magnetic Resonance Cholangiopancreatography (MRCP) study in the context of acute pancreaticobiliary disease. Methods: A retrospective study was performed assessing US results, age, gender, elevated lipase and biliary enzymes for consecutive patients who underwent an urgent MRCP following an initial US for acute pancreaticobiliary disease between January 2017-December 2018. Multivariable binary logistic regression models were constructed to assess for predictors of clinically significant MRCPs, and discrepant US/MRCP results. Results: A total of 155 patients (mean age 56, 111 females) were included. Age (OR 1.03, P < 0.05), hyperlipasemia (OR 5.33, P < 0.05) and a positive US (OR 40.75, P < 0.05) were found to be independent predictors for a subsequent abnormal MRCP. Contrarily, gender and elevated biliary enzymes were not reliable predictors of an abnormal MRCP, or significant MRCP/US discrepancies. Of 66 cases (43%) of discordant US/MRCPs, half had clinically significant discrepant findings such as newly discovered choledocholithiasis and pancreaticobiliary neoplasia. Age was the sole predictor for a significant US/MRCP discrepancy, with 2% increase in the odds of a significant discrepancy per year of increase in age. Conclusion: An abnormal US, hyperlipasemia and increased age serve as predictors for a subsequent abnormal MRCP, as opposed to gender and biliary enzyme elevation. Age was the sole predictor of a significant US/MRCP discrepancy that provided new information which significantly impacted subsequent management. In the remaining cases, however, MRCP proved useful in reaffirming the clinical diagnosis and avoiding further investigations.

Abstract 102: Adding Computed Tomography Angiography (CTA) to the Acute Stroke Evaluation: A Single-center Experience

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Matthew E Ehrlich ◽  
Heather L Turner ◽  
Lillian J Currie ◽  
Max Wintermark ◽  
Bradford B Worrall ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Medical Center ◽  
Single Center Experience ◽  
Intracranial Vessel ◽  
Vessel Imaging ◽  
Stroke Team ◽  
Significant Difference ◽  
Increase Risk ◽  
Baseline Creatinine ◽  
The University

Objective: To evaluate the safety and utility of CTA acquisition during initial acute stroke evaluation. We hypothesized CTA would not increase risk of renal injury or delay therapy. Design/Methods: We performed a pilot study of CTA acquisition in the acute stroke evaluation at the University of Virginia Medical Center in the first three quarters of 2014. We extracted data from Acute Stroke Team Leader consultations with additional chart review. We collected door-to-CT read times, door-to-needle times, baseline creatinine (Cr) values on presentation, and Cr values 24-48 hours after stroke alert evaluation. Differences in means of these variables were compared between those receiving CTA versus non-contrasted head CT (NCHCT) only. Additionally, we captured CTA results immediately relevant to treatment decisions. Results: Of 289 patients, 157 had CTA completed while 132 had only NCHCT. In the CTA group, 18 patients (11.5%) were treated with IV tissue plasminogen activator (tPA) compared to 11 (8.3%) in the NCHCT group, with no significant difference between groups (p=0.377). There was no difference between mean door-to-CT-read times between the NCHCT (43.07 minutes) and CTA (41.46 minutes) groups (p=0.70). Likewise, there was no significant difference in mean door-to-needle times between the NCHCT (81.36 minutes) and CTA (68.11 minutes) groups (p=0.577). There was a difference between mean Cr values on presentation (1.39mg/dL NCHCT, 1.06mg/dL CTA; p=0.004), but there was no difference between the groups at 24-48 hours (p=0.059) and no difference between the mean change in Cr values (p=0.489). No patients developed a new requirement for hemodialysis. CTA imaging revealed 14 patients with vascular anomalies, and 53 patients with severe stenosis or occlusion of a major cervical or intracranial vessel. One patient in the CTA group and none in the NCHCT group had intravascular intervention. Conclusions: Overall, CTA during acute stroke evaluations were safe and may offer clinical utility, without delaying evaluation or therapy delivery. Additional cost of acute CTA acquisition is negligible given it replaces MRA typically performed later, following admission, as standard vessel imaging. Further prospective study is required.

Abstract W P21: Should We Perform Thrombectomy In Patients With Wake-up Strokes? A Case Series Using Ct Perfusion For Patient Selection

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Gabriel Vidal ◽  
James Milburn ◽  
Garrett Bennett ◽  
Vivek Sabharwal ◽  
Mustafa Al Hasan
Keyword(s):  
Risk Factors ◽  
Ct Perfusion ◽  
Medical Center ◽  
Case Series ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Single Center Experience ◽  
Aspiration Technique ◽  
Group 2

Background and objectives: Approximately 25% of patients who present with acute ischemic stroke are wake-up strokes. These patients are often not treated with IV thrombolytics because of unclear onset of symptoms. Little data exists on endovascular therapy as acute treatment for this population, particularly with an aspiration technique. The objective of this study is to compare outcomes of patients who presented with wake-up strokes due to large vessel occlusion treated with neuroendovascular procedures versus those who received conservative treatment, based on a 2-year (2012-2013), single center experience at Ochsner Medical Center in New Orleans, LA. Method: 24 consecutive patients, who presented with wake-up strokes, were outside the IV tPA window, and had both CTA confirmed intracranial LVO and CT-perfusion data upon arrival to our institution were retrospectively studied. Patients with hemorrhages, tandem lesions, or high-grade carotid stenosis were excluded from this analysis. Decision to perform endovascular treatment was made by the vascular neurologist and neuro-interventionalist based on stroke severity and CTA/perfusion data. Patients in group 1 (n = 8) underwent endovascular revascularization procedures; patients in group 2 (n = 16) were treated conservatively (medical management alone). Presentation NIHSS, risk factors, mortality, discharge NIHSS, discharge mRS, and follow up mRS were compared. Results: There were no statistical differences in patient population regarding age, gender, and risk factors. There was no statistical difference in their initial NIHSS (16.8 vs. 21.8, p=0.05162), or mortality (0% vs 21%, pr=0.262). The two groups were statistically different in their discharge NIHSS (7.25 vs 21.81, p<0.00045), discharge mRS (2 vs 5, p<0.00001), clinic follow up mRS (1.37 vs 4.94, p<0.00001), and good outcome at discharge (mRS 0-2)(75% vs 0%, pr<0.0002). Conclusion: Patients with wake-up strokes, LVO, and favorable CT-perfusion data who underwent neuroendovascular reperfusion treatment had significantly better outcomes in our population, despite similar stroke severity at presentation. This suggests that with careful selection, neuroendovascular therapy for wake-up strokes may lead to improved outcomes.

scholarly journals A new direction for prenatal chromosome microarray testing: software-targeting for detection of clinically significant chromosome imbalance without equivocal findings

2014 ◽  
Author(s):  
Joo Wook Ahn ◽  
Susan Bint ◽  
Melita D Irving ◽  
Phillipa M Kyle ◽  
Ranjit Akolekar ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Copy Number Variants ◽  
Parental Anxiety ◽  
Testing Strategy ◽  
Full Resolution ◽  
Resolution Analysis ◽  
Chromosome Imbalance ◽  
Clinically Significant ◽  
Chromosome Microarray ◽  
Duplication Syndrome

Purpose. To design and validate a prenatal chromosome microarray testing strategy that moves away from size-based detection thresholds, towards a more clinically relevant analysis, providing higher resolution than G-banded chromosomes but avoiding the detection of imbalances of unclear prognosis that cause parental anxiety. Methods. All prenatal samples fulfilling our criteria for karyotype analysis (n=342) were tested by chromosome microarray and only copy number variants of established deletion/duplication syndrome regions and any other imbalance >3Mb were detected and reported. A retrospective full-resolution analysis of 249 of these samples was carried out to ascertain the performance of this testing strategy. Results. Using our prenatal analysis, 23/342 (6.7%) samples were found to be abnormal. Of the remaining samples, 249 were anonymized and reanalyzed at full-resolution; a further 46 regions of imbalance were detected in 44 of these traces (17.7%). None of these additional imbalances were of clear clinical significance. Conclusion. This prenatal chromosome microarray strategy detected all CNVs of clear prognostic value and did not miss any imbalances of clear clinical significance. This strategy avoided both the problems associated with interpreting imbalances of uncertain prognosis and the parental anxiety that are a result of such findings.

scholarly journals Retrospective Analysis of Reoperation Rate After Standard Lumbar Discectomy and Microdiscectomy - Single Center Experience

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Vojin Kovacevic ◽  
Nemanja Jovanovic
Keyword(s):  
Lumbar Disc ◽  
Reoperation Rate ◽  
Neurological Deficits ◽  
Treatment Modalities ◽  
Single Center Experience ◽  
Group 4 ◽  
Significant Difference ◽  
Recurrent Herniation ◽  
Clinically Significant

Abstract Discectomy is a surgical procedure in the treatment of lumbar disc herniation (LDH) if sciatica or neurological deficits occur and still persist after a course of conservative therapy. Standard discectomy (SD) and microdiscectomy (MD) are still equal in curent clinical practice. Many retrospective and prospective studies have shown that there is no clinically significant difference in the functional outcome after two treatment modalities. The aim of our study was to determine whether there are differences in the incidence of reoperation after performing SD and MD. The research included 545 patients with average period of postoperative follow-up of approximately 5.75 years. Standard discectomy was performed in 393 patients (72.11%), and micro-discectomy in 152 (27.8%) patients. The total number of reoperated patients was 37/545, or 6.78%. In the SD group, the number of reoperated patients was 33/393 (8.39%) and in the MD group 4/152 or 2.63%. Statistically significant difference (p <0.05) was recorded in favor of the MD group. Although it has been proven that both SD and MD give good endpoints of treatment and similar functional recovery, the advantage is given to microdiscectomy due to statistically significantly lower rates of recurrent herniation. This result is attributed to better visualization of neural structures and pathological substrates, as well as their mutual relationship.

Hemodynamic Effects of Ketamine Compared With Propofol or Dexmedetomidine as Continuous ICU Sedation

2021 ◽  
pp. 106002802110510
Author(s):  
Evan Atchley ◽  
Eljim Tesoro ◽  
Robert Meyer ◽  
Alexia Bauer ◽  
Mark Pulver ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Clinically Significant ◽  
Critically Ill Adults ◽  
Icu Sedation ◽  
Ill Adults ◽  
Positive Effect

Background Ketamine has seen increased use for sedation in the intensive care unit. In contrast to propofol or dexmedetomidine, ketamine may provide a positive effect on hemodynamics. Objective The objective of this study was to compare the development of clinically significant hypotension or bradycardia (ie, negative hemodynamic event) between critically ill adults receiving sedation with ketamine and either propofol or dexmedetomidine. Methods This was a retrospective cohort study of adults admitted to an intensive care unit at an academic medical center between January 2016 and January 2021. Results Patients in the ketamine group (n = 78) had significantly less clinically significant hypotension or bradycardia compared with those receiving propofol or dexmedetomidine (n = 156) (34.6% vs 63.5%; P < 0.001). Patients receiving ketamine also experienced smaller degree of hypotension observed by percent decrease in mean arterial pressure (25.3% [17.4] vs 33.8% [14.5]; P < 0.001) and absolute reduction in systolic blood pressure (26.5 [23.8] vs 42.0 [37.8] mm Hg; P < 0.001) and bradycardia (15.5 [24.3] vs 32.0 [23.0] reduction in beats per minute; P < 0.001). In multivariate logistic regression modeling, receipt of propofol or dexmedetomidine was the only independent predictor of a negative hemodynamic event (odds ratio [OR]: 3.3, 95% confidence interval [CI], 1.7 to 6.1; P < 0.001). Conclusion and Relevance Ketamine was associated with less clinically relevant hypotension or bradycardia when compared with propofol or dexmedetomidine, in addition to a smaller absolute decrease in hemodynamic parameters. The clinical significance of these findings requires further investigation.

Short-term anterior chamber inflammation in phacoemulsification with and without Ex-Press glaucoma implant

2019 ◽  
Vol 30 (3) ◽  
pp. 533-537
Author(s):  
Shmuel Graffi ◽  
Beatrice Tiosano ◽  
Modi Naftali ◽  
Nakhoul Nakhoul ◽  
Michael Mimouni ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Medical Center ◽  
Glaucoma Surgery ◽  
Consecutive Series ◽  
Device Implantation ◽  
Significant Difference ◽  
Clinically Significant ◽  
Retrospective Comparative Study

Purpose: The aim of this study was to investigate the incidence of clinically significant anterior chamber inflammation in a combined surgery, namely, phacoemulsification and Ex-Press miniature glaucoma device implantation, compared to phacoemulsification alone. Methods: A retrospective comparative study of a consecutive series of 210 participants above 18 years of age diagnosed with significant cataract and who required glaucoma surgery, namely, Ex-Press miniature glaucoma device implantation or cataract alone in one or both eyes. All were operated on by a single experienced glaucoma surgeon in a single medical center. A total of 231 eyes were included in this study. All cases underwent an uneventful surgery and were examined the day following the surgery for visual acuity, intraocular pressure, and signs of excessive anterior chamber inflammation (Standardization of Uveitis Nomenclature grading ⩾ 3). Results: The combined group included 55 eyes of 51 patients, of whom 15 (27.3%) demonstrated excessive anterior chamber inflammation. The phacoemulsification group included 176 eyes of 159 patients, of whom 12 (6.7%) demonstrated excessive anterior chamber inflammation. Visual acuity and intraocular pressure measurements showed no statistically significant difference between the two groups. Conclusion: The Ex-Press glaucoma device is efficient, safe, and known for its inert nature. However, combination of this procedure with phacoemulsification surgery might result in a condition encouraging excessive inflammation, which eventually could lead to excessive anterior chamber inflammations if not treated vigorously. Emphasizing and recognizing the risks, especially in glaucoma patients, is important.

Eight drugs in one day chemotherapy in children with brain tumors: a critical toxicity appraisal.

1988 ◽  
Vol 6 (6) ◽  
pp. 996-1000 ◽  
Author(s):  
J R Geyer ◽  
T W Pendergrass ◽  
J M Milstein ◽  
W A Bleyer
Keyword(s):  
Hearing Loss ◽  
Anticancer Agents ◽  
Recurrent Disease ◽  
Medical Center ◽  
High Dose ◽  
Hematologic Toxicity ◽  
Newly Diagnosed ◽  
Severe Nausea ◽  
Chemotherapeutic Regimen ◽  
Clinically Significant

The toxicity of a new chemotherapeutic regimen for CNS tumors using eight anticancer agents administered in a 12-hour period was evaluated in 34 children with newly diagnosed and recurrent tumors treated at the Children's Hospital and Medical Center in Seattle. The chemotherapy included methylprednisolone, vincristine, lomustine (CCNU), procarbazine, hydroxyurea, cisplatin (CDDP), and either cyclophosphamide or imidazole carboximide (DTIC). The first five patients additionally received high-dose methotrexate (HDMTX), but because of excessive toxicity this was replaced by cytarabine. Of 125 courses administered without HDMTX, red cell transfusions were required in 15% of the courses and platelet transfusions were required in 8%. Hospitalization for empiric treatment of fever associated with neutropenia occurred in 6% of courses. Three episodes of documented sepsis occurred. Virtually all hematologic toxicity occurred in patients with recurrent disease. Renal toxicity occurred in 14% of patient courses. One patient died of renal failure and sepsis following therapy. Neurologic and hepatic complications were infrequent. High-frequency hearing loss above the voice range was common, but clinically significant hearing loss occurred in only three patients. Severe nausea and vomiting were infrequent. Overall, the toxicity of "eight in one" chemotherapy in newly diagnosed patients was minimal; toxicity was greater in patients with recurrent disease.

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