scholarly journals Characteristics and outcomes of cases of children and adolescents with pediatric inflammatory multisystem syndrome in a tertiary care centre in Mexico City.

2021 ◽  
Author(s):  
Ricardo Gil Guevara ◽  
Maria de Lourdes Marroquin Yanez ◽  
Rodolfo Norberto Jimenez-Juarez ◽  
Victor Olivar Lopez ◽  
Adrian Chavez Lopez ◽  
...  
Keyword(s):  
Mexico City ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Case Definition ◽  
Kawasaki Syndrome ◽  
Tertiary Care Centre ◽  
Cardiac Damage ◽  
Coronary Aneurysms

Background: pediatric inflammatory multisystem syndrome (PIMS) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children that resembles Kawasaki syndrome and poses children at high risk of cardiorespiratory instability and/or cardiac damage. This study aims to describe the clinical presentation and outcomes of patients with PIMS in Mexico City. Methods: this was an observational study (May 1, 2020, to September 30, 2021) of children with PIMS according to Centers of Disease Control and Prevention case definition criteria, hospitalized in a single tertiary care pediatric center in Mexico City. Demographic characteristics, epidemiological data, medical history, laboratory tests, cardiology evaluations, treatment, and clinical outcomes were analyzed. Results: Seventy-five cases fulfilled case-definition criteria for PIMS (median age 10.9 years, IQR: 5.6-15.6). Fifteen (20%) had a severe underlying disease. Forty-eight cases (64%) were admitted to the intensive care unit, 33 (44%) patients required invasive mechanical ventilation, and 39 (52%) received vasopressor support. Two distinct groups of patients were identified: cluster 1 (n=60) who had rash or gastrointestinal symptoms and cluster 2 (n=15) with predominantly respiratory manifestations. Two cases (2.7%) died, both with severe underlying conditions. Five cases (6.7%) developed coronary aneurysms, all of them from cluster 1. Conclusion: clinical manifestations and outcomes are in general comparable what has been previously reported in international series. In our series, there was a high proportion of patients with severe respiratory involvement and positive RT-PCR SARS-CoV-2 and a low frequency of coronary aneurysms which suggests a possible higher proportion of children with severe acute COVID-19 in our included cases.

scholarly journals CLINICAL PROFILE AND MANAGEMENT OF PATIENTS OF AMOEBIC LIVER ABSCESS IN A TERTIARY CARE CENTRE

2020 ◽  
pp. 5-7
Author(s):  
Rakesh Mishra ◽  
Debabrata Banerjee ◽  
Debarshi Jana
Keyword(s):  
Drug Treatment ◽  
Liver Abscess ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Needle Aspiration ◽  
Intestinal Disease ◽  
Amoebic Liver Abscess ◽  
Treatment Modalities ◽  
Tertiary Care Centre ◽  
Early Recovery

Introduction: Amoebiasis is caused by the protozoan Entamoeba histolytica. Most infections are asymptomatic; clinical manifestations include amoebic dysentery and extra intestinal disease. Amoebic liver abscess is the most common extraintestinal manifestation of amoebiasis. Amoebae establish hepatic infection by ascending the portal venous system. Aim: To study various aspects of Amoebic Liver Abscess like demographic profiles, clinical presentations, association with intestinal disease, radiological and laboratory findings, treatment modalities and complications. Materials and Methods: A hospital based prospective observational study was performed in the Department of Internal Medicine, Command Hospital (Eastern Command), Kolkata, from Jan 2018 to Jun 2019. All confirmed cases of amoebic liver abscess above the age of 18 years admitted in Command Hospital (EC) were included in this study. The patient were then subsequently followed up for 01 year with USG abdomen every 03 monthly. Results: Total 40 patients of Amoebic Liver Abscess with age more than 18 year were enrolled in the study. The age ranged from 26 to 70 years (mean age 46.2 year). Male patients were dominated over female. 80.0 % were from rural background. About 55% patients were addicted to alcohol & 25.0 % were known diabetics at presentation. In all, 07 (17.5%) patients with abscess size of 6 cm to 10 cm (Vol> 300 cc) were treated by needle aspiration and drug therapy. Remaining 17(42.5%) patients with abscess size more than 10 cm were treated with pigtail drainage and drug. Conclusion: There is significant advantage of pigtail drainage with drug treatment over needle aspiration with drug and only with drug treatment in terms of decrease in lesion size and early recovery.

scholarly journals Evaluation of mineral status in hypothyroidism in a tertiary care centre

2020 ◽  
Vol 8 (2) ◽  
pp. 667
Author(s):  
Shikha Saxena ◽  
Prem Chandra Srivastava ◽  
Rashmi Katyal ◽  
Biswajit Das ◽  
Sileena Jaideep Pannu
Keyword(s):  
Serum Calcium ◽  
Serum Magnesium ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Serum Zinc ◽  
The Body ◽  
Endocrine Disorders ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Mineral Status

Background: Hypothyroidism is known to be the commonest form of endocrine disorders and has been linked with disturbances in various minerals metabolism. Calcium, phosphorus and magnesium and trace element zinc are required for many enzymes in various metabolic pathways which are directly or indirectly regulated by thyroid hormones. Aim and objectives of the study was to estimate serum zinc, calcium, magnesium and phosphorus in hypothyroid patients, with the objectives to evaluate any relationship with TSH and to compare them with euthyroid controls.Methods: The analytical cross-sectional study included 50 hypothyroid subjects with TSH levels >4.5 mcg IU/mL and 50 euthyroid subjects of 20-50 years in RMCH, Bareilly. TSH was estimated by ECLIA, serum calcium and phosphorus were estimated by autoanalyzer and serum zinc & magnesium by the kit method using semi autoanalyzer. All the biochemical parameters were expressed as median with Interquartile Range (IQR). Mann-Whitney test was applied to compare the parameters of cases and control. Spearman’s rank correlation coefficient 2-tailed was used to correlate the parameters among the cases.Results: A significantly decreased level of serum calcium and increased level of serum magnesium and phosphorus were observed in hypothyroid cases. A significant negative correlation between TSH and serum calcium while a significant positive correlation of serum magnesium and phosphorus with TSH was observed.Conclusions: The indexed study indicates the significant effect of overt or subclinical hypothyroidism over the mineral status of the body which may have inconsistent effect over the various metabolism and enzymes and thereby clinical manifestations.

scholarly journals Clinical and Laboratory Profile and Therapeutic Response of Scrub Typhus in Children in a Tertiary Care Centre in Nepal

2020 ◽  
Vol 5 (1) ◽  
pp. 897-901
Author(s):  
Sumit Agrawal ◽  
Krishna Hari Subedi ◽  
Rajesh Kumar Shah ◽  
Santoshanand Jha ◽  
Sher Bahadur Pun
Keyword(s):  
Retrospective Study ◽  
Scrub Typhus ◽  
Indian Subcontinent ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Common Disease ◽  
Tertiary Care Centre ◽  
Institutional Review ◽  
Laboratory Profile ◽  
Loss Of Appetite

Introduction Scrub typhus is the most common ricketisial infection from the Indian subcontinent. It is caused by the organism Orienta tsutsugamushi inhabiting in trombiculid mites and transmitied to humans by the bite of these mites. The disease has a variety of clinical manifestations in children. As this is a common disease in our country so a retrospective study was conducted to study the clinical and laboratory profile and therapeutic outcomes of scrub typhus in children. Methodology A retrospective study was conducted at Sukraraj Tropical and Infectious disease Hospital, Teku, Kathmandu, Nepal after obtaining ethical clearance from Institutional Review Committee, and reviewing the medical records of serologically confirmed scrub typhus in children aged less than 14 years admitted to the hospital between March 2017 and February 2018. Relevant data were entered in excel spreadsheet and analyzed using SPSS 20. Result A total of 20 children were enrolled in the study. Of them 70% were female, with the mean age being 11.45 ± 3.1 years (range 3-14 years) and majority were from Dhading district (40%). All the children had fever; while there was cough, loss of appetite, rashes, headache, myalgia, arthralgia and hepatosplenomegaly in 45%, 90%, 20%, 55%, 35%, 35% and 30% of children respectively. There was thrombocytopenia in 50% of children; while hyponatremia, elevation of SGOT and SGPT was present in 30%, 70% and 55% of patients respectively. Azithromycin was used for treatment in 95% of children and all had defervescence of fever. Conclusion Scrub typhus should be suspected in children having prolonged fever with organomegaly, thrombocytopenia and elevated transaminases. Azithromycin can be used effectively in children diagnosed as scrub typhus.

scholarly journals Acute Flaccid Paralysis with Acute Encephalitis Syndrome at a tertiary care centre of eastern Nepal 

2017 ◽  
Vol 13 (1) ◽  
pp. 216-219
Author(s):  
Shipra Chaudhary ◽  
Rupa Rajbhandari Singh ◽  
Nisha Keshary Bhatta ◽  
Gauri Shankar Shah ◽  
Jyoti Agrawal
Keyword(s):  
Acute Flaccid Paralysis ◽  
Tertiary Care ◽  
Altered Mental Status ◽  
Case Definition ◽  
Flaccid Paralysis ◽  
Tertiary Care Centre ◽  
Acute Encephalitis Syndrome ◽  
Acute Encephalitis ◽  
Common Causes ◽  
One Year

Background & Objectives: Acute encephalitis syndrome (AES) can have widely varied presentation. Hence this study was done to find out clinical features and outcome of Acute Enecphalitis Syndrome (AES) with Acute Flaccid Paralysis (AFP).Materials & Methods: A Prospective hospital-based study was carried out over one-year period, including all cases fulfilling AFP case definition. All cases of AFP meeting AES definition were further analysed in terms of history, clinical examination, investigations and outcome. Statistical analysis was done using SPSS version 17. Results: Out of total 43 children with AFP, 23 (53.5%) children  had AES. Amongst AFP with AES, altered mental status and seizures were present in 87% and 74% respectively. The mean Glasgow Coma Scale (GCS) was 7.61±3.65. Predominant weakness pattern was quadriparesis (87%). Cerebrospinal fluid was abnormal in 11 (47.9%) children with Japanese encephalitis (JE) positive 8.7%. Amongst 60.9% children with complications, respiratory failure (52.1%) was the most common. During 60-day follow-up, 11 (47.9%) children expired while 2 (8.7%) still had residual paralysis. Conclusion: AES is one of the common causes of AFP besides other causes. AFP with AES is commonly associated with quadriparesis, low GCS, respiratory complications, neurological sequelae and a high mortality. Thus, this study stresses upon the importance of AES surveillance along with AFP surveillance. 

scholarly journals 439. Clinical Characteristics and Mortality of an Initial Cohort of COVID-19 Patients in México City

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S287-S287
Author(s):  
Paulo F Castañeda-Mendez ◽  
José Luis Castillo-Álvarez ◽  
Armando Barragán-Reyes ◽  
Daniela Bay-Sansores ◽  
Jessica Isabel Pulido-Enríquez ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mexico City ◽  
Clinical Characteristics ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Case Series ◽  
Special Focus ◽  
Tertiary Care Center ◽  
Initial Cohort

Abstract Background As of today, more than 8 million people have been infected and around 440,000 of them have lost their lives due to complications of SARS-CoV-2 infection. The first confirmed case of COVID-19 in Mexico was on February 28, 2020, and currently, there are more than 150,300 confirmed cases and more than 17,500 deaths have been reported, this work presents the characteristics of the first cases on a tertiary care center with special focus on common comorbidities in Mexicans. Methods We conducted a case series of patients with the diagnosis of pneumonia due to SARS-CoV-2 virus admitted to a tertiary care center in Mexico City, between March 14th and May 4th, 2020. Data collected included demographic information, comorbidities, clinical presentation, and outcomes. Regarding clinical outcomes, we measured the need of admission to Intensive Care Unit (ICU), mortality during hospitalization, discharge, and patients that remained hospitalized. Results 85 patients were included, median age 53.5 years; 69.4% were male. Most common clinical manifestations at admission were fever (61, 71.8%), cough (29, 34.1%), headache (25, 29.4%) and dyspnea (22, 25.9%). Most common comorbidities were overweight (44/82, 53.6%), obesity (25/82, 30.5%), hypertension (18, 21.2%), and diabetes (17, 20%). 31 of 85 (36.5%) patients were diagnosed with critical disease, whereas 54 of 85 (63.5%) were classified as non-critical. In the 31 critically ill patients, the length of invasive mechanical ventilation was 13 days [range {2–45}]; 5 patients (16.1%) required tracheostomy. The mean of mechanical ventilation prior to tracheostomy was 19.8 days [range {14–25}]. In all patients, the total length of hospitalization was 12.1 days [range {2–52}], 14.8 days [range {3–52}] in ICU patients, and 6.7 days [range {2–30}] in floor unit patients. No readmissions were documented. Global mortality was 4.7% (9.6% in ICU, 1.8% in floor unit). Of the 4 deceased patients, 3 presented comorbidities (75%), while 1 was previously healthy, documenting massive pulmonary embolism as the cause of sudden death. Conclusion This study shows that the clinical characteristics in this initial cohort are not different that described elsewhere. Mortality is low but it is mainly related to prevalent comorbidities in the Mexican population. Disclosures All Authors: No reported disclosures

scholarly journals Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Infection ◽  
2021 ◽  
Author(s):  
Charlotte Thibeault ◽  
◽  
Barbara Mühlemann ◽  
Elisa T. Helbig ◽  
Mirja Mittermaier ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Median Duration ◽  
Prospective Observational Study ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Detailed Knowledge ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Duration Of Symptoms

Abstract Purpose Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10–1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00–16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26–46.75, vs 18 days, IQR 16–46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6–15.5) for non-IMV and 49.5 days (IQR 36.8–82.5) for IMV patients. Conclusions Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19.

scholarly journals Alcohol state markers- facility and utility for clinical management of alcohol use disorders: study from a tertiary care centre in South India

2021 ◽  
Vol 9 (10) ◽  
pp. 3105
Author(s):  
Liji M. J. ◽  
P. R. Varghese ◽  
Susheela Jacob Innah ◽  
Praveenlal Kuttichira
Keyword(s):  
Alcohol Use ◽  
Clinical Management ◽  
Tertiary Care ◽  
Alcohol Use Disorders ◽  
Clinical Manifestations ◽  
Gamma Glutamyl Transferase ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Alcohol Biomarker ◽  
Glutamyl Transferase

Background: Alcoholism is broadly any drinking of alcohol resulting in significant psychological and physiological health problems. As alcoholism is not a recognized diagnostic entity the detection and monitoring of the clinical manifestations of alcoholism is of great importance in the alcohol use disorders (AUD) treatment. Hence, the use of alcohol biomarkers plays a vital role in the diagnosis, treatment and prognosis of AUDs.Methods: This study aimed to understand the utility of state markers in alcohol related distress, both for diagnosis and prognosis in a tertiary care centre. The relative number and the frequency of the alcohol biomarker tests such as AST (aspartate aminotransferase), ALT (alanine aminotransferase), MCV (mean corpuscular volume) and GGT (gamma-glutamyl transferase) investigated in the hospital departments (32 departments) were collected. Test requests and results in January to March on five consecutive years from 2016 to 2020 were analyzed, by comparing psychiatry department with all other departments and AUD with non-AUD cases.Results: The study findings revealed that, the tests AST, ALT and MCV were well utilized for the AUD treatment procedure in the tertiary care centre, irrespective of the department the patient got admitted. Since GGT was the least preferred test, the figures of GGT could not be analysed because of the exceptionally low number.Conclusions: The utility of the commonly available alcohol biomarker tests is especially useful for the clinical management of AUD patients and these are well utilized in an appreciable manner in the study centre. Development of more accurate, specific, and sensitive panel of biomarker tests may further motivate clinicians to better monitor individuals who suffer from alcoholism.

scholarly journals CLINICOETIOLOGICAL EVALUATION OF THE PATIENTS OF MACROCYTIC ANEMIA PRESENTING AT A TERTIARY CARE CENTRE IN KUMAON REGION OF UTRRAKHAND

2021 ◽  
pp. 11-14
Author(s):  
Harish Chandra Arya ◽  
Ashok Kumar
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Tertiary Care ◽  
Macrocytic Anemia ◽  
Clinical Manifestations ◽  
Cobalamin Deficiency ◽  
Dietary Habit ◽  
Thyroid Disorder ◽  
Care Centre ◽  
Tertiary Care Centre

INTRODUCTION: Macrocytosis is common in various clinical settings and it is found in approximately 1.7– 3.6% of people admitted for care for any cause [1, 2, 3]. Macrocytic anemia is generally classified as megaloblastic or nonmegaloblastic anemia. The causes of macrocytosis fall into two groups: (a) deficiency of vitamin B12 (cobalamin) or folate (or rarely abnormalities of their metabolism) in which the bone marrow is megaloblastic and (b) other causes,in which the bone marrow is usually normoblastic.A high level of suspicion,proper elicitation of the history and thorough examination and investigation of the patient helps in the diagnosis of macrocytic anemia. AIM AND OBJECTIVES: To evaluate the etiology of macrocytic anemia at a tertiary care centre. To determine the etiology of macrocytic anemia.To evaluate clinical manifestations associated with macrocytic anemia. MATERIAL AND METHOD: This 21 month Cross sectional observational study was carried out in OPD/IPD Department of Medicine, Government Medical College Haldwani (Uttarakhand). Full clinical examination and information regarding alcohol intake, dietary habit, drug intake, thyroid disorder and other comorbid illnesses was obtained.All patients were investigated with a completeHaemogramLiver function tests Serum TSH fasting vitamin B12 was measured Ultrasound as and when required. RESULT: In this study106 patients were taken 58 (45.3% ) were male and 48(54.7%) were females. Mean age was 44.83+16.85 years.Hemoglobin and MCV was in the range of 6.42 ± 2.09,(108.24 ± 7.10) respectively .The majority of patient,28 (52.83%) had vit B12 level in the range of 101 – 200 pg/ml,The majority of patients,44 (41.1%) had LDH level in the range of 281 – 1000 IU/L . CONCLUSION: In this study, there was a preponderance of young people.Vegetarians were most susceptible to MA especially cobalamin deficiency. Nutritional deficiency was the most common cause of MA, followed by alcohol and alcoholic liver disease.Data regarding the magnitude of the problem in different parts of India and the factors that might influence its incidence were lacking. Macrocytic anemia must be considered in the differential diagnosis of patients presenting with pyrexia of unknown origin,mild icterus or pancytopenia.

scholarly journals Clinical profile and seroepidemiology of scrub typhus and its concurrent infections associated with other tropical fevers: a two-year study from a tertiary care centre in North India

2020 ◽  
Vol 7 (11) ◽  
pp. 4440
Author(s):  
Monika Matlani ◽  
Supriya Maheshwari ◽  
Neha Dubey ◽  
Shyam S. Mina ◽  
Vinita Dogra
Keyword(s):  
Clinical Presentation ◽  
Scrub Typhus ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Clinical Profile ◽  
North India ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Igm Elisa ◽  
Concurrent Infections

Background: The study showed epidemiological aspects, clinical profile and laboratory features of patients presenting with scrub typhus alone and scrub typhus along with concurrent infections namely typhoid, malaria, leptospira, chikungunya and dengue.Methods: A total of 383 suspected cases of Scrub typhus were tested by IgM ELISA from January 2017 to October 2018. Appropriates tests were performed to determine the coinfections of scrub typhus with dengue, chikungunya, malaria, leptospirosis and typhoid fever.Results: Of the 383 samples received, 68 were positive for scrub typhus. Commonest clinical manifestations were fever, shortness of breath, myalgia, headache and jaundice. Maximum number of co infection cases were observed along with dengue.Conclusions: With the rapidly changing epidemiology of scrub typhus, it is very important to become familiar with its clinical presentation when presenting alone and as a concurrent infection with other acute febrile infections. 

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