scholarly journals Impact of Fluoroquinolone Exposure Prior to Tuberculosis Diagnosis on Clinical Outcomes in Immunocompromised Patients

2016 ◽  
Vol 60 (7) ◽  
pp. 4005-4012 ◽  
Author(s):  
Ju Young Lee ◽  
Hyun Jung Lee ◽  
Yong Kyun Kim ◽  
Shinae Yu ◽  
Jiwon Jung ◽  
...  
Keyword(s):  
Median Time ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Care Hospital ◽  
Immunocompromised Patients ◽  
Tb Treatment ◽  
Significant Difference ◽  
Tuberculosis Diagnosis ◽  
The Difference

ABSTRACTThere have been concerns about an association of fluoroquinolone (FQ) use prior to tuberculosis (TB) diagnosis with adverse outcomes. However, FQ use might prevent clinical deterioration in missed TB patients, especially in those who are immunocompromised, until they receive definitive anti-TB treatment. All adult immunocompromised patients with smear-negative and culture-positive TB at a tertiary care hospital in Korea over a 2-year period were included in this study. Long-term FQ (≥7 days) use was defined as exposure to FQ for at least 7 days prior to TB diagnosis. A total of 194 patients were identified: 33 (17%) in the long-term FQ group and 161 (83%) in the comparator, including a short-term FQ group (n= 23), non-FQ group (n= 78), and a group receiving no antibiotics (n= 60). Patients in the long-term FQ group presented with atypical chest radiologic pattern more frequently than those in the comparator (77% [24/31] versus 46% [63/138];P= 0.001). The median time from mycobacterial test to positive mycobacterial culture appeared to be longer in the long-term FQ group (8.1 weeks versus 7.7 weeks;P= 0.09), although the difference was not statistically significant. Patients in the long-term FQ group were less likely to receive empirical anti-TB treatment (55% versus 74%;P= 0.03). The median time from mycobacterial test to anti-TB therapy was longer in the long-term FQ group (4.6 weeks versus 2.2 weeks;P< 0.001), but there was no significant difference in FQ resistance (0% versus 3%;P> 0.99) or in the 30-day (6% versus 6%;P> 0.99) or 90-day (12% versus 12%;P> 0.99) mortality rate between the two groups. FQ exposure (≥7 days) prior to TB diagnosis in immunocompromised patients appears not to be associated with adverse outcomes.

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

scholarly journals Comparative Study of Length and Diameter of Umbilical Cord in Normal Vs Gestational Hypertensive cases in a Tertiary Care Hospital in Eastern Nepal

2019 ◽  
Vol 7 (2) ◽  
pp. 68-71
Author(s):  
Abhishek Karn ◽  
Subodh Kumar Yadav ◽  
Renu Yadav ◽  
Rakesh Kumar Adhikari
Keyword(s):  
Umbilical Cord ◽  
Gestational Hypertension ◽  
Tertiary Care ◽  
Well Being ◽  
Care Hospital ◽  
Medical College ◽  
Number Of Factors ◽  
Significant Difference ◽  
The Difference ◽  
Umbilical Cords

INTRODUCTION :- The well being of the fetus and hence the baby is influenced by a number of factors among which the length and diameter of umbilical cord is one important aspect. Studies have found association between gestational hypertension and the structure of umbilical cord. The objective of this study was to determine the effects of gestational hypertension on the length and diameter of umbilical cord.  MATERIAL AND METHODS :- A total of 70 umbilical cords with placenta were collected in Nobel Medical College and Teaching Hospital for comparison of umbilical cords length and diameter between normotensives and patients with gestational hypertension. Data were statistically analyzed.  RESULTS :- The difference in umbilical cords' diameter was statistically significant between normotensives and patients with gestational hypertension whereas the length of the umbilical cord had no statistically significant difference.  CONCLUSION :- We concluded that gestational hypertension affects the diameter of umbilical cord by decreasing it significantly which may affect normal fetal development.

scholarly journals Comparison of Jaffe and enzymatic methods for creatinine estimation and their effect in GFR calculation in a tertiary care hospital

Biomedicine ◽  
2020 ◽  
Vol 39 (2) ◽  
pp. 319-325
Author(s):  
RajLaxmi Sarangi ◽  
Sanjukta Mishra ◽  
Mona Pathak ◽  
Srikrushna Mahapatra
Keyword(s):  
Kidney Disease ◽  
Health Centre ◽  
Tertiary Care ◽  
Care Hospital ◽  
Enzymatic Method ◽  
Significant Difference ◽  
Care Health ◽  
Mdrd Formula ◽  
The Difference ◽  
Enzymatic Methods

Introduction and Aim: Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) gives the idea of overall functional status of kidney. Measurement of SCr by different method and discordant result between them can misclassify different stages of chronic kidney disease (CKD). Many of the tertiary care health centre, SCr measured by Jaffe method is still the method of choice because of its cost effectiveness even if it is more susceptible for interference. Our aim was to measure SCr level by both Jaffe’s & enzymatic method and analysing the discordance rate of eGFR and their effect in staging of kidney disease in CKD patients. Materials and Methods: In this observational study 330 serum sample were analysed for creatinine by Jaffe’s and enzymatic methods in a fully automated analyser using commercially available kits. Modification of Diet in Renal Disease (MDRD) formula was used for estimating GFR. Results: In 330 subjects eGFR values calculated on incorporating SCr were found as 58.84 ± 68.34 (median (IQR) = 26.67(15.09-90.84) and 44.49 ± 41.18 (Median (IQR) = 26.86 (14.69-67.69)) ml/min/1.73 m2 respectively by Jaffe’s and enzymatic method. Concordance correlation coefficient between two methods for SCr was statistically significant. Bland-Altman plot showed with increasing value of SCr, the difference between the SCr values given by these two methods increased. Jaffe’s creatinine has lower value in comparison to enzymatic Cr. There was a significant difference between eGFR obtained from SCr estimated by Jaffe’s and enzymatic method. Conclusion: All laboratory should use uniform method for creatinine estimation. Enzymatic method for creatinine estimation should not be compromised over cost of test, so that less variability in creatinine result can lead to more accurate staging of the disease.  

scholarly journals 61. Short- versus prolonged-courses of antimicrobial therapy for patients with uncomplicated Pseudomonas aeruginosa bloodstream infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S41-S42
Author(s):  
Moonsuk Bae ◽  
Yun-Seo Jeong ◽  
Seongman Bae ◽  
Min Jae Kim ◽  
Yong Pil Chong ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Bloodstream Infection ◽  
Antimicrobial Therapy ◽  
Propensity Score Analysis ◽  
Tertiary Care ◽  
Care Hospital ◽  
Eligibility Criteria ◽  
Short Course ◽  
Significant Difference ◽  
The Difference

Abstract Background The optimal duration of antimicrobial therapy for uncomplicated Pseudomonas aeruginosa bloodstream infection (BSI) is unknown. We compared the outcomes of short and prolonged courses of antimicrobial therapy in adults with uncomplicated pseudomonal BSI. Methods All patients with uncomplicated P. aeruginosa BSI admitted at a tertiary-care hospital from May 2016 to September 2020 were included. We compared the rate of recurrent P. aeruginosa infection and 30-day mortality among patients who underwent short (7‒11 days) and prolonged (12‒21 days) courses of antimicrobial therapy using propensity score analysis with the inverse probability of treatment weighting (IPTW) method. Results We evaluated 1,477 patients with uncomplicated P. aeruginosa BSI; of them, 290 met the eligibility criteria, including 97 (33%) who underwent short-course therapy (9 [interquartile range (IQR), 8‒11] days) and 193 (67%) who underwent prolonged-course therapy (15 [IQR, 14‒18] days). We found no significant difference in the risk of recurrence or 30-day mortality between the prolonged-course and short-course groups (n=10, 11% vs. n=32, 16%; IPTW-adjusted hazard ratio (HR) 0.61; 95% confidence interval (CI) 0.30−1.24; p=0.17). The recurrence of P. aeruginosa infection at any site within 180 days of completing therapy occurred significantly more in the prolonged-course group (n=10, 10% vs. n=38, 20%; IPTW-adjusted HR 0.48; 95% CI 0.24−0.96, p=0.04). The resistance acquisition in subsequent P. aeruginosa isolates was more frequent in the prolonged-course group, although the difference was not statistically significant (n=2, 20% vs. n=12, 32%; p=0.70). Conclusion Short-course antimicrobial therapy could be as effective as prolonged-course therapy for uncomplicated P. aeruginosa bloodstream infection. Disclosures All Authors: No reported disclosures

scholarly journals DOES AUTO TRANSFUSION OF UNPROCESSED RESIDUAL BLOOD IN THE CARDIOPULMONARY BYPASS CIRCUIT LEAD TO UNFAVORABLE OUTCOMES?

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S819-23
Author(s):  
Musfireh Siddiqeh ◽  
Imran Khan ◽  
Ali Gohar Zamir ◽  
Asif Mehmood Janjua ◽  
Beenish Munir ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Case Control Study ◽  
Tertiary Care ◽  
Case Control ◽  
Adverse Outcomes ◽  
Care Hospital ◽  
Residual Volume ◽  
Significant Difference ◽  
Residual Blood ◽  
Control Study

Objective: Transfusion of residual blood left in the cardiopulmonary bypass circuit is recommended. Whether this blood should be processed or not before transfusion is not known. Study Design: A prospective non-randomized case control study. Place and Duration of Study: A tertiary care heart center, from Jan 2016 to Dec 2018. Methodology: A prospective non-randomized case control study was designed. Consecutive patients operated at a tertiary care hospital were included in the study who underwent different open-heart procedures on cardiopulmonary bypass. Patients were divided into two groups. Those who received the unprocessed residual blood transfusion, residual volume retransfused at the end of cardiopulmonary bypass and those who did not, residual volume not retransfused (RVNR). Important perioperative data was collected from the hospital database andanalyzed using IBM SPSS-statistics 23.0 (IBM, SPSS Inc., Chicago, IL). Results: Of the 120 patients, 56 patients were included in the RVR group and 64 in the RVNR group. Mean age in the RVR group was 49.41 ± 14.38 years and in the RVNR group 49.27 ± 16.36 years (p=0.96). Female patients were 9 (16.07%) in the RVR group and 20 (31.25%) in the RVNR group. Residual blood left in the circuit was 271.43 ± 52 ml in the RVR group and 264.06 ± 54.5 ml in the RVNR group (p=0.45). Hemoglobin measured in ICU was 10.5 ± 1.12 gm/dl in the RVR group and 9.97 ± 1.25 gm/dl in the RVNR group (0.02). Blood products were needed in 27 patients in RVR group and 21 patients in RVNR group (p=0.57). There was no significant difference between the two groups with respect to total drainage in the first 24 hours (p=0.89). Similarly, the re-exploration rates were not different between the two groups (p=0.50). Conclusion: Re-transfusion of residual blood left in the CPB circuit is a safe practiced. If this blood is transfused in an unprocessed form, it does not lead to adverse outcomes.

scholarly journals Clinical Experience With Pulmonary Nocardiosis In A Tertiary Care Hospital In Pakistan

2019 ◽  
Author(s):  
Kashif Aziz ◽  
Habib Ahmad
Keyword(s):  
Clinical Experience ◽  
White Cell Count ◽  
Tertiary Care ◽  
University Hospital ◽  
P Value ◽  
Care Hospital ◽  
Immunocompromised Patients ◽  
Pulmonary Nocardiosis ◽  
Significant Difference ◽  
High Index Of Suspicion

Abstract Background Pulmonary nocardiosis is a rare disease. It usually affects immunocompromised patients. In this study we evaluated our clinical experience with pulmonary nocardiosis in our centre. Method It was a retrospective study done in Aga Khan University Hospital. Study was started after ethical approval. Cases from 2007 to 2017 were retrieved. Patient with diagnosis of Culture positive Pulmonary Nocardiosis with age more than 18 years included. Patient who were already on treatment of Nocardiosis at time of admission were excluded. Patients’ medical records were reviewed to identify epidemiologic, clinical, microbiologic, and radiographic features. Data was entered on SPSS V22. Results 56 patient met inclusion criteria but 12 had missing data so 44 patients’ data was included at end. 8 patients had disseminated disease. 52% were immunocompromised and 48% were immunocompetent. 31 were females. Diabetes mellitus was most common comorbidity. Fever and shortness of breath were most common presentations. Pleural effusion and consolidation were most common chest xray findings. Mean white cell count was 12.35±7 ×109/L. 70% patient had some degree of hyponatremia. Culture showed that all strains were sensitive to amikacin and 67% were sensitive to imipenum. Mean length of stay was 7.7days. 30 day mortality was 23%. 16% required ICU stay. There was significant difference between immunocompromized and immunocompetent group regarding 30 day mortality (p value 0.019) and ICU admission need (p value 0.021). Conclusion Pulmonary nocardiosis is often missed, high index of suspicion is required especially in immunocompromised patients and mortality is often very high.

scholarly journals Hypoglycemia but Not Hyperglycemia Is Associated with Mortality in Critically Ill Patients with Diabetes

2018 ◽  
Vol 28 (2) ◽  
pp. 186-192 ◽  
Author(s):  
Bernhard Wernly ◽  
Peter Jirak ◽  
Michael Lichtenauer ◽  
Marcus Franz ◽  
Bjoern Kabisch ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Glucose Concentration ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Care Hospital ◽  
Patients With Diabetes ◽  
Long Term Mortality

Background: Both severe hyperglycemia (> 200 mg/dL) and hypoglycemia (≤70 mg/dL) are known to be associated with increased mortality in critically ill patients. Therefore, we investigated associations of a single episode of blood glucose deviation (concentration either ≤70 mg/dL and/or > 200 mg/dL) during an intensive care unit (ICU) stay with mortality in these patients. Methods: A total of 4,986 patients (age 65 ± 15 years; 39% female; 14% type 2 diabetes [T2DM] based on medical records) admitted to a German ICU in a tertiary care hospital were investigated retrospectively. The intra-ICU and long-term mortality of patients between 4 and 7 years after their ICU submission were assessed. Results: A total 62,659 glucose measurements were analyzed. A single glucose deviation was associated with adverse outcomes compared to patients without a glucose deviation, represented by both intra-ICU mortality (22 vs. 10%; OR 2.62; 95% CI 2.23–3.09; p < 0.001) and long-term mortality (HR 2.01; 95% CI 1.81–2.24; p < 0.001). In patients suffering from T2DM hypoglycemia (30 vs. 13%; OR 2.94; 95% CI 2.28–3.80; p < 0.001) but not hyperglycemia (16 vs. 14%; OR 1.05; 95% CI 0.68–1.62; p = 0.84) was associated with mortality. Conclusion: In patients with dia­betes, hypo- but not hyperglycemia was associated with increased mortality, whereas in patients without diabetes, both hyper- and hypoglycemia were associated with adverse outcome. Blood glucose concentration might need differential approaches depending on concomitant diseases.

scholarly journals Teflon implants vs titanium implants in stapedotomy - A comparative study

2020 ◽  
Vol 7 ◽  
Author(s):  
Haritosh Velankar ◽  
Cassandra Carvalho ◽  
Karan Vayangankar
Keyword(s):  
Tertiary Care ◽  
Pure Tone Audiometry ◽  
Titanium Implants ◽  
Long Term Results ◽  
Care Hospital ◽  
Surgical Skill ◽  
Significant Difference ◽  
Term Evaluation ◽  
Operating Surgeon

Objective: This study compares two types of implants- a Teflon piston and a titanium piston, used in stapes surgery for otosclerosis. Study Design: A non-randomised prospective study conducted on 40 patients, in 2 groups of 20 each, undergoing stapedotomy in a tertiary care hospital. Pure tone audiometry results were noted preoperatively and 3 weeks post-operatively.Results: Both Teflon and titanium prostheses provided almost equal benefits to patients in terms of Air-Bone gap closure.Conclusion: While there is statistically no significant difference in the results observed, surgical skill of the operating surgeon plays an important role in hearing improvement and long-term results would require long term evaluation.

Association of Rugae Pattern with Skeletal Malocclusion in Orthodontic Patients Visiting Tertiary Care Hospital

2020 ◽  
Author(s):  
Sarwat Memon
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Class Iii ◽  
Chi Square ◽  
Cross Sectional ◽  
Skeletal Malocclusion ◽  
Palatal Rugae ◽  
Significant Difference ◽  
Orthodontic Patients

Background: The palatal rugae are special constructions that are inalterable in their position and pattern during the lifestyles of an individual. This imparts them an exceptional role in the forensic dentistry and may play potential role in malocclusion identification. This study was aimed to see association of rugae pattern with sagittal skeletal malocclusion in orthodontic patients visiting tertiary care hospital. Methods: This cross-sectional examination was completed on pretreatment records (lateral Cephalometric radiographs and maxillary dental casts) of 384 subjects at the orthodontic department of Ziauddin Dental Hospital, Karachi. The study duration was from January to July 2019. The samples were sub-divided into three sagittal skeletal groups based on ANB angle proposed by Steiner’s on lateral Cephalometric radiographs (Class I with ANB angle between 0° to 4°; Class II: ANB angle greater than 5°; Class III: ANB angle less than 0°). The shapes of three most-anterior primary rugae were then evaluated bilaterally using Kapali et al., Classification. Chi Square test was applied to find association of rugae pattern among sagittal skeletal malocclusions groups. Results: Circular and curved rugae shapes were the most prevalent in all skeletal malocclusions. The primary palatal rugae pattern was seen to be significantly different among three skeletal malocclusion groups (p<0.05). The right and left sided palatal rugae pattern showed significant difference in all three skeletal malocclusion groups (p<0.05). Conclusion: The present study showed no specific palatal rugae pattern associated with sagittal skeletal malocclusion. Further studies on larger sample and use of modern 3D technologies to scan the maxillary casts are required for results that are more precise.

Community acquired pneumonia-current scenario among immunocompromised patients in a tertiary care hospital

2016 ◽  
Vol 5 (01) ◽  
pp. 4715
Author(s):  
A. V. Sowmya* ◽  
G. Jayalakshmi ◽  
David Agatha
Keyword(s):  
Diabetes Mellitus ◽  
Antimicrobial Therapy ◽  
Tertiary Care ◽  
Community Acquired Pneumonia ◽  
Polymicrobial Infection ◽  
Resistance Pattern ◽  
Care Hospital ◽  
Immunocompromised Patients ◽  
Drug Resistant ◽  
Etiologic Agents

Pneumonia is a common illness accounting for majority of hospitalizations worldwide with significant mortality and morbidity. Antimicrobial therapy, being the main stay of treatment, the choices of antibiotics depends on the nature of the etiologic agents and the host factors. The current study was aimed to identify the bacterial & fungal etiologic agents of Community Acquired Pneumonia (CAP) in Immunocompromised (IC) patients, with their antimicrobial resistant pattern and to analyze the associated immunocompromised states. Various respiratory samples from study group of 75 immunocompromised patients with features of pneumonia were collected, processed and the isolates were identified with their antimicrobial susceptibility& resistance pattern according to CLSI guidelines. The results were analyzed statistically. Diabetes mellitus is the most common immunocompromised state (48%) associated with CAP. Monomicrobial and polymicrobial infection rates were 80.36% and 19.64% respectively. Gram negative pathogens and fungal pathogens were identified in 60% and 25.37% of culture positive cases respectively. Diabetes mellitus is commonly found in association with polymicrobial infection (19.44%) and fungal infection (16.66%). Drug resistant strains comprise about 75% of MRSA strains, 72.72 % of ESBL producers and 3.44% of Amp C producers. As the number of elderly people with associated IC state is on rise, with change in the pattern of microbial etiologic agents causing CAP, a prior knowledge of the host and microbial factors will help in formulating empirical antimicrobial therapy and proper treatment thereby curbing the spread of infections by drug resistant pathogens and the associated morbidity and mortality.

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