Are patients with cancer with sepsis and bacteraemia at a higher risk of mortality? A retrospective chart review of patients presenting to a tertiary care centre in Lebanon

BackgroundInfective endocarditis (IE) is more common in patients with cancer as compared with the general population. Due to an immunocompromised state, the need for invasive procedures, hypercoagulability and the presence of indwelling catheters, patients with cancer are particularly predisposed to the development of IE.ObjectivesLimited information exists about IE in patients with cancer. We aimed to evaluate the characteristics of patients with cancer and IE at our tertiary care centre, including a comparison of the microorganisms implicated and their association with mortality.MethodsA retrospective chart review of patients with cancer who had echocardiography for suspicion of endocarditis was conducted. A total of 56 patients with a confirmed diagnosis of cancer and endocarditis, based on the modified Duke criteria, were included in the study. Baseline demographics, risk factors for developing IE, echocardiography findings, microbiology and mortality data were analysed.ResultsFollowing the findings of vegetations by echocardiography, the median survival time was 8.5 months. Staphylococcus aureus was the most common organism identified as causing endocarditis. The mitral and aortic valves were the most commonly involved sites of endocarditis. Patients with S. aureus endocarditis (SAE) had a significantly poorer survival when compared with patients without SAE (p=0.0217) over the 12-month period from diagnosis of endocarditis.ConclusionsOverall survival of patients with cancer and endocarditis is poor, with a worse outcome in patients with SAE.

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AOS5 Clinical and bacteriological spectra of neutropenic sepsis in patients with cancer treated at a tertiary care centre in Kashmir Valley

European Journal of Cancer ◽

10.1016/j.ejca.2012.02.022 ◽

2012 ◽

Vol 48 ◽

pp. S5

Author(s):

G. Bhat ◽

V. Gupta

Keyword(s):

Tertiary Care ◽

Care Centre ◽

Kashmir Valley ◽

Tertiary Care Centre ◽

Patients With Cancer ◽

Neutropenic Sepsis

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Emerging trends in the prenatal diagnosis of complex CHD and its influence on infant mortality in this cohort

Cardiology in the Young ◽

10.1017/s1047951118002147 ◽

2018 ◽

Vol 29 (3) ◽

pp. 270-276 ◽

Cited By ~ 1

Author(s):

Sudheer R. Gorla ◽

Abhishek Chakraborty ◽

Ashish Garg ◽

Rubee A. Gugol ◽

Richard E. Kardon ◽

...

Keyword(s):

Prenatal Diagnosis ◽

Infant Mortality ◽

Chart Review ◽

Fetal Echocardiography ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Tertiary Care Centre ◽

Prenatal Detection ◽

Emerging Trends ◽

Conotruncal Anomalies

AbstractBackgroundFetal echocardiography is the main modality of prenatal diagnosis of CHD. This study was done to describe the trends and benefits associated with prenatal diagnosis of complex CHD at a tertiary care centre.MethodsRetrospective chart review of patients with complex CHD over an 18-year period was performed. Rates of prenatal detection along with early and late infant mortality outcomes were studied.ResultsOf 381 complex CHD patients born during the study period, 68.8% were diagnosed prenatally. Prenatal detection rate increased during the study period from low-50s in the first quarter to mid-80s in the last quarter (p=0.001). Rate of detection of conotruncal anomalies increased over the study period. No infant mortality benefit was noted with prenatal detection.ConclusionsImproved obstetrical screening indications and techniques have contributed to higher proportions of prenatal diagnosis of complex CHD. However, prenatal diagnosis did not confer survival benefits in infancy in our study.

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Local incidence of Jarisch–Herxheimer reaction in pregnancy following penicillin treatment for syphilis: A case series

Official Journal of the Association of Medical Microbiology and Infectious Disease Canada ◽

10.3138/jammi-2021-0001 ◽

2021 ◽

pp. e20210001

Author(s):

Amreet Dhaliwal ◽

Alison A Lopez ◽

Jared Bullard ◽

Vanessa Poliquin

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Gestational Age ◽

Tertiary Care ◽

Case Series ◽

Retrospective Chart Review ◽

Antimicrobial Treatment ◽

Care Centre ◽

Tertiary Care Centre ◽

Gestational Age At Delivery

Background: The literature suggests that the Jarisch–Herxheimer (J-H) reaction following antimicrobial treatment of syphilis is common and may precipitate uterine activity. Local practice is to transfer syphilitic parturients beyond gestational age of viability from rural locations to a tertiary care centre for treatment. Study objectives were to delineate local incidence and risk factors for the J-H reaction among pregnant women receiving treatment for syphilis. Methods: A retrospective chart review was conducted on pregnant women diagnosed with syphilis and treated during pregnancy at a tertiary care centre between 2012 and 2018. J-H reaction was defined as having ≥1 of the following symptoms within 24 hours of antibiotic treatment: fever (temperature ≥38°C), clinical description of a painful or itchy skin lesion, headache, hypotension (systolic BP <90), uterine contractions, or fetal heart rate decelerations. Descriptive statistical analysis was performed with mean and median used as measures of central tendency for continuous and categorical data, respectively. Results: Fifty-eight charts were eligible for inclusion. Mean maternal age was 25.1 (SD 5.6) years, and mean gestational age was 20.4 (SD 9.5) weeks when syphilis was diagnosed. One patient (1/58, 1.7%) met J-H reaction criteria. Mean gestational age at delivery was 37.1 (SD 3.4) weeks. One stillbirth (1.7%) was identified. Conclusions: The J-H reaction is less common at our centre than the literature suggests. Further research is important to identify risk factors associated with J-H reaction to optimize resource allocation in the context of treatment of syphilis during pregnancy.

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Enterococcal Bacteremia in a Tertiary Care Centre in Winnipeg

Canadian Journal of Infectious Diseases ◽

10.1155/1999/454985 ◽

1999 ◽

Vol 10 (1) ◽

pp. 57-63 ◽

Cited By ~ 1

Author(s):

Tariq AA Madani ◽

Amin Kabani ◽

Pamela Orr ◽

Lindsay Nicolle

Keyword(s):

Chart Review ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Clinical Microbiology Laboratory ◽

Tertiary Care Centre ◽

Vancomycin Resistant ◽

Polymicrobial Bacteremia ◽

High Level ◽

Enterococcal Bacteremia ◽

Overall Mortality

OBJECTIVE: To review experience with enterococcal bacteremia before the emergence of vancomycin-resistant enterococcus at a tertiary care teaching hospital.DESIGN: Retrospective chart review of episodes of enterococcal bacteremia identified through the clinical microbiology laboratory from January 1990 to December 1994. Antimicrobial susceptibilities were performed for all isolates and pulsed-field gel electrophoresis for genetic typing of selected strains.RESULTS: One hundred and twenty-six episodes of bacteremia were identified in 109 patients: 108Enterococcus faecalis, 13Enterococcus faecium, four bothE faecalisandE faecium, and oneEnterococcus durans. Enterococcal isolates occurred with polymicrobial bacteremia in 62 (49%) episodes. The most common sites of infection were central venous catheters (45%) and the urinary tract (21%). Enterococcal bacteremia was usually nosocomially acquired (88%), and associated with older age, instrumentation, and prior or current antimicrobial therapy. Overall mortality was 22%, and 7.2% was partially or fully attributable to enterococcal bacteremia. Resistance to ampicillin, high level gentamicin and high level streptomycin were 0%, 32% and 31% forE faecalis, respectively, and 44%, 0% and 47% forE faecium, respectively.CONCLUSIONS: During this review, the frequency and impact of enterococcal bacteremia at this institution was relatively limited. Isolates resistant to ampicillin and aminoglycosides were emerging, but differences in patient outcomes were similar for resistant and susceptible isolates.

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Cannabinoid hyperemesis syndrome presentation to the emergency department: A two-year multicentre retrospective chart review in a major urban area

CJEM ◽

10.1017/cem.2017.381 ◽

2017 ◽

Vol 20 (4) ◽

pp. 550-555 ◽

Cited By ~ 8

Author(s):

Jeremy M. Hernandez ◽

Jared Paty ◽

Ira M. Price

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Case Series ◽

Retrospective Chart Review ◽

Kappa Statistic ◽

Cannabis Use ◽

Urgent Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Cannabinoid Hyperemesis Syndrome

AbstractObjectiveCannabinoid hyperemesis syndrome (CHS) is a paradoxical side effect of cannabis use. Patients with CHS often present multiple times to the emergency department (ED) with cyclical nausea, vomiting, and abdominal pain, and are discharged with various misdiagnoses. CHS studies to date are limited to case series. The objective was to examine the epidemiology of CHS cases presenting to two major urban tertiary care centre EDs and one urgent care centre over a 2-year period.MethodsUsing explicit variables, trained abstractors, and standardized abstraction forms, we abstracted data for all adults (ages 18 to 55 years) with a presenting complaint of vomiting and/or a discharge diagnosis of vomiting and/or cyclical vomiting, during a 2-year period. The inter-rater agreement was measured using a kappa statistic.ResultsWe identified 494 cases: mean age 31 (+/-11) years; 36% male; and 19.4% of charts specifically reported cannabis use. Among the regular cannabis users (>three times per week), 43% had repeat ED visits for similar complaints. Moreover, of these patients, 92% had bloodwork done in the ED, 92% received intravenous fluids, 89% received antiemetics, 27% received opiates, 19% underwent imaging, 8% were admitted to hospital, and 8% were referred to the gastroenterology service. The inter-rater reliability for data abstraction was kappa=1.ConclusionsThis study suggests that CHS may be an overlooked diagnosis for nausea and vomiting, a factor that can possibly contribute to unnecessary investigations and treatment in the ED. Additionally, this indicates a lack of screening for CHS on ED history, especially in quantifying cannabis use and eliciting associated symptoms of CHS.

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Comparison of Community-Acquired Pneumonia Requiring Admission to Hospital in HIV-and Non-HIV-Infected Patients

Canadian Journal of Infectious Diseases ◽

10.1155/1996/272180 ◽

1996 ◽

Vol 7 (4) ◽

pp. 253-258 ◽

Cited By ~ 3

Author(s):

Claire Touchie ◽

Thomas J Marrie

Keyword(s):

Chart Review ◽

Tertiary Care ◽

Pneumocystis Carinii ◽

Vital Signs ◽

Retrospective Chart Review ◽

Community Acquired Pneumonia ◽

Tertiary Care Centre ◽

Immunodeficiency Virus ◽

Hospital Transfer ◽

Two Populations

OBJECTIVE: To compare community-acquired pneumonia (CAP) in hospitalized human immunodeficiency virus (HIV)-infected patients with that in hospitalized non-HIV-infected patients by assessing presenting characteristics, etiology and outcomes.DESIGN: Retrospective chart review.SETTING: A tertiary care centre in Halifax, Nova Scotia.POPULATION STUDIED: Thirty-two HIV-infected patients requiring hospitalization for treatment of CAP were identified from September 1991 to October 1993 and compared with 33 age-matched non-HIV-infected patients who presented with pneumonia during the same period.MAIN RESULTS: The two populations were comparable in age, sex and race. Fifty per cent of the HIV-infected and 20.8% of the non-HIV-infected patients had had a previous episode of pneumonia.Pneumocystis cariniipneumonia (PCP) accounted for 16 of the 32 episodes of CAP in the HIV-infected patients, while none of the non-HIV-infected patients had PCP. Pneumonia secondary toStreptococcus pneumoniaewas more common in the non-HIV-infected patients (five versus one, P=0.02). Vital signs and initialPO2did not differ between the two groups. White blood cell count was lower at admission for the HIV population (5.7×109/L versus 12.7×109/L, P=0.003). The HIV patients were more likely to undergo bronchoscopy (27.7% versus 0%, P<0.001). The length of stay in hospital, transfer to the intensive care unit and necessity for intubation were the same for both groups. The in-hospital mortality for HIV-infected patients was eight of 32 (25%) while for the non-HIV-infected patients it was none of 33 (P=0.002).CONCLUSIONS: Patients with HIV infection who present with CAP are more likely to have PCP, to have had a past episode of pneumonia and to die while in hospital than age- and sex-matched non-HIV-infected patients with CAP.

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Ten-Year Review of Candidemia in a Canadian Tertiary Care Centre: Predominance of Non-albicans CandidaSpecies

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2013/929717 ◽

2013 ◽

Vol 24 (3) ◽

pp. e65-e68 ◽

Cited By ~ 12

Author(s):

Ghada N Al-Rawahi ◽

Diane L Roscoe

Keyword(s):

Risk Factors ◽

Demographic Data ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Final Analysis ◽

Antibiotic Use ◽

Care Centre ◽

Tertiary Care Centre ◽

Medical Diagnoses ◽

Associated Risk Factors

OBJECTIVE: To review the epidemiology and associated risk factors for candidemia at a tertiary care centre, in view of recent reports on the changing epidemiology of bloodstream infection due toCandidaspecies.METHODS: Between January 2000 and December 2009, patients with blood culture samples positive forCandidaspecies were identified using the microbiology laboratory information system. Patient data were collected by retrospective chart review of clinical characteristics including demographic data, underlying medical diagnoses and risk factors.RESULTS: A total of 266 candidemia episodes were included in the final analysis. Fifty-nine per cent of these episodes occurred in males and 51% were in patients >60 years of age. The most common risk factor for candidemia was previous antibiotic use (85%). The most frequent species wasCandida albicans(49%), followed byCandida glabrata(30%).C albicanswas the predominant species in all study years with the exception of 2002, in whichC glabratawas more frequent. The likelihood of recovering a non-albicans Candidaspecies was found to be significantly associated with previous antifungal therapy (P=0.0004), immunosuppressive therapy (P=0.002), abdominal surgery (P=0.003) and malignancy (P=0.05). Mixed candidemia was found in 10 episodes (4%); 80% grewC albicansandC glabrata. Risk factors for mixed candidemia were not significantly different from those with monomicrobial candidemia.CONCLUSION:C albicansremains the most commonly isolated species in this setting, consistent with findings from other Canadian centres. However, non-albicans Candidaspecies were overall predominant. Mixed-species candidemia does not appear to be more prevalent in patients with identified risk factors.

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Telemedicine as an Acceptable Model of Care in Advanced stage Cancer Patients in the Era of Coronavirus Disease 2019 – An Observational Study in a Tertiary Care Centre

Indian Journal of Palliative Care ◽

10.25259/ijpc_45_21 ◽

2021 ◽

Vol 27 ◽

pp. 306-312

Author(s):

Shreya Das Adhikari ◽

Swagata Biswas ◽

Seema Mishra ◽

Vinod Kumar ◽

Sachidanand Jee Bharti ◽

...

Keyword(s):

Cancer Patients ◽

Tertiary Care ◽

Routine Care ◽

Categorical Variables ◽

Care Centre ◽

Tertiary Care Centre ◽

Patients With Cancer ◽

Acceptable Model ◽

Advanced Stage Cancer

Objectives: The availability of routine care for patients with cancer during the coronavirus disease 2019 (COVID-19) pandemic has become challenging, and the use of telemedicine can be promising in this area. The objective of the study is to evaluate the feasibility of telemedicine-based palliative interventions in cancer patients. Materials and Methods: This retrospective study was conducted in a tertiary care centre with 547 follow-up patients who used palliative medicine teleconsultation services. The following data were retrieved from the records: Patient’s reason for the call, the main barriers to a hospital visit, the assistance given to them by the physician on the call and the patients’ satisfaction with the service on a 4-point scale. The data were analysed using percentages for categorical variables and mean/standard deviation for quantitative variables. Results: Out of the 547 patients, 462 (84.46%) utilised voice calling service, and the major reason for not visiting the hospital were cited to be fear of contracting COVID-19 (37.3%), inability to attend due to health constraints (7.13%) and issues with transportation (48.8%). The majority of the calls (63.62%) calls were regarding uncontrolled symptoms of the primary diseases. A total of 402 (73.49%) patients were very satisfied, and a total of 399 (72.94%) decided to continue to use this medium in the future as well. Conclusion: Telemedicine is a good modality for the assessment of chronic pain and providing symptomatic supportive care in patients with cancer in the COIVD-19 pandemic.

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Prevalence of Post Tonsillectomy Haemorrhage at a Tertiary Care Centre in Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.5831 ◽

2021 ◽

Vol 59 (234) ◽

Author(s):

Prashant Tripathi ◽

Rohita Bajracharya ◽

Kunjan Acharya ◽

Bijaya Kharel ◽

Yogesh Neupane ◽

...

Keyword(s):

Chart Review ◽

Tertiary Care ◽

Neck Surgery ◽

Sleep Apnoea ◽

University Teaching ◽

Care Centre ◽

Recurrent Tonsillitis ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Obstructive Sleep

Introduction: Tonsillectomy is one of the common ENT surgical procedures. Post-tonsillectomy haemorrhage remains a frequent complication which can be potentially life-threatening. The objective of the present study was to calculate the prevalence of haemorrhage following a tonsillectomy at a tertiary care centre. Methods: It was a descriptive cross-sectional study performed by medical chart review of the patients who underwent tonsillectomy from January 2018 to December 2019 at the department of ENT- Head and Neck Surgery of Tribhuvan University Teaching Hospital. Ethical approval was obtained from the institutional review committee (Ref:-282(6-11) E2 076/077). Convenient sampling method was used. All patients of any age who had tonsillectomy for recurrent tonsillitis or tonsillar hypertrophy with or without obstructive sleep apnoea and no missing information on chart review were included in the study. Data were entered in MS-Excel 2007 and analyzed in rate and percentage. Results: Ten (5.18%) out of a total of 193 patients who underwent tonsillectomy had a post tonsillectomy haemorrhage. All 10 (100%) were adults patients, operated for recurrent tonsillitis, and used electrocautery. It was common in male patients 7 (70%). All of the haemorrhages was between a third and sixth postoperative day and were mild in severity. Conclusions: The prevalence of post-tonsillectomy haemorrhage was high at our centre during the study period of two years. It was common in adults, males and surgery done for recurrent tonsillitis using electrocauterization.

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