scholarly journals An Unusual Visit from an Old Foe: Oral Presentation of Syphilis in a Teenage Patient

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Bedirhan Tarhan ◽  
Sydur Rahman ◽  
Diana Halloran ◽  
Jeremy Sites ◽  
Avni Bhatt ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Hospital Medicine ◽  
Adolescent Females ◽  
Clinical Findings ◽  
Secondary Syphilis ◽  
Pediatric Hospital ◽  
Syphilis Infection ◽  
Macular Rash ◽  
Inguinal Lymphadenopathy

The authors report an atypical case of secondary syphilis in an adolescent female presenting to a tertiary-care center with fever, weight loss, oral sores, painful inguinal lymphadenopathy, and transient macular rash. Given the lower prevalence of syphilis in adolescent females, this infection was not included on the initial differential diagnosis. The evolving presentation of syphilis over time complicates the diagnosis and management of these infections, as it did for the patient in this report. The authors provide a detailed discussion of the patient’s clinical findings, including the protean features of syphilis infection. This case is particularly relevant to the fields of general pediatrics and pediatric hospital medicine.

scholarly journals Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s263-s264
Author(s):  
Jordan Polistico ◽  
Avnish Sandhu ◽  
Teena Chopra ◽  
Erin Goldman ◽  
Jennifer LeRose ◽  
...  
Keyword(s):  
Influenza Season ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Turnaround Time ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Rapid Pcr ◽  
The Impact

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

scholarly journals Medical Trainee Continuity of Care Following Emergency Department Consultations in a Pediatric Hospital

2016 ◽  
Vol 8 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Kim Bjorklund ◽  
Emily A. Eismann ◽  
Roger Cornwall
Keyword(s):  
Emergency Department ◽  
Continuity Of Care ◽  
Broad Spectrum ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care ◽  
Well Being ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Medical Trainee

ABSTRACT Background The importance of continuity of care in training is widely recognized; however, a broad-spectrum assessment across all specialties has not been performed. Objective We assessed the continuity of care provided by trainees, following patient consultations in the emergency department (ED) across all specialties at a large pediatric tertiary care center. Methods Medical records were reviewed to identify patients seen in consultation by a resident or fellow trainee in the ED over a 1-year period, and to determine if the patient followed up with the same trainee for the same condition during the next 6 months. Results Resident and fellow trainees from 33 specialties participated in 3400 ED consultations. Approximately 50% (1718 of 3400) of the patients seen in consultation by a trainee in the ED followed up with the same specialty within 6 months, but only 4.1% (70 of 1718) followed up with the same trainee for the same condition. Trainee continuity of care ranged from 0% to 21% among specialties, where specialties with resident clinics (14.4%) have a greater continuity of care than specialties without resident clinics (2.7%, P &lt; .001). Continuity of care did not differ between fellows (4.2%) and residents (4.0%, P = .87), but did differ between postgraduate years for residents (P &lt; .001). Conclusions Trainee continuity of care for ED consultations was low across all specialties and levels of training. If continuity of care is important for patient well-being and trainee education, efforts to improve continuity for trainees must be undertaken.

scholarly journals Prevalence of ear cleaning and its characteristic physical findings in patients visiting tertiary care center in Bhutan

2018 ◽  
Vol 4 (1) ◽  
pp. 42-45
Author(s):  
Tika Ram Adhikari ◽  
Sonam Jamtsho
Keyword(s):  
External Auditory Canal ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Clinical Findings ◽  
Tertiary Care Center ◽  
Ear Canal ◽  
Cross Sectional ◽  
Bony Canal ◽  
Physical Findings

Introduction: Many studies have been done on prevalence and complications of ear bud across the globe but very few talk about the characteristics physical findings associated with ear cleaning. We aim to find the prevalence and characteristic physical findings of cotton bud usage in patients visiting a tertiary care center in Bhutan. Methods: A cross sectional study in a tertiary care center in Bhutan over a period of one month. Results: The prevalence of ear cleaning was 92.15%. The most common physical finding was shiny external auditory canal (66%), excoriations in the external auditory canal (longitudinal furrowing along the floor or Circular scratch marks)(52%), erythema and edema of ear canal (46.6%), wax in the bony canal near tympanic membrane(9.3%), stenosed external auditory canal (3.8%), cotton wool remnants in ear canal(2.8%). Conclusions: It is important to recognize these characteristic clinical findings of cleaning the ear so that proper counseling can be given against its usage and prevent undue complications associated with it.

scholarly journals Utility of lung ultrasound in childhood pneumonia in a tertiary care center

2020 ◽  
Vol 7 (6) ◽  
pp. 1237
Author(s):  
Niharika Shetty ◽  
Sarala Sabapathy ◽  
Mallesh K.
Keyword(s):  
Lung Ultrasound ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Findings ◽  
Childhood Mortality ◽  
Mortality And Morbidity ◽  
Childhood Pneumonia ◽  
Inter Observer Variability ◽  
Ultrasound Findings ◽  
Valuable Role

Background: Pneumonia is a major cause of childhood mortality and morbidity worldwide. Chest radiography has been used as a modality for diagnosing but has the disadvantage of radiation exposure and inter-observer variability. Hence studies have explored the possibility of using lung ultrasound in the diagnosis of pneumonia. To assess lung ultrasound (LUS) findings in childhood pneumonia and to correlate lung ultrasound findings with clinical findings.Methods: 210 children between 2 months to 5 years admitted in the hospital with diagnosis of pneumonia were enrolled in the study. They underwent LUS within 24 hours of admission and the results were analysed.Results: Out of the 210 patients enrolled in the study, 41 (19.5%) had positive LUS findings. However, LUS findings correlated well with clinical findings in cases with very severe pneumonia.Conclusions: This study showed that lung ultrasound cannot be used a sole diagnostic tool in childhood pneumonia, but it has a valuable role in detection of complications. Lung ultrasound will require more training for detection of early indicators of pneumonia.

scholarly journals An observational study of clinical profile and outcome of syphilis infection during pregnancy in the tertiary care center

2020 ◽  
Vol 9 (8) ◽  
pp. 3408
Author(s):  
Pooja Gangwar ◽  
Arti Jhinwal ◽  
Preksha Gupta ◽  
Eshu Dixit ◽  
Suchita Bajaj
Keyword(s):  
Informed Consent ◽  
Observational Study ◽  
Care Center ◽  
Tertiary Care ◽  
Transmitted Disease ◽  
Fetal Loss ◽  
Adverse Outcomes ◽  
Public Health Approach ◽  
Syphilis Infection ◽  
Populations At Risk

Background: Syphilis is a sexually transmitted disease (STD) caused by the bacterium treponema pallidum, but little is known about its mechanism of action. In pregnancy it leads to adverse outcomes among more than half of the women with active disease, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death.Methods: It is an observational study in the department of obstetrics and gynecology Mahatma Gandhi Memorial Medical College Maharaja Yashwant Rao Hospital, Indore between January 2014 to December 2015 total 20870. In Include written informed consent, All the patients attending STI/RTI clinic with clinical diagnosis of STD. In Exclusion criteria include patients not give informed consent. Case definition: All VDRL + TPHA positive patients.Results: Out of 20870 females on which VDRL was performed 77 (0.036%) were found to be positive. The seroprevalence at study hospital thus came out to be 0.036%. These were further confirmed by TPHA and 73 (94.8%) out of 77 samples were positive. A total agreement was seen between TPHA and VDRL with a titer of 1 in 8 and above. Among total 20870 screened females, 77% (16101) were ANC patients of which 26 cases out of 77 that is 33.76% females were syphilis positive.Conclusions: Low prevalence of syphilis in pregnant women and adult general population is very encouraging. participation of people and public health approach to promote awareness of syphilis among physicians and populations at risk in India are very urgently needed to avoid the adverse consequences which could result from undiagnosed or improper treatment.

scholarly journals Differences and diversity of autoimmune-mediated encephalitis in 77 cases from a single tertiary care center

2019 ◽  
Author(s):  
Abhinbhen Wasontiwong Saraya ◽  
Kanthita Worachotsueptrakun ◽  
Kritchai Vutipongsatorn ◽  
Chanikarn Sonpee ◽  
Thiravat Hemachudha
Keyword(s):  
Behavioral Change ◽  
Care Center ◽  
Tertiary Care ◽  
Autoimmune Encephalitis ◽  
Numerical Data ◽  
Clinical Findings ◽  
Exact Test ◽  
Abnormal Movements ◽  
Surface Antibody ◽  
Surface Antibodies

Abstract Background Since the discovery of N-methyl-D-aspartate receptor (NMDAr) antibody in 2007, the incidence of autoantibody-mediated encephalitis has risen globally. Here we analyzed and compared groups of autoantibody-associated encephalitis patients based on clinical findings and laboratory results in order to find differences between two major groups of autoantibody-mediated encephalitis: intracellular and neuronal surface antibodies. Methods 77 records of autoimmune encephalitis/encephalomyelitis patients admitted to King Chulalongkorn Memorial Hospital (KCMH) between October 2010 and February 2017 were reviewed. Patients with infections or those with classic central nervous system demyelinating features were excluded. Categorical data was analyzed using chi-square and Fisher’s exact test. Unpaired, two-tailed t-test was performed to analyze numerical data. Results Of 77 patients, 40% presented with neuronal surface antibodies and 33% had intracellular antibodies. The most common autoantibody detected in each group was anti-NMDA receptor antibody (25/31, 81%) and anti-Ri antibody (7/25, 28%) respectively. In the neuronal surface antibody group, behavioral change was the most common complaint (45%), followed by seizures (39%), abnormal movements (29%) and psychosis/mood disorder (23%). In the latter group, seizure was the most common presenting symptom (32%), followed by motor weakness (20%), behavioral change (16%) and abnormal movements (16%). Patients with neuronal surface antibodies were significantly younger (35 vs 48 years old, p=0.04) and were more likely to present with behavioral change (45% vs 16%, p=0.02). Mortality rate was higher in the intracellular group although this was statistically insignificant (16% vs 3.2%, p=0.09). No significant differences were detected in magnetic resonance imaging and cerebrospinal fluid (CSF) profile. Conclusions The prevalence of neuronal surface antibody group was much higher than the intracellular group. In the earlier stages of the disease, both groups have comparable clinical outcomes. Furthermore, it is difficult to distinguish autoantibody-associated encephalitis patients based on clinical data, neuroimaging and CSF profile. Therefore, we recommend that patients with features of autoimmune encephalitis should be screened for both the neuronal surface and intracellular antibodies regardless of clinical presentation.

Self-extubation Laryngeal Injuries at an Academic Tertiary Care Center: A Retrospective Pilot Study

2017 ◽  
Vol 126 (7) ◽  
pp. 555-560
Author(s):  
Jason E. Cohn ◽  
Andrew Touati ◽  
Mark Lentner ◽  
Mark Weitzel ◽  
Casey Fisher ◽  
...  
Keyword(s):  
Symptom Score ◽  
Significant Positive Correlation ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Clinical Score ◽  
Clinical Findings ◽  
Laryngeal Edema ◽  
Common Symptom ◽  
Positive Correlation

Objectives: The purpose of this study is to identify laryngeal symptoms and injuries in self-extubated patients. Methods: A retrospective chart review was conducted to identify symptoms and clinical findings associated with self-extubation. A novel scoring system was developed and used to quantify these findings. Symptom score included all symptoms that patients reported after self-extubation. Clinical score consisted of laryngeal findings visualized on nasopharyngeal laryngoscopy. Finally, a total self-extubation score was calculated as the sum of the symptom and clinical scores. Additionally, duration of intubation and endotracheal tube size were correlated with these scores. Results: Sixty (n = 60) patients who self-extubated in our institution’s intensive care unit were identified. Average calculated symptom, clinical, and total self-extubation scores were 0.92, 1.43, and 2.35, respectively. The most common symptom observed was hoarseness (62%), while the most common clinical finding was posterior laryngeal edema (58%). A significant positive correlation was found between duration of intubation and both symptom score and total self-extubation score (r = 0.314, P = .008 and r = 0.223, P = .05, respectively). Symptom score predicted clinical score with a significant positive correlation present (r = 0.278, P = .02). Conclusions: This study demonstrates that the majority of self-extubated patients have laryngeal symptoms and clinical findings. A comprehensive, multidisciplinary evaluation is warranted for self-extubations.

scholarly journals Retrospective analysis of demographic factors and changing pattern of clinical features of acquired syphilis at a tertiary care center in South India

2018 ◽  
Vol 4 (4) ◽  
pp. 534
Author(s):  
P. Sivayadevi ◽  
Heber Anandan
Keyword(s):  
Retrospective Analysis ◽  
Clinical Features ◽  
Care Center ◽  
Tertiary Care ◽  
Demographic Factors ◽  
Secondary Syphilis ◽  
Sexually Transmitted ◽  
Medical College ◽  
Wide Range ◽  
Common Skin

<p class="abstract"><strong>Background:</strong> Syphilis presents with a wide range of mucocutaneous and systemic manifestations, which can mimic many other diseases. The pattern of acquired syphilis is changing in recent years because of widespread use of antibiotics and HIV infection which leads to under diagnosis. Aim was to study the demographic factors and changing pattern of clinical features of acquired syphilis.</p><p class="abstract"><strong>Methods:</strong> Retrospective analysis of all cases of sexually transmitted infections registered in the Department of Venereology, Thanjavur Medical College from January 2013 to December 2017 was done. The data regarding epidemiological, clinical and investigational details were recorded and analyzed for changing trends in incidence, pattern and clinical presentation of syphilis.<strong></strong></p><p class="abstract"><strong>Results:</strong> Of the total 14,672 cases attended theSTI clinic, 140 patients were diagnosed as having syphilis. There were 101 (79.4%) males and 39 (27.8%) females. Primary Syphilis was diagnosed in 18 (12.25%), Secondary syphilis in 38 (27.14%) and latent in 84 (60%) cases. Palmoplantar syphilide was the most common skin manifestation seen in 20 (52.63%) cases of secondary syphilis. 11 (7.85%) patients was human immunodeficiency virus (HIV) reactive.</p><p class="abstract"><strong>Conclusions:</strong> Our study indicates an increasing trend in the prevalence of syphilis cases in last 5 years with a rise in early symptomatic syphilis demanding steps to increase awareness among the general population.</p>

scholarly journals Study of Clinical Findings and Treatment Outcomes of Rhino-OrbitalCerebral Mucormycosis at a Tertiary Care Center in Central India

2021 ◽  
Vol 8 (40) ◽  
pp. 3464-3469
Author(s):  
Kavita Anand Dhabarde ◽  
Pallavi Madhusudan Doble ◽  
Nehali Sureshchandra Pant ◽  
Nisha Vilas Rahul
Keyword(s):  
Treatment Outcomes ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Arterial Occlusion ◽  
Central India ◽  
Clinical Findings ◽  
Tertiary Care Center ◽  
Ocular Movements

BACKGROUND Mucormycosis is a potentially lethal angioinvasive fungal infection. Increasing incidence of rhino-orbital-cerebral mucormycosis in setting of corona virus disease-19 (COVID-19) during second wave in India and elsewhere has become a matter of immediate concern. This study was done to assess the clinical findings and treatment outcomes of rhino-orbital-cerebral-mucormycosis presenting to a tertiary care center in central India. METHODS This is a longitudinal study. We observed 38 COVID-19 associated mucormycosis cases. Their demographic data, clinical manifestations, underlying systemic conditions, microbiological and radiological reports, medical treatments and surgical interventions were recorded and analysed. RESULTS Common ocular presenting features were ophthalmoplegia (68 %), proptosis (44 %), periorbital swelling (13 %), diminution of vision (37 %), central retinal arterial occlusion (2.5 %), optic atrophy (2.5 %). Visual acuity at 1 month after surgery was compared with that at presentation and was found unchanged in 27 patients, improved in 3 patients and deteriorated in 6 patients. Functional outcome was evaluated in terms of ocular movements, and it was found that ocular movements were same as presentation in 30 patients, improved in 3 patients and deteriorated in 3 patients at follow up one month after surgery. Radiological outcome was evaluated, and it was found that residual disease was present in 4 patients and absent in 32 patients. Mortality was found in 2 patients at 1 month follow-up period. CONCLUSIONS Early diagnosis, blood sugar levels control, urgent systemic antifungal therapy and sinus debridement surgery are lifesaving in cases of COVID-19 associated mucormycosis. KEYWORDS Mucormycosis, COVID-19, Diabetes Mellitus, Ophthalmoplegia, Orbital Apex Syndrome, Orbital Cellulitis, Proptosis

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