scholarly journals Maintaining an Adult Hematology/Oncology Service at a Tertiary Care Center during the SARS-CoV-2 Pandemic: An Eight-Week-Experience with a Newly Implemented Procedural Plan

2021 ◽  
pp. 1-6
Author(s):  
Philipp G. Hemmati ◽  
Dorothea Fischer ◽  
Frank Breywisch ◽  
Sabine Wohlfarth ◽  
Matthias Kramer ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Care Center ◽  
Tertiary Care ◽  
Cancer Center ◽  
Staff Members ◽  
Oncology Service ◽  
Containment Measures ◽  
Vulnerable Patient ◽  
Set Up ◽  
Oncology Unit

Treatment of cancer patients has become challenging when large parts of hospital services need to be shut down as a consequence of a local COVID-19 outbreak that requires rapid containment measures, in conjunction with the shifting of priorities to vital services. Reports providing conceptual frameworks and first experiences on how to maintain a clinical hematology/oncology service during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic are scarce. Here, we report our first 8 weeks of experience after implementing a procedural plan at a hematology/oncology unit with its associated cancer center at a large academic teaching hospital in Germany. By strictly separating team workflows and implementing vigorous testing for SARS-CoV-2 infections for all patients and staff members irrespective of clinical symptoms, we were successful in maintaining a comprehensive hematology/oncology service to allow for the continuation of treatment for our patients. Notably, this was achieved without introducing or further transmitting SARS-CoV-2 infections within the unit and the entire center. Although challenging, our approach appears safe and feasible and may help others to set up or optimize their procedures for cancer treatment or for other exceedingly vulnerable patient cohorts.

Research Utilization in Critical Care: An Exemplar

1994 ◽  
Vol 5 (2) ◽  
pp. 124-132
Author(s):  
Marita G. Titler ◽  
Linda Moss ◽  
Jane Greiner ◽  
Michele Alpen ◽  
Gerry Jones ◽  
...  
Keyword(s):  
Critical Care ◽  
Pain Management ◽  
Research Utilization ◽  
Care Center ◽  
Tertiary Care ◽  
Practice Change ◽  
Research Committee ◽  
Staff Members ◽  
Number Of Patients ◽  
Management Protocol

The authors describe the process and outcome of implementing a research-based pain management protocol in four adult critical care units at a large, Midwestern tertiary care center. The project was initiated and directed by members of the divisional research committee. Strategies used to change practice included determining if pain management was a problem via quality assessment monitors, surveying nurses regarding their knowledge and attitude toward pain management, educating staff members about the research base for the practice change, using change champions in each unit, and developing a core group of nurses in each unit to facilitate the change. Outcomes of this research utilization project include a 41% decline in the number of patients in pain, a 44% decline in pain intensity, and improvement in nurses knowledge about pain

scholarly journals Correlation of Hormonal Profile and Lipid Levels with Female Adult Acne in a Tertiary Care Center of Nepal

2018 ◽  
Vol 16 (2) ◽  
pp. 222-227 ◽  
Author(s):  
Smriti Shrestha
Keyword(s):  
Lipid Profile ◽  
Clinical Symptoms ◽  
Care Center ◽  
Tertiary Care ◽  
Thyroid Stimulating Hormone ◽  
Bivariate Analysis ◽  
Female Adult ◽  
Chi Square ◽  
Chi Square Test ◽  
Relationship Of

 Background: Acne beyond 25 years of age is frequently associated with hormonal derangement in women. Hormonal association provides the impetus for hormonal therapy as well as underpins the need for blood investigations in this population. Hence, we aim to estimate the presence of hormonal derangement and lipid alteration in female adult acne.Methods: A prospective, observational study was conducted in Dhulikhel Hospital from July 2015 to February 2016. Females older than 25 years with acne were taken in the study after informed consent. Total 100 patients were enrolled aftersample sizeestimation. Hormonal paneland lipid profile were measured. Hormones tested were androgens, C-peptide and thyroid stimulating hormone. Data analysis was done with SPSS-23. Bivariate analysis was done by chi-square test for categorical data.Results: In this study, majority of patients were younger than 30 years (70.5%) and perioral area most commonly involved. Hormonal alteration was seen in 37.2% patients, among which 17.9% had hyperandrogenism, 15.4% had abnormal thyroid level and 10.3% had high C-peptides respectively. Lipid profile was altered in 15.4% patients. Hormonal alteration had significant association with irregular menstruation (P<0.05) but not acne severity.Conclusions: We observed hormonal alteration frequently in females with adult acne, which comprised of various hormonal parameters including hyperandrogenism. Hormonal alteration reflects deranged metabolic milieu and we suggestthat wide hormonal panel should be done in female adult acne. Relationship of hormones with menstrual irregularity but not with acne severity, suggest that clinical symptoms should lead hormonal investigations in all grades of acne.

Incidence of brain metastases and overall survival in patients with primary cardiac sarcoma: A retrospective case series.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10584-10584
Author(s):  
Maryann Shango ◽  
Lili Zhao ◽  
Monika Leja ◽  
Jonathan B. McHugh ◽  
Scott Schuetze ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Cancer Center ◽  
R0 Resection ◽  
Left Heart ◽  
Retrospective Case ◽  
Imaging Evaluation ◽  
Presenting Symptoms ◽  
Primary Cardiac Sarcoma

10584 Background: Primary cardiac sarcoma (PCS) is the most common primary cardiac malignancy, but is a rare primary site of sarcoma. We present 21 cases from a tertiary care center to better understand this uncommon malignancy. Methods: A cancer center-based registry and pathology database were searched to identify pts diagnosed with PCS from 1992-2013 at University of Michigan. Kaplan-meier method was used to estimate survival. Cox proportional hazard model was used to associate variables to occurrence of metastases (mets) or death. Results: Atotal of 21 pts (F12, 9M) with PCS were identified, median age 36 (range 11-74). The most common presenting symptoms included dyspnea (16) and chest pain (6; 5 with associated pericardial effusion). Histologies included: angiosarcoma (9), leiomyosarcoma (4), undifferentiated pleomorphic (3), spindle cell (2), fibrosarcoma (1), rhabdomyosarcoma (1) and synovial (1). Sites of origin were R atrium (7), R ventricle (2), L atrium (10) and pericardium (2). Ten pts presented with mets; most common sites were lung (8), liver (2), brain (2), pancreas (2) and bone (2). Surgery was attempted in 12 pts, achieving 1 R0 resection. Pts received a median of 1 (0-7) systemic therapies. Median overall (OS) was 12.6 mos (range 3-79) from diagnosis. Pts without prior surgery were more likely to have mets or death (p=0.038). Brain mets were common, occurring in 7 of 21 pts after a median of 7 mos (range 1-75) from diagnosis. Median OS after diagnosis of brain mets was 8 mos. Of the 7 pts who developed brain metastasis, 5 had PCS originating in the left heart. Of the 2 pts with PCS in the right heart, one was evaluated for and had a right to left shunt. The likelihood of developing brain mets did not correlate with age, chemotherapy, or surgery. Conclusions: PCS portends an extremely poor prognosis, marked by inability to achieve complete resection and a high incidence of disseminated disease at diagnosis. Metastatic disease to the brain was much more common in PCS (33%) as compared to STS of any origin (approximately 1-8%), particularly in pts with PCS originating in the left heart. Clinicians should have a low threshold for brain imaging evaluation of PCS pts.

scholarly journals Cystic Echinococcosis in a Single Tertiary Care Center in Rome, Italy

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Linda Petrone ◽  
Gilda Cuzzi ◽  
Lidia Colace ◽  
Giuseppe Maria Ettorre ◽  
Elisa Busi-Rizzi ◽  
...  
Keyword(s):  
Cystic Echinococcosis ◽  
Retrospective Cohort ◽  
Southern Italy ◽  
Care Center ◽  
Tertiary Care ◽  
Control Measures ◽  
Central Regions ◽  
Set Up ◽  
Improve Patient Management ◽  
Improve Patient

Background. Cystic echinococcosis (CE) is a chronic, clinically complex, and neglected disease. Its prevalence in Italy, a country of medium to high endemicity, remains poorly defined, as notification has long ceased to be mandatory.Methods. We set up a retrospective cohort study involving all CE patients followed at our institute between January 2005 and December 2012. Demographical and clinical features were recorded and analyzed.Results. CE was found in 28 patients (64.3%), mostly Italians from the central regions (50%), followed by subjects from the islands (33.3%) and Southern Italy (16.7%). Their median age was 45 years (IQR: 38.5–66.5), with Eastern Europeans being significantly younger (28 years, IQR: 19–39) than other patients (P≤0.0001). A total of 149 cysts, mostly with hepatic localization (96%), were described. Based on the WHO classification, the cysts were mainly small (80.5%) and active (CE1 (73.8%); CE2 (7.4%)). Active cysts were more common in Eastern Europeans (85.7%) than Italians (66.7%).Conclusion. Our data confirm CE occurrence in Italy. We emphasize the importance to have a national CE registry, opportunely recently introduced. This is essential to assess CE prevalence in this country, implement appropriate control measures, and improve patient management.

scholarly journals Anaphylaxis in Omani Patients: A Study from a Tertiary Care Center

2021 ◽  
Author(s):  
Salem Al Tamemi ◽  
Yusra Al Lamki ◽  
Shafiq Ur-Rehman Naseem ◽  
Nabila Al Siyabi ◽  
Bushra Al Siyabi ◽  
...  
Keyword(s):  
Clinical Features ◽  
Allergic Disease ◽  
Clinical Symptoms ◽  
Care Center ◽  
Tertiary Care ◽  
University Hospital ◽  
Tertiary Care Center ◽  
Total Ige ◽  
Sultan Qaboos University ◽  
True Incidence

Objective: Anaphylaxis is an acute and potentially fatal allergic reaction. To the best of the author’s knowledge, no studies have yet been conducted to evaluate the spectrum of anaphylactic reactions among Omani patients. As such, this study aimed to describe the clinical features, causes, investigation, and management of anaphylaxis among patients presenting to a tertiary care center in Oman. Methods: This retrospective study took place between August 2005 and June 2020 at the allergy and immunology clinic of the Sultan Qaboos University Hospital, Muscat, Oman. All patients diagnosed with anaphylaxis during the study period were included. Data were collected from electronic medical records. Results: A total of 100 patients were diagnosed with anaphylaxis during the study period. Of these, 52% were male. The mean age was 15.9  16.2 years, with 70% being <18 years old. The eosinophil count ranged from 0–16.9 ×109 /L, with a mean of 0.8  2.2 ×109 /L and a median 2 of 0.30 (IQR: 0.15-0.65) ×109 /L. Total IgE levels ranged from 25–8,706 kIU/L, with a mean of 935.1  1369.5 kIU/L and a median of 500.4 (IQR: 186.0-972.5) kIU/L. Overall, the majority of patients had a family history of allergies (72%), other concomitant allergic condition (66%) and were all prescribed epinephrine (100%). The most common cause of anaphylaxis was food (65%), the second most frequent trigger was insect venom (32%). The majority of patients had one category cause (81%) however two or more causes were present in 19% of the patients. Clinical symptoms manifested most frequently as cutaneous (92%), and respiratory (85%). The majority of patients (87%) demonstrated involvement of more than one bodily system. Total IgE levels were significantly higher in patients with concomitant presence of other allergic conditions 1193.8 kIU/L compared to patients without another concomitant allergic disease mean 503.6 kIU/L (p=0.03). In addition, concomitant other allergic disease is significantly higher in patients <18 years of age 75.4% compared to patients >18 years of age 45.2% (p= 0.01). Conclusions: Due to its life-threatening nature, knowledge of the epidemiology and clinical features of anaphylaxis in different populations is necessary in order to deliver rapid treatment. This study found that the clinical features of anaphylactic patients in Oman were similar to those reported elsewhere. Further research is needed to determine the true incidence of anaphylaxis in Oman in order to minimize associated morbidity and mortality.

scholarly journals EMERALD: Emergency visit audit of patients treated under medical oncology in a tertiary cancer center: Logical steps to decrease the burden

2017 ◽  
Vol 06 (04) ◽  
pp. 186-189 ◽  
Author(s):  
Amit Joshi ◽  
Vijay M. Patil ◽  
Vanita Noronha ◽  
Anant Ramaswamy ◽  
Sudeep Gupta ◽  
...  
Keyword(s):  
Medical Records ◽  
Emergency Services ◽  
Medical Oncology ◽  
Tertiary Care ◽  
Cancer Center ◽  
Emergency Visits ◽  
Oncology Unit ◽  
Curative Intention ◽  
Tertiary Cancer Center

Abstract Background: We are a tertiary care cancer center and have approximately 1000–1500 emergency visits by cancer patients undergoing treatment under the adult medical oncology unit each month. However, due to the lack of a systematic audit, we are unable to plan steps toward the improvement in quality of emergency services, and hence the audit was planned. Methods: All emergency visits under the adult medical oncology department in the month of July 2015 were audited. The cause of visit, the demographic details, cancer details, and chemotherapy status were obtained from the electronic medical records. The emergency visits were classified as avoidable or unavoidable. Descriptive statistics were performed. Reasons for avoidable emergency visits were sought. Results: Out of 1199 visits, 1168 visits were classifiable. Six hundred and ninety-six visits were classified as unavoidable (59.6%, 95% CI: 56.7–62.4), 386 visits were classified as probably avoidable visit (33.0%, 95% CI: 30.4–35.8) whereas the remaining 86 (7.4%, 95% CI: 6.0–9.01) were classified as absolutely avoidable. Two hundred and ninety-seven visits happened on weekends (25.6%) and 138 visits converted into an inpatient admission (11.9%). The factors associated with avoidable visits were curative intention of treatment (odds ratio - 2.49), discontinued chemotherapy status (risk ratio [RR] - 8.28), and private category file status (RR – 1.89). Conclusion: A proportion of visits to emergency services can be curtailed. Approximately one-fourth of patients are seen on weekends, and only about one-tenth of patients get admitted.

scholarly journals Plasmablastic Lymphoma: A Clinicopathological Study from a Tertiary Care Cancer Center in South India

2020 ◽  
Vol 9 (02) ◽  
pp. 105-108
Author(s):  
Manasi C. Mundada ◽  
Faiq Ahmed ◽  
Rachna Khera ◽  
Sudha Murthy ◽  
Senthil Rajappa ◽  
...  
Keyword(s):  
South India ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
B Cell Lymphoma ◽  
Plasmablastic Lymphoma ◽  
World Health ◽  
Proliferation Index ◽  
Cancer Center

Abstract Background Plasmablastic lymphoma (PBL) is a rare aggressive B cell lymphoma that is commonly encountered in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). In this case series, we describe the clinicopathological features of cases of PBL seen at a tertiary care center in South India. Materials and Methods Medical records of patients diagnosed with PBL between January 2009 and November 2017 were reviewed. PBL was defined as per the World Health Organization 2016 classification for hematopoietic and lymphoid neoplasms. The slides were reviewed with hematoxylin and eosin along with immunohistochemistry (IHC) including CD45, CD20, PAX5, CD79a, CD3, CD5, CD138, MUMI, EMA, ALK, and Ki67. Epstein-Barr virus (EBV) association was documented by rapid in situ hybridization (RISH) studies wherever possible. The demographic data, clinical presentation, treatment details, and outcomes are elaborated using descriptive statistics. Results During the study period, nine patients with PBL were identified. The median age at presentation was 47 years (range: 36–54 years). All patients had associated HIV/AIDS, eight (89%) had extranodal disease, and six (66%) had advanced clinical stage (stage III). All biopsies were positive for CD45, CD138, and MUM1, and negative for CD79a and T cell markers with a high Ki67 proliferation index (85–90%); CD20 was faint positive in one patient, and CD56 was positive in one (11%) patient. EBV-RISH was tested in two patients and was positive in one. Bone marrow was uninvolved in all the cases. At the time of last follow-up, three patients were alive. Treatment details were available in six patients. With frontline therapy, four patients achieved a complete remission (CR) and one patient developed progressive disease. Three of four patients in CR are alive till the last follow-up. Conclusion PBL is a rare form of lymphoma with predominant association with HIV, extranodal location, and characteristic IHC pattern.

scholarly journals Cardiac involvement in patients of dengue fever in reference to ECG and Echocardiography – A tertiary care center study

2020 ◽  
Vol 8 (6) ◽  
pp. 392-397
Author(s):  
Dr. Nitesh Sukhwani ◽  
◽  
Dr. Rohit Chhari ◽  
Keyword(s):  
Cardiac Involvement ◽  
Clinical Symptoms ◽  
Care Center ◽  
Tertiary Care ◽  
Total Duration ◽  
Clinical Manifestations ◽  
General Medicine ◽  
Research Centre ◽  
Metabolic Derangement ◽  
Multiple Organs

Introduction: Dengue rarely affects the heart but clinical symptoms of cardiac involvement mayrange greatly from silent illness to severe myocarditis resulting in death. Clinical features areasymptomatic and most are transient among patients with DF/DHF. Material and methods: It wasan observational study conducted at the Department of General Medicine, Peoples College of MedicalSciences and Research Centre, Bhopal. The total duration of the study was One and a half yearsfrom Dec 2018 to May 2020. All dengue patients presenting to People’s Hospital during one and halfyears from which data was collected using as per given proforma. Results: In the present studygroup of 58 patients, it was found that 49 patients (84.5%) have not shown any cardiacabnormalities and 9 patients have abnormal values (15.5%) but are not significant. It is also foundthat the incidence of cardiac manifestations was more common in DHF and dengue shock syndromewhich was 15.5% and 3.4%, respectively. Conclusion: Clinical manifestations of cardiacinvolvement can vary widely from silent disease to severe myocarditis resulting in death. Rhythmabnormalities, hypotension, arrhythmias, myocarditis, myocardial depression with symptoms ofheart failure and shock, and pericarditis have been reported. Involvement of multiple organs, as wellas the presence of metabolic derangement, can further confuse the picture.

scholarly journals Trends of variation of the laboratory parameters during the course of COVID-19 Illness

2021 ◽  
Vol 12 (12) ◽  
pp. 9-16
Author(s):  
Anjali Goyal ◽  
Chandni Gadara ◽  
Heta Patel ◽  
Misha Antani ◽  
Nilay Suthar
Keyword(s):  
Disease Progression ◽  
Clinical Symptoms ◽  
Care Center ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
Disease Course ◽  
Acute Phase Reactants ◽  
Laboratory Parameters

Background: The coronavirus pandemic which had its origin in the Wuhan China has been spreading across the globe with far reaching complications and a variable clinical course. A variation of the laboratory parameters during the disease course remains a constant parameter to monitor the disease course and progression. Since the laboratory parameters are standardized globally, these may also act as uniform guidelines for the patients monitoring and treatment. Aims and Objectives: The aim of the study was to serial charting of the laboratory parameters in the recovered and expired patients of COVID-19 and to determine an associated prognostic significance. Materials and Methods: A retrospective observational study from the laboratory and medical records was conducted on the patients admitted from March 17, 2020, to May 31, 2020, at the tertiary care center dedicated to the treatment of RT-PCR confirmed COVID-19 positive patients. Results: The group of parameters showing a poor prognosis include a rising WBC count, high neutrophilic percentage, low lymphocyte percentage (<10) an NLR > 15, low lymphocyte monocyte ratio < 3, rising blood urea nitrogen, serum creatinine levels, and serum electrolyte levels. The liver function tests variation reflecting a poor metabolic activity of the liver, namely, a low serum albumin and albumin globulin ratio, rising SGOT levels, and total bilirubin levels. A highly significant variation in the acute phase reactants showing an exponential rise such as the serum lactate dehydrogenase levels, serum ferritin, fibrinogen, C-reactive protein, and IL 6 levels an increased level of D Dimer (>3) and a prolongation of the APTT. Conclusion: The variation of the laboratory parameters acts as a fair marker for the disease progression. Since the disease shows a variable progression with a sudden worsening of the clinical symptoms, a comprehensive monitoring of the laboratory parameters serves to diagnose and treat the disease progression.

scholarly journals Cancer Scenario in Kashmir—A Study Conducted in a Tertiary Care Center, Srinagar, Kashmir, India

2021 ◽  
Author(s):  
Dar Abdul Waheed ◽  
Saba Sumaira ◽  
Lone Mushtaq Ahmad ◽  
Qurat Ul Ain ◽  
Sanaullah Kuchay ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Stomach Cancer ◽  
Clinical Symptoms ◽  
Care Center ◽  
Tertiary Care ◽  
Cancer Control ◽  
Incidence Rates ◽  
Anatomical Site ◽  
Female Ratio ◽  
Common Cancer

Abstract Background Cancer can have profound social and economic consequences for the people in India, often leading to family impoverishment and societal inequity. Reported age-adjusted incidence rates for cancer are still quite low in the demographically young country. Slightly more than 1 million new cases of cancer are diagnosed every year in a population of 1.2 billion. It accounts for about 23 and 7% deaths in United States and India, respectively. The world's population is expected to be 7.5 billion by 2020 and approximations predict that about 15.0 million new cancer cases will be diagnosed, with deaths of about 12.0 million cancer patients. Early detection of cancers is a challenging task because clinical symptoms develop slowly. Objective The aim of the present study was to analyze the cancer scenario in the Kashmir valley. Materials and Methods This was a retrospective study. So, all patients were included who had histopathologically confirmed neoplasm registered at Regional Cancer Centre of Government Medical College Srinagar, Kashmir between 2015 and 2018. All the patient characteristics including age, sex, and anatomical site of the disease were studied in detail. Results The number of cancer patients in 2015, 2016, 2017, and 2018 were 230, 239, 391, and 511, respectively, with a combined total of 1,371. Thus, it is clear from these figures that the number of cancer cases has increased gradually with time. Stomach cancer is the most common cancer in the Kashmir territory. In males the most common cancer is stomach cancer with 175 (12.8%) reported cases and in females the most common cancer is breast cancer with 151 (11%) reported cases. The male to female ratio was 1.4:1. Conclusion A careful reading the reported cancer cases indicates an increased number of cancer patients every year in Indian-occupied Kashmir. Kashmir is a growing state in India playing a crucial role in the development of India and, hence, it needs special attention on this issue. A multidisciplinary approach to cancer treatment is essential and this has to be made available at all regional cancer centers. Cancer control is an area in which we need participation from all sectors of the society.

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