Abstract WP238: Safety and Outcomes of Stroke Mimics After Thrombolysis: A Single Center Experience

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Kathleen Mays-Wilson ◽  
Patricia Penstone ◽  
Daniel Miller ◽  
Panayiotis D Mitsias ◽  
Christopher A Lewandowski
Keyword(s):  
Treatment Time ◽  
Tertiary Care ◽  
Conversion Disorder ◽  
Bleeding Complications ◽  
Published Data ◽  
Care Hospital ◽  
Stroke Mimics ◽  
Single Center Experience ◽  
Primary Stroke Center ◽  
Stroke Center

Background: Administration of intravenous (IV) t-PA for acute ischemic stroke (AIS) improves outcomes. The most dreaded complication is intracerebral hemorrhage (ICH). Some patients have symptoms that impersonate an AIS but are later found to have an alternate diagnosis; these are termed stroke mimics (SM). SM treated with IV t-PA are exposed to hemorrhagic complications without benefit. Objectives: To describe the characteristics, safety, and outcomes of SM patients treated with t-PA under 4.5 hours. Methods: We reviewed all patients hospitalized after IV t-PA treatment at a tertiary care hospital and primary stroke center from January 2008 through December 2011. SMs were determined by review of clinical and imaging findings. SM are described and compared to t-PA treated patients with AIS for demographics, ICH, bleeding complications, and outcomes. Results: We identified 38 SM (12%) and 285 AIS (88%) t-PA treated patients. Compared to AIS, SM patients were younger (55.1 vs. 67.0 yrs, p<.001), more often women (68% vs.49%, p=.025), and reported a history of stroke more often (45% v 14%, p<.001). There were no differences in race, baseline stroke scale (9.4 v 10.9, p=.26), or onset to treatment time (164 min v 159 min, p=.63); 12 SM were in the 3-4.5 hour window. There were no ICHs or deaths in SM patients. There were two (5.2%) SM systemic hemorrhages; a femoral artery bleed post cardiac catheterization requiring transfusion, and an UGI bleed after a nasogastric tube not requiring transfusion. The average SM length of stay was 3.4 +/- 2.2 days. The mean discharge NIHSS score was 1.3 +/-2.5 in the SM v 4.6+/-5.7 in the AIS patients (p<.001). SM discharges were: home (84%), rehab center (12%), Nursing home 3%, and other (3%). The most common cause of SM was conversion disorder (47%) seizures (32 %) and migraine (8%). Conclusion: SM are not uncommon. Treatment of SM with IV t-PA appears to be safe in this cohort. The most common etiologies of stroke mimics were conversion disorder, seizures, and migraine. These results are consistent with existing published data on use of IV t-PA in SMs. Until more specific diagnostics are available, suspected SM should not be a reason to withhold t-PA treatment.

The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan: 2011-2016

2017 ◽  
Vol 157 (4) ◽  
pp. 602-607 ◽  
Author(s):  
Alexander Lanigan ◽  
Brentley Lindsey ◽  
Stephen Maturo ◽  
Joseph Brennan ◽  
Adrienne Laury
Keyword(s):  
Soft Tissue ◽  
Tertiary Care ◽  
Case Series ◽  
Soft Tissue Injuries ◽  
Published Data ◽  
Care Hospital ◽  
Neck Injuries ◽  
Facial Fractures ◽  
Tympanic Membrane Perforations ◽  
Tissue Injuries

Objective Define the number and type of facial and penetrating neck injuries sustained in combat operations in Iraq and Afghanistan from 2011 to 2016. Compare recent injury trends to prior years of modern conflict. Study Design Case series with chart review. Setting Tertiary care hospital. Methods The Joint Theater Trauma Registry (JTTR) was queried for facial and neck injuries from Iraq and Afghanistan from June 2011 to May 2016. Injury patterns, severity, and patient demographics were analyzed and compared to previously published data from combat operations during January 2003 to May 2011. Results A total of 5312 discrete facial and neck injuries among 922 service members were identified. There were 3842 soft tissue injuries (72.3%) of the head/neck and 1469 (27.7%) facial fractures. Soft tissue injuries of the face/cheek (31.4%) and neck/larynx/trachea (18.8%) were most common. The most common facial fractures were of the orbit (26.3%) and maxilla/zygoma (25.1%). Injuries per month were highest in 2011 to 2012 and steadily declined through 2016. The percentage of nonbattle injuries trended up over time, ranging from 14.7% to 65%. Concurrent facial/neck soft tissue trauma or fracture was associated with an overall mortality rate of 2.44%. Comparison of our data to that previously published revealed no statistical difference in concurrent mortality (3.5%-2.2%, P = .053); an increase in orbital fractures ( P < .005), facial nerve injury ( P < .0005), and ear/tympanic membrane perforations ( P < .0005); and a decrease in mandible fractures ( P < .005). Conclusion Penetrating neck and facial injuries remain common in modern warfare. Assessing injury characteristics and trends supports continued improvements in battlefield protection and identifies areas requiring further intervention.

scholarly journals Common orthopedic problems in the neonate: a comparative study of 2 periods at a tertiary-care hospital

2019 ◽  
Vol 13 (3) ◽  
pp. 101-105
Author(s):  
Anongnart Sirisabya ◽  
Tanteera Tooptakong ◽  
Noppachart Limpaphayom
Keyword(s):  
Parental Education ◽  
Tertiary Care ◽  
Newborn Infants ◽  
International Classification Of Diseases ◽  
Published Data ◽  
Care Hospital ◽  
Average Birth Weight ◽  
Live Births ◽  
Starting Point ◽  
Siriraj Hospital

Abstract Background In 1975, King Chulalongkorn Memorial Hospital (KCMH) in Bangkok, Thailand, published data on common orthopedic problems in neonates. Objectives To determine the more recent incidence of these conditions and to compare the results with those reported 40 years ago by KCMH. The data were also compared with a recent report from Siriraj Hospital. Methods We reviewed medical records of newborn infants from 2012 to 2016, all of whom were born in KCMH with deformities of upper and lower extremities or other birth-related injuries. The cases were grouped according to International Classification of Diseases, 10th edition. The incidence of common neonatal orthopedic problems was calculated as cases per 1,000 live births and compared, using a chi-squared test, with the earlier data from KCMH and with the data recently reported by Siriraj hospital. Results Of the 24,825 live births, 54% were male and 46% were female. The average birth weight was 3,052.2 ± 516.1 g (range, 535–5,320 g) for infants. The most common deformity was postural clubfoot, followed by calcaneovalgus and hip dysplasia, with incidences of 1.37, 0.93 and 0.52 per 1,000 live births, respectively. The incidence of calcaneovalgus, metatarsus adductus, and clubfoot was lower than in the 1975 study and in the report from Siriraj. In all 3 studies, the incidence of birth-related injury was similar and clavicular fracture was the most common, with a rate of 1.3/1,000 live births. Conclusion The incidence of common neonatal orthopedic problems varies among institutions. Birth-related injury is a major challenge. The results may be utilized as updated data and as a starting point for parental education.

scholarly journals Clinicopathological study of testicular tumors: an experience in a tertiary care hospital in Kashmir valley, Jammu and Kashmir, India

2017 ◽  
Vol 5 (6) ◽  
pp. 2741
Author(s):  
Ambreen Beigh ◽  
Sheikh Junaid ◽  
Arshi Beg ◽  
Summyia Farooq ◽  
Lateef Ahmed Wani ◽  
...  
Keyword(s):  
Prospective Study ◽  
Clinical Presentation ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Published Data ◽  
Care Hospital ◽  
Kashmir Valley ◽  
Testicular Tumors ◽  
Rare Type ◽  
Jammu And Kashmir

Background: Testicular and paratesticular neoplasia are rare type of tumors affecting adolescents and young adults in India, as observed by paucity of published data. This study was undertaken to analyze the patterns of testicular tumors at a tertiary level hospital in Kashmir valley, Jammu and Kashmir, India highlighting the patient’s demography, clinical presentation, diagnostic evaluation and pathological finding.Methods: This 5-year (retrospective and prospective) study was performed in the Department of Pathology, Government Medical College Srinagar, Jammu and Kashmir, India from January 2012 to December 2016. For the retrospective study, all cases of testicular tumors, their histopathological reports and required clinical details were searched from records maintained in the Department of Pathology, GMC Srinagar, Jammu and Kashmir, India. For the prospective study, the orchiedectomy specimens received in our department were subjected to routine histopathological processing followed by a detailed gross and microscopic examination. Tumour typing and subtyping was done according to WHO classification (2004).Results: A total of 37 cases of testicular and paratesticular neoplasia were included in present study with a mean age of 35.1 years. Out of these 37 cases, 31 (83.78%) were malignant and 6 cases (16.22%) were benign. Right testis was affected in 70.3% of cases. The most common clinical presentation was scrotal swelling. Germ cell tumor was the most common type accounting for 89.2% of tumors followed by lymphomas (8.1%).Conclusions:It is concluded that despite new techniques in imaging and tumor marker assay, the diagnosis of testicular tumors is dependent upon histopathological examination. The present study fairly provides an insight into the clinical presentations, prevalence and patterns of testicular tumors. 

scholarly journals Survival and Biomarkers of COVID-19 Patients Treated with Remdesivir and Favipiravir in ICU: A Single Center Experience in Bangladesh

2020 ◽  
Author(s):  
Nasir M ◽  
Perveen RA ◽  
Murshed M ◽  
Nazneen R ◽  
Talha KA
Keyword(s):  
Survival Rate ◽  
Disease Progression ◽  
Critically Ill ◽  
Treated Patient ◽  
Day Treatment ◽  
Therapeutic Option ◽  
Tertiary Care ◽  
Prognostic Biomarkers ◽  
Care Hospital ◽  
Single Center Experience

Abstract Background: Since the first detection of a bunch of COVID-19 in late 2019, it become a global concern due to its transmissibility and ability to progress patients in severe respiratory failure and acute respiratory distress syndrome, which need intensive care unit support for a long time. We observed the repurposing use of remdesivir and favipiravir whether considered as a therapeutic option or not through survival rate and changes in biomarker during 10-day treatment stay in ICU.Materials and method: The retrospective observational study in a tertiary care hospital dedicated to COVID-19 at Dhaka, Bangladesh was done at the peak of COVID-19 pandemic in Bangladesh. The mortality rate, length of ICU stays and eight prognostic biomarkers of patients treated with remdesivir and favipiravir was observed as one of the first ever reported experience in Bangladesh.Results: Among the critically ill patients in ICU, 26 (44.8%) died and 32 (55.2%) were cured during the study period and highest mean duration of stay in ICU was observed (14.33 days and 18.13 days) in FPV-treated patients. Mean of means for all biomarkers CRP (26.0) and d-Dimer (2.64) was recorded higher in favipiravir treated patients in death cases, but NLR, d-NLR, platelet, PLR was much higher in remdesivir treated patient of both death and improved cases. Though overall outcome variables between death and improved cases were not statistically significant (p<0.39)Conclusion: The severity of disease progression in critically ill COVID-19 patients in ICU depends on comorbidities and hyper responsive inflammatory or immunological biomarkers to predict. Though the emergency use authorization and repurposing use of different antivirals are still on trial, but remdesivir and favipiravir revealed not much hope in improving prognostic biomarkers, survival rate and disease progression at the initial peak of pandemic in Bangladesh.

Abstract WP126: Association of 24-Hour Blood Pressure Parameters Post-Intravenous Alteplase With Symptomatic Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Taha Nisar ◽  
Toluwalase Tofade ◽  
Ava Liberman ◽  
Priyank Khandelwal
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Treatment Time ◽  
Tertiary Care ◽  
Significant Risk ◽  
Binary Logistic Regression Analysis ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Intravenous Alteplase ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction: Higher blood pressure (BP) at presentation is associated with a higher risk of symptomatic intracerebral hemorrhage (sICH) post-intravenous alteplase (IV-rtPA). We investigated the association of different BP parameters post-IV-rtPA with the development of sICH at a tertiary care center. Methods: We performed a retrospective chart review of adult patients with an acute ischemic stroke treated with IV-rtPA at a comprehensive stroke center from July 2014 to March 2018. We excluded patients who underwent mechanical thrombectomy. At the comprehensive stroke center, the BP values are documented according to standard post-IV-rtPA care guidelines. We recorded the BP values over a period of 24-hours post-IV-rtPA. A binary logistic regression analysis was performed, controlling for age, sex, pre-treatment NIHSS, atrial fibrillation, onset to treatment time, with the BP parameters as the predictors. The primary outcome was the development of sICH. SICH was defined as an intracerebral hemorrhage (ICH) that causes worsening of NIHSS score by ≥4 points post-IV-rtPA. Results: 84 patients met our inclusion criteria. 45 (53.57%) patients were male. The mean age was 63.50±15 years. 5 (5.95%) patients developed sICH. In our cohort, the BP parameters of higher maximum systolic blood pressure (SBP) (195.8±9 vs.172.22±17; OR, 1.14; 95% CI, 1.03-1.26; P 0.016), higher maximum diastolic blood pressure (DBP) (120.2±18 vs.104.76±15; OR, 1.08; 95% CI, 1.01-1.17; P 0.04), wider SBP range (79.4±20 vs.58.75±18; OR, 1.06; 95% CI, 1.01-1.12; P 0.033), wider DBP range (74.2±27 vs.47.27±15; OR, 1.11; 95% CI, 1.03-1.2; P 0.008), and coefficient variation (CV) DBP (17.7±6 vs.12.65±4; OR, 1.19; 95% CI, 1.01-1.42; P 0.048) were significantly associated with a risk of sICH post IV-rtPA. Conclusions: Our study demonstrates significant risk of sICH with higher maximum SBP and DBP, wider SBP and DBP ranges, and CV DBP post-IV-rtPA.

Peripartum Management of Women with Suspected Hereditary Thrombocytopenia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3224-3224
Author(s):  
Cynthia M. Wu ◽  
Mohan K. Pai ◽  
Uma Athale ◽  
John G. Kelton ◽  
Donnie M. Arnold
Keyword(s):  
Platelet Count ◽  
Post Partum ◽  
Tertiary Care ◽  
Diagnostic Testing ◽  
Bleeding Complications ◽  
Severe Thrombocytopenia ◽  
Care Hospital ◽  
Count Response ◽  
Hereditary Thrombocytopenia ◽  
Platelet Transfusions

Introduction: Hereditary macrothrombocytopenic disorders are rare syndromes characterized by mild to moderate thrombocytopenia, large platelets, and a variable bleeding phenotype. In general, the diagnosis must be made clinically and management is empiric. Because of the autosomally inherited nature of these disorders, peripartum management must take into account the risk of bleeding for both mother and baby, during the pregnancy and at delivery. Study Purpose: To describe the peripartum management and bleeding complications in pregnant women with suspected inherited macrothrombocytopenic disorders and their children. Study Design: We performed a retrospective review of all mothers referred to our tertiary care hospital from 2004 to 2007 for evaluation of macrothrombocytopenia in pregnancy where hereditary thrombocytopenia was suspected. The diagnosis was confirmed if at least 2 of the following clinical features were present: life-long thrombocytopenia; family history of thrombocytopenia that spanned at least 2 generations; and the lack of a platelet count response to IVIG or corticosteroids. Data relating to bleeding and therapies used to treat or to prevent bleeding before or during delivery for mother and child were extracted from medical charts. Blood films were reviewed with experts in morphology, and diagnostic testing was performed when possible. Results: A total of 5 mothers and 8 babies were included. The median platelet count of mothers at delivery was 54 x 109/L (range 15–83 x 109/L) and the median MPV was 9.8 fL (range 7.4–11.3 fL). Of the 8 babies, 4 were thrombocytopenic with a median platelet count at birth of 50 x 109/L (range 9–93 x 109/L) and a median MPV of 9.4 fL (range 8.9–9.6fL). One mother and her baby had neutrophilic Dohle body inclusions, and none had skeletal, neurologic or renal abnormalities. Three mothers were previously treated with IVIG, including one who also received prednisone, with no platelet count response. During pregnancy, fetal blood sampling for platelet count measurements was not done. None of the mothers had epidural anesthesia, all delivered vaginally and 7 of 8 labours were induced. Two mothers received prophylactic tranexamic acid at the time of active labour and 1 received DDAVP. Prophylactic platelet transfusions were not given. One mother had bleeding associated with spontaneous rupture of membranes, and one had a post partum hemorrhage associated with uterine atony and vaginal laceration. The latter was repaired surgically and treated with platelet transfusions and DDAVP. None of the babies bled, but 1 was given a platelet transfusion because of severe thrombocytopenia at birth (platelet count = 9 x 109/L) with persistent platelet clumping. Conclusions: The frequency of pregnancy-related bleeding in mothers with hereditary macrothrombocytopenia was low in this cohort even in the absence of prophylaxis. There is a need for improved diagnosis and risk stratification of mothers with hereditary macrothrombocytopenia. A multicentre prospective study would assist in determining optimal peripartum management.

scholarly journals 697. 8 Years of Characteristics and Outcomes of Patients with MRSA Endocarditis Based on Vancomycin Minimum Inhibitory Concentration: Experience at a Tertiary Care Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S400-S400
Author(s):  
Rodolfo M Alpizar-Rivas ◽  
Javier Balda ◽  
Salwa Elarabi ◽  
Bertrand Jaber ◽  
Claudia Nader
Keyword(s):  
Minimum Inhibitory Concentration ◽  
Inhibitory Concentration ◽  
Care Center ◽  
Tertiary Care ◽  
Care Hospital ◽  
Single Center Experience ◽  
Valvular Surgery ◽  
Increase Risk ◽  
Icd 10 ◽  
Line Infection

Abstract Background Vancomycin has been the mainstay of treatment for methicillin-resistant Staphylococcus aureus (MRSA) infective endocarditis (IE). MRSA reduced susceptibility to vancomycin is a growing threat. Data assessing the effect of vancomycin reduced susceptibility on outcomes is limited. Our study aimed to evaluate characteristics and outcomes of MRSA-related IE based on the minimum inhibitory concentration (MIC) to vancomycin Characteristics and outcomes of 51 patients with MRSA-related endocarditis according to the minimal inhibitory concentration (MIC) to vancomycin Methods IRB approval was obtained for a retrospective cohort study at a tertiary care center. Records of hospitalized adults diagnose with IE by ICD-9/ICD-10 CM codes were identified from 2011 to 2018. 51 patients had MRSA-related IE and were selected for the analysis. Demographic, microbiologic, Imaging and outcome variables were obtained. Characteristics and outcomes of patients with MRSA-related IE according to the MIC to vancomycin (≤ vs. &gt; 1 mcg/mL) were compared Results 35.3% of patients had a MIC &gt; 1 mcg/mL. 59% were men, mean age was 46±3 years old. 65% acquired the infection through injection drug use. Only 3.9% of patients had prosthetic valve IE. 35.3% had tricuspid valve vegetation, 25.5% mitral valve and 21.6% aortic valve vegetation. Two patients had IE possibly related to a PICC-line infection; both of these patients had a MIC to vancomycin &gt;1 mcg/mL, suggestive of prolonged antibiotic therapy. All patients with MRSA-related IE were started empirically on vancomycin. Patients with a MIC &gt; 1 mcg/mL were more likely to be switched to a combination of daptomycin and ceftaroline, compared to those with a MIC ≤ 1 mcg/mL (44.4% vs. 6.1%; P=0.001). 25.4% underwent valvular replacement within 6 months. 12% died within 90 days. MRSA-related IE with MIC &gt; 1mcg/mL did not confer and an increase risk in in-hospital mortality (11.1% vs. 15.2%; P=0.67) or mortality at 90 days (11.1% vs. 12.5%; P=0.89). Conclusion In this single-center experience, we found that in 8 years 35% of patients with MRSA-related IE had MIC &gt;1 mcg/mL. This is an alarming finding. Although our study did not reach statistic significance we didn’t found difference in valvular surgery requirement or mortality among those with MIC &gt; 1mcg/d as compared to those with a more sensitive MRSA strain. A study with more power or a metha-analysis will be require to better answer this question. Disclosures All Authors: No reported disclosures

scholarly journals Therapeutic dosing of low-molecular-weight heparin may decrease mortality in patients with severe COVID-19 infection

2020 ◽  
Vol 40 (6) ◽  
pp. 462-468
Author(s):  
Kadir Canoglu ◽  
Bengu Saylan
Keyword(s):  
Molecular Weight ◽  
Therapeutic Dose ◽  
Low Molecular Weight Heparin ◽  
Tertiary Care ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Care Hospital ◽  
Coagulation Parameters ◽  
Icu Admission ◽  
Prophylactic Dose

ABSTRACT BACKGROUND: Venous thromboembolism or extensive thrombosis is relatively common in patients with severe COVID-19 infection and has been associated with increased mortality. During the current COVID-19 pandemic, several prophylactic doses and types of low-molecular-weight heparin (LMWH) are being used worldwide; however, there are no high-quality studies or recommendations for an optimal prophylactic LMWH dose. OBJECTIVES: Investigate the relationship between coagulation parameters and the LMWH dose, and mortality and ICU admission in hospitalized patients with severe COVID-19 pneumonia. DESIGN: Retrospective. SETTING: Tertiary care hospital. PATIENTS AND METHODS: Data on clinical features, coagulation parameters and anticoagulant medications of inpatients with severe COVID-19 were collected for the period between 11 March 2020 and 31 April 2020. MAIN OUTCOME MEASURES: Mortality and ICU admission for prophylactic dose LMWH (0.5 mg/kg twice daily) and therapeutic dose LMWH (1 mg/kg twice daily). SAMPLE SIZE: 154 cases. RESULTS: Ninety-eight (63.6%) patients were treated with the LMWH prophylactic dose and 56 (36.4%) patients were treated with the therapeutic dose. Forty-four (44.9%) of 98 patients using the prophylactic dose LMWH died, while 10 (17.9%) of 56 patients using the therapeutic dose LMWH died ( P =.001). Mortality was 6.4-fold higher in the prophylactic dose LMWH users than in the therapeutic dose LMWH users (OR=6.5, 95% CI: 2.4–17.6, P <.001). CONCLUSIONS: Therapeutic dosing of LMWH may decrease mortality in patients with severe COVID-19 infected pneumonia. More aggressive thromboprophylaxis regimens using higher doses of heparin should be evaluated in prospective studies. LIMITATIONS: Lack of information about bleeding complications. LMWH was not compared with other anticoagulant therapies. There was no comparison between our two groups on the APACHE score. Used different doses of LMWH in different clinics in our hospital. Single-center, retrospective study. CONFLICT OF INTEREST: None.

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