Migraine Features in Patients with Persistent Postural-Perceptual Dizziness

Objectives: To evaluate the presence of migraine features in patients with persistent postural-perceptual dizziness (PPPD). Methods: In a retrospective survey study, consecutive patients presenting to a tertiary care neurotology clinic during an 18-month period were given questionnaires about headache and dizziness symptoms. The survey responses plus history and examination of the patient were used to diagnose patients with PPPD. The prevalence of migraine headache, vestibular migraine (VM), and migraine characteristics was evaluated. Results: In total, 36 subjects with PPPD were included in the study. The mean age of the subjects was 56 ± 16 years with a female (72%) predominance. A total of 19 (53%) patients met the International Classification of Headache Disorders criteria for migraine headache, and 6 of those (17%) met the criteria for definite VM. Of the patients who did not meet full migraine headache criteria, 6 (17%) patients met 4 of 5 criteria, and 5 (14%) patients met 3 of 5 criteria. There was no significant difference between PPPD patients who fulfilled full migraine headache criteria and those who did not in sensitivity to light, sound, smells, weather changes, feelings of mental fog/confusion, and sinus pain/facial pressure. Conclusions: This study demonstrates that a majority of patients with PPPD fulfill the criteria for migraine headache. A large proportion of PPPD patients who do not meet the full criteria for migraine headache still meet a majority of the migraine headache criteria. This suggests an association between the 2 conditions. PPPD may be a part of the spectrum of otologic migraine, where migraine manifests as otologic symptoms.

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Gender-wise Comparative Assessment of Lifestyle Patterns and Well-being Status among Healthcare Employees at a Tertiary Care Hospital

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0041-1727578 ◽

2021 ◽

Author(s):

Vanajakshamma Velam ◽

Vyshnavi Kancherla ◽

Latheef Kasala ◽

Anusha Kancherla ◽

Mounica Reddy Pillaram

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Well Being ◽

Care Hospital ◽

Cross Sectional ◽

Significant Difference ◽

Female Employees ◽

The Mean ◽

Lifestyle Patterns ◽

Comprehensive Study

Abstract Background This study was an attempt to assess and compare the gender-wise lifestyle patterns and well-being status among the employees of a tertiary care teaching hospital. Material and Methods This is a cross-sectional, questionnaire-based study conducted at a tertiary care hospital between May and August 2019. A total of 777 employees belonging to both genders (male and female) and working at different professional levels were assessed. All the enrolled employees were subjected to a comprehensive study tool consisting of various dimensions of their health, which included physical, mental, social, spiritual and intellectual health dimensions. Results Among the participants, 327 (42.1%) were male and 450 (57.9%) were female. There was no significant difference in the mean age of male (37.91 ± 7.52) and female (36.85 ± 8.16) employees (p = 0.07). A significantly higher proportion of diabetes and hypertension were seen in male employees (9.8% and 14.4%, respectively) than in female (5.6% and 6.2% respectively). The overall well-being was better in male employees than in females and was statistically significant (p < 0.0001). We found that male employees had statistically significant better well-being in terms of physical, mental and social health whereas female employees had intellectual health. Conclusion The overall well-being in healthcare staff was good at our tertiary care hospital, and the outstanding/good well-being rate was higher in male employees than in female employees. Female employees experienced risks with regard to their physical health.

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The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings

Therapeutic Advances in Infectious Disease ◽

10.1177/20499361211036592 ◽

2021 ◽

Vol 8 ◽

pp. 204993612110365

Author(s):

Kundan Mishra ◽

Suman Kumar ◽

Sandeep Ninawe ◽

Rajat Bahl ◽

Ashok Meshram ◽

...

Keyword(s):

Overall Survival ◽

Acute Myeloid Leukemia ◽

Febrile Neutropenia ◽

Burkholderia Cepacia ◽

Myeloid Leukemia ◽

Tertiary Care ◽

Care Hospital ◽

Significant Difference ◽

The Mean ◽

Acute Myeloid

Introduction: Acute myeloid leukemia (AML) is the commonest leukemia in adults. Mortality in thew first 30-days ranges from 6% to 43%, while infections account for 30–66% of early deaths. We aim to present our experience of infections in newly-diagnosed AML. Method: This prospective, observational study, was undertaken at a tertiary care hospital in Northern India. Patients with confirmed AML (bone marrow morphology and flow cytometry) and who had developed febrile neutropenia (FN), were included. Result: A total of fifty-five patients were included in the study. The median age of the patients was 47.1 years (12–71) and 28 (50.9%) were males. Fever (33, 60%) was the commonest presentation at the time of diagnosis. One or more comorbid conditions were present in 20 patients (36.36%). Infection at presentation was detected in 17 patients (30.9%). The mean duration to develop febrile neutropenia since the start of therapy was 11.24 days. With each ten-thousand increase in white blood cell (WBC) count, the mean number of days of FN development decreased by 0.35 days ( p = 0.029). Clinical and/or radiological localization was possible in 23 patients (41.81%). Thirty-four blood samples (34/242, 14.04%) from 26 patients (26/55, 47.3%) isolated one or more organisms. Gram negative bacilli (GNB) were isolated in 24 (70.58%) samples. Burkholderia cepacia (8/34, 23.52%) was the commonest organism. The number of days required to develop febrile neutropenia was inversely associated with overall survival (OS). However, when compared, there was no statistically significant difference in OS between patients developing fever on day-10 and day-25 ( p = 0.063). Thirteen patients (23.63%) died during the study period. Discussion: Low percentage of blood culture positivity and high incidence of MDR organisms are a matter of concern. Days to develop febrile neutropenia were inversely associated with overall survival (OS), emphasizing the importance of preventive measures against infections. Conclusion: Infections continues to be a major cause of morbidity and mortality among AML patients.

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A Comparative Study of Endoscopic Coblation Adenoidectomy and Regular Curettage Adenoidectomy in a Tertiary Care Hospital in Kerala

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/645 ◽

2021 ◽

Vol 8 (41) ◽

pp. 3559-3566

Author(s):

Abdul Salam R. T. ◽

Shahul Hameed A. ◽

Meera Rajan

Keyword(s):

Blood Loss ◽

Comparative Study ◽

Tertiary Care ◽

Operation Time ◽

Care Hospital ◽

Adenoid Tissue ◽

Significant Difference ◽

Tube Function ◽

Prospective Comparative Study ◽

The Mean

BACKGROUND An ideal surgery to remove hypertrophied adenoid mass should be safe, with less bleeding and operation time along with post-operative improvement in the eustachian tubal ventilation and normal respiration. It should also have low morbidity and mortality. Among the various methods described for its removal, the two commonly used methods are conventional cold curettage method and coblation technique. The purpose of this study was to collate the safety and efficacy of endoscopic coblation adenoidectomy with the conventional curettage adenoidectomy. METHODS A prospective comparative study with fifty patients was studied who underwent adenoidectomy. Twenty five patients underwent endoscopy assisted coblation adenoidectomy and twenty five patients underwent regular adenoidectomy by curettage. RESULTS Patients who underwent coblation adenoidectomy showed better results during follow up in terms of completeness of removal. 80 % of children undergoing regular adenoidectomy by curettage method showed remnant adenoid tissue in the nasopharynx at the end of the procedure. But it was 6 % among the children undergoing endoscopic assisted coblation adenoidectomy. The mean duration of operation was higher for endoscopic assisted coblation adenoidectomy which was significant statistically. The mean blood loss was 30.36 ml in regular curettage adenoidectomy; 10.6 ml with endoscopic coblation adenoidectomy. The grading of pain was significantly lower in endoscopic assisted coblation adenoidectomy. There was no significant difference between two groups in terms of eustachian tube function after surgery. CONCLUSIONS Coblation adenoidectomy has significant advantages over conventional adenoidectomy in terms of completeness of removal, reduced blood loss, and lower post-operative pain grade. KEYWORDS Coblation, Adenoidectomy, Curettage, Haemorrhage and Complications

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Usefulness of the Non-Contact Tonometry in Out-Patient Screening

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v15i2.232 ◽

2016 ◽

Vol 15 (2) ◽

Author(s):

Satheesh Solomon T Selvin ◽

Chris Elsa Samson Jacob ◽

Thomas Kuriakose

Keyword(s):

Central Corneal Thickness ◽

Care Center ◽

Corneal Thickness ◽

Tertiary Care ◽

Cross Sectional Study ◽

Applanation Tonometry ◽

Cross Sectional ◽

Significant Difference ◽

Iop Measurement ◽

The Mean

Purpose: Goldmann applanation tonometry (GAT) is considered the gold standard for Intraocular Pressure (IOP) measurement. It has the disadvantages of being a contact device, need for a slit-lamp, non-portability and need of a skilled examiner. Many hospitals are using a Non Contact Tonometry (NCT) as a screening device to save clinician time, however the usefulness is not proved in terms of reliability. This study was aimed to determine the usefulness of the Air-puff tonometer (TONOREF NIDEK II, NIDEK CO., LTD., JAPAN) over a GAT in a tertiary care center. Design: Cross-sectional Study Methods: This was a cross-sectional, non interventional observational study conducted on 224 eyes (right eye) from 224 patients. All patients underwent the IOP measurement with both methods and a central corneal thickness (CCT) measured. The data was analyzed using SPSS 20.0 software. Results: The mean age of the patients was 40.3±11.29 years. There was a statistically significant difference (p<0.001) between the mean NCT and GAT readings which persisted even after correction for central corneal thickness. The correlation between NCT and GAT using Pearson’s correlation coefficient was strong irrespective of the corrections for their corneal thickness (r = 0.751 and 0.718 for uncorrected and corrected values respectively). The correlation of the individual clinicians for the readings varied from moderate to strong. The ROC curve showed the best sensitivity and specificity to occur at around 13 to 14 mmHg. Conclusion: NCT seems to overestimate the IOP at low ranges as compared to the GAT and underestimate at higher ranges. The crossover of the values is seen between 12 to 13 mmHg. The clinician should do an individualized analysis of his/her GAT measurements to the readings of the NCT machine at the clinic to obtain clinician specific nomogram.

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Abstract 3091: Image Sharing Prior To Transfer Of Patients With Stroke

Stroke ◽

10.1161/str.43.suppl_1.a3091 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Minal Jain ◽

Anunaya Jain ◽

Abhijit R Kanthala ◽

Kate C Young ◽

Babak S Jahromi

Keyword(s):

Intensive Care ◽

Sinus Thrombosis ◽

Statistical Significance ◽

Tertiary Care ◽

Admission Diagnosis ◽

Stroke Severity ◽

Image Sharing ◽

Interhospital Transfer ◽

Significant Difference ◽

The Mean

Introduction: The lack of 24X7 availability of sub-specialty neurologists and neurosurgeons in regional county hospitals frequently leads to transfer of patients with stroke/ICH to higher tertiary care centers. Transfer of patients without prior communication may delay both diagnosis as well as time sensitive treatments. Recently our institution adopted image sharing prior to transfer to facilitate triage of inter-hospital transfers. Aim: To analyze if image sharing enabled judicious selection of patients more likely to require intensive care/intervention. Methods: We analyzed consecutive adult patients with an admission diagnosis of stroke/TIA/carotid stenosis/carotid-dissection/aneursym/hemiplegia/cerebral venous sinus thrombosis for whom an interhospital transfer request was made. Results: The cohort had 197 subjects with 52.6% females. The mean age of subjects was 61.1 years (SD 16.1 years). The mean distance of healthcare facilities requesting transfer from our center was 47.7 miles (SD 28.5 miles). Of all transfer requests, 78.7% (155) were accepted to our facility, 14.7% (29) were asked to follow up in outpatient clinics, 3% (6) transfers were cancelled because a higher level of care was deemed unnecessary, 1% (2) patients declined transfer and 2.5% (5) were lost to other facilities. The median stroke severity measured by NIHSS on arrival was 3 (IQR 1 to 8). Images were shared prior to decision making for transfer for 20.3% (40) patients. Fewer patients were accepted for transfer with image sharing (73%) than without (83.7%), although this did not reach statistical significance (z statistic -1.51; p=0.132). There was no significant difference in NIHSS (p=0.3919), neurological status measured by GCS (p=0.294) or age (p=0.9942) between subjects who had image sharing versus those who did not. Amongst all accepted patients 45.1% were deemed to need intensive care and 47.7% received interventions (surgical, medical or advanced diagnostic testing). The proportion of patients who underwent intervention or were admitted to an intensive care unit was much higher when patients’ images were shared prior to transfer (85.2%) when compared to patients transferred without image sharing (56.8%; z statistic 2.755; p=0.006). The odds of undergoing intervention when patients were transferred after image sharing was 4.37 as compared to patients transferred without image sharing (95% CI 1.43 to 13.39). Conclusion: Subjects who had their images shared prior to transfer had significantly higher intervention rate. Thus image sharing is a possible tool to increase specificity for selecting patients with stroke related diagnoses, who would benefit from transfer to a tertiary care center.

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Preoperative Anxiety and Fear of Anesthesia in Patients admitted in Tertiary Care Hospitals of Rawalpindi

Journal of Rawalpindi Medical College ◽

10.37939/jrmc.v24i1.1542 ◽

2020 ◽

Vol 24 (1) ◽

pp. 52-58

Author(s):

Zahra Mariyam ◽

Laibah Safdar ◽

Shafaq Fatima ◽

Jawad Zaheer

Keyword(s):

Formal Education ◽

Tertiary Care ◽

Previous History ◽

Female Gender ◽

Preoperative Anxiety ◽

Cross Sectional ◽

Significant Difference ◽

History Of ◽

History Of Anesthesia ◽

The Mean

Background: Preoperative apprehension is a widespread global problem. This anxiety and apprehension can significantly affect all aspects of anesthesia and surgery. Thus, it is essential to detect and address the patient's anxiety to assist in recovery after surgery and improve the patient's outcome. Materials and Methods: This is a cross-sectional study conducted over one year in the allied hospitals of Rawalpindi Medical University (RMU). Our sample size was 380 preoperative patients, who were selected by convenience sampling. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used.Results: The overall prevalence of anxiety was 30.5%, while the prevalence of information requirement was 33.2%. The mean total APAIS was 12.73±8.56, the mean anxiety subscore was 8.25±5.58, and the mean need for information subscore was 4.48±3.16. A statistically significant difference was found in the scores of the patients based on age, gender, education, type of anesthesia, and type of surgery (p< 0.05). The previous history of anesthesia and the presence of comorbidities did not bring a significant difference in the scores of the patients (p>0.05). Postoperative pain was the most important concern, found in 32% of the patients. Conclusion: Younger age group, female gender, having no formal education, surgery under regional anesthesia, and undergoing C-section, IOL implantation and septoplasty are associated with higher preoperative anxiety, while the presence of comorbidities and previous history of anesthesia are factors that do not significantly affect preoperative anxiety in our population.

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MON-667 Prevalence and Predictors of Diabetic Retinopathy Among Type 2 Diabetes Patients at a Tertiary Care Center

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.274 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Khaled Ahmed Baagar ◽

Fahmi Khan ◽

Mahmoud Zirie ◽

Sara Darwish ◽

Ahmed K A Mohammed ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Diabetic Retinopathy ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Vitamin D Levels ◽

Significant Difference ◽

The Mean

Abstract Objective: Diabetic retinopathy (DR) is one of the most common microvascular complications of type 2 diabetes (T2D). The reported prevalence of DR from different populations in the last decade was 13 - 38.1%. A report from our center 17 years ago showed that DR prevalence was 43.6%. With the all accumulated evidence showing that diabetes control decreases DR risk and the introduction of new drugs that helped better T2D control, we aimed to assess the current prevalence and predictors of DR among patients with T2D attending out-patient department at our tertiary care center. Methods: We conducted a cross-sectional study involving 638 patients. We collected information about their baseline characteristics, confirmed DR with its severity and maculopathy diagnosis, age at T2D diagnosis, duration of T2D, and averages of HbA1C, blood pressure (BP), cholesterol, and vitamin D levels over the previous year. A statistical analysis was performed using the software SPSS 23.0. A multivariate logistic regression analysis examined the independent predictors of DR development. Results: The mean age of the patients was 55.8 ± 10.3 years, and 42.8% were males. The mean BMI was 32.4 ± 12.4 kg/m2 with 58% had obesity. The mean duration of T2D was 11.5 ± 7.7 years, and the mean age at T2D diagnosis was 44.0 ± 9.98 years. The mean HbA1C was 8.3 ± 1.6 % with 77% had average HbA1C above 7% and 51.3% had average HbA1c above 8%. The mean systolic and diastolic BP were 136.37 ± 15.01 mmHg and 74.12 ± 8.078 mmHg, respectively. DR was diagnosed in 223 cases (35%). Of the 638 patients, 24.5% had non-proliferative DR, 9.2% had proliferative DR, and 4.2% had maculopathy. There was no significant difference in DR prevalence between males (36%) and females (34.1%) (P = 0.59). Predictors of DR development were age above 40 years, duration of T2D more than 10 years, early age of T2D diagnosis, average HbA1C more than 8%, and hypertension. Discussion: T2D is a major health challenge to our community with its very high prevalence. The prevalence of DR in T2D patients attending our institution was significant (more than one-third, 35%) in comparison to reports from other centers. However, we showed an improvement in DR development in our patients from 43.6% to 35%, probably due to better T2D and BP control. Similar to previous reports, T2D patients with older age, long T2D duration, younger age at T2D diagnosis, uncontrolled diabetes, and uncontrolled BP were more likely to develop DR. Conclusion: Physicians treating T2D patients should ensure regular retina screening especially for those with risk factors for DR. Also, they should fix the modifiable risk factors of DR; diabetes and BP control. References: (1) Alaboud et al. Saudi Med J 2016; Vol. 37 (12): 1408–1411.doi: 10.15537/smj.2016.12.17062. (2) Lim MC et al. Ann Acad Med Singapore. 2008 Sep;37(9):753–9. (3) Hammes H-P et al. PLoS ONE 10(7): e0132492. doi:10.1371/journal. pone.0132492

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TOTAL KNEE ARTHROPLASTY;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.09.823 ◽

2017 ◽

Vol 24 (09) ◽

pp. 1403-1408

Author(s):

Faisal Abdul Jabbar ◽

Rehana Ali Shah ◽

Muhammad Hashim

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Knee Arthroplasty ◽

Tertiary Care ◽

Osteoarthritis Of The Knee ◽

Care Hospital ◽

Level Of Satisfaction ◽

Significant Difference ◽

Total Knee ◽

The Mean

Objectives: We aim to evaluate the level of satisfaction after total knee arthroplastyprocedure in the patient population at a tertiary care hospital in Karachi, Pakistan, and to assessthe relationship between patient satisfaction and the outcome based on traditional scores.Methods: Study Design: Case series for determination of patient satisfaction. Period: Oneyear duration from April 2015 to May 2016. Setting: Tertiary care centre in Karachi, Pakistan.The inclusion criteria was all the patients with late stage osteoarthritis of the knee joint andunderwent total knee arthroplasty at our institute. Data was analyzed using SPSS version 22.Results: A total of n= 102 patients were included in the study while n= 109 knee surgerieswere done in total (n= 95 patients had unilateral surgery, while n= 7 patients had bilateralsurgeries on both the knee joints) n= 58 patients were females while n= 44 patients weremales, the median age was 60 years, patients had a mean body mass index (BMI) of 27kg/m2. Of the total surgeries performed n= 100 were in the satisfaction group while n= 9 were inthe dissatisfaction group. The majority of the patients reported that they would recommend theprocedure. The co morbid conditions did not affect the patient’s level of satisfaction having ap value of 0.678. In the dissatisfied group, there was no significant difference when it comes togender, the mean age of patients in the dissatisfaction group was higher than the mean age ofpatients in the satisfaction. We found that WOMAC scores for functioning and the final WOMACscores were correlated with patient satisfaction and that was statistically significant, similarlySF-36 form patients were satisfied about the improvement in the physical health while they didnot improve the mental health aspect of their disease. Conclusion: According to our studytotal knee arthroplasty is an effective treatment for osteoarthritis of the knee, patient satisfactionis correlated with post-operative WOMAC function and overall scores, and SF-36 physicalcomponent. It is important to keep patients expectations in check through proper counseling.

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EFFECT OF DIABETES MELLITUS ON RIFAMPICIN PEAK SERUM CONCENTRATION

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2016v8i10.13238 ◽

2016 ◽

Vol 8 (10) ◽

pp. 149

Author(s):

Saranya P. ◽

Parthasarathy V. ◽

Hariprasad B. ◽

Shobha Rani H.

Keyword(s):

Diabetes Mellitus ◽

Serum Concentration ◽

Pulmonary Tuberculosis ◽

Tertiary Care ◽

Peak Serum Concentration ◽

Peak Serum ◽

Diabetic Patients ◽

Care Hospital ◽

Significant Difference ◽

The Mean

Objective: To comparatively analyze the peak serum concentration (Cmax) of rifampicin and to determine the incidence of decreased Cmax between diabetic and non-diabetic adult pulmonary tuberculosis patients.Methods: A cross-sectional observational study was carried out in the chest and tuberculosis (TB) department of a tertiary care hospital after the approval of the institutional ethics committee. Five millilitre (ml) of blood was withdrawn by venipuncture from each patient at a time point of 2 h post dose administration at steady state concentration (Css). The separated serum was centrifuged at a rate of 3500 rotations per minute (rpm) for a period of fifteen minutes and the resultant serum was stored at-70 ° C until analysis. Estimation of rifampicin concentration was carried out in Thermo TSQ Ultra (MS/MS) with Shimadzu 20 AD UFLC LC-MS.Results: The mean (Standard Deviation (SD)) age of the study population was 46.8 (14.2) years. The mean serum Cmax of rifampicin was significantly less in diabetic patients with pulmonary tuberculosis (p=0.0305). Statistically, a significant difference in the incidence of a decrease in Cmax was found between diabetic and non-diabetic patients (p=0.0335). Diabetes mellitus was found to be the predominant factor that affects rifampicin Cmax.Conclusion: In this study, an effect of diabetes mellitus (DM) on the peak serum concentration of rifampicin was observed. Patients with hyperglycemia levels had significantly reduced levels of rifampicin serum concentrations, thus showing an inversely proportional relationship between blood glucose and rifampicin serum levels.

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Migraine and vertigo

Oxford Textbook of Headache Syndromes ◽

10.1093/med/9780198724322.003.0013 ◽

2020 ◽

pp. 128-137

Author(s):

Yoon-Hee Cha

Keyword(s):

Migraine Headache ◽

Clinical Characteristics ◽

Vestibular Migraine ◽

Headache Disorders ◽

Temporal Profile ◽

Growing Body ◽

Vestibular Symptoms ◽

The Common ◽

Treatment Responses

The phenomena of migraine headache and vertigo share many epidemiological, anatomical, and clinical characteristics. The historically parallel development of the neuroscience of each field has formally intersected in the development of consensus criteria for vestibular migraine and the inclusion of vestibular migraine in the International Classification of Headache Disorders. Differences exist in the temporal profile of head pain and vertigo as manifestations of migraine, which can obscure the association. However, the growing body of evidence on the common demographic, neurochemical signature, and treatment responses of pain and vestibular symptoms indicate that they exist as symptoms of a common syndrome, one which can only be fully understood by recognizing the significance of each kind of manifestation.

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