Treatment Patterns and Outcomes in Bleb-Related Endophthalmitis: A 9-Year Analysis at a Tertiary Eye Center

2020 ◽  
pp. 247412642095396
Author(s):  
Cason B. Robbins ◽  
Henry L. Feng ◽  
Divakar Gupta ◽  
Sharon Fekrat
Keyword(s):  
Initial Treatment ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Light Perception ◽  
Initial Management ◽  
Pars Plana ◽  
Line Loss

Purpose: Clinical presentation, treatment choices, and outcomes in cases of bleb-related endophthalmitis (BRE) at a tertiary care center over a 9-year period are described. Methods: A retrospective review was conducted of patients diagnosed with BRE at Duke Eye Center (Durham, North Carolina) from January 1, 2009 to January 1, 2018, with at least 6 months of follow-up, assessing demographic data, initial management, and visual acuity (VA). Results: Twenty eyes of 20 patients with BRE were identified. Median time from surgery to presentation was 6.53 years. Presenting VA of light perception only was significantly associated with the decision to pursue pars plana vitrectomy (PPV) as initial treatment (odds ratio 59.4, 95% CI, 2.1-1670.8, P = .016). Twelve eyes (60%) had culture-proven infectious endophthalmitis. Eleven eyes (55%) underwent PPV during treatment; 5 eyes underwent PPV on presentation, and 6 eyes underwent PPV after initial presentation. Compared with pre-endophthalmitis VA, 6 eyes that underwent subsequent PPV had greater VA loss at 6 months than cases not undergoing subsequent PPV (Early Treatment Diabetic Retinopathy Study line loss of 14 vs 4 lines, respectively; P = .044). Conclusions: BRE eyes presenting with light-perception VA were more likely to undergo initial PPV; yet many eyes in this study required PPV during treatment. Visual outcomes are often poor in BRE despite intensive management. There was greater VA loss from pre-endophthalmitis VA levels at 6 months in eyes undergoing PPV after initial treatment. Prospective studies are needed to assess the optimal role of PPV in patients with BRE.

scholarly journals Outcomes of Canal Wall Down Mastoidectomy following Type III Tympanoplasty

2021 ◽  
Vol 27 (2) ◽  
pp. 145-151
Author(s):  
Shoukat Ali ◽  
SM Masudul Alam ◽  
KM Nurul Alam ◽  
KM Mamun Morshed ◽  
Sirajul Islam Mahfuz ◽  
...  
Keyword(s):  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Canal Wall ◽  
Short Term ◽  
Recurrence Rates ◽  
Type Iii ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy

Objectives: To see the hearing outcomes following Type III tympanoplasty with stapes columella grafting after canal wall down mastoidectomy and find out the recurrence rates in patients undergoing this procedure. Methods: This prospective observational study includes 120 cases undergoing Type III tympanoplasty with stapes columella grafting following canal wall down mastoidectomy for cholesteatoma at a tertiary care center from 2018 to 2020. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if they were found to have undergone the aforementioned procedure. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 6 months and 1 year postoperatively. Results: One hundred and twenty patients were included for this study. Erosion of the otic capsule, posterior fossa plate, or tegmen was noted in 20% of cases, highlighting disease severity. One hundred and two (85%) had undergone prior otologic surgery. Mean time to short-term follow-up was 6 ± 3 months. The average short-term ABG was 25 ± 12 dB HL; 36% achieved an ABG <20 dB and thirteen had follow-up at least 1 year postoperatively (mean = 33 ± 16 months). At longer-term follow-up, mean ABG was 24 ± 11 dB HL. Hearing remained stable over time (P = .26). Conclusion: In some patients undergoing canal wall down mastoidectomy for advanced or recurrent cholesteatoma, Type III tympanoplasty with stapes columella grafting yields marginal hearing benefit. Bangladesh J Otorhinolaryngol 2021; 27(2): 145-151

Clinical Spectrum and Long-Term Anatomical and Functional Outcomes of Pars Plana Vitrectomy in Retinal Detachments Associated With Choroidal Coloboma

2019 ◽  
Vol 4 (2) ◽  
pp. 103-109
Author(s):  
Naresh Babu Kannan ◽  
Sagnik Sen ◽  
Piyush Kohli ◽  
Obuli Ramachandran ◽  
Kim Ramasamy
Keyword(s):  
Pars Plana Vitrectomy ◽  
Silicone Oil ◽  
Care Center ◽  
Tertiary Care ◽  
Visual Outcome ◽  
Patients Âgés ◽  
Pars Plana ◽  
23 Gauge

Purpose: Choroidal coloboma (CC) eyes are associated with a high risk of retinal detachment (RD), which are challenging to repair. Methods: We retrospectively evaluated medical records of 30 patients with CC associated with RD who underwent pars plana vitrectomy at our tertiary care center. Data recorded were age, CC and RD morphology, breaks, resurgeries performed, and final outcome. Results: Patients’ ages ranged from 2 to 49 years. CC was present in 53 of 60 eyes (88%), with 41 of 60 eyes (68.3%) associated with iris coloboma. RD was present in 36 of 53 CC eyes (67.9%), with 10 of 53 (18.9%) having bilateral RD. Thirty-one eyes with RD underwent 23-gauge pars plana vitrectomy. Colobomatous region breaks were detected in 5 of 31 eyes (16.1%), peripheral breaks only in 12 of 31 (38.7%), and both types in 3 of 31 eyes (9.7%). Silicone oil endotamponade was used in 29 of 31 eyes (93.5%) and perfluoropropane (C3F8) in 2 of 31 eyes (6.45%). Median postoperative follow-up duration was 31.5 months. Fourteen of 31 eyes (45.2%) developed redetachment requiring resurgery, with 50% developing within 6 months. Eighteen of 31 eyes (58.1%) maintained retinal attachment at last follow-up without endotamponade, whereas the rest were oil filled. Final visual outcome between macula-involved and macula-spared CC eyes was not significantly different; however, best visual acuity achieved any time during follow-up was significantly better in macula-spared eyes. Conclusions: RD surgery in CC eyes has a risk of frequent redetachments and subnormal gain of vision over the long term, especially in colobomas involving the macula. Endolaser in 360° peripheries in addition to barrage of the margin of the coloboma may be considered to help maintain the attached retina.

scholarly journals Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury

2010 ◽  
Vol 29 (5) ◽  
pp. E3 ◽  
Author(s):  
Andrew P. Carlson ◽  
Pedro Ramirez ◽  
George Kennedy ◽  
A. Robb McLean ◽  
Cristina Murray-Krezan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
High Resource ◽  
Interhospital Transfer ◽  
Neurosurgical Intervention

Object Patients with mild traumatic brain injury (mTBI) only rarely need neurosurgical intervention; however, there is a subset of patients whose condition will deteriorate. Given the high resource utilization required for interhospital transfer and the relative infrequency of the need for intervention, this study was undertaken to determine how often patients who were transferred required intervention and if there were factors that could predict that need. Methods The authors performed a retrospective review of cases involving patients who were transferred to the University of New Mexico Level 1 trauma center for evaluation of mTBI between January 2005 and December 2009. Information including demographic data, lesion type, need for neurosurgical intervention, and short-term outcome was recorded. Results During the 4-year study period, 292 patients (age range newborn to 92 years) were transferred for evaluation of mTBI. Of these 292 patients, 182 (62.3%) had an acute traumatic finding of some kind; 110 (60.4%) of these had a follow-up CT to evaluate progression, whereas 60 (33.0%) did not require a follow-up CT. In 15 cases (5.1% overall), the patients were taken immediately to the operating room (either before or after the first CT). Only 4 patients (1.5% overall) had either clinical or radiographic deterioration requiring delayed surgical intervention after the second CT scan. Epidural hematoma (EDH) and subdural hematoma (SDH) were both found to be significantly associated with the need for surgery (OR 29.5 for EDH, 95% CI 6.6–131.8; OR 9.7 for SDH, 95% CI 2.4–39.1). There were no in-hospital deaths in the series, and 97% of patients were discharged with a Glasgow Coma Scale score of 15. Conclusions Most patients who are transferred with mTBI who need neurosurgical intervention have a surgical lesion initially. Only a very small percentage will have a delayed deterioration requiring surgery, with EDH and SDH being more concerning lesions. In most cases of mTBI, triage can be performed by a neurosurgeon and the patient can be observed without interhospital transfer.

scholarly journals Adherence to Long-Term Follow-up in Patients With Sporadic Vestibular Schwannomas Managed With Serial Observation

OTO Open ◽  
2021 ◽  
Vol 5 (3) ◽  
pp. 2473974X2110366
Author(s):  
Mallory Raymond ◽  
Arian Ghanouni ◽  
Kaitlyn Brooks ◽  
Sarah M. Clark ◽  
Douglas E. Mattox
Keyword(s):  
Vestibular Schwannoma ◽  
Tumor Size ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Long Term Follow Up ◽  
Lost To Follow Up

Objectives To examine the long-term adherence to serial imaging of patients with sporadic vestibular schwannoma and analyze factors associated with being lost to follow-up. Study Design Retrospective chart review with telephone interview. Setting Single tertiary care center. Methods Patients with a sporadic vestibular schwannoma and started on observational surveillance management between January 2005 and December 2010 were included. Demographic data, tumor size, hearing and vestibular changes, and follow-up length were recorded. Patient factors were analyzed for association with being lost to follow-up. Results In total, 122 patients were included with a median length of follow-up of 5 months (range, 0-146). After initial surveillance, 22.1% (n = 27) of patients had a change in management to either microsurgery or radiosurgery. Of the remaining 77.9% (n = 95), nearly half (44.2%, n = 42) never returned for a second visit, and all but 3 were eventually lost to follow-up. There was no association between sex, race, age at diagnosis, initial tumor size, insurance status, household income, or driving distance to hospital and being lost to follow-up. Of 26 interviewed patients initially lost to follow-up, 11 (42.3%) sought care at another institution, 5 (19.2%) chose to no longer receive care, 1 (3.8%) had transportation difficulties, and 9 (36.4%) had poor understanding of their diagnosis or instructions. Conclusions The length of follow-up for patients undergoing surveillance of sporadic vestibular schwannoma varies widely, and patients are commonly lost to follow-up. Further efforts should be made to identify at-risk patients and provide adequate education to improve long-term surveillance.

scholarly journals Pediatric Ventriculoperitoneal Shunt: Outcome Analysis in a Tertiary Care Center in Nepal

2020 ◽  
Vol 42 (1) ◽  
pp. 40-43
Author(s):  
Suman Phuyal ◽  
Binod Rajbhandari ◽  
Amit B Pradhanang ◽  
Gopal Sedain ◽  
Sushil K Shilpakar ◽  
...  
Keyword(s):  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Shunt Infection ◽  
Outcome Analysis ◽  
Dramatic Improvement ◽  
Shunt Surgery ◽  
Vp Shunt ◽  
Male Preponderance

Introduction Ventriculoperitoneal (VP) shunt is a commonly performed neurosurgical procedure in pediatric surgical practice. It results in a dramatic improvement in patient survival and neurological function but is associated with several complications requiring multiple shunt revisions throughout a patient’s lifetime. The main aim of the study was to evaluate the outcome especially complications of shunt surgery at our center. MethodsA single-institutional, retrospective observational study was conducted in 60 operated cases of congenital hydrocephalus with a minimum follow-up for up to 6 months. Parameters for analysis included demographic data, etiology of hydrocephalus, surgery time, and type of complications. ResultsOut of 86 patients, 60 patients who fulfilled the inclusion criteria were enrolled in the study. The mean age of the patients at the time of VP shunt placement was 3 months, range from 8 days to 15 years with male preponderance. The majority of the patients belonged to the 0-1-year age group (76.8%). The commonest etiology of hydrocephalus was congenital aqueduct stenosis. Fifteen patients (25%) developed complications within six months follow-up period. Eight patients (13.3%) developed clinical shunt infection with four cases having culture positive. Four (6.67%) had mechanical complications in the form of shunt obstruction. Three patients had ascites, subdural collection, and shunt extrusion from the anus. The shunt related mortality was 1.67%. ConclusionThe shunt infection and obstruction still remain the most important complications. Despite inherent problems, shunt surgery is the procedure of choice until a safer effective alternative is available.

scholarly journals Evaluation of the Anxiety Level of Mothers of Children with Epilepsy during the COVID-19 Pandemic Period

2021 ◽  
pp. 1-8
Author(s):  
Halil Celik ◽  
Sadettin Burak Acikel ◽  
Fatih Mehmet Akif Ozdemir ◽  
Erhan Aksoy ◽  
Ulkuhan Oztoprak ◽  
...  
Keyword(s):  
Neurological Disease ◽  
Chronic Conditions ◽  
Care Center ◽  
Tertiary Care ◽  
Anxiety Level ◽  
Childhood And Adolescence ◽  
Routine Examination ◽  
Significant Difference ◽  
Anxiety Levels

<b><i>Background and Aim:</i></b> Although anyone can be affected by the COVID-19 pandemic, it may cause additional concern for people with chronic conditions. Epilepsy is the most common neurological disease in childhood and adolescence. The aim of this study was to determine anxiety levels among the mothers of children under follow-up for epilepsy in our clinic during the COVID-19 pandemic. <b><i>Methods:</i></b> The study group consisted of the mothers of epilepsy patients who were under follow-up in the pediatric neurology outpatient clinic of the tertiary care center and were scheduled for a routine examination during the COVID-19 pandemic. The mothers’ anxiety levels according to the Beck Anxiety Inventory and their opinions about COVID-19 in relation to their child were assessed and compared based on whether the mother/patient attended their appointments in person and whether the child had frequent or infrequent seizures. <b><i>Results:</i></b> There was no statistically significant difference in anxiety level between the mothers of 64 children with epilepsy who attended their appointment during the pandemic and those of the mothers of 52 who did not attend their appointment. However, the mothers of children with frequent seizures had significantly higher anxiety levels. <b><i>Conclusion:</i></b> Anxiety level of mothers whose children have frequent seizures was significantly higher compared to mothers whose children have infrequent seizures. It is important to be aware about this point and using telemedicine approach in suitable population and postpone routine outpatient follow-up appointments as much as possible.

Nephrocalcinosis, Renal Dysfunction, and Calculi in Patients With Primary Hypoparathyroidism on Long-Term Conventional Therapy

2020 ◽  
Vol 105 (4) ◽  
pp. e1215-e1224 ◽  
Author(s):  
Soma Saha ◽  
Devasenathipathy Kandasamy ◽  
Raju Sharma ◽  
Chandrasekhar Bal ◽  
Vishnubhatla Sreenivas ◽  
...  
Keyword(s):  
Renal Dysfunction ◽  
Conventional Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Fractional Excretion ◽  
Renal Calculi ◽  
Serum Total Calcium ◽  
Calcium Phosphorus

Abstract Context There are concerns about the long-term safety of conventional therapy on renal health in patients with hypoparathyroidism. Careful audit of these would help comparisons with upcoming parathyroid hormone therapy. Objective We investigated nephrocalcinosis, renal dysfunction, and calculi, their predictors and progression over long-term follow-up in patients with primary hypoparathyroidism (PH). Design and Setting An observational study at a tertiary care center was conducted. Participants and Methods A total of 165 PH patients receiving conventional therapy were evaluated by radiographs, ultrasonography, and computed tomography. Their glomerular filtration rate (GFR) was measured by Tc-99m-diethylenetriamine penta-acetic acid clearance. Clinical characteristics, serum total calcium, phosphorus, creatinine, hypercalciuria, and fractional excretion of phosphorus (FEPh) at presentation and during follow-up were analyzed as possible predictors of renal complications. Controls were 165 apparently healthy individuals. Results Nephrocalcinosis was present in 6.7% of PH patients but not in controls. Patients younger than 15 years at presentation and with higher serum calcium-phosphorus product were at higher risk. Nephrocalcinosis showed no significant association with cataract and intracranial calcification. Prevalence of renal calculi was comparable between hypoparathyroid patients and controls (5% vs 3.6%, P = .58). Fourteen percent of patients had a GFR less than 60 mL/min/1.73 m2. Increased FEPh during follow-up was the significant predictor of low GFR. Nephrocalcinosis developed in 9% of patients over 10 years of conventional therapy. Conclusion A total of 6.7% of PH patients had nephrocalcinosis, and 14% showed renal dysfunction. Prevalence of renal calculi was similar in patients and controls. Nine percent of patients developed nephrocalcinosis over 10 years of conventional therapy.

scholarly journals Postpartum follow up of gestational diabetes in a Tertiary Care Center

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
C. A. Cabizuca ◽  
P. S. Rocha ◽  
J. V. Marques ◽  
T. F. L. R. Costa ◽  
A. S. N. Santos ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

scholarly journals Effectiveness of Transjugular Intrahepatic Portosystemic Shunt in Variceal Bleeding: An Audit from a Tertiary Care Center in North India

2017 ◽  
Vol 01 (03) ◽  
pp. 150-155
Author(s):  
Arun Gupta ◽  
Ajay Mehta ◽  
Nitin Mishra ◽  
Rajendra Bansal ◽  
Ajit Yadav
Keyword(s):  
Variceal Bleeding ◽  
Patency Rate ◽  
Care Center ◽  
Tertiary Care ◽  
Portosystemic Shunt ◽  
North India ◽  
Related Complication ◽  
Variceal Bleed ◽  
Intrahepatic Portosystemic Shunt

AbstractVariceal bleeding is one of the most feared complications of cirrhosis and portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective minimally invasive option to achieve adequate decompression of the portal system. The aim of the study was to assess the efficacy and complications of TIPS in patients presenting with variceal bleed. It was a retrospective study done in a tertiary care center in North India in cirrhotic patients with acute or recurrent variceal bleed who underwent TIPS from April 2010 to October 2013. All the patients were followed up till April 2014. We could successfully implant TIPS in 100% of our patients with 100% success rate in controlling variceal bleeding immediately and during the follow-up period. Our primary patency rate was 94.5% and overall patency rate was 100%. Major TIPS-related complication was hepatic encephalopathy in 20% of patients; 7 of 22 patients died during the follow-up period. TIPS is a safe and effective procedure for control of acute or recurrent variceal bleed. Emerging evidence in favor of early TIPS is further going to expand its indication in variceal bleed. Hepatic encephalopathy was the major procedure-related complication in our study consistent with previous literature reports.

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