scholarly journals Impact of a National Lockdown for COVID-19 on Morbidity and Mortality Among Children with Sickle Cell Anaemia at a Tertiary Care Hospital in Uganda

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 33-34
Author(s):  
Ruth Namazzi ◽  
Robert Opoka ◽  
Andrea L Conroy ◽  
Dibyadyuti Datta ◽  
Micheal Goings ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Sickle Cell Anaemia ◽  
Conflicts Of Interest ◽  
Tertiary Care ◽  
School Closure ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Phone Calls ◽  
The Impact

COVID-19 and its prevention has put considerable strain on health care systems in low and middle-income countries (LMIC). In Uganda, a national lockdown was declared on March 18, 2020, in response to COVID-19 pandemic and concern of spread of cases without aggressive measures to prevent spread. The lockdown consisted of closure of all offices except essential ones, orders to stay at home unless an emergency occurred, school closure, a ban on all meetings of more than 10 people, a ban on public and private transport, closing down of all shops, malls, restaurants, places of worship and other facilities in which group meetings might occur, keeping a distance of at least 2 metres from other people in public places and a 7:00 p.m. to 6:30 a.m. curfew. Hospitals however remained open and operational. We describe the impact of the lockdown in Uganda in response to the COVID-19 pandemic on the morbidity and mortality in children with sickle cell anaemia (SCA) at a tertiary hospital in Uganda. The number of clinic visits for SCA related complications and death were compared in the pre-lockdown (November 2019 to February 2020) and during COVID-19 lockdown periods (March 2020 to June 2020) in children aged 1- 4.99 years enrolled in a SCA research study [Zinc for Infection Prevention in Sickle cell anaemia (NCT03528434)] at Jinja Hospital, Uganda. In the study, children with SCA are asked to return to the hospital for evaluation whenever they are unwell. Follow up phone calls are made to ascertain the wellbeing of the children and identify any who are unable to come to the hospital. During the lockdown, follow up calls continued and facilitation was provided for caregivers to bring any child who was unwell to the hospital for evaluation. A total of 238 children with a mean (standard deviation) age of 2.7(1.1) years were enrolled and were being followed up when the pandemic started. The incidence of hospital sick visits pre-lockdown and during the lockdown period was 7.7 vs 4.0 person-year, (p= <0.0001). Incidence of hospitalization, pain crises, severe anaemia, or malaria were all higher in the pre-lockdown period than during the lockdown period, 2.4 vs.1.0, 1.8 vs. 0.7, 0.7 vs. 0.4, 0.6 vs. 0.2 and per person year respectively (all p values < 0.01). There were no deaths during the lockdown period compared to 1 death in the pre-lockdown period. Less than 1000 cases of COVID-19 were reported nationally in this period, and none of the study children had known COVID-19 infection, though testing capacity for this was limited. In this cohort of children with SCA, hospitalization and morbidity from SCA-related complications and malaria were are significantly lower during a lockdown period for COVID-19 pandemic than before the lockdown. Reduced access to hospital care is unlikely to explain these findings, as sick children still received care at the hospital, and there was no increase in mortality. Reduced interaction with peers because of the lockdown and social distancing, leading to fewer infections that may trigger SCA-complications, may explain the reduced incidence of SCA complications in this population during the COVID-19 lockdown period in Uganda. Disclosures No relevant conflicts of interest to declare.

Influence of the localization of the primary tumor in the survival of patients with metastatic colon-rectal cancer treated with bevacizumab.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 665-665
Author(s):  
Inmaculada Gallego Jimenez ◽  
Amelia Lopez Ladron ◽  
David Morales Pancorbo ◽  
Eva Fernandez Parra ◽  
Maria Rodriguez de la Borbolla ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Primary Tumor ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Left Colon ◽  
Care Hospital ◽  
First Line Therapy ◽  
Colon Rectal Cancer ◽  
The Impact

665 Background: Bevacizumab, a humanized antibody against the molecular target endotelial growth factor VEGF-A, has incorporated to the standard of care of metastatic colon-rectal cancer (mCRC). A recent study has suggested that the left colon localization of the primary tumor may be a factor associated with a poorer survival in individuals treated against mCRC with bevacizumab including chemotherapy. Our objective was to analyze the impact of the localization of the primary tumor on the survival of patients with mCRC treated with bevacizumab. Methods: Prospective cohort study conducted in a tertiary-care hospital in Spain. Twenty-nine consecutive patients with mCRC who started a first-line therapy including bevacizumab were included. Patients were followed up until death, lost to follow-up or the censoring date (31th August, 2013). The primary end-point of the study was death from any cause. Predictors of survival, including the localization of the primary tumor, were assessed. Results: The median (Q1-Q3) age was 59 (52-67) years and 13 (45%) patients were male. Chemotherapy scheme was XELOX in 13 (45%) patients, FOLFOX in 8 (28%), FOLFIRI in 5 (17%), XELIRI in 2 (7%) and capecitabine in 1 (3%) patient. The localization of the primary tumor were distributed as follows: rectum in 6 (21%), sigmoid colon in 9 (31%), left colon in 9 (31%) and right colon in 5 (17%) patients. After a median (Q1-Q3) follow-up of 29 (13-41) months, 19 (66%) patients died. There were no patients lost to the follow-up. The mean (SD) survival in patients with left colon cancer was 25 (8) months whereas it was 47 (7) months in the remaining population (p = 0.1). The low sample size precluded to perform reliable multivariate analyses. Conclusions: Our study suggests that left colon localization of the primary tumor may have a worse prognosis in patients with mCRC treated with bevacizumab. Although no statistically significant differences have been observed, this fact may have been a consequence of the limited power of the analysed sample. Collaborative studies should be perfomed in order to clarify this issue.

scholarly journals Smoking Cessation Intervention in a Cardiovascular Hospital Based Clinical Setting

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Zainab Samaan ◽  
Barb Nowacki ◽  
Karleen Schulze ◽  
Patrick Magloire ◽  
Sonia S. Anand
Keyword(s):  
Smoking Cessation ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Smoking Reduction ◽  
Quit Smoking ◽  
The Impact ◽  
Cessation Clinic ◽  
Smoking Cessation Clinic

Introduction. Smoking is a leading cause of morbidity and mortality globally and it is a significant modifiable risk factor for cardiovascular disease (CVD) and other chronic diseases. Efforts to encourage and support smokers to quit are critical to prevent premature smoking-associated morbidity and mortality. Hospital settings are seldom equipped to help patients to quit smoking thus missing out a valuable opportunity to support patients at risk of smoking complications. We report the impact of a smoking cessation clinic we have established in a tertiary care hospital setting to serve patients with CVD. Methods. Patients received behavioural and pharmacological treatments and were followed up for a minimum of 6 months (mean 541 days, SD 197 days). The main study outcome is ≥50% reduction in number of cigarettes smoked at followup. Results. One hundred and eighty-six patients completed ≥6 months followup. More than half of the patients (52.7%) achieved ≥50% smoking reduction at follow up. Establishment of a plan to quit smoking and use of nicotine replacement therapy (NRT) were significantly associated with smoking reduction at followup. Conclusions. A hospital-based smoking cessation clinic is a beneficial intervention to bring about smoking reduction in approximately half of the patients.

HLH (Hemophagocytic Lymphohistiocytosis) At a Tertiary Care Hospital, B J Wadia Hospital for Children,In Mumbai, India

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4936-4936
Author(s):  
Mukesh Manharlal Desai ◽  
Harvinder Iqbal Palaha ◽  
Snehal Desai ◽  
Manisha Madkaikar ◽  
Bharat Agarwal ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Viral Infection ◽  
Serum Ferritin ◽  
Conflicts Of Interest ◽  
Fungal Infections ◽  
Tertiary Care ◽  
The Other ◽  
Care Hospital ◽  
The Mean

Abstract Abstract 4936 We present a retrospective analysis of HLH diagnosed at B J Wadia Hospital for Children, a tertiary care exclusive pediatric institute in Mumbai. In all, 43 cases were diagnosed as HLH as per 2009 Guidelines (Filipovich et al). There were 15 (34.9%) males and 28 (63.1%) females. The mean age was 3 yrs 4 mths with a range of 15 days to 12 yrs. The commonest presenting symptom was fever in 85% of cases. RS, GI, Renal and CNS symptoms were seen in 48.8%, 65%, 11.6% and 24% of our cases. Skin pigmentation, Petachiae, Oedma and arthritis was present in 12(27.9%); 4(9.3%), 13(30.2%), and 4(9.3%) of cases respectively. 41(95.3%) babies had Hepatomegaly while 35(81.3%) had Splenomegaly. Lymphadenopathy was seen in 13(30.2%). 12 (27.9%) had pigmentation, 13(30.2%0 had oedema while 4 (9.3%) each had petachiae and arthritis. Mean Hb of 8.2 gm/dl and a range of 3.5 to 10 gm/dl. The Mean WBC count & ANC were 8030 (range 1300 – 29400) & 4614 (300-19400). 37(86%) had thrombocytopenia. Liver injury 27(62.7%), hyponatremia 28(65.1%) and renal failure in 6(13.95%) was seen at diagnosis. Coagulopathy was present in 38(88.4%) and serum ferritin was >500 in 36(83.7%) with a mean of 26135 ng/ml and range of 82 to 200,000 ng/ml. 24(55.8) cases had Hypertriglyceridemia with mean levels of 236. 13 patients had infections 6 UTI & 7 bacterial diarrhoea. Only 2 out of 16 children had CSF abnormality at diagnosis. BM was hypo cellular in 3 and hyper cellular in 40 and all showed hemophagocytosis. PS showed HLH in 4 cases. Cultures isolated K pneumoniae in 5, P aeruginosa in 2, S. Typhi in 1, Candida in 4, and H1N1 in 1. Kalazar was the cause of HLH in 1 and 2 patients had P vivax seen on PS. 1 child had SPTCL & HLH while another child has ALCl & HLH. The child with SPTCL had gross hemophagocytosis on skin biopsy as well as in the Bone Marrow. Perforin was done in 30(70%) and was low in 6/30 (20%) cases, while GRA (Granule Release Assay) was done in 15(35%) and was abnormal in 4/15(26.6%). GRA was established last year only. In 29(67.4%) cases IAHS was diagnosed. The IAHS were, HIV 1, Post Chicken pox 1, Dengue 2, Viral aseptic meningitis 1, P vivax 1, Leishmaniasis 1, MTB in 1, S. typhi in 1, gram −ve sepsis in 8, candidia in 3, viral infection 9. 2 cases had MAS (Macrophage Activation Syndrome) with JRA; serum ferritin was as high as 200,000 ng/ml at diagnosis. 1 child had Griscelli Syndrome with HLH. Perforin deficiency presented at a mean age of 5 mths & all had severe fulminant presentation with brief H/o of viral infection and hepatosplenomegaly. Hepatic injury was severe and rapidly progressive, CNS affection was present in 3/6 cases and all died. 2/4 children with GRA abnormalities presented early at 15 days & 1 mth of life, 1 had a gm −ve sepsis with response to HLH protocol but relapsed & Died, the other child presented with fever, hepatosplenomegaly, pancytopenia & neuroregression and BMA confirmed HLH. Of the other 2 babies with GRA abnormalities 1 was a case of Griscelli who presented at 4 yrs 6 mths of life while the other presented at 1 6 mths yr of life as what appeared like IAHS and sucumbed to his disease. 2/4 with GRA abnormalities are alive and well. 1 child had thrombocytopenia and Malena as the sole presentation of HLH and the Bone Marrow done 4 times showed gross hemophagocytosis. 2/4 children with elevated creatinine required peritoneal dialysis. All our cases received Dexa, CsA & Etoposide as in HLH 2004 protocol. We ensured that the 1st 2 doses of etoposide were given after which etoposide may be witheld depending on clinical situation. IT MTX was given when there was CSf abnormalities or gross CNS signs. The Mortality was 32.5% (14/43). 3 of them died during Follow up with relapse of HLH, 1 child with ALCL died of Lymphoma while child with SPTCL is alive but with systemic symptoms. 8/43 (18.6%) are lost to follow up. Majority of IAHS did well with treatment. 8 are presently on regular follow up. In IAHS reassesment of HLH status if normal at 8 weeks, treatment was discontinued. 21/43 children completed 8 weeks of treatment. Conclusions: HLH is not an uncommon diagnosis in tertiary care centre in India. IAHS was the commonest cause of HLH and prompt dignosis with treatment HLH 2004 protocol is necessary to control the hyperinflammation. Our Ferritin values were very high. Incidence of Perforin deficiency was 20% and 26.6% respectively. Mortality in perforin deficiency was 100%. Bacterial infection and fungal infections were also common among the IAHS. Disclosures: No relevant conflicts of interest to declare.

Validation of a Non-Invasive Hemoglobin Estimation in Patients with Sickle Cell Disease

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4770-4770
Author(s):  
Murtadha K. Al-Khabori ◽  
Abdulhakeem Al-Hashim ◽  
Zeba Jabeen ◽  
Khalil Al Farsi ◽  
Mohammed Al-Huneini ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Correlation Coefficient ◽  
Sickle Cell ◽  
Conflicts Of Interest ◽  
Pearson Correlation ◽  
Tertiary Care ◽  
Coefficient Of Determination ◽  
Care Hospital ◽  
Cell Disease ◽  
Non Invasive

Abstract Abstract 4770 Introduction: The care of patients with Sickle Cell Disease (SCD) is frequently complicated by difficult venous access complicating blood sampling for laboratory investigations including hemoglobin (Hb) measurement. Non-invasive hemoglobin concentration monitoring is a potential solution, albeit not validated yet in patients with SCD. The primary objective of this study was to validate non-invasive pulse CO-oximetry based hemoglobin estimation in this patient population. Methods: We conducted a prospective observational study on patients with SCD admitted to the inpatient wards over 4 weeks in a tertiary care hospital. We estimated a spot Hemoglobin (Sp Hb) measurement using Masimo Pronto-7 Pulse CO-oximetry device (two measurements per patient) and compared it to a venous sample Hb (Reference Hemoglobin; Ref Hb) measured using Abbott CELL-DYN Sapphire hematology analyzer. We calculated Pearson correlation coefficient and coefficient of determination (R2). The multivariable linear regression model of predicting the estimation differences included age, gender, weight, height, blood pressure and reference hemoglobin. Results: We enrolled 98 patients (45 males, 53 females) with a mean age of 26 years (SD 8.8; 14–75) and a mean Ref Hb of 9.2 g/dL (SD 1.5; 5.3–13). The mean Sp Hb was 10.1 g/dL (SD 2.0; 5.3–14.5). The correlation coefficient between the Sp Hb and Ref Hb was 0.54 (R2 = 29%) with a mean difference of 0.9 g/dL (SD 1.7; −4.8 to 4.5). In the multivariable model, gender (p =0.042) and Ref Hb level (p=0.001) were statistically significant predictors for the difference in measurement. A strong correlation between the two CO-oximetry Hb measurements was obtained (correlation coefficient = 0.81, R2 = 65%). Conclusions: Our study demonstrated the validity of the CO-oximetry Hb measurement in adult patients with SCD. Larger prospective studies are needed to confirm our results. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Single Institutional Experience with Nivolumab in Relapsed/Refractory Classic Hodgkin

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5355-5355
Author(s):  
Reyad Dada ◽  
Bassim T. Malas Al-Beirouti ◽  
Yazeed Zabai
Keyword(s):  
Hodgkin Lymphoma ◽  
Tumor Cells ◽  
Conflicts Of Interest ◽  
Performance Status ◽  
Tertiary Care ◽  
Single Agent ◽  
Care Hospital ◽  
Activated T Cells ◽  
Serious Adverse Events

Abstract Objectives : One of the newly discovered mechanisms to escape the immune response in classic Hodgkin lymphoma (cHL) is to induce immune tolerance through interaction of program cell death 1 (PD-1) on activated T cells and PD ligand-1 (PD-L1) on tumor cells. Tissue of patients with cHL was recently found to overexpress PD-L1. Nivolumab is a novel checkpoint inhibitor designed to block PD-1 and inhibits interaction between PD-1 and PD-L1. Unlike many available antibodies and chemotherapies, nivolumab itself is not cytotoxic but rather inhibits the tolerance of tumor cells through activation of the immune system. Patients and methods: We report on ten patients with relapsed/refractory cHL who were treated between 05/2016 and 03/2018 with single agent nivolumab in a tertiary care hospital. Follow-up was performed after 4 cycles with positron emission tomography (PET). Patients' files were retrospectively analyzed. Results: Mean age was 26.2 year (range 15-40). Prior to nivolumab 3/10 and 5/10 patients failed ASCT and brentuximab vedotin respectively. Mean follow-up time was 12.3 months (range 5-32). Average of prior lines was 6.3. After 4 cycles of nivolumab response rate was 80% with complete metabolic (CR) and partial remission rates of 70% and 10% respectively. In one case PET showed stable disease and another patient experienced progressive disease. Three deaths occurred after 5, 9 and 32 months of nivolumab's initiation. One patients experienced pneumonitis grade 2 which was manageable by oral steroids. Another patient had an asymptomatic TSH elevation. Two patients had grade 2 neutropenia. No serious adverse events (grade ≥3) were observed. All patients experienced a remarkable improvement of quality of life. On treatment start, two patients had performance status ECOG 3 and 4 which were attributed to refractory Hodgkin lymphoma. They recovered dramatically each to ECOG 2 within 7 days and 10 days after nivolumab start respectively. Conclusion: The CR rate seen in our cohort supports the high sensitivity of relapsed/refractory cHL to checkpoint inhibition seen in Checkmate 205. Nivolumab induces impressive clinical and radiological responses with excellent tolerance. The drug enriches our treatments armamentarium in treating cHL. Further controlled studies are needed to determine the effectiveness on a large patients' cohort and its role in earlier lines. Disclosures No relevant conflicts of interest to declare.

Clinical pharmacist interventions in post stroke follow up patients in tertiary care hospital on coastal region

2020 ◽  
Vol 8 (2) ◽  
pp. 45-52
Author(s):  
Prakash A ◽  
Kalyan Rao B ◽  
Sujitha Sri K ◽  
Lakshman Naik R ◽  
Shaik Shahin Kouser ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Medical Condition ◽  
Tertiary Care ◽  
Inappropriate Drug ◽  
Care Hospital ◽  
Stroke Patients ◽  
Total Study Population ◽  
Patient Counselling ◽  
The Impact

Stroke is basically a medical condition where there is low blood flow to the brain and thus results in cell death. It remains the second most common cause of death. Stroke patients also have different comorbidities on an average where they are prescribed with 6-10 medicines. This increase the chances for drug-related problems (DRPs) and adverse drug events (ADEs) or adverse drug reactions (ADRs) and the interventions found during the follow up of stroke patients. Several studies finding of interventions in stroke patients and reconciliation are ways to reduce ADRs and improve medication use safety. Interventions and medical reconciliation (MR) address a wide array of potential medication-related issues, which is carefully planned that may be done by pharmacist or doctor or professional (or) physician. Here the aim was to access the impact of interventions which includes medications reconciliation and counselling of stroke patients and also identification and categorization of DRPs. Polypharmacy causing DRPs was statistically significant in all the regions inappropriate drug selection (2.85%), and dose selection (2.85%) was the primary cause of DRPs 85% partially solved. Epidemiologically of all the three regions (GNT, VIJ, RJY) in the total study population. Males are more affected than females. Majority of comorbidities like HTN(70.05%), and DM(47.01%)were in leading role causing stroke absorbed during interventions. Leaflet & patient counselling had prominent role in conducting medical reconciliation. Other health care professionals systematically find, differentiate & report interventions like (DRPs, ADRs, and causes).

scholarly journals A study of clinical and hematological profile of children with sickle cell disease in a tertiary care hospital, Valsad, India

2017 ◽  
Vol 4 (4) ◽  
pp. 1317 ◽  
Author(s):  
Kinjal G. Patel ◽  
Chintu Chaudhari ◽  
Diwakar Sharma
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Age Group ◽  
Cell Disease ◽  
Significant Difference ◽  
The Common

Background: Sickle cell disease is commonly seen in rural population of south part of Gujarat in India. It is one of the common causes of recurrent hospitalization, morbidity and mortality in pediatric population. This study was therefore undertaken to evaluate the clinical profile of sickle cell disease in a tertiary care hospital.Methods: This was the prospective observational study done from November 2015 to October 2016. All the hospitalized diagnosed case of sickle cell disease and trait in age group of 6 months to 14 years were taken in this study. Sickle cell disease with some genetic or metabolic disease and sickle-beta-thalassemia patients were not included in this study.Results: Total 61 patients were admitted over a one year of study period, out of which 47 were sickle cell disease and 14 sickle cell trait patients. Morbidity events were commonly observed in 5-12 years of age groups (68.85%). Seasonal variation also observed, 47.54% of total cases are seen in winter season. Pain (60.65%) was the most common presenting symptom. Severe pallor (39.34%) and splenomegaly (24.59%) was the most common sign in both groups. Vaso-occlusive crisis (59.01%) was the most common morbidity event observed, of which abdominal pain was the most common site of pain involvement. On laboratory analysis, there was statistically significant difference observed in disease and trait. In patients with sickle cell disease acute painful crisis (59.57%) was the common morbidity event observed while in sickle cell trait patients acute febrile illness (71.42%) observed.Conclusions: Vaso-occlusive crisis is the commonest manifestation in pediatric age group. Comprehensive medical care and management is required to decrease the morbidity and mortality. 

scholarly journals Impact of pharmacist intervention on glycemic control of type 2 diabetes patients in a tertiary care hospital

2021 ◽  
Author(s):  
Kamelia Sadeghi ◽  
Karanesh Dass ◽  
Shobha Hiremath ◽  
Swapna Bhaskar
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Standard Treatment ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Pharmacist Intervention ◽  
Care Hospital ◽  
The Impact

Objective: Diabetes is one of the most common chronic disease that requires comparatively more care to achieve optimal therapeutic outcomes. The aim of this study was to study the impact of pharmacist intervention on glycemic control of type 2 diabetes patients in a tertiary care hospital. The objectives were: To assess the parameters of glycemic control namely FBS, PPBS, and HbA1c; To provide patient education to one group of patients while other group of patients get standard care; To assess the impact of the educational intervention on blood sugar levels and HbA1c. Materials and methods: It was hospital based prospective interventional study carried out in the general medicine out-patient department of St. Philomena’s hospital, a tertiary care hospital, in Bangalore, India. The patients recruited were divided equally and randomly into control and intervention groups. Patients in the interventional group received patient informational leaflets, and education in addition to standard treatment, while the control group patients received only standard treatment. Parameters of glycemic control namely FBS, PPBS, and HbA1c of the patients were measured at baseline and at the end of the follow up period of 3 months and compared using appropriate statistical tests. Result: 50 patients having HbA1c value of >8% were included in the study. FBS, PPBS, and HbA1c values of all patients were measured at baseline and compared to the values obtained at the end of the follow up period, and was found to be statistically significant (p < 0.05). The difference in the baseline and follow up values between the control and intervention groups was also compared and found to be statistically significant (p< 0.05). Conclusion: It was observed from our study that pharmacist led educational intervention program for the management of type 2 diabetes had a positive impact in lowering the levels of glycemic parameter.

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