Outcome of Fungal Infection in Patients Undergoing Myelosuppressive Chemotherapy in a Tertiary Care Centre During 12 Years (1995-2006).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1384-1384
Author(s):  
Marie von Lilienfeld-Toal ◽  
Axel Glasmacher ◽  
Günter Marklein ◽  
Peter Brossart ◽  
Corinna Hahn-Ast
Keyword(s):  
Research Funding ◽  
Fungal Infections ◽  
Lymphoblastic Leukemia ◽  
Tertiary Care ◽  
Underlying Disease ◽  
Aggressive Lymphoma ◽  
Tertiary Care Centre ◽  
Myelosuppressive Chemotherapy ◽  
Mortality And Morbidity ◽  
Related Mortality

Abstract Abstract 1384 Poster Board I-406 Invasive fungal infections (IFI) contribute significantly to mortality and morbidity in patients receiving myelosuppressive chemotherapy for hematological malignancies. The present study evaluates the incidence of IFI, the overall survival (OS), the infection-related mortality and changes in treatment of IFI in our department from 1995 until 2006. Data of all consecutive chemotherapy courses were retrospectively collected with a standard questionnaire. EORTC/MSG criteria for IFI were applied with a modification: A positive PCR-result for Aspergillus spp. in bronchoalveolar lavage was also defined as probable IFI. In total, 1693 courses of 592 patients were evaluated. Sixty-three percent were given to treat acute myeloid leukemia, the rest for acute lymphoblastic leukemia or aggressive lymphoma. IFI were observed in 139/592 patients (23%, 95% confidence interval (CI) 20-27%), and in 149/1693 (8.8%, 95%CI 8-10%) courses. IFI-related mortality was 57% in 1995-2001 and 29% in 2002-2006, p<0.001. Accordingly, median OS in patients with IFI increased in the later years: 54 days (95%CI 26–82 days) in 1995-2001 versus 229 days (95% CI 35–423 days) in 2002-2006, p=0.001, figure 1. By multivariate analysis, factors predictive for better OS were controlled disease after chemotherapy (hazard ratio (HR) 0.226, p<0.001), possible IFI (in contrast to proven/probable IFI, HR 0.511, p=0.002), age < 60 years (HR 0.611, p=0.015), and use of novel antifungals (HR 0.493, p=0.002). In conclusion, IFI-related mortality decreased and OS in patients with IFI increased significantly in recent years compared to 1995-2001. In our cohort improved OS was associated with controlled underlying disease, certainty of IFI diagnosis (possible), younger age, and the use of novel antifungal agents. Figure 1 p=0.001 Figure 1. p=0.001 Time period ········ 2002-2006 —— 1995-2001 Number at risk 2002-2006 78 28 18 9 6 2 1995-2001 61 8 6 5 5 5 Disclosures: von Lilienfeld-Toal: MSD: Honoraria, Research Funding. Glasmacher: Celgene: Employment, Equity Ownership. Hahn-Ast: MSD: Research Funding.

scholarly journals Surgical management and perioperative complications of peritonitis secondary to hollow viscus perforation in a tertiary care centre

2021 ◽  
Vol 8 (11) ◽  
pp. 3359
Author(s):  
Lokesh M. G. ◽  
S. Chandrashekar ◽  
Arundathi Raikar ◽  
Abhishek S. S.
Keyword(s):  
Perioperative Complications ◽  
Tertiary Care ◽  
Surgical Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Hollow Viscus ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Threatening Condition ◽  
Hollow Viscus Perforation

Background: High mortality and morbidity is associated with peritonitis secondary to hollow viscus perforation, proving it a most common life threatening condition which needs emergency surgical care. Hence a proper evaluation was needed regarding appropriate management to have a better outcome, which was a challenge to operating surgeon.Methods: A serial study of 96 cases of peritonitis secondary to hollow viscus perforation was conducted at tertiary care centre, department of general surgery, Mysore medical college and research institute, Mysore, Karnataka from the period of August 2020 to July 2021. Data related to aetiology, surgical intervention and its peri-operative complications were noted. Appropriate statistical analyses were done to draw the inference.Results: Out of 96 cases studied, 74 were male, 22 were female with mean age of 45.53 years. Most common cause of peritonitis was GU perforation, followed by idiopathic, infective, malignancy, appendicular perforation and Trauma.Conclusions: Hollow viscus perforation being most common surgical emergencies, surgical outcomes and its related complications depends on age, general condition, site, co-morbidities and aetiologies.

scholarly journals Retrospective analysis of paediatric tracheostomy in Indian tertiary care centre

2020 ◽  
Vol 6 (3) ◽  
pp. 533
Author(s):  
Digant Patni ◽  
Vishal R. Munjal
Keyword(s):  
Retrospective Analysis ◽  
Tertiary Care ◽  
Care Facility ◽  
Tertiary Care Centre ◽  
Prolonged Intubation ◽  
Changing Trend ◽  
Lost To Follow Up ◽  
Neurological Infection ◽  
Related Mortality

<p class="abstract"><strong>Background:</strong> Tracheostomy is frequently performed surgical procedure. The present study was carried out to assess data on various indications, surgical issues if any, complications and outcomes of paediatric tracheostomy.</p><p class="abstract"><strong>Methods:</strong> This study is a retrospective analysis of 32 paediatric patients between 1 to 12 years of age, who underwent tracheostomy at SAIMS, Indore between June 2015 to June 2019. Data was analysed in terms of patient age, sex, emergency or planned procedure, any surgical challenge, complications and post-operative follow up.  </p><p class="abstract"><strong>Results:</strong> Majority of patients were of prolonged intubation due to respiratory and laryngotracheobronchitis (15.6%) each, neuromuscular disease (15.6%), seizure disorder (9.4%), metabolic disease (9.4%) and neurological infection (6.3%). Obstructive causes included head injury (9.4%), sub-glottic stenosis (6.3%), malignancy (6.3%) and craniofacial anomaly (3.1%). Common complication encountered were partial blockage of tube, peri-stomal granulation and accidental decannulation. There was no tracheostomy related mortality in this study. Out of 32 patients, 16 were successfully decannulated, 6 were lost to follow up, 6 could not be decannulated and 4 expired due to worsening of primary disease.</p><p class="abstract"><strong>Conclusions:</strong> There is a changing trend in indications of tracheostomy and overall complications have reduced due to trained team and better care facility.</p>

scholarly journals Neonatal candidiasis: clinical spectrum and epidemiology in a tertiary care centre

2017 ◽  
Vol 4 (2) ◽  
pp. 438
Author(s):  
Bhavana Koppad ◽  
Kulkarni Poornima Prakash
Keyword(s):  
Candida Albicans ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Candida Guilliermondii ◽  
Clinical Spectrum ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Neonatal Candidiasis

Background: Candidial infections are a serious problem in neonatal intensive care units (NICU) which increases the mortality and morbidity in addition to increasing health care costs. Confirming the diagnosis by laboratory tests is difficult and a high index of suspicion is required. The objective of this study was to identify the clinical spectrum and epidemiology of neonatal candidiasis in a tertiary care NICU.Methods: The present study was carried out in the NICU of SDM medical college and hospital, Dharwad. All babies who were admitted to NICU and who had positive blood culture for Candida were included in the study. One year Data (1st December 2015 to 31st November 2016) was collected retrospectively from NICU case records. Statistical test used was chi square test.Results: Total admissions to the NICU during the study period were 2591. Blood cultures were positive in 132 babies. Among these, Candidial sepsis was noted in 39.39% (52) babies. Out of the 52 positive fungal cultures, 15 were Candida albicans, 35 were Candida non albicans and 2 were mixed cultures (Candida albicans and non albicans) showing an increasing incidence of non-albicans Candida infections. Among the non albicans Candida, Candida tropicalis and Candida guilliermondii were the predominant species (11 each) followed by Candida famata (6), Candida krusei (6) and Candida parapsilosis (3). Candidial sepsis was seen to be more common among preterm and low birth weight babies. Usage of antibiotics, Total parenteral nutrition (TPN) and mechanical ventilation were common risk factors noted in our study.Conclusions: Systemic Candidiasis is a disease of modern neonatal intensive care. It deserves urgent attention for its prevention as well as effective treatment in order to minimize neonatal morbidity and mortality.

scholarly journals Peripartum Hysterectomy in a Teaching Hospital in India

2013 ◽  
Vol 4 (1) ◽  
pp. 5-9
Author(s):  
Swati Agrawal ◽  
Reena Yadav ◽  
Chitra Raghunandan ◽  
Shilpa Dhingra ◽  
Harvinder Kaur
Keyword(s):  
Tertiary Care ◽  
Hemodynamic Instability ◽  
Medical Sciences ◽  
Tertiary Care Centre ◽  
Maternal Deaths ◽  
Mortality And Morbidity ◽  
Maternal Characteristics ◽  
Peripartum Hysterectomy ◽  
Characteristics Method ◽  
Life Saving

Objectives: To find the incidence and clinical implications of peripartum hysterectomy in a tertiary care centre of India. Methods: A retrospective study of all cases of caesarean and postpartum hysterectomy between January 2006 and December 2011. Maternal characteristics, method of delivery, indications for hysterectomy and complications were reviewed. Results: The rate of peripartum hysterectomy was 0.47:1000 deliveries. Most were operative deliveries. The main indications were placenta accreta (38.88%), massive atonic PPH (36.11%) and uterine rupture (22.22%). Half the hysterectomies were subtotal while the rest were total. Maternal morbidity was high and there were seven maternal deaths (19.44%). All deaths were in patients brought in a critical condition to the hospital after massive blood loss. Conclusion: Peripartum hysterectomy is potentially a life saving procedure but the mortality and morbidity is high, especially if performed late when the hemodynamic instability has already set in. DOI: http://dx.doi.org/10.3126/ajms.v4i1.6967 Asian Journal of Medical Sciences 4(2013) 5-9

scholarly journals Clinical Profile and Outcome of Neonates Admitted to Neonatal Intensive Care Unit (NICU) at a Tertiary Care Centre in Eastern Nepal

2013 ◽  
Vol 33 (3) ◽  
pp. 177-181 ◽  
Author(s):  
Gauri Shankar Shah ◽  
Satish Yadav ◽  
Anil Thapa ◽  
Lokraj Shah
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Clinical Profile ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Development Goals

Introduction: Neonatal period is the most susceptible period of life due to different causes, which in most cases are preventable. Every year millions of neonates are born and a large proportion of them are admitted to the neonatal intensive care unit (NICU) for various indications. One of the Millennium Development Goals is to reduce under five mortality by two thirds by 2015. Therefore, this study was conducted to identify the clinical profile, pattern of diseases and common causes of mortality and morbidity in neonates admitted to NICU. Materials and Methods: A retrospective study was conducted at level III Neonatal NICU of a tertiary -care teaching hospital from January, 2012 to December, 2012. Results: Total of 361 neonates were admitted in NICU. Eighty six neonates (23.8%) were admitted due to prematurity and 73 (20.2%) with birth asphyxia. Among birth asphyxia, 40(54.8%)were in HIE III, 27.4% and 17.8% in HIE II and HIE I, respectively. One hundred eighteen (32.6%) cases were diagnosed as sepsis. The overall mortality was 20.2% during hospital stay. Conclusions: Sepsis, prematurity and birth asphyxia were major causes for admission in NICU. All these etiologies are preventable up to some extent and, if detected earlier, can be effectively treated in order to reduce morbidity and mortality. DOI: http://dx.doi.org/10.3126/jnps.v33i3.8447   J. Nepal Paediatr. Soc. 2013;33(3):177-181

scholarly journals Cutaneous manifestations of diabetes mellitus: a clinical study

2018 ◽  
Vol 4 (3) ◽  
pp. 352
Author(s):  
Nancy Bhardwaj ◽  
Samarjit Roy ◽  
Rashmi Jindal ◽  
Sohaib Ahmad
Keyword(s):  
Diabetes Mellitus ◽  
Bacterial Infections ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Diabetic Control ◽  
Diabetic Patients ◽  
Tertiary Care Centre ◽  
Cutaneous Manifestations ◽  
Female Ratio ◽  
Cutaneous Infections

<p class="abstract"><strong>Background:</strong> Diabetes mellitus is a leading cause of morbidity with adverse effects on various systems including skin. Cutaneous manifestations seen in diabetes aid in its diagnosis and some of them may also correlate with diabetic control, duration and other complications. This study was undertaken to estimate burden of skin disorders among diabetics in a tertiary care centre of Uttarakhand.</p><p class="abstract"><strong>Methods:</strong> The study was conducted at Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India, over a period of one year from January 2016 to December 2016. Three hundred and seventy seven patients irrespective of age and sex were included in the study and those with gestational diabetes were excluded. Patients were examined for mucocutaneous manifestations and evaluated. Structured case reporting form was used to generate data.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 377 patients studies, 114 (30.2%) were in the age group of 51-60 years. Male to female ratio was 1.44:1. Mucocutaneous manifestations were present in 278/377 (73.7%) patients. Common cutaneous manifestations were cutaneous infections [fungal infections (n=106/377; 28.1%), bacterial infections (n=33/377; 8.8%)], pruritus (n=47/377; 12.5%), xerosis (n=39/377; 10.3%), diabetic dermopathy (n=36/377; 9.5%) and diabetic ulcers (n=24/377; 6.4%). Uncommon manifestations were necrobiosis lipoidica diabeticorum, alopecia areata, scleredema diabeticorum and granuloma annulare. Cutaneous reactions due to treatment of diabetes were noted in 4 (1%) patients.</p><p class="abstract"><strong>Conclusions:</strong> As prevalence of cutaneous manifestations is high in diabetic patients, knowledge of these will help in a timely and comprehensive management of both diabetes and dermatoses.</p>

scholarly journals Effects of Not Intubating Non-Trauma Patients With Low Glasgow Coma Scale Scores: a Retrospective Study

2022 ◽  
Vol 2 (1) ◽  
pp. 83-90
Author(s):  
Loui K Alsulimani ◽  
Ohoud Baajlan ◽  
Khalid Alghamdi ◽  
Raghad Alahmadi ◽  
Abdullah Bakhsh ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
Altered Mental Status ◽  
Trauma Patients ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Coma Scale ◽  
Scale Scores ◽  
Gcs Score

Background: Endotracheal intubation (EI) is a critical life-saving procedure commonly performed on emergency department (ED) patients who present with altered mental status (AMS).  Aims: We aimed to investigate the safety of observing, without EI, patients who present to the ED with decreased levels of consciousness (LOC).  Methods: We reviewed the data of all adult ED patients with a Glasgow Coma Scale (GCS) score ≤ 8, during the period between 2012 and 2018, in an academic tertiary care centre. Trauma patients were excluded. The patients were divided into two groups for comparison: those who were intubated and those who were not. Data on mortality, morbidity, and baseline clinical characteristics were collected and analysed.  Results: After screening 6334 electronic medical records of patients presenting to the ED with decreased LOC, only 257 patients met the inclusion criteria. 173 (67.3%) patients were intubated, while 84 (32.7%) were not. Among the intubated patients, 165 (95.4%) were intubated early (within two hours of presentation). Mortality, morbidity and length of stay for the intubated group were higher, although the baseline clinical characteristics were the same.  Conclusion: It might be safe to observe non-trauma emergency patients with a GCS score ≤ 8 without intubation. However, such decision should be taken carefully, as delayed intubation can be associated with higher mortality and morbidity

scholarly journals A Prospective Study of Clinical Profile in Febrile Illness with Thrombocytopenia in Children Aged 1 to 12 Years Admitted in a Tertiary Care Centre in Telangana

2021 ◽  
Vol 8 (35) ◽  
pp. 3247-3251
Author(s):  
Sreelatha Martha ◽  
Goutham Deeti ◽  
Chaitanya Jyothi Ravula ◽  
Nirmala Cherukuri ◽  
Srinivasa Suresh Nadavapalli
Keyword(s):  
Dengue Fever ◽  
Enteric Fever ◽  
Lymphoblastic Leukemia ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Clinical Problem ◽  
Severe Thrombocytopenia ◽  
Tertiary Care Centre ◽  
Female Ratio ◽  
Gi Symptoms

BACKGROUND Fever with thrombocytopenia is a common clinical problem in paediatric wards. Significant number of acute febrile illnesses have an infectious aetiology and are often associated with thrombocytopenia. The objective of the study was to determine the clinico-etiological profile and outcome of children admitted with febrile thrombocytopenia, especially in those with infective aetiology. METHODS The study design is a prospective observational study. It was conducted from September 2017 to August 2019 in the Department of Paediatrics, Niloufer Institute of Women and Child Health, Hyderabad. A total of hundred (100) children in the age group of 1 year to 12 years presented with fever, and thrombocytopenia were included in the study. Newborns, infants, children with febrile thrombocytopenia, known ITP (idiopathic thrombocytopenic purpura), already diagnosed haematological malignancy and children on antiplatelet drugs like aspirin were excluded from the study. After informed written consent, detailed history was elicited, clinical examination and necessary laboratory investigations were carried out, and the data was captured in a pre-structured proforma. Study parameters were analysed using Statistical Package for Social Sciences (SPSS) version 16 software. RESULTS The study included 100 children. A ratio of 1.4 : 1 was observed in male to female ratio. As of the clinical features, gastrointestinal (GI) symptoms such as nausea, vomiting and pain abdomen were more common, followed by headache and myalgia. On examination, two-thirds of the children had hepatomegaly, and onethird had splenomegaly. Among 100 children with febrile thrombocytopenia, 38 children had bleeding manifestations (cutaneous bleeds > GI bleeds > other bleeds) in those with moderate to severe thrombocytopenia. In the etiological profile, dengue fever was more common, followed by undiagnosed fever, enteric fever, ALL (acute lymphoblastic leukemia), scrub typhus, malaria and leptospira, respectively. Out of 100 children, 94 were discharged, and 6 children with ALL were referred to the haemato-oncology center for further management. CONCLUSIONS Clinical presentation of cases with febrile thrombocytopenia is varied. Common causes of febrile thrombocytopenia observed in this study were dengue fever followed by un diagnosed fever and enteric fever. KEYWORDS Fever, Thrombocytopenia, Platelet count, Bleeding

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