Yellow oleander poisoning in Sri Lanka: outcome in a secondary care hospital

2002 ◽  
Vol 21 (6) ◽  
pp. 293-295 ◽  
Author(s):  
M MD Fonseka ◽  
S L Seneviratne ◽  
C E de Silva ◽  
S B Gunatilake ◽  
H J de Silva
Keyword(s):  
Sri Lanka ◽  
Secondary Care ◽  
Heart Block ◽  
Cardiac Pacing ◽  
Complete Recovery ◽  
Definitive Treatment ◽  
Block Type ◽  
Care Hospital ◽  
Life Threatening ◽  
Degree Heart Block

Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is common in Sri Lanka. We studied all patients with yellow oleander poisoning (YOP) admitted to a secondary care hospital in north central Sri Lanka from May to August 1999, with the objective of determining the outcome of management using currently available treatment. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was done for those not responding to drug therapy. During the study period 168 patients with YOP were admitted to the hospital (male:female=55:113). There were six deaths (2.4%), four had third-degree heart block and two died of undetermined causes. They died soon after delayed admission to the hospital before any definitive treatment could be instituted. Of the remaining 162 patients, 90 (55.6%) patients required treatment, and 80 were treated with only atropine and/or isoprenaline while 10 required cardiac pacing in addition. Twenty-five (14.8%) patients had arrhythmias that were considered life threatening (second-degree heart block type II, third-degree heart block and nodal bradycardia). All patients who were treated made a complete recovery. Only a small proportion of patients (17%) admitted with YOP developed life-threatening cardiac arrhythmias. Treatment with atropine and isoprenaline was safe and adequate in most cases.

Managing anorexia nervosa in primary care

2021 ◽  
pp. 175573802110246
Author(s):  
Clarissa Hjalmarsson ◽  
Natasha Faye Daniels
Keyword(s):  
Primary Care ◽  
Anorexia Nervosa ◽  
Secondary Care ◽  
Psychiatric Illness ◽  
Signs And Symptoms ◽  
Vital Role ◽  
Definitive Treatment ◽  
Life Threatening ◽  
Patients Experience ◽  
Ongoing Support

Anorexia nervosa is a potentially debilitating mental illness, with significant physical and psychological sequelae. It has the highest mortality of any psychiatric illness. Early intervention is associated with better outcomes. However, patients typically experience long delays in accessing definitive treatment. Patients experience on average a three-and-a-half year delay between falling ill and accessing treatment, 6 months of which elapse between visiting a GP and receiving treatment. Patients often present to primary care either directly, with anorexia, or indirectly, with related symptoms such as amenorrhea. GPs play a vital role in recognising the signs and symptoms of this disease, identifying whether the patient has acute and potentially life-threatening symptoms, and referring them promptly and appropriately to secondary care. The current pressures on mental health services may also require GPs to provide ongoing support and management for patients while they await treatment from secondary care.

Gene for Progressive Familial Heart Block Type I Maps to Chromosome 19q13

Circulation ◽  
1995 ◽  
Vol 91 (6) ◽  
pp. 1633-1640 ◽  
Author(s):  
Paul A. Brink ◽  
Alet Ferreira ◽  
Johanna C. Moolman ◽  
Hettie W. Weymar ◽  
Pieter-Luttig van der Merwe ◽  
...  
Keyword(s):  
Heart Block ◽  
Block Type ◽  
Type I ◽  
Chromosome 19Q13

scholarly journals Assessment of implementation of antibiotic stewardship program in surgical prophylaxis at a secondary care hospital in Ras Al Khaimah, United Arab Emirates

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hessa Saleh Alshehhi ◽  
Areeg Anwer Ali ◽  
Duaa Salem Jawhar ◽  
Essam Mahran Aly ◽  
Srinivas Swamy ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
United Arab Emirates ◽  
Antibiotic Stewardship ◽  
Secondary Care ◽  
Care Hospital ◽  
Surgical Prophylaxis ◽  
Patient Profile ◽  
Stewardship Program ◽  
Prescribing Practice ◽  
Surgical Antibiotic Prophylaxis

AbstractAntibiotic overuse is a major factor for causing antibiotic resistance globally. However, only few studies reported the implementation and evaluation of antimicrobial stewardship programs in Gulf Cooperation Council. This study was conducted within 8-months periods to evaluate the effect of the newly implemented antibiotic stewardship program on improving the prescribing practice of surgical antibiotic prophylaxis in a secondary care hospital in the United Arab Emirates by releasing local hospital guidelines. The data of 493 in patients were documented in the predesigned patient profile form and the prescribing practice of surgical antibiotic prophylaxis for clean and clean-contaminant surgical procedures was compared and analyzed two months’ prior (period A) and post (period B) the implementation of antibiotic stewardship program. The 347 patient’s data (PD) were analyzed during period A and 146 PD during period B. The prescription of piperacillin/tazobactam was decreased from 2.4% from all surgical prophylaxis antibiotic orders in period A to 0% in period B. The appropriateness of the antibiotic therapy was found to differ non significantly for the selection of prophylactic antibiotic (p = 0.552) and for the timing of first dose administration (p = 0.061) between A and B periods. The total compliance was decreased non significantly (P = 0.08) from 45.3 to 40.2%. Overall, the guidelines have improved the prescribing practice of antibiotics prior to surgery. However, further improvement can be achieved by initiating educational intervention via cyclic auditing strategy.

Proton pump inhibitor use and appropriateness analysis: a snapshot from a secondary care hospital

2021 ◽  
Author(s):  
Sukaina Salim Damji ◽  
Syed Arman Rabbani ◽  
Padma G M Rao ◽  
Ain-ur Rashid Butt
Keyword(s):  
United Arab Emirates ◽  
Proton Pump ◽  
Secondary Care ◽  
Stress Ulcer ◽  
Risk Category ◽  
Care Hospital ◽  
High Prevalence ◽  
Potential Risks ◽  
Internal Medicine Wards ◽  
Ulcer Prophylaxis

Abstract Objectives Proton pump inhibitors (PPIs) have become one of the most frequently prescribed drugs since their introduction 30 years ago. Effectiveness and safety profile of PPIs has led to their overutilization and has exposed patients to a number of potential risks. The objective of this study was to evaluate the use of PPIs in a secondary care hospital in the United Arab Emirates. Methods This prospective observational drug-utilization study was conducted in patients receiving treatment with PPIs and admitted to internal medicine wards of the study site. Electronic patient case records were reviewed and data on PPI prescribing was collected and analysed. Appropriateness of PPI use was assessed as per international guidelines. Key findings Out of 172 patients enrolled, 53.5% were females with median age of 57 years (34.3, 71.0). Four different PPIs were prescribed to study patients, pantoprazole (86.6%), esomeprazole (5.8%), rabeprazole (4.1%) and omeprazole (3.5%). Ninety-two (53.5%) patients were prescribed intravenous PPI, whereas 80 (46.5%) patients were given PPI in oral form. Overall, 103 (59.9%) patients had inappropriate PPI prescriptions. Of these inappropriate prescriptions, 22 patients had no clear indication for PPI use and for 16 patients; PPIs were indicated for stress ulcer prophylaxis in low-risk category. Corticosteroid use [odds ratio (OR): 4.34, 95% confidence interval (CI): 1.22–15.46; P = 0.023] was significantly associated with greater odds of inappropriate PPI use. Conclusions We report a high prevalence of inappropriate PPI prescribing among the hospitalized patients in our study. Inappropriate PPI prescribing is a concerning issue and collective efforts should be made to check and minimize the same.

scholarly journals 1147. Short Course of Voriconazole Therapy as a Risk Factor for Relapse of Invasive Pulmonary Aspergillosis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S600-S601
Author(s):  
Dong Hoon Shin ◽  
Seung-Jin Yoo ◽  
Jongtak Jung ◽  
Kang Il Jun ◽  
Hyungjin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Tertiary Care ◽  
Invasive Pulmonary Aspergillosis ◽  
Care Hospital ◽  
Pulmonary Aspergillosis ◽  
Treatment Termination ◽  
Duration Of Therapy ◽  
Short Course ◽  
Life Threatening

Abstract Background Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection which usually occurs in immunocompromised patients. Recommended duration of voriconazole therapy is a minimum of 6-12 weeks for IPA, despite the lack of any firm evidence. In addition, risk factors for relapse of IPA are still unclear. Here, we explored risk factors for IPA relapse after initial treatment. Methods All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography (CT). Results Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1–12.3; P=0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2–17.5; P=0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors. Conclusion Less improvement in CT, and short duration of voriconazole therapy were the independent risk factors for relapse after treatment of IPA. Longer duration of therapy should be considered for those at higher risk of relapse. Disclosures All Authors: No reported disclosures

A baby with red plaques on the face and a first-degree heart block: neonatal lupus

The Lancet ◽  
2020 ◽  
Vol 396 (10260) ◽  
pp. 1432
Author(s):  
Sayed Meelad Habib ◽  
Maarten H Vermeer
Keyword(s):  
Heart Block ◽  
Neonatal Lupus ◽  
The Face ◽  
Degree Heart Block

scholarly journals Report of a Rare Case of Trauma-Induced Thyroid Storm

2002 ◽  
Vol 81 (8) ◽  
pp. 570-574 ◽  
Author(s):  
Neil M. Vora ◽  
Fred Fedok ◽  
Brendan C. Stack
Keyword(s):  
Nervous System ◽  
Rare Case ◽  
Hepatic Dysfunction ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Definitive Treatment ◽  
Thyroid Storm ◽  
Vehicle Accident ◽  
Hyperthyroid State ◽  
Life Threatening

Thyroid storm is a potentially life-threatening endocrinologic emergency characterized by an exacerbation of a hyperthyroid state. Several inciting factors can instigate the conversion of thyrotoxicosis to thyroid storm; trauma is one such trigger, but it is rare. Patients with thyroid storm can manifest fever, nervous system disorders, gastrointestinal or hepatic dysfunction (e.g., nausea, vomiting, diarrhea, and/or jaundice), and arrhythmia and other cardiovascular abnormalities. Treatment of thyroid storm is multimodal and is best managed by the endocrinologist and medical intensivist. Initial medical and supportive therapies are directed at stabilizing the patient, correcting the hyperthyroid state, managing the systemic decompensation, and treating the underlying cause. Once this has been achieved, definitive treatment in the form of radioactive ablation or surgery should be undertaken. We describe a case of thyroid storm in a young man that was precipitated by a motor vehicle accident.

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