scholarly journals Characteristics of Pituitary Tumors Including Non-Functioning Tumors - a Tertiary Care Center Experience

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A640-A640
Author(s):  
Lohit Kumbar ◽  
Mala Dharmalingam
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Pituitary Tumors ◽  
Tertiary Care Center ◽  
Duration Of Symptoms ◽  
Significant Difference ◽  
Males And Females ◽  
The Mean ◽  
Number Of Males ◽  
Suprasellar Extension

Abstract Introduction: Pituitary tumors compromise 10-20% of intracranial tumors. Non-functioning pituitary adenomas (NFPAs) are benign neoplasms which constitutes about 1/3rd of the pituitary tumors. There is few data on the characteristics of non-functioning tumors comparing with functioning tumors. Wide spread availability of MRI has eased the diagnosis of non-functioning tumors and early diagnosis. Objectives: To study the characteristics of pituitary tumors and the incidence of non-functioning tumors and compare with functioning tumors presenting to a tertiary care center. MethodsA retrospective study including 146 individuals with pituitary tumor were included from 2014 to 2020. Results: The study included 62(42.5%) male and 84(57.5%) female. The mean age was 41.97 + 13.93 years in males and 39.88 + 16.12 years in females. The mean duration of symptoms prior to presentation was 7.52 + 7.12 months and 10.37 + 11.60 months in males and females respectively. Macroadenoma (size >1cm) incidence was more with 55(88.7%) in males and 58(69%) in females. More number of males (87.1%) underwent surgery when compared to females (64.3%)(p – 0.002). There was more number of suprasellar and invasion of pituitary tumors seen in males compared to females(P- <0.01). There was no significant difference between various parameters like TSH, T4, LH, FSH, prolactin, Electrolytes, cortisol, ACTH, GH and IGF1 between males and females(p- NS). Seventy percent (103) of them were non-functioning tumors. Functioning tumors included 7(4.8%) acromegaly, 8(5.5%) cushings disease, 2(1.4%) gonadotropinoma, 24(16.4%) prolactinoma and 2(1.4%) posterior fossa tumor. Mean age in non- functioning tumors was 43.74 + 15.5 years. Mean diameter of tumor in non-functioning tumors was 21.04 + 11.54 cm when compared to functioning tumors (17.03 + 10.33 cm)(p- 0.61). Most of the patients with non-functioning tumors who underwent surgery received post operatively hydrocortisone and levothyroxine when compared to patients with functioning tumors(p < 0.01). There was no significant difference in terms of gender, suprasellar extension, invasion and pituitary hormones(p-NS). ConclusionMost of the pituitary tumors in our study were macroadenomas with more number of males undergoing surgery as most of them had suprasellar extension and invasion. Non- functioning tumors should be followed up regularly as most of them required hydrocortisone and levothyroxine post-operatively.

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

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

A study of peripartum cardiomyopathy in a tertiary care center in India

2017 ◽  
Vol 6 (2) ◽  
pp. 523 ◽  
Author(s):  
Aditi V. Joshi ◽  
Michelle N. Fonseca ◽  
Deepali S. Kharat-Kapote
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Fetal Outcome ◽  
Peripartum Cardiomyopathy ◽  
Early Interventions ◽  
Tertiary Care Center ◽  
Common Risk Factor ◽  
The Mean ◽  
Time Of Presentation ◽  
Underlying Pathogenesis

Background: Peripartum cardiomyopathy is an idiopathic and reversible form of dilated cardiomyopathy. The aim of the study was to study the mean age of presentation of peripartum cardiomyopathy in pregnant patients over a period of 1 year in a tertiary health care and study the maternal and fetal outcome of patients with peripartum cardiomyopathy.Methods: A retrospective observational study with total of 22 patients with peripartum cardiomyopathy was diagnosed in a total of 10,279 deliveries conducted at LTMMC, Sion hospital between September 2014 to February 2016.Results: Our study revealed that most of the affected patients were young with the mean age at presentation being 26.8±4.29 years. Most of the patients were diagnosed in the postpartum period (63.6%). the most common risk factor was pre-eclampsia (22.7%) followed by anemia (18.2%). The mean Ejection fraction at the time of presentation was 25.3±9.8%. There were 2 (9.1%) intrauterine fetal deaths and 1 neonatal death.Conclusions: There is a need for more multi-centric studies in order to understand the underlying pathogenesis and to determine the possible early interventions to help provide better pregnancy outcome.

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

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. 

Long-Term Hearing Outcomes following Total Ossicular Reconstruction with Titanium Prostheses

2019 ◽  
Vol 161 (1) ◽  
pp. 123-129 ◽  
Author(s):  
C. Burton Wood ◽  
Robert Yawn ◽  
Anne Sun Lowery ◽  
Brendan P. O’Connell ◽  
David Haynes ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Ossicular Chain ◽  
Tertiary Care Center ◽  
Ossicular Chain Reconstruction ◽  
The Mean ◽  
Hearing Outcomes

Objective(1) Characterize a large cohort of patients undergoing total ossicular chain reconstruction with titanium prosthesis. (2) Analyze long-term hearing outcomes of the same cohort.Study DesignCase series with chart review.SettingTertiary care center.Subject and MethodsThis study reviews patients who underwent total ossicular chain reconstruction (OCR) with titanium prostheses (TORPs) at a single tertiary care center from 2005 to 2015. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if length of follow-up was 2 years or more. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 2 years.ResultsIn total, 153 patients were identified who met inclusion criteria. The mean age of included patients was 40 years (range, 6-89 years). Sixty patients (39%) had a history of OCR, and 120 patients (78%) had a diagnosis of cholesteatoma at the time of OCR. Preoperatively, the mean ABG was 36 ± 12, whereas the mean ABG at 2-year follow-up improved to 26 ± 13. This was statistically significant ( P < .0001) using a Wilcoxon matched-pairs signed rank test. Twelve patients (8%) required revision OCR. Two revisions were performed due to prosthesis extrusion (<1%).ConclusionTitanium prostheses lead to significant improvement in hearing over long periods. The results are sustained as far out as 5 years following surgery. In addition, rates of revision surgery with titanium TORPs are low. Based on this series, there are no readily identifiable predictors for outcomes following total OCR.

Supine versus prone PCNL in lower calyceal stone: Comparative study in a tertiary care center

2020 ◽  
pp. 039156032096240
Author(s):  
Sunirmal Choudhury ◽  
Paragmani Talukdar ◽  
Tapan Kumar Mandal ◽  
Tapas Kumar Majhi
Keyword(s):  
Prone Position ◽  
Care Center ◽  
Tertiary Care ◽  
Renal Calculus ◽  
P Value ◽  
Tertiary Care Center ◽  
Stone Free Rate ◽  
The Mean ◽  
Hemoglobin Drop ◽  
Free Rate

Introduction: Renal calculus disease is an age old disease of human being. PCNL (Percutaneous nephrolithotomy) stands as a gold standard treatment for large renal calculus which is traditionally being done in prone position. Objective: To evaluate the safety and efficacy of supine PCNL versus prone PCNL comparing intraoperative time, requirement of relook PCNL, post op hemoglobin drop, post operative hospital stay, post operative complication, SFR ( stone free rate). Methods and materials: It is a prospective study done in Urology department in a tertiary care center in Eastern India between October 2017 and October 2018. A total of 84 patients with lower calyceal renal stones underwent PCNL, 42 of them in supine and 42 in prone position. Lower calyceal stone, size measuring 1 to 2 cm were included in the study. Results: The mean intra operative time was 91.76 min in supine group and 85.43 min in prone group with a p value of 0.115. The mean hemoglobin drop was 1.11 g/dl and 1.18 g/dl in supine and prone position, respectively ( p value 0.75). The mean post operative hospital stay was 4.1 and 3.86 days in supine and prone group ( p value 0.58), respectively. Two patients in each group require relook PCNL. Stone free rate at 1 month was 95.23% and 90.47% ( p value 0.9), respectively in case of supine and prone group. Conclusion: Supine PCNL is feasible, comparable to prone PCNL in respect to operative parameters with relatively higher stone free rate though statistically insignificant.

Remote video auditing in the endoscopy unit for evaluation of duodenoscope reprocessing in a tertiary care center

Endoscopy ◽  
2020 ◽  
Vol 52 (10) ◽  
pp. 864-870
Author(s):  
Kara L. Raphael ◽  
Ellen McNoble ◽  
Jessica Goldbeck ◽  
Megan Stiles ◽  
Larry S. Miller ◽  
...  
Keyword(s):  
Care Setting ◽  
Care Center ◽  
Compliance Rate ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Video Camera ◽  
Turnover Time ◽  
Tertiary Care Center ◽  
The Mean ◽  
Tertiary Care Setting

Background A significant proportion of duodenoscope-transmitted infections have resulted from errors related to reprocessing. Remote video auditing (RVA) is a tool that can monitor reprocessing compliance but it has not been previously evaluated in a tertiary care setting. The aims of this study were to evaluate: 1) RVA feasibility in a tertiary care setting (defined as the ability to audit every step of duodenoscope reprocessing without delaying the next procedure due to unavailability of duodenoscopes); and 2) the use of RVA as a compliance monitoring tool. Methods This was a prospective study at a tertiary care center. A video camera with offsite monitoring was installed in March 2018. Auditors delivered a compliance score after each procedure. The duodenoscope was not used until it passed the audit. Feasibility and compliance data were collected from April 2018 to August 2019 after a 1-month run-in phase. Both per-step compliance and overall 100 % compliance rates were measured. Results Of 743 duodenoscope reprocessing procedures, 32 666 individual steps were audited and 99.9 % of the steps were fully viewable. The mean time per audit was 38.3 minutes, the mean duodenoscope turnover time was 76.1 minutes, and there were no delays to the next procedure due to unavailability of duodenoscopes. The per-step compliance rate was 99.5 % but the overall 100 % compliance rate was 90.3 %. Conclusions The use of RVA in duodenoscope reprocessing was feasible and promoted sustained high-level compliance in a tertiary care center.

scholarly journals Comparison of bortezomib-cyclophosphamide-dexamethasone versus bortezomib-dexamethasone based regimens in newly diagnosed multiple myeloma patients

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Rafiye Ciftciler ◽  
Hakan Goker ◽  
Yahya Buyukasik ◽  
Nilgun Sayınalp ◽  
Ibrahim C. Haznedaroglu ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Mortality Rate ◽  
Care Center ◽  
Tertiary Care ◽  
Progression Free Survival ◽  
Tertiary Care Center ◽  
Newly Diagnosed ◽  
Free Survival ◽  
Significant Difference

The treatment landscape and clinical outcome of multiple myeloma (MM) patients have changed in the last decades, with an improved median survival of 8-10 years. This study aimed to evaluate the bortezomib, cyclophosphamide and dexamethasone (VCD) regimen versus bortezomib and dexamethasone (VD) regimen in patients with newly diagnosed MM. This study has been performed in a retrospective manner. One hundred and three patients with newly diagnosed MM who received chemotherapy at our tertiary care center between the years of 2009 and 2018 were evaluated. A total of 103 patients were included. The 5-year overall survival (OS) for patients who received VD regimen and patients who received VCD regimen were 75% and 83%, respectively. The OS for VD patients was 113.1±12.5 versus 122.2±9.5 months for VCD patients with no statistically significant difference (P=0.47). The 5- year PFS (progression free survival) for patients who received VD regimen and patients who received VCD regimen were 66% and 75%, respectively. The PFS for VCD patients was higher than the PFS for VD patients (67.1±7.4 versus 97.7±13.4 months), but no statistically significant difference was observed (P=0.59). Relapse rate (P=0.002) and mortality rate (P=0.01) were higher in VD group than VCD group and they were statistically significant. The OS and PFS were clinically longer in patients receiving VCD regimen than in patients receiving VD regimen, although not statistically significant. Cyclophosphamide should be given to patients at physician discretion and depending on patient’s frailty function.

scholarly journals Symptomatology and allergen types in patients presenting with allergic rhinitis

2012 ◽  
Vol 18 (1) ◽  
pp. 30-35
Author(s):  
R Nepali ◽  
B Sigdel ◽  
P Baniya
Keyword(s):  
Allergic Rhinitis ◽  
Allergic Conjunctivitis ◽  
Care Center ◽  
Tertiary Care ◽  
Chief Complaint ◽  
Age Group ◽  
Tertiary Care Center ◽  
Co Morbidity ◽  
Males And Females ◽  
Global Health Problem

Allergic rhinitis, despite its complex patho-physiology, is a global health problem with the increasing prevalence. The current study which was conducted at one of the tertiary care center in the country comprised of 548 diagnosed cases of allergic rhinitis and thus treated during the period extending from January 2010 to June 2011. In the study, males and females were almost equally distributed, constituting the ratio of 1:0.9. Among them, the patients from 20 –29 year of age group was the most commonly affected (38.1%). In our study most of the patients were housewives (30.3%) and the house dusts mites (76.3%), was the most common etiological factors. Majority of the patients presented with sneezing (86.7%) as the chief complaint. Of the total subjects, 18.6% presented with co-morbidity of allergic conjunctivitis and 8.9% with that of sinusitis. DOI: http://dx.doi.org/10.3329/bjo.v18i1.10411  Bangladesh J Otorhinolaryngol 2012; 18(1): 30-35

Accuracy of venous thromboembolism assessment and compliance to prophylaxis in a tertiary care center

2016 ◽  
Vol 31 (8) ◽  
pp. 541-545 ◽  
Author(s):  
Pamela S Kim ◽  
Antonios P Gasparis ◽  
Kristan Probeck ◽  
Doreen Elitharp ◽  
Apostolos Tassiopoulos ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Risk Level ◽  
Tertiary Care Center ◽  
Potential Harm ◽  
Number Of Patients ◽  
Quality Programs ◽  
The Mean

Background Proper assessment of venous thromboembolism (VTE) risk level in hospitalized patients is vital to providing adequate prophylaxis. Clinical decision support (CDS) tools with electronic medical record (EMR) have been used by institutions to improve assessment and prophylaxis. As such, this study was conducted after implementing such a system to compare admitting service (AS) assessment of VTE risk level to the VTE consult service (CS) assessment. In addition, compliance of ordered prophylaxis based on AS assessment was evaluated. Methods At a tertiary care center, we performed a review of randomly selected patients assessed within 18 h of admission for VTE risk over a five-month period. A total of 104 patients were evaluated, four of which were excluded because of VTE presence on admission. Patients were assessed for VTE risk independently, first by the AS, followed by the VTE CS. Prophylaxis orders were then reviewed based on AS assessment compliance to CDS recommendations for prophylaxis based on ACCP guidelines. Results All 100 patients underwent VTE risk assessment within 18 h from admission. The mean age was 63 years. Comparing AS to CS assessment, 13 patients had incorrect assessments ( p < .001). Of these, six patients were under-assessed ( p = .029), and seven patients were over-assessed ( p = .014). Based on AS assessment there were eight patients who had incorrect prophylaxis ordered. Unnecessary exposure to complications due to inappropriate prophylaxis occurred in five patients. Conclusion Despite the use of EMR CDS tools, there continues to be a significant number of patients that are being under-assessed and under-prophylaxed for VTE resulting in exposing patients to potential harm. Quality programs need to be instituted to further improve VTE assessment and prophylaxis.

scholarly journals Psychiatric Disorders in Patients with Irritable Bowel Syndrome at a Tertiary Care Centre in Bangladesh

2020 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Psychiatric Disorders ◽  
Psychiatric Illness ◽  
Care Center ◽  
General Health Questionnaire ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Asian Countries ◽  
Significant Difference ◽  
Irritable Bowel

Background/Aims: Irritable bowel syndrome (IBS) is one of the common functional gastrointestinal disorder. Psychosomatic illness is a common association with IBS. Although studies in both western and Asian countries showed significant coexisting psychiatric illness in IBS patients, such studies are scarce in south-east Asian countries like Bangladesh. So, the aim of this study was to find out the association of psychiatric co-morbidities in patients with IBS in a tertiary care center. Methods: This was a cross-sectional study conducted from July 2017 to January 2019. Patients were selected from the dedicated IBS clinic of a tertiary care center in Bangladesh. IBS population were enrolled according to the Rome-IV diagnostic criteria. Relevant history, physical examination and investigations were done to exclude organic diseases. A psychiatric assessment of all the study subjects was done by a clinical psychiatrist using the General Health Questionnaire (GHQ)-12. Results: Ninety-six IBS patients were enrolled in this study. The mean age was 33.51±9.87 years. Male outnumbered female (85.4% vs 14.6%). IBS diarrhea (83.3%) was predominant in this study. Approximately 60.41% of IBS patients had different psychiatric illnesses. Major depressive disorder (27.1%) and generalized anxiety disorder (15.6%) were the most common psychiatric illness in this study. There was no significant difference in psychiatric comorbidities among various IBS types. Conclusions: A significant number of IBS patients have co-morbid psychiatric disorders. So, IBS patients should meticulously be screened for such co-morbidities for effective and integrated management.

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