scholarly journals Predictors of slow clinical response and extended treatment in patients with extra-pulmonary tuberculosis in Pakistan, A hospital-based prospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259801
Author(s):  
Atiqa Ambreen ◽  
Sabira Tahseen ◽  
Ahmad Wali ◽  
Muhammad Jamil ◽  
Syed Zeeshan Haider Naqvi ◽  
...  
Keyword(s):  
Clinical Response ◽  
Extrapulmonary Tuberculosis ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Multivariate Regression Analysis ◽  
Care Hospital ◽  
Duration Of Treatment ◽  
Extended Treatment ◽  
Tb Treatment ◽  
Optimal Duration

The optimal duration of treatment in different forms of extrapulmonary tuberculosis (EPTB) is not clearly defined. This study aimed to identify predictors of slow clinical response and extended anti-TB treatment in EPTB patients. Socio-demographic, clinical, and microbiological characteristics of EPTB patients registered for anti-TB treatment at a tertiary care hospital, were analysed for identification of predictors of extended treatment. A total of 251 patients (137 lymphadenitis, and 114 pleuritis) were included in the analysis. Treatment was extended to more than 6 months in 58/251 (23%) patients. In the multivariate regression analysis, culture-positive EPTB (p = 0.007) [OR (95% CI) = 3.81 (1.43, 10.11)], history of diabetes (p = 0.014) [OR (95% CI) = 25.18 (1.94, 325.83)], smokeless tobacco use (p = 0.002) [OR (95% CI) = 17.69 (2.80, 111.72)], and slow regression of local signs and symptoms after 2 months of treatment (p < 0.001) [OR (95% CI) = 17.09 [(5.79, 50.39)] were seen to be significantly associated with treatment extension. Identification of predictors of extended treatment can help clinical decisions regarding optimal duration of treatment. Further studies are needed to identify subgroups of EPTB patients who can benefit from a shorter or longer treatment regimen.

scholarly journals ANTI TUBERCULAR DRUGS INDUCED HEPATOTOXICITY IN A NEW TERTIARY CARE HOSPITAL OF A TRIBAL DISTRICT OF ODISHA

2021 ◽  
pp. 45-48
Author(s):  
MANAS RANJAN NAIK ◽  
MANORANJAN DASH ◽  
BIBHU PRASAD BEHERA ◽  
TRUPTI REKHA SWAIN
Keyword(s):  
Significant Influence ◽  
Liver Enzymes ◽  
Extrapulmonary Tuberculosis ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Normal Liver ◽  
Care Hospital ◽  
Drug Induced ◽  
Medical College ◽  
A Prospective Study

Objective: India accounts for about one-fourth of the global TB burden. WHO TB statistics for India for 2018 gives an estimated incidence fig. of 2.69 million cases (199 per one lakh population). Drug-induced Hepatotoxicity is responsible for significant morbidity and mortality of the TB patient if these drugs continued after symptoms of hepatotoxicity develop. Whether the hepatotoxicity is due to individual drugs or due to additive effects is still unclear. The management therapy for TB patients with anti-TB DIH is imperative to ensure successful TB treatment and not recurrence DIH. Aim of the current study is to find out the pattern of Liver enzyme raised after antitubercular therapy in the tribal population of Koraput district where different phylogenetic populations reside where clinically it was observed by the physician little early onset of hepatotoxicity than national and international data. Methods: A prospective study was done after clearance from the Institutional Ethical Committee, Saheed Laxman Nayak Medical College, Koraput, from January 2019 to December 2019. Patients with>15 y of age with pulmonary and extrapulmonary tuberculosis with normal liver enzymes were included. Patients having abnormal liver enzymes before treatment, seropositive TB patients with human immunodeficiency virus infection, pregnant ladies and children<15 y of age were excluded. Results: Out of 922 patients in total; 4.78% (44) tuberculosis patients developed anti TB DIH. 68.18% (30) patients are below 50 y of age and 31.82% (14) are above 50 y of age group among TB patients with DIH. Age has no statistically significant influence on the occurrence of anti-TB DIH, but there is a statistically significant influence of sex on the occurrence of anti TB DIH. The mean occurrence of anti TB DIH is 18±18.16 d. One case of anti TB DIH patients shows signs and symptoms as early as on day 6th. The commonest symptoms are nausea and vomiting in 64% of patients who developed DIH. Interruption of ATT after DIH occurred in 79.54% of patients with recurrence in only 9.9% of patients after the reintroduction of ATT. Conclusion: Anti TB DIH mostly occurred between 7-28 d of starting the ATT in this geographical region. The duration of the anti TB ATT regimen is prolonged due to DIH. We recommend that all patients should have LTs 2 w after starting ATT, even if asymptomatic.

Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

2021 ◽  
Author(s):  
Seema Sachdeva seema sachdeva ◽  
Akshay Kumar Akshay Kumar ◽  
Parveen Aggarwal Parveen Aggarwal
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Fish Bone ◽  
Quality Improvement Initiative ◽  
Care Hospital ◽  
Analysis Model ◽  
Post Intervention ◽  
Targeted Interventions ◽  
Administration Time

Abstract BackgroundSevere exacerbation of asthma are potentially life-threatening and therefore require prompt care and frequent management. Important elements of early treatment includes recognition of early signs and symptoms of breathing difficulty and timely prescription and administration of therapeutic agents. A subsequent delay in receiving nebulization during an acute exacerbation of asthma can leads to cardiac arrest and even death. AimTo reduce the gap in administration of nebulization from its prescription time among red triaged patients by 50% from its baseline. Setting and designThis interventional study was conducted among red triaged patients in emergency department of tertiary care hospital, India . Material and MethodsBaseline information was collected during first 4 weeks to find gap in administration of nebulization from its prescription time. Fish bone analysis and process map were laid down to analyse the situation. The intervention using targeted bundles was done via 3 PDSA (PDSA1: indenting the nebulizers, PDSA 2: training of doctors and nurses, PDSA 3; introducing equipment checklist) to reduce the gap . A run chart using time series analysis model was used to compare the pre and post intervention nebulization gap. ResultsTotal 74 patients (30 in pre- intervention, 44 in post intervention) admitted in red triaged area were observed for nebulization gap from prescription to administration. Median time for nebulization gap before intervention was 46.5 minutes which reduced to 15 minutes in post intervention phase. ConclusionThis bundles of targeted interventions was successful to reduce the nebulization gap. Key words: nebulization gap, prescription time, administration time

scholarly journals Commonest modes of presentation of bone and soft tissue tumors at sarcoma services of A Tertiary Care Hospital of KPK.

2020 ◽  
Vol 27 (12) ◽  
pp. 2744-2748
Author(s):  
Muhammad Ibrahim ◽  
Zeeshan Khan ◽  
Muhammad Saeed ◽  
Israr Ahmad ◽  
Salik Kashif ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Tertiary Care ◽  
Sampling Technique ◽  
Signs And Symptoms ◽  
Soft Tissue Tumors ◽  
Care Hospital ◽  
Duration Of Symptoms ◽  
Mode Of Presentation ◽  
Number Of Patients ◽  
Delays In Diagnosis

Objectives: The aim of this study is to assess the commonest mode of presentation at our sarcoma unit and the duration from onset of symptoms till presentation. Study Design: Retrospectively study. Setting: Sarcoma Unit of Hayatabad Medical Complex, Peshawar. Period: June 2016 to December 2019. Material & Methods: Two hundred and eighty two patients were included in this study of which 172 patients were male and 110 were female. Sample size was calculated through non-probability consecutive sampling technique. Results: Average age of patients presenting to us was 30.2years (±18.5) ranging from 3years to 83years. Highest numbers of patients fell into the age group category of 11-20years i.e. 94 (33.33%). The average duration of symptoms among our patients was 19.6 months (±26.09) ranging from 0.1months (3 days) to 168 months (14years). Highest number of patients fell into the 7months-12months category i.e. 86 patients (30.5%). The commonest mode of presentation among our patients was painful lump i.e. 128(45.3%) while patients presenting with painless lump were 57(20.2%) and those presenting with only pain were 28(9.9%). Conclusion: The study concluded that there is a need of greater awareness amount general population and health care professionals regarding red flag signs and symptoms in order to avoid the delays in diagnosis which may leads to poor prognosis.

scholarly journals Incidence of tuberculosis and opportunistic respiratory infections in cases of human immunodeficiency virus: a one-year study at a tertiary care hospital

2020 ◽  
Vol 7 (7) ◽  
pp. 1068
Author(s):  
Chintha Venkata Subrahmanyam ◽  
Mahesh Vidavaluru
Keyword(s):  
Respiratory Infections ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Pulmonary Complications ◽  
Care Hospital ◽  
Cd4 Cell Count ◽  
Cd4 Counts ◽  
Management Protocol ◽  
One Year ◽  
Tract Infections

Background: Evaluation of respiratory signs and symptoms among HIV patients is a challenging task for a number of reasons. A definitive diagnosis is highly recommended before starting management protocol. Objectives of this study was to primarily evaluate the incidence of pulmonary tuberculosis and opportunistic respiratory infections among the cases of HIV and to estimate the CD4 counts of all the patients and correlate with the respiratory infections among the cases.Methods: The present study was a one-year study conducted at Narayana Medical College and all the cases of HIV presented with signs and symptoms of lower respiratory tract infections were included after obtaining consent. Relevant biochemical, microbiological investigations and CD4 counts of all the cases were done and noted. The data was entered in Microsoft excel spread sheet and analysed for any corrections. Mean, median and SD was calculated for all the continuous variables.Results: A total of 127 cases with 87 males and females 40 females with a ratio of 2.2:1 were included. Mean age of the total cases in the study was 46.12±8.3 years and 29.92% were above 60 years. Hetero sexual exposure was the commonest cause and 59.84% of cases were diagnosed with bacterial pneumonia. Prevalence of tuberculosis among the cases of this study was 22.05%. The mean CD4 cell count with SD among the study was 168.57±142.21.Conclusions: Knowledge of the pattern of pulmonary complications in patients with HIV infection in relation to CD4 count will help clinicians develop faster diagnostic and therapeutic approach to patient management.

scholarly journals A prospective study of efficacy and safety of olopatadine versus azelastine in allergic conjunctivitis at a tertiary care hospital

2017 ◽  
Vol 6 (8) ◽  
pp. 1948 ◽  
Author(s):  
Jayanthi C. R. ◽  
Nanthini R. ◽  
. Vijayalakshmi
Keyword(s):  
Mast Cell ◽  
Adverse Events ◽  
Allergic Conjunctivitis ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Eye Drops ◽  
Care Hospital ◽  
Efficacy And Safety ◽  
H1 Receptor ◽  
Olopatadine Hydrochloride

Background: Allergic conjunctivitis, an ocular surface inflammatory disease with significant social and economic impact affects approximately 25% of the general population. H1 receptor blockers, mast cell stabilizers and drugs that block cytokine and prostaglandin formation form the treatment armamentarium. Olopatadine hydrochloride and Azelastine hydrochloride are dual-acting selective H1 receptor antagonist with mast-cell stabilizing property. This study was undertaken to assess the efficacy and safety of olopatadine hydrochloride 0.1% and Azelastine hydrochloride 0.05% in allergic conjunctivitis amongst Indians.Methods: After obtaining Institutional Ethics Committee approval and written informed consent, 120 patients diagnosed with allergic conjunctivitis fulfilling the inclusion/exclusion criteria were enrolled in the study. Study was done from April 2014 to June 2015 at Minto eye hospital. Study subjects were treated with olopatadine hydrochloride 0.1% and Azelastine hydrochloride 0.05% eye drops BD for 15 days. Ocular symptoms, instead of and signs and adverse events, if any were recorded on the day 8 and day 15 follow up visits.Results: At the end of the study period, the reduction in the ocular itching score from baseline was higher in the olopatadine group compared to the azelastine group (p<0.002). Similarly, the scores of ocular congestion (p<0.008), foreign body sensation (p<0.009), tearing (p<0.001), erythema (p<0.002) and chemosis (p<0.015) also showed larger reduction in the olopatadine treated patients. The common adverse events encountered in both the groups were stinging after instillation, burning, bitter taste and headache.Conclusions: In allergic conjunctivitis, both olopatadine and azelastine were found to be effective in relieving ocular signs and symptoms, but olopatadine was found to be superior in terms of efficacy, safety and tolerability with minimal side effects.

FACTORS CAUSING DELAY IN TIME TO DOOR AT EMERGENCY DEPARTMENT(ED) IN CASES OF ACUTE STROKE AND IT'S IMPACT ON OUTCOME AT TERTIARY CARE CENTRE

2020 ◽  
pp. 67-70
Author(s):  
Yogender Kumar Yadav ◽  
Dina J Shah ◽  
Jyoti B Sharma ◽  
Nalini Bala Pandey
Keyword(s):  
Acute Stroke ◽  
Average Length ◽  
Tertiary Care ◽  
Onset Time ◽  
Signs And Symptoms ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
End Points ◽  
Exact Test

BACKGROUND: The effectiveness of stroke management is highly dependent on post onset time of treatment. The study hypothesized that perceptual, social and behavioral factors affect delay in seeking help after symptom onset and worsen the outcome and recovery. OBJECTIVE: To look at the causes of delay in arrival to denitive care hospital ED after symptoms of acute stoke and its impact on patient's clinical outcome. METHODS: An observational prospective study conducted on 63 patients with signs and symptoms of acute stroke (CPSS/NIHSS positive) reported to ED. Reasons for delay in arrival to ED observed. Patients divided into two groups, those who came within 4.5 hours of onset of acute stroke symptoms and those who came after 4.5 hours. Impact of delay on patient's outcome studied at time of discharge as primary end-points in terms of average length of stay (ALOS), complications and death. Secondary end-points evaluate in terms of improvement, deterioration and death within 30th day. Statistical analysis using Chi-square or Fisher's exact test applied to compare both the groups. Odds ratio with 95 % condence limit was also calculated. RESULTS: There were multiple overlapping causes of delay; most frequently was “rst went to physician who doesn't treat stroke (8; 38.1%) and non-availability of nearby stroke centre (8; 38.1%)”. Total 21 (33.34%) patients came after window period (4.5hours). Primary endpoints in terms of ALOS (8 days compared to 9 days, p=0.48), complications (OR=1.4, 95%CI:0.2-8.8, p=0.74) and death (OR=3, 95%CI:0.4-19.3, p=0.24) at time of discharge. Secondary endpoints in terms of improvement (OR=2.8, 95%CI:1.0-7.8, p=0.03), deterioration (OR=6.0, 95%CI:1.4-24.5, p=0.01) and death within 30 days (OR=1.2, 95%CI:0.2-5.5, p=0.81). CONCLUSION: Inadequate knowledge of stroke identication and management causes delay in arrival to hospital. This delay can cause signicant impact on patient outcome and recovery

scholarly journals Utility of GeneXpert in Diagnosis of Multidrug-resistant Extrapulmonary Tuberculosis

2017 ◽  
Vol 03 (02) ◽  
pp. 085-087
Author(s):  
Ankush Chaudhary ◽  
Ketaki Utpat ◽  
Unnati Desai ◽  
Jyotsna Joshi
Keyword(s):  
Lymph Node ◽  
Psoas Abscess ◽  
Extrapulmonary Tuberculosis ◽  
Tertiary Care ◽  
False Negative ◽  
Multidrug Resistant ◽  
Nucleic Acid Amplification ◽  
Lower Sensitivity ◽  
Care Hospital ◽  
Gluteal Abscess

ABSTRACT Background: The Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assay (GeneXpert) is a rapid semi-quantitative nucleic acid amplification test with established role in the diagnosis of pulmonary tuberculosis (PTB) and multidrug-resistant (MDR) PTB. We determined the performance of the GeneXpert assay for the diagnosis of extrapulmonary tuberculosis (EPTB) MDR cases. Aims and objectives: To study the role of GeneXpert in the diagnosis of EPTB MDR. Materials and methods: A retrospective study was conducted over a period of 2 years at a tertiary care hospital after Ethics Committee permission. Data of 44 consecutive patients of diagnosed EPTB MDR were retrieved for GeneXpert and culture drug susceptibility test (DST). Sensitivity of GeneXpert in the diagnosis of EPTB MDR was calculated comparing culture DST results. Results: Various EPTB MDR cases studied were lymph node TB (n = 23) 51%, pleural effusion (n = 14) 32%, central nervous system TB/spinal TB/psoas abscess/gluteal abscess (n = 7) 17%. Sensitivity for GeneXpert was found to be 91.30, 57, 100% respectively. True positive and false negative were 36 and 8 cases respectively. The overall sensitivity of GeneXpert in diagnosing EPTB MDR was 81.80%. The sensitivity among lymph node, pleural effusions, and spinal/psoas abscess/gluteal abscess was 91.30, 57.14, and 100% respectively. Conclusion: GeneXpert sensitivity for the diagnosis of EPTB MDR varied with site of extrapulmonary involvement, with lower sensitivity in pleural fluid as compared with higher sensitivity among lymph node and spine TB. Nevertheless, given the rapid turnaround time and simplicity, it is a useful tool in the diagnosis of EPTB MDR when used in correct clinical context. Subsequent confirmation with culture DST, however, is recommended to diagnose false negatives.

scholarly journals A comparative study between ferrous carboxy maltose and iron sucrose in the management of post-partum anaemia in tertiary care hospital

2019 ◽  
Vol 8 (12) ◽  
pp. 4866
Author(s):  
Seeta Sunil Garag ◽  
Sanjana Kumar
Keyword(s):  
Post Partum ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Signs And Symptoms ◽  
Iron Sucrose ◽  
Care Hospital ◽  
Global Public Health ◽  
Maternal Morbidity And Mortality ◽  
The Mean ◽  
Global Public Health Problem

Background: Anaemia is a global public health problem contributing tremendously to maternal morbidity and mortality. It is the most common indirect cause of maternal mortality. Variety of injectable iron preparations are now available which can be effective tools for combating post-partum anaemia. This study aims to compare FCM (Ferrous carboxy maltose) and iron sucrose in the treatment of iron deficiency anaemia in post-partum women at KIMS, Hubli, Karnataka, India.Methods: This study was conducted at KIMS, Hubli in the year 2018-19 wherein 100 post-partum women with hb levels ranging from 5-10g% were selected for the study and randomly allocated into 2 groups- FCM group and iron sucrose group. They were administered 1g of FCM and 1g of iron sucrose respectively after clinical evaluation and baseline measurement of hb. They were followed up after 2 weeks for repeat hb% and review of signs and symptoms. FCM and iron sucrose were compared in terms of their efficacy.Results: The mean increase in hb% was found to be 3.2 g% in the FCM group and 2 g% in the iron sucrose group. FCM was also found to be more efficacious in providing relief of common signs and symptoms like easy fatigability and pallor compared to iron sucrose.Conclusions: Ferrous carboxy maltose was found to be more efficacious compared to iron sucrose.

scholarly journals Hospital Outcomes of Infants with Neonatal Opioid Withdrawal Syndrome at a Tertiary Care Hospital with High Rates of Concurrent Nonopioid (Polysubstance) Exposure

2020 ◽  
Author(s):  
Erin Morris ◽  
Tyler Bardsley ◽  
Krista Schulte ◽  
Jeanette Seidel ◽  
Julie H. Shakib ◽  
...  
Keyword(s):  
Withdrawal Syndrome ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Opioid Withdrawal ◽  
Adjunctive Treatment ◽  
Care Hospital ◽  
Hospital Outcomes ◽  
Long Acting ◽  
Opioid Withdrawal Syndrome

Objective Neonatal opioid withdrawal syndrome (NOWS) describes infants' withdrawal signs and symptoms after birth due to an interruption of prenatal opioid exposure. Many infants with NOWS are also exposed to nonopioids, however. This study was to determine hospital outcomes of infants exposed to opioids alone or coexposed with nonopioid substances (polysubstance). Study Design We reviewed infants of ≥34 weeks of gestation with prenatal opioid exposure from April 2015 to May 2018. We compared the median lengths of stay (LOS) and treatment (LOT) and the percentages of infants requiring pharmacologic and adjunctive treatment in infants exposed to opioids alone or polysubstance. We used Wilcoxon's test for continuous outcomes or Chi-squared test for categorical outcomes to determine statistical significance. We used multivariable regression model to calculate each drug category's estimates of adjusted mean ratios for LOS and LOT plus estimates of adjusted odds ratios for pharmacologic/adjunctive treatments. Results Of the 175 infants, 33 (19%) infants had opioid exposure alone. Opioid exposure included short- and/or long-acting opioids. A total of 142 (81%) had polysubstance exposure with 47% of mothers using nicotine products. We saw similar hospital outcomes between infants exposed to opioids alone or polysubstance; however, a higher percentage of infants with both short- and long-acting opioid exposure required pharmacologic treatment compared with either opioid alone. Focusing on individual drug categories, we detected differential hospital outcomes in which short-acting opioids decreased LOT, whereas long-acting opioids increased LOS, LOT, and need for pharmacologic and adjunctive treatment. Coexposure of opioids with stimulants decreased LOT and reduced need for adjunctive treatment. Coexposures with antidepressants increased LOT, while with antiepilepetics increased LOS. Conclusion Because infants with NOWS often have coexposures to other nonopioid substances, appreciating the associated risks of individual or combination of drugs in modulating hospital outcomes may help counsel families on their infants' expected hospital course. Key Points

THYROTOXIC PERIODIC PARALYSIS AND COMPLICATED THYROTOXICOSIS, TWO PRESENTATIONS OF HYPERTHYROIDISM WITH NOTABLE DIFFERENCES IN THEIR CLINICAL MANIFESTATIONS: AN EXPERIENCE FROM A TERTIARY CARE HOSPITAL IN THE UNITED STATES

2020 ◽  
Vol 26 (7) ◽  
pp. 699-706
Author(s):  
Ana M. Rivas ◽  
Subhanudh Thavaraputta ◽  
Menfil Andres Orellana-Barrios ◽  
John Drew Payne ◽  
David Sotello ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
The United States ◽  
Periodic Paralysis ◽  
Admission Diagnosis ◽  
Care Hospital ◽  
Qtc Prolongation ◽  
Free Triiodothyronine ◽  
Thyrotoxic Periodic Paralysis

Objective: Thyrotoxic periodic paralysis (TPP) is a muscular disorder characterized by sudden episodes of muscle weakness and hypokalemia in the setting of thyrotoxicosis. We aimed to report our experience with TPP in West Texas and compare its clinical presentation to that of patients admitted for complicated thyrotoxicosis. Methods: Retrospective review of records of adult patients with admission diagnosis of hyperthyroidism, thyrotoxicosis, and/or discharge diagnosis of periodic paralysis seen at our institution in a 6-year period. Results: Patients admitted for complicated thyrotoxicosis were more commonly females of a mean age of 44 years. Patients with TPP were more commonly Hispanic males of a mean age of 27 years. Despite no significantly different thyroid hormone levels, patients with TPP presented with less-severe signs and symptoms of hyperthyroidism, as reflected by lower Burch-Wartofsky score on admission (19 vs. 35; P<.001) and lower occurrence of atrial fibrillation in the TPP group (0% vs. 36%; P<.001). Finally, 89% of TPP patients presented with corrected QT (QTc) prolongation, whereas only 19% of thyrotoxic patient presented with a prolonged QTc. Conclusion: Hispanic patients with TTP seems to have relative resistance to the actions of thyroid hormones and commonly present with QTc prolongation, a risk factor for cardiac arrhythmias. Abbreviations: BWS = Burch-Wartofsky point scale; EKG = electrocardiogram; FT3 = free triiodothyronine; FT4 = free thyroxine; ICD = International Classification of Diseases; QTc = corrected QT; TPP = thyrotoxic periodic paralysis

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