scholarly journals Case Report: Pregnancy with Fetal Hydrathorax

2021 ◽  
Vol 2 (2) ◽  
pp. 67-72
Author(s):  
Aditya Arya Putra ◽  
Rahmad Rizal Budi Wicaksono ◽  
M. Besari Adi Pramono ◽  
Arsita Eka Rini
Keyword(s):  
Pulmonary Hypoplasia ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
Good Prognosis ◽  
Pathological Examination ◽  
Prior History ◽  
Fetal Outcomes ◽  
First Case ◽  
Experienced Difficulty

Background: Cases of fetal hydrothorax (FHT) are rare, with an occurrence probability of 1 in every 10,000-15,000 pregnancies. The condition may remain undiagnosed, and the fetus may be aborted, or death may occur soon after birth in outlying hospitals before transfer to a tertiary care center. The incidence rate of FHT is higher in males than females (2:1). One of the most effective methods of diagnosing fetal hydrothorax is sonography. Three forms of currently available treatments are: thoracentesis, thoracoamniotic shunting (TAS), and thoracomaternal cutaneous drainage. Fetal outcomes could be improved by performing the Extrauterine Intrapartum Treatment (EXIT) procedure.Case Presentation: We present two cases of first pregnancy primary FHT. In the first case, a 24-year-old woman was diagnosed with asymptomatic FHT in the 28th week of gestation without any prior history. In the second case, a 22-year-old woman with poor medical history was diagnosed in the 35th week of pregnancy and was experienced difficulty of breathing. Both pregnancies were delivered by cesarean section based on obstetric indications. Thoracentesis was performed on both neonates, and pathological examination of the pleural fluid was conducted. However, they died shortly after birth.Conclusion: The EXIT procedure is still a challenging method. A fetus with FHT is at significant risk of pulmonary hypoplasia and respiratory distress following delivery. Early diagnosis and intervention of FHT are vital to ensure a good prognosis. Approaching multidisciplinary groups, providing supportive diagnostic facilities and financial support is essential in improving fetal outcomes and preventing FHT in subsequent pregnancies.

scholarly journals Frequency and clinical manifestations of post-poliomyelitis syndrome in a brazilian tertiary care center

2012 ◽  
Vol 70 (8) ◽  
pp. 571-573 ◽  
Author(s):  
Abrahão Augusto Juviniano Quadros ◽  
Mônica Tilli Reis Pessoa Conde ◽  
Luis Fabiano Marin ◽  
Helga Cristina Almeida Silva ◽  
Tatiana Mesquita e Silva ◽  
...  
Keyword(s):  
Joint Pain ◽  
Care Center ◽  
Neuromuscular Disorders ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Paralytic Poliomyelitis ◽  
Prior History ◽  
Cold Intolerance ◽  
Infection Age ◽  
History Of

OBJECTIVE: To determine the frequency and clinical manifestations of patients with post-poliomyelitis syndrome (PPS) in a Brazilian division of neuromuscular disorders. METHODS: A total of 167 patients with prior history of paralytic poliomyelitis was investigated for PPS, based on international diagnostic criteria. Other variables analyzed were: gender, race, age at poliomyelitis infection, age at PPS onset, and PPS symptoms. RESULTS: One hundred and twenty-nine patients presented PPS, corresponding to 77.2% of the studied population. 62.8% were women and 37.2% were men. Mean age of patients with PPS at onset of PPS symptoms was 39.9±9.69 years. Their main clinical manifestations were: new weakness in the previously affected limbs (69%) and in the apparently not affected limbs (31%); joint pain (79.8%); fatigue (77.5%); muscle pain (76%); and cold intolerance (69.8%). CONCLUSIONS: Most patients of our sample presented PPS. In Brazil, PPS frequency and clinical features are quite similar to those of other countries.

scholarly journals Pulmonary Aspergillus and Mucor Co-Infection

2021 ◽  
Author(s):  
Ravindra Chari M ◽  
Manju Rajaram ◽  
Madhusmita M ◽  
Pampa ChToi ◽  
Sneha L
Keyword(s):  
Computed Tomography ◽  
Amphotericin B ◽  
Male Patient ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Middle Lobe ◽  
Prior History ◽  
Tertiary Care Centre ◽  
High Resolution Computed Tomography ◽  
First Case

Co-infections or consecutive infections of mucormycosis and aspergillosis are very rare. Additionally, distinguishing between these two infections is also difficult as both these conditions have similar clinical features. We report two similar cases from Tamilnadu, who presented to a tertiary care centre in Puducherry, India in 2017 (first case) and 2019 (second case).The first case was a 70-year-old, non-diabetic male patient who presented with haemoptysis with a prior history of pulmonary tuberculosis. Computed tomography bronchial angiography revealed an air-crescent sign and the histopathological examination showed a fungal ball (aspergillus and mucor) in the upper lobe and foci of fungal infection in the middle lobe. The second case was a 65-year-old diabetic male patient who presented with blackish expectoration and haemoptysis. A high-resolution computed tomography scan showed a reverse-halo sign in the right upper lobe. The results of the bronchoscopy-guided biopsy were consistent with a diagnosis of mixed mucormycosis and aspergillosis with angioinvasion. Both patients responded to amphotericin B with surgical excision of the affected lobe in the first case.A high degree of clinical suspicion, early surgical intervention and antifungal therapy are essential in the treatment of this rare co-infection. Keywords:Aspergillosis; Mucormycosis; Bronchoscopy; Coinfection; Amphotericin B; Case Report; India.

scholarly journals Risk factors on admission and condition at discharge of 529 consecutive COVID-19 patients at a tertiary care center in Santiago, Chile

2020 ◽  
Author(s):  
Cesar Maquilon ◽  
Jonas Gongora ◽  
Monica Antolini ◽  
Bernardita Alvarado ◽  
Nicolas Valdes ◽  
...  
Keyword(s):  
Health Insurance ◽  
Research Question ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
High Sensitivity ◽  
Quality Adjusted Life Year ◽  
Risk Of Death ◽  
First Case

Abstract Background: The first case of COVID-19 was reported in Chile on March 3, 2020. Public and private hospitals were managed in a centralized manner. On May 30, Chile had 99,668 cases, 1054 deaths, 1383 ICU patients, 1174 patients on invasive mechanical ventilation (IMV), and 51 patients on non-invasive ventilation (NIMV). Research question: What are the variables associated with condition at discharge?Method: We performed a retrospective cohort study of 529 patients with a positive RT-PCR for SARS CoV-2who were consecutively discharged between March 14 and June 4, 2020, at Clínica Dávila, Santiago. Patients were analyzed according to laboratory variables on admission, Quality-Adjusted Life Year (QALY) score, health insurance, and type of respiratory support. Condition at discharge was survivor, non-survivor, or transfer to another center. Differences were evaluated by Chi-square test, Student’s t test, or Mann–Whitney U test. Logistic regression analysis was performed to identify variables that were predictive of condition at discharge.Results: Median (interquartile range, IQR) age was 49 (37–62) years, and the median (IQR) stay in the hospital was 6 (3–10) days. A total of 352 patients (66.5%) had respiratory symptoms, 177 (33.4%) had other symptoms or diagnoses on admission, and 116 required ventilatory support; 448 (84.7%) were survivors, 54 (10.2%) were non-survivors, and 27 (5.1%) were transferred. The median ages of the survivors and non-survivors were 46 (36–59) and 75.5 (66–84), respectively.Having state health insurance increased the risk of death by 2.8-fold (OR, 2.825; 95% CI: 1.383–5.772; P = 0.004). Multivariate analysis revealed the following predictive variables: age ≥ 60 years (OR, 15.3; 95% CI: 7.25–32.2; P = .001); PaO2/FiO2 on admission ≤ 200 vs > 200 (OR, 5,205; CI 95%: 1,942–13,94); high-sensitivity troponin, ≥ 15 vs <15 ng /L (OR, 5,163; 95% CI: 1.95–13,64; P = .001); and QALY ≤ 15 vs > 15 points (OR, 14,011; 95% CI: 4,826–40,679; P=.001).Interpretation: The variables analyzed and patient’s clinical evolution may allow assignment of ICU beds to patients with the greatest chance of survival, especially in countries or regions where this resource is limited.

scholarly journals Incidence and risk factors for retinopathy of prematurity at a medical college hospital in rural Tamil Nadu, India

2020 ◽  
Vol 7 (11) ◽  
pp. 2119
Author(s):  
Sengodi Elumalai ◽  
Rajasekaran Kathavarayan ◽  
Venkatesh Govindasamy
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Blood Transfusion ◽  
Retinopathy Of Prematurity ◽  
Tamil Nadu ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
College Hospital

Background: The objective of the research was to evaluate the incidence of retinopathy of prematurity (ROP), association of prenatal and postnatal risk factors, pattern of ROP and treatment outcomes among infants admitted to neonatal intensive care unit (NICU) of tertiary care center located in Thiruvannamalai, Tamil Nadu.Methods: A retrospective study done in all infants admitted between April 2019 and March 2020 who met the criteria for ROP screening with gestational age (GA) less than or equal to 36 weeks or birth weight less than 2000 grams or with GA more than 36 weeks and birth weight more than 2000 gram with significant risk factors like intrauterine growth restriction, respiratory distress syndrome, sepsis, long term oxygen use, phototherapy, blood transfusion and maternal anemia. Treatment was offered to infants with stage 3 ROP and stage 2 in zone 2 with or without plus disease. Qualified infants were treated with argon laser photocoagulation within 72 hours of diagnosis. They were followed until the disease was successfully treated.Results: Out of total 3121 neonates, 717 neonates met the screening criteria. Incidence of ROP was found to be 33% (n=237). 46.4% (n=110) of ROP belongs to 32-36 weeks GA. 42.6% (n=101) of ROP belongs to 1500-2000 gm birth weight.Conclusions: Incidence of ROP is quite high in high risk neonates in our unit. Significant risk factors are long term oxygen use, blood transfusion and sepsis.

Cytomegalovirus Retinitis Outcomes in HIV-Infected and Non–HIV Patients at a Tertiary Care Center

2017 ◽  
Vol 1 (1) ◽  
pp. 57-64 ◽  
Author(s):  
Anton Orlin ◽  
Jennifer Nadelmann ◽  
Mrinali Gupta ◽  
Sarju Patel ◽  
Donald J. D’Amico ◽  
...  
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
Final Visual Acuity ◽  
Tertiary Care Center ◽  
Hiv Patients ◽  
Cmv Retinitis

Purpose: To describe cytomegalovirus (CMV) retinitis outcomes in HIV-infected and non–HIV patients at a tertiary care center. Participants: Twenty-six eyes from 20 patients with active CMV retinitis were included in this study. Patients were immunocompromised due to HIV or secondary to immunosuppressive therapy for malignancy and organ transplantation. Methods: This is a retrospective, observational study of patients with newly diagnosed active CMV retinitis. The main outcomes included the incidence of visual acuity loss, the loss of visual acuity to 20/200 or worse, and the loss of 3 lines of vision or more. Secondary outcomes included the identification of risk factors for these visual results and the development of various complications such as retinal detachment (RD) and cataract formation. Results: In all, 51.9% (n = 14) of eyes lost vision from baseline at most recent follow-up and 34.6% (n = 9) lost 3 lines or more of vision, 34.6% (n = 9) of the eyes lost significant vision at most recent follow-up and had a final vision of 20/200 or worse, and 22.73% of phakic eyes underwent cataract surgery, whereas 23.1% (n = 6) of eyes developed RD. Patients presenting with a CD4+ T-cell count <100 cells/µL were more likely to lose vision when compared to those presenting with a count >100 cells/µL ( P = .0440). Although not statistically significant, patients who were immunocompromised due to HIV were less likely to lose 3 or more lines of vision ( P = .1881) and less likely to have a final visual acuity of 20/200 or worse ( P = .1881), when compared to patients who were immunocompromised due to other reasons. There was also a nonsignificant trend for eyes affected by a larger area of CMV retinitis at baseline (>25%) to have a final visual acuity of 20/200 or worse when compared to eyes with CMV retinitis involving <25% of the total retina ( P = .089). We did not detect trends or associations between any other risk factors tested and visual outcomes. We did not identify an association between HIV status and baseline area or zone affected by CMV retinitis. Conclusions: Our cohort demonstrated that CMV retinitis remains a vision-threatening problem among patients who are immunocompromised due to HIV or other conditions. Immunocompromised patients are still at a significant risk of vision loss and complications from CMV retinitis and should be managed by a multidisciplinary team of physicians. In the immediate future, improved therapies are necessary to achieve immune recovery in patients, particularly for those remaining chronically immunosuppressed.

scholarly journals Changes to Foot and Ankle Surgical Care During the COVID-19 Pandemic

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0019
Author(s):  
Alessandra L. Falk ◽  
James Hunker ◽  
Mani Kahn ◽  
Yi Guo ◽  
Chaiyaporn Kulsakdinun
Keyword(s):  
New York ◽  
Ankle Instability ◽  
Elective Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
New York State ◽  
Surgical Care ◽  
Foot And Ankle ◽  
First Case ◽  
Orthopedic Care

Category: Other; Ankle Introduction/Purpose: On March 1, 2020, the first case of novel coronavirus (COVID-19) in New York City (NYC) was confirmed. By March 16, the NYC mayor and New York State Governor issued executive orders to postpone elective surgeries. At our tertiary care academic medical care center in the Bronx, the densely populated community of 1.4 million saw many COVID-19 positive cases. In response, the hospital quickly accommodated these patients, while maintaining outpatient orthopedic care. Consequently, only emergent orthopedic cases were granted permission to rapidly proceed to surgery. Most foot and ankle cases were deemed amenable to non-surgical or delayed surgical care. The purpose of this study is to characterize a series of patients with foot and ankle pathology whose orthopedic care was altered due to the pandemic. Methods: This is a retrospective chart review from February 2020-May 2020 encompassing the time that elective surgery was on hold and one month prior, to capture those patients were scheduled for surgery prior to the pandemic. Included were patients with foot and ankle pathology that required urgent orthopedic care, who were seen in the foot and ankle clinic, fracture clinic, and subsequently in the general orthopedic clinic that was instituted on an emergent bases. Excluded were patients who required intervention to address elective foot and ankle issues such as osteoarthritis, or ankle instability, and those were referred to an outside institution for further treatment. Throughout the pandemic, contact was made with patients either directly in clinic, via a telehealth portal or telephone. Descriptive statistics are taken. Results: Of the 17 patients included in this series, 11 (65%) patients were managed non operatively. Of these, 4 chose nonoperative management due to shared decision making between the patient and surgeon. 2 patients could not have surgery due to complications related to COVID-19. As the zenith of the pandemic passed 2 patients remained fearful of infection and therefore chose non operative management. 3 patients that had been in contact with the orthopedic department refused further imaging. 6 patients were managed operatively. 2 patients had surgery during the peak of the pandemic, both of whom tested positive for COVID and who failed conservative management. 4 patients had delayed surgery. Of these four cases, 3 were malunion corrections that would have benefitted from more prompt surgery. Conclusion: There was an overall decrease in foot & ankle cases. Non- emergent foot and ankle surgery was delayed to divert resources to patients who were stricken with the COVID-19 virus. While every attempt was made to provide the appropriate care for all, a personalized approach to foot and ankle health was developed to address health concerns, preferences, and logistics. As the course of this global pandemic is still uncertain, it is imperative to have a strategy in place to deal with urgent cases, should a second wave of cases once again affect our ability to provide routine care.

Complications Associated with 327 Foreign Bodies of the Pharynx, Larynx, and Esophagus

1997 ◽  
Vol 106 (4) ◽  
pp. 301-304 ◽  
Author(s):  
Bhuvanesh Singh ◽  
Gady Har-El ◽  
Manoj Kantu ◽  
Frank E. Lucente
Keyword(s):  
Older Patients ◽  
Foreign Bodies ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
Perioperative Period ◽  
Pulmonary Complications ◽  
Retropharyngeal Abscess ◽  
Delayed Presentation ◽  
Upper Aerodigestive Tract

We intended to identify the types and incidence of complications associated with foreign bodies (FBs) impacted in the upper aerodigestive tract (UADT) and to ascertain factors predisposing to the development of these complications. The design was a retrospective cohort study of 327 patients with UADT foreign bodies admitted to a tertiary care center. The overall incidence (7.6%) and types of complications varied by age. Complications developed in 4.8% of 208 patients 10 years of age and under, with pulmonary complications being most common. In contrast, complications occurred in 12.6% of 119 older patients, with retropharyngeal abscess being the most common (p < .0001). Delayed presentation (>24 hours after the onset of symptoms) was the only factor associated with an increase in the incidence of complications in the younger patients (p = .02). In contrast, pharyngeal location of the FB (p = .0004), the FB's being a fish bone (p = .006), and radiolucency (p = .02) were all associated with an increased incidence of complications in patients over 10 years of age. A significant risk for complications is present for patients admitted for the management of FBs in the UADT. Older patients with sharp FBs are at greatest risk. In this group of patients, close observation in the perioperative period is required, especially if there is evidence of mucosal injury.

scholarly journals Bilateral Ectopic Hypoplastic Uteri Attached to Bilateral Pelvic Sidewalls in a 21-Year-Old Patient with Primary Amenorrhea: The First Published Report

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Ahmed Nazer ◽  
Ahmed Abu-Zaid ◽  
Osama AlOmar ◽  
Hany Salem ◽  
Ayman Azzam ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Primary Amenorrhea ◽  
Mullerian Duct ◽  
Tertiary Care Center ◽  
First Case ◽  
Published Report ◽  
Müllerian Duct Anomalies ◽  
Embryonic Life ◽  
Mullerian Duct Anomalies

Müllerian duct anomalies (MDAs) encompass a group of anatomical malformations resulting from defective development, fusion, migration, or resorption of Müllerian (paramesonephric) ducts during embryonic life. Herein, we report the first case of an exceedingly uncommon MDA (bilateral ectopic hypoplastic uteri attached to bilateral pelvic sidewalls) in a 21-year-old woman who was referred to our tertiary care center as a case of primary amenorrhea for workup and further management.

scholarly journals Retrospective study of massive obstetric haemorrhage and its materno fetal outcomes in a tertiary care centre

2017 ◽  
Vol 6 (2) ◽  
pp. 554
Author(s):  
Anju Padmasekar ◽  
Shyamala Jothy
Keyword(s):  
Retrospective Study ◽  
Tamil Nadu ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Significant Risk ◽  
Perinatal Outcomes ◽  
Tertiary Care Centre ◽  
Fetal Outcomes ◽  
Medical College ◽  
Obstetric Haemorrhage

Background: Massive obstetric haemorrhage is defined as blood loss of >1500 ml, or a decrease in haemoglobin>4 gm/dl or acute transfusion requirement of >4 units of blood when need for further transfusion is foreseeable. The purpose of this study is to analyse the demographic, medical and obstetric risk factors for massive obstetric haemorrhage and it’s materno fetal outcomes.Methods: Criteria for patient selection was all patients who had an acute obstetric haemorrhage necessitating a transfusion of >4 units of blood at a stretch when there was a need for more. This is a retrospective study conducted for a period of one year January to December 2015. Data regarding all cases under study during this period was obtained from Medical Records Department with prior permission. This study was conducted in the Department of Obstetrics and Gynecology, Government Raja Mirasudhar Teaching Hospital, Thanjavur Medical College, Tamil Nadu. Maternal outcomes like mode of delivery, rate of hysterectomy, postpartum complications, maternal mortality and fetal outcomes like intra uterine death, still birth and preterm birth were analysed.Results: The rate of massive obstetric haemorrhage in our hospital during the study period was 5.7/1000 births. Massive obstetric haemorrhage contributed to 25% of all maternal deaths in 2015. Atonic PPH was the commonest cause. Multiparity and previous caesarean section were identified to be significant risk factors.Conclusions: We found an increased association of massive obstetric haemorrhage with multiparity, caesarean sections and pre-eclampsia. Atonic PPH was the commonest cause. Massive obstetric haemorrhage had contributed significantly to adverse maternal and perinatal outcomes.

scholarly journals Pre-operative Assessment of Pediatric Congenital Heart Disease Patients in the COVID-19 Era: Lessons Learned

2021 ◽  
pp. 1-18
Author(s):  
Nour K. Younis ◽  
Rana O. Zareef ◽  
Marwa A. Diab ◽  
Omar El Sedawi ◽  
Issam M. El-Rassi ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Lessons Learned ◽  
Open Heart ◽  
Assessment Protocol ◽  
First Case ◽  
Almost All ◽  
Operative Assessment

Abstract Background: Equal to COVID-19 patients, non-COVID-19 patients are affected by the medical and social drawbacks of the COVID-19 pandemic. A significant reduction in elective life-changing surgeries has been witnessed in almost all affected countries. This study discusses an applicable and effective pre-operative assessment protocol that can be applied during the COVID-19 era. Methods: Our study is a descriptive retrospective observational study that involves pediatric patients with CHD requiring open heart surgeries at our tertiary care center between March and November 2020. We reviewed the charts of eligible patients aged 18 years and below. We identified the total numbers of scheduled, performed, and postponed surgeries, respectively. A thorough description of the clinical and physical presentation of the postponed cases, who tested positive for SARS-CoV-2, is provided. Results: 68 open heart surgeries were scheduled at our center between March and November 2020. Three surgeries (4%) were postponed due to COVID-19. The three patients were asymptomatic COVID-19 cases detected on routine SARS-CoV-2 PCR testing. No symptoms of cough, chest pain, dyspnea, rhinorrhea, diarrhea, abdominal pain, anosmia, and ageusia were reported by our patients. All patients were afebrile and hemodynamically stable. Owing to the pre-operative assessment protocol that was implemented after the first case was detected, only three healthcare workers were at risk of COVID-19 transmission and were imposed to infectious evaluation and home quarantine. Conclusion: Adopting our discussed preoperative COVID-19 assessment protocol for CHD patients is an effective method to detect COVID-19 infections, optimize patient care, and ensure healthcare workers’ safety.

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