scholarly journals The role of thrombocytapheresis in the management of extreme thrombocytosis: a 6 years’ experience from a tertiary care center

2021 ◽  
Author(s):  
Deepika Chenna ◽  
Isha Polavarapu ◽  
Dhivya Kandasamy ◽  
Ganesh Mohan ◽  
Shamee Shastry
Keyword(s):  
Platelet Count ◽  
Prophylactic Treatment ◽  
Care Center ◽  
Tertiary Care ◽  
Percentage Reduction ◽  
Platelet Volume ◽  
Average Percentage ◽  
American Society ◽  
Complete Blood Counts

Background. According to the American Society for Apheresis (ASFA) guidelines, thrombocytapheresis is a Category II indication in symptomatic patients and is a Category III indication when used as secondary or prophylactic treatment. The role of thrombocytapheresis is to prevent untoward complications that might occur even before the cytoreductive agents can exert their action. Methods. A retrospective analysis of patients who underwent thrombocytapheresis between 2012 to 2018 was conducted. Demographic details, complete blood counts, diagnosis and indication for thrombocytapheresis were noted. Results. A total of 12 patients with thrombocytosis were included in the study. The cause of thrombocytosis was primary in 3 (25%) patients and secondary in 9 (75%) patients. The average percentage reduction in platelet count was 47.1% (range 12.3%-65.64%). There was a significant decrease in platelet count, platelet crit, and mean platelet volume after the procedure when compared to pre-procedure. Conclusion. Thrombocytapheresis selectively reduces platelet counts with no effect on other cellular and plasma components. The role of thrombocytapheresis in extreme thrombocytosis is to be considered for an immediate decrease in platelet count and to minimize the risks associated with thrombocytosis.

Defining the role of the pediatric critical care nurse practitioner in a tertiary care center

2000 ◽  
Vol 28 (7) ◽  
pp. 2626-2630 ◽  
Author(s):  
Shari L. Derengowski ◽  
Sharon Y. Irving ◽  
Pamela V. Koogle ◽  
Robert M. Englander
Keyword(s):  
Critical Care ◽  
Nurse Practitioner ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Pediatric Critical Care ◽  
Care Nurse ◽  
Critical Care Nurse

scholarly journals Role of platelet distribution width and plateletcrit in assessment of nonthrombocytopenic preeclampsia and eclampsia in a tertiary care hospital of Odisha: an observational study

2020 ◽  
Vol 9 (5) ◽  
pp. 1996
Author(s):  
Kirtirekha Mohapatra ◽  
Pranati Mohanty ◽  
Nahida Nigar Sultana
Keyword(s):  
Platelet Count ◽  
Observational Study ◽  
Severe Disease ◽  
Tertiary Care ◽  
Measurement Tool ◽  
Care Hospital ◽  
Platelet Distribution Width ◽  
Distribution Width ◽  
Platelet Indices

Background: Preeclampsia (PE) is a major cause of maternal and foetal morbidity and mortality in pregnancy. A decreased platelet count is observed during the progression of preeclampsia, and is considered a marker of the severity of preeclampsia. Considering the role of the PDW, PCT and platelet indices during the disease, the aim of this study was to evaluate the feasibility of using platelet indices as a severity marker for PE.Methods: This was a prospective, observational study, hospital-based study, from 2017-19 with 400 pregnant women being included on the basis of a predefined inclusion and exclusion criteria, through antenatal clinic, and labour room of the department of obstetrics and gynecology, S. C. B. Medical College, Cuttack, Odisha, India.Results: Study found that platelet count and plateletcrit showed a significant negative correlation with MAP whereas platelet distribution width showed a maximum positive correlation. In the preeclampsia group, subjects with PCT <0.22% were at risk of developing severe disease with a sensitivity of 53.5% and a high specificity of 85.5%. The AUC of 0.75 showed that it has a good predictability. In the eclampsia group, subjects with PCT <0.16% had a risk of developing severe disease with a sensitivity of 89.5% and specificity of 73.7%. The AUC 0.9 shows PCT to be a good predictor for assessing severity of eclampsia.Conclusions: This study suggests that platelet distribution width and plateletcrit are useful in risk evaluation of preeclampsia. These are a valid measurement tool to predict the severe progression of PE even when normal platelet counts are observed.

Predictive Value of Combination of D-dimer and Fibrinogen in Diagnosing Acute CVST

2021 ◽  
pp. 097275312110631
Author(s):  
Abhishek Pathak ◽  
Varun Kumar Singh ◽  
Anand Kumar ◽  
Vijaya Nath Mishra ◽  
Deepika Joshi ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Predictive Value ◽  
Sinus Thrombosis ◽  
Care Center ◽  
Tertiary Care ◽  
Cerebral Venous Sinus Thrombosis ◽  
Latex Agglutination ◽  
D Dimer ◽  
Latex Agglutination Assay

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon subtype of stroke, and the role of D-dimer and fibrinogen in early diagnosis of CVST has been studied with varying results. The present study aims to study the role of the combination of D-dimer and fibrinogen in early diagnosis of acute CVST. Methods: Forty consecutive confirmed acute CVST cases admitted at a tertiary care center were recruited for the study. D-dimer and fibrinogen were assessed by a rapid semiquantitative latex agglutination assay. Results: Out of the 40 CVST patients, 21 (52.50%) were females. The mean age of the patients was 37.58 years ± 19.17 years. Common clinical features were headache ( N = 38 [95%]), papilloedema ( N = 15 [37.5%]), and seizures ( N = 12 [30%]). Although the sensitivity (75%) of the combination of D-dimer and fibrinogen assay was lower than that of D-dimer or fibrinogen alone, the specificity and positive predictive value (75% each) was higher. Conclusions: The combination of D-dimer and fibrinogen testing may aid in an early diagnosis of acute CVST and in better management.

Role of Office-Based Vaginoscopy in a Tertiary Care Center

2021 ◽  
Author(s):  
Rahul S. Patel ◽  
Alana L. Christie ◽  
Philippe E. Zimmern
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

Abstract 19134: Elevated Troponin T is Associated with Adverse Outcomes After Aortic Valve Replacement

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ashwat Dhillon ◽  
Kanhaiya Poddar ◽  
Murat Tuzcu ◽  
Eric Roselli ◽  
Lars Svensson ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Troponin T ◽  
Coronary Revascularization ◽  
Care Center ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Post Procedure

Background: Data regarding association of elevated cardiac enzymes and adverse outcomes in patients who undergo aortic valve replacement (AVR) has been inconclusive. Role of coronary revascularization prior to AVR remains uncertain. We sought to understand prognostic implication of post procedure troponin T (TnT) elevation in patients undergoing AVR. Hypothesis: We hypothesized that patients with significantly elevated TnT after AVR will have worse outcomes representing important coronary circulation which is not revascularized. Methods: We retrospectively studied 4648 consecutive patients who underwent AVR at a single tertiary care center between January 2007 and December 2013. These were divided into surgical AVR (SAVR) and transcatheter AVR (TAVR). Median post procedure peak TnT was identified in the SAVR and TAVR groups. Patients were divided into quartiles based on median TnT level. Results: Of 4648 patients who underwent AVR, 4200 (66% male) were SAVR and 448 (59% male) were TAVR. Median post procedure peak TnT values in the TAVR and SAVR group were 0.19 [0.08-0.39] & 0.36 [0.22-0.64] respectively (p<0.001). 6 month mortality was 1.5% (65/4200) in SAVR cases and 2.7% (12/448) in TAVR cases (p=0.08). In patients with TnT less than 50 th percentile, 6 month mortality was 0.7% & 1.8% after SAVR & TAVR respectively (p=0.1). In patients with TnT higher than 50 th percentile, 6 month mortality was 2.4% & 3.6% after SAVR & TAVR respectively (p=0.26). In the SAVR group, mortality was 0.7% in patients with TnT levels less than 50 th percentile & 2.4% in patients with TnT higher than 50 th percentile (p<0.001). See Figure. Conclusion: Peak troponin T was significantly higher after SAVR as compared to TAVR. Higher post procedure peak TnT is associated with increased 6 month mortality. These results are highly significant in the SAVR group. The mechanism and significance of these findings requires further studies.

Treatment Patterns and Outcomes in Bleb-Related Endophthalmitis: A 9-Year Analysis at a Tertiary Eye Center

2020 ◽  
pp. 247412642095396
Author(s):  
Cason B. Robbins ◽  
Henry L. Feng ◽  
Divakar Gupta ◽  
Sharon Fekrat
Keyword(s):  
Initial Treatment ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Light Perception ◽  
Initial Management ◽  
Pars Plana ◽  
Line Loss

Purpose: Clinical presentation, treatment choices, and outcomes in cases of bleb-related endophthalmitis (BRE) at a tertiary care center over a 9-year period are described. Methods: A retrospective review was conducted of patients diagnosed with BRE at Duke Eye Center (Durham, North Carolina) from January 1, 2009 to January 1, 2018, with at least 6 months of follow-up, assessing demographic data, initial management, and visual acuity (VA). Results: Twenty eyes of 20 patients with BRE were identified. Median time from surgery to presentation was 6.53 years. Presenting VA of light perception only was significantly associated with the decision to pursue pars plana vitrectomy (PPV) as initial treatment (odds ratio 59.4, 95% CI, 2.1-1670.8, P = .016). Twelve eyes (60%) had culture-proven infectious endophthalmitis. Eleven eyes (55%) underwent PPV during treatment; 5 eyes underwent PPV on presentation, and 6 eyes underwent PPV after initial presentation. Compared with pre-endophthalmitis VA, 6 eyes that underwent subsequent PPV had greater VA loss at 6 months than cases not undergoing subsequent PPV (Early Treatment Diabetic Retinopathy Study line loss of 14 vs 4 lines, respectively; P = .044). Conclusions: BRE eyes presenting with light-perception VA were more likely to undergo initial PPV; yet many eyes in this study required PPV during treatment. Visual outcomes are often poor in BRE despite intensive management. There was greater VA loss from pre-endophthalmitis VA levels at 6 months in eyes undergoing PPV after initial treatment. Prospective studies are needed to assess the optimal role of PPV in patients with BRE.

scholarly journals Efficacy of Dexmedetomidine as an Adjuvant to Local Anesthetic Agent in Scalp Block and Scalp Infiltration to Control Postcraniotomy Pain: A Double-Blind Randomized Trial

2018 ◽  
Vol 09 (01) ◽  
pp. 073-079 ◽  
Author(s):  
Shankar Vallapu ◽  
Nidhi Bidyut Panda ◽  
Navneh Samagh ◽  
Neerja Bharti
Keyword(s):  
Nerve Block ◽  
Care Center ◽  
Tertiary Care ◽  
Primary Objective ◽  
Analgesic Requirement ◽  
Double Blind ◽  
Respiratory Parameters ◽  
Scalp Block ◽  
American Society ◽  
American Society Of Anesthesiologists

ABSTRACT Context: Scalp infiltration and scalp block are being used to manage postcraniotomy pain. Dexmedetomidine has been successfully used as an adjuvant in regional anesthesia. The study was intended to compare whether addition of dexmedetomidine prolonged the duration of analgesia as well as to compare the two techniques. Aims: The primary objective was to assess whether addition of dexmedetomidine to bupivacaine prolonged the duration of analgesia. The secondary objective was to compare between scalp nerve block and scalp infiltration as techniques for pain relief. Settings and Design: The randomized control study was conducted in a tertiary care center from November 2013 to October 2014. Materials and Methods: A total of 150 American Society of Anesthesiologists Physical Status I–II patients, aged 18–70 years undergoing elective craniotomy were included. Patients were randomized into three groups of 50 patients, i.e., Group BI (bupivacaine infiltration), Group BDI (bupivacaine and dexmedetomidine infiltration), and Group BDNB (bupivacaine and dexmedetomidine scalp nerve block). Patient's pain score, pain-free interval, rescue analgesic requirement, and hemodynamic and respiratory parameters were noted for 48 h. Patients were followed up at 1 and 3 months to assess postcraniotomy pain. Results: Pain-free period was significantly longer in Group BDNB than Groups BDI and BI (P < 0.0001) and pain control was better in dexmedetomidine containing groups than in bupivacaine group (BI) (P < 0.0001). The rescue analgesic requirement was significantly lower in Group BDNB and Group BDI compared to Group BI. Conclusion: The addition of dexmedetomidine (1 µg/kg) to bupivacaine prolonged the pain-free period. Scalp nerve block is a superior technique than scalp infiltration.

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