Acute Isoniazid Neurotoxicity in an Urban Hospital

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 700-704
Author(s):  
Binita R. Shah ◽  
Karen Santucci ◽  
Richard Sinert ◽  
Phillip Steiner
Keyword(s):  
New York ◽  
Case Series ◽  
Pediatric Emergency ◽  
Tuberculous Infection ◽  
Urban Hospital ◽  
Average Delay ◽  
Number Of Children ◽  
Refractory Seizures ◽  
Age Range ◽  
Increasing Trends

Objectives. To describe the presentation and treatment of acute isoniazid (INH) neurotoxicity appearing at an inner-city municipal hospital. Design. Case series. Participants. Seven patients (eight patient visits) with an age range of 5 days to 14.9 years. Results. At our institution, no children appeared with acute INH neurotoxicity in the period 1985 through 1990, whereas seven patients were treated from 1991 through 1993. This paralleled the rise in the number of children with tuberculous infection and disease seen at our institution, from an average 96 per year to 213 per year during these two time periods. All seven patients were receiving INH daily for tuberculosis (TB) prophylaxis. Accidental ingestion (five episodes) and suicidal attempts (three episodes) accounted for these visits. The total amount ingested range from 14.3 to 99.3 mg/kg (mean, 54 mg/kg). All but one patient presented with afebrile seizures. One patient presented twice with seizures. Acute INH neurotoxicity was not suspected on the first admission; however, when readmitted 4 weeks later with another seizure, the diagnosis of acute INH neurotoxicity was made. Intervention. Intravenous pyridoxine was used in five episodes. Because it was not a stocked item in our pediatric emergency cart (as well as at another hospital, necessitating a transfer of a patient with refractory seizures to our hospital), the average delay was 5.8 hours (range, 1.3 to 13 hours) before it was given. Two patients with refractory seizures failed to respond to anticonvulsants, and their seizures were controlled only after parenteral pyridoxine. Conclusions. We have seen an increased incidence of acute INH neurotoxicity because of the resurgence of TB in New York City. Others as well may see a similar rise based on local trends in TB infection and disease. Acute INH toxicity should be suspected in children presenting with seizures with or without fever. In patients with a known access to INH, seizures should be considered to be caused by INH toxicity unless proved otherwise. Parenteral pyridoxine, the specific antidote for INH-induced refractory seizures, should be readily available in every emergency department in the areas similarly experiencing increasing trends of TB.

A Case Series of SARS-CoV-2 RT-PCR-Positive Hospitalized Infants 60 Days of Age or Younger From 2 New York City Pediatric Emergency Departments

2021 ◽  
Vol 60 (4-5) ◽  
pp. 247-251
Author(s):  
Ameer Hassoun ◽  
Nessy Dahan ◽  
Christopher Kelly
Keyword(s):  
New York ◽  
Case Reports ◽  
Severe Disease ◽  
Case Series ◽  
Pediatric Emergency ◽  
Rt Pcr ◽  
Vulnerable Group ◽  
Mild Disease ◽  
Young Infants ◽  
Novel Coronavirus

The emergence of novel coronavirus disease-2019 poses an unprecedented challenge to pediatricians. While the majority of children experience mild disease, initial case reports on young infants are conflicting. We present a case series of 8 hospitalized infants 60 days of age or younger with coronavirus disease-2019. A quarter of these patients had coinfections (viral or bacterial). None of these infants had severe disease. Continued vigilance in testing this vulnerable group of infants is warranted.

Primary Calvarial Ewing Sarcoma: A Case Series

2021 ◽  
Author(s):  
Sandeep Mohindra ◽  
Manjul Tripathi ◽  
Aman Batish ◽  
Ankur Kapoor ◽  
Ninad Ramesh Patil ◽  
...  
Keyword(s):  
Ewing Sarcoma ◽  
Tumor Resection ◽  
Case Series ◽  
Radical Excision ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Intradural Tumor ◽  
Age Range

Abstract Background Calvarial Ewing tumor is a relatively rare differential among bony neoplasms. We present our experience of managing primary calvarial Ewing sarcoma (EWS), highlighting their clinical and radiological findings. Method In a retrospective analysis, we evaluated our 12-year database for pathologically proven EWS. A literature search was conducted for the comparative presentation and update on the management and outcome. Result From January 2008 to December 2020, we managed eight patients (male:female = 5:3; age range 6 months to 19 years, mean 11.5 years) harboring primary calvarial EWS. All cases underwent wide local excision; two patients required intradural tumor resection, while one required rotation flap for scalp reconstruction. Mean hospital stay was 8 days. All patients received adjuvant chemo- and radiotherapy. Three patients remained asymptomatic at 5 years of follow-up, while two patients died. Conclusion Primary calvarial EWS is a rare entity. It usually affects patients in the first two decades of life. These tumors can be purely intracranial, causing raised intracranial pressure symptoms, which may exhibit rapidly enlarging subgaleal tumors with only cosmetic deformities or symptoms of both. Radical excision followed by adjuvant therapy may offer a favorable long-term outcome.

scholarly journals Characteristics and Outcomes Among Hospitalized COVID-19-Positive Patients in a Nonurban Environment

2021 ◽  
Author(s):  
Robert P Lennon ◽  
Theodore J Demetriou ◽  
M Fahad Khalid ◽  
Lauren Jodi Van Scoy ◽  
Erin L Miller ◽  
...  
Keyword(s):  
New York ◽  
Medical Center ◽  
Academic Medical Center ◽  
Military Medicine ◽  
Case Series ◽  
Outcome Data ◽  
Urban Environments ◽  
Urban Setting ◽  
Published Data ◽  
Retrospective Case

ABSTRACT Introduction Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. Materials and Methods This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area. Results The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC’s cohort had shorter hospital stays (4.1 versus 7.2 days, P < .001) but more African American patients (23% versus 12%, P = .02) and higher prevalence of abnormal alanine (>60U/L; 39.0% versus 5.9%, P < .001) and aspartate (>40U/L; 58.4% versus 42.4%, P = .012) aminotransferase, oxygen saturation <90% (20.4% versus 7.2%, P = .004), and mortality (21% versus 1.4%, P < .001). Conclusions Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.

scholarly journals Buprenorphine/Naloxone Maintenance Therapy: an Observational Retrospective Report on the Effect of Dose on 18 months Retention in an Office-Based Treatment Program

2017 ◽  
Vol 11 ◽  
pp. 117822181773132
Author(s):  
Theodore V Parran ◽  
AG Mace ◽  
Yael J Dahan ◽  
Christopher A Adelman ◽  
Mykola Kolganov
Keyword(s):  
Treatment Program ◽  
Dose Range ◽  
Primary Care Clinic ◽  
Case Series ◽  
Funding Agency ◽  
Retrospective Report ◽  
Urban Hospital ◽  
Care Clinic ◽  
Patient Retention

Context and objective: Buprenorphine has been available with few reports of the dose range necessary to adequately maintain patients. We report on the effect of 8 mg/d versus 16 mg/d of buprenorphine on long-term patient retention in office-based opioid maintenance (OBOMT). Design, setting, and participants: Case series, at an urban hospital-based primary care clinic providing OBOMT to 157 opiate-dependent, low socioeconomic status, uninsured, nonhomeless patients. Intervention: The OBOMT program operated by a comprehensive sobriety treatment program experienced State funding cuts. Thus, after 2 years, the program was required by the State funder to decrease the buprenorphine maintenance dose from 16 to 8 mg/d for all new admissions. We report on patient retention before and after dose reduction. Main outcome measures: The primary outcomes of this study were to measure and compare patient retention in the 2 cohorts at each point of treatment transition over the 18 months following OBOMT initiation. Results: No significant differences in patient retention were observed between the 16 and 8 mg/d patient cohorts. Lower dose buprenorphine maintenance (8 mg/d) in uninsured patients enrolled in publicly funded long-term OBOMT combined with comprehensive sobriety counseling was as effective as higher dose therapy (16 mg/d) in promoting patient retention throughout the study period. This lower dose resulted in a substantial saving to the public funding agency. Conclusions: In an observational retrospective report, retention in treatment of opiate-addicted patients was the same at 8 and 16 mg/d buprenorphine doses after 18 months. These data have implications for public and managed care funding of OBOMT, for the general prescribing of buprenorphine in outpatient care, and may be instructive in the ongoing debate about the relationship between buprenorphine dose.

scholarly journals Estimating, monitoring, and forecasting COVID-19 epidemics: a spatiotemporal approach applied to NYC data

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Vinicius V. L. Albani ◽  
Roberto M. Velho ◽  
Jorge P. Zubelli
Keyword(s):  
New York ◽  
New York City ◽  
Census Data ◽  
Age Group ◽  
Age Classes ◽  
Basic Model ◽  
Monitoring And Forecasting ◽  
Group Sex ◽  
Age Range ◽  
Spatial Locations

AbstractWe propose a susceptible-exposed-infective-recovered-type (SEIR-type) meta-population model to simulate and monitor the (COVID-19) epidemic evolution. The basic model consists of seven categories, namely, susceptible (S), exposed (E), three infective classes, recovered (R), and deceased (D). We define these categories for n age and sex groups in m different spatial locations. Therefore, the resulting model contains all epidemiological classes for each age group, sex, and location. The mixing between them is accomplished by means of time-dependent infection rate matrices. The model is calibrated with the curve of daily new infections in New York City and its boroughs, including census data, and the proportions of infections, hospitalizations, and deaths for each age range. We finally obtain a model that matches the reported curves and predicts accurate infection information for different locations and age classes.

Acute Isoniazid Neurotoxicity in an Urban Hospital

PEDIATRICS ◽  
1996 ◽  
Vol 97 (5) ◽  
pp. 782-782
Author(s):  
Mirzada Pasic Kurbasic ◽  
J. Thomas Badgett
Keyword(s):  
Bosnia And Herzegovina ◽  
Liver Dysfunction ◽  
Metabolic Disturbance ◽  
University Hospital ◽  
Urban Hospital ◽  
Period 2 ◽  
High Doses ◽  
Age Range

In the May issue of Pediatrics, Dr Shah and collaborators pointed out an increased incidence of isoniazid (INH) neurotoxicity.1 At the Children's University Hospital in Tuzla, Bosnia, and Herzegovina, four patients (age range, 6 to 9 years) were admitted for INH neurotoxicity in a 15-month period.2 None of them had liver dysfunction or metabolic disturbance, such as acidosis or hyperglycemia. All intoxications were accidental. Patients responded well to high doses of intravenous pyridoxine, including two with seizures and coma that had been unresponsive to treatment with phenobarbital and diazepam, respectively, before admission.

Object Concept and Object Relations in Childhood Psychosis: A Pilot Study

1971 ◽  
Vol 16 (4) ◽  
pp. 347-354 ◽  
Author(s):  
L. Gratton
Keyword(s):  
New York ◽  
Mental Retardation ◽  
Cognitive Development ◽  
Pilot Study ◽  
Motor Development ◽  
Day School ◽  
Child Relationship ◽  
Two Systems ◽  
Early Infantile Autism ◽  
Age Range

The two master theories of human development, the Freudian and Piagetan, have evolved in parallel fashion without ever meeting. The advent of ‘ego metapsychology’ brought the two systems closer together, to be finally correlated by Anthony, Wolff, et al. The role of the mother is primordial in both cognitive and psychoanalytic systems. As already shown experimentally by Gouin-Décarie the two systems are interconnected in that a failure or fixation in the libidinal development is accompanied by an ‘adherence’ in the cognitive sphere. The aim of this pilot study was to verify the hypothesis that any condition accompanied or caused by a severe disturbance in the mother-child relationship will result in severe mental retardation or arrest in cognitive development within the sensorio-motor stage. The sample was composed of twenty randomly selected children (age range: 3 to 9 years), divided into a psychotic sub-group and a non-psychotic one, the latter serving as control. These children were attending the Pride of Judea Day School in New York City. All had a complete psychiatric and psychological evaluation, plus a detailed developmental history, carried out independently of this research. The Piagetan Test of Sensorio-Motor development elaborated by Gouin-Décarie was administered to both groups. The results showed that an ‘adherence’ of cognitive development to the sensorio motor stage was positively correlated with Early Infantile Autism and Mental Retardation. In order to further clarify this correlation the subjects' early development in their first two years of life was scrutinized using a check list of autistic signs. A statistically highly significant correlation could then be established between the arrest of cognitive development in the sensorio motor stage and an autistic type of development within the first two years of life, irrespective of diagnosis. In view of these findings it seems pointless to apply interpretative psychotherapies to these children or to submit them to standard kindergarten techniques when they lack the very rudiments for abstract thinking.

scholarly journals Evaluating Dental Faculty’s Perspective regarding Emergency Introduction of Online Teaching and Learning: Early Experience during COVID-19 Lockdown in United States

2022 ◽  
Vol 2022 ◽  
pp. 1-10
Author(s):  
Aman Gupta ◽  
Ana Janic ◽  
Joshua Thomson
Keyword(s):  
New York ◽  
Student Learning ◽  
Teaching Methods ◽  
Online Teaching ◽  
Teaching And Learning ◽  
Social Impact ◽  
Teaching Experience ◽  
Exact Test ◽  
Holistic Understanding ◽  
Age Range

Objectives. The March 2020 lockdown mandated institution closures and forced educators to provide remote instruction. We intended to gain an in-depth and holistic understanding of dental faculty’s experience and perceptions during this mandatory shift. Insights were gathered in 6 key areas: prior remote instruction experience; magnitude of transition and frequency of instruction methods used; training received; preferred teaching methods based on how they promote student learning, interaction, engagement, and performance; social impact; and future of teaching. Methods. An anonymous QualtricsXM survey was distributed to all dental faculties at University of Detroit Mercy in May 2020. Data was collected over a three-week period and analyzed using Statistical Package for the Social Sciences (SPSS) Statistics 26 (IBM; Armonk, New York, USA). Pearson chi-squared test and Fisher’s exact test were used to evaluate categorical data. Results. Out of the 30 participants who transitioned to online remote instruction, 16 (53.3%) reported an age between 30 and 49 years and 14 (46.7%) reported ≥50 years of age. Our analysis revealed that faculty in 30–49-year age range had no prior online synchronous teaching experience. The transition was described as interesting, useful, time-consuming, and challenging. In-person live teaching received highest number of first place rankings (50%), and online asynchronous method received highest number of last place rankings (42.86%). Faculties in >50 year age range expressed maximum satisfaction with online small-group discussions, and those in 30–49 years age group were more satisfied with one-on-one online discussion. Conclusion. Our study finds that the faculty tends to gravitate to online methods that are similar to or mimic their past in-person teaching environment. Forced remote instruction gave new content delivery experiences to faculties of all ranges of age and experience in teaching. This exposure is likely to result in a more widespread adoption of a variety of instructional methods in future. Our study strongly suggests that traditional in-person instruction is the preferred method for delivery of content and is likely better for student learning. Majority of the faculties believed that the future of dental education would be a mix of both in-class and online instruction. In summer and fall 2021, our institution adopted hybrid, flexible models for didactic instruction to allow students the opportunity to digest content in their preferred method. Careful planning and systematic, continued training will be required to enhance technological skills and to incorporate newer models into didactic and clinical instruction. For the success of blended learning, courses will need redesigning of assessment methods, commitment, and support from administrators.

scholarly journals HIV-1 Infection Does Not Change Disease Course or Inflammatory Pattern of SARS-CoV-2-Infected Patients Presenting at a Large Urban Medical Center in New York City

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Justin Laracy ◽  
Jason Zucker ◽  
Delivette Castor ◽  
Donald J McMahon ◽  
Tai Wei Guo ◽  
...  
Keyword(s):  
New York ◽  
Mechanical Ventilation ◽  
Medical Center ◽  
Inflammatory Marker ◽  
Admission Rate ◽  
Ventilation Rate ◽  
Urban Hospital ◽  
Hiv Diagnosis ◽  
Significant Difference ◽  
Study Population

Abstract Background The clinical impact of coronavirus disease 2019 (COVID-19) among people with HIV (PWH) remains unclear. In this retrospective cohort study of COVID-19, we compared clinical outcomes and laboratory parameters among PWH and controls. Methods Sixty-eight PWH diagnosed with COVID-19 were matched 1:4 to patients without known HIV diagnosis, drawn from a study population of all patients who were diagnosed with COVID-19 at an academic urban hospital. The primary outcome was death/discharge to hospice within 30 days of hospital presentation. Results PWH were more likely to be admitted from the emergency department than patients without HIV (91% vs 71%; P = .001). We observed no statistically significant difference between admitted PWH and patients without HIV in terms of 30-day mortality rate (19% vs 13%, respectively) or mechanical ventilation rate (18% vs 20%, respectively). PWH had higher erythrocyte sedimentation rates than controls on admission but did not differ in other inflammatory marker levels or nasopharyngeal/oropharyngeal severe acute respiratory syndrome coronavirus 2 viral load estimated by reverse transcriptase polymerase chain reaction cycle thresholds. Conclusions HIV infection status was associated with a higher admission rate; however, among hospitalized patients, PWH did not differ from HIV-uninfected controls by rate of mechanical ventilation or death/discharge to hospice.

scholarly journals EFFECT OF SUBCUTANEOUS RECOMBINANT HUMAN ERYTHROPOIETIN ON BLOOD PRESSURE IN PRE-DIALYSIS CHRONIC KIDNEY DISEASE (CKD) PATIENTS

2021 ◽  
Vol 71 (1) ◽  
pp. 261-65
Author(s):  
Muhammad Sajid Hussain ◽  
Qasim Raza ◽  
Muhammad Omer Aamir ◽  
Nadia Murtaza ◽  
Sadia Naureen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Body Weight ◽  
Kidney Disease ◽  
Recombinant Human Erythropoietin ◽  
Case Series ◽  
Military Hospital ◽  
P Value ◽  
Human Erythropoietin ◽  
Age Range

Objective: To determine the effect of subcutaneous recombinant human erythropoietin on blood pressure in predialysis chronic kidney disease (CKD) patients. Study Design: Case-series descriptive study. Place and Duration of Study: Combined Military Hospital Peshawar, from Mar 2016 to Sep 2016. Methodology: A total of 100 cases were enrolled. Inclusion criteria was patients of 18 to 60 years of both gender & estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2 having Hb <10g/dL and pre-dialysis while Exclusion Criteria was pregnancy or lactation, BP more than 140/90 mmHg, patients on Haemodialysis and worsening renal function. Baseline BP, body weight and eGFR of anaemic chronic kidney disease patients were recorded prior to EPO Alpha therapy. Erythropoiesis-stimulating agents (ESAs) i.e. EPO Alpha (50-100 Units/kg thrice or once weekly) was administered subcutaneously. Subsequent blood pressure, body weight and eGFR monitoring was done after 2 and 4 weeks post EPO Alpha injection. Results: Mean age range was 46.71 years with range of 20-60 years, 73 (73%) were male while 27 (27%) werefemales. Mean ± SD for other quantitative variables like eGFR was 23.12 ± 5.28, Hb levels (g/dL) was 8.62 ± 0.85,Weight (kg) was 56.66 ± 6.62 and duration of CKD was 9.87 ± 4.02. Frequency of Hypertension (post EPO) was 2(2%) and p-value was 0.453. Conclusion: We concluded that the frequency of hypertension in pre-dialysis patients with chronic kidney disease (CKD) receiving recombinant human erythropoietin (rhEPo) subcutaneously (SC) in low doses, is very low, so rhEPo can be used subcutaneously......................

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