Prevalence of Renal and Cervical Vertebral Anomalies in Patients with Isolated Microtia and/or Aural Atresia

Objective The objective of this study was to determine whether patients with isolated microtia or aural atresia have an increased prevalence of renal or cervical vertebral anomalies. Design The study design was a retrospective medical record review. Setting The setting was the following four distinct institutions: an urban tertiary care children's hospital, two urban academic medical centers, and a staff-model health maintenance organization. Participants Patients diagnosed with microtia, aural atresia, or oculoauriculovertebral spectrum were identified. Patients with facial asymmetry, craniofacial microsomia, and other craniofacial abnormalities or syndromes were excluded. Main Outcome Measures Main outcome measures were the number of patients with isolated microtia or aural atresia who underwent a renal ultrasound or cervical spine X-ray, the results of those studies, and further evaluation or treatment for any abnormalities found. Statistical Analysis A binomial analysis using a one-sided 95% confidence level was performed. Results A total of 514 patients with isolated microtia and/or aural atresia were identified. Of these patients, 145 (28%) had undergone a renal ultrasound and 81 (16%) had undergone cervical spine X-rays. A total of 3 patients (2%) had minimal renal pelviectasis, all of which had resolved on repeat ultrasound and required no treatment. There were no structural renal abnormalities identified, and there were no cervical spine abnormalities identified. Conclusions The data suggest that there is no increased prevalence of structural renal or cervical vertebral anomalies in patients with isolated microtia and/or aural atresia. Therefore, these patients do not require routine screening renal ultrasound or cervical spine X-rays.

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Computed Tomography- and Radiography-Based Morphometric Analysis of the Lateral Mass of the Subaxial Cervical Spine in the Indian Population

Asian Spine Journal ◽

10.4184/asj.2018.12.1.18 ◽

2018 ◽

Vol 12 (1) ◽

pp. 18-28

Author(s):

Nirmal D Patil ◽

Sudhir K Srivastava ◽

Sunil Bhosale ◽

Shaligram Purohit

Keyword(s):

Computed Tomography ◽

Cervical Spine ◽

Indian Population ◽

Tertiary Care ◽

X Rays ◽

Lateral Mass ◽

Cross Sectional ◽

X Ray ◽

Subaxial Cervical Spine ◽

Screw Length

<sec><title>Study Design</title>This was a double-blinded cross-sectional study, which obtained no financial support for the research.</sec><sec><title>Purpose</title>To obtain a detailed morphometry of the lateral mass of the subaxial cervical spine.</sec><sec><title>Overview of Literature</title>The literature offers little data on the dimensions of the lateral mass of the subaxial cervical spine.</sec><sec><title>Methods</title>We assessed axial, sagittal, and coronal computed tomography (CT) cuts and anteroposterior and lateral X-rays of the lateral mass of the subaxial cervical spine of 104 patients (2,080 lateral masses) who presented to a tertiary care public hospital (King Edward Memorial Hospital, Mumbai) in a metropolitan city in India.</sec><sec><title>Results</title>For a majority of the parameters, males and females significantly differed at all levels (<italic>p</italic><0.05). Females consistently required higher (<italic>p</italic><0.05) minimum lateral angulation and lateral angulation. While the minimum lateral angulation followed the order of C5<C4<C6<C3, the lateral angulation followed the order of C3<C5<C4<C6. The lateral mass becomes longer and narrower from C3 to C7. In axial cuts, the dimensions increased from C3 to C6. The sagittal cut thickness and diagonal length increased and the sagittal cut height decreased from C3 to C7. The sagittal cut height was consistently lower in the Indian population at all levels, especially at the C7 level, as compared with the Western population, thereby questioning the acceptance of a 3.5-mm lateral mass screw. A good correlation exists between X-ray- and CT-based assessments of the lateral mass.</sec><sec><title>Conclusions</title>Larger lateral angulation is required for Indian patients, especially females. The screw length can be effectively calculated by analyzing the lateral X-ray. A CT scan should be reserved for specific indications, and a caution must be exercised while inserting C7 lateral mass screws.</sec>

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COVID-19 Infection Rate among Dental Health Care Workers

Open Access Journal of Dental Sciences ◽

10.23880/oajds-16000285 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Guy Tobias

Keyword(s):

Health Care ◽

Health Care Providers ◽

Dental Treatment ◽

Dental Health ◽

Health Maintenance Organization ◽

Care Providers ◽

Waiting Room ◽

Health Maintenance ◽

Number Of Patients ◽

Public Clinics

Background: First infections of COVID-19 pandemic occurred in December 2019 in China and then spread rapidly all over the world. In February 2020, the first Corona case was diagnosed in Israel, since then, three national lockdowns have been imposed. Israeli Ministry of health published guidelines for dental treatment during times of social distancing which include: 1) Questioning patients prior to admittance. 2) Increasing intervals between appointments. 3) Restricting number of people permitted in the waiting room to prevent crowds. 4) Wearing masks at all times. 5) Wearing long sleeve waterproof surgical gowns, goggles / face shield. Methods: Data from 54 dental clinics (MaccabiDent health maintenance organization) were collected between March and October 2020 regarding: 1) Number of treatments performed. 2) Number of health care providers participating in the procedures. 3) Number of patients with positive COVID-19 results. 4) Number of healthcare workers positive for COVID-19. 5) Number of paramedical and administrative staff positive for COVID-19. 6) Number of patients treated by dentists who later turned out to be infected by the virus. Results: 1,079 dentists and 354 dental hygienists worked during the study period, and performed 1.29 million procedures of these, seventy eight dentists treated 99 verified COVID-19 patients. 17 dentists (1.58%) tested positive for the virus. Conclusion: By following guidelines, the risk of transmission of coronavirus is minimal in the dental setting. Practical Implications: This article reinforces the evidence regarding the importance of education and following guidelines regarding infection control for dental professionals employed in public clinics.

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Need to travel for urologic care: The impact of insurance.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.396 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 396-396

Author(s):

Matthew Mossanen ◽

Kenn Dhartha ◽

Sarah Holt ◽

Jonathan L. Wright ◽

Jonathan D. Harper ◽

...

Keyword(s):

Private Insurance ◽

Tertiary Care ◽

Health Maintenance Organization ◽

Retroperitoneal Lymph Node Dissection ◽

Care Hospital ◽

Health Maintenance ◽

Hospital Referral ◽

Service Areas ◽

Chi Squared ◽

The Impact

396 Background: We sought to examine the impact of the Affordable Care Act on access to subspecialty services, such as urologic care, through evaluating the need to travel by insurance status for index urologic procedures. Methods: We accessed the Comprehensive Hospital Abstract Reporting System from 2011-2012. Patients were identified using billing claims and ICD-9 codes. Procedures analyzed were: radical cystectomy (RC), radical prostatectomy (RP), transurethral prostate resection, shockwave lithotripsy, nephrectomy, percutaneous nephrolithotomy (PCNL), retroperitoneal lymph node dissection (RPLND), and pyeloplasty. Patients were categorized as Medicaid, Medicare, private/Health Maintenance Organization, or other (i.e. charity care). Hospital service areas (HSAs, where the majority of local patients were hospitalized), and hospital referral regions (HRR, where most patients received tertiary care) were identified. Chi squared analysis and multivariate logistic regression were performed. Results: We identified 600 patients with Medicaid, 3,806 patients with Medicare, 4,998 patients with private insurance, and 554 with other. 13.3% of Medicaid patients undergoing RC left their HRR versus 29.9% for Medicare and 39.8% for private insurance (Chi squared p < 0.05). We found similar trends for RP (10.8% of Medicaid traveled outside of their HRR vs. 19.5% for Medicare and 24.6% for private, p < 0.05) and PCNL (21.9% of patients with private insurance traveled outside of HRR vs. 12% with Medicare and 17.2% with Medicaid, p < 0.05). On multivariate analysis, (adjusting for race, age, and comorbidity) private insurance had higher odds of leaving their HRR (OR = 1.4, CI 1.1 – 1.8, p< 0.002). Non-white patients (OR = 0.66, 0.54 – 0.81, p <0.001), those with increased comorbidities (OR = 0.95, CI 0.91 - .99, p<0.04), and older patients (p < 0.001) are less likely to travel outside of their HRR. Conclusions: Patients undergoing complex urologic procedures like RC, RP, and PCNL are more likely to travel outside of their HRR if they have private insurance, potentially reflecting increased capacity to access healthcare resources based on income. Patients of older age and with greater comorbidities may be less likely to travel outside of their HRR to obtain urologic care.

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Design and Implementation of a novel Weekend Elective Paediatric Surgery Program to Reduce COVID-19 Related Backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends – Extra Lists (ORRACLE-Xtra) (Preprint)

10.2196/preprints.35584 ◽

2021 ◽

Author(s):

Clyde Matava ◽

Jeannette So ◽

RJ Williams ◽

Simon Kelley ◽

Keyword(s):

Operating Room ◽

Outcome Measures ◽

Tertiary Care ◽

Well Being ◽

Parental Satisfaction ◽

Paediatric Surgery ◽

Improvement Project ◽

Number Of Patients ◽

Process And Outcome ◽

Percent Decrease

BACKGROUND The COVID-19 pandemic caused by the SARS-COV-2 virus has resulted in unprecedented challenges for the healthcare system. Ramp down of surgical services led to significant backlogs for time-sensitive scheduled pediatric patients. We designed and implemented a novel pilot weekend surgical quality improvement project called Operating Room Ramp-Up After COVID Lockdown Ends – Extra Lists (ORRACLE-Xtra). OBJECTIVE Our overall goals were to increase patient access to surgery (and reduce the waitlist), improve operating room efficiencies, and optimize parent and staff experience. METHODS Using the DMAIC framework (define, measure, analyze, improve, control), we implemented ORRACLE-Xtra in a tertiary care academic pediatric hospital during a quiescence of the COVID-19 pandemic and defined process and outcome measures based on provincial targets of out of window cases. Parental and staff satisfaction was tracked by surveys. Results: ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period resulting in a 5 percent decrease in the total number of patients on our waitlist with P-CATS IV 59.5%, with 38.1% out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% with staff reporting 79.1% satisfaction of working on the weekends. RESULTS ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period resulting in a 5 percent decrease in the total number of patients on our waitlist with P-CATS IV 59.5%, with 38.1% out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% with staff reporting 79.1% satisfaction of working on the weekends. CONCLUSIONS Through the ORRACLE-Xtra pilot program, we have shown that hospitals impacted by COVID-19 can reduce the surgical backlog using innovative models of service delivery in a Canadian context. Sustained funding is critical to achieving more meaningful reductions in wait times for scheduled surgeries over the longer term and needs to be balanced with staff well-being. CLINICALTRIAL N/A

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Role of early CT scan in diagnosis of occult scaphoid fractures- a prospective study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173985 ◽

2017 ◽

Vol 5 (9) ◽

pp. 4072

Author(s):

Omeshwar Singh ◽

Anuradha Sen ◽

Sumeet Singh Charak ◽

Shakeel Ahmad

Keyword(s):

Ct Scan ◽

Tertiary Care ◽

False Negative ◽

False Negative Rate ◽

Scaphoid Bone ◽

X Rays ◽

X Ray ◽

Scaphoid Fractures ◽

Number Of Patients

Background: Wrists injuries are one of the common presentations to emergency departments and orthopaedic clinics. The scaphoid bone is the most commonly injured of the carpal bones accounting for 50-80% of carpal injuries and predominantly occurs in young healthy individuals. Scaphoid fractures are the most problematic to diagnose in a clinical setting because it can take up to 6 weeks for scaphoid fractures to become conclusive on plain X-ray films. Aim of the study was to retrospective study was carried out to study the role of early CT scan in diagnosis of occult scaphoid fractures.Methods: A total of 123 patients presented with an acute wrist injury with subsequent signs of scaphoid injury in the absence of a diagnostic fracture on plain X-ray within the time period from June 2014 to May 2016 in a tertiary care centre.Results: This study shows that 31% of normal X-rays were pathological on CT scan and out of these; scaphoid fractures (74% of pathologies) represent a large number of patients with fractures that were missed by initial plain films.Conclusions: This study shows an extremely high false-negative rate for plain X-rays and advocate CT at the first attendance to fracture clinic if there is suspicion of scaphoid injury. An earlier diagnosis leads to appropriate management and reduces restrictions to the patient in terms of prolonged immobilization and repeated clinical reviews.

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LOWER CERVICAL FRACTURE AND DISLOCATIONS

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.02.440 ◽

2018 ◽

Vol 25 (02) ◽

pp. 185-190

Author(s):

Faisal Abdul Jabbar ◽

Abdul Ali Khan ◽

Rehana Ali Shah

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Burst Fracture ◽

Tertiary Care ◽

Insertion Site ◽

Fracture Dislocation ◽

X Rays ◽

Cord Injury ◽

Screw Breakage ◽

Set Up

Objectives: The aim of our study is to determine the outcome of cervical pediclescrew fixation for fractures/dislocations of the cervical spine at our set up in Karachi, Pakistan.Study Design: A prospective case series. Period: 04 years duration from January 2013 toDecember 2016. Setting: Tertiary Care Centre in Karachi, Pakistan. Method: All the patientswho were included in the study signed a full informed consent. The inclusion criterion was allthe patients who cervical spine fracture/dislocation, presented to us within 24 hours of injuryand were operated at our set up. Data was collected in a predesigned proforma which includeda complete history and physical examination, age, gender, cause of injury, co morbidities, preoperativeradiological findings, past medical and surgical history. Serial X rays, MRI and CTscans were taken at 3, 6, 12 and 24 months post operatively for evaluation of stability, fusion andany complication such as deformity. The American Spinal Cord Injury Association impairmentscale was utilized in all the patients at follow ups to determine the sensory and motor functionimprovement post operatively. Data was analyzed using IBM SPSS for windows version 21.Results: The study population consisted of n= 40 patients of which n= 28 were male andn= 12 were female with a mean age of 45.2 years. The various types of injuries sustained bythe patients were as follows, n= 6 (15%) cases of cases had compression fractures (vertical),n=15 (37.5%) had flexion rotation injury and n=19 (47.5%) had flexion compression fracturesrespectively. While the division of bony injuries in the patient was as follows, n=5 (12.5%) hadcervical spinal burst fracture with dislocation, n= 15 (37.5%) patients had joint facet fracturewith dislocation bilaterally along with compression fracture of the vertebral body, n= 14 (35%)patients had facet joint fracture with dislocation bilaterally and n= 6 (15%) had unilateral fracturedislocation of joint facet. Complications such as injury to the vertebral artery, spinal cord, nerveroot were not observed in any of the patients in this series, all the patients achieved full bonyfusion at the 6 month follow up as observed on radiographic images. We also did not find anyincidence of screw penetration into the pedicle, similarly no incidence of screw breakage orloosening was observed. N=24 patients with incomplete injury of the spinal cord showedimprovements in their ASIA impairment scale, the patients n= 15 who had a complete spinalcord injury failed to show any improvement post operatively, but reported some decrease in painand numbness post operatively. Conclusion: For fractures/dislocations of the cervical spine thecervical pedicle screw is a reliable and effective method and provides good stability and bonyfusion. However the technique is dependent on surgeons experience and the extensive use ofpre-operative imaging to select the best insertion site of the screws as individualized for everypatient accordingly.

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Prospective study on prescribing pattern of antihypertensive drugs at a tertiary care hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20184312 ◽

2018 ◽

Vol 7 (11) ◽

pp. 2126

Author(s):

Vishwanath M. ◽

Murgesh J. V. ◽

Arpitha D. ◽

Nithiya D.

Keyword(s):

Drug Therapy ◽

Tertiary Care Hospital ◽

Antihypertensive Drugs ◽

Tertiary Care ◽

Care Hospital ◽

Prescribing Pattern ◽

Case Record ◽

Health Maintenance ◽

Number Of Patients ◽

Wide Range

Background: Hypertension is the leading non-communicable disease risk attributing to cardio vascular morbidity and mortality. Various reasons are socio-economic, behavioural, sedentary life style, nutritional, age, obesity and poor health maintenance. A wide range of antihypertensive drugs belonging to different pharmacological classes are available alone or in combinations. Present study was done to evaluate the prescribing pattern of antihypertensive drugs at a tertiary care hospital.Methods: A prospective, observational, non-interventional, hospital-based study was carried out in hypertensive patients attending outpatient department of General Medicine at Medical College Hospital attached to Vijayanagar Institute of Medical Sciences, Ballari. Data was collected from outpatient slip of patients in a predesigned case record form, which was analysed using descriptive statistics.Results: Among 200 patients analysed 95 (47.5%) were males and 105 (52.5%) were females, with maximum number of patients falling in the age group 61-70years. Among antihypertensives prescribed, amlodipine (78.5%) was most frequently prescribed drug. Frequently used drugs for monotherapy - amlodipine (37.5%), for two drug therapy - amlodipine + atenolol (25.5%), and for three drug therapy - amlodipine + atenolol + telmisartan (2.5%). WHO prescribing indicators: Average number of drugs per encounter is 2.38 (±1.19). Percentage of drugs prescribed by generic name is 76.47%. Percentage of drugs prescribed from essential drug list is 97.89%.Conclusions: Present study shows current trends in prescription of antihypertensives in tertiary care hospital and their rational use. Study emphasizes need for preventive and educative measures about hypertension in population.

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STUDY OF INFLAMMATORY MARKERS IN RELATION TO RADIOLOGICAL FINDINGS IN COVID 19

10.36106/ijsr/9604567 ◽

2021 ◽

pp. 48-50

Author(s):

Kalyanisri. Koneru ◽

V M Kiran Ogirala ◽

Kommavarapu. Kalyani Madhuri ◽

Bokam. Bhanu Rekha

Keyword(s):

Hospital Stay ◽

Tertiary Care ◽

P Value ◽

Care Hospital ◽

X Rays ◽

X Ray ◽

Duration Of Hospital Stay ◽

Number Of Patients ◽

Chest X Ray ◽

Severity Of The Disease

BACKGROUND Currently, the Coronavirus disease 2019 (COVID-19) has become pandemic globally. Elevated inammatory markers are observed and are a common pathophysiological response to acute illness. Chest X-ray changes are also commonly seen in COVID -19 patients. The present study was undertaken to determine the relationship between inammatory markers to chest X-ray ndings in COVID-19 patients. METHODS This is a prospective observational study of COVID-19 patients admitted to tertiary care hospital from may 2020-November 2020. Comorbidities, inammatory markers, and Chest X ray were collected and analyzed. Correlations between radiological and inammatory markers were studied. AIMS & OBJECTIVES: Ÿ Correlation of inammatory markers to radiographic ndings and their outcome in COVID 19 patients Ÿ The outcome was studied in terms of: Ÿ Patients requiring oxygen/ NIVsupport Ÿ duration of hospital stay Ÿ Number of patients Recovered/death RESULTS: Ÿ Out of 500 patients studied, the mean age was 49.41 years, and (295)59% of patients were male,(205)41% were females. (455)91% patients discharged and (43)8.6% died. We found a positive correlation between inammatory markers and Chest X-ray ndings at the time of admission with a signicant statistical P-value. The inammatory markers CRP, ESR, D-Dimer & Sr.ferritin compared with the mode of ventilation(O2 & NIV, duration of hospital stay and outcome also showed signicant statistical P-value. CONCLUSIONS We conclude that in patients with raised inammatory markers there were increased abnormalities on Chest X-rays which required an increase in oxygen or NIVsupport. This can be a useful predictor of the severity of the disease and assessment of outcome.

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