Clinical profile of persistent pulmonary hypertension in new born: experience in an extramural institution

Background: Persistent pulmonary artery hypertension of the new born (PPHN) has an incidence of 1.9 per 1000 live births with a mortality of 12 to 29%. In our tertiary care referral institute, the mortality was relatively high. A department audit was undertaken which will help us to introspect and to reason out the factors favouring survival and mortality in our NICU.Methods: Neonates with the diagnosis of PPHN from January 2016 to December 2016 were identified from our department database. After excluding cardiac causes of pulmonary hypertension, transport, prenatal, perinatal and post-natal data, treatment details and outcome information was collected from case records. The statistical analysis was calculated with SPSS software. Mean, standard deviation was calculated for continuous variables. Chi square test and Fischer’s exact test was used to test the association between categorical variables and t test for continuous variables.Results: The incidence PPHN in our unit was 1.5%. The average duration of hospital stay was 17 days. Among the 45.7 % of babies, PPHN was secondary to MAS, followed by CDH (22.3 %). Based on oxygenation index, 15 babies, 42.3% had mild, 10 babies, 28.6% had moderate, 8 babies, 22.3% had severe PPHN and 3 babies ,8.6% had severe PPHN. Overall mortality was 42.3%. SpO2 on arrival at emergency room, adequacy of cardiorespiratory during transport and presence of shock is significantly associated with mortality.Conclusions: This study show MAS and CDH are common causes of PPHN. Severity of illness at arrival was predictive of high mortality. Prior stabilization and adequate transport may improve outcomes.

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Evaluation of the Risk of Clinical Deterioration among Inpatients with COVID-19

Advances in Virology ◽

10.1155/2021/6689669 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Víctor O. Costa ◽

Eveline M. Nicolini ◽

Bruna M. A. da Costa ◽

Fabrício M. Teixeira ◽

Júlia P. Ferreira ◽

...

Keyword(s):

Clinical Laboratory ◽

Lung Parenchyma ◽

Clinical Deterioration ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Exact Test ◽

Laboratory Confirmation ◽

Chi Square Test ◽

Imaging Markers

This study aims to assess the risk of severe forms of COVID-19, based on clinical, laboratory, and imaging markers in patients initially admitted to the ward. This is a retrospective observational study, with data from electronic medical records of inpatients, with laboratory confirmation of COVID-19, between March and September 2020, in a hospital from Juiz de Fora-MG, Brazil. Participants (n = 74) were separated into two groups by clinical evolution: those who remained in the ward and those who progressed to the ICU. Mann–Whitney U test was taken for continuous variables and the chi-square test or Fisher’s exact test for categorical variables. Comparing the proposed groups, lower values of lymphocytes ( p = <0.001) and increases in serum creatinine ( p = 0.009), LDH ( p = 0.057), troponin ( p = 0.018), IL-6 ( p = 0.053), complement C4 ( p = 0.040), and CRP ( p = 0.053) showed significant differences or statistical tendency for clinical deterioration. The average age of the groups was 47.9 ± 16.5 and 66.5 ± 7.3 years ( p = 0.001). Hypertension ( p = 0.064), heart disease ( p = 0.048), and COPD ( p = 0.039) were more linked to ICU admission, as well as the presence of tachypnea on admission ( p = 0.051). Ground-glass involvement >25% of the lung parenchyma or pleural effusion on chest CT showed association with evolution to ICU ( p = 0.027), as well as bilateral opacifications ( p = 0.030) when compared to unilateral ones. Laboratory, clinical, and imaging markers may have significant relation with worse outcomes and the need for intensive treatment, being helpful as predictive factors.

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Impact of Donor Inflow in COVID 19 Pandemic: A Tertiary Care Hospitals Blood Service Experience

Bangladesh Journal of Medicine ◽

10.3329/bjm.v33i1.56793 ◽

2021 ◽

Vol 33 (1) ◽

pp. 70-75

Author(s):

Md Abdul Quader ◽

Quazi Tarikul Islam

Keyword(s):

Tertiary Care ◽

Hospital Setting ◽

Police Department ◽

Distribution Patterns ◽

Categorical Variables ◽

Time Interval ◽

Continuous Variables ◽

Chi Square ◽

Travel Restrictions ◽

Chi Square Test

Background: The severe acute respiratory syndrome (SARS) causing the COVID 19 pandemic infection has affected one and all across the world and halting mosthuman activities. During the disease outbreak and country lockdown, Blood Transfusion Services faced numerous challenges to maintain the sustainability in service provision. We intend to identify the challenges faced during COVID-19 outbreak and the following imposed national lockdown. Methods: This retrospective study was done during the lockdown period from26/03/2020 to 30/05/2020 comprising 66 days to detect donor inflow declination and to compare the donor inflow with pre lockdown and post lockdown period of same duration. The periods were divided into six equal intervals to compare donor distribution patterns in lockdown, pre lockdown and post lockdown period. Mean and standard deviation was calculated for continuous variables and chi square test was done for categorical variables. Results: The donations collected during the lockdown period and post lockdown period were almost 71.37% and 62.82% less respectively when compared with the pre lockdown collection (211and 274 versus 737).While in interval periods, donor inflow was declined substantially in lockdown period and in post lockdown period, inflow was declined as of lockdown period initially but it increases as time passed. But the increment was not as such of pre lockdown period. Donor inflow in age group and time interval of donation frequency were statistically significant (p <0.00005 and p< 0.0037 respectively). Conclusion: Concerns of being infected through hospital contact, lack of public transport facilities, travel restrictions imposed by the police department, and no availability of medical student donors in the hospital setting were the main attributing factors for donor inflow. Bangladesh J Medicine July 2022; 33(1) : 70-75

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Changes in Pediatric Faculty Burnout During the COVID-19 Pandemic

Hospital Pediatrics ◽

10.1542/hpeds.2021-006045 ◽

2021 ◽

Author(s):

Audrey M. Uong ◽

Michael D. Cabana ◽

Janet R. Serwint ◽

Carol A. Bernstein ◽

Elaine E. Schulte

Keyword(s):

Emotional Exhaustion ◽

Tertiary Care ◽

Categorical Variables ◽

Academic Rank ◽

Continuous Variables ◽

Cross Sectional ◽

Exact Test ◽

Faculty Burnout ◽

Student’S T ◽

The Impact

OBJECTIVES To examine the impact of the coronavirus disease 2019 (COVID-19) pandemic and associated workflow changes, such as deployment on pediatric faculty burnout in an early epicenter of the pandemic. We hypothesized burnout would increase during the COVID-19 surge. METHODS We conducted serial cross-sectional surveys of pediatric faculty at an academic, tertiary-care children’s hospital that experienced a COVID-19 surge in the Northeastern United States. Surveys were administered pre-surge (February 2020), during the surge (April 2020), and postsurge (September 2020). The primary outcome was burnout prevalence. We also measured areas of worklife scores. We compared responses between all 3 survey periods. Continuous variables were analyzed by using Student’s t or Mann–Whitney tests, and categorical variables were analyzed by using χ2 or Fisher’s exact test, as appropriate. RESULTS Our response rate was 89 of 223 (40%) presurge, 100 of 267 (37%) during the surge, and 113 of 275 (41%) postsurge. There were no differences in demographics, including sex, race, and academic rank between survey periods. Frequency of burnout was similar in all 3 periods (20% to 26%). The mean scores of emotional exhaustion improved during the surge (2.25 to 1.9; P = .04). CONCLUSIONS Contrary to our hypothesis, we found no changes in pediatric faculty burnout after a COVID-19 surge. Emotional exhaustion improved during the COVID-19 surge. However, these findings represent short-term responses to the COVID-19 surge. Longer-term monitoring of the impact of the COVID-19 surge on pediatric faculty burnout may be necessary for health care organizations to mitigate burnout.

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Clinical Characteristics and Outcomes of Hematologic Malignancy Patients with Clostridium difficile Toxin EIA vs. PCR Positive Test Results

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.987 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S396-S396

Author(s):

Matthew Ziegler ◽

Daniel Landsburg ◽

David Pegues ◽

Kevin Alby ◽

Cheryl Gilmar ◽

...

Keyword(s):

Hematologic Malignancy ◽

Tertiary Care ◽

Positive Test ◽

Categorical Variables ◽

Continuous Variables ◽

Test Results ◽

Exact Test ◽

Academic Center ◽

Chi Squared ◽

Record Review

Abstract Background C. difficile infection is common in patients with hematologic malignancy. There is increasing recognition that molecular (polymerase chain reaction, PCR) based testing lacks specificity for infection, while detecting patients with colonization. The objective of our study was to evaluate characteristics of patients with toxin enzyme immunoassay (EIA) vs. PCR positive C. difficile test results. Methods A retrospective review of inpatients at a tertiary care academic center with hematologic malignancy and a positive C. difficile test from 1/2015 to 1/2016 was performed. Data on demographics, comorbidities, clinical features, and outcomes were collected using medical record review. Characteristics were compared between patients with EIA vs. PCR positive test results using chi-squared or Fisher’s exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. Results A total of 130 patients were included: 51% and 49% had a PCR positive and EIA positive result, respectively. Diagnoses included AML (42%), multiple myeloma (22%), and Non-Hodgkin’s lymphoma (13%). Antibiotic exposure was similar, with a median of 4 days of anti-pseudomonal antibiotics received in the prior 30 days. There was no difference in history of a positive C. difficile test in the prior year (12% in the EIA group, 10% in the PCR group, P = 0.71). Patients with EIA positive results were more likely to have a WBC ≥15/mm3 (18% vs. 6%, P = 0.02). However, there were no differences in presence of fever, stool frequency, or imaging evidence of colitis at the time of testing. Medications in the prior 72 hours were similar, including the use of proton pump inhibitors of ~40% and of laxatives of 28%. Clinical outcomes were also similar between patients with EIA vs. PCR positive tests: all-cause death (22% vs. 20%), recurrent CDI (9% vs. 13%), colectomy (1% vs. 4%), and megacolon (0% vs. 3%). Most patients received treatment with oral vancomycin for a median duration of 14 days. Conclusion In patients with hematologic malignancy, those with EIA vs. PCR positive C. difficile test results were clinically similar. These findings suggest that algorithms for testing and treatment of C. difficile in hematologic malignancy patients will need to be specifically targeted towards this immunocompromised population. Disclosures All authors: No reported disclosures.

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Comparison of intravenous hydralazine and intravenous labetalol in the management of severe hypertensive disorders of pregnancy: a tertiary care centre study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182330 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2251

Author(s):

Manvi Verma ◽

Shashi Gupta ◽

B. R. Bhagat ◽

Aakanksha Mahajan ◽

Baseerat Kaur

Keyword(s):

Adverse Effects ◽

Severe Hypertension ◽

Tertiary Care ◽

Fetal Outcome ◽

Categorical Variables ◽

Tertiary Care Centre ◽

Low Birth Weight Infants ◽

Chi Square ◽

Exact Test ◽

Student’S T

Background: Severe hypertension in pregnancy (SBP ≥160 mmHg &/or DBP ≥ 110 mmHg) must be treated judiciously to prevent maternal and fetal complications. The study was conducted to compare the efficacy, adverse effects, maternal and fetal outcome between Hydralazine and Labetalol which are the most commonly used drugs for the purpose.Methods: In a prospective study, 130 pregnant patients each with severe hypertension presenting to SMGS Hospital Jammu were randomized in 2 groups and administered hydralazine or labetalol intravenously. The efficacy of the two drugs was measured in terms of number of doses required to obtain target BP and the timing to achieve the same. The incidence of adverse effects, maternal and fetal outcomes were also compared. Comparisons among the two groups was performed by using independent Student’s t test for normally distributed variables, Fishers’ exact test, and Pearson Chi Square test for categorical variables. The level of significance was set at p<0.05 for all analysis.Results: There was no statistical difference between the two drugs in terms of efficacy. Significantly more low-birth weight infants were born in the hydralazine group. Also, the adverse effects were significantly more in the hydralazine group.Conclusions: Both hydralazine and labetalol can be used to treat hypertensive emergencies of pregnancy but hydralazine is associated with more side effects.

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Vanishing congenital lung malformations: What is the incidence of true regression?

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-210740 ◽

2021 ◽

pp. 1-7

Author(s):

C. Griggs ◽

M. Schmaedick ◽

C. Gerall ◽

W. Fan ◽

C. Orlas ◽

...

Keyword(s):

Neonatal Intensive Care ◽

Statistical Significance ◽

Multivariable Analysis ◽

Retrospective Chart Review ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Exact Test ◽

Congenital Lung Malformation ◽

Nicu Admission

BACKGROUND: A congenital lung malformation (CLM) that is diagnosed on prenatal ultrasound exam may subsequently become undetectable on later scans, a “vanishing” CLM. OBJECTIVE: The purpose of our study is to characterize the prenatal natural history and postnatal outcomes of “vanishing” lesions treated at our institution. METHODS: We performed a retrospective chart review of 107 patients diagnosed prenatally with CLM at our institution. Comparisons were made using Kruskal-Wallis or t-test for continuous variables and Fisher’s exact test or Chi-Square test for categorical variables. Multivariable analysis using logistic regression was performed. RESULTS: Of the 104 patients, 59 (56.7%) had lesions that became sonographically undetectable on serial ultrasound scans. Patients with lesions that vanished prenatally tended to need less Neonatal Intensive Care Unit (NICU) admission at birth (persistent CLM: 54.8%vs vanished CLM: 28.8%), decreased need for supplemental O2 at birth (persistent CLM: 31.0%vs vanished CLM: 11.9%), and decreased delay in feeds (persistent CLM: 26.2%vs vanished CLM: 8.5%) compared to those with persistent CLM. After multivariate analysis controlling for maternal steroid administration and sex, admission to NICU maintained a slight statistical significance, with patients in the vanishing CLM group 2.5 times less likely to be admitted to the NICU. None of our patients whose lesions vanished prenatally required mechanical ventilation. Eighty-six patients underwent postnatal computed tomography (CT) chest. Only 2 patients had lesions that regressed on postnatal CT. CONCLUSION: Lesions that vanish on prenatal imaging may be associated with improved clinical outcomes. The rate of true regression at our institution was as low as 2.3%.

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Abstract TP236: Eval to Groin Puncture Times: Efficiencies and Deficiencies of Live Physician vs Telemedicine Triage

Stroke ◽

10.1161/str.51.suppl_1.tp236 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

David Rosenbaum-Halevi ◽

Sujan T Reddy ◽

Alyssa D Trevino ◽

Muhammad Bilal Tariq ◽

Mahan Shahrivari ◽

...

Keyword(s):

Primary Outcome ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Specific Level ◽

Site Specific ◽

Exact Test ◽

Wilcoxon Rank Sum Test ◽

Significant Difference ◽

A Site

Introduction: Telemedicine (TM) is increasingly implemented in community hospitals acute ischemic stroke (AIS). The efficiency of TM to facilitate thrombectomy (IAT) is unknown. We addressed this question by studying our spoke hospitals which are staffed by both in-person (IP) consultation (Day: 8am-5pm) and TM (Night: 5pm-8am) to analyze differences between TM and IP and comparing to our university hub which has IP staffing day and night. Methods: We performed a retrospective analysis from 3/2016 to 3/2019 of all IAT cases directly admitted to 4 IAT capable centers (1 hub + 3 spokes) in our system. Demographic, clinical, and time metrics were analyzed. Primary outcome was door to groin (DTG) time. Continuous variables were analyzed with Wilcoxon rank sum test, and categorical variables with chi-square or Fischer’s exact test. Results: Table 1 summarizes the cohort. Eval to tPA (ETPA) time was faster at spokes vs hub (p < 0.0001), with no significant difference in DTG between spoke and hub (p= 0.444). At spokes, while DTPA times were no different between IP and TM at spokes, IP achieved faster DTG times (p<0.0001) (Fig.1A). DTG was equal during day vs. night at the hub. At the spokes, day (IP) DTG times were faster than night (TM) at some but not all spokes (Fig.1B). TPA administration did not delay DTG at either the hub or the spokes (Fig. 1C). At spokes, TM-TPA cases were associated with faster DTG than TM-noTPA (Fig. 1D). Conclusions: While no difference is noted between TM and IP in rapid TPA treatment, our data show delayed DTG at spokes during the TM day and night service. While DTG in TM was prolonged, differences in spoke metrics imply that availability of staff and resources play a significant role. Further analysis is needed to identify factors that prolong DTG at a site-specific level.

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Abstract TP69: Safety and Outcomes of IV Thrombolysis with Alteplase for Acute Ischemic Stroke Patients with Thrombocytopenia

Stroke ◽

10.1161/str.48.suppl_1.tp69 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Haris Kamal ◽

Nour Abdelhamid ◽

Liang Zhu ◽

Sean Savitz ◽

James Grotta ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Strong Evidence ◽

Demographic Data ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Exact Test ◽

Chi Square Test ◽

Iv Tpa

Background: Intravenous tPA (IV tPA) has been the mainstay for reperfusion therapies for acute ischemic stroke (AIS) patients for 2 decades. Many contraindications from the initial NINDS trial were derived from experts’ consensus and not tested in the trial. Many AIS patients present with thrombocytopenia (< 100,000) and may be excluded from treatment in spite of lack of strong evidence. Some clinicians opt to treat these patients weighing the benefits and risks along with the lack of strong evidence behind this exclusion. We sought to evaluate the safety in AIS patients with low platelets receiving IV tPA as compared to those who do not. Methods: Restrospective chart review of all patients presenting with AIS between 1/2006 to 7/2016 at our center. We analyzed patients who had platelets <100,000 among this cohort and stratified them into those who were treated with IV tPA and those who received antiplatelet therapy only. Demographic data, medical history, medications, presence of sICH after treatment, presenting NIHSS were collected. Two sample Wilcoxon rank sum test was used to compare continuous variables between the two groups, and chi-square test or Fisher’s exact test used to compare categorical variables. Results: 21 patients were treated with IV tPA while 122 patients were treated with antiplatelets. Table 1 lists the demographic variables of the two groups with and without IV tPA. Patients included had moderate thrombocytopenia with very few <50,000. No significant differences were found in presenting NIHSS, race, gender, and history of atrial fibrillation between the two groups except platelets (p=0.0128), age (p=0.0462) and glucose (p=0.0279). Table 2 lists the outcome variables of mRS and symptomatic ICH. There was no petechial or sICH among 21 treated patients. Conclusion: While limited by small numbers and lack of randomization, our data suggest that IV tPA is safe in patients with moderately reduced platelet counts.

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Single Center Outcomes of Status Epilepticus at a Paediatric Intensive Care Unit

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.307 ◽

2015 ◽

Vol 43 (1) ◽

pp. 105-112 ◽

Cited By ~ 3

Author(s):

Samir Shah ◽

Namrata Shah ◽

Robert Johnson ◽

Alina Nico West ◽

Narayan Prasad

Keyword(s):

Intensive Care ◽

Status Epilepticus ◽

Tertiary Care ◽

Unfavorable Outcome ◽

Paediatric Intensive Care ◽

Categorical Variables ◽

Admission Diagnosis ◽

Continuous Variables ◽

Exact Test ◽

Refractory Seizures

AbstractBackground:Status epilepticus (SE) is a frequent admission diagnosis to paediatric intensive care units (PICUs) and is associated with variable outcomes. We have audited our experience of patients presenting in SE at a Canadian PICU to determine unfavorable outcome variables.Methods:Charts of patients <18 years of age presenting in SE to a tertiary care PICU over a 10-year period were audited. Data were analyzed at three care-points: transport, the emergency department (ED) and the PICU. Patient outcome before PICU discharge was categorized as “favorable” for return to pre-status functioning level or “unfavorable” for new deficit/death. Student’st-test andthe Kruskal-Wallis test were used for analysis of normal and skewed continuous variables, respectively, and either Chi-square test or Fisher’s exact test for categorical variables.Results:189 patients (54% males) were identified with a median age of 1.9 years. Idiopathic SE had the highest incidence; infectious/vascular etiologies were associated with more unfavorable outcomes. Progression to refractory SE in the ED had a higher incidence of death (p<0.05). Patients with an unfavorable outcome had a higher incidence of apnea during transport (p=0.01), longer hospital stays (p<0.05), need for therapeutic coma (p=0.01), longer duration of therapeutic coma (p<0.05), need for mechanical ventilation (p<0.05), and recurrent or refractory seizures during inpatient stay (p<0.05). Multivariate analysis of unfavorable outcomes of patients in SE presenting to the PICU included renal failure, cerebral edema, apnea during transport, refractory seizures, and recurrent seizures.Conclusions:Refractory seizures in children presenting with SE are associated with worsened outcomes in the PICU.

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Histomorphology of germ cell tumors at various anatomic sites: a 5 years study at a tertiary care centre

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20213936 ◽

2021 ◽

Vol 9 (10) ◽

pp. 3079

Author(s):

Manal A. Lateef ◽

M. I. Lone

Keyword(s):

Germ Cell ◽

Malignant Tumors ◽

Tertiary Care ◽

Germ Cell Tumors ◽

Cystic Teratoma ◽

The Body ◽

Categorical Variables ◽

Continuous Variables ◽

Tertiary Care Centre ◽

Exact Test

Background: Germ cell tumors (GCTs) are a heterogeneous group of neoplasms, which occur in the gonads, and at extra gonadal sites of the body. The aim of the study was to observe the different histopathological patterns of various GCTs in the body at all possible sites and to know their IHC staining patterns.Methods: The study was conducted for a period of 5 years from 2015 to 2019 and was an observational study. The recorded data was compiled and entered in a spreadsheet and then exported to data editor of SPSS Version 20.0. Continuous variables were expressed as mean SD and categorical variables were summarized as frequencies and percentages. Graphically the data was presented by bar and pie diagrams Chi-square test or Fisher’s exact test was applied for comparing categorical values. P<0.05 was considered statistically significant. All p values were 2 tailed.Results: A total of 93 cases were analyzed and the mean age of the patients was 27.8 years. Mature cystic teratoma was the most common histopathological variant and was mostly seen in the ovaries. There was a difference in age predilection of benign and malignant tumors. Most of the malignant GCTs were gonadal while EGCTs were likely to be benign. MGCTs (mixed GCTs) were mostly testicular in origin with only one MGCT being extragonadal.Conclusions: Mature cystic teratomas were the most frequent GCTs with frequent site being in ovaries. Out 0f 18 EGCTs only 2 were malignant, rest all were mature cystic teratomas.

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