scholarly journals Characteristic of COVID-19 infection in pediatric patients: early findings from a tertiary care center, Nagercoil, Tamil Nadu, India

2020 ◽  
Vol 7 (10) ◽  
pp. 2048
Author(s):  
Babitha Rexlin G. ◽  
Suresh P. M.
Keyword(s):  
Tamil Nadu ◽  
Care Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Respiratory Illness ◽  
Family Welfare ◽  
P Value ◽  
Mild Disease ◽  
Tertiary Care Facility

Background: The planet faces a new challenge with COVID-19 disease caused by novel SARS-CoV2. Pediatric COVID-19 is considered to be mild. Methods: The study aim was to describe the clinical presentation, diagnostic findings and outcome of a cohort of paediatric patients according to Ministry of health and family welfare (MOHFW) criteria, at KKGMCH a tertiary care facility in Kanyakumari district. It’s a retrospective chart review including data of children aged 0 to 12 years with COVID-19 from 20 March to 19 July 2020. Results: Of the 137 children with COVID-19, 17 (12.45%) were infants, 65 (35%) were 1-5 years and 72 (52.55%) were 6-12 years. Age didn’t have influence on acquiring the illness as p value is 0.125. Age had no influence on severity too as p value is 0.28. 46.7% were female and 53.3% were male. There was an apparent male preponderance with (OR 1.63, 95% CI 1.00 to 2.21) but a non-significant p value of 0.54. of the 34 (24.8%) mild symptomatic, 22 (64.7%) were males and 12 (35.2%) were females. The p value is 0.086 stating gender non-influential on severity. 129 (94.1%) children had contact history. The contacts were parents or close relatives. No child with comorbidity presented during this period. Most common clinical features were fever (8.76%), cough (6.6%), rhinorrhoea (2.2%), vomiting (2.9%) and diarrhoea (1.5%). Children never progressed to severe respiratory illness requiring intensive care as per MOHFW criteria. 1 (0.7%) presented with focal consolidation in chest x-ray. All 137 (100%) children got cured.Conclusion: Study concludes pediatric COVID-19 is a mild disease without mortality at beginning of pandemic in Kanyakumari district. Factors like age and gender neither influenced the occurrence of the disease nor the severity.

scholarly journals Immunization status of children aged 1-5 years attending tertiary care center and reasons for partial or non-immunization

2020 ◽  
Vol 7 (10) ◽  
pp. 1978
Author(s):  
Babitha Rexlin G. ◽  
Suresh Placode Manikandan
Keyword(s):  
Tamil Nadu ◽  
Parental Education ◽  
Care Center ◽  
Tertiary Care ◽  
Family Health ◽  
Female Gender ◽  
Home Delivery ◽  
Family Welfare ◽  
P Value ◽  
Immunization Status

Background: Immunization is a reliable evidence-based approach to eradicate deadly infectious diseases. National family health survey (NHFS4) data reveals that immunization after 1 year of age dropped in Kanyakumari district, Tamil Nadu, India.  Methods: Our aim was to determine immunization status and reasons for partial or non-immunization of children aged 1 to 5 years in Kanyakumari district from April 2019 to March 2020. It’s a prospective and descriptive hospital-based study. Here 613 children were split-up in three categories based on ministry of health and family welfare (MOHFW) guidelines as fully, partially or unimmunized. The samples were analysed with IBM. SPSS statistics software 23.0 Version.Results: Of the 613 children 5 were excluded from the study due to contraindications to immunizations. Of the 608 children 529 (87%) were fully immunized, 79(13%) were partially immunized and none were unimmunized. Among partially immunized, 2 parents lacked information (2.5%), 26 parents lacked motivation (32.9%), 45 parents faced obstacles (57%) and 6 parents had other reasons (7.6%). 2 parents who lacked information were migrant laborers, illiterates and the children were home delivered. In the partial immunization, chi-square and regression analysis revealed that for female gender the p-value was 0.001, OR 2.084 with 95% confidence interval (CI) (1.347 to 3.226), for parental education the p-value was 0.0005, OR 1.561 with 95% CI (1.034 to 2.335) and for home delivery the p value was 0.0005, OR 1.564 with 95% CI (1.006 to 2.432).  Conclusions: The study determines that factors associated with partial immunization are female children, illiterate/less educated parents and home delivery.  

S210 – Asymmetric Sudden SNHL: Is All This Screening Necessary?

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P146-P146
Author(s):  
Selena E. Heman-Ackah ◽  
Dunn Ryan ◽  
Tina C. Huang
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Diagnostic Evaluation ◽  
Diagnostic Screening ◽  
Tertiary Care Facility

Objectives A number of factors have been identified that contribute to the presentation of asymmetric sudden sensorineural hearing loss (ASSNHL). Routinely patients presenting with ASSNHL undergo a battery of serologic testing and imaging in an attempt to determine a cause. The study will assess the utility of this diagnostic evaluation in elucidating a cause of an asymmetric sensorineural hearing loss. At the conclusion of this presentation, the participants should be able to: 1) Understand the utility of diagnostic screening in the management of ASSNHL. 2) Understand the cost-effectiveness of the diagnostic screening for ASSNHL. Methods The study design is a retrospective chart review. Charts from patients presenting to the otolaryngology clinic of a tertiary care facility between January 1, 2000, and November 30, 2007, with ASSNHL confirmed with audiometric evaluation were reviewed. Diagnostic tests included in the work-up of ASSNHL and test results were recorded. Percentage of positive tests was determined and compared to national data. Cost analysis of the diagnostic battery was performed. Results All patients presenting with sudden sensorineural hearing loss received 1 or more of the following serologic and radiographic tests: ANA, cholesterol, creatinine, DNA-ds, ESR, blood glucose, Lyme titer, rheumatoid factor, RPR, FTA-ABS, HSP, T3, TSH and MRI with gadolinium. The average cost associated with the full diagnostic evaluation is greater than $1,500. The positive rate for any of these tests was extremely low. Conclusions The utility of the comprehensive ASSNHL evaluation should be reconsidered. The choice of diagnostic evaluation should be directed by patient risk factors and exposures.

scholarly journals Utilization and Diagnostic Yield of Neurogenetic Testing at a Tertiary Care Facility

2007 ◽  
Vol 53 (6) ◽  
pp. 1016-1022 ◽  
Author(s):  
Kerstin L Edlefsen ◽  
Jonathan F Tait ◽  
Mark H Wener ◽  
Michael Astion
Keyword(s):  
Positive Result ◽  
Diagnostic Yield ◽  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Molecular Genetic ◽  
Tertiary Care ◽  
Care Facility ◽  
Utilization Review ◽  
Tertiary Care Facility

Abstract Background: Institutions face increasing charges related to molecular genetic testing for neurological diseases. The literature contains little information on the utilization and performance of these tests. Methods: A retrospective utilization review was performed to determine the diagnostic yield of neurogenetic tests ordered during calendar year 2005 at a large academic medical center in the western United States. Results: Overall, a relevant mutation was identified in 30.2% of the 162 patients tested and in 21.5% of the 121 probands, defined as patients for whom no mutation has been previously identified in a family member. Patients with muscle weakness (n = 65) had a mutation detected in 26.2% of all patients and 23.5% of probands (n = 51), with an estimated testing cost per positive result of $3190. Patients tested for neuropathy (n = 36) had a mutation detected in 27.8% of patients and 22.6% of probands (n = 31), with an estimated cost per positive result of $5955. Patients with chorea (n = 25) had a positive result obtained in 68% of patients and 71.4% of probands (n = 7); the estimated cost per positive test was $440. Other diagnostic categories evaluated include ataxias (n = 18; yield, 11.1%; $7620 per positive), familial stroke or dementia syndromes (n = 8; yield, 12.5%; $6760 per positive), and multisystem mitochondrial disorders (n = 10; yield, 20%; $6485 per positive). Conclusions: Expert clinicians at a tertiary care center who ordered neurogenetic tests obtained a positive result in 21.5% of patients without previously identified familial mutations. These results can be used for comparison and to help establish utilization guidelines for neurogenetic testing.

Understanding the Role of the Otolaryngology Hospitalist: Tracheostomies and Tracheostomy Care

2021 ◽  
pp. 000348942110457
Author(s):  
Mohamad Issa ◽  
Nadeem El-Kouri ◽  
Sara Mater ◽  
Jonathan Y. Lee ◽  
Carl Snyderman ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Wait Time ◽  
High Volume ◽  
Care Team ◽  
Consulting Services ◽  
Tertiary Care Facility

Introduction: The concept of a hospitalist has been well established. This model has been associated with reduced length of stay contributing to reduction in healthcare costs. Minimal literature is available assessing the effects of an otolaryngology (ENT) hospitalist at a tertiary medical center. The aim of this study is to assess the role of an ENT hospitalist on (1) performing tracheostomies and (2) providing care as part of the tracheostomy care team (TCT). Methods: Retrospective chart review of all tracheostomies performed by the ENT service over 2 years (July 2015-June 2017), and prospective data collection of all tracheostomy care consults over 1 year (July 2016-June 2017). In year 1 (from July 2015 to June 2016), no ENT hospitalist was employed, and in year 2 (from July 2016 to June 2017), an ENT hospitalist was employed. Results: Compared to other Ear, Nose, and Throat (ENT) surgeons, the ENT hospitalist performed tracheostomies with shorter patient wait times, and performed a greater proportion of percutaneous tracheostomies at the bedside versus open tracheostomies in the operating room. The tracheostomy care team (TCT) received 91 consults over the course of 1 year with an average of 1.1 billable procedures generated per consult. Conclusion: In this study, an ENT hospitalist was decreased patient wait time to tracheostomy and increased bedside percutaneous tracheostomies, which has positive implications for resource utilization and healthcare cost. The average wait time to receive a tracheostomy was reduced when calculated across the entire department due to the availability of the ENT hospitalist to see and perform tracheostomies. The TCT generated many billable bedside procedures in addition to encouraged decannulation of patients. This study highlights the fact that the ENT hospitalist contributes to providing expedient tracheostomies and provides valuable consulting services as part of a TCT at a high-volume tertiary care facility.

scholarly journals Bleb-Related Endophthalmitis: A 15-Year Review

2018 ◽  
Vol 3 (1) ◽  
pp. 21-27
Author(s):  
Lekha K. Mukkamala ◽  
Tian Xia ◽  
Rana Mady ◽  
Lisa Athwal ◽  
Marco A. Zarbin ◽  
...  
Keyword(s):  
Open Angle Glaucoma ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Glaucoma Surgery ◽  
Patient Characteristics ◽  
Light Perception ◽  
Hand Motion ◽  
Tertiary Care Facility ◽  
Systemic Antibiotics

Purpose: The purpose of this study is to describe the patient characteristics, management, and outcomes of bleb-related endophthalmitis (BRE). Methods: A retrospective chart review was conducted of patients who presented to a tertiary care facility from 2001 to 2016 with BRE. Collected data included demographics, medical and ocular history, visual acuity (VA), intraocular pressure (IOP), presence of hypopyon, treatment, microbiology, visual outcomes particularly of VA and IOP, and complications. Results: Thirty-six eyes (36 patients: 21 females, mean 66.8 years old, 78% with primary open-angle glaucoma) presented an average of 4.5 years (range, 2 days-33 years) after glaucoma surgery (30 trabeculectomies with mitomycin C, 6 tube shunts) with endophthalmitis. Mean VA and IOP at presentation were hand motion (HM; logMAR 2.1) and 19.9 mmHg, respectively, with 82% displaying hypopyon and 87% with purulent blebitis. Eighteen (50%) eyes (mean VA HM) underwent vitreous tap and injection (T/I) of intravitreal antibiotics (vancomycin 1 mg/0.1 cc and ceftazidime 2.25 mg/0.1 cc), and 18 (50%) eyes (mean VA HM) underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. Eight (45%) eyes initially treated with T/I required a subsequent PPV, and 5 (28%) eyes treated initially with PPV underwent a second PPV. All patients also received systemic antibiotics (33 intravenous [IV] and 3 oral) and topical medications. Average time to documented resolution was 15 days, with mean VA of HM and IOP of 13.6 mmHg. Thirty-one (86%) eyes had vision worse than 20/200 at resolution, and those presenting with light perception or no light perception (NLP) vision (n = 6) had worse vision final VA (logMAR 2.6) than those with initial vision of HM or better (final VA logMAR 1.7). Three (8.6%) eyes were enucleated, with 4 worsening to NLP during the course of the infection. Conclusions: BRE is a visually devastating infection requiring prompt diagnosis and management. Despite aggressive treatment with antibiotics, visual prognosis is poor.

scholarly journals WILSON’S DISEASE

2015 ◽  
Vol 22 (12) ◽  
pp. 1586-1590
Author(s):  
Sunil Kumar ◽  
Awais Bashir ◽  
Raheel Ahmed
Keyword(s):  
Wilson’S Disease ◽  
Tertiary Care ◽  
Care Facility ◽  
Wilson's Disease ◽  
P Value ◽  
Chi Square ◽  
Female Ratio ◽  
Male Predominance ◽  
Tertiary Care Facility ◽  
Chi Square Test

Objectives: To determine the frequency of various neurological manifestationsof Wilson’s disease in patients presenting to tertiary care facility. Study design: Cross sectionalstudy. Setting: Neurology ward, JPMC, Karachi. Period: 14-03-2012 to 13-09-2012. Patientsand Methods: A total of 150 diagnosed patients of Wilson’s disease between the age 15 and55 years were recruited. Structured questionnaire was used to collect the data regardingneurological manifestations of Wilson’s disease along with slit lamp examination for kayser-Fleischer rings. Data were entered and analyzed in SPSS version 17. Chi-Square test was usedas test of significance. Results: Mean age + S.D of patients was 38.7 + 8.23 years. Most of thepatients (42%) belongs to age between 41 to 50 years. Male to female ratio was 2:1. Tremorwas the most common neurological manifestation (88.7%) followed by dysarthria in 77.3%,dystonia was present in 59.3%, chorea in 36%, and Parkinsonism in 28.7%. All patients hadthe Kayser-Fleischer ring positive. Upon stratification of gender, tremor & dysarthria were morecommon in males as compared to females. Only dysarthria was significantly noted to increasewith increasing age up to 5th decade of life and decreased after age of 51 years. (P value< 0.001). Conclusion: Neurologic manifestations are very common in patients of Wilson’sdisease, tremor being the most common with male predominance.

Emergency General Surgery Regionalization: Retrospective Cohort Study of Emergency General Surgery Patients at a Tertiary Care Center

2021 ◽  
pp. 000313482110385
Author(s):  
Sullivan A. Ayuso ◽  
Sharbel A. Elhage ◽  
Kyle W. Cunningham ◽  
A. Britton Christmas ◽  
Ronald F. Sing ◽  
...  
Keyword(s):  
General Surgery ◽  
Tertiary Care Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
Geographic Origin ◽  
Care Facility ◽  
Care Hospital ◽  
Emergency General Surgery ◽  
Tertiary Care Facility ◽  
Tertiary Care Hospitals

Background Emergency general surgery (EGS) patients presenting at tertiary care hospitals may bypass local hospitals with adequate resources. However, many tertiary care hospitals frequently operate at capacity. We hypothesized that understanding patient geographic origin could identify opportunities for enhanced system triage and optimization and be an important first step for EGS regionalization and care coordination that could potentially lead to improved utilization of resources. Methods We analyzed patient zip code and categorized EGS patients who were cared for at our tertiary care hospital as potentially divertible if the southern region hospital was geographically closer to their home, regional hospital admission (RHA) patients, or local admission (LA) patients if the tertiary care facility was closer. Baseline characteristics and outcomes were compared for RHA and LA patients. Results Of 14 714 EGS patients presenting to the tertiary care hospital, 30.2% were categorized as RHA patients. Overall, 1526 (10.4%) patients required an operation including 527 (34.5%) patients who were potentially divertible. Appendectomy and cholecystectomy comprised 66% of the operations for potentially divertible patients. Length of stay was not significantly different ( P = .06) for RHA patients, but they did have lower measured short-term and long-term mortality when compared to their LA counterparts ( P < .05). Conclusions EGS diagnoses and patient geocode analysis can identify opportunities to optimize regional operating room and bed utilization. Understanding where EGS patients are cared for and factors that influenced care facility will be critical for next steps in developing EGS regionalization within our system.

scholarly journals 748. The Impact of a Positive Respiratory Viral Panel Among Hospitalized Adult Patients with Negative Rapid Influenza Testing at an Academic Tertiary Care Facility: A-matched Cohort Study

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S268-S268
Author(s):  
Emily Ciccone ◽  
Alan Kinlaw ◽  
Vahini Chundi ◽  
Melissa Miller ◽  
David Weber ◽  
...  
Keyword(s):  
Clinical Management ◽  
Tertiary Care ◽  
Care Facility ◽  
Respiratory Illness ◽  
Adult Patients ◽  
Nucleic Acid Amplification ◽  
Matched Cohort ◽  
Research Support ◽  
Tertiary Care Facility ◽  
The Impact

Abstract Background Multiplex nucleic acid amplification assays (NAATs) are increasingly used to evaluate respiratory illnesses. Viral diagnosis has the potential to change clinical management and, specifically, decrease antibiotic use. However, the assays are expensive, and their effect on clinical management is unknown. This study evaluated the incremental impact of a multiplex respiratory viral panel after negative rapid influenza testing. Methods We completed a retrospective review of all adult patients with respiratory viral panel (RVP; GenMark) and/or rapid influenza or RSV/influenza PCR tests (PCR; Cepheid Xpert) collected within 48 hours of admission to non-ICU, inpatient units from September 1, 2015 to April 15, 2016. We matched hospitalizations with a positive RVP simultaneously with or following negative PCR testing (PCR−RVP+) 1:1 with patient encounters with negative rapid PCR testing only (PCR−). Matching of the referent PCR-group occurred without replacement based on age (±10 years), sex, race, season of testing (±50 days), and any respiratory viral test in the prior 30 days. The primary outcome was a change in management, defined as antimicrobial de-escalation (discontinuation, switch from intravenous to oral administration, and/or narrowing of spectrum), antiviral initiation, and/or change in isolation precautions. Results During the study period, there were 153 PCR−RVP+ patient encounters and 524 with PCR− testing only from which we identified 134 matched pairs. In the matched cohort, the median age was 60 years (IQR: 41–71), 47.8% were female, and 34.3% were non-White. Respiratory viral testing was associated with management change in 3.7% of PCR− and 23.9% of PCR−RVP+ patients (risk difference 20.1%; 95% CI 12.2–28.0%). Antimicrobial de-escalation did not occur after testing for any PCR- patients but did occur for 15.7% of PCR−RVP+ patients (95% CI 9.5–21.8%). Conclusion Among patients with negative rapid influenza testing, a subsequent or simultaneous positive RVP was associated with a higher frequency of antibiotic de-escalation. This suggests multiplex NAATs could play a role in improving antimicrobial stewardship in the setting of respiratory illness. Disclosures M. Miller, GenMark: Investigator, Research support. R. Jhaveri, GenMark: Investigator, Research support.

scholarly journals Accurate Operative Time Prediction in Thyroid Surgery: A Rural Tertiary Care Facility Experience

2021 ◽  
pp. 014556132110167
Author(s):  
Kevin P. Stavrides ◽  
Timothy L. Lindemann ◽  
Evan J. Harlor ◽  
Thorsen W. Haugen ◽  
Nicholas Purdy
Keyword(s):  
Operative Time ◽  
Care Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Time Estimation ◽  
Patient Characteristics ◽  
Endocrine Surgery ◽  
Time Averaging ◽  
Tertiary Care Facility ◽  
Mean Differences

Objective: To determine whether surgeons can estimate thyroid operative time more accurately than a system-generated average time estimate. Methods: Four otolaryngologists at a single institution with extensive endocrine surgery experience were asked to predict their operative times for all eligible thyroid surgeries. These estimates were compared to system-generated operative time predications based on averaging the surgeon’s previous 10 cases with the same Current Procedural Terminology code. The surgeon-generated estimations and system-generated estimations were then compared to each other and the actual operative time. Results: A final sample of 73 cases was used for all analyses. Average age was 51 years old and the majority of patients were female. Surgeon-generated operative time estimates were significantly more accurate than system-generated estimates based on time averaging ( P < .001). These findings were consistent across each surgeon individually and within each procedure type (hemithyroidectomy and total thyroidectomy). These findings had a power of over 99% based on mean differences. Conclusion: As the financial center of modern hospitals, an efficient operating room is integral to economic success. Improving the precision of operative time estimation reduces costly unplanned staff overtime, canceled cases, and underutilization. Our research at a rural tertiary care center shows that experienced thyroid surgeons can substantially reduce the error of estimating thyroid operative times by considering individual patient characteristics. Although no objective variables have so far been identified to correlate with thyroid operative time, surgeon-generated operative time estimation is significantly more accurate than a generic system approach of averaging previous operative times.

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