scholarly journals Epidemiological, clinical profile and outcome of multi-system inflammatory syndrome in children (MIS-C) admitted in government tertiary care hospital of Kanyakumari district

2021 ◽  
Vol 8 (11) ◽  
pp. 1879
Author(s):  
Steeve Gnana Samuel ◽  
Suresh Placode Monikanta ◽  
Arul Prasath Subramoniam Vasudevan ◽  
Nagalekshmi Rajamanickam
Keyword(s):  
Tertiary Care ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Intensive Care Treatment ◽  
Care Hospital ◽  
Cutaneous Manifestations ◽  
Female Ratio ◽  
Wide Range ◽  
High Index Of Suspicion ◽  
Inflammatory Syndrome

We report twelve children with a median age of 7 year (IQR 3years to 12 years) who fulfilled MIS-C WHO criteria. The male to female ratio was 2:1. Affected children had gastrointestinal symptoms (92%), respiratory symptoms (67%), cardiovascular symptoms (58%), neurological symptoms (50%), renal symptoms (33%), followed by muco-cutaneous manifestations (25%). 83% of children had lymphocytopenia. It was found that lymphocytopenia was directly correlated to disease severity. The majority of the children had elevated CRP, transaminase, and deranged coagulation profiles. All 4 systems were involved in 7 children (58%). Intensive care treatment was required for all the cases (100%). There were no deaths. Children with coronavirus disease 2019 (COVID-19) associated MIS-C can present with a wide range of signs and symptoms. They can deteriorate quickly and hence a high index of suspicion; early referral and early initiation of treatment with steroids and IVIg can save the lives of children with MIS-C.

scholarly journals Incidence of scrub typhus in a tertiary care hospital in Kolkata, India

2020 ◽  
Vol 7 (5) ◽  
pp. 825
Author(s):  
Kausik Munsi ◽  
Sayonee Das ◽  
Ramiz Islam ◽  
Parvez Shahide Biswas ◽  
Satyabrata Ganguly ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Signs And Symptoms ◽  
Care Hospital ◽  
Female Ratio ◽  
Gi Symptoms ◽  
Ns1 Antigen ◽  
Morbilliform Rash ◽  
Almost All

Background: Authors aimed to identify incidence of scrub typhus among patients of fever. Scrub typhus is an endemic disease in India caused by Orientia tsutsugamushi, transmitted by trombiculid mites. It is an important cause of acute febrile illness in India. Signs and symptoms include fever, headache, myalgia and GI symptoms and is generally associated with morbilliform rash (<40%), eschar (<50%) which is due to bite of the mite. Abnormal LFTs and lymphocytosis are commonly seen in early phase of illness. It’s often labelled as PUO. Early diagnosis and prompt administration of therapy mostly leads to complete recoveryMethods: Authors screened 100 patients presenting with fever, malaise, headache, with or without rash for more than a week from the month of May to December 2019. Routine blood investigations with fever profile (Dengue NS1 antigen, MP, MPDA, TyphidotM) and cultures were done. Patients in whom no cause of fever could be established, having lymphocytosis, hyponatremia and transaminitis, they were tested for Scrub typhus by using Indirect immunofluorescence & detection of IgM antibody.Results: Total 22 patients were found positive for scrub typhus by using the aforementioned method (22%). Male: Female ratio was 3:4 (9 vs 12). Patients were in the age group of 16-76 years. Lymphocytosis, hyponatremia and transaminitis were cardinal features seen in almost all patients diagnosed with Scrub Typhus.Conclusions: This study will help clinicians to have a stronger suspicion of scrub typhus in undiagnosed febrile patients.

scholarly journals Awareness and Community Response To Stroke Signs and Symptoms Following the National ‘Act Fast’ Campaign in An Ethnically Diverse Population

2021 ◽  
Author(s):  
Zain A. Bhutta ◽  
Sameer A. Pathan ◽  
Tuukka Puolakka ◽  
Naveed Akhtar ◽  
Stephen H. Thomas ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Signs And Symptoms ◽  
Community Response ◽  
Stroke Onset ◽  
Care Hospital ◽  
Stroke Patients ◽  
Convenience Sample ◽  
Total N ◽  
Female Ratio ◽  
Study Population

Abstract Background Evaluation of public education stroke campaigns and behavioral studies to assess emergency response at stroke onset are scarce. We aimed to assess patient’s and bystanders’ foreknowledge of stroke signs and symptoms and their response at stroke onset. We also enquired if ‘Act FAST’ stroke campaign in Qatar contributed to their foreknowledge. Methods In Qatar, the first national stroke awareness campaign, ‘Act FAST’, was launched in May 2015. The study population included a convenience sample of stroke patients admitted to the stroke service in Qatar’s largest tertiary care hospital from November 2015-February 2016. We interviewed patients with acute onset stroke admitted to the stroke unit using a validated questionnaire. If the patient had disabling stroke, we interviewed relatives/bystanders present at stroke onset. The primary outcome was the correct response of calling Emergency Medical Services (EMS), recognizing the possibility of stroke. Results The questionnaire was administered to 165 participants, 142 (86.1%) stroke patients, and 23 (13.9%) bystanders. The mean age of the study population was 52.6 (SD = 11.7), and sex (male-female) ratio was 7:1. Ethnic categories were South-Asian (n = 101, 62.2%), Middle-Eastern (n = 14, 8.5%), Far-Eastern (n = 26, 15.8%), African (n = 16, 9.7%) and Others (n = 8, 4.9%). From the study group, 33 (20.1%) participants had foreknowledge of stroke signs and symptoms, and of these, 27 (16.5%) knew about the Act FAST campaign in Qatar. The behavioral responses of the participants (total n = 165) on stroke onset included; immediately activated EMS (n = 55, 33.3%), called friends/relatives (n = 69, 41.8%), drove to hospital (n = 33, 20%), decided to rest and waited for improvement in condition (n = 21, 12.7%), and 12 (7.3%) responded as none of the above. Of the participants who admitted having watched the Act FAST campaign, 92.6% (25/27) reported that the campaign affected their response to stroke onset. There was no association of ethnicity, marital status or FAST campaign awareness with behavioral response of EMS activation on stroke onset. Conclusions The foreknowledge of stroke signs and symptoms and the Act FAST campaign was low in the community. However, seeking help by activating EMS at stroke onset was generally high in the study population irrespective of the awareness to the campaign.

PREVALENCE AND CLINICAL PROFILE OF FUNCTIONAL CONSTIPATION IN CHILDREN WITH PERSISTENT GASTROINTESTINAL SYMPTOMS

2021 ◽  
pp. 30-32
Author(s):  
Sushma Keshav ◽  
Santosh Kondekar
Keyword(s):  
Tertiary Care ◽  
Gastrointestinal Symptoms ◽  
Growth Failure ◽  
Functional Constipation ◽  
Abdominal Distension ◽  
Care Hospital ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Female Ratio ◽  
Abdominal Symptoms

Background: Constipation is a common pediatric problem worldwide affecting the quality of life of children and parents. But only few children with constipation seek medical help. Alonger duration of constipation before diagnosis has been associated with complications like malnutrition, changes in behavior and growth failure and poorer long-term outcome. Methods: Children up to 12 years of age presenting to the Pediatric outpatient of a tertiary care hospital with persistent abdominal symptoms were enrolled over a period of one year. Their clinical prole was recorded and analyzed. Prevalence of functional constipation was calculated as a percentage and the association of persistent abdominal symptom with constipation was studied. Results: Amongst the 500 children studied, 84 were found to have functional constipation according to ROME IV criteria, the prevalence being 16.8%. Demographically, the mean age for cases with functional constipation was 5.19 years and the male female ratio was 1.6:1. Abdominal symptoms that were signicantly associated with functional constipation were hard stools (p 0.0001), fussy eaters (p 0.0072), abdominal distension (p 0.0053), pain abdomen (p 0.03) and decreased appetite (p0.0305). The common treatment received by these children were lactulose in 27 (32.24%), diet modication in 20 (23.8%), enema in 07 (08.33%), polyethylene glycol in 05 (05.95%) and least common was glycerin suppositories in 3 (03.57%). Conclusion: To conclude, persistent abdominal symptoms in children cannot be neglected and functional constipation must be evaluated in children coming to the outpatient with persistent abdominal symptoms.

scholarly journals EXPERIENCE OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS-2 (SARS-COV-2) - COVID-19 AT A TERTIARY CARE HOSPITAL IN QUETTA, BALUCHISTAN

2021 ◽  
Vol 71 (6) ◽  
pp. 2152-56
Author(s):  
Naveed Asif ◽  
Shahzeb Ahmed Satti ◽  
Alveena Younas ◽  
Mehwish Gilani ◽  
Waqas Shaikh ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Military Hospital ◽  
Nasopharyngeal Swab ◽  
Care Hospital ◽  
Male Predominance ◽  
Wide Range ◽  
Study Participants

Objective: To share the experience of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)-COVID-19 at a tertiary care hospital in Quetta, Baluchistan. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pathology, Combined Military Hospital Quetta, from Mar to Dec 2020. Methodology: This study included 14,741 study participants presenting to CMH Quetta with signs and symptoms of Coronavirus Disease-19 (COVID-19) and others undergoing COVID-19 PCR for screening purpose. Nasopharyngeal swab collected from these study participants were tested for COVID-19 viral RNA by real-time Reverse Transcription Polymerase Chain reaction (RT-PCR) assay. Results: Out of these 14,741 study participants, 1886 (12.7%) were found to be SARS-CoV-2 PCR positive. Among 1886 study participants, 1503 (80%) were males while 383 (20%) were females. Mean age of the study participants was 36 ± 14 years. Most frequent clinical presentations were body aches (96.5%), fever (94.1%), cough (66.8%) and loss of appetite (68.2%). Around 67 (3.5%) positive study participants were asymptomatic. Conclusion: In this study, we observed male predominance but severity of signs and symptoms among female study participants. SARS-COVID-19 caused disease with wide range of clinical spectrum and disease can be fatal as well.

A STUDY ON CLINICAL PROFILE AND OUTCOME OF SNAKE ENVENOMATION IN CHILDREN AT TERTIARY CARE HOSPITAL JHALAWAR, RAJASTHAN

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Abhishek Bansal ◽  
Kalu Ram Meena
Keyword(s):  
Tertiary Care ◽  
Clinical Signs ◽  
Public Health Problem ◽  
Pediatric Intensive Care ◽  
Signs And Symptoms ◽  
Snake Bite ◽  
Lower Limbs ◽  
Common Symptom ◽  
Care Hospital ◽  
Female Ratio

Background: Snake bite is generally considered to be a rural problem and has been linked with environmental and occupational condition is a neglected public health problem. Method: This study was conducted in children admitted with snake bite in Pediatric Intensive Care Unit in the year 2019. Their demographic details, site of bite, arrival time, 20Minutes Whole Blood Clotting time, clinical signs and symptoms, complications and outcome were measured. Results: The male: female ratio was 1.33:1. Peak age group affected was 6 to 12 years old children. Lower limbs were commonly bitten. 88.1% of children arrived in the hospital between 0 and 6 hours after the bite. Pain and swelling at the site of bite were the most common symptom of envenomation. There were only two deaths during the study period. Conclusion: Snake bite is a life threatening emergency. Identification, timely diagnosis and early administration of anti-snake venom will certainly aid to curb mortality in snake bite.

scholarly journals A Case of Early Disseminated Neurological Lyme Disease Followed by Atypical Cutaneous Manifestations

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Vamsi Kantamaneni ◽  
Vikas Sunder ◽  
Mohammad Bilal ◽  
Scott Vargo
Keyword(s):  
Lyme Disease ◽  
Tertiary Care ◽  
Sensu Stricto ◽  
The Body ◽  
Care Hospital ◽  
Lower Extremity Weakness ◽  
Cutaneous Manifestations ◽  
Stool Incontinence ◽  
Western Blot Testing ◽  
High Index Of Suspicion

Lyme disease (LD) is a tick-borne illness caused by Borrelia burgdorferi sensu stricto. An 80-year-old female from Pennsylvania, USA, presented to an outside hospital with fever, confusion, lower extremity weakness, and stool incontinence. CT head and MRI spine were unremarkable. An infectious work-up including lumbar puncture was negative. She was transferred to our tertiary care hospital. Patient was noted to have mild unilateral right-sided facial droop and a diffuse macular rash throughout the body. She denied any outdoor activities, tick bites, or previous rash. Intravenous ceftriaxone was started for suspected LD. The patient’s symptoms including facial droop resolved within 24 hours of antibiotic therapy. Polymerase chain reaction of the blood, IgM ELISA, and IgM Western blot testing for LD came back positive a few days after initiation of therapy. She was treated for a total of 21 days for neurological LD with complete symptom resolution. Not all patients have the classic “targetoid” EM rash on initial presentation, rash could develop after neurological manifestations, and prompt initiation of antibiotics without awaiting serology is paramount to making a quick and a full recovery. There should be a high index of suspicion for early disseminated LD, as presentations can be atypical.

scholarly journals Epidemiology and Treatment Outcomes of Head Injury in Bangladesh: Perspective from the Largest Tertiary Care Hospital

2021 ◽  
Author(s):  
Sukriti Das ◽  
Bipin Chaurasia ◽  
Dipankar Ghosh ◽  
Asit Chandra Sarker
Keyword(s):  
Head Injury ◽  
Road Traffic ◽  
Head Injuries ◽  
Skull Fracture ◽  
Tertiary Care ◽  
Acute Subdural Hematoma ◽  
Care Hospital ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
The Government

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

Characteristics and Laboratory Findings of Food-Induced Anaphylaxis in Children: Study in an Asian Developing Country

2021 ◽  
pp. 1-9
Author(s):  
Rapisa Nantanee ◽  
Narissara Suratannon ◽  
Pantipa Chatchatee
Keyword(s):  
Developing Country ◽  
Immunoglobulin E ◽  
Tertiary Care ◽  
Elevated Serum ◽  
Cow’S Milk ◽  
Care Hospital ◽  
Serum Tryptase ◽  
Cutaneous Manifestations ◽  
Cow's Milk ◽  
Geographical Regions

<b><i>Introduction:</i></b> Food allergy is the major cause of pediatric anaphylaxis. Characteristics and triggers may be different in different geographical regions. Studies focusing on food-induced anaphylaxis (FIA) in Asian developing countries are limited. Our study aimed to study characteristics of FIA in a tertiary care center in an Asian developing country. <b><i>Methods:</i></b> Retrospective review of pediatric anaphylaxis admission and outpatient visit at a tertiary care hospital in Bangkok, Thailand during 2008–2018 was performed. Data regarding clinical presentation, place reaction occurred, time of onset, investigations (serum tryptase, specific immunoglobulin E, and skin test), treatment, and follow-up periods were collected. <b><i>Results:</i></b> One hundred seventy-four anaphylaxis admission records of which 61 episodes of FIA were retrieved. Data from outpatients visit consisted of 17 patients. Most patients were male (76.7%). The median age was 7.1 years (interquartile range 1.9–12.4). The major causes of FIA were shrimp/shellfish (37%), wheat (15.1%), and cow’s milk (11%). Food causing anaphylaxis varied according to age-group: infants had anaphylactic reactions to egg, wheat, and cow’s milk, preschools to wheat and peanut, and older children to shrimp/shellfish. Cutaneous manifestations occurred in all patients, followed by lower respiratory tract symptoms (83.6%) and gastrointestinal symptoms (50.8%). There was no biphasic anaphylaxis reported. Elevated serum tryptase was found in only 4 patients (7%). <b><i>Conclusion:</i></b> Recognizing characteristics of pediatric FIA is crucial. The common causes of FIA in our study in Asian children were egg in infants, wheat and peanut in preschool children, and shrimp/shellfish in school-age children and adolescents. Skin manifestation presented in all patients with FIA.

COMPARISON OF CLINICO-SOCIAL PROFILE OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS IN TERTIARY CARE HOSPITAL IN A RURALAREA: A RETROSPECTIVE STUDY

2021 ◽  
pp. 70-72
Author(s):  
Gaurav Santosh Nemade ◽  
Sumit Nitin Dhus ◽  
Arushi Ramesh Shetty ◽  
Neha Dhananjay Firake
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Female Ratio ◽  
Extra Pulmonary Tuberculosis ◽  
Younger Age ◽  
Tobacco Addiction ◽  
History Of ◽  
Early Case ◽  
Male To Female ◽  
Clinical Characteristic

BACKGROUND AND OBJECTIVES: The burden of tuberculosis (TB) in India is the highest accounting for 26% of the global incidence. A total of 1.4 million people died from TB in 2019 (including 208 000 people with HIV). India accounts for a fourth of the global burden of TB and 29% of global mortality. Therefore, we carried out this study to compare demographic, lifestyle and clinical characteristic between pulmonary TB (PTB) and extrapulmonary TB (EPTB). MATERIALS AND METHODOLOGY:Aretrospective analysis was carried of 348 patients diagnosed in DOTS centre, Pravara Rural Hospital, Loni. Characteristics of demographic and clinical characteristics were obtained from medical case records. RESULTS:Among the 348 cases, 71.3% were PTB and 28.7% were EPTB including, pleural (36%), meningeal (27%) and lymphatic (20%) cases. The male to female ratio in PTB and EPTB are 1.99 and 1.22 respectively. EPTB was more common at younger age (<25 years). Tobacco addiction (10.9%), diabetes mellitus (4.03%), HIV positivity (12.1%) and history of contact with Tb patients (17.7%) were more likely to be associated with PTB. CONCLUSION:Increased awareness of the risk factors may facilitate early case nding and better management outcomes for these patients.

Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

2021 ◽  
Author(s):  
Seema Sachdeva seema sachdeva ◽  
Akshay Kumar Akshay Kumar ◽  
Parveen Aggarwal Parveen Aggarwal
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Fish Bone ◽  
Quality Improvement Initiative ◽  
Care Hospital ◽  
Analysis Model ◽  
Post Intervention ◽  
Targeted Interventions ◽  
Administration Time

Abstract BackgroundSevere exacerbation of asthma are potentially life-threatening and therefore require prompt care and frequent management. Important elements of early treatment includes recognition of early signs and symptoms of breathing difficulty and timely prescription and administration of therapeutic agents. A subsequent delay in receiving nebulization during an acute exacerbation of asthma can leads to cardiac arrest and even death. AimTo reduce the gap in administration of nebulization from its prescription time among red triaged patients by 50% from its baseline. Setting and designThis interventional study was conducted among red triaged patients in emergency department of tertiary care hospital, India . Material and MethodsBaseline information was collected during first 4 weeks to find gap in administration of nebulization from its prescription time. Fish bone analysis and process map were laid down to analyse the situation. The intervention using targeted bundles was done via 3 PDSA (PDSA1: indenting the nebulizers, PDSA 2: training of doctors and nurses, PDSA 3; introducing equipment checklist) to reduce the gap . A run chart using time series analysis model was used to compare the pre and post intervention nebulization gap. ResultsTotal 74 patients (30 in pre- intervention, 44 in post intervention) admitted in red triaged area were observed for nebulization gap from prescription to administration. Median time for nebulization gap before intervention was 46.5 minutes which reduced to 15 minutes in post intervention phase. ConclusionThis bundles of targeted interventions was successful to reduce the nebulization gap. Key words: nebulization gap, prescription time, administration time

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