scholarly journals Emerging problem to health care workers in form of virus and fungus combo: a tertiary care centre experience

2021 ◽  
Vol 8 (10) ◽  
pp. 5020
Author(s):  
Vimla Beniwal ◽  
Surender Kumar Beniwal ◽  
Jaishri Murli Manoher ◽  
Hari Ram Jat
Keyword(s):  
Risk Factors ◽  
Early Diagnosis ◽  
Tertiary Care ◽  
Treatment Guideline ◽  
Signs And Symptoms ◽  
Tertiary Care Centre ◽  
Male Predominance ◽  
Care Workers ◽  
Ocular Movement ◽  
Unilateral Involvement

Background: Rhino-orbital-cerebral mucormycosis has reached epidemic proportion during second wave of COVID-19 pandemic in India. In this study we aimed to understand the demographics, presentation, temporal sequence, risk factors and outcomes to undertake measures for prevention and treatment and benefit of administering liposomal amphotericin via retrobulbar injection in addition to systemic antifungals in the setting of rhino-orbital-mucormycosis.Methods: Study of patients with COVID-19-associated mucormycosis managed or co-managed by ophthalmologists in our centre from April 2021 to June 2021.Results: Male predominance and more than 75% associated with COVID-19 infection. Common risk factors associated were DM and corticosteroids use. Unilateral involvement was common (82.4%). Most common primary symptom and sign of ROCM is orbital/facial pain (68.4%) and ptosis (84.2 %) respectively. retro bulbar amphotericin B injections had slight improvement in vision (25%), ptosis (37.5%) and extra ocular movement (25%) with few complications. Surgical management were PNS debridement (42.1%), exenteration added in 17.5 % and with above procedure additional maxillectomy needed in 14%. 22.8 % cases were succumbed by disease while 40.1 % of live patients needed orbital exenteration.Conclusions: ROCM has visible signs and symptoms, help us in early diagnosis as compared to mucormycosis at other anatomical sites and should be known to all ophthalmologists. Early diagnosis by involving root level health worker and creation of standard treatment guideline on emerging heath problem is an urgent need. 

Risk factors for urinary tract infection in pediatric patients

2017 ◽  
Vol 5 (1) ◽  
pp. 184 ◽  
Author(s):  
Kavitha J. ◽  
M. A. Aravind ◽  
Ganesh Jayachandran ◽  
Sathiya Priya
Keyword(s):  
Risk Factors ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Tertiary Care ◽  
Recurrent Infection ◽  
Signs And Symptoms ◽  
Tertiary Care Centre ◽  
Asymptomatic Children ◽  
Study Population

Background: Urinary tract infection (UTI) is one of the common infections occurring in children causing significant morbidity and mortality. The knowledge about the risk factors helps in the management as well as preventing the recurrence of urinary tract infection. Hence this study aims to assess the various risk factors and profile of UTI.Methods:In this prospective case control study conducted in tertiary care centre between July 2011 to August 2012, children with signs and symptoms suggestive of urinary tract infection and urine culture positive for UTI were included. Age and sex matched asymptomatic children were taken as control.  Preformed questionnaire was given to each patient and the results were analysed.Results: Among the 214 cases studied, 111 boys were not circumcised constituting 86.7%. Whereas the other risk factors like recent hospitalisation, recent catheterisation, common toilet usage, cleaning perineum from back to front, constipation, usage of tight underclothing, diaper usage, worm infestation, neurological abnormality, voluntary withholding of urine, reduced water intake constitute 9.3%, 0.5%, 19.6%, 17.4%, 18.2%, 0.9%, 7.9%, 26.2%, 3.7%, 33.6% and 34.6% respectively.Conclusions: Recurrent infection was most often due to unresolved bacteriuria or persistent bacteriuria than reinfection. Signs like supra pubic tenderness and hypertension are very rare. Common organisms causing urinary tract infection in our study population are E. coli followed by Klebsiella, Proteus and Pseudomonas. The risk factors of UTI depend on socioeconomic status and cultural habits.

scholarly journals A clinical study of ectopic pregnancy at a tertiary care centre in Telangana, India

2020 ◽  
Vol 9 (2) ◽  
pp. 682
Author(s):  
Subha Ranjan Samantaray ◽  
Ipsita Mohapatra ◽  
Achanta Vivekanada
Keyword(s):  
Risk Factors ◽  
Early Diagnosis ◽  
Ectopic Pregnancy ◽  
Vaginal Bleeding ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
High Morbidity ◽  
Tertiary Care Centre ◽  
Life Threatening ◽  
History Of

Background: Ectopic pregnancy (EP) is a life-threatening obstetrics emergency in early trimester, associated with a high morbidity and mortality if not timely intervened.  High index of clinical suspicion is required for early diagnosis, specifically in women presenting with amenorrhoea, pain abdomen and vaginal bleeding. Aim of this study is to determine the incidence, risk factors, clinical presentation, management and outcome of ectopic pregnancy.Methods: This retrospective observational study was conducted in the department of obstetrics and gynaecology, at Prathima institute of medical sciences, Telangana from July 2012 to June 2019, for a period of 7 years. A total of 53 cases of ectopic pregnancy were analyzed for parameters like age, gravidity, gestational age, risk factors, clinical presentation, management and morbidity.Results: Incidence of ectopic pregnancy was 5.3 per thousand deliveries. Majority of cases were in age group of 20 to 25 years (52.8%) and were gravida 3 and above (68%). The commonest risk factors identified were history of previous pelvic surgeries (37.7%) followed by history of abortion (18.8%). Commonest symptoms were abdominal pain (90.6%), amenorrhoea (75.5%) and vaginal bleeding (47.2%). Only 41.5 % of cases had triad of symptoms. Fallopian tube (92.4%), specifically ampulla (62.3%) was the most frequent site affected. About 73.6% cases presented with ruptured tube. Surgery (94.3%) was the mainstay of therapy.Conclusions: ectopic pregnancy is a life-threatening emergency, early diagnosis and treatment will improve the prognosis.

PAEDIATRIC POSTERIOR FOSSA TUMORS : AN EPIDEMIOLOGICAL AND ANALYTICAL STUDY AT TERTIARY CARE CENTRE IN EASTERN INDIA

2021 ◽  
pp. 54-56
Author(s):  
S. I. Sadique ◽  
Md. Shahid Alam ◽  
S. Chatterjee ◽  
S. Ghosh
Keyword(s):  
Early Diagnosis ◽  
Posterior Fossa ◽  
Tertiary Care ◽  
Male Dominance ◽  
Morbidity And Mortality ◽  
Posterior Fossa Tumors ◽  
Tertiary Care Centre ◽  
Therapeutic Modalities ◽  
Common Location ◽  
Group 5

Introduction: Posterior fossa is the commonest site of primary intracranial tumors in children, accounting for 45-60% of 1 all pediatric tumors . The aims and objectives of the study is to analyse the incidence, clinical features, surgical outcome and complications in paediatric patients with posterior fossa tumor. Material and Methods: The present study is a non-randomized prospective observational study, conducted in the department of neurosurgery, Bangur Institute of Neurosciences (B.I.N), IPGME & R, Kolkata from January 2019 to December 2020. Sample size is 50. Observations & Results: Out of 480 cases of total CNS tumors who presented in the study period, 96 cases(20%) were of paediatric posterior fossa tumors. Male dominance was seen i.e. 32 cases(64%). Most of them were in the age group 5-12 years i.e. 30 cases(60%). Headache and vomiting was the most common presenting complain present in 41 cases(82%). Fourth Ventricle was the most common location, 30 cases(60%) with Medulloblastoma being the most common tumor, 24 cases(48%). Brainstem involvement was seen in 22 cases(44%). Post-op hydrocephalus and cerebellar mutism were seen in 6 cases(12%) each. Overall mortality was 8%(4 cases). Conclusion: Posterior fossa tumors are critical brain lesions with signicant neurological morbidity and mortality. Early diagnosis of posterior fossa tumors is vital to prevent potential risks of Brain stem compression, herniation, hydrocephalus and death. With rapid advancement in radiology and the advent of modern therapeutic modalities, early diagnosis and treatment reduced the morbidity and mortality rate and improved prognosis among the patients.

Histopathological Study of Lesions of the Nasal Cavity, Paranasal Sinuses and Nasopharynx in a Tertiary Care Centre, Visakhapatnam over a Period of 2 Years

2021 ◽  
Vol 8 (33) ◽  
pp. 3054-3059
Author(s):  
Rajendra Prasad Jagannadham ◽  
Lakshmi Latchupatula ◽  
Sravani Ponnada ◽  
Neelima Lalam ◽  
Raghunadhababu Gudipudi ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Paranasal Sinuses ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Histopathological Study ◽  
Histopathological Diagnosis ◽  
Malignant Tumours ◽  
Tertiary Care Centre ◽  
Female Ratio ◽  
Male Predominance

BACKGROUND A variety of non - neoplastic and neoplastic conditions involve the nasal cavity, paranasal sinuses and nasopharynx and these are very common lesions encountered in clinical practice. Histopathological examination of these lesions is the gold standard for diagnosis because management and prognosis vary among different lesions. The aim of the present study was to evaluate the histopathological study of the lesions of the nasal cavity, paranasal sinuses and nasopharynx in relation to their incidence, age, gender and site wise distribution and to compare the results with the available data. METHODS A study of 88 cases was conducted for a period of 2 years from August 2017 to July 2019. After fixation, Processing and Haematoxylin and Eosin staining and special stains histopathological diagnosis was made. RESULTS Among 88 total cases, 58 were males and 30 were females. A male predominance was observed with a male to female ratio of 1.93 : 1. They were more common in third, fourth and fifth decade of life. Malignant nasal lesions were seen after fourth decade of life. Nasal lesions were more common in nasal cavity (67.05 %), followed by paranasal sinuses (18.18 %) and nasopharynx (14.75). Out of 88 total cases, 39 (44.32 %) were non - neoplastic, 30 (34.09 %) were benign and 19 (21.59 %) were malignant nasal lesions. CONCLUSIONS Sinonasal lesions and nasopharyngeal lesions can have various differential diagnoses. A complete clinical, radiological and histopathological correlation helps to categorize these sinonasal lesions into various non - neoplastic and neoplastic types. But histopathological examination remains the mainstay of definitive diagnosis. KEYWORDS Nasal Cavity, Paranasal Sinuses, Nasopharynx, Benign Tumours, Malignant Tumours, Histopathological Examination

scholarly journals Clinico-Pathological Study of Ocular Surface Squamous Neoplasia in a Tertiary Care Centre of Western Region of Nepal

2019 ◽  
Vol 7 (1) ◽  
pp. 9-13
Author(s):  
Sushila Patel ◽  
Binita Bhattarai Pokharel ◽  
Anita Shah ◽  
Manita Sunam Goda ◽  
Saraswati Khadka Thapa
Keyword(s):  
Ocular Surface ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Western Region ◽  
Invasive Squamous Cell Carcinoma ◽  
Care Centre ◽  
Ocular Surface Squamous Neoplasia ◽  
Tertiary Care Centre ◽  
Male Predominance ◽  
Wide Range

INTRODUCTION: Ocular surface squamous neoplasia (OSSN) consists of a wide range of conjunctival and corneal lesions ranging from dysplastic lesions to invasive squamous cell carcinoma. In recent times, the incidence of OSSN seems to be on the rise, especially in developing countries. The present study was aimed to analyse demographic pattern, clinical characteristics, and histopathology findings of OSSN in a tertiary care centre of western region of Nepal.  MATERIAL AND METHODS: It was a retrospective study. We analyzed 94 cases of OSSN who presented to cornea department of Lumbini Eye Institute, Bhairahawa, Nepal over a period 1.5 years from 1st July 2017 to 31st December 2018. All the patients with OSSN, detailed clinical history and examination were recorded. Lesions were excised with a 3 mm margin clearance and sent for histopathological examination.  RESULTS: Mean age of our patients with OSSN was 48.89±17.955 years ranging from 17 to 85 years. There were 52 (55.32%) male and 42 (44.68%) female. Mean duration of presentation was 6.34±6.17 months. A solitary nodule at the limbus was the commonest presentation. Right eyes were involved more than left eyes. Lesions were found most commonly on temporal site 52 (55.32%) followed by nasal 36 (38.30%). On histopathological examination benign lesions were found in 31 (32.98%) eyes, preinvasive lesion in 50 (53.19%) eyes and invasive lesions in 13 (13.83%) eyes.  CONCLUSION: OSSN were seen more commonly in young adults with male predominance. Benign and pre invasive lesions are found more commonly than invasive lesions.

scholarly journals Clinical and Etiological Profile of Mycotic Keratitis from a Tertiary Care Centre in South India

2021 ◽  
Vol 10 (27) ◽  
pp. 2001-2006
Author(s):  
John Britto Augustin ◽  
Sureshbaboo Variamkandi
Keyword(s):  
Risk Factors ◽  
Corneal Ulcer ◽  
Fusarium Species ◽  
Tertiary Care ◽  
Government Medical College ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Medical College ◽  
Corneal Ulcers ◽  
Prompt Treatment

BACKGROUND Corneal ulcer is the leading cause of ocular morbidity and monocular blindness worldwide. To effectively prevent blindness in patients with corneal ulcer, a proper understanding of the risk factors predisposing to ulceration, its clinical and microbiological characteristics are essential. Timely identification of aetiological agents causing corneal ulcers and their prompt treatment helps to save the vision. We wanted to detect aetiological agents of corneal ulcer with special references to fungal causes and characterize the fungal aetiological agents to species level. METHODS This is a cross sectional study, conducted in Government Medical college, Kozhikode, between January 2016 and June 2017. All patients who were clinically diagnosed as cases of infectious corneal ulcer in the Ophthalmology department, Government Medical College, Kozhikode were included in the study. Corneal scrapings collected from the infected eye were subjected to microbiological examination and culture. A total of 120 cases were analysed. Each patient was examined with the slit lamp bio microscope after staining with fluorescein. Scrapings from cornea at the site of corneal ulcer were collected by ophthalmologist after a detailed clinical history and examination of the affected eye. The laboratory procedures used in the diagnosis of infectious keratitis were based on direct visualization of organisms by subjecting corneal scrapings to Gram stain and KOH wet mount and inoculation of material on to blood agar and Sabouraud dextrose agar. RESULTS Among the 120 cases, a total of 49 cases were culture positive. Twenty-one [17.5 %] were bacterial, twenty-two [18.34 %] were fungal and six [5.0 %] were poly microbial [bacteria and fungus]. Among the fungal aetiology, fusarium species was most common [32.14 %], followed by aspergillus species - 25.0 %. Trauma was the major risk factor. Diabetes mellitus, exposure keratitis were the other comorbidities / risk factors. CONCLUSIONS This study shows majority of infected corneal ulcers are associated with risk factors and the aetiology are mainly fungi. Microscopy, culture, and clinical correlation helped in adequate management. Thus, prognosis and outcome of corneal ulcers rely on timely identification of their aetiology and prompt treatment. KEY WORDS Corneal ulcer, Fungal Keratitis

scholarly journals Clinical profile and risk factors for mortality among COVID-19 inpatients at a tertiary care centre in Bengaluru, India

2021 ◽  
Author(s):  
Yamini Marimuthu ◽  
Radhika Kunnavil ◽  
NS Anil ◽  
Sharath Burugina Nagaraja ◽  
N Satyanarayana ◽  
...  
Keyword(s):  
Risk Factors ◽  
South India ◽  
Linear Models ◽  
Tertiary Care ◽  
Male Gender ◽  
Clinical Profile ◽  
Rank Test ◽  
Care Hospital ◽  
Care Centre ◽  
Tertiary Care Centre

COVID-19 is an emerging viral disease affecting more than 200 countries worldwide and it present with varied clinical profile throughout the world. Without effective drugs to cure COVID-19, early identification and control of risk factors are important measures to combat COVID-19.  This study was conducted to determine the clinical profile and risk factors associated with mortality among COVID-19 patients in a tertiary care hospital in South India. This record-based longitudinal study was conducted by reviewing the case records of COVID-19 patients admitted for treatment from June 2020 to September 2020 in a tertiary care centre in South India. The clinical details, discharge/death details, were collected and entered in MS Excel. Potential risk factors for COVID-19 mortality were analysed using univariate binomial logistic regression, generalized linear models (GLM) with Poisson distribution. Survival curves were made using the Kaplan-Meier method. Log-rank test was used to test the equality of survivor functions between the groups. Out of 854 COVID-19 patients, 56.6% were men and the mean (standard deviation) age was 45.3(17.2) years. The median survival time was significantly lesser in male COVID-19 patients (16 days) as compared to female patients (20 days). Increasing age, male gender, patients presenting with symptoms of fever, cough, breathlessness, smoking, alcohol consumption, comorbidities were significantly associated with mortality among COVID-19 patients. Patients with older age, male gender, breathlessness, fever, cough, smoking and alcohol and comorbidities need careful observation and early intervention.  Public health campaigns aimed at reducing the prevalence of risk factors like diabetes, hypertension, smoking and alcohol use are also needed.

scholarly journals A Study on Shock Index in Early Diagnosis of Sepsis in Emergency Department of Tertiary Care Centre of Nepal

2019 ◽  
Vol 2 (2) ◽  
pp. 37-42
Author(s):  
Manish Nath Pant ◽  
Subash Dawadi ◽  
Ashish Thapa
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Severe Sepsis ◽  
Early Diagnosis ◽  
Blood Lactate ◽  
Lactate Level ◽  
Tertiary Care ◽  
Serum Lactate ◽  
Shock Index ◽  
Tertiary Care Centre

Introduction: Sepsis and its consequences, severe sepsis and septic shock is at menace in country like ours where infectious disease are at toll. Early diagnosis and treatment is very important to decrease the morbidity and mortality. Shock index is one of such tool that is very handy in these situations as this is just a mathematical calculation using heart rate(HR) and systolic blood pressure(SBP). The main aim of this study was to find the effectiveness of using SI as an adjunct to blood lactate in diagnosing patients in sepsis. Methods: This was an observational hospital-based study conducted at Emergency Department of TUTH, Maharajgunj on 104 patients, obtained by purposive sampling method, who had presented to the “Red Area”, aged between 18 to 65 years. These patients were screened for severe sepsis using triage vital signs, basic laboratory tests and an initial serum lactate level. Test characteristics were calculated for hyperlactatemia. I considered the following covariates in our analysis: heart rate >90 beats/min; mean arterial pressure <65 mmHg; respiratory rate > 20 breaths/min; ≥2 SIRS including white blood cell count; SI <0.6; SI 0.6 to 1; SI 1 to 1.4and SI ≥ 1.4.  Results: There was a positive correlation between shock index and blood lactate level, r=0.2, n=104, p=0.042. No relationship was found between SI>=1 and hyperlactemia, X2 (.285, N = 104) = 1, p =.594 and relationship was found between SI >=0.7 and hyperlactemia, X2 (4.1, N = 104) = 1, p =.04. sensitivity and specificity for detecting hyperlactemia of SI>=1, SI.=0.7, SIRS was 84% and 20%, 93% and 0%, 79% and 20% respectively. Conclusions: There was weak correlation between the lactate level and shock index with statistically significant correlation between the shock index grouped >=0.7 and hyperlactatemia with high sensitivity and very low specificity.

scholarly journals Evaluation of Risk Factors for Retinopathy of Prematurity in Premature Born Infants in Tertiary Care Centre in Punjab

2020 ◽  
Vol 9 (1) ◽  
pp. 1-5
Author(s):  
Jatinder Singh ◽  
Vaneeta Bhardwar ◽  
Harshdhawann Singh ◽  
Isha Bhardwaj ◽  
Sushmita Choudhary ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retinopathy Of Prematurity ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Premature Born

scholarly journals Evaluation of Specific Risk Factors and Outcomes of Colistin-Resistant Klebsiella pneumoniae Infections in a Tertiary Care Centre - An Observational Study

2021 ◽  
Vol 4 (2) ◽  
pp. 1-6
Author(s):  
Prakash Shastri ◽  
Shamanth A Shankarnarayan
Keyword(s):  
Risk Factors ◽  
Blood Stream Infection ◽  
Tertiary Care ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Line ◽  
Multidrug Resistant ◽  
Automated System ◽  
Tertiary Care Centre ◽  
Broth Microdilution Method

Background: Incidence of multidrug resistant Klebsiella pnumoniae infections are increasing globally especially in ICUs. Aim: We evaluated the burden of colistin resistant K. pneumoniae (ColR KP) and the risk factors associated with the outcome of these patients. Methods: Consecutive patients developing K. pneumoniae infections were included. K. pneumoniae from endotracheal tube and catheterized urine sample, having cell count <105 cfu/ml, and which did not necessitate a change in antibiotics as per the treating physicians was considered as colonizer. Demographic and clinical details were collected and samples were processed as per standard protocol. Any growth was identified and its antimicrobial susceptibility was carried out by using Vitek 2 automated system. Minimum inhibitory concentration of >4 μg/ml for Colistin was considered as resistant. The resistant isolates were confirmed with Broth microdilution method. Risk factor associated with the outcome of ColR KP was analyzed. Findings: Burden of K. pneumoniae infection was 50.02 per 1000 admissions. K. pneumonie (n=155) was isolated from patients with ventilator associated pneumonia (84, 54.2%), followed by blood stream infection (49, 31.6%) and urinary tract infection (22, 14.2%). ColR KP and intermediate (ColI KP) isolates were 58 (37.41%) and 97 (62.6%) respectively. Among ColR KP infected patients 32 (55.1%) died whereas 26 (44.8%) patients were discharged. Higher mortality was witnessed in ColI KP cases (75, 77.3%) compared to ColR-KP cases (32, 55.1%) (p=0.004; OR=2.77; 95% CI=1.37 to 5.59). Colistin resistance and presence of central line were independently associated with mortality. Conclusion: Colistin resistant K. pneumoniae infections among ICU patients are on rise. Presence of central venous catheter and resistance to colistin were independent predictors of mortality.

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