Role of stroboscopy in evaluation of patients with vocal abnormalities

Background: Stroboscopy is an examination in which strobe light is combined with laryngoscopy, to visualize the vocal fold vibration. It makes use of the Talbot’s law for visualizing the vibrating vocal fold having frequency of around 250 times per sec. This technique was used for studying voice abnormalities and evaluate related pathologies. The aim and objective was to evaluate patients with vocal abnormalities with the help of stroboscope and to study the mucosal wave pattern pre and post treatment of vocal cord pathologies.Methods: A prospective observational study was conducted at a tertiary care facility in central India. 50 patients with vocal abnormalities for more than 2 weeks were subjected to stroboscopy. Written informed consent from eligible patients was obtained and they were evaluated by stroboscopy using Karl Storz stroboscope with 70 degree 8 mm telescope, model no.: 20140020032. A second follow up stroboscopy was done two months post treatment and the parameters were recorded.Results: VC nodule was observed as the most common pathology followed by vocal polyp, carcinoma and chronic laryngitis. It was also observed that there was statistically significant difference (p<0.001) in pre and post treatment findings of different parameters of voice evaluated using stroboscopy.Conclusions: Video stroboscopic evaluation proved to be a useful and reliable tool for evaluation and treatment of the patients with voice abnormalities as the changes in pre and post treatment voice parameters were found to be statistically significant.

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Acute Contained Ruptured Aortic Aneurysm Presenting as Left Vocal Fold Immobility

Case Reports in Otolaryngology ◽

10.1155/2015/219090 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Sharon H. Gnagi ◽

Brittany E. Howard ◽

Joseph M. Hoxworth ◽

David G. Lott

Keyword(s):

Aortic Aneurysm ◽

Ct Scan ◽

Vocal Fold ◽

Recurrent Laryngeal Nerve Palsy ◽

Tertiary Care ◽

Care Facility ◽

Aortic Aneurysms ◽

Ruptured Aortic Aneurysm ◽

Tertiary Care Facility ◽

Vocal Fold Immobility

Objective. To recognize intrathoracic abnormalities, including expansion or rupture of aortic aneurysms, as a source of acute onset vocal fold immobility.Methods. A case report and review of the literature.Results. An 85-year-old female with prior history of an aortic aneurysm presented to a tertiary care facility with sudden onset hoarseness. On laryngoscopy, the left vocal fold was immobile in the paramedian position. A CT scan obtained that day revealed a new, large hematoma surrounding the upper descending aortic stent graft consistent with an acute contained ruptured aortic aneurysm. She was referred to the emergency department for evaluation and treatment by vascular surgery. She was counseled regarding surgical options and ultimately decided not to pursue further treatment. Her vocal fold immobility was subsequently treated via office-based injection medialization two weeks after presentation and again 5 months after the initial injection which dramatically improved her voice. Follow-up CT scan at 8 months demonstrated a reduction of the hematoma. The left vocal cord remains immobile to date.Conclusion. Ortner’s syndrome, or cardiovocal syndrome, is hoarseness secondary to left recurrent laryngeal nerve palsy caused by cardiovascular pathology. It is a rare condition and, while typically presenting gradually, may also present with acute symptomatology.

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Treatment-Resistant Bipolar Disorder: A Comparison of Rapid Cyclers and Nonrapid Cyclers

CNS Spectrums ◽

10.1017/s1092852900028716 ◽

2003 ◽

Vol 8 (12) ◽

pp. 948-952 ◽

Cited By ~ 2

Author(s):

Dong Vo ◽

David L. Dunner

Keyword(s):

Lithium Treatment ◽

Tertiary Care ◽

Care Facility ◽

Treatment Resistance ◽

Rapid Cycling ◽

Treatment Resistant ◽

Tertiary Care Facility ◽

Significant Difference ◽

Persistent Depression ◽

Bipolar Patients

ABSTRACTBackground: We investigated clinical factors to determine their relationship to treatment resistance among bipolar patients who had a consultation at a tertiary care facility.Methods: Patients were separated into two categories: rapid-cycling disorders and nonrapid-cycling disorders. We hypothesized that there would be less usage of lithium carbonate among nonrapid-cycling treatment-resistant patients than among rapid cyclers and also that there would be higher rates of comorbidity seen among nonrapid-cycling than rapid-cycling patients in order to account for these particular patients being treatment resistant.Findings: Continued recyling and persistent depression characterized rapid cyclers, whereas persistent depression characterized nonrapid cyclers. Less than 30% of patients had adequate lithium treatment and there was no significant difference comparing rapid cyclers with non-rapid cyclers. Rates of comorbidity were also not significantly different between these groups. We also assessed a number of other factors.Conclusion: Some of these factors were significant, but when a Bonferonni correction was applied, these significant differences were not maintained. The study of treatment resistance among nonrapid-cycling bipolar patients merits further research.

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Donor profile and trends of eye donation in Central India

International Journal of Clinical and Experimental Ophthalmology ◽

10.29328/journal.ijceo.1001035 ◽

2021 ◽

Vol 5 (1) ◽

pp. 005-008

Author(s):

Jat Neha Singh

Keyword(s):

Research Training ◽

Tertiary Care ◽

Corneal Transplantation ◽

Care Facility ◽

Central India ◽

Time Interval ◽

Eye Bank ◽

Tertiary Care Facility ◽

Corneal Donation ◽

Eye Donation

Background: The present study was conducted to study the donor profile and to assess the trends of cornea donation. Methodology: This was conducted as a hospital based cross sectional study at a tertiary care centre in Central India for a period of 5 years. Data was retrieved from 70 patients from eye bank who filled form of eye donation at Eye bank of our institution. Sociodemographic profile of donors, cause of death and time since death was recorded. Source of information regarding corneal donation and reason for not willing to donate the cornea for research purpose was recorded from the filled form. Further cornea enucleated were subjected to serology and their utilization for various purposes were recorded in questionnaire. Results: The present study retrieved data from a total of 70 donor forms with mean age of 65.84 ± 18.4 years. Cornea obtained from younger patients were mainly utilized for corneal transplantation whereas that from elderly age group > 60 years were mainly utilized for research/training purpose and the observed difference was statistically significant (p < 0.01). The corneas retrieved and utilized immediately after death were significantly used for optical or therapeutic purposes (p < 0.05). Conclusion: The present highlights the donor profile and trends of corneal donation at the tertiary care facility of Central India. It was observed that though the younger population and older population both are aware regarding corneal donation but still they are less aware on purpose for which cornea can be utilized. Quality of donor cornea is better when death to enucleation time interval was less.

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Postoperative Hemorrhage after Endoscopic Sinus Surgery

Otolaryngology ◽

10.1016/j.otohns.2008.05.257 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P80-P80

Author(s):

Troy D. Woodard ◽

James A Stankiewicz

Keyword(s):

Endoscopic Sinus Surgery ◽

Tertiary Care ◽

Care Facility ◽

Postoperative Hemorrhage ◽

Sinus Surgery ◽

Complication Rates ◽

Tertiary Care Facility ◽

Significant Difference ◽

Extent Of Surgery ◽

The Mean

Objective 1) Identify complication rates of patients that underwent endoscopic sinus surgery and developed postoperative hemorrhage. 2) Determine if there is a correlation of preoperative variables with the development of this complication. Methods Retrospectively review patients who had functional endoscopic sinus surgery and developed postoperative hemorrhage from 1987 to 2007 in an university tertiary care facility. Analyze baseline characteristics and preoperative clinical variables for significant correlations. Results 29 of 5000 endoscopic cases resulted in postoperative hemorrhage (.58% complication rate). The mean age of the patients was 50 years old and there were equal proportions of male and female patients. While the extent of surgery demonstrated no significant difference among the patients, hemorrhage was most likely to occur in patients with previous surgery. An overwhelming majority of patients required a surgical procedure to control the bleeding. Hemorrhage was primarily isolated on the patient's right side and involved the sphenopalatine or posterior septal arteries. Conclusions Endoscopic sinus surgery has vastly increased in popularity. However, there still is a paucity of information in the literature on complications associated with endoscopic sinus surgery, particularly postoperative hemorrhage. The results from this study provide identifying characteristics that predispose patients to develop this complication and what methods can be successfully utilized to treat this complication.

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A Pilot Testing of the Effect of Guided Meditation on Anxiety, Depression and Sleep Quality among COVID-19 Patients Admitted in a Tertiary Care Facility

Journal of Complementary and Alternative Medical Research ◽

10.9734/jocamr/2021/v15i430272 ◽

2021 ◽

pp. 11-21

Author(s):

Devanshi Chowdhary ◽

Suman Dabas ◽

. Vanita ◽

Poonam Joshi ◽

Anjan Trikha

Keyword(s):

Sleep Quality ◽

Tertiary Care ◽

Care Facility ◽

Routine Care ◽

Anxiety And Depression ◽

Control Groups ◽

Tertiary Care Facility ◽

Significant Difference ◽

And Control ◽

Anxiety Depression

Hospitalization of COVID- 19 patients may lead to the development of varied levels of anxiety, depression, and sleep disturbances. The present study was conceptualized to investigate the effect of guided meditation on anxiety, depression, and sleep quality among the hospitalized Covid-19 patients in a tertiary care facility. Materials and Methods: A total of 60 COVID-19 patients were conveniently enrolled and randomized to experimental (30) and control arms (30) using a computer-generated random table and opaque sealed envelope technique in a selected COVID unit of a tertiary care facility. The subjects were enrolled in accordance to the inclusion criteria. Intervention: The guided meditation was an audio recording of Sri Sri Ravi Shankar of 20 minutes duration. The intervention was provided twice a day to the experimental group for consecutive 5 days. A close watch was kept on the vital signs of the subjects during the intervention using a pulse oximeter. At the same time, the control group continued to receive the standard routine care. Results: There was a significant difference observed in the post-test anxiety and depression scores in the experiment and control groups (4.83±3.68 vs. 12.37±3.9 p=0.001 and 7.90±2.41 vs.12.67±2.65 p=0.001). A significant difference was also observed in the global sleep quality index (median (IQR)) in the experimental and control groups (11(9-14) vs. 15(10.75-17) p= 0.01). Conclusion: The guided meditation was effective in improving the global sleep quality index and alleviating the anxiety and depression to great extent as compared to the standard routine care provided to COVID-19 patients admitted in a tertiary care facility.

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Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses in a Tertiary Care Center in India

International Journal of Research Foundation of Hospital and Health Care Administration ◽

10.5005/jp-journals-10035-1034 ◽

2015 ◽

Vol 3 (1) ◽

pp. 33-40 ◽

Cited By ~ 2

Author(s):

V Jithesh ◽

Shakti Kumar Gupta ◽

Parmeshwar Kumar ◽

Aarti Vij

Keyword(s):

Comparative Study ◽

Care Center ◽

Tertiary Care ◽

Care Facility ◽

Patient Communication ◽

Tertiary Care Center ◽

Tertiary Care Facility ◽

Significant Difference ◽

Hands On ◽

Doctors And Nurses

ABSTRACT Background Standardized handovers have been known to improve outcome, reduce error and enhance communication. Few, if aany, comparative studies on clinical handovers have been conducted in the India. Objective To study clinical handover practices among nurses and doctors in a neurosciences center in India. Design and setting This descriptive and cross-sectional study was conducted over 4 months in a 200 bedded public sector tertiary care facility in New Delhi, India. Materials and methods The handover practices of nurses and resident doctors in a neurology ward were assessed across shifts, weekdays and weekends using a pretested checklist. Ten elements were observed under the categories of time, place, record, process, staff interaction and patient communication. Outcomes were analyzed using z-test, analysis of variance (ANOVA) and Spearman's correlation coefficient. Results Three hundred and eighty-two handovers each of nurses and doctors revealed varying adherence for time (44%), place (63%), documentation (50%), process (78%), staff interaction (50%) and patient communication (45%) related elements with overall compliance being 55%. Doctors fared better only in process elements and bedside handovers; however, only nurses had a statistically significant fall in levels over weekends and in night shifts. Staff interaction and patient communication were positively correlated and bedside handover was negatively related to handover duration in both groups. No statistically significant difference was found between the two groups when assessed as categories. Conclusion Study revealed a need for a system change and standardization of clinical handovers. Greater administrative commitment, use of technology, customized training and leadership development will aid in continuity of care, promote patient safety and ensure better outcomes. How to cite this article Kumar P, Jithesh V, Vij A, Gupta SK. Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses in a Tertiary Care Center in India. Int J Res Foundation Hosp Healthc Adm 2015;3(1):33-40.

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Assessing Acute St-Elevation Myocardial Infarction With Prognostic Significance Of The Hyponatramia

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i3.2445 ◽

2020 ◽

Vol 11 (3) ◽

pp. 3251-3260

Author(s):

Makrand B Mane

Keyword(s):

Myocardial Infarction ◽

Ejection Fraction ◽

Tertiary Care ◽

Prognostic Significance ◽

Care Facility ◽

Early Death ◽

Public Health Issue ◽

Care Hospital ◽

Tertiary Care Facility ◽

Significant Public Health

Acute Myocardial Infarction (AMI) has become a significant public health issue in developed and developing nations, following extensive diagnostic and management research over recent decades. The study intended to research the prognostic values of inexplicable Hyponatremia in patients with severe STelevation of myocardial infarction, in 100 consecutive patients admitted to Tertiary care hospital. In the analysis, identified patients on admission were diagnosed with or produced Hyponatremia within 72 hours—a lower ejection fraction than those with usual amounts of sodium. The research aimed to evaluate the prognosis significance of Hyponatremia for the estimation of early death in acute ST-elevated myocardial infarction. One hundred straight patients admitted in the Coronary Centre Tertiary Care Facility with severe STelevated myocardial infarction were studied. The data of the study on various risk factors in association with the development of Hyponatremia like as age, sex, use of tobacco, diabetes, hypertension, ejection fraction etc. were analyzed. Thus, the researchers reported that in patients diagnosed with severe ST section escalation, Hyponatremia showed the initial emergence of hyponatremia myocardial infarctions. This condition correlates with the severity of LV dysfunction (in term of LVEF) and can be considered as an individual early death indicator as well as a prediction exacerbates with hyponatremia frequency.

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Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility

The Egyptian Heart Journal ◽

10.1186/s43044-019-0018-y ◽

2019 ◽

Vol 71 (1) ◽

Cited By ~ 1

Author(s):

Hussein Hassan Rizk ◽

Ahmed Adel Elamragy ◽

Ghada Sayed Youssef ◽

Marwa Sayed Meshaal ◽

Ahmad Samir ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

Tertiary Care ◽

Care Facility ◽

Period 2 ◽

Peripheral Embolization ◽

Tertiary Care Facility ◽

Few Data ◽

Healthcare Associated ◽

Complications And Mortality

Abstract Background Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years. Results The IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients’ clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007). Conclusion This Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.

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Characteristics of Critically Ill Patients with COVID-19 Compared to Patients with Influenza—A Single Center Experience

Journal of Clinical Medicine ◽

10.3390/jcm10102056 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2056

Author(s):

Frank Herbstreit ◽

Marvin Overbeck ◽

Marc Moritz Berger ◽

Annabell Skarabis ◽

Thorsten Brenner ◽

...

Keyword(s):

Influenza A ◽

Health Care Systems ◽

Severe Disease ◽

Tertiary Care ◽

Care Facility ◽

High Volume ◽

Single Center Experience ◽

Severe Influenza ◽

Tertiary Care Facility ◽

Care Systems

Infections with SARS-CoV-2 spread worldwide early in 2020. In previous winters, we had been treating patients with seasonal influenza. While creating a larger impact on the health care systems, comparisons regarding the intensive care unit (ICU) courses of both diseases are lacking. We compared patients with influenza and SARS-CoV-2 infections treated at a tertiary care facility offering treatment for acute respiratory distress syndrome (ARDS) and being a high-volume facility for extracorporeal membrane oxygenation (ECMO). Patients with COVID-19 during the first wave of the pandemic (n = 64) were compared to 64 patients with severe influenza from 2016 to 2020 at our ICU. All patients were treated using a standardized protocol. ECMO was used in cases of severe ARDS. Both groups had similar comorbidities. Time in ICU and mortality were not significantly different, yet mortality with ECMO was high amongst COVID-19 patients with approximately two-thirds not surviving. This is in contrast to a mortality of less than 40% in influenza patients with ECMO. Mortality was higher than estimated by SAPSII score on admission in both groups. Patients with COVID-19 were more likely to be male and non-smokers than those with influenza. The outcomes for patients with severe disease were similar. The study helps to understand similarities and differences between patients treated for severe influenza infections and COVID-19.

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