The Effect of Covid -19 Pandemic On Eye-Related Emergency Department Visits: A Comparison of Tertiary Eye Care Hospital Two -Year Results

Abstract Purpose: The aim of study is to examine the clinical and demographic impact of the Covid 19 pandemic on emergency department admissions to a tertiary eye care hospital.Methods: Records of admissions to the ophthalmology emergency department during a one-year period before the pandemic (group 1) and during the pandemic (group 2) were retrospectively reviewed between March 15, 2019, and March 15, 2021. Application numbers, demographic characteristics of patients were recorded. The cases were grouped by age and diagnosis, and the findings were compared within and between the groups. Results: A total of 161 941 patients (Group 1: 103 178 and Group 2: 58 763) were admitted to the emergency department of our hospital within 2 years. All admission diagnoses were significantly lower in the pandemic period than in the pre-pandemic period (p:0.001). However, the rate of sight-threatening cases or cases requiring urgent treatment (retinal diseases, uveitis, etc.) was significantly higher in the pandemic period than in the pre-pandemic period (p:0.001). The most common admission diagnoses were ocular infectious/inflammatory diseases while the foreign body on the ocular surface/ocular trauma group was second. Admissions for allergic and infectious diseases were significantly less during the pandemic period (p: 0.001, p: 0.002 respectively).Conclusion: The Covid 19 pandemic has led to significant changes in the application numbers, demographic features and reasons for admissions to the emergency department.

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Outcome of intraoperative use of mitomycin C combined with conjunctival auto graft in recurrent pterygium

IMC Journal of Medical Science ◽

10.3329/imcjms.v10i2.31110 ◽

2017 ◽

Vol 10 (2) ◽

pp. 49-52 ◽

Cited By ~ 1

Author(s):

Manash Kumar Goswami ◽

F. Hossain ◽

A.B. Shamsudduha ◽

M Asaduzzaman

Keyword(s):

Mitomycin C ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Study Population ◽

Recurrent Pterygium ◽

Pterygium Surgery ◽

Group 2 ◽

One Year ◽

Group 1

Background and objectives: Recurrent pterygium is an important ocular problem in our country. There are different modalities of treatment for recurrent pterygium. The present study was undertaken to determine the effect of intraoperative mitomycin C along with conjunctival auto graft to prevent recurrence of pterygium.Methods: Patients with recurrent pterygium attending a tertiary care hospital in Dhaka from January 2013 to June 2015 were included in the study. Cases were randomized into two groups. Group 1 had pterygium surgery with conjunctival auto graft and Group 2 had auto graft and intraoperative mitomycin C (0.02%). All cases were followed up for one year to assess recurrence of pterygium.Results: A total of 54 recurrent pterygia cases were included in the study. The age of study population was 25 to 65 years. The recurrence rate of pterygium after 12 months was 77.7% in group 1 and none in group 2. No major postoperative complication was observed.Conclusion: The study demonstrated that the use of intraoperative mitomycin C along with conjunctival auto graft had significant effect in preventing the recurrence of pterygium.IMC J Med Sci 2016; 10(2): 49-52

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Pediatric congenital heart diseases: Patterns of presentation to the emergency department of a tertiary care hospital

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.3.1592 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Surraiya Bano ◽

Saleem Akhtar ◽

Uzma Rahim Khan

Keyword(s):

Emergency Department ◽

Congenital Heart ◽

Tertiary Care Hospital ◽

Heart Diseases ◽

Tertiary Care ◽

Care Hospital ◽

Cardiac Defects ◽

Congenital Cardiac Defects ◽

Group 2 ◽

Group 1

Objective: To observe presentation of Pediatric congenital cardiac defects to the Emergency Department (ED) of a tertiary care hospital in Pakistan. Methods: This is a retrospective chart review of patients under the age of 16 years with congenital cardiac defects presenting to the Emergency Department of Aga Khan University Hospital over a period of eighteen months, from January 2012 to June 2013. Study population was divided into two groups; first group constituted children with undiagnosed congenital cardiac defects, whereas second group constituted children with diagnosed congenial cardiac defects presented to ED. In previously diagnose cases each visit was counted as a separate encounter. Results: Out of 133 children, 44 (33.5%) were diagnosed congenital cardiac disease for the first time (Group-1) in ED, while 89 (66.5%) children were diagnosed cases of congenital heart disease (Group-2). Among Group-1; main reasons for ED visits were cyanosis, cardiac failure, murmur evaluation and cardiogenic shock where as in Group-2; main presentations were cardiac failure, hyper cyanotic spells, gastroenteritis, lower respiratory tract infection, and post-operative issues. There were total 13 deaths. Conclusion: High index of suspicion is necessary for early diagnosis and management of children with congenital heart disease in the pediatric emergency department. doi: https://doi.org/10.12669/pjms.36.3.1592 How to cite this:Bano S, Akhtar S, Khan U. Pediatric congenital heart diseases: Patterns of presentation to the emergency department of a tertiary care hospital. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1592 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Risk of stroke after emergency department visits for neurologic complaints

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000673 ◽

2019 ◽

Vol 10 (2) ◽

pp. 106-114 ◽

Cited By ~ 1

Author(s):

Marc B. Rosenman ◽

Elissa Oh ◽

Christopher T. Richards ◽

Scott Mendelson ◽

Julia Lee ◽

...

Keyword(s):

Emergency Department ◽

Emergency Department Visits ◽

University Hospital ◽

Electronic Health Record Data ◽

Head Ct ◽

Group 4 ◽

International Statistical Classification ◽

Group 3 ◽

Group 2 ◽

Group 1

ObjectiveTo assess the risk of subsequent stroke among older patients discharged from an emergency department (ED) without a diagnosis of TIA or stroke.MethodsUsing electronic health record data from a large urban, university hospital and a community-based hospital, we analyzed patients aged 60–89 years discharged to home from the ED without an International Statistical Classification of Diseases and Related Health Problems, 9th or 10th Revision diagnosis of TIA or stroke. Based on the presence/absence of a head CT and the presence/absence of a chief complaint suggestive of TIA or stroke (“symptoms”) during the index ED visit, we created 4 mutually exclusive groups (group 1, reference: head CT no, symptoms no; group 2: head CT no, symptoms yes; group 3: head CT yes, symptoms no; and group 4: head CT yes, symptoms yes). We calculated rates of stroke in the 30, 90, and 365 days after the index visit and used multivariable logistic regression to estimate odds ratios (ORs) for subsequent stroke.ResultsAmong 35,622 patients (mean age 70 years, 59% women, and 16% African American), unadjusted rates of stroke in 365 days were as follows: group 4: 2.5%; group 3: 1.1%; group 2: 0.69%; and group 1: 0.54%. The adjusted OR for stroke was 3.30 (95% confidence interval [CI], 1.61–6.76) in group 4, 1.56 (95% CI, 1.16–2.09) in group 3, and 0.61 (95% CI, 0.22–1.67) in group 2.ConclusionsAmong patients discharged from the ED without a diagnosis of TIA or stroke, the occurrence of a head CT and/or specific neurologic symptoms established a clinically meaningful risk gradient for subsequent stroke.

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The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00382-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Francesco A. Ciarleglio ◽

Marta Rigoni ◽

Liliana Mereu ◽

Cai Tommaso ◽

Alessandro Carrara ◽

...

Keyword(s):

Emergency Department ◽

Blood Transfusion ◽

Emergency Surgery ◽

Surgical Care ◽

Close Correlation ◽

Negative Effects ◽

Group 2 ◽

Retrospective Comparative Study ◽

The Impact ◽

Group 1

Abstract Background The aim of this retrospective comparative study was to assess the impact of COVID-19 and delayed emergency department access on emergency surgery outcomes, by comparing the main clinical outcomes in the period March–May 2019 (group 1) with the same period during the national COVID-19 lockdown in Italy (March–May 2020, group 2). Methods A comparison (groups 1 versus 2) and subgroup analysis were performed between patients’ demographic, medical history, surgical, clinical and management characteristics. Results Two-hundred forty-six patients were included, 137 in group 1 and 109 in group 2 (p = 0.03). No significant differences were observed in the peri-operative characteristics of the two groups. A declared delay in access to hospital and preoperative SARS-CoV-2 infection rates were 15.5% and 5.8%, respectively in group 2. The overall morbidity (OR = 2.22, 95% CI 1.08–4.55, p = 0.03) and 30-day mortality (OR = 1.34, 95% CI 0.33–5.50, =0.68) were significantly higher in group 2. The delayed access cohort showed a close correlation with increased morbidity (OR = 3.19, 95% CI 0.89–11.44, p = 0.07), blood transfusion (OR = 5.13, 95% CI 1.05–25.15, p = 0.04) and 30-day mortality risk (OR = 8.00, 95% CI 1.01–63.23, p = 0.05). SARS-CoV-2-positive patients had higher risk of blood transfusion (20% vs 7.8%, p = 0.37) and ICU admissions (20% vs 2.6%, p = 0.17) and a longer median LOS (9 days vs 4 days, p = 0.11). Conclusions This article provides enhanced understanding of the effects of the COVID-19 pandemic on patient access to emergency surgical care. Our findings suggest that COVID-19 changed the quality of surgical care with poorer prognosis and higher morbidity rates. Delayed emergency department access and a “filter effect” induced by a fear of COVID-19 infection in the population resulted in only the most severe cases reaching the emergency department in time.

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MRI Spectrum of Japanese Encephalitis in Northeast India: A Cross-Sectional Study

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1722820 ◽

2021 ◽

Vol 12 (02) ◽

pp. 281-289

Author(s):

Pranjal Phukan ◽

Kalyan Sarma ◽

Barun Kumar Sharma ◽

Deb K. Boruah ◽

Bidyut Bikash Gogoi ◽

...

Keyword(s):

Japanese Encephalitis ◽

Statistical Significance ◽

Tertiary Care ◽

Care Hospital ◽

Mri Findings ◽

Mri Scan ◽

Cross Sectional ◽

Adc Value ◽

Group 2 ◽

Group 1

Abstract Objective Japanese encephalitis (JE) is an arthropod-borne flavivirus infection having high mortality and morbidity. This study was performed to evaluate the conventional magnetic resonance imaging (MRI) findings in JE and to find out any difference between pediatric and adult JE. Materials and Methods This retrospective study was performed on serologically positive 54 JE patients presented to a tertiary care hospital with acute encephalitic symptoms between April 2016 and October 2019. Relevant neurological examination, cerebrospinal fluid analysis, and MRI scan of the brain were performed. Results Fifty-four JE patients (n = 31 males and n = 23 females) having 32 pediatric and 22 adult JE were included in the study sample. Group 1 JE (n = 16) patients had encephalitic symptoms with duration less than 15 days up to the day of MRI scan and group 2 JE (n = 38) had symptoms more than 15 days. Group 1 JE had mean apparent diffusion coefficient (ADC) value of 0.563 ± 0.109 (standard deviation [SD]) × 10–3 mm2/sec and group 2 JE had 1.095 ± 0.206 (SD) × 10–3 mm2/sec. The mean ADC value of pediatric JE was 0.907 ± 0.336 (SD) × 10–3 mm2/sec and adult JE was 0.982 ± 0.253 (SD) × 10–3 mm2/sec. Conclusion The majority of the JE patient shows abnormal signal alterations in bilateral thalami and substantia nigra. Diffusion-weighted imaging with ADC mapping helps in evaluating the stage of the JE. No statistical significance of the various conventional MRI findings was found between the pediatric JE and adult JE.

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Intracoronary Injection of Autologous CD34+ Cells Improves One-Year Left Ventricular Systolic Function in Patients with Diffuse Coronary Artery Disease and Preserved Cardiac Performance—A Randomized, Open-Label, Controlled Phase II Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm9041043 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1043 ◽

Cited By ~ 2

Author(s):

Pei-Hsun Sung ◽

Yi-Chen Li ◽

Mel S. Lee ◽

Hao-Yi Hsiao ◽

Ming-Chun Ma ◽

...

Keyword(s):

Systolic Function ◽

Coronary Intervention ◽

Left Ventricular ◽

Diffuse Coronary Artery Disease ◽

Cd34 Cells ◽

Group 2 ◽

Artery Disease ◽

One Year ◽

Lv Systolic Function ◽

Group 1

This phase II randomized controlled trial tested whether intracoronary autologous CD34+ cell therapy could further improve left ventricular (LV) systolic function in patients with diffuse coronary artery disease (CAD) with relatively preserved LV ejection fraction (defined as LVEF >40%) unsuitable for coronary intervention. Between December 2013 and November 2017, 60 consecutive patients were randomly allocated into group 1 (CD34+ cells, 3.0 × 107/vessel/n = 30) and group 2 (optimal medical therapy; n = 30). All patients were followed for one year, and preclinical and clinical parameters were compared between two groups. Three-dimensional echocardiography demonstrated no significant difference in LVEF between groups 1 and 2 (54.9% vs. 51.0%, respectively, p = 0.295) at 12 months. However, compared with baseline, 12-month LVEF was significantly increased in group 1 (p < 0.001) but not in group 2 (p = 0.297). From baseline, there were gradual increases in LVEF in group 1 compared to those in group 2 at 1-month, 3-months, 6-months and 12 months (+1.6%, +2.2%, +2.9% and +4.6% in the group 1 vs. −1.6%, −1.5%, −1.4% and −0.9% in the group 2; all p < 0.05). Additionally, one-year angiogenesis (2.8 ± 0.9 vs. 1.3 ± 1.1), angina (0.4 ± 0.8 vs. 1.8 ± 0.9) and HF (0.7 ± 0.8 vs. 1.8 ± 0.6) scores were significantly improved in group 1 compared to those in group 2 (all p < 0.001). In conclusion, autologous CD34+ cell therapy gradually and effectively improved LV systolic function in patients with diffuse CAD and preserved LVEF who were non-candidates for coronary intervention (Trial registration: ISRCTN26002902 on the website of ISRCTN registry).

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Efficacy of Probiotic Saccharomyces boulardii as an Adjuvant Therapy in Acute Childhood Diarrhoea

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v36i3.15539 ◽

2017 ◽

Vol 36 (3) ◽

pp. 250-255 ◽

Cited By ~ 5

Author(s):

Dillip Kumar Dash ◽

Mrutunjaya Dash ◽

M.D. Mohanty ◽

Naresh Acharya

Keyword(s):

Hospital Stay ◽

Tertiary Care ◽

Acute Diarrhoea ◽

Oral Rehydration Therapy ◽

Saccharomyces Boulardii ◽

Care Hospital ◽

Oral Rehydration ◽

Group 2 ◽

A Prospective Study ◽

Group 1

Introduction: Administration of S. boulardii in addition to rehydration therapy in diarrhea found to be beneficial in many aspects owing to a variety of causes and importantly it is was not associated with any adverse effects.Material and Methods: We conducted a prospective study of children suffering from acute diarrhoea, at a private tertiary care hospital. Children were divided into 2 groups randomly as per odd(Group 1 ) and even (Group 2) bed allotted in indoor at the time of admission: Group 1 included children on oral rehydration therapy (ORT) + Zinc + Saccharomyces boulardii (Probiotic 5 billion CFU twice daily) and Group 2 comprised of children on ORT+ Zinc. Our objective was to systematically review data on the effect of S. boulardii on acute childhood diarrhoea.Results: Out of a total of 126 children less than 2 years, 2-6 years and 6-14 years were 72 (57.14%), 42(33.33%) and 12(09.52%) respectively. The duration of diarrhoea in Group 1 was 26.31 hours and Group 2 was 47.81 hours (p<0.01). The frequency of diarrhoea showed improvement within 24 and 72 hours in Group 1 and Group 2 respectively (p<0.01).Similarly, the mean duration of hospital stay was 2.68 days in Group 1 and 4.8 days in Group 2.The treatment cost was INR 850 and INR 1650 while social cost was INR 1250 and 2600 in Group 1 and 2 respectively.Conclusion:This study shows that S. boulardii reduced the duration, frequency and hospital stay of diarrhoea thereby reducing the treatment and social costs.J Nepal Paediatr Soc 2016;36(3):250-255

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Effect of anterior capsular polishing on the incidence of YAG capsulotomy

Annals of King Edward Medical University ◽

10.21649/akemu.v11i3.1021 ◽

2016 ◽

Vol 11 (3) ◽

Author(s):

Muhammad A Ahad ◽

Mohammad Rashad Qamar ◽

Sameh K Hindi ◽

Martin N Kid

Keyword(s):

Outcome Measure ◽

Early Postoperative Period ◽

Controlled Study ◽

Control Group ◽

Anterior Capsule ◽

Main Outcome Measure ◽

Group I ◽

Group 2 ◽

One Year ◽

Group 1

Purpose: To study the effect of anterior capsule polishing during phacoemulsification on the incidence of post operative YAG laser capsulotomy. Method: A retrospective controlled study of 159 patients who underwent uncomplicated phacoemulsification with anterior capsular polishing between October 1998 and March 2000. 169 age matched patients who underwent phacoemulsification but without anterior capsule polishing served as controls. Main outcome measure: Incidence of visually significant YAG capsulotomy, which improved the Snellen acuity for more than 1 line or at least 1 line with subjective improvements in symptoms. Results: 2.51 % of patients with anterior capsular polishing (Group 1) had YAG capsulotomy compared to 7.1% of patients in control group at one year. However, after two years, 11.3% of patients in Group I had YAG capsulotomy compared to 12.4% in Group 2. Conclusion: Anterior capsular polishing during cataract surgery may delay the opacification of posterior capsule during the early postoperative period. But does not decrease the incidence of YAG capsulotomy after two years.

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Pulsed Radiofrequency for Chronic Inguinal Neuralgia

January 2018 - Pain Physician ◽

10.36076/ppj/2015.18.e147 ◽

2015 ◽

Vol 2;18 (2;3) ◽

pp. E147-E155

Author(s):

Yasser M. Amr

Keyword(s):

Pain Relief ◽

Nerve Root ◽

Small Sample ◽

Pulsed Radiofrequency ◽

Group 2 ◽

One Year ◽

The One ◽

Inguinal Neuralgia ◽

Group 1

Background: Chronic inguinal neuralgia has been reported after inguinal herniorrhaphy, caesarean section, appendectomy, and trauma to the lower quadrant of the abdomen or inguinal region. Objectives: This study was designed to evaluate the efficacy of pulsed radiofrequency in management of chronic inguinal neuralgia. Study Design: Randomized, double-blind controlled trial. Setting: Hospital outpatient setting. Methods: Twenty-one patients were allocated into 2 groups. Group 1 received 2 cycles of pulsed radiofrequency (PRF) for each nerve root. In Group 2, after stimulation, we spent the same time to mimic PRF. Both groups received bupivacaine 0.25% + 4 mg dexamethasone in 2 mL for each nerve root. Visual Analogue Scale (VAS) was assessed. Duration of the first block effective pain relief was reported. Repeated PRF blockade was allowed for any patient who reported a VAS > 30 mm in both groups during the one year follow-up period. The number and duration of blocks were reported and adverse effects were also reported. Results: Significantly longer duration of pain relief was noticed in Group 1 (P = 0.005) after the first block, while the durations of pain relief of the second block were comparable (P = 0.59). In Group 1 the second PRF produced pain relief from the twenty-fourth week until the tenth month while in Group 2, pain relief was reported from the sixteenth week until the eighth month after the use of PRF. All patients in Group 2 received 3 blocks (the first was a sham PRF) during the one year follow-up period. Meanwhile, 2 PRF blocks were sufficient to achieve pain relief for patients in Group 1 except 4 patients who needed a third PRF block. No adverse events were reported. Limitations: Small sample size. Conclusion: For intractable chronic inguinal pain, PRF for the dorsal root ganglion represents a promising treatment modality. Key words: Radiofrequency, chronic, inguinal neuralgia

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The difference in outcome of patients with open inguinal hernia repair by using delayed absorbable sutures instead of non-absorbable sutures for mesh fixation

International Surgery Journal ◽

10.18203/2349-2902.isj20205423 ◽

2020 ◽

Vol 8 (1) ◽

pp. 24

Author(s):

Ali G. Mohammed Redha ◽

Adil A. Jaber ◽

Aqeel M. Nasser

Keyword(s):

Hernia Repair ◽

Mesh Fixation ◽

Good Alternative ◽

P Value ◽

Absorbable Sutures ◽

Significant Difference ◽

The Difference ◽

Group 2 ◽

One Year ◽

Group 1

Background: Different methods are found for mesh fixation in inguinal hernioplasty both open and laparoscopic. In open technique, sutures have been the method of choice for their reduced costs and surgeons’ habits. Whether absorbable instead of non-absorbable sutures can be used still a matter of debate in view of hernia recurrence and post-operative complications.Methods: This is a prospective done on 158 male patients with uncomplicated unilateral inguinal hernias. Two groups of 69 patients were evaluated after periods up to 1 year after open hernioplasty by using delayed absorbable sutures in one group (group 1) and non-absorbable sutures in the other group (group 2) for fixation of mesh.Results: In spite of a noticeable reduction in complication in the group 1 in term of number and percentage when compared with group 2 mainly chronic pain, there is no significant difference (p value>0.05). However, these results are associated with zero recurrence in both groups during a period of one year follow up.Conclusions: Delayed absorbable sutures are good alternative of non-absorbable sutures in open mesh hernia repair associated with less complications and almost no increase in chance of recurrence.

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