scholarly journals Single Center Experience on Implementation of the Postpartum Intrauterine Device (PPIUD) in Sri Lanka: A Retrospective Study.

2020 ◽  
Author(s):  
DLW Dasanayake ◽  
Malitha Patabendige ◽  
Yamuna Amarasinghe
Keyword(s):  
Sri Lanka ◽  
Intrauterine Device ◽  
Tertiary Care ◽  
Cost Effective ◽  
Health Staff ◽  
Short Report ◽  
Single Center Experience ◽  
Resource Limited ◽  
One Year

Abstract Objectives to study the institutionalization of PPIUD services at Teaching Hospital, Mahamodara, Galle (THMG) and to study the feasibility, challenges and barriers for implementation.Results Total of 46,815 deliveries had occurred in the facility during the study period. Out of that 23,117 (49.4%) women had been counseled and 5775 (25.0%) of them were primigravida and 892 (3.9%) were teenage mothers. Total of 14,051 (60.8%) women were interviewed, but only 772 (5.5%) women consented for PPIUD. Consent withdrawal was seen in 29 (3.8 %) cases. A total of 409 community health staff were trained for counseling and follow up. PPIUD uptake was 470 (3.4%) which is comparable to national figures. Follow up data at one year was available from 199 women and spontaneous expulsion had occurred in eight (6.7%) cases with no cases of perforation or failure in terms of pregnancy. This short report gives the impression that PPIUD can be successfully implemented in resource limited settings and this also provides a feedback for the policy makers to take the necessary actions to improve the uptake of this cost effective, safe PPFP method. A routine PPIUD service has been successfully established within a tertiary care maternity setting in Sri Lanka.

Pediatric Autoimmune Encephalitis in Sri Lanka: A Single-Center Experience over 7 Years

2021 ◽  
Author(s):  
Jithangi Wanigasinghe ◽  
K. W. D. A. Anuradha ◽  
Thashi Chang
Keyword(s):  
Sri Lanka ◽  
Tertiary Care ◽  
Cerebral Performance Category ◽  
Autoimmune Encephalitis ◽  
Normal Function ◽  
Substantial Improvement ◽  
Older Children ◽  
Surface Binding ◽  
Delay In Diagnosis ◽  
Single Center Experience

AbstractPediatric autoimmune encephalitis (AE) remains a diagnostic and therapeutic challenge in resource-poor settings. Minimizing delay in diagnosis and appropriate escalation of treatment will help reduce both the short- and long-term neurodisabilities. A retrospective observational study was performed on children consecutively diagnosed with possible AE and then prospectively followed up in a single tertiary care children's hospital in Sri Lanka. Serum and cerebrospinal fluid were tested for neuroglial surface-binding autoantibodies using cell-based assays in majority of these children. Twenty-five children (mean age 7.6 years, standard deviation = 4) were recruited. In these children, presenting symptom was psychiatric in 11 children (44%), seizures in 10 (40%), language regression in 2 (8%), and combination of psychosis and convulsions in 2 (8%). Psychiatric presentations were more common in older (>6 years) compared with young children (p = 0.001), while neurological presentations were more common in children aged ≤6 years (p = 0.001). N-methyl-D-aspartate receptor (NMDAR) antibodies were detected in 9 (45%) and unspecified voltage-gated potassium channel antibodies in 1 (5%) of the 20 tested. All received intravenous steroids and immunoglobulins; 19 (76%) plasma exchange; 7 (29%) rituximab. Complete/substantial improvement at 3 months occurred in 64%. Pediatric Cerebral Performance Category score at last review was 1 (normal function for age) in 43%. Higher proportion of younger children required less intense therapy and had better recovery (56%). Death (8%), incomplete recovery (71%), and relapses (8%) were more in older children. Clinical presentation and disease outcomes were different in children aged <6 years compared with older age group. NMDAR antibody encephalitis was the commonest AE syndrome identified in this cohort.

Abstract 2524: Long-Term (4 year) Outcome following Drug Eluting Stent Implantation versus Coronary Artery By-pass Surgery in Unprotected Left Main Coronary artery Lesions

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Alaide Chieffo ◽  
Valeria Magni ◽  
Francesco Maisano ◽  
Alfonso Ielasi ◽  
Azeem Latib ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Composite Endpoint ◽  
Drug Eluting Stent ◽  
Target Vessel Revascularization ◽  
Single Center Experience ◽  
Cerebrovascular Events ◽  
Drug Eluting ◽  
One Year

One-year outcome following drug-eluting stent (DES) implantation versus coronary artery by-pass grafting (CABG) in unprotected LMCA lesions have been previously reported from our center. Methods and results Two hundred forty-nine consecutive patients with an unprotected LMCA stenosis electively treated (107 with PCI and DES implantation and 142 with CABG) in our Center, between March 2002 and July 2004, were analysed. Hierarchical study end points were occurrence at 4 years of: death; death and/or myocardial infarction (MI); death, MI and/or stroke; target vessel revascularization (TVR, defined as any revascularization in left coronary system); and major cardiac cerebrovascular events (MACCE). A propensity analysis was performed to adjust for baseline differences between the two cohorts. At 4 year-clinical follow-up, no difference was found between PCI and CABG in the occurrence of death (respectively 12.0% vs. 14.1%; unadjusted odds ratio- OR=0.845; 95% confidence interval-CI=0.365 to 1.890; P=0.80; adjusted OR=0.652; 95% CI=0.254 to 1.620; P=0.42). At adjusted analysis, PCI group showed a trend toward a lower occurrence of the composite endpoint of death and myocardial infarction (13.0% vs. 19.7%; adjusted OR=0.461; 95% CI=0.180 to 1.088; P=0.08). PCI was associated with a lower rate of the composite endpoint of death, MI and/or stroke (respectively 14.0% vs. 22.5%; unadjusted OR=0.519; 95% CI=0.238to 1.071; P=0.07; adjusted OR=0.431; 95% CI=0.175 to 0.971; P=0.04). Indeed, CABG was correlated to lower TVR (8.4% vs. 28% ; unadjusted OR= 5.018; 95% CI= 1.990-23.8; p=0.0001; adjusted OR= 5.928; 95% CI= 1.933 – 38.0; p= 0.0003). No difference was detected in the occurrence of MACCE ( in PCI 36.4% vs. 28.1% in CABG, unadjusted OR=1.409; 95% CI=0.798 to 2.509 P=0.259; adjusted OR=1.438; 95% CI=0.754 to 2.766; P=0.3007). Conclusions At 4 year-clinical follow-up, in this single-center experience, there was still no difference in the occurrence of MACCE between elective PCI with DES implantation and CABG in LMCA lesions. There was an advantage of PCI in the composite endpoint of death, MI and/or stroke, while a benefit in the need for reintervention was still found in CABG. :

scholarly journals Clinical Course of Nonfunctional Pituitary Microadenoma in Children: A Single-Center Experience

2019 ◽  
Vol 104 (12) ◽  
pp. 5906-5912 ◽  
Author(s):  
Vidhu V Thaker ◽  
Adrianne E Lage ◽  
Garima Kumari ◽  
V Michelle Silvera ◽  
Laurie E Cohen
Keyword(s):  
Clinical Course ◽  
Clinical Care ◽  
Tertiary Care ◽  
Drug Induced ◽  
Health Records ◽  
Clinical Data Warehouse ◽  
Pituitary Microadenoma ◽  
Single Center Experience

Abstract Context Pituitary lesions consistent with microadenomas are increasingly discovered by MRI. Sparse data are available on the long-term clinical and imaging course of such lesions in children. Objective The aim of this study was to define the clinical and imaging course of pituitary lesions representing or possibly representing nonfunctioning microadenomas in children to guide clinical management. Design Retrospective observational study. Methods The clinical data warehouse at a tertiary care academic children’s hospital was queried with the terms “pituitary” AND “microadenoma” and “pituitary” AND “incidentaloma.” The electronic health records of the identified subjects were reviewed to extract data on the clinical and imaging course. Results A total of 78 children had nonfunctioning pituitary lesions incidentally discovered during clinical care, of which 44 (56%) were reported as presumed or possible microadenomas. In the children with microadenoma (median age 15 years, interquartile range 2), a majority (70%) underwent imaging for nonendocrine symptoms, the most common being headache (n = 16, 36%). No significant increase in the size of the microadenoma or cysts or worsening of pituitary function was seen over the average clinical follow-up of 4.5 ± 2.6 years. Four cases of drug-induced hyperprolactinemia resolved with discontinuation of the offending medication. Conclusions Asymptomatic pituitary lesions representing cysts, microadenomas, or possible microadenomas follow a benign course in children. In the absence of new endocrine or visual symptoms, repeat MRI may not be needed, and if performed, should be done in no less than a year. When possible, it is prudent to discontinue hyperprolactinemia-inducing medications before imaging.

Retrospective Analysis of 1230 Patients of Immune Thrombocytopenic Purpura Reporting to a Tertiary Care Hospital in India from 1992–2004.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5294-5294
Author(s):  
Dharma R. Choudhary ◽  
Rajat Kumar ◽  
R. Saxena ◽  
Manoranjan Mahapatra ◽  
Atul Kotwal ◽  
...  
Keyword(s):  
Developing Countries ◽  
Response Rate ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cost Effective ◽  
Repeated Measure ◽  
Care Hospital ◽  
Chronic Itp ◽  
Acute Itp

Abstract Background: There is very little published epidemiological data from developing countries regarding ITP and no large series from India. The aim of the study was to analyze the presenting features, response to different therapeutic options and suggest cost effective therapy. Method: The records of hematology department of All India Institute Of Medical Science were analyzed from January 1992 to June 2004. This is a premium tertiary care hospital in India. Diagnosis of ITP was made according to the standard criteria. Response criteria: complete response was defined as a platelet count increase to 100x109 /l or more, for at least 2 months: partial response was defined as doubling of platelet counts from initial levels and &gt; 50x 109/l for at least 2 months; no response included none of the above. Statistical methods: Database was created in MS Access and SPSS ver 11 was used for statistical analysis. Descriptive statistics were calculated and appropriate tests of significance like Chi Square, repeated measure linear model were carried out. Results: During the study period, 1230 patients of ITP were seen in hematology department, with a median age of 19.6 years (range 0.9–80). Females were 51.1% and males 48.9%. Median follow-up was of 9 months (range 0–178). Presenting features were: skin bleed − 91.1%; mucosal bleed − 57.5%; hematuria − 7.2%; gastrointestinal bleed − 12.5% and intracraniall bleed − 2.8%. Per-vaginal bleeding − 31.2 % of females. History of preceding viral fever was seen in 13.1% and palpable spleen in 2.5%. The mean platelet counts at presentation were 34+ 18.3x109/l. There were 595 (48.4%) patients of acute ITP and 635 (51.6%) patients of chronic ITP. Childhood ITP (age ≤ 12 yr) was seen in 46.5% and adult ITP in 53.5%. Response to therapy: Prednisolone was given to 99.6% patients with response of 57.3 %; Intravenous gamma globulin was given to 8.9% with response in 63.6%. Splenectomy was performed in 5% of acute ITP and 15.1% of chronic ITP (p = 0.00). The overall number of splenectomies was 126, with a response rate of 83.3%. Of these 126, acute ITP constituted 23.8% while chronic ITP formed 76.2% of cases. There was no statistically significant difference in response rate in these two groups (p =0.575). Danazole was given to 66 patients with response in 44%. Various other modalities of treatment were given to 24 patients (Anti D-14; Dapsone-2; Cyclosporin-2; Azathioprine-5; and Vincristine with Cyclophosphamide -1 patient), with a response in 25% of patients. The overall response rate with all treatment modalities was 68%: in childhood ITP − 65% and in adult ITP − 70.5%. Childhood ITP did not respond as expected, possibly due to referral bias of more refractory cases being referred to the center. The values of platelets showed a continuous increase during follow up and this increase was statistically significant (P=0.000 for all, Repeated measure model). Conclusion: Pattern of ITP in India is similar to that seen in other centers. In this study Prednisolone was given as first line agent to almost all patients with response in 57.3%; Splenectomy were done in 10.2% of prednisolone refractory or dependent patients with a response in 83.3%. These should form the primary modalities of therapy in developing countries. Significant numbers of patients were refractory to above-mentioned modalities and thus there is a requirement for other cost-effective therapies.

scholarly journals One Year of Hepatitis B Immunoglobulin Plus Tenofovir Therapy is Safe and Effective in Preventing Recurrent Hepatitis B Infection Post-Liver Transplantation

2014 ◽  
Vol 28 (1) ◽  
pp. 41-44 ◽  
Author(s):  
Tomohiro Tanaka ◽  
Eberhard L Renner ◽  
Nazia Selzner ◽  
George Therapondos ◽  
Leslie B Lilly
Keyword(s):  
Liver Transplantation ◽  
Hepatitis B ◽  
Low Dose ◽  
Cost Effective ◽  
Hbv Infection ◽  
Recurrent Hepatitis ◽  
Hepatitis B Immunoglobulin ◽  
One Year ◽  
Related Liver Disease

BACKGROUND: Hepatitis B immunoglobulin (HBIG) given in combination with a nucleos(t)ide analogue has reduced the rate of recurrent hepatitis B virus (HBV) infection following liver transplantation (LT); however, the most effective protocol remains unclear.OBJECTIVE: To evaluate the use of tenofovir disoproxil fumarate (TDF) in combination with one year of low-dose HBIG.METHODS: Twenty-four adults who underwent LT for HBV-related liver disease at the University Health Network (Toronto, Ontario) and received TDF (± lamivudine) and one year of HBIG to prevent recurrent HBV infection from June 2005 to June 2011 were evaluated.RESULTS: The median length of follow-up post-LT was 29.1 months. Three patients died during the follow-up period. Patient survival was 100% and 84.1% at one and five years, respectively. None of the patients developed recurrent HBV infection. No significant adverse event was observed due to TDF administration; renal function pre- and post-LT were also acceptably preserved.CONCLUSION: The present study demonstrated that a short, finite course of low-dose HBIG combined with maintenance of long-term TDF staring before LT is cost-effective and safe. However, further prospective study involving a larger patient cohort with a longer followup period is required to confirm the results.

scholarly journals Y Stenting in Wide-Necked Bifurcation Aneurysms: A Single-Center Experience

2022 ◽  
Author(s):  
Apratim Chatterjee ◽  
Anshu Mahajan ◽  
Vinit Banga ◽  
Piyush Ojha ◽  
Gaurav Goel
Keyword(s):  
Cost Effective ◽  
Stent Migration ◽  
Hematoma Expansion ◽  
Technical Aspects ◽  
Single Center Experience ◽  
Level Of Consciousness ◽  
Resource Poor ◽  
Wide Availability ◽  
Cost Effective Alternative

AbstractStent-assisted coiling is an endovascular means of managing wide-necked bifurcation aneurysms. In spite of the wide availability of various newer devices in managing such difficult aneurysms, the Y stenting offers a safe and cost-effective alternative to treat such cases in resource poor settings. This article provides an insight of our initial six cases of Y stent-assisted coiling along with their follow-up over a period of 6 months with no recanalization in any case. It also highlights the various technical aspects involved in such cases. One case had recurrent subdural hematoma probably due to use of antiplatelets and another patient had sudden dip in level of consciousness probably due to hematoma expansion that might also have been due to antiplatelet usage. However, none of the cases had any issues regarding stent migration, malapposition, and dissection. In our experience, Neuroform Atlas stent used for Y stenting offers a safe and technically easy alternative to various newer bifurcation devices.

Sign in / Sign up

Export Citation Format

Share Document