Patient Characteristics and Evolution of Surgical Management of Gastric/ Gastro-esophageal Junction (GOJ) Adenocarcinoma From 1998 to 2018: Experience From a Single Gastrointestinal Surgical Unit in a Resource Limited Setting

2021 ◽  
Author(s):  
Duminda Subasinghe ◽  
TG Amal Priyantha
Keyword(s):  
Curative Resection ◽  
Distal Gastrectomy ◽  
Care Center ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Sri Lankan ◽  
Curative Therapy ◽  
High Risk Factors ◽  
Resource Limited ◽  
Low Incidence

Abstract Introduction: Gastric/gastro-oesopageal junctional adenocarcinoma/ (GC/GOJ CA) is the fourth commonly diagnosed cancer and the second commonest cancer related cause of death worldwide. Curative therapy for GC involves surgical resection with an accompanying lymphadenectomy. Yet, most of the GC/GOJ tumours are inoperable at presentation and has a poor prognosis in our setup probably due to the absence of screening programme. The objective of this study was to describe the operability and curative resection rate and outcomes of gastric/GOJ adenocarcinoma in Sri Lankan setting from 1998 to 2018.Methodology- In a retrospective analysis of prospectively maintained data from, surgery for GCs in a tertiary care center over a period of 21 years. All patients underwent surgery for GC/GOJ adenocarcinoma by single gastrointestinal surgeon. Results: There were 153 patients with mean age of 57.4(22 to 84) years. The majority (n=109) were Males (Male: Female was 2.3 : 1) . There were 88(56.4%) distal, 60(39.2%) proximal and 5(3.2%) diffuse cancers. Only 82 (53.6 %) patients underwent curative resection. Only 3 patients underwent palliative major resection (total gastrectomy(n=1), distal gastrectomy(n=2) Among curative resections,51(62.2%) had distal gastrectomy and 17(20.7%) had total gastrectomy.R0 resection was performed in 75 (91.5%), and 6 (7.3%) had microscopic positive margins (R1). Resectability of the proximal GCs (48.3%, n=29) was lower (63.4%, n=54) than the distal GCs (p= 0.117). Further, resectability among patients with GCs has not increased significantly over the past 21 years.Conclusions: Majority of the patients especially with proximal GC are inoperable at presentation. Despite the availability of endoscopes the operability has not changed significantly over the years. Given the low incidence, screening for GC is not seemingly feasible in Sri Lanka. Therefore an attempt has to be made to identify those with high risk factors during diagnostic endoscopic procedures.

scholarly journals An infant with 49XXXXY syndrome: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
N. P. G. C. R. Naotunna ◽  
C. Liyanage ◽  
N. Atapattu
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Chromosome Analysis ◽  
Dehydroepiandrosterone Sulfate ◽  
Ambiguous Genitalia ◽  
Normal Vaginal Delivery ◽  
Sri Lankan ◽  
Pediatric Endocrinology ◽  
First Child

Abstract Background 49XXXXY syndrome is the rarest X chromosome aneuploidy, with approximate incidence of 1:85,000–100,000 male births. Worldwide, around 100 cases have been reported. In this report, we describe one such case seen in Sri Lanka. Case presentation A 10-day-old Sri Lankan neonate born in a tertiary care center was referred to the pediatric endocrinology unit of Lady Ridgeway Hospital due to detection of ambiguous genitalia at birth. He was the first child born to nonconsanguineous healthy parents following an uncomplicated antenatal period. He was born at term via normal vaginal delivery, with a birth weight of 2.385 kg. The baby was active, and there was no documented hypoglycemia or alteration in basic biochemical investigations. On examination, the child had hypertelorism, upslanting palpebral fissures, flat occiput, and mild webbing of the neck. System examination was normal. Genitalia examination revealed bifid scrotum, perineal urethra, 2 cm phallus, and bilateral testis in situ. Hormonal analysis, including dehydroepiandrosterone sulfate, testosterone, and 17-OH progesterone levels, was normal except for an elevated level of follicle-stimulating hormone, indicating gonadal dysgenesis. Ultrasound of the abdomen detected testis located at bilateral inguinal canal, and no Müllerian structures were visible. Echocardiography showed a small patent foramen ovale with otherwise normal heart. Chromosome analysis revealed 49XXXXY syndrome. Conclusion 49XXXXY syndrome should be entertained as a rare possibility for ambiguous genitalia, and karyotyping is an essential investigation for evaluation of such patients.

Effect of outside referrals to a tertiary care liver tumor board on diagnostic testing and initial curative therapy.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 259-259
Author(s):  
Yapei Zhang ◽  
Jennifer Arango ◽  
Jeffrey Weinreb ◽  
Tamar Hamosh Taddei
Keyword(s):  
Liver Disease ◽  
Diagnostic Method ◽  
Care Center ◽  
Tertiary Care ◽  
Tumor Board ◽  
Tertiary Care Center ◽  
Disease Etiology ◽  
Time To Treatment ◽  
Curative Therapy ◽  
To Receive

259 Background: Hepatocellular carcinoma (HCC) is a complex and unique cancer. Arriving at the optimal treatment plan is best accomplished by a multidisciplinary tumor board (MDTB). We hypothesized that patients referred from outside institutions to our tertiary care center for MDTB review may face disparities in diagnosis and treatment. Methods: We performed chart review of incident HCC cases presented from 2/1/13-2/1/16 at an American College of Surgeons accredited MDTB that convenes weekly at a tertiary care, university-affiliated hospital. We examined variables such as demographics, originating institution, liver disease etiology, location of index imaging, date of first tumor board presentation, diagnostic method (imaging, biopsy, tumor board consensus), BCLC stage at diagnosis, initial treatment, and time to treatment. Results: 167 cases of HCC were referred from 37 outside institutions (outside cases); 127 cases originated from our institution (internal cases). The two groups were comparable in gender distribution, liver disease etiology, and BCLC stage at tumor board presentation. Compared to internal cases, outside cases were diagnosed less often by imaging (47% vs. 77%, p < 0.000001) and more often by biopsy (38% vs. 17%, p < 0.001) or MDTB consensus (16% vs. 6%, p < 0.05). When stratified by BCLC stage, this difference in diagnostic method persisted in early and mid-staged patients (Stages 0, A, B), but not in advanced staged patients. Outside cases were also more likely to receive tumor biopsy (33% vs. 9%, p < 0.05) and less likely to receive initial curative therapy (resection, ablation, transplantation) (22% vs. 32%, p < 0.05). There was no significant difference in time to treatment. Conclusions: Despite similar demographics and disease profiles compared to patients from our tertiary care center, patients referred from outside facilities for MDTB review more often required biopsies or MDTB consensus to diagnose HCC, and were less likely to receive curative therapy. Differences in HCC diagnostic imaging protocols across institutions may help explain these results. Further study will help identify disparities in receipt of curative therapy.

scholarly journals Peri-partum cardiomayopathy-not a rare entity, clinical profile in a rural tertiary care center in Gujarat, India

2017 ◽  
Vol 6 (4) ◽  
pp. 1544 ◽  
Author(s):  
Rumi Bhattacharjee ◽  
Nitin Raithata ◽  
Molina Patel ◽  
Smruti Vaishnav
Keyword(s):  
Heart Failure ◽  
Care Center ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Fetal Outcome ◽  
Obstetric Complications ◽  
Tertiary Care Center ◽  
Diagnostic Dilemma ◽  
High Risk Factors ◽  
High Index Of Suspicion

Background: Peri-partum cardiomayopathy (PPCM) in pregnancy has a potential to adversely affect both mother and fetus. Severe cases can be associated with life threatening complications unless managed promptly by multidisciplinary team. The objective was to study maternal and fetal outcome of PPCM patients.Methods: An observational cohort over 4 years (2012 to 2015) was conducted in a Rural tertiary care center. Consecutive antenatal and postpartum women with PPCM were studied for medical and obstetric complications, deliveries, fetal outcome and maternal mortality.Results: The incidence of PPCM was 0.3% and Most patients presented with typical signs and symptoms of heart failure. 55.5% were in NYHA 3 and 4 and 50% had ejection fraction below 30%. 83.3% required ICU admissions of varying length and Maternal mortality was in 1 patient (5.56%). PPCM occurred in 55.5% of ante partum against 44.4% of postpartum patients. Obstetric complications like PPH occurred in 11.1% while poor fetal outcome like preterm deliveries occurred in 50% while still births in 16.67%.Conclusions: The low incidence and rarity of PPCM presents itself with diagnostic dilemma. Obstetrician should have high index of suspicion in patients with heart failure and high risk factors. Early diagnosis and prompt treatment can only improve the outcome.

scholarly journals Riots in Beirut: Description of the Impact of a New Type of Mass Casualty Event on the Emergency System in Lebanon

2019 ◽  
Vol 13 (5-6) ◽  
pp. 849-852
Author(s):  
Mohamad El Warea ◽  
Roula Sasso ◽  
Rana Bachir ◽  
Mazen El Sayed
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Mass Casualty ◽  
Control Measures ◽  
Body Region ◽  
Mass Casualty Event ◽  
The Impact

ABSTRACTIntroduction:In the summer of 2015, Beirut experienced a garbage crisis that led to rioting. Riot control measures resulted in multiple casualties. This study examines injury patterns of riot victims presenting to the emergency department of a tertiary care center in a developing country.Methods:A retrospective study was conducted in the emergency department of the American University of Beirut Medical Center between August 22 and August 30, 2015. Patients seen in the emergency department with riot injuries were included. Patient characteristics, injuries, and resources utilized in the emergency department were analyzed.Results:Ninety-five patients were identified. Most patients presented to the emergency department within a short time period. The mean age of the patients was 28.0 ± 8.7 years. Most (90.5%) of the patients were males and 92.6% were protestors. Emergency medical services were utilized by 41.0% of patients. Laceration was the most common presenting complaint (28.5%), and blunt trauma was the most common type of injury (50.5%). The head/face/neck was the most common injured body region (55.8%). Most patients did not require blood tests or procedures (91.6% and 61.0%, respectively), and 91.2% of patients were treated in the emergency department and discharged. One patient required intensive care unit admission and another was dead on arrival.Conclusions:Most patients had mild injuries on presentation. The emergency department experienced a high influx of patients. Complications and deaths can occur from seemingly nonlethal weapons used during riots and warrant effective prehospital and hospital disaster planning.

Survival of Premature Babies with the Revolutionary Kangaroo Mother Care Technique at a Tertiary Care Center, Sindh, Pakistan

2021 ◽  
Vol 15 (11) ◽  
pp. 3244-3246
Author(s):  
Bakhtiar Ahmed Bhambrho ◽  
Nisar Ahmed Shar ◽  
Amjad Ali Mughal ◽  
Farukh Imtiaz ◽  
Pardeep Kumar ◽  
...  
Keyword(s):  
Birth Weight ◽  
Health Workers ◽  
Care Center ◽  
Tertiary Care ◽  
Scale Up ◽  
Sampling Technique ◽  
Kangaroo Mother Care ◽  
Primary Data ◽  
Resource Limited ◽  
Skin To Skin

Background: Kangaroo mother care (KMC) is a resource-limited method for low-birth-weight babies that seeks to mitigate mortality rates by thermoregulation, breastfeeding assistance, and early hospital discharge. Methods: This study was carried out at GIMS hospital Khairpur Kangaroo Mother Care Unit at PAQSJIMS between August 2019 to September 2020. A total of hundred mothers and their infants were enrolled in the study. A non-probability convenience sampling technique was employed. A Questionnaire filled with the permission of admitted mother and primary data collected as per proforma i.e. date of admission, mother name, address, age, parity, gravida, date of delivery, place of delivery, Type of delivery, gestation at birth (weeks), birth weight, gender, Date of KMS admission, weight at KMC, discharge date of KMC, weight of Discharge KMC, status at the time of discharge and cause of death (if any). All mothers used KMC kits and the infant weight at admission and discharge were documented. Results: The average age (Figure 1) of mothers was recorded as 31.69 (20-40 years). The babies weight at the time of KMC unit admission was recorded as 0.7 – 1.8 grams and after 3-4 weeks admission the babies survived and gained weight recorded at time of discharge was 0.8 to 2.2 grams which showed that all mothers used kits properly, and all babies survived. Conclusions: All mothers were pleased to operate KMC kits. KMC is a very innovative technique to save the lives of premature newborns. This therapy emphasizes mothers for continuous skin-to-skin touch with infants, as well as wrapping the child in a warm blanket. The availability of space facilities and capacity building for health workers are therefore the fundamental requirements that must be funded by international aid agencies in order to scale up the initiative in these environments. Keywords: Neonatal survival, KMC, care, breastfeeding.

scholarly journals The Effectiveness of Gelfoam as the Sole and Primary Embolization Agent in the Management of Hemoptysis: A Retrospective Study from a Tertiary Care Center

2021 ◽  
Vol 11 ◽  
pp. 10
Author(s):  
Abhinandan Ruge ◽  
Nidhi Kumar ◽  
Clyde Menezes
Keyword(s):  
Care Center ◽  
Spinal Cord Ischemia ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Short Term ◽  
Term Outcome ◽  
Term Efficacy ◽  
Targeted Analysis ◽  
Resource Limited ◽  
First Choice

Objectives: The objective of this study was to evaluate the role of Gelfoam as an effective embolizing agent in patients with hemoptysis presenting to a tertiary care center in developing nations. Material and Methods: A retrospective analysis of data from 30 patients treated by Interventional radiologist at St. John’s Medical College, Bangalore, India, was performed. The study included 22 males (73.3%) and 8 (26.65%) female patients. Gelfoam was used as the sole embolizing agent and arteries with features of abnormal blush and hypertrophy were targeted. Analysis of the etiology, immediate, and short-term outcome and complications, when present, was performed. The median follow-up period was 45 days following an embolization procedure at this center. Results: A high short-term efficacy was noted following embolization procedures with Gelfoam as the sole agent. Twenty-eight out of 30 procedures were deemed successful, and post-tubercular changes were noted to be the cause for hemoptysis in 23 patients. The high short-term efficacy (93.3%), evidenced by a complete stoppage of hemoptysis, along with a relatively low rate of complications (spinal cord ischemia in only 2.3%), strengthens the position of Gelfoam as the sole embolizing agent in a resource-limited setting. Conclusion: In an economically constrained setting, Gelfoam proves to be a useful first choice single embolization agent, while polyvinyl alcohol particles coupled with microcatheter systems remain within reach of only those who can afford them.

scholarly journals Safety and Immunogenicity of CoronaVac and ChAdOx1 Against the SARS-CoV-2 Circulating Variants of Concern (Alpha, Delta, Beta) in Thai Healthcare Workers

2021 ◽  
Author(s):  
Nasikarn Angkasekwinai ◽  
Jaturong Sewatanon ◽  
Suvimol Niyomnaitham ◽  
Supaporn Phumiamorn ◽  
Kasama Sukapirom ◽  
...  
Keyword(s):  
Neutralizing Antibodies ◽  
Care Center ◽  
Seroconversion Rate ◽  
Geometric Mean ◽  
Tertiary Care ◽  
Adenovirus Vector ◽  
Electronic Diary ◽  
Vector Vaccine ◽  
Resource Limited ◽  
Care Workers

Importance: Inactivated vaccine (CoronaVac) and chimpanzee adenovirus-vector vaccine (ChAdOx1) have been more available in resource-limited settings. However, the data comparing between these two vaccines in the same setting are limited. Objectives: To determine adverse events (AEs) and immunogenicity of CoronaVac and ChAdOx1 in health care workers (HCWs). Design: This prospective study was conducted from February to July 2021. Setting: A single center, university-based tertiary care center in Bangkok. Participants: Healthy HCWs. Exposure: Two doses of CoronaVac (4 weeks apart) or ChAdOx1 (8 weeks apart) intramuscularly. Main Outcomes and Measures: Self-reported AEs were collected for 7 days following each vaccination using electronic diary. The immunogenicity was determined by the level of IgG antibodies against receptor binding domain (RBD) of the SARS-CoV-2 spike protein (S1 subunit). The 50% plaque reduction neutralization tests against original Wuhan strain and circulating VOCs were performed in subset of samples at 2 weeks after the second dose. Results: Of the 360 HCWs, 180 received each vaccine. The median (interquartile range: IQR) age was 35 (29-44) years old and 84.2% were female. Participants who received ChAdOx1 reported higher frequency of AEs than those received CoronaVac after both the first dose (84.4% vs. 66.1%, P < 0.001) and second dose (75.6% vs. 60.6%, P = 0.002), with more AEs in those younger than 30 years of age for both vaccines. The seroconversion rate was 75.6% and 100% following the first dose of CoronaVac and ChAdOx1, respectively. All participants seroconverted at 2 weeks after the second dose. The anti-SARS-CoV-2 RBD IgG levels induced by CoronaVac was lower than ChAdOX1 with geometric means of 164.4 and 278.5 BAU/mL, respectively (P = 0.0066). Both vaccines induced similar levels of neutralizing antibodies against the Wuhan strain, geometric mean titer (GMT) of 337.4 vs 331.2; however, CoronaVac induced significantly lower GMT against Alpha (23.1 vs. 92.5), Delta (21.2 vs. 69.7), and Beta (10.2 vs. 43.6) variants, respectively. Conclusions and Relevance: CoronaVac induces lower measurable antibodies but with lower frequency of AEs than ChAdOx1. The low neutralizing antibodies against the circulating VOCs induced by CoronaVac supports the need for earlier boosting to prevent breakthrough infections. Trial Registration: TCTR20210720002 https://www.thaiclinicaltrials.org/

Abstract 16460: Differential Effect of the Emory Risk Score on Early versus Late Pacemaker Implantation in TAVR Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
NACHIKET MADHAV APTE ◽  
Farhad Sami ◽  
AMIT SHRESHTA ◽  
Tarun Dalia ◽  
Sagar Ranka ◽  
...  
Keyword(s):  
Risk Score ◽  
Statistical Tests ◽  
Care Center ◽  
Tertiary Care ◽  
Pacemaker Implantation ◽  
Patient Characteristics ◽  
P Value ◽  
Limited Data ◽  
Post Discharge ◽  
The Mean

Introduction: The Emory risk score has been developed to predict new pacemaker implantation in patients undergoing TAVR procedures. There is limited data on assessing risk of early versus late pacemaker implantation in these patients. Hypothesis: The Emory risk score is similar for patients with both early and late pacemaker implantation in TAVR patients. Methods: A single center observational study was performed at our tertiary care center. All patients who underwent pacemaker implantation after TAVR procedures were included. Patients were categorized as early or late if they had pacemaker implantation within the same admission versus implantation post discharge. Standard statistical tests were used for analysis with two-sided p value <0.05 considered significant. IRB approval was obtained for the study Results: A total of 97 patients were studied between January 2017 to April 2020. The mean age was 77.5 ± 7 years and females were 41.2%. At baseline patients with early implantation of pacemakers (n=66) had a higher proportion of underlying RBBB (45.2% vs 23.3%, p=0.43), higher valve size as well as a higher incidence of valve oversizing > 146% (43.9 % vs 19.4 %, p =0.23)when compared to patients with late pacemakers(n=31). There was no difference between patient characteristics, baseline comorbidities, pre procedural ECG parameters as well as use of beta blocking agents. Late pacemaker implantations were associated with a overall lower Emory Risk score (1.06±1.41 vs 1.70±1.35, p =0.037). Conclusions: The Emory Risk score is significantly different for early and late pacemaker implantation. Further studies are needed evaluate risk of late pacemaker implantation.

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