scholarly journals High Rates of Malaria Microscopy but Low Turnaround of Test-results Among Inpatients in Tertiary Care: With Delayed Initiation, Monotherapy and Incomplete Dosing of Antimalarials

2020 ◽  
Author(s):  
Ronald Kiguba ◽  
Charles Karamagi ◽  
Sheila M. Bird
Keyword(s):  
Tertiary Care ◽  
Significant Risk ◽  
Malaria Diagnosis ◽  
Significant Risk Factor ◽  
Test Results ◽  
Laboratory Services ◽  
Mulago National Referral Hospital ◽  
Delayed Initiation ◽  
National Referral Hospital ◽  
Malaria Microscopy

Abstract Objectives:To describe the patterns of malaria diagnosis and antimalarial use: monotherapy, missed Day 1 dosing and risk-factors. Methods: Prospective cohort of consented adult inpatients on the medical and gynaecological wards of Uganda’s 1790-bed Mulago National Referral Hospital.Results: One in five (19%, 146/762; 95% confidence interval (CI): 16% to 22%) inpatients had an admitting or discharge malaria diagnosis or both. Microscopy was requested in 77% (108/141; 95% CI: 69% to 83%) of inpatients with an admitting malaria diagnosis; results were available for 46% (50/108; 95% CI: 37% to 56%), of whom 42% (21/50; 95% CI: 28% to 57%) were positive. Artesunate (AS) only (47%, 47/100; 95% CI: 37% to 57%) was the most frequently hospital-administered antimalarial followed by quinine (Q) only (23%, 95% CI: 15% to 32%). A quarter (25%, 25/100; 95% CI: 17% to 35%) of the inpatients missed their Day 1 dose of hospital-initiated antimalarials. Nearly half (47%, 95% CI: 34% to 61%) of 57 inpatients on AS and 18%(95% CI: 4% to 32%) of 28inpatients on Q missed at least one day of dosing in Days 1-3. Number of admitting diagnoses was a significant risk-factor for missed Day 1 dosing of hospital-initiated antimalarials (OR = 2.7, 95% CI: 1.53-4.54; P-value < 0.001).Conclusions: Half the malaria microscopy results were not available; yet, the rate of testing was high. Improvement in laboratory services, procurement, prescription, dispensing and administration of antimalarials could curb missed treatment for confirmed malaria cases, monotherapy and delayed doses.

Neurodevelopmental outcome of healthy term newborn with serum bilirubin >15 mg/dl at one year

2020 ◽  
pp. 1-6
Author(s):  
P. Dubey ◽  
J. Shrivastava ◽  
B.P. Choubey ◽  
A. Agrawal ◽  
V. Thakur
Keyword(s):  
Serum Bilirubin ◽  
Tertiary Care ◽  
Neurodevelopmental Outcome ◽  
Significant Risk ◽  
Central India ◽  
Significant Risk Factor ◽  
Motor Domain ◽  
Medical Emergency ◽  
One Year ◽  
Group 1

BACKGROUND: Neonatal hyperbilirubinemia is a common medical emergency in early neonatal period. Unconjugated bilirubin is neurotoxic and can lead to lifelong neurological sequelae in survivors. OBJECTIVE: To find out the association between serum bilirubin and neurodevelopmental outcome at 1 year of age using Development Assessment Scale for Indian Infants (DASII). METHODS: A prospective cohort study was conducted in the Department of Pediatrics of a tertiary care institution of Central India between January 2018 and August 2019. Total 108 term healthy neonates, with at least one serum bilirubin value of >15 mg/dl, were included. Subjects were divided into three groups based on the serum bilirubin; group 1: (15–20 mg/dl) –85(78.7%) cases, group 2: (20–25 mg/dl) –17(15.7%), and group 3: (>25 mg/dl) –6(5.5%). Developmental assessment was done using DASII at 3, 6, 9, 12 months of age. RESULTS: Out of 108 cases, 101(93.5%) received phototherapy, and 7(6.5%) received double volume exchange transfusion. Severe delay was observed in 5(4.6%) and mild delay in 2(1.9%) cases in the motor domain of DASII at one year. Severe delay in the motor domain was associated with mean TSB of 27.940±2.89 mg/dl and mild delay with mean TSB of 22.75±1.76 mg/dl (p = 0.001). On cluster analysis, delay was observed in locomotion 1 score in 11(13%) cases (p = 0.003) and manipulation score in 6(7.1%) cases in group 1. CONCLUSION: Increased serum bilirubin was a significant risk factor for the delayed neurodevelopment in babies with neonatal jaundice. Even a moderate level of bilirubin significantly affects the developmental outcome.

An Outbreak of Pyodermas Among Neonates Caused by Ultrasound Gel Contaminated With Methicillin-SusceptibleStaphylococcus Aureus

2000 ◽  
Vol 21 (12) ◽  
pp. 761-764 ◽  
Author(s):  
Klaus Weist ◽  
Constanze Wendt ◽  
Lyle R. Petersen ◽  
Hans Versmold ◽  
Henning Rüden
Keyword(s):  
Hip Joint ◽  
Case Control Study ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Case Control ◽  
University Hospital ◽  
Good Physical Condition ◽  
Rapd Pcr ◽  
Control Study

Objective:To investigate an outbreak of methicillin-susceptibleStaphylococcus aureus(MSSA); infections in a neonatal clinic.Design:Prospective chart review, environmental sampling, and genotyping by two independent methods: pulsed-field gel electrophoresis (PFGE) and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). A case-control study was performed with 31 controls from the same clinic.Setting:A German 1,350-bed tertiary-care teaching university hospital.Results:There was a significant increase in the incidence of pyodermas with MSSA 10 neonates in good physical condition with no infection immediately after birth developed pyodermas. A shared spatula and ultrasound gel were the only identified infection sources. The gel contained MSSA and was used for hip-joint sonographies in all neonates. PFGE and RAPD-PCR patterns from 6 neonates and from the gel were indistinguishable and thus genetically related clones. The case-control study revealed no significant risk factor with the exception of cesarean section (P=.006). The attack rate by days of hip-joint sonography between April 15 and April 27, 1994, was 11.8% to 40%.Conclusions:Inappropriate hygienic measures in connection with lubricants during routine ultrasound scanning may lead to nosocomialS aureusinfections of the skin. To our knowledge this source ofS aureusinfections has not previously been described.

scholarly journals Convulsive status epilepticus in children: clinical profile and outcome in a tertiary care hospital

2019 ◽  
Vol 6 (2) ◽  
pp. 280
Author(s):  
Madhu P. K. ◽  
Krithika R.
Keyword(s):  
Status Epilepticus ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Refractory Status Epilepticus ◽  
Clinical Profile ◽  
Convulsive Status Epilepticus ◽  
Care Hospital ◽  
Mortality And Morbidity

Background: The outcome of status epilepticus (SE) depends on various determinants such as age, type and duration of SE, etiology, management and associated comorbidities. This study was undertaken to describe the clinical profile and outcome of children with convulsive status epilepticus presenting to pediatric intensive care unit (PICU).Methods: Eighty-seven children between the age group 1 month to 12 years who at presentation or during the PICU stay had convulsive status epilepticus (CSE) were included in the study. Clinical profile, etiological spectrum and outcome at the end of hospital stay were analysed.Results: Median age of CSE was 4 years and 55 (63.2%) were below 5 years of age.  Acute symptomatic etiology of CSE was a significant risk factor (p= 0.03) for refractory status epilepticus (RSE) which was seen in 31 patients (39%). Acute symptomatic etiology was the cause of CSE in 46 (59.2%) children. Remote symptomatic (26.4%), cryptogenic (18.4%) and progressive (2.3%) were other etiologies. Neuro-infection (29.8%) and febrile seizures (11.5%) were the most common acute symptomatic causes. Mortality and morbidity occurred in 23 (26.4%) and 8 (9.2%) patients respectively. Remaining 56 (64.6%) returned to baseline condition at the end of hospital stay. Longer duration (p= 0.03) and acute symptomatic etiology (p=0.049) were significant risk factors for mortality.Conclusions: Most common causes of CSE in children are acute symptomatic. Longer duration of status is associated with higher mortality. Hence, termination of seizure activity at the earliest, prudent management of respiratory or circulatory impairments in these children and improving the overall health care to prevent neuro-infections are important steps to improve outcome.

Cervical Metastasis in Squamous Cell Carcinoma of the Hard Palate and Maxillary Alveolus

2016 ◽  
Vol 95 (10-11) ◽  
pp. E6-E25 ◽  
Author(s):  
Yekaterina Koshkareva ◽  
Jefrey C. Liu ◽  
Miriam Lango ◽  
Tomas Galloway ◽  
John P. Gaughan ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Hard Palate ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Surgical Excision ◽  
Significant Risk Factor ◽  
Cancer Center

We conducted a retrospective study to determine the incidence and treatment outcomes of neck metastases in patients with squamous cell carcinoma (SCC) of the hard palate and/or maxillary alveolus after surgical excision of the primary tumor. We also sought to identify any risk factors for recurrence. Our study population was made up of 20 patients—9 men and 11 women, aged 46 to 88 years (mean: 72.6)—who had undergone excision of an SCC of the hard palate and/or maxillary alveolus at a tertiary care cancer center over a 7-year period. Half of all patients were former tobacco users. Of the 20 tumors, 10 involved the maxillary alveolus, 4 involved the hard palate, and 6 involved both sites. Three patients were clinically categorized as T1, 9 as T2, 6 as T3, and 2 as T4; pathologically, 8 tumors were categorized as T4a. In addition to maxillectomy, a neck dissection was performed in 7 patients—4 therapeutically and 3 electively. Eight of 20 patients experienced a recurrence: 4 local, 6 regional, and 2 distant (several patients had a recurrence at more than one site). Univariate analysis identified perineural invasion (p = 0.04) as a statistically significant risk factor for recurrence. Of 14 patients with a clinicopathologically negative neck, 5 (36%) developed a cervical recurrence, and 4 of them died of their disease. An advanced stage (T4 vs. <T4) was not significantly correlated with the risk of regional metastasis (p = 0.58). The rate of occult nodal metastasis in clinically and radiologically N0 necks was high. Clinical and radiologic understaging was common, and regional recurrences frequently resulted in death. We conclude that elective nodal evaluation and treatment of the neck warrants strong consideration for most patients with cancer of the hard palate and/or maxillary alveolus.

scholarly journals MO220MID TERM E GFR AND ITS IMPACT ON ADVERSE PREGNANCY OUTCOMES- IMPORTANCE OF GESTATIONAL HYPERFILTERATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Anupma Kaul ◽  
Amita Pandey
Keyword(s):  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcome ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Adverse Pregnancy Outcomes ◽  
Reference Level ◽  
Singleton Pregnancy ◽  
Baseline Serum ◽  
Adverse Pregnancy

Abstract Background and Aims The hemodynamic adaptation plays a crucial role in maintaining gestation, the clinical significance of midterm renal hyperfiltration on pregnancy outcomes is unknown. The present study was retrospective study among all pregnant ladies whose midterm eGFR wascompared with their baseline and its change from baseline was considered as a surrogatemarker for Mid term hyperfilteration among women without underlying evidence of CKD tofurther evaluate its value as a prognostic factor of the eGFR during gestation Method All pregnant females aged 18-50 years whose pre gestational baseline serum creatinine was available and had a singleton pregnancy were included in the study .The study was conducted from January 2015 till December 2018 in a tertiary care Institute in Northern India . MRH was represented by the highest eGFR, which was calculated using the Chronic Kidney Disease Epidemiology Collaboration method. An adverse pregnancy event was defined by the composition of preterm birth (gestational age &lt;37 weeks), low birth weight (&lt;2.5 kg), and preeclampsia. Results Total of 1045 pregnancies were evaluated to study. Among them, 15 , 305, 680, and 45 mothers had midterm eGFR levels of 60–90, 90–120, 120–150, and ≥150 ml/min per 1.73 m2, respectively. The adjusted odds ratio and associated 95% confidence interval (95% CI) of an adverse pregnancy outcome for eGFR levels below and above the reference level of 120–150 ml/min per 1.73 m2 were 1.97 (95% CI, 1.34 to 2.89; P&lt;0.001) for ≥150 ml/min per 1.73 m2; 1.57 (95% CI, 1.23 to 2.00; P&lt;0.001) for 90–120 ml/min per 1.73 m2; and 4.93 (95% CI, 1.97 to 12.31; P&lt;0.001) for 60–90 ml/min per 1.73 m2. Moreover, among mothers without baseline CKD, women with adverse pregnancy outcomes had less prominent MRH than those without (P&lt;0.001) Conclusion There was an unique relationship between the midterm eGFR and adverse pregnancy outcomes, and the optimal range of midterm eGFR levels was 120–150 ml/min per 1.73 m2. In those females without evident functional renal impairment, the absence of prominent MRH could be a significant risk factor for poor pregnancy outcomes

scholarly journals Sex differences in clinical presentation in acute MI

2017 ◽  
Vol 4 (4) ◽  
pp. 940
Author(s):  
Ashwin Kodliwadmath ◽  
Naren V. Nimbal
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Chest Pain ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Control Group ◽  
Care Hospital ◽  
Acute Mi

Background: Acute myocardial infarction differs in women and men with respect to risk factors and clinical presentation. There are studies carried out worldwide on this issue but few from India. This study was done to study the sex based differences in the risk factors and clinical features of acute MI in patients with Indian ethnicity.Methods: Comparative prospective study consisting of 100 women as study group and 100 men as control group with acute MI, who were admitted in a tertiary care hospital, from December 2016 to June 2017.Results: Chest pain was the main complaint in majority of the women (82%) and men (88%). Radiation of chest pain (87%) and sweating (90%) were significantly present in men compared to women (65% and 62% respectively), while breathlessness was significantly present in women (78%) compared to men (64%) and fatigue in women (76%) significantly more than men (55%). Smoking was a significant risk factor in men (69%) compared to women (5%), while diabetes mellitus was a significant risk factor in women (62%) compared to men (39%).Conclusions: Women with acute MI had more atypical presentation of symptoms, similar risk factors, compared to men except for smoking which was more significant in men and diabetes more common in women.

scholarly journals Non-Adherence to Anti-Hypertensive Treatment

2020 ◽  
Vol 32 (1) ◽  
pp. 126-129
Author(s):  
Shalini . ◽  
Manish Kumar Goel
Keyword(s):  
Side Effects ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Developed Countries ◽  
New Delhi ◽  
Care Hospital ◽  
Chi Square ◽  
Cross Sectional

Background: In developed countries, adherence among patients suffering from chronic diseases averages only 50%; in developing countries it is assumed to be much lower. Aims & objectives: To find out the prevalence of non-adherence to antihypertensive treatment among individuals seeking anti-hypertensive treatment from tertiary care hospital in New Delhi & to find out the factors related to non-adherence to the anti-hypertensive treatment among study subjects. Material and Methods: A cross-sectional hospital-based study was conducted from June to October 2018 among 150 diagnosed cases of hypertension. The drug adherence was assessed by using standard Brief Medication Questionnaire I (BMQ I) and to know the determinants of non-adherence a semi-structured (self-designed and pre tested) questionnaire was used. The association of different factors with adherence was analyzed by applying chi square (χ2) test. Results: Among total of 150 participants 44% were males and 56% were females. The magnitude of non-adherence to anti-hypertensive drugs was 35.3%. Side effects of anti-hypertensive drugs was significant risk factor for non-adherence to anti-hypertensive drugs and common reasons for non-adherence were unwanted side effects (64.2%) followed by worry about long term side effects (62.3%). Conclusion: Prevalence of non-adherence to anti-hypertensive drugs was quite high, most common reason for non-adherence to anti-hypertensive medication was unwanted side effects and worry about long term side effects.

scholarly journals Predictors of Relapse after Inpatient Opioid Detoxification during 1-Year Follow-Up

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Harsh Chalana ◽  
Tanu Kundal ◽  
Varun Gupta ◽  
Amandeep Singh Malhari
Keyword(s):  
Treatment Plan ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Patient Characteristics ◽  
Time Period ◽  
Significant Difference ◽  
Risk Patients ◽  
Opioid Detoxification

Introduction. Relapse rate after opioid detoxification is very high. We studied the possibility that predetoxification patient characteristics might predict relapse at follow-up and thus conducted this 1-year follow-up study to assess the predictors of relapse after inpatient opioid detoxification.Materials and Methods. We conducted this study in our tertiary care institute in India over two-year time period (1 Jan 2014 to 31 Dec 2015). Out of 581 patients admitted, 466 patients were considered for study.Results and Discussion. No significant difference was found between relapsed and nonrelapsed patients regarding sociodemographic profile; however substance abuse pattern and forensic history showed significant differences. Relapsed patients abused greater amount and used injections more commonly, as compared to nonrelapsed group. Longer duration of abuse was also a significant risk factor. Patients with past attempt of opioid detoxification and family history (parental or first degree) of alcohol abuse had decreased possibility of maintaining remission during 1-year follow-up. Relapsed patients were found to abuse their spouse or parents.Conclusion. Our study compared profiles of relapsed and nonrelapsed patients after inpatient detoxification and concluded predictors of relapse during 1-year follow-up period. Early identification of predictors of relapse and hence high risk patients might be helpful in designing more effective and focused treatment plan.

scholarly journals Ventilator-Associated Pneumonia in Neurosurgical Patients: A Tertiary Care Center Study

2019 ◽  
Vol 41 (2) ◽  
pp. 40-44 ◽  
Author(s):  
Dipendra K Shrestha ◽  
Binod Rajbhandari ◽  
Amit Pradhanang ◽  
Gopal Sedain ◽  
Sushil K Shilpakar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Risk Factor ◽  
Head Injury ◽  
Prolonged Mechanical Ventilation ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Ventilator Associated Pneumonia ◽  
Neurosurgical Patients

Introduction: Ventilator-associated pneumonia (VAP) is a well recognized complication in patients who are admitted to the Intensive Care Unit (ICU). A number of factors have been suspected or identified to increase the risk of VAP in Neurosurgical patients. Early and rapid diagnosis and initiation of the appropriate antibiotic treatment reduce mortality and decrease the development of MDR organisms. The aim of our study is to determine the incidence of VAP in the neurosurgical patients and also to assess the probable contributing neurosurgical risk factors and find out the causative bacterial pathogens and the resistant pattern of these bacteria in neurosurgical patient in ICU of our institute Methods: A retrospective observational study of 106 neurosurgical patients who were on mechanical ventilation for more than 48 hours was done. Results: Out of 106 patients, 35 patients fulfilled the clinical and microbiological criteria for the diagnosis of VAP. The commonest age group involved was between 15-25 years of age with male preponderance. Head injury was the commonest etiology. There was a linear correlation between the number of days in ICU and the development of VAP. The majority of the pathogen isolated were gram-negative bacteria and all were sensitive to Colistin. Conclusion: Head injury is a significant risk factor for VAP. Prolonged mechanical ventilation is an important risk factor for VAP.

scholarly journals Use of carbapenems and glycopepdides is significant risk for multidrug resistant Acinetobacter baumannii infections

2018 ◽  
Vol 12 (02) ◽  
pp. 67-72
Author(s):  
Salih Hosoglu ◽  
Eyup Arslan ◽  
Emel Aslan ◽  
Özcan Deveci
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Acinetobacter Baumannii ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Control Group ◽  
Time Interval ◽  
And Control

Introduction: Multi-drug resistant Acinetobacter baumannii (MDR-Ab) infections are an important healthcare problem globally. The aim of this study was to evaluate risk factors associated with MDR-Ab infections in hospitalized patients in Turkey. Methodology: A case-control study was performed in a tertiary care 1,303-bed university hospital, among case patients with MDR-Ab infections. The hospital records of case and control patients were retrospectively evaluated over a year. Patients who were hospitalized in the same department and in the same time interval as the case patients, without MDR-Ab infection or colonization, were chosen for control group. Demographic characteristics, Acute Physiology And Chronic Health Evaluation II (APACHE II) scores, comorbid diseases, use of invasive tools and duration of usage, and duration of use of antibiotics were recorded for all patients. Comparisons between case and control groups for possible risk factors were performed. Results: In total, 95 cases and 95 controls were included in the study. Univariate analysis highlighted several variables as risk factors for MDR-Ab infections. Multivariate analysis showed that only antibiotic usage over seven days (OR = 2.38, CI = 1.18-4.83, p = 0.016) was found to be a significant risk factor. When antibiotic treatment patterns in both groups were compared, the use of carbapenems (p = 0.001) and glycopeptide antibiotics (p=0.001) in patient treatment were found significantly higher in the MDR-Ab case group. Conclusion: This study showed us that previous antibiotic use is a significant risk factor for MDR-Ab infections. The use of carbapenems and glycopeptides should be considered as primary risk factors for developing MDR-Ab infection.

Sign in / Sign up

Export Citation Format

Share Document