Risk factors on admission and condition at discharge of 529 consecutive COVID-19 patients at a tertiary care center in Santiago, Chile

Abstract Background: The first case of COVID-19 was reported in Chile on March 3, 2020. Public and private hospitals were managed in a centralized manner. On May 30, Chile had 99,668 cases, 1054 deaths, 1383 ICU patients, 1174 patients on invasive mechanical ventilation (IMV), and 51 patients on non-invasive ventilation (NIMV). Research question: What are the variables associated with condition at discharge?Method: We performed a retrospective cohort study of 529 patients with a positive RT-PCR for SARS CoV-2who were consecutively discharged between March 14 and June 4, 2020, at Clínica Dávila, Santiago. Patients were analyzed according to laboratory variables on admission, Quality-Adjusted Life Year (QALY) score, health insurance, and type of respiratory support. Condition at discharge was survivor, non-survivor, or transfer to another center. Differences were evaluated by Chi-square test, Student’s t test, or Mann–Whitney U test. Logistic regression analysis was performed to identify variables that were predictive of condition at discharge.Results: Median (interquartile range, IQR) age was 49 (37–62) years, and the median (IQR) stay in the hospital was 6 (3–10) days. A total of 352 patients (66.5%) had respiratory symptoms, 177 (33.4%) had other symptoms or diagnoses on admission, and 116 required ventilatory support; 448 (84.7%) were survivors, 54 (10.2%) were non-survivors, and 27 (5.1%) were transferred. The median ages of the survivors and non-survivors were 46 (36–59) and 75.5 (66–84), respectively.Having state health insurance increased the risk of death by 2.8-fold (OR, 2.825; 95% CI: 1.383–5.772; P = 0.004). Multivariate analysis revealed the following predictive variables: age ≥ 60 years (OR, 15.3; 95% CI: 7.25–32.2; P = .001); PaO2/FiO2 on admission ≤ 200 vs > 200 (OR, 5,205; CI 95%: 1,942–13,94); high-sensitivity troponin, ≥ 15 vs <15 ng /L (OR, 5,163; 95% CI: 1.95–13,64; P = .001); and QALY ≤ 15 vs > 15 points (OR, 14,011; 95% CI: 4,826–40,679; P=.001).Interpretation: The variables analyzed and patient’s clinical evolution may allow assignment of ICU beds to patients with the greatest chance of survival, especially in countries or regions where this resource is limited.

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Usefulness of some current balance tests for identifying individuals with disequilibrium due to vestibular impairments

Journal of Vestibular Research ◽

10.3233/ves-2008-185-606 ◽

2009 ◽

Vol 18 (5-6) ◽

pp. 295-303

Author(s):

Helen S. Cohen ◽

Kay T. Kimball

Keyword(s):

Sensitivity And Specificity ◽

Care Center ◽

Tertiary Care ◽

High Sensitivity ◽

Community Dwelling ◽

Functional Mobility ◽

Vestibular Disorders ◽

Timed Up And Go ◽

Balance Tests ◽

Walking Balance

The goal of this study was to determine which of several clinical balance tests best identifies patients with vestibular disorders. We compared the scores of normals and patients on the Berg Balance Scale (Berg), Dynamic Gait Index (DGI), Timed Up and Go (TUG), Computerized Dynamic Posturography Sensory Organization Test (SOT), and a new obstacle avoidance test: the Functional Mobility Test (FMT). The study was performed in an out-patient balance laboratory at a tertiary care center. Subjects were 40 normal adults, and 40 adults with vestibular impairments. The main outcome measures were the sensitivity of tests to patients and specificity to normals. When adjusted for age the Berg, TUG, DGI and FMT had moderate sensitivity and specificity. SOT had moderately high sensitivity and specificity. SOT and FMT, combined, had high sensitivity and moderate specificity. Therefore, the kinds of tests of standing and walking balance that clinicians may use to screen patients for falling are not as good for screening for vestibular disorders as SOT. SOT combined with FMT is better. When screening patients for vestibular disorders, when objective diagnostic tests of the vestibular system, itself, are unavailable, tests of both standing and walking balance, together, give the most information about community-dwelling patients. These tests may also indicate the presence of sub-clinical balance problems in community-dwelling, asymptomatic adults.

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Accidental tramadol ingestion in children admitted in tertiary care centre

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20195200 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2661

Author(s):

Vadlakonda Sruthi ◽

Annaladasu Narendra

Keyword(s):

Pediatric Population ◽

Care Center ◽

Tertiary Care ◽

Ventilatory Support ◽

Case Series ◽

Pediatric Intensive Care ◽

Hemodynamic Instability ◽

Tertiary Care Centre ◽

Medical College ◽

History Of

Background: Tramadol use has been increasing in the adult and pediatric population. Practitioners must be alert because Tramadol misuse can lead to severe intoxication in which respiratory failure and seizures are frequent. Overdoses can lead to death. We report 47 pediatric cases with history of accidental tramadol exposure in children.Methods: An observational, retrospective, single center case -series of children with a history of accidental tramadol exposure in children admitted in pediatric intensive care unit of tertiary care center, Niloufer Hospital (Osmania Medical College) Hyderabad, Telangana India.Results: Of 47 children, 22 (47%) are male and 25 (53%) were female. At presentation 11 (23%) had loss of consciousness, 14 (29%) seizures, 17 (36%) hypotonia was noted. Pupils were miotic in 22 (47%) mydriatic in 2 (4.2%) normal in rest of children. Hemodynamic instability noted in 13 (27.6%). Serotonin syndrome (tachycardia, hyperthermia, hypertension, hyper reflex, clonus) was noted on 5 (10.6%) children. Respiratory depression was seen in 4 (8%) children who needed ventilatory support. Antidote Naloxone was given in 7 children. No adverse reaction was noted with Naloxone. All 47 children were successfully discharged.Conclusions: Overdoses can lead to death and practitioners must be alert because of the increasing use of tramadol in the adult and pediatric population. The handling of the tramadol should be explained to parents and general population and naloxone could be efficient when opioid toxicity signs are present.

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Diagnostic accuracy of B scan ultrasonography for posterior segment eye disorders in a tertiary care setting in Eastern India

10.1101/2020.08.13.20173898 ◽

2020 ◽

Author(s):

Maheswar Chaudhury ◽

Bikash Parida ◽

Sandeep Kumar Panigrahi

Keyword(s):

Diagnostic Accuracy ◽

Care Center ◽

Tertiary Care ◽

High Sensitivity ◽

Posterior Segment ◽

Radiology Department ◽

Posterior Chamber ◽

Eastern India ◽

Predictive Values ◽

Eye Disorders

Introduction: Ophthalmic ultrasound (USG) produces real time high resolution images of the eye and orbit. It can categorize and predict the location of pathology in the posterior chamber of eye very well. It is useful even in pre-operative evaluation and diagnosing posterior segment eye disorders. However, the diagnostic accuracy has usually not being studied thoroughly, with special emphasis to its probability of predicting posterior-segment eye disorders using B-scan USG. Objectives: To find out the prevalence and pattern of posterior segment disorders using B-scan ultrasonography, and to find its diagnostic accuracy. Materials and Methods: The study was prospective in nature and conducted in the department of radiodiagnosis and ophthalmology of a tertiary care center of Eastern India. Patients referred to the radiology department for ruling out intra-ocular pathology using B-scan ophthalmic ultrasound were included in the study, irrespective of any age and gender. Data were captured on an excel sheet and analyzed using Stata 12.1 SE. Results: The mean age of 84 study participants was 37.4 ± 19.5 years, with maximum in between 40-50 years. Males were more (72.6%). 50% presented with low vision, and most commonly associated with cataract (45%). Prevalance of posterior segment eye disorders was 13.1%. Sensitivity and negative predictive values were 100%. Post-test probability was 95.5%. Accuracy was however very less (39.3%). Conclusion: Using B-scan ultrasonography for pre-operative assessment and confirmation of diagnosis increases the probability of detecting presence or absence of posterior segment pathology. Absence of posterior segment disorder using this is also very helpful in ruling out disease entirely. It also a very high sensitivity and hence can be used even in rural health centers.

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Outcome of NIV in Critical Care Setting: Experience from a Tertiary Care Center

Bangladesh Critical Care Journal ◽

10.3329/bccj.v1i1.14358 ◽

2013 ◽

Vol 1 (1) ◽

pp. 3-7

Author(s):

Md Motiul Islam ◽

Mirza Nazim Uddin ◽

ARM Nooruzzaman ◽

Rahan Rabbani ◽

Ahmad Mursel Anam ◽

...

Keyword(s):

Care Setting ◽

Tertiary Care Hospital ◽

Care Center ◽

Tertiary Care ◽

Ventilatory Support ◽

Positive Outcome ◽

Care Hospital ◽

Positive Outcomes ◽

Mechanical Ventilatory Support ◽

Report Data

NIV is a method of ventilatory support which is delivered to the patient without using an invasive airway. For the last two decades it is increasingly used as an accepted method of mechanical ventilatory support as it is proved to have many positive outcomes as it can prevent invasive ventilation & its complication. In a tertiary care hospital of Bangladesh we are using this method in all patients meeting the NIV criteria & not having absolute contraindication irrespective of diagnosis. Our study aimed to access the out come of the NIV trial using our local resource & to compare it with others. This is an ongoing prospective study and till this report data from 82 patients were analyzed here of which 50% patient ended with positive outcome & 50% ended as negative outcome. As the result of this method varies significantly by diagnosis & severity of disease we are generating specific recommendations according to the likely outcome according to the diagnosis. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14358 Bangladesh Crit Care J March 2013; 1: 3-7

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The impact of health insurance status on the stage of cervical cancer diagnosis at a tertiary care center in Massachusetts

Gynecologic Oncology ◽

10.1016/j.ygyno.2018.05.002 ◽

2018 ◽

Vol 150 (1) ◽

pp. 67-72 ◽

Cited By ~ 3

Author(s):

Michelle Davis ◽

Kyle Strickland ◽

Sarah Rae Easter ◽

Michael Worley ◽

Colleen Feltmate ◽

...

Keyword(s):

Cervical Cancer ◽

Health Insurance ◽

Cancer Diagnosis ◽

Care Center ◽

Tertiary Care ◽

Insurance Status ◽

Tertiary Care Center ◽

Health Insurance Status ◽

The Impact

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The Role of Tracheotomy and Timing of Weaning and Decannulation in Patients Affected by Severe COVID-19

Ear Nose & Throat Journal ◽

10.1177/0145561320965196 ◽

2020 ◽

pp. 014556132096519

Author(s):

Cecilia Botti ◽

Francesca Lusetti ◽

Stefano Peroni ◽

Tommaso Neri ◽

Andrea Castellucci ◽

...

Keyword(s):

Intensive Care ◽

Care Center ◽

Invasive Mechanical Ventilation ◽

Tertiary Care ◽

Orotracheal Intubation ◽

Optimal Timing ◽

Prolonged Intubation ◽

Day Range ◽

The Individual

Objectives: Patients with acute respiratory failure due to coronavirus disease 2019 (COVID-19) have a high likelihood of needing prolonged intubation and may subsequently require tracheotomy. Indications and timing for performing tracheotomy in patients affected by severe COVID-19 pneumonia are still elusive. The aim of this study is to analyze the role of tracheotomy in the context of this pandemic. Moreover, we report the timing of the procedure and the time needed to complete weaning and decannulation in our center. Methods: This retrospective, observational cohort study included adults (≥18 years) with severe COVID-19 pneumonia who were admitted to the intensive care unit (ICU) of the tertiary care center of Reggio Emilia (Italy). All patients underwent orotracheal intubation with invasive mechanical ventilation, followed by percutaneous or open surgical tracheotomy. Indications, timing of the procedure, and time needed to complete weaning and decannulation were reported. Results: Forty-four patients were included in the analysis. Median time from orotracheal intubation to surgery was 7 (range 2-17) days. Fifteen (34.1%) patients died during the follow-up period (median 22 days, range 8-68) after the intubation. Weaning from the ventilator was first attempted on median 25th day (range 13-43) from orotracheal intubation. A median of 35 (range 18-79) days was required to complete weaning. Median duration of ICU stay was 22 (range 10-67) days. Mean decannulation time was 36 (range 10-77) days from surgery. Conclusions: Since it is not possible to establish an optimal timing for performing tracheotomy, decision-making should be made on case-by-case basis. It should be adapted to the context of the pandemic, taking into account the availability of intensive care resources, potential risks for health care workers, and benefits for the individual patient.

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Abstract 3229: Criteria for Appropriate Utilization of Helicopter Interfacility Transfer of ICH Patients

Stroke ◽

10.1161/str.43.suppl_1.a3229 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Dustin J Calhoun ◽

Shana Bogenschneider ◽

Phaniraj Iyengar ◽

Andrew W Asimos

Keyword(s):

Care Center ◽

Tertiary Care ◽

Retrospective Chart Review ◽

High Sensitivity ◽

Brainstem Compression ◽

Tertiary Center ◽

Ich Score ◽

Gcs Score ◽

To Receive ◽

Neurosurgical Intervention

Background: Many intracranial hemorrhage (ICH) patients are emergently transferred to tertiary neurosurgical centers by helicopter emergency medical services (HEMS), yet no guidelines exist for HEMS use in acute ICH. The American Stroke Association (ASA) publishes guidelines for neurosurgical intervention in ICH patients. Additionally, high ICH scores have been shown to predict lethal ICHs. We hypothesized that an algorithm including ASA guideline criteria and ICH score would identify patients for whom HEMS transportation might be appropriate. Objectives: To determine, in ICH patients transferred by HEMS, (1) the sensitivity of ASA guidelines for predicting emergent neurosurgical intervention, and (2) the ability of an ICH score ≥4 to predict early mortality and failure to receive intervention. Methods: We conducted a retrospective chart review of ICH patients transported by HEMS to one tertiary care center between September 2008 and February 2011. We reviewed medical records and brain CTs from the hospital of first presentation to calculate ICH scores and to evaluate for the seven ASA guideline criteria: GCS score ≤8, herniation, intraventricular hemorrhage, hydrocephalus, brainstem compression, lobar clot >30 mL within 1 cm of the paranchymal surface, and cerebellar hemorrhage. We reviewed tertiary center records for neurosurgical interventions and in-hospital mortality. Results: Review of 137 patient records identified 86 patients with an ICH and an available initial brain CT. All patients who received an emergent intervention met at least one of the criteria (sensitivity 100%), while 16 (18.6%) patients transferred by HEMS met no ASA criteria. No patient with an ICH score of ≥4 (n=19) received an emergent neurosurgical intervention, and only one such patient survived to hospital discharge. Comparison of this group to all others produced a hazard ratio of 5.86. Thirty-five (40.7%) patients had either no ASA criteria or an ICH score ≥4. Conclusions: The ASA guidelines have high sensitivity for detecting those patients who will receive emergent neurosurgical intervention after transfer, while patients with ICH scores of ≥4 almost uniformly have lethal hemorrhages and do not undergo emergent intervention. An algorithm including the presence of at least one of the seven ASA ICH neurosurgical intervention criteria and an ICH score <4 can be used to screen for appropriate use of HEMS transport in acute ICH.

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Changes to Foot and Ankle Surgical Care During the COVID-19 Pandemic

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00199 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0019

Author(s):

Alessandra L. Falk ◽

James Hunker ◽

Mani Kahn ◽

Yi Guo ◽

Chaiyaporn Kulsakdinun

Keyword(s):

New York ◽

Ankle Instability ◽

Elective Surgery ◽

Care Center ◽

Tertiary Care ◽

New York State ◽

Surgical Care ◽

Foot And Ankle ◽

First Case ◽

Orthopedic Care

Category: Other; Ankle Introduction/Purpose: On March 1, 2020, the first case of novel coronavirus (COVID-19) in New York City (NYC) was confirmed. By March 16, the NYC mayor and New York State Governor issued executive orders to postpone elective surgeries. At our tertiary care academic medical care center in the Bronx, the densely populated community of 1.4 million saw many COVID-19 positive cases. In response, the hospital quickly accommodated these patients, while maintaining outpatient orthopedic care. Consequently, only emergent orthopedic cases were granted permission to rapidly proceed to surgery. Most foot and ankle cases were deemed amenable to non-surgical or delayed surgical care. The purpose of this study is to characterize a series of patients with foot and ankle pathology whose orthopedic care was altered due to the pandemic. Methods: This is a retrospective chart review from February 2020-May 2020 encompassing the time that elective surgery was on hold and one month prior, to capture those patients were scheduled for surgery prior to the pandemic. Included were patients with foot and ankle pathology that required urgent orthopedic care, who were seen in the foot and ankle clinic, fracture clinic, and subsequently in the general orthopedic clinic that was instituted on an emergent bases. Excluded were patients who required intervention to address elective foot and ankle issues such as osteoarthritis, or ankle instability, and those were referred to an outside institution for further treatment. Throughout the pandemic, contact was made with patients either directly in clinic, via a telehealth portal or telephone. Descriptive statistics are taken. Results: Of the 17 patients included in this series, 11 (65%) patients were managed non operatively. Of these, 4 chose nonoperative management due to shared decision making between the patient and surgeon. 2 patients could not have surgery due to complications related to COVID-19. As the zenith of the pandemic passed 2 patients remained fearful of infection and therefore chose non operative management. 3 patients that had been in contact with the orthopedic department refused further imaging. 6 patients were managed operatively. 2 patients had surgery during the peak of the pandemic, both of whom tested positive for COVID and who failed conservative management. 4 patients had delayed surgery. Of these four cases, 3 were malunion corrections that would have benefitted from more prompt surgery. Conclusion: There was an overall decrease in foot & ankle cases. Non- emergent foot and ankle surgery was delayed to divert resources to patients who were stricken with the COVID-19 virus. While every attempt was made to provide the appropriate care for all, a personalized approach to foot and ankle health was developed to address health concerns, preferences, and logistics. As the course of this global pandemic is still uncertain, it is imperative to have a strategy in place to deal with urgent cases, should a second wave of cases once again affect our ability to provide routine care.

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Bilateral Ectopic Hypoplastic Uteri Attached to Bilateral Pelvic Sidewalls in a 21-Year-Old Patient with Primary Amenorrhea: The First Published Report

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/450165 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

Ahmed Nazer ◽

Ahmed Abu-Zaid ◽

Osama AlOmar ◽

Hany Salem ◽

Ayman Azzam ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Primary Amenorrhea ◽

Mullerian Duct ◽

Tertiary Care Center ◽

First Case ◽

Published Report ◽

Müllerian Duct Anomalies ◽

Embryonic Life ◽

Mullerian Duct Anomalies

Müllerian duct anomalies (MDAs) encompass a group of anatomical malformations resulting from defective development, fusion, migration, or resorption of Müllerian (paramesonephric) ducts during embryonic life. Herein, we report the first case of an exceedingly uncommon MDA (bilateral ectopic hypoplastic uteri attached to bilateral pelvic sidewalls) in a 21-year-old woman who was referred to our tertiary care center as a case of primary amenorrhea for workup and further management.

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Microbiologic Spectrum and Antibiotic Susceptibility Pattern among Patients with Urinary and Respiratory Tract Infection

International Journal of Microbiology ◽

10.1155/2014/682304 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Maryam Sotoudeh Anvari ◽

Mohammad Naderan ◽

Mohammad Ali Boroumand ◽

Saeed Shoar ◽

Robab Bakhshi ◽

...

Keyword(s):

Respiratory Tract ◽

Wide Spectrum ◽

Care Center ◽

Tertiary Care ◽

High Sensitivity ◽

Cross Sectional ◽

Disk Diffusion Test ◽

Antibiotic Susceptibility Pattern ◽

E Coli ◽

Tract Infections

Aim. To demonstrate the prevalence of isolated organisms in urinary/respiratory tract infections and their antibiotic susceptibilities in a tertiary care center.Methods and Material. Between January 2008 and January 2010, patients referring to the clinic of cardiology or those admitted to the cardiac wards were enrolled in this cross-sectional descriptive study. Urine and sputum sampling was done for all the patients and the specimens underwent microbiologic examination and, in case of isolation of microorganism, antibiotic disk diffusion test was performed.Results. Escherichia coli (E. coli)was the most prevalent isolated organism in-hospital and community-acquired UTIs and was highly resistant to cephalothin in all the samples followed by cotrimoxazole, and ceftriaxone. It revealed high sensitivity to imipenem, amikacin, and nitrofurantoin.Acinetobacterconstituted the most prevalent organism isolated from respiratory secretions and represented the highest resistance to ceftriaxone and the greatest sensitivity to imipenem.Conclusions. E. coliandAcinetobacterremain the most common uropathogenic and respiratory organisms, respectively. However, their increasing resistance to wide-spectrum imipenem, meropenem, and vancomycin is a major concern.

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