CLINICAL CHARACTERISTICS, LABORATORY ABNORMALITIES AND OUTCOME OF COVID-19 POSITIVE PATIENTS ADMITTED IN TERTIARY CARE HOSPITAL OF KARACHI

Background and Objective:COVID-19 is a corona virus disease infecting people worldwide. There are few local small-scale studies addressing this. We planned a study with good sample size to reveal clinical features and laboratory abnormalities in relation to ICU admission and mortality. Methods and Materials: This observational study was conducted at Dept. of Medicine Liyari General Hospital Karachi after ethical approval. The indoorconfirmed COVID-19 (PCR positive) patients (age>18 years) were included. Pregnant/lactating women, outdoor cases were excluded. Their demographic data, symptoms and signs,co morbidities, laboratory findings (blood complete picture, renal/liver function tests, inflammatory markers (i.e., CRP, ESR, ferritin, LDH, D dimers, troponins), area and duration of admission, disease severity, outcome as death or recovery were documented. Data was collected manually from record of the patients admitted from 15th March till 30th September 2020. The data was analyzed by SPSS software. Chi-square test applied with significant p<0.05. Results:Amongst879 patients 773(87.9%) were admitted in isolation wards whereas 106(12.1%) admitted in ICU. Mortality was 3.9% overall and average length of stay was 11 days. The mean age was 51.8+18.4 years. Most cases were male (65%) and > 50 yearsage (58.9%).Frequent co morbidities were diabetes(26.1%), dyslipidemia (23%), hypertension (19.9%) and ischemic heart disease (17.3%). Fever wasmost common symptom. Tachycardia, hypotension, anemia and lymphocytopenia wereassociated with ICU admission and mortality.Inflammatory markers were elevated in most of the cases but only LDH, ferritin and D-dimers were statistically associated with ICU admission and mortality. Conclusion:This study concludes that COVID-19 positive patients with age above fifty, tachycardia, hypotension elevated LDH, Ferritin, D dimers anemia and lymphocytopenia were associated with mortality and ICU admission.

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Brucellosis, Unravelling an Enigma: Eight Years of Experience from a Tertiary Care Hospital in Central Kerala, India

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/46011.14270 ◽

2020 ◽

Author(s):

M Ardra ◽

Chithra Valsan ◽

KA Sathiavathy

Keyword(s):

Tertiary Care Hospital ◽

Demographic Data ◽

Tertiary Care ◽

Clinical Signs ◽

Unknown Origin ◽

Personal Contact ◽

Human Brucellosis ◽

Care Hospital ◽

Laboratory Findings ◽

Middle East Countries

Introduction: Various emerging and re-emerging infectious diseases have made the existence of mankind in this world a great challenge. In the midst of these havocs, some important diseases has undermined in the dark. Brucellosis is an endemic zoonotic disease in most of the developing world and it has far-reaching and deleterious effects on humans and animals alike. In humans, brucellosis shows a variety of non-specific clinical signs. To recognise and diagnose this neglected but debilitating disease, the awareness and alertness of medical personnel has to be enhanced. Aim: To determine the prevalence of brucellosis in Tertiary Care Hospital. Materials and Methods: A retrospective study was conducted from June 2011 to May 2019, all culture proven cases of human brucellosis admitted in a Tertiary Care Hospital in central Kerala, India were reviewed. Demographic data, clinical presentations, laboratory parameters, treatment and outcomes of the same were analysed in Microsoft excel sheets as percentages. Results: Of the 12 culture proven Brucella cases, 11 presented as Pyrexia of Unknown Origin (PUO) cases and one was a soft tissue infection. Eleven patients had history of either consumption of unpasteurised milk products or had contact with animals before the symptoms developed. A 75% cases were imported cases from middle-east countries. In one case the route of entry was by close personal contact probably sexual transmission. All the patients complained of fever and malaise (100%), while low backache and arthralgia was noted in 83%. Most common clinical and laboratory findings associated with brucellosis were hepatosplenomegaly (41.7%) and anaemia (66.6%). Oral doxycycline for six weeks combined with either aminoglycoside or rifampicin was used for treatment. There was no death or relapses noted. Conclusion: This study emphasises the close collaboration of an alert clinician and an experienced microbiologist to correctly diagnose and treat an infection with multiple presentations as brucellosis, in endemic areas also.

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ECG CHANGES IN PATIENTS WITH COVID-19 – A RETROSPECTIVE OBSERVATIONAL STUDY AT A TERTIARY CARE HOSPITAL IN CHENNAI

10.36106/paripex/9800205 ◽

2021 ◽

pp. 5-7

Author(s):

A .Shaik Sulaiman Meeran ◽

T. Balaji ◽

P. Raja ◽

Kiran Chandramohan

Keyword(s):

Risk Factors ◽

Observational Study ◽

Virus Disease ◽

Tertiary Care ◽

P Wave ◽

Retrospective Observational Study ◽

Care Hospital ◽

Icu Admission ◽

Corona Virus ◽

Increased Risk

Background:A global outbreak of corona virus disease, caused by severe respiratory corona virus 2, has emerged since December 2019. However electrocardiographic manifestations of patients with COVID-19 have not been fully described. We aim to investigate ECG characteristics in COVID-19 patients and risk factors of ICU admission Methods:This retrospective observational study included the patients with COVID-19 at the Government Kilpauk Medical College, Chennai between June 1st and 31st, 2020. Demographic, clinical and ECG characteristics were collected and comparison were made between ICU and non ICU admission groups. Logistic regression was used to identify risk factors of ICU admission Results:Among the 159 patients included ST-T abnormalities were the most common ECG feature followed by arrhythmias. Compared with non ICU group, the ICU group showed higher heart rate and P wave duration and was more frequently associated with CVD, ST-T abnormalities, arrythmias, QTc prolongation and pathological Q waves. ST-T abnormalities and history of CVD were associated with increased risk of ICU admission Conclusion:COVID-19 is frequently related to cardiovascular manifestations including ECG abnormalities and cardiovascular comorbidities. ST-T abnormalities and CVD at admission were associated with increased odds of ICU admission

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Clinical profile of patients of pyrexia with hepatic dysfunction in a tertiary care hospital in Southern Rajasthan region of India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20204905 ◽

2020 ◽

Vol 8 (11) ◽

pp. 4066

Author(s):

Abhishek Mistry ◽

Yogesh Kumar Singhal ◽

Pankaj Gupta ◽

D. C. Kumawat

Keyword(s):

Liver Function ◽

Hepatic Dysfunction ◽

Demographic Data ◽

Tertiary Care ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Care Hospital ◽

General Physical Examination ◽

Function Tests ◽

General Physical

Background: Pyrexia in association with hepatic dysfunction is commonly found in clinical practice with varied etiologies like malaria, dengue, typhoid, scrub typhus, viral hepatitis, etc. The liver is frequently involved in systemic infections, resulting in various types of abnormal liver function tests. It is very important to know the frequency and pattern of abnormal liver function tests in each infection for its appropriate management.Methods: A complete data of all the patients admitted in medicine wards and medicine ICU from January to December 2018 were studied. One hundred and ten patients with fever with abnormal liver function tests were interviewed and presenting complaints were noted. Demographic data such as age and sex were noted. These patients underwent a thorough general physical examination and systemic examination. The findings were noted on a predesigned and pretested proforma. The selected patient underwent blood investigations related to liver functions.Results: Most of the patients were of age group of 21 to 50 years (65 patients), 67 patients (60.91%) were males and 43 (39.09%) were females. Malaria (25.45%) and dengue (26.36%) were major etiologies. Hepatomegaly (46.36%), icterus in (45.45%) and splenomegaly (42.73%) were most common clinical signs.Conclusions: Present study will help clinicians to identify etiological factors and clinical picture in patients of pyrexia with hepatic dysfunction.

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Pediatric Oncology Patients and COVID-19: An Experience from the Tertiary COVID Care Facility in Eastern India: A Prospective Observational Study

Indian Journal of Medical and Paediatric Oncology ◽

10.1055/s-0041-1732814 ◽

2021 ◽

Vol 42 (02) ◽

pp. 130-134

Author(s):

Satyabrata Roy Chowdhoury ◽

Himanshu Sekhar Biswas ◽

Sumantra Raut ◽

Subhajit Bhakta ◽

Atanu Roy ◽

...

Keyword(s):

Observational Study ◽

Pediatric Oncology ◽

Prospective Observational Study ◽

Tertiary Care ◽

Care Facility ◽

Common Symptom ◽

Care Hospital ◽

Newly Diagnosed ◽

Oncology Patients ◽

Icu Admission

Abstract Introduction Pediatric oncology patients presumably are one of the most vulnerable groups during this ongoing coronavirus disease 2019 (COVID-19) pandemic. Not only they are immunocompromised thanks to their inherent disease and treatment regimens, but delay in initiation and maintenance of their treatment in this pandemic era also poses great concern. But the magnitude of this effect on pediatric oncology patients has not been well established due to paucity of data. Objective This study was proposed to assess clinicoepidemiological profile and outcome of the pediatric oncology patients who were infected with severe acute respiratory syndrome coronavirus 2 virus attending a COVID-19 care facility. Materials and Methods This was a prospective observational study conducted in a tertiary care hospital. All confirmed oncology patients up to age 12 years who either attended the oncology outpatient department or referred to COVID-19 care center from other cancer treatment facility were included in the study from May 2020 to September 2020. Data on demography, clinical features, investigations, treatment, complications, and outcome were collected. Descriptive statistical analysis was performed and common relevant investigations were compared between non-intensive care unit (ICU) and ICU group. Results The rate of COVID-19 positivity among the pediatric oncology patient attending oncology clinic of the hospital is 8.21%. Total 28 patients (12 from oncology clinic of our hospital and 16 from other hospitals referred to our COVID-19 unit) were included in our study. The most common malignancy was acute lymphoblastic leukemia (64.28%). The most common symptom was fever (64.28%). Oxygen therapy was needed for 42.85% patients. Eight patients required ICU admission (two required invasive ventilation and one required noninvasive ventilation). Positive C-reactive protein value was associated with severe disease requiring ICU admission. Mean delay in starting chemotherapy in newly diagnosed cases was 28.77 days (standard deviation = 9.67). One newly diagnosed patient expired due to preexisting disease. Conclusion Though vulnerable, most of the pediatric oncology patients suffered a mild COVID-19 infection without any significant COVID-19-related morbidity and mortality. There is a significant delay in starting specific oncology therapy, that is, chemotherapy as a result of the ongoing COVID-19 pandemic in newly diagnosed pediatric oncology patients, which can increase morbidities and mortality related to malignancy.

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Clinical Profile of Bloodstream Infections in Covid-19 Patients: A Retrospective Cohort Study

10.21203/rs.3.rs-614387/v1 ◽

2021 ◽

Author(s):

Naveenraj Palanisamy ◽

Nakka Vihari ◽

Durga Shankar Meena ◽

Deepak Kumar ◽

Naresh Midha ◽

...

Keyword(s):

Virus Disease ◽

Demographic Data ◽

Tertiary Care ◽

Bloodstream Infections ◽

Clinical Profile ◽

Resistance Pattern ◽

Western India ◽

Care Hospital ◽

Timely Initiation ◽

Gram Negative

Abstract Background: Bloodstream infections (BSIs) are emerging cause of significant morbidity and mortality in severe Corona virus disease (Covid-19). We aimed to assess the prevalence, clinical profile and outcome of BSIs in critically ill Covid-19 disease. Material and Methods: This was a single-centre retrospective study conducted at a tertiary care hospital in Western India. All the patients (age >18 years) with reverse-transcription polymerase chain reaction (RT-PCR) confirmed Covid-19 pneumonia admitted in Covid intensive care unit (ICU) between September 2020 to February 2021 were included. Hospital electronic records were searched for demographic data, time of bloodstream infection since admission, clinical profile, antimicrobial resistance pattern and clinical outcome of all patients who developed BSIs.Results: Out of 750 patients admitted in Covid ICU, 8.5% developed secondary BSIs. All severe Covid-19 pneumonia patients developed BSIs succumbed to illness. The major proportion of BSIs were gram-negative pathogens (53/64, 82.8%). Acinetobacter baumannii was the commonest isolate followed by Klebsiella pneumoniae (32.8% and 21.9% respectively). Multidrug-resistance microorganisms (MDRO) were found in 57.8% of the cases. The majority of MDRO belonged to K. pneumoniae and Enterococcus groups. The proportion of gram-negative bacteria resistant to carbapenems was 47.2% (25/53). Conclusion: BSIs in severe Covid-19 patients carries a substantial mortality, which is a cause for concern. Timely initiation of empirical antibiotics and prompt de-escalation are vital to improve the outcome. At the same time, strict compliance of infection control practices should be accomplished to reduce the occurrence of MDRO.

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NEUTROPHIL-LYMPHOCYTIC RATIO (NLR) OR ALBUMIN-GLOBULIN RATIO (AGR) WHICH ONE IS A BETTER PREDICTOR MARKER IN ASSESSMENT OF SEVERITY OF COVID-19 INFECTION

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i8.2109 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Parul Barya ◽

Sanjeev Narang ◽

V. K. Jain ◽

Romi Shrivastava

Keyword(s):

Complete Blood Count ◽

Demographic Data ◽

Tertiary Care ◽

Nasopharyngeal Swab ◽

Care Hospital ◽

Laboratory Findings ◽

Severity Scores ◽

History Of ◽

Sensitivity Specificity ◽

G Ratio

The current study retrospectively enrolled, 75 confirmed COVID-19 patients who were hospitalized in a tertiary care hospital from December 2020 to February 2021. The diagnosis was confirmed by RT-PCR from nasopharyngeal swab. Demographic data and laboratory values were collected from medical records and patient file. The following variables were recorded for each COVID-19 patient: age, sex, chest CT severity scores of lung involvement at admission, history of Comorbidities like diabetes mellitus, hypertension were noted and laboratory findings like Absolute neutrophils count, Absolute lymphocytes count recorded from Complete blood count of patient and Serum albumin, globulin level recorded from Liver function test of patient. This study proves that N-L ratio is more accurate predictor of severity of SARS-COVID-19 infection than A-G ratio with more sensitivity, specificity, positive and negative predictive value and can be used as a severity marker in places where medical resources is limited. However, a larger study with more subjects requires for exact correlation. Keywords: NLR, AGR, Severity & COVID-19.

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Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

Clinical Pediatrics ◽

10.1177/00099228211047242 ◽

2021 ◽

pp. 000992282110472

Author(s):

Andrew Brown ◽

Mary Quaile ◽

Hannah Morris ◽

Dmitry Tumin ◽

Clayten L. Parker ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Discharge ◽

Care Coordination ◽

Chronic Conditions ◽

Tertiary Care ◽

Care Hospital ◽

Icu Admission ◽

Complex Chronic Conditions

Objective To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. Methods We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children’s hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Results Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission ( P = .020) and prolonged length of stay ( P = .004) were associated with decreased likelihood of completing recommended follow-up. Conclusions Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

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THROMBOCYTOPENIA

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.01.1862 ◽

2011 ◽

Vol 18 (01) ◽

pp. 75-79

Author(s):

ATIF SITWAT HAYAT ◽

MOHAMMAD SAEED SIDDIQUI ◽

NAILA SHAIKH ◽

Muqeet Ullah

Keyword(s):

Plasmodium Falciparum ◽

Falciparum Malaria ◽

Tertiary Care ◽

Febrile Illness ◽

Blood Film ◽

Falciparum Infection ◽

Common Symptom ◽

Severe Thrombocytopenia ◽

Care Hospital ◽

Cell Counts

Background: Malaria is usually associated with reduction in blood cell counts and mild to moderate thrombocytopenia is a common feature of falciparum infection. This study has been conducted to find out frequency and degree of thrombocytopenia in patients suffering from falciparum malaria at a tertiary care hospital of Abbottabad. Methods: It was a descriptive case-control study being carried out at Ayub teaching hospital and Northern institute of Medical Sciences (NIMS) Abbottabad over a period of ten months. All patients with acute febrile illness without localizing signs were considered for study. A total 250 patients having falciparum malaria diagnosed by peripheral blood film examination have been studied. Complete blood counts were performed by Automated Beckman Coulter Analyzer. Blood films were examined by clinical pathologist for plasmodium falciparum via light microscopy using oil-immersion lens. Results: Out of 250 patients, 155(62%) were females and 95(38%) males with M:F ratio of 1:1.5. Mean age was 36±1.2 years (range 17-58 years). Out of 250, 175(70%) had thrombocytopenia (p<0.05) while 75(30%) had normal platelet counts. Thus mild, moderate and severe thrombocytopenia had been observed in 121(48.4%), 41(16.4%) and 13(5.2%) respectively (p<0.05). Fever appeared to be most common symptom observed in all patients (100%) followed by vomiting and nausea (88%). Anemia was the commonest sign present (80%) during our study. Conclusions: We discovered high frequency of mild thrombocytopenia in falciparum malaria. Therefore, thrombocytopenia can be supportive in diagnosis of plasmodium falciparum infection.

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Nasomaxillary swellings: our experience at tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210680 ◽

2021 ◽

Vol 7 (3) ◽

pp. 469

Author(s):

Mukesh Rawat ◽

Archana Lall ◽

Kavita Sachdeva

Keyword(s):

Tertiary Care Hospital ◽

Histopathological Examination ◽

Tertiary Care ◽

Final Diagnosis ◽

Inverted Papilloma ◽

Nasal Endoscopy ◽

Common Symptom ◽

Fungal Sinusitis ◽

Care Hospital ◽

Malignant Lesions

Background: A wide spectrum of lesions may present as nasomaxillary swellings ranges from benign to malignant lesions including fungal sinusitis and fibro vascular lesions example: JNA (Juvenile nasopharyngeal angiofibroma) and Inverted papilloma. Many Pathologies ranging from benign to malignant tumors may mimic a simple Nasomaxillary mass. It is diagnostic challenge to determine pathology behind it. A detailed clinical evaluation with nasal endoscopy and relevant pre-operative investigations including radiological imaging and histopathological examination is essential to reach up to final diagnosis. The aim of the study was to do clinicopathological evaluation of patients presenting with nasomaxillary swelling and correlation of clinical, radiological and Histopathological findings.Methods: This was a prospective observational study on 50 nasomaxillary swelling patients who are presented in the Department of ENT and Head and Neck Surgery of N.S.C.B. MCH Jabalpur, a tertiary care Hospital, between March 2018 to August 2019. A detailed history taking and clinical examination with nasal endoscopy and relevant preoperative investigations including CECT Nose and PNS and histopathological examination was done in all patients.Results: 50 Nasomaxillary swelling patients were selected for this study. 30 patients were male and 20 were females. Ages of patients were varied from 12 years to 72 years. 23 patients (46%) were malignant and 27 (54%) were benign. Histopathological examination results shows benign lesions like JNA (6 cases), fungal sinusitis (6 cases), dermoid cyst (1 case), inverted papilloma (3 cases), sebaceous cyst (1 case), jaw lesions (10 cases), (odontogenic like radicular/ infected cyst, dentigerous cyst, cystic ameloblastoma and non-odontogenic like fibrous dysplasia) and malignant lesions like SCC (squamous cell carcinoma) (12 cases), spindle cell sarcoma (2 cases), undifferentiated carcinoma (3 cases), adenocarcinoma (3 cases), adenoid cystic carcinoma (1 case), Invasive pleomorphic sarcoma (1 case) and malignant melanoma (1 case). SCC was most common lesion f/b JNA and fungal sinusitis. Well differentiated SCC was most common histological type (10 out of 12 cases of SCC). Most common symptom was nasal obstruction (66% cases) f/b epistaxis (52% cases) but epitasis was most common symptom among malignant and JNA cases. In 6 cases (3 JNA, 1 inverted papilloma, 1 malignancy and 1 radicular cyst) radiological diagnosis were not correlated with histological findings.Conclusions: Most our cases were malignant nasomaxillary lesions followed by fungal sinusitis and JNA. Most patients presented in advanced stage of disease so rapidly evaluation including nasal endoscopy should be done. CECT scan is essential to determine tumors extent and bony lesions. All patients should undergo hisotopatholigical examination. The final diagnosis should be made on the basis of clinical, radiological and histopathological findings.

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An assessment of pattern of adverse drug reactions of cardiovascular drugs in a tertiary care institute

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20180097 ◽

2018 ◽

Vol 7 (2) ◽

pp. 273 ◽

Cited By ~ 1

Author(s):

Smita Y. Wankhede ◽

Milind L. Pardeshi ◽

Vishal V. Ghorpade ◽

Balasaheb B. Ghongane

Keyword(s):

Adverse Drug Reactions ◽

Demographic Data ◽

Tertiary Care ◽

Cardiovascular Drugs ◽

Care Hospital ◽

Drug Reactions ◽

Microsoft Excel ◽

Entire Study ◽

Cardiovascular Medications ◽

One Year

Background: Cardiovascular disease is very prevalent in India. So, use of cardiovascular drugs is also more. So, it is very important to keep watch on adverse drug reactions. Aim of this study was to assess the pattern of adverse drug reactions (ADRs) reported with cardiovascular drugs in a tertiary care institute.Methods: The study was carried out in medicine department of a tertiary care hospital over a period of one year. Each ADR was analysed for demographic data, causality, relationship between frequency of ADRs and the number of drugs used etc. In statistical analysis Microsoft excel 2013, SPSS software was used.Results: A total of 136 patients, 58 (43%) men and 78 (57%) women, using cardiovascular medications reported ADRs during the entire study period. Total 168 ADRs were reported out of which, Amlodipine (causing headache and edema feet) was the most common drug with 51 (30.3%) ADR’s followed by Enalapril, Aspirin and Isosorbide Dinitrate with 37 (22%), 24 (14.2%), 23 (13.6%) ADRs respectively. Most common ADR was headache (due to amlodipine and Isosorbide di nitrate) affecting 38 (22.62%) cases followed by dry cough 37 (22.02%) cases, edema feet 36 (21.43%), gastritis 24 (14.29%) and 10 (5.95%) of nausea.Conclusions: Monitoring ADRs in patients using cardiovascular drugs is a matter of importance since this class of medicines are mostly used as multidrug therapy and always prone for ADRs.

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