Evaluation of Clinical and Radiological Factors Determining the Need of Post-operative Ventilator Requirement in Patients of Esophageal Atresia

Objective: Ventilator requirement is an important constituent of post-operative care of patients of esophageal atresia (EA). In contrast to the developed world, the situation is very different in developing countries where the resources are limited, and ventilator may not be available to all patients of EA. This study was conducted to assess whether there are certain criteria, which may predict the possibility of non- requirement of ventilator for patients of EA in the post-operative period. Design: This study was a retrospective observational study. Setting: This study was conducted at a tertiary care teaching hospital. Duration: This study was conducted from 5 years and 6 months. Materials and Methods: We used certain parameters to assess the requirement of ventilators for the patients in the post-operative period. These included the presentation of patients before or after 3 days of life and birth weight (BW) of more or <2.5 kg. Presence of respiratory distress (RD) was analyzed. The presence of consolidation on X-ray was also evaluated. Results: The total number of patients was 175. In univariate analysis, the need of ventilator was significantly higher in patients presenting after 3 days of life, weight <2.5 kg, presence of RD, and pneumatic patch. In multivariate analysis, the age of presentation, weight, RD, and consolidation were found to independent factor for the ventilator requirement. Conclusion: On the basis of clinical and radiological features, namely, age, sex, BW, RD, and consolidation, we may prioritize these patients of EA, who may not be requiring the ventilator in the post-operative period. Further prospective studies on the basis of these factors may substantiate our efforts.

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Role of early CT scan in diagnosis of occult scaphoid fractures- a prospective study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173985 ◽

2017 ◽

Vol 5 (9) ◽

pp. 4072

Author(s):

Omeshwar Singh ◽

Anuradha Sen ◽

Sumeet Singh Charak ◽

Shakeel Ahmad

Keyword(s):

Ct Scan ◽

Tertiary Care ◽

False Negative ◽

False Negative Rate ◽

Scaphoid Bone ◽

X Rays ◽

X Ray ◽

Scaphoid Fractures ◽

Number Of Patients

Background: Wrists injuries are one of the common presentations to emergency departments and orthopaedic clinics. The scaphoid bone is the most commonly injured of the carpal bones accounting for 50-80% of carpal injuries and predominantly occurs in young healthy individuals. Scaphoid fractures are the most problematic to diagnose in a clinical setting because it can take up to 6 weeks for scaphoid fractures to become conclusive on plain X-ray films. Aim of the study was to retrospective study was carried out to study the role of early CT scan in diagnosis of occult scaphoid fractures.Methods: A total of 123 patients presented with an acute wrist injury with subsequent signs of scaphoid injury in the absence of a diagnostic fracture on plain X-ray within the time period from June 2014 to May 2016 in a tertiary care centre.Results: This study shows that 31% of normal X-rays were pathological on CT scan and out of these; scaphoid fractures (74% of pathologies) represent a large number of patients with fractures that were missed by initial plain films.Conclusions: This study shows an extremely high false-negative rate for plain X-rays and advocate CT at the first attendance to fracture clinic if there is suspicion of scaphoid injury. An earlier diagnosis leads to appropriate management and reduces restrictions to the patient in terms of prolonged immobilization and repeated clinical reviews.

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The Impact of MassPAT on Opioid Prescribing Patterns for Otolaryngology Surgeries

Otolaryngology ◽

10.1177/0194599820987454 ◽

2021 ◽

Vol 164 (4) ◽

pp. 781-787

Author(s):

Samuel Rubin ◽

Jacqueline A. Wulu ◽

Heather A. Edwards ◽

Robert W. Dolan ◽

David M. Brams ◽

...

Keyword(s):

Medical Center ◽

Univariate Analysis ◽

Tertiary Care ◽

Prescribing Patterns ◽

Care Hospital ◽

Number Of Patients ◽

Significant Difference ◽

Awareness Tool ◽

The Impact ◽

Best Fit

Objective Determine whether opioid prescriber patterns have changed for tonsillectomy, parotidectomy, and thyroidectomy after implementation of the Massachusetts Prescription Awareness Tool (MassPAT). Study Design Retrospective cohort study. Setting Single-center tertiary care hospital. Methods Patients were included if they received tonsillectomy, parotidectomy, or thyroid surgery at Lahey Hospital and Medical Center (Burlington, Massachusetts) between October 1, 2015, and October 1, 2019. Prescribing patterns were compared prior to implementation of MassPAT, October 1, 2015, to October 14, 2016, to postimplementation of MassPAT, October 15, 2016, to October 1, 2019. Quantity of opioids prescribed was described using total morphine milligram equivalents (MME). Data were analyzed using univariate analysis, multivariate analysis, and trend line using line of best fit. Results A total of 737 subjects were included in the study. There was a downward trend in the quantity of opioids prescribed for all 3 surgeries during the study period. There was a significant difference in the quantity of opioids prescribed pre- and postimplementation of MassPAT for tonsillectomy (647.70 ± 218.50 MME vs 474.60 ± 185.90 MME, P < .001), parotidectomy (241.20 ± 57.66 MME vs 156.70 ± 72.99 MME, P < .001), and thyroidectomy (171.20 ± 93.77 MME vs 108.50 ± 63.84 MME, P < .001). There was also a decrease in the number of patients who did not receive opioids for thyroidectomy pre- and post-MassPAT (7.56% vs 24.14%). Conclusion We have demonstrated that there is an association with state drug monitoring programs and decrease in the amount of opioids prescribed for acute postoperative pain control for common otolaryngology surgeries.

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Abstract P554: Effect of Antithrombotic Medications on MMA Embolization for Chronic Sub Dural Hematoma a Case Control Study

Stroke ◽

10.1161/str.52.suppl_1.p554 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Osman Mir ◽

Howard Riina ◽

Omar Tanweer ◽

Peter Kan ◽

Jan-Karl Burkhardt

Keyword(s):

Univariate Analysis ◽

Tertiary Care ◽

Chronic Subdural Hematoma ◽

Successful Outcome ◽

Fisher Exact Test ◽

Exact Test ◽

Number Of Patients ◽

Significant Difference ◽

Surgical Evacuation ◽

Tertiary Care Centers

Background: Chronic subdural hematoma (CSDH) is a serious problem with an incidence of 20.6 per 100000 in North America and is predicted to grow with aging population and Antithrombotic use. MMA embolization is a therapy for treatment of CSDH, which in retrospective studies has been shown to be effective. It is unclear when and if the antithrombotic medications could be resumed in the setting of CSDH. Hypothesis: Among patients with CSDH who undergo MMA embolization outcomes are no different in patients who resume the antithrombotic (AT) medications Methods: We did a retrospective review of all cases of MMA embolization done over last 2.5 years in 2 tertiary care centers. Comparison of cases (antithrombotic resumption) vs controls in which antithrombotic medications were stopped. A successful outcome was defined as reduction of at least 50% volume in CSDH. Univariate analysis regarding all outcome measures for baseline variables using Fisher exact test or t-test. Multivariate logistic regression with favorable and unfavorable outcomes as dependent variables controlling for age and surgical evacuation of the hematoma. Results: There were a total of 57 MMA embolization cases, 33 of them had no AT started after surgery and 23 of them had AT resumption at a mean of 2.4 days. Almost equal number of patients had AC (12 pt’s) and AP (11 pt’s) resumed. About 40% of patients had surgical evacuation done prior to MMA embolization and there was significant reduction in volume of CSDH on follow up imaging as shown in fig. The significant difference between the patients who had AT resumption vs others, was that these patients had more often CAD (71% vs 21% p= 0.001) and Afib (58% vs 18% p=0.002) necessitating the renewal of AT. There was no significant difference in hematoma reduction or volume even after adjusting for surgical evacuation (OR 1.0039 95% CI 0 .60- 1.67). Conclusions: There is no significant difference in CSDH volume reduction in patients who have AT resumption after MMA embolization.

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STUDY OF INFLAMMATORY MARKERS IN RELATION TO RADIOLOGICAL FINDINGS IN COVID 19

10.36106/ijsr/9604567 ◽

2021 ◽

pp. 48-50

Author(s):

Kalyanisri. Koneru ◽

V M Kiran Ogirala ◽

Kommavarapu. Kalyani Madhuri ◽

Bokam. Bhanu Rekha

Keyword(s):

Hospital Stay ◽

Tertiary Care ◽

P Value ◽

Care Hospital ◽

X Rays ◽

X Ray ◽

Duration Of Hospital Stay ◽

Number Of Patients ◽

Chest X Ray ◽

Severity Of The Disease

BACKGROUND Currently, the Coronavirus disease 2019 (COVID-19) has become pandemic globally. Elevated inammatory markers are observed and are a common pathophysiological response to acute illness. Chest X-ray changes are also commonly seen in COVID -19 patients. The present study was undertaken to determine the relationship between inammatory markers to chest X-ray ndings in COVID-19 patients. METHODS This is a prospective observational study of COVID-19 patients admitted to tertiary care hospital from may 2020-November 2020. Comorbidities, inammatory markers, and Chest X ray were collected and analyzed. Correlations between radiological and inammatory markers were studied. AIMS & OBJECTIVES: Ÿ Correlation of inammatory markers to radiographic ndings and their outcome in COVID 19 patients Ÿ The outcome was studied in terms of: Ÿ Patients requiring oxygen/ NIVsupport Ÿ duration of hospital stay Ÿ Number of patients Recovered/death RESULTS: Ÿ Out of 500 patients studied, the mean age was 49.41 years, and (295)59% of patients were male,(205)41% were females. (455)91% patients discharged and (43)8.6% died. We found a positive correlation between inammatory markers and Chest X-ray ndings at the time of admission with a signicant statistical P-value. The inammatory markers CRP, ESR, D-Dimer & Sr.ferritin compared with the mode of ventilation(O2 & NIV, duration of hospital stay and outcome also showed signicant statistical P-value. CONCLUSIONS We conclude that in patients with raised inammatory markers there were increased abnormalities on Chest X-rays which required an increase in oxygen or NIVsupport. This can be a useful predictor of the severity of the disease and assessment of outcome.

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Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty

Medicina ◽

10.3390/medicina57020188 ◽

2021 ◽

Vol 57 (2) ◽

pp. 188

Author(s):

Daniel C. Santana ◽

Matthew J. Hadad ◽

Ahmed Emara ◽

Alison K. Klika ◽

Wael Barsoum ◽

...

Keyword(s):

Knee Arthroplasty ◽

Perioperative Management ◽

Recent Literature ◽

Patient Specific ◽

Antithrombotic Agents ◽

Coronary Syndrome ◽

Risk Of Bleeding ◽

Post Operative Period ◽

Number Of Patients ◽

Hip And Knee Arthroplasty

Total hip and knee arthroplasty are common major orthopedic operations being performed on an increasing number of patients. Many patients undergoing total joint arthroplasty (TJA) are on chronic antithrombotic agents due to other medical conditions, such as atrial fibrillation or acute coronary syndrome. Given the risk of bleeding associated with TJAs, as well as the risk of thromboembolic events in the post-operative period, the management of chronic antithrombotic agents perioperatively is critical to achieving successful outcomes in arthroplasty. In this review, we provide a concise overview of society guidelines regarding the perioperative management of chronic antithrombotic agents in the setting of elective TJAs and summarize the recent literature that may inform future guidelines. Ultimately, antithrombotic regimen management should be patient-specific, in consultation with cardiology, internal medicine, hematology, and other physicians who play an essential role in perioperative care.

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600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.794 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S362-S363

Author(s):

Gaurav Agnihotri ◽

Alan E Gross ◽

Minji Seok ◽

Cheng Yu Yen ◽

Farah Khan ◽

...

Keyword(s):

Hospital Readmission ◽

Multinomial Logistic Regression ◽

Univariate Analysis ◽

Tertiary Care ◽

Intervention Group ◽

Care Hospital ◽

Full Time ◽

Post Intervention ◽

Before And After ◽

The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p< 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

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Code Blue Events in the Neonatal and Pediatric Intensive Care Units at a Tertiary Care Children's Hospital

American Journal of Perinatology ◽

10.1055/s-0040-1719116 ◽

2020 ◽

Author(s):

Catherine M. Groden ◽

Erwin T. Cabacungan ◽

Ruby Gupta

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Life Support ◽

Univariate Analysis ◽

Tertiary Care ◽

Neonatal Resuscitation ◽

Advanced Life Support ◽

Pediatric Intensive Care ◽

Code Blue ◽

Neonatal Resuscitation Program

Objective The authors aim to compare all code blue events, regardless of the need for chest compressions, in the neonatal intensive care unit (NICU) versus the pediatric intensive care unit (PICU). We hypothesize that code events in the two units differ, reflecting different disease processes. Study Design This is a retrospective analysis of 107 code events using the code narrator, which is an electronic medical record of real-time code documentation, from April 2018 to March 2019. Events were divided into two groups, NICU and PICU. Neonatal resuscitation program algorithm was used for NICU events and a pediatric advanced life-support algorithm was used for PICU events. Events and outcomes were compared using univariate analysis. The Mann–Whitney test and linear regressions were done to compare the total code duration, time from the start of code to airway insertion, and time from airway insertion to end of code event. Results In the PICU, there were almost four times more code blue events per month and more likely to involve patients with seizures and no chronic condition. NICU events more often involved ventilated patients and those under 2 months of age. The median code duration for NICU events was 2.5 times shorter than for PICU events (11.5 vs. 29 minutes), even when adjusted for patient characteristics. Survival to discharge was not different in the two groups. Conclusion Our study suggests that NICU code events as compared with PICU code events are more likely to be driven by airway problems, involve patients <2 months of age, and resolve quickly once airway is taken care of. This supports the use of a ventilation-focused neonatal resuscitation program for patients in the NICU. Key Points

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Disease course of Neurofibromatosis Type 2; a 30-year follow-up study of 353 patients seen at a single institution

Neuro-Oncology ◽

10.1093/neuonc/noaa284 ◽

2020 ◽

Author(s):

Claire Forde ◽

Andrew T King ◽

Scott A Rutherford ◽

Charlotte Hammerbeck-Ward ◽

Simon K Lloyd ◽

...

Keyword(s):

De Novo ◽

Radiation Treatment ◽

Univariate Analysis ◽

Age At Onset ◽

Neurofibromatosis Type ◽

Neurofibromatosis Type 2 ◽

Disease Course ◽

Number Of Patients

Abstract Background Limited data exists on the disease course of Neurofibromatosis Type 2 (NF2) to guide clinical trial design. Methods A prospective database of patients meeting NF2 diagnostic criteria, reviewed between 1990–2020, was evaluated. Follow-up to first vestibular schwannoma (VS) intervention and death was assessed by univariate analysis and stratified by age at onset, era referred and inheritance type. Interventions for NF2-related tumours were assessed. Cox regression was performed to determine the relationship between individual factors from time of diagnosis to NF2-related death. Results Three-hundred-and-fifty-three patients were evaluated. During 4643.1 follow-up years from diagnosis to censoring 60 patients (17.0%) died. The annual mean number of patients undergoing VS surgery or radiotherapy declined, from 4.66 and 1.65 respectively per 100 NF2 patients in 1990-1999 to 2.11 and 1.01 in 2010-2020, as the number receiving bevacizumab increased (2.51 per 100 NF2 patients in 2010-2020). Five patients stopped bevacizumab to remove growing meningioma or spinal schwannoma. 153/353 (43.3%) had at least one neurosurgical intervention/radiation treatment within 5 years of diagnosis. Patients asymptomatic at diagnosis had longer time to intervention and better survival compared to those presenting with symptoms. Those symptomatically presenting <16 and >40 years had poorer overall survival than those presenting at 26-39 years (P=0.03 and P=0.02 respectively) but those presenting between 16-39 had shorter time to VS intervention. Individuals with de novo constitutional variants had worse survival than those with de novo mosaic or inherited disease (P=0.004). Conclusion Understanding disease course improves prognostication, allowing for better informed decisions about care.

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Paradigm Shift in Clinical Practice of Sexual Health in Men During COVID-19 Pandemic

Journal of Psychosexual Health ◽

10.1177/26318318211032386 ◽

2021 ◽

pp. 263183182110323

Author(s):

Aditya Prakash Sharma ◽

Japleen Kaur ◽

Ravimohan S. Mavuduru ◽

Shrawan K. Singh

Keyword(s):

Health Care ◽

Sexual Health ◽

Surgical Procedures ◽

Care Center ◽

Tertiary Care ◽

Health Care Seeking ◽

Care Seeking ◽

Health Seeking ◽

Number Of Patients ◽

The Impact

Sexual health-care seeking behavior and practices have been affected during COVID-19 pandemic. The impact of COVID-19 on this subspecialty is far reaching. This study aimed to assess the impact of COVID-19 on health-care seeking practice pertaining to sexual health in men in our tertiary care center and review the relevant literature regarding impact of COVID-19 on sexual health seeking practice and challenges faced. Outpatient data was analyzed from January 2019 to April 2021. Patients awaiting surgical procedures due to COVID were documented. A narrative synthesis of literature based on systematic search using the keywords sexual health, sexual health seeking, sexual health practice, andrology, and COVID with operators “AND” and “OR” was carried out in three search engines PubMed, Scopus, and Embase. The study outcomes were obtained by comparing data of outpatient attendance and compiling the reviewed literature. The mean attendance fell significantly from 95.11±11.17 to 17.25±13.70 persons (P <.0001) per outpatient clinic, March 2020 being the reference point. Teleconsultation has taken over physical consultation. In 98/949 cases, teleconsult could not be provided despite registration. Over 25 patients were waiting for surgical procedures pertaining to andrology due to shut down of elective services. Similar trends have been reported from other countries. Number of patients seeking consultation for sexual health problems has dramatically decreased during COVID-19 era. Establishment of data safe teleconsultation facility and its widespread advertisement is needed to encourage patients to seek consult.

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Impact of COVID-19 pandemic on non-COVID patient’s management in urology: a public hospital experience in Mumbai

African Journal of Urology ◽

10.1186/s12301-021-00196-0 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Nikhilesh A. Jibhakate ◽

Sujata K. Patwardhan ◽

Ajit S. Sawant ◽

Hemant R. Pathak ◽

Bhushan P. Patil ◽

...

Keyword(s):

Tertiary Care ◽

Stone Disease ◽

Outpatient Clinics ◽

Percentage Decrease ◽

Emergency Procedures ◽

Number Of Patients ◽

Long Term Impact ◽

Tertiary Care Hospitals ◽

The Impact ◽

Near Future

Abstract Background To evaluate the impact of COVID-19 lockdown on non-COVID urological patient’s management in tertiary care urology centres. Methods This is an observational study in which data of patients visiting the urology department of all the MCGM run tertiary care hospitals were recorded for the duration of 1 April 2020 to 31 July 2020 and were compared to data of pre-COVID-19 period of similar duration. Results There was a decrease of 93.86% in indoor admissions of urology patients during the COVID-19 lockdown. Indoor admissions for stone disease, haematuria, malignancy accounted for 53.65%, 15.85%, 9.75%, respectively. Elective surgeries had the highest percentage decrease followed by emergency and semi-emergency procedures. There was a reduction of more than 80% in patients attending outpatient clinics. Stone disease and its consequences were the main reasons for visiting outdoor clinics (39%). A substantial number of patients presented with flank and abdominal pain (14.8%) and benign enlargement of the prostate (10.23%). Malignancy accounted for a very small number of patients visiting outdoor clinics (1.58%). Conclusions COVID-19 pandemic has a profound impact on patient care and education in Urology. There was more than ninety percent reduction in indoor admissions, operative procedures, and outpatient clinics attendance. Once the pandemic is controlled, there will be a large number of patients seeking consultation and management for urological conditions and we should be prepared for it. Surgical training of urology residents needs to be compensated in near future. Long-term impact on urological patient outcome remains to be defined.

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