scholarly journals The changing pattern of fever of unknown origin in the Republic of North Macedonia

2019 ◽  
Vol 57 (3) ◽  
pp. 248-253
Author(s):  
Mile Bosilkovski ◽  
Marija Dimzova ◽  
Marija Cvetkova ◽  
Kostadin Poposki ◽  
Katerina Spasovska ◽  
...  
Keyword(s):  
Fever Of Unknown Origin ◽  
Tertiary Care ◽  
Unknown Origin ◽  
Course Evaluation ◽  
Diagnostic Tools ◽  
Solid Organ ◽  
Care Hospital ◽  
Time Periods ◽  
The Republic ◽  
Second Period

Abstract Introduction. The study aimed to compare the etiologic spectrum of diseases causing fever of unknown origin (FUO) and methods for definitive diagnosis in a tertiary care hospital in the Republic of North Macedonia during two different time periods. Patients and methods. There were analysed retrospectively the causes for FUO and final diagnostic approaches in 185 patients with classic FUO that were treated at the University Hospital for Infectious Diseases in Skopje during two time periods. Seventy nine patients were treated during 1991 to 1995 and 106 patients during 2011 to 2015. Results. When comparing these two periods, infections were present in 46.8% and 29.2% (p = 0.014), non-infective inflammatory disorders in 22.8% and 25.5% (p = 0.674), neoplasms in 10.1% and 13.2% (p = 0.522), miscellaneous in 8.9% and 12.3% (p = 0.461) and undiagnosed cases in 11.4% and 19.8% (p = 0.124), respectively. The most common causes for FUO during the first period were abscesses (8.9%), tuberculosis and systemic lupus erythematosus (7.6% each), whereas in the second period the commonest causes were adult onset Still disease and solid organ neoplasm (7.6% each), polymyalgia rheumatica, abscesses and visceral leishmaniasis (5.7% each). The newer imaging techniques and clinical course evaluation had superior diagnostic significance during the second period. Conclusion. A changing pattern of diseases causing FUO during the examined periods was evident. Infections continue to be the most common cause but with decreasing incidence when compared to 20 years ago. Even nowadays clinical evaluation and follow-up still remain the vital diagnostic tools in determining the etiology of FUO.

scholarly journals Aetiology of Fever of Unknown Origin: One-Year Experience in a Tertiary Care Hospital of Bangladesh

2016 ◽  
Vol 6 (1) ◽  
pp. 7-11
Author(s):  
Muhammad Abdur Rahimi ◽  
AKM Shaheen Ahmed ◽  
Md Delwar Hossain ◽  
Md Raziur Rahman ◽  
Swapan Kumar Ghosh ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lupus Erythematosus ◽  
Fever Of Unknown Origin ◽  
Tertiary Care ◽  
Unknown Origin ◽  
Care Hospital ◽  
Cross Sectional ◽  
Extra Pulmonary Tuberculosis ◽  
Common Causes ◽  
Extra Pulmonary

Background: Fever of unknown origin (FUO) is not an uncommon problem in general medical practice. Sometimes extensive investigations fail to reach an aetiological diagnosis; on the other hand, in few cases, fever resolves spontaneously. This study was aimed to evaluate the aetiology of FUO in a tertiary care setting.Methods: This cross-sectional study was done in the Department of Internal Medicine of BIRDEM General Hospital, Dhaka, Bangladesh from July 2012 to June 2013.Results: Among the 33 patients studied (1.23% of total admissions), 22 (66.7%) were male. Mean age of the study population was 40.2±7.9 years. Most patients (84.8%) were diabetic. Infection (20, 60.6%) was the commonest cause, followed by malignancy (9, 27.3%). Among the infective causes (20), extra-pulmonary tuberculosis (5, 25%) was the commonest, followed by liver abscess (4, 20%). Other less common causes were Kala-azar (1), malaria (2), histoplasmosis (2), melioidosis (1), cholecystitis (1), renal abscess (1), rickettsial fever (1), apical dental abscess (1) and infective endocarditis (1). Non-Hodgkin’s lymphoma (6), renal cell carcinoma (2) and hepatocellular carcinoma (1) constituted the malignant causes of FUO in this series. Systemic lupus erythematosus was the aetiology of FUO in 1 case. One case remained undiagnosed and 2 patients left hospital before a definite diagnosis could be made.Conclusion: Extra-pulmonary tuberculosis and non-Hodgkin’s lymphoma were the two most common causes of FUO in this study. Repeated history taking, clinical examinations and careful stepwise investigations can diagnose the aetiolgy in most cases of FUO.Birdem Med J 2016; 6(1): 7-11

scholarly journals Fever in the tropics: aetiology and clinical profile of fever of unknown origin in children-a prospective observational study in a tertiary care hospital in South India

2019 ◽  
Vol 6 (5) ◽  
pp. 1834
Author(s):  
Ramachandran Sumathisri ◽  
Karuppiah Pandi ◽  
Sadagopan Srinivasan
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Fever Of Unknown Origin ◽  
Urine Analysis ◽  
Complete Blood Count ◽  
Tertiary Care ◽  
Unknown Origin ◽  
Tuberculin Test ◽  
Care Hospital ◽  
Indian Children

Background: Fever of unknown origin (FUO) is an important cause of morbidity and mortality in children, especially in tropical countries with varied aetiology and clinical presentation. Aim of this study is to determine the aetiology and outcome of FUO in Indian children. Study design is Prospective, observational study.  Methods: We enrolled 75 children aged 1 to 12 years who were admitted with fever >8 days to the paediatric department from January 2015 to August 2016. Initial evaluation included complete blood count, peripheral smear, urine analysis, chest radiography, blood culture and tuberculin test.  Results: In 72 children (96%), a definitive diagnosis could be established, whereas 3 children (4%) remained undiagnosed. Most common aetiology of FUO was infectious disease (90.6%) followed by malignancy (4%) and collagen vascular disease (1.3%). Among the infections group, scrub typhus was found to be the commonest aetiology (52%).Conclusions: Infections were the most common etiological factor for FUO in children aged 1-12 years of our region.

scholarly journals Management of Ectopic Pregnancy in a Tertiary Care Hospital by Surgery

2016 ◽  
Vol 28 (1) ◽  
pp. 21-25
Author(s):  
Saida Akter ◽  
Sharmin Sultana
Keyword(s):  
Physical Examination ◽  
Ectopic Pregnancy ◽  
Radical Surgery ◽  
Tertiary Care ◽  
Total Abdominal Hysterectomy ◽  
Conservative Surgery ◽  
Diagnostic Tools ◽  
Care Hospital ◽  
College Hospital ◽  
Cross Sectional

Introduction: Tubal ectopics if large, uncontrollably bleeding or severely damaged need radical surgery (salpingectomy), otherwise conservative surgery (salpingotomy, salpingostomy) is the way of operative management. Laparoscopic surgery usually done in case of haemodynamically stable condition.Objective: To explore the different ways of surgical management of ectopic pregnancy in a tertiary care hospital.Materials and methods: This cross sectional study was carried out in the Department of Obstetrics and Gynaecology, Shaheed Suhrawardy Hospital and Dhaka Medical College Hospital during August 2005 and June 2006. The study population consisted of 50 women with ectopic pregnancy. Selected women underwent meticulous history taking and physical examinations. Some investigations like ultrasonography, culdocentesis, urine for pregnancy tests were done. Patients were treated by either radical or conservative surgery.Results: All (100%) women had abdominal tenderness. Ectopic pregnancy was diagnosed by history, physical examination and culdocentesis (84%), ultrasonography (12%) and laparotomy (4%). Two (4%) women were treated by conservative surgery, while the rest by radical surgery; 40 (80%) underwent unilateral salpingectomy, 3 (6%) unilateral salpingectomy with contralateral tubectomy, 2 (4%) unilateral salpingo oophorectomy, 1 (2%) total abdominal hysterectomy and 2 (4%) resection of rudimentary horn.Conclusion: Most common diagnostic tools were by history, physical examination and culdocentesis and common management was unilateral salpingectomy.Bangladesh J Obstet Gynaecol, 2013; Vol. 28(1) : 21-25

scholarly journals Frequency and Pattern of Bronchiectasis in Patients with Chronic Obstructive Pulmonary Disease Presenting in a Tertiary Care Hospital

2021 ◽  
Vol 35 (3) ◽  
pp. 54-57
Author(s):  
Asifa Karamat
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Tertiary Care ◽  
Lower Lobe ◽  
The United States ◽  
Diagnostic Tools ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Care Hospital ◽  
Obstructive Pulmonary Disease

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a high burden respiratory issue all over the world. It has high morbidity and mortality in the United States. Bronchiectasis is associated with chronic obstructive pulmonary disease (COPD) and is under diagnosed as diagnostic tools like HRCT though easily available but an expensive test in developing countries like Pakistan. We aim to establish the frequency and patterns of bronchiectasis in patients of COPD. Aims and Objectives: To establish the frequency and pattern of bronchiectasis in COPD in our population so that we can improve patient care and quality of life of these patients. Place and duration of study: We did a cross sectional survey in Department of Pulmonology, Gulab Devi Hospital, Lahore. Study was completed from 1st September 2017 to 28th February 2018. Material & Methods: After taking an informed consent 150 already diagnosed COPD patients were included. Bronchiectasis was seen on high resolution CT scan (HRCT). Data was collected on a structured proforma and analyzed on SPSS version 20. Results: Bronchiectasis was observed in 76 (50.6%) patients of COPD while 74 patients had no bronchiectasis. Out of 76, cylindrical bronchiectasis was seen in 82%. Lower lobe and bilateral involvement was more common. Means of age, gender, exacerbations of COPD, and history of pulmonary tuberculosis were not related to bronchiectasis while pack years of smoking, duration of illness and Modified Medical Research Council (MMRC) Dyspnea Scale were significantly related to bronchiectasis. Conclusion: This is observed that bronchiectasisis quite common (50.6%) in patients of COPD in our population.

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

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.

Disease Spectrum of Cervical Lymphadenopathy in adults

2021 ◽  
Vol 15 (11) ◽  
pp. 2853-2855
Author(s):  
Rabia Amin Butt ◽  
Zonaira Rathore ◽  
Afia Sarwar ◽  
Faiza Azam ◽  
Faria Waqar Khan ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Tertiary Care ◽  
Cervical Lymphadenopathy ◽  
Diagnostic Tools ◽  
Tuberculous Lymphadenitis ◽  
Care Hospital ◽  
Inclusion Criteria ◽  
Non Hodgkin Lymphoma ◽  
Malignant Lesions ◽  
Age Range

Aim: To determine the frequency of different diseases resulting in cervical lymphadenopathy in specimens of patients presenting in tertiary care hospital. Methodology: It was a cross sectional study conducted at the histopathology section of the pathology department of Services Institute of Medical Sciences/Services Hospital Lahore. The study was approved by the ethical committee of the institution. The study was completed in six months.100 cases fulfilling the inclusion criteria were registered. Inclusion criteria included patients above 16 years of age, patients from both sexes, unilateral or bilateral irrespective of duration. Lymph nodes less than 1cm were not included in the study. Informed consent was taken. Both FNAC and Biopsy were used as diagnostic tools. All the data was analysed with SPSS version 11. Results: During a period of six months, a total of 100 cases of cervical lymphadenopathy were studied. These included 75 benign and 25 malignant cases. Out of benign cases 53% were diagnosed as tuberculous lymphadenitis. About 81.3% were in the age range of 16-25 years and 18.7% were in the age range of 26-35 years. 22% cases were diagnosed as reactive lymphadenitis. About 54.54% of these patients were in the age range of 16-25 years and 45.46% were in the age range of 26-35 years. The highest frequency among malignant lesions consisted of Non-Hodgkin lymphoma 16% followed by Hodgkin lymphoma 5% and metastatic disease 4%.The age range of malignant lesions was in the range of 36-78 years. Conclusion: Our study concludes that cervical lymphadenopathy is the common clinical presentation in our setup and tuberculosis is the commonest cause. Keywords: Hodgkin lymphoma, Non-Hodgkin lymphoma, Fine needle aspiration cytology

Pattern of acquisition of hospital-associated pathogens in the ICU of an academic tertiary care hospital

2022 ◽  
Author(s):  
Shazia Damji ◽  
Jerrold Perrott ◽  
Salomeh Shajari ◽  
Jennifer Grant ◽  
Titus Wong ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Median Time ◽  
Broad Spectrum ◽  
Health Authority ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Primary Objective ◽  
Solid Organ ◽  
Care Hospital ◽  
Broad Spectrum Antibiotics

BACKGROUND: Among hospitalized patients, a 48-hour window from time of hospitalization defines nosocomial infections and guides empiric antibiotic selection. This time frame may lead to overuse of broad-spectrum antibiotics. Our primary objective was to determine the earliest and median time since hospital admission to acquire antibiotic-resistant pathogens among patients admitted to the intensive care unit (ICU) of an academic, tertiary care hospital. METHODS: Retrospective chart review was conducted for adult patients admitted to the ICU from home or another hospital within the same health authority in 2018, to identify the time to acquisition of hospital-associated pathogens: methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, extended-spectrum beta-lactamase (ESBL)–producing Enterobacterales, non-ESBL ceftriaxone-resistant Enterobacterales, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Patients transferred from hospitals outside the health authority, admitted to ICU after 14 days of hospitalization, who were solid organ or bone marrow transplant recipients, or who were otherwise immunocompromised were excluded. RESULTS: In 2018, 1,343 patients were admitted to this ICU; 820 met the inclusion criteria. Of these, 121 (14.76%) acquired a hospital-associated pathogen in the ICU. The probability of isolating a hospital-associated pathogen by 48 hours of hospital admission was 3%. The earliest time to isolate any of these pathogens was 29 hours, and the median was 9 days (interquartile range [IQR] 3.8–15.6 days). CONCLUSIONS: Most patients (85.3%) in this ICU never acquired a hospital-associated pathogen. The median time to acquire a hospital-associated pathogen among the remaining patients suggests that initiating empiric broad-spectrum antibiotics on the basis of a 48-hour threshold may be premature.

scholarly journals A clinical study of trends of ectopic pregnancy and its management in a tertiary care hospital

2019 ◽  
Vol 8 (12) ◽  
pp. 4834
Author(s):  
Chandana M. Puttaraju ◽  
Nagothi Nagendra Prasad ◽  
M. P. A. Sailakshmi
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Sex Education ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Diagnostic Tools ◽  
Care Hospital ◽  
Care Teaching ◽  
Β Hcg ◽  
Ectopic Pregnancies

Background: Ectopic gestation is a gynaecological emergency which culminates in pregnancy loss and causes significant maternal morbidity, mortality besides jeopardizing future conception. The study discusses the incidence, risk factors, symptomatology and management of ectopic pregnancy in a tertiary care teaching hospital.Methods: This was a prospective study of 45 cases of ectopic pregnancies at a tertiary care teaching hospital from January 2012 to December 2013. Information was collected in a structured proforma, tabulated and descriptive analysis was carried out.Results: The incidence of ectopic pregnancy was 1.17%. Majority of the patients (80%) belonged to 20-30 yrs age group. Second gravidas predominated (42.2%). Fallopian tube was the most common site (95.5%). Rudimentary horn ectopic accounted for 4.65%. Previous abdominopelvic surgery (31.1%), IUCD usage (22.2%), PID (20%), abortions (20%), tubectomy (15.5%) were the principal risk factors. 42% of the patients had no risk factor. The triad of amenorrhea, bleeding per vaginum and abdominal pain was seen in 51.1% of cases. Ultrasound, UPT, β-hCG estimation were the diagnostic tools. Ruptured ectopic pregnancy accounted for 64.4%. Nearly 95.5% of patients underwent surgery; salpingectomy (76%). Methotrexate was successful in 4.44%. There was no maternal mortality.Conclusions: Mostly diagnosis, prompt surgical or medical management is cornerstone of treatment. Primary prevention such as improved access to family planning services, sex education, treatment of STI, PID, surgical asepsis  and haemostasis, implementing legislation for dispensing MTP drugs ameliorate risk factors and hence reduce ectopic pregnancy.

scholarly journals CLINICAL SPECTRUM OF SCRUB TYPHUS IN A TERTIARY CARE HOSPITAL AT EASTERN INDIA

2018 ◽  
Vol 11 (5) ◽  
pp. 351 ◽  
Author(s):  
Srikant Kumar Dhar ◽  
Sobhitendu Kabi ◽  
Chandan Das ◽  
Swati Samant ◽  
Debasmita Tripathy ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Gastrointestinal Symptoms ◽  
Unknown Origin ◽  
Immunoglobulin M ◽  
Care Hospital ◽  
Diagnostic Features ◽  
Laboratory Findings ◽  
Pyrexia Of Unknown Origin

 Objective: Our hospital, tertiary care hospital in the capital of the state of Odisha, had been witnessing pyrexia of unknown origin, associated with breathlessness, renal, and liver impairment, which did not respond to high antibiotics but to doxycycline; therefore, the present study was undertaken to identify whether scrub typhus is the etiological agent, and thereafter, their characteristic features were further evaluated as an effort in supporting its diagnoses and treating patients accordingly.Methods: A total of 65 adult patients (age >15 years) admitted with pyrexia between April 2015 and October 2017 were evaluated. Immunoglobulin M (IgM) scrub typhus test was done in all these patients. IgM scrub typhus test positive samples were included in the study and various clinical parameters analyzed.Results: Of the 65 patients included in the study, all were found to be positive for IgM antibodies against Orientia tsutsugamushi. The cases were seen mainly in the months between September and November. The common symptoms found were fever, myalgia, breathlessness, rash, and abdominal pain and rarely altered sensorium. The diagnostic features like eschar were found in 23% patients. Nearly, two-thirds of patients had fever more than 7 days and myalgia (76.92%), headache (58.46%). The most common complications were renal failure (20%) followed by pneumonia (10.76%). Laboratory findings of high C-reacting protein (89.23%) and leukocytosis are found in 35.38%.Conclusion: Our results showed that scrub typhus should be considered in the differential diagnosis of pyrexia of unknown origin associated with breathlessness, myalgia, rash, gastrointestinal symptoms, hepatorenal syndrome, or acute respiratory distress syndrome. Empirical treatment with doxycycline may be given in the cases with strong suspicion of scrub typhus.

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