Spontaneous pneumomediastinum: ten years of our experience in diagnosis and outcome

Open Medicine ◽  
2014 ◽  
Vol 9 (5) ◽  
pp. 642-647
Author(s):  
Sanja Hromis ◽  
Biljana Zvezdin ◽  
Ivan Kopitovic ◽  
Senka Milutinov ◽  
Violeta Kolarov ◽  
...  
Keyword(s):  
Chest Pain ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Sudden Onset ◽  
Recurrent Event ◽  
First Episode ◽  
Close Monitoring ◽  
Tertiary Care Centre ◽  
Benign Condition ◽  
Spontaneous Pneumomediastinum

AbstractSpontaneous pneumomediastinum (SPM) is a rare clinical condition that may be mild but also dramatic with sudden onset of chest pain and dyspnea accompanied by swelling and subcutaneous crepitations. The objective of this study was to analyze the clinical presentation and outcome of SPM in a specialized pulmonary tertiary care centre over a 10 years year period. In subsequent followup, we received information related to recurrence episodes of SPM by patients or their GPs physicians. Eighteen patients, 15 (83%) men, mean age 24 years (SD ±7.86) were diagnosed with SPM. Predominant symptoms were chest pain and cough (n=11) then dyspnea (n=9). Asthma was the most common predisposing condition (n=12). Pneumomediastinum was present on chest radiograph in 17 cases (94%), and in one case it was detected only by computed tomography. The mean length of hospital stay was 7 days (SD ±4.4 days). All our patients recovered and there were no complications. Recurrent event occurred in one asthma patient, 2 years after the first episode. Although, SPM is usually a self-limiting and benign condition, close monitoring is necessary. Recurrence is rare, but possible, with no evidence that routine monitoring of those patients is needed.

A CLINICOEPIDEMIOLOGICAL STUDY ON PAEDERUS DERMATITIS IN A TERTIARY CARE CENTRE, CHENNAI

2021 ◽  
pp. 25-27
Author(s):  
P. Mohan ◽  
P. Revathi Guru ◽  
V. Sudha ◽  
L. Balamurugan ◽  
Pavithra Gunasekaran ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Sudden Onset ◽  
The Body ◽  
Care Hospital ◽  
Age Group ◽  
Common Condition ◽  
Tertiary Care Centre ◽  
Linear Lesions ◽  
Paederus Dermatitis

Paederus dermatitis is a form of irritant contact dermatitis due to contact with certain insects of the genus Paederus presenting with mostly erythematous linear lesions of sudden onset on exposed parts of the body. To study the clinico epi Aim: demiological features in patients with Paederus dermatitis. A retrospective analysis of clinicoepidemiological Materials & Methods: features of patients affected with Paederus dermatitis who had attended the Dermatology OPD, in a tertiary care hospital between January 2018 to December 2019 was done. All the required data had been collected from the OPD records and details were tabulated and analysed. A total of 56 patients had been affected with Result: Paederus dermatitis during the study period, of which 32 were males and 24 were females. 41out of 56 (73.21%) of patients presented between the months of August and December. Most common age group affected were between 11 to 30 yrs, with front and back of neck being the most common affected sites. In 42 out of the 56 patients the lesions resolved with post inammatory hyperpigmentation. Conclusion: Paederus dermatitis is a common condition that is often misdiagnosed and hence awareness is required for the clinicians and the general public to prevent it.

Abstract 13123: Early Mobilization of Older Adults in the Cardiac Intensive Care Unit

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael Goldfarb ◽  
Koorosh Semsar-kazerooni ◽  
Jose Morais ◽  
Diana Dima
Keyword(s):  
Older Adults ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Hospital Death ◽  
Healthcare Team ◽  
Tertiary Care Centre ◽  
Discharge Home

Background: Early mobilization (EM) is beneficial in general critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease. Methods: Consecutive admissions of adults ≥ 80 years old to a cardiac ICU at an academic tertiary care centre before (January to December 2017) and after (February 2018 to June 2019) implementation of a structured nurse-driven EM program. Mobility was measured using the validated Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk > 50 feet). The primary outcome was discharge home. Results: There were 412 patients included (N=234, intervention; N=178, preintervention). There was no difference in mean age between groups (overall mean age 86.3±4.8 years old) or sex (overall female N=215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prior to hospitalization and in 209 patients (89.3%) on admission. Nearly half of patients undergoing EM (N=107; 45.7%) improved their LOF by ≥1 during cardiac ICU stay. Mobilization occurred during nearly all opportunities (838/850; 98.6%) and most mobility activities were completed (2,207/2,553; 86.4%). Adverse events were rare (5/2,207 activities [0.2%]) and transient (N=5). There were no falls, line dislodgements, or healthcare team injuries). Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4% vs. 65.7%, P=0.047, respectively) and had a lower rate of in-hospital death (6.4% vs. 14.6%, P=0.006, respectively). There was no difference in length of hospital stay or re-admission. In the multivariable analysis, predictors of discharge home were younger age, heart failure, and higher prehospital LOF. Outcomes were similar in adults ≥ age 90. Conclusion: EM is safe in older adults in the cardiac ICU and is associated with reduced discharge to healthcare facility and in-hospital mortality.

scholarly journals Potential drug-drug interactions among elderly in-patients with cardiac illness at a tertiary care centre

2020 ◽  
Vol 9 (3) ◽  
pp. 470
Author(s):  
Akanksha Mathur ◽  
Nidhi Jain ◽  
Achal Sharma ◽  
Prashant C. Shah
Keyword(s):  
Risk Factors ◽  
Drug Interactions ◽  
Hospital Stay ◽  
Pearson Correlation ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Hospitalized Patients ◽  
Close Monitoring ◽  
Potential Drug ◽  
Cardiac Illness

Background: Drug interactions are major cause of concern in hospitalized patients with cardiac illness especially in elderly population. Therefore, the study was conducted to determine the prevalence and pattern of potential drug-drug interactions (pDDI) and risk factors, if any.Methods: It was a prospective observational study involving 75 elderly in-patients with cardiac diseases. IHEC approval was taken before commencement of study and written informed consent was taken from all the study participants. Data was collected using structured data collection tool. pDDI were analyzed using MEDSCAPE databse. Data was analyzed using SPSS 20.0 in terms of descriptive statistics. Pearson correlation coefficient was used to find the association between the risk factors and potential DDIs. P value of ≤0.05 was considered statistically significant.Results: The prevalence of pDDI was found to be 100%. Total 593 pDDI and 33 interacting drug pairs were observed in the study. The common drug interacting pairs were aspirin and furosemide 140 (23.61%), followed by aspirin+ enalapril 98 (16.53%) and heparin and clopidogrel 56 (9.44%). Majority of pDDI 480 (81%) were found to be of moderate severity. A significant association was documented between length of hospital stay (p=0.041) and occurrence of pDDI. A statistically significant correlation (r =0.621; p<0.01) was noted between number of drugs prescribed and total number of pDDIs.Conclusions: A high prevalence of pDDI was observed. The prevalence rate is directly related to number of drugs prescribed and length of hospital stay. Therefore, close monitoring of hospitalized patients is recommended.

scholarly journals Impact and outcome of cardiac diseases in pregnancy

2020 ◽  
Vol 10 (1) ◽  
pp. 102
Author(s):  
Gira Dabhi ◽  
Jignesh Chauhan ◽  
Munjal Pandya ◽  
Rahul Sinhar
Keyword(s):  
Heart Disease ◽  
Cardiac Disease ◽  
Nyha Class ◽  
Demographic Data ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Close Monitoring ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
In Pregnancy

Background: Present study done to study incidence, effect of pregnancy on cardiac disease and vice-versa and feto-maternal outcome in patients with cardiac disease in pregnancy at tertiary care hospital.Methods: It’s a retrospective observational study conducted in Department of OBGY at tertiary care hospital between 01 June 2019 to 31 May 2020. 28 cases of cardiac disease out of 8659 patients registered included in the study. Demographic data like age, parity, etiological factors of cardiac disease, mode of delivery, neonatal outcome noted from case records.Results: In study, 32% were unregistered cases and 10.7% had never sought any medical care before. Majority (53.6%) cases belonged to 20-25 years. Heart disease noted to be more in primipara (35.7%). 71.4% belonged to NYHA class 1+2 and had a relatively uneventful peripartum period. Majority (53.6%) patients had rheumatic valvular disease. Cases of Congenital heart disease were17.8%, pulmonary artery hypertension was 25%, Maternal mortality were 2(7.2%). 46.5% women delivered with caesarean section. PIH (18%) and anemia (7.2%) were most commonly associated conditions. 85.6% women delivered live newborns and full term, pre-term deliveries and IUGR were 71.4%, 17.8% and 10.7% respectively.Conclusions: Rheumatic origin is the most common cardiac disease associated with pregnancy. The availability of early diagnostic techniques and reference to tertiary care centre, timely admission and close monitoring of patient and delivery with multidisciplinary approach include specialized cardiologic care, high risk obstetric support and neonatology expertise can minimize feto-maternal morbidity and mortality. Pre-conceptional counselling, regular antenatal check-ups and contraceptive advice must be included in counselling part.

scholarly journals Spontaneous pneumomediastinum – a rare cause of chest pain and dyspnoe in children

2021 ◽  
pp. e570
Author(s):  
Marcin Mikoś ◽  
Katarzyna Jończyk-Potoczna ◽  
Paulina Sobkowiak ◽  
Anna Bręborowicz ◽  
Edyta Nagła ◽  
...  
Keyword(s):  
Chest Pain ◽  
Respiratory Insufficiency ◽  
Genetic Material ◽  
Severe Pneumonia ◽  
Rare Condition ◽  
Bronchial Tree ◽  
Human Bocavirus ◽  
Esophageal Rupture ◽  
Benign Condition ◽  
Spontaneous Pneumomediastinum

Introduction. Spontaneous pneumomediastinum is a very rare condition in children. Nevertheless it should be considered in the differential diagnosis in patients who present with chest pain and dyspnoe.Aim. The aim of our study was to describe clinical presentation, management and outcomes of the paediatric patients with spontaneous pneumomediastinumMaterial and Methods. This was a retrospective analysis of the charts of all the patients who were admitted to the Department of Pneumonology, Paediatric Allergy and Clinical Immunology in a ten year period from 01.01.2011 till 31.12.2020 in whom spontaneous pneumomediastinum was diagnosed.Results. There were 11 children (7 females) with spontaneous pneumomediastinum. The median age of the children was 11 years (range 3 to 17.5 years). Most of the children presented to the hospital with chest pain, three children complained of the neck swelling and four children developed dyspnoe. Three children with the primary spontaneous pneumomediastinum had a history of physical exercise prior to the onset of symptoms. The secondary spontaneous pneumomediastinum occurred in two children with asthma and 4 children with pneumonia. Genetic material of human Bocavirus was identified in 3 cases. In 81.8% of children pneumomediastinum was accompanied by subcutaneous emphysema and in one case, in a child with severe pneumonia and respiratory insufficiency caused by Bocavirus with pneumorrhachis. In 10 children computed tomography was performed, bronchoscopy in 4 and esophagoscopy in two children. There was no evidence of esophageal rupture or bronchial tree rupture in any of our patients. Three children with pneumonia and pneumomediastinum developed respiratory insufficiency, two of these were treated with mechanical ventilation and one with High Flow Nasal Cannula oxygen therapy. All the children received oxygen. In one child surgical procedure was performed and the drain was inserted into mediastinal space in order to decompress it. Outcome was favourable in all children. Mean time to recovery was 10.6 ± 1.2 days. There was no recurrence of symptoms in any of our patients.Conclusions. Spontaneous pneumomediastinum in most cases is a benign condition, sporadically however it may progress rapidly, leading to respiratory insufficiency and warrant invasive management.

scholarly journals A STUDY ON RESPIRATORY COMPLICATIONS AND ITS OUTCOME IN ACUTE PANCREATITIS

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Abhijith Valsalan ◽  
Alfie J Kavalakat ◽  
Gowri Gopal ◽  
John Thomas P ◽  
Rashifa Vakiyath ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Early Death ◽  
Face Mask ◽  
First Episode ◽  
Respiratory Complications ◽  
Tertiary Care Centre ◽  
Respiratory Dysfunction ◽  
Ventilator Support

Background: Respiratory complications are frequent in acute pancreatitis, and respiratory dysfunction, presenting as Acute lung injury (ALI) or Acute Respiratory Distress Syndrome (ARDS), is a major component of multiple organ dysfunction syndrome (MODS), with a frequent need for ventilator support, which contributes to early death in severe acute pancreatitis. The current study was done with the objective of assessing the morbidity and mortality of acute pancreatitis cases with respiratory complications and to find out whether there is any association between the aetiology of acute pancreatitis and respiratory complications. Methodology: It was a prospective observational study conducted in a tertiary care centre in Kerala. All participants admitted with symptoms suggestive of acute pancreatitis were screened for potential enrolment. The inclusion criteria employed were that the patients should be aged above 18 years, and presenting with the first episode of pancreatitis, irrespective of aetiology. All the patients who were admitted were monitored daily for the worsening of any respiratory complications and provided with adequate respiratory supports. Results: Out of the 101 participants recruited, males were 84.2%. Mean (SD) age was 42.1 (11.4) years. Majority of cases (61%) had alcoholic aetiology. Fourteen patients required high flow nasal oxygen support, four patients were given face mask support, five patients required ventilator support and three patients required tracheostomy support. Respiratory complications and requirement of support were found to be associated with higher morbidity as well as mortality. Respiratory complications were higher in those with alcoholic etiology but this was not significant in univariate analysis. Conclusion: Respiratory complications pose challenges in clinical course of acute pancreatitis in terms of morbidity as well as mortality. Aetiology did not seem to play a major role in development of respiratory complications.

scholarly journals A Review of 11 Years ofStenotrophomonas maltophiliaBlood Isolates at a Tertiary Care Institute in Canada

2012 ◽  
Vol 23 (4) ◽  
pp. 165-169 ◽  
Author(s):  
Prenilla Naidu ◽  
Stephanie Smith
Keyword(s):  
Infection Control ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Surveillance Program ◽  
Tertiary Care Centre ◽  
Alberta Hospital ◽  
University Of Alberta ◽  
Drug Of Choice

BACKGROUND:Stenotrophomonas maltophiliahas emerged as a significant nosocomial pathogen with increasing resistance to trimethoprim/sulphamethoxazole (TMP/SMX), the current drug of choice for treatment.OBJECTIVES: To describe the microbiological and clinical characteristics ofS maltophiliabloodstream infections (BSIs) over an 11-year period at a tertiary care centre in Canada.METHODS: All adultS maltophiliaBSIs from 1999 to 2009 in a 750-bed tertiary care teaching hospital (University of Alberta Hospital, Edmonton, Alberta) were identified through the infection control nosocomial infection surveillance program. Demographic and clinical data were extracted from the infection control database and from patient charts. Microbiological data were confirmed through the laboratory information system.RESULTS: Twenty-five episodes ofS maltophiliaBSI (0.9% of all BSIs) involving 24 patients were identified between 1999 and 2009. The patient age range was 18 to 83 years (average 45.7 years). The majority were men (14 of 24 [58.3%]). The mean length of hospital stay was 83.3 days (range eight to 310 days). The rate ofS maltophiliaBSIs per 1000 admissions ranged from 0.04 to 0.22 (average 0.09). Greater than one-half of the episodes (13 of 25 [52%]) were admitted to the intensive care unit before BSI onset. Laboratory data were available for 24 of the 25 isolates. Polymicrobial infections were present in 11 of 24 (45.8%) patients. Resistance to TMP/SMX occurred in 8.3% of all infections. Fifteen per cent of isolates were resistant to ticarcillin/clavulanate. Mortality attributed to bacteremia was 16.7%.CONCLUSIONS: In the University of Alberta Hospital, the rate ofS maltophiliaBSI remains low and constant, and TMP/SMX remains the drug of choice for treatment.

scholarly journals Vascular comorbidities worsen prognosis of patients with heart failure hospitalised with COVID-19

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001668
Author(s):  
Jacob Mok ◽  
Juan Carlos Malpartida ◽  
Kimberly O'Dell ◽  
Joshua Davis ◽  
Cuilan Gao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Hospital Mortality ◽  
Ischaemic Stroke ◽  
Tertiary Care ◽  
Vascular Diseases ◽  
Length Of Hospital Stay ◽  
Arterial Disease ◽  
Tertiary Care Centre ◽  
Peripheral Arterial

BackgroundPrior diagnosis of heart failure (HF) is associated with increased length of hospital stay (LOS) and mortality from COVID-19. Associations between substance use, venous thromboembolism (VTE) or peripheral arterial disease (PAD) and its effects on LOS or mortality in patients with HF hospitalised with COVID-19 remain unknown.ObjectiveThis study identified risk factors associated with poor in-hospital outcomes among patients with HF hospitalised with COVID-19.MethodsCase–control study was conducted of patients with prior diagnosis of HF hospitalised with COVID-19 at an academic tertiary care centre from 1 January 2020 to 28 February 2021. Patients with HF hospitalised with COVID-19 with risk factors were compared with those without risk factors for clinical characteristics, LOS and mortality. Multivariate regression was conducted to identify multiple predictors of increased LOS and in-hospital mortality in patients with HF hospitalised with COVID-19.ResultsTotal of 211 patients with HF were hospitalised with COVID-19. Women had longer LOS than men (9 days vs 7 days; p<0.001). Compared with patients without PAD or ischaemic stroke, patients with PAD or ischaemic stroke had longer LOS (7 days vs 9 days; p=0.012 and 7 days vs 11 days, p<0.001, respectively). Older patients (aged 65 and above) had increased in-hospital mortality compared with younger patients (adjusted OR: 1.04; 95% CI 1.00 to 1.07; p=0.036). Prior diagnosis of VTE increased mortality more than threefold in patients with HF hospitalised with COVID-19 (adjusted OR: 3.33; 95% CI 1.29 to 8.43; p=0.011).ConclusionVascular diseases increase LOS and mortality in patients with HF hospitalised with COVID-19.

scholarly journals A clinico-pathological study of patients with thyroid swelling and their management in a tertiary care centre in western Uttar Pradesh

2021 ◽  
Vol 12 (1) ◽  
pp. 95-99
Author(s):  
Mohini Tyagi ◽  
Probal Chatterjee
Keyword(s):  
Thyroid Disease ◽  
Multinodular Goiter ◽  
Clinical Presentation ◽  
Histopathological Examination ◽  
Care Center ◽  
Tertiary Care ◽  
Pathological Study ◽  
Tertiary Care Centre ◽  
Benign Condition ◽  
Thyroid Swelling

Background: Thyroid diseases are common worldwide and in India too there is a significant burden of thyroid disease. Thyroid disease has a reported prevalence of 4-7% in the general population on neck palpation and in autopsy series it may be as high as 50% if subclinical nodules are included. The clinical presentation of thyroid swellings can be very misleading and a definitive diagnosis cannot be done without proper investigations. Aims: To conduct a clinic-pathological study of thyroid swellings along with their management in a tertiary care center. Objectives: 1. To study the various clinical presentations of thyroid swellings 2. To record the FNAC findings in each case. 3. To perform histopathological examination of all operative specimens and compare the results with preoperative diagnosis. Materials and Methods: A one-year prospective study was done in which 50 patients with thyroid swelling were identified. Detailed information regarding all relevant parameters was recorded and treatment was done as per standard protocol. Results: Female preponderance of cases was seen (3.16:1). Maximum cases were in 36-45 year age group and 70% cases were premenopausal females. Multinodular goiter was commonest clinical presentation and colloid goiter was most common FNAC finding. Hemithyroidectomy was the most frequently performed operation. Final results showed that colloid goiter was the most commonly diagnosed benign condition while papillary carcinoma was the commonest malignancy. Conclusion: Most studies show female preponderance of cases. Multinodular goiter is the commonest clinical presentation world-wide. Colloid goiter is the most commonly diagnosed cause of thyroid swelling. Though FNAC is not 100% accurate, it has an important role in the initial evaluation of these patients. Histopathogical examination of specimen is the gold-standard investigation for final diagnosis. Due to the risk of an underlying malignancy, a proper evaluation of thyroid swellings is a must as they have excellent cure rate if treated early.

scholarly journals Psychosocial Needs of the Families with a Person with First Episode Psychosis

2019 ◽  
Vol 10 (1) ◽  
pp. 56
Author(s):  
Praful Prabhuappa Kapse ◽  
Manisha Kiran
Keyword(s):  
Tertiary Care ◽  
Family Members ◽  
First Episode Psychosis ◽  
First Episode ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Episode Psychosis ◽  
The Family ◽  
Expressed Emotions

Background: The people who experience psychotic symptoms first time can be frightening for them and their close family members. It is crucial to provide family support and care to persons with first episode psychosis. Aim: To assess the needs of family members presenting to a tertiary care centre. Methods: Cross-sectional outpatient based study design was adapted to collect data from the family members of persons with first episode psychosis presented to a tertiary care centre. Total 60 family members were randomly selected for the study and assessed for the burden, attitude, ways of coping and quality of life. Results: Study results indicate the high burden; it has noted that high negative expressed emotions among family members. Negative coping styles were also found and the family members and having a poor quality of life. Conclusion: First episode of psychosis can traumatizing to the patients and their family members. Family members can experience the burden of caregiving including financial burden, can have faulty ways of coping and negative expressed emotions towards their own wards having psychosis which can lead to poor treatment outcome. Findings indicated that need to provide psychosocial intervention for family members of persons with first episode psychosis. Keyword: Family, psychosocial intervention, needs, first episode psychosis, expressed emotions, burden

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