scholarly journals Spinal cord hemangioblastomas with a focus on clinical presentation, diagnosis, and treatment at a tertiary care hospital of Karachi, Pakistan: A retrospective chart review

2021 ◽  
Vol 12 ◽  
pp. 24
Author(s):  
Syed Sarmad Bukhari ◽  
Muhammad Ehsan Bari ◽  
Nasir Ud Din ◽  
Zubair Ahmad
Keyword(s):  
Spinal Cord ◽  
Stromal Cells ◽  
Tertiary Care ◽  
Neuron Specific Enolase ◽  
Retrospective Chart Review ◽  
Vascular Tumors ◽  
Care Hospital ◽  
Mitotic Figures ◽  
Cluster Of Differentiation

Background: Hemangioblastomas are benign neoplasms that consist of stromal cells and small blood vessels. They are highly vascular tumors and can arise throughout the central nervous system. This study aims to provide an overview of our experience with this rare tumor’s presentation, radiology, histopathology, and outcomes as literature regarding this pathology is sparse from our country. Methods: The study is a retrospective review of cases that were histopathology proven cases of spinal cord hemangioblastomas. The clinical characteristics of these patients were examined, and their presentation was recorded. The radiology was also reviewed to describe classic appearance on magnetic resonance imaging. A detailed review of immunohistochemistry was also performed and outcome was described. Results: A total of 25 cases of spinal hemangioblastomas were found in our records in the period of 2001–2019. There were 20 males (80%) and only 5 female patients (20%). Gross tumor fragments ranged in size from 0.24 cm2 to 10.5 cm2 (mean 3.28 ± 2.65). Histologically, tumor was composed of nests of large stromal cells with clear to vacuolated cytoplasm separated by thin-walled capillaries. Focal intratumoral hemorrhage was noted. No significant cytological atypia or mitotic figures were noted. Immunohistochemical stains were performed to confirm the diagnosis and exclude other tumors. Inhibin was tested in 20 cases and it was positive in 16 cases (80%). Neuron-specific enolase was positive in 6/8 cases. Cluster of differentiation (CD) CD68 was positive in 6/6 cases and vimentin in 4/4 cases. Glial fibrillary acidic protein (GFAP) and epithelial membrane antigen were performed in 14 and 8 cases, respectively, and all were negative. Cytokeratin AE1/AE3 was negative in 13/13 cases. CD34 highlighted vasculature in the 8 cases in which it was performed and was negative in tumor cells. Follow-up was available in 17 out of 25 cases and ranged from 12 months to 216 months (mean 61.8 ± 60.6 months). Recurrence occurred in 2 out of 17 (11.7%) patients for whom follow-up information was available. Conclusion: Our experience shows that spinal cord hemangioblastomas can be surgically removed in most cases with a low risk of recurrence. Most patients in our study were male and unlike other studies, none of our cases showed GFAP positivity.

Pediatric Cartilage Interleave Tympanoplasty

2007 ◽  
Vol 137 (2) ◽  
pp. 284-288 ◽  
Author(s):  
Michael Gaslin ◽  
Robert C. O'Reilly ◽  
Thierry Morlet ◽  
Michael McCormick
Keyword(s):  
Tympanic Membrane ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Care Hospital ◽  
Membrane Repair ◽  
Hearing Results ◽  
Cartilage Tympanoplasty ◽  
Long Term Follow Up

OBJECTIVE: To describe a novel technique of cartilage tympanoplasty, and review surgical and hearing results in children. STUDY DESIGN AND SETTING: Retrospective chart review of all patients who had undergone tympanoplasty at a pediatric tertiary care hospital from August 2002 to July 2005. Forty-two patients were identified with a minimum follow-up time of 12 months. RESULTS: Mean preoperative perforation size was 21.3 percent (range 10%-90%), and mean patient age was 7.9 years (range 3-16 years). Median clinical follow-up was 24 months. Tympanic membrane closure and graft integration were achieved in 40 of 42 patients (95.2%), and 35 of 42 (85.7%) patients maintained an intact, stable tympanic membrane on long-term follow-up. A total of 93.8 percent of patients achieved a postoperative air-bone gap of less than or equal to 20 dB, and mean improvement in the air-bone gap was 10.7 dB. CONCLUSION AND SIGNIFICANCE: Cartilage interleave tympanoplasty is a versatile, stable, and effective technique for tympanic membrane repair in children.

Chemo-prophylaxis of COVID-19 with hydroxychloroquine: a study of health care workers attitude, adherence to regime and toxicities/side effects (Preprint)

2020 ◽  
Author(s):  
Debajyoti Bhattacharyya ◽  
Neeraj Raizada ◽  
Bharathnag Nagappa ◽  
Arvind Tomar ◽  
Prateek Maurya ◽  
...  
Keyword(s):  
Side Effects ◽  
Health Care Workers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Perceived Threat ◽  
Care Hospital ◽  
Care Workers ◽  
Perceived Danger ◽  
Structured Questionnaire

BACKGROUND There are apprehensions among healthcare worker (HCWs) about COVID-19. The HCWs have been given hydroxychloroquine (HCQ) chemo-prophylaxis for seven weeks as per Government of India guidelines. OBJECTIVE To assess the apprehensions among HCWs about COVID-19 and to document accessibility, adherence and side effects related to HCQ prophylaxis in HCWs. METHODS A longitudinal follow up study was conducted in a tertiary care hospital. HCQ was given in the dose of 400 mg twice on day one, and then 400 mg weekly for seven weeks. 391 HCWs were interviewed using semi structured questionnaire. RESULTS 62.2% HCWs expressed perceived danger posted by COVID-19 infection. Doctors (54%) showed least acceptance and paramedics (88%) showed highest acceptance to chemo-prophylaxis. 17.5% participants developed at least one of the side effects to HCQ. Females and nursing profession were significantly associated with adverse effects. Common side effects were gastro-intestinal symptoms, headache and abnormal mood change. Most of these were mild, not requiring any intervention. Gender, professions and perceived threat of COVID-19 were significantly associated with acceptance and adherence to HCQ prophylaxis. CONCLUSIONS Two third of HCWs had perceived danger due to COVID-19. Three fourth of the HCWs accepted chemo-prophylaxis and four out of five who accepted had complete adherence to prophylaxis schedule. One out of five had developed at least one of side effects; however, most of these were mild not requiring any intervention.

scholarly journals Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Faizus Sazzad ◽  
Ong Zhi Xian ◽  
Ashlynn Ler ◽  
Chang Guohao ◽  
Kang Giap Swee ◽  
...  
Keyword(s):  
Heart Valve ◽  
Operative Time ◽  
Tertiary Care ◽  
Paravalvular Leak ◽  
Valvular Regurgitation ◽  
Care Hospital ◽  
Valve Repair ◽  
Replacement Surgery ◽  
Triple Valve

Abstract Background CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. Methods Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 132 patients between January 2016 and June 2018. Results In our study, the overall mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. Fifty-eight patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. After reviewed by the cardiologist blinded towards the study, we report trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography was found in 1 (1.01%) patients. There were no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. Single mitral valve and aortic surgeries had comparable incidences of post surgical complications. Conclusion We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.

scholarly journals 99. Effectiveness of Antibiotic Prophylaxis Among Patients Undergoing Elective Transurethral Resection of the Prostate in the Era of Antibiotic Resistance

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S179-S180
Author(s):  
Thana Khawcharoenporn ◽  
Pimjira Kanoktipakorn
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Prophylaxis ◽  
Transurethral Resection ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Prophylactic Antibiotics ◽  
Care Hospital ◽  
Extended Spectrum Beta Lactamase ◽  
Observational Cohort

Abstract Background Data existing on effectiveness of antibiotic prophylaxis (AP) for transurethral resection of the prostate (TURP) are limited in the era of antibiotic resistance. Methods A 4-year prospective observational cohort study was conducted among patients undergoing TURP in an academic tertiary-care hospital during 2016–2019. Patients were excluded if pre-operative (pre-op) urine cultures were not sent or grew mixed (>2) organisms, or they had pre-op urinary tract infection (UTI) or lost follow-up after TURP. Appropriateness of AP was defined as 1) correct dosing and duration and narrowest spectrum according to the hospital AP guidelines and local epidemiology and 2) being active against uropathogens isolated from the pre-op culture. Primary outcome was the rate of UTI within 30 days post TURP compared between appropriate antibiotic prophylaxis (AAP) and inappropriate antibiotic prophylaxis (IAP) groups. Results 342 patients were screened and 61 were excluded. Of the 281 patients included, 139 (49%) received AAP and 142 (51%) received IAP. The reasons for IAP were prescribing too broad-spectrum antibiotics (57%), inactive antibiotics (41%) and incorrect dosing (2%). Pre-op urine cultures were no growth in 148 patients (53%). Among the 133 positive urine cultures with 144 isolates, Escherichia coli (52%) was the most commonly isolated. Thirty-one percent of these 144 isolates produced extended-spectrum beta-lactamase (ESBL) and 23 (16%) isolates were multidrug-resistant. The resistant rates of Enterobacteriaceae were 73% for ciprofloxacin, 65% for TMP-SMX and 46% for ceftriaxone. The two most commonly prescribed prophylactic antibiotics were ceftriaxone (51%) and ciprofloxacin (34%). The rate of UTI within 30 days post-TURP was significantly higher in IAP group compared to AAP group (47% vs 27%; P< 0.001). Prescribing inactive prophylactic antibiotics was the independent factor associated with 30-day post-TURP UTI (adjusted odds ratio 2.88; P=0.001). Conclusion Appropriate antibiotic prophylaxis significantly reduced UTI within 30 days of elective TURP. Obtaining pre-op urine culture and prescribing an active prophylactic agent are critical for preventing post-TURP UTI in the era of antibiotic resistance. Disclosures All Authors: No reported disclosures

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

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.

A STUDY OF 50 CASES OF DIABETIC FOOT AT TERTIARY CARE HOSPITAL

2021 ◽  
pp. 27-29
Author(s):  
Deep N. Patel ◽  
Rajnish R. Patel ◽  
Hitendra K. Desai ◽  
Rajesh K. Patel ◽  
Haresh Memariya ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Tertiary Care ◽  
Care Hospital ◽  
Economic Class ◽  
Control Of Diabetes ◽  
Education And Awareness ◽  
Careful Assessment ◽  
Diabetes Melitus

BACKGROUND AND OBJECTIVES :- The present study was attempted to nd out the role of conventional and newer modalities for the treatment and rehabilitation and prevention of complication of diabetic foot patients. MATERIALAND METHOD:-. 50 patients of diabetic foot admitted in civil Hospital,ahmedabad were studied within two years from 2018 to 2020 and careful assessment of history, clinical ndings, investigation, management and follow-up of these patients done. RESULT:-According to my study, Diabetic foot is common in males & 51-60 years of age group,in smokers, in lower socio-economic class, with average duration of 8 to 10 years of diabetes melitus, most common type of lesion was abscess,most common site was forefoot, mostly was of neuropathic in nature & mostly managed by debridement. Mean hospital stay was 1 week to 1 month. CONCLUSION:- Patient education and awareness regarding good sugar control of diabetes, use of proper antibiotics, adequate debridement and proper dressing ;with eusol, betadine hydrogen peroxide along with newer dressing methods like vacuum dressing found to be effective. Amputation done only for gangrene and proper rehabilitation method carried out for these patients.

Cognitive and Functional Outcomes of Early Versus Delayed Cranioplasty after Decompressive Craniectomy

2018 ◽  
Vol 15 (01) ◽  
pp. 029-035
Author(s):  
Arun Kumar ◽  
Biswaranjan Nayak ◽  
Krishnamurthy B. H ◽  
Sushant Patro ◽  
Abhijeet C. R ◽  
...  
Keyword(s):  
Decompressive Craniectomy ◽  
Functional Outcomes ◽  
Tertiary Care ◽  
Age Distribution ◽  
Total Sample ◽  
Individual Case ◽  
Care Hospital ◽  
Early Cranioplasty ◽  
State Examination

Abstract Introduction Delay in doing cranioplasty (CP) after decompressive craniectomy (DC) may cause motor, cognitive, and language deficits. Studies show doing CP before developing such symptoms helps in improving the outcome. CP improves cerebrospinal fluid (CSF) dynamics and cerebral blood flow, which may lead to better cognitive and functional outcome. Objective The aim of the study was to assess cognitive and functional outcomes of early versus delayed cranioplasty (DCP) after DC. Methodology This was a prospective observational study on 42 patients aged over 16 years and up to 70 years, who had undergone CP after DC for severe traumatic brain injury in in-patient and outpatient department of neurosurgery at a tertiary care hospital in Bhubaneswar, Odisha, India from the period of March 01, 2016 to December 31, 2017. Cognitive and functional outcomes were compared in early and DCP groups in preoperative and follow-up period at 1 month, 3 months, and 6 months. Early cranioplasty (ECP) was within 2 months, and DCP was beyond 2 months. Results Total sample size under this study was 42; 21 in ECP and 21 in DCP group. Mean age was 41.40 ± 15.95 years. The age distribution was quite young with 38.1% in 30 to 49 age group and had very high proportion of males (85.7%). This analysis revealed that both the ECP and DCP groups have resulted in significant improvement in mini-mental state examination (MMSE) and Glasgow Outcome Scale Extended (GOSE) score after CP. But in the ECP group, there has been steady and significant improvement in MMSE and GOSE score at different follow-ups starting from postoperative 1 month in MMSE score and from 3 months up to 6 months in GOSE score. Conclusion Neurosurgeon should evaluate and carefully monitor each individual case and take up CP as early as possible with suitable indication.

scholarly journals PITYRIASIS ROSEA MIMICKING POLYMORPHIC ERUPTIONS OF PREGNANCY

2017 ◽  
Vol 10 (10) ◽  
pp. 21
Author(s):  
Balaji Ommurugan ◽  
Amita Priya ◽  
Swaminathan Tambaram Natesh
Keyword(s):  
Pregnancy Outcomes ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
First Trimester ◽  
Adverse Outcomes ◽  
Unknown Etiology ◽  
Care Hospital ◽  
Pityriasis Rosea ◽  
Human Herpes Virus

ABSTRACTPityriasis Rosea is a self-limiting skin disorder of unknown etiology affecting women more than men. It is very rare in pregnancy and evidence shows conflicting reports on pregnancy outcomes related to Pityriasis Rosea. But however recent evidence says, pregnancy outcomes are not altered, although clinicians must monitor the patient throughout the gestation for adverse outcomes. Hence, we report a case of Pityriasis Rosea infection in a primigravida, in the first trimester and the follow up done in a tertiary care hospital in Southern India.KEYWORDSRASH, FIRST TRIMESTER, ANOMALY SCAN, HUMAN HERPES VIRUS

scholarly journals A comparative study of the efficacy of amisulpride and olanzapine in patients with schizophrenia attending the outpatient Department of Psychiatry in a tertiary care hospital, Silchar, Assam, India

2019 ◽  
Vol 8 (2) ◽  
pp. 284
Author(s):  
Ali N. Yashin ◽  
Dolly Roy ◽  
Prosenjit Ghosh
Keyword(s):  
Atypical Antipsychotics ◽  
Rating Scale ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Brief Psychiatric Rating Scale ◽  
Parallel Group ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

Background: Schizophrenia is one of the most commonly encountered psychiatric disorders. It is characterized by impairment in perception or expression of reality, leading to occupational and social dysfunction. Now a day’s mainstay of treatment of schizophrenia is by using atypical antipsychotics. Amisulpride and olanzapine are atypical antipsychotics which are commonly used in treatment of schizophrenia. The current study is undertaken to assess the efficacy of amisulpride which is a relatively newer antipsychotics against existing antipsychotic olanzapine.Methods: This was designed as a single-blind, prospective, parallel-group, observational study. Eighty adult patients of either sex were randomized to receive standard doses of the two drugs orally for 12 weeks, with follow up at 4 and 8 weeks. Effectiveness was assessed by change in the score of Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) score during the treatment period. Data were entered in Microsoft excel and statistical analysis were done using graph pad and p value <0.05 considered to be statistically significant.Results: Out of 80 adults patients 76 patients were evaluated by dividing into two groups, 38 patients were included in each group. Final BPRS score was less for olanzapine as compared to amisulpride (p<0.001). Improvement in CGI score is more in olanzapine group than amisulpride group which became statistically significant from 8th weeks onwards.Conclusions: Both amisulpride and olanzapine are very effective in controlling the symptoms of schizophrenia which is evident by significant decrease in BPRS, CGI-S and CGI-I score, but efficacy of amisulpride is still inferior to olanzapine.

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