scholarly journals GUILLIAN BARRE SYNDROME;

2019 ◽  
Vol 26 (02) ◽  
Author(s):  
Shahid Iqbal ◽  
Naeemullah Bullo ◽  
Dileep Kumar ◽  
Suneel Kumar ◽  
Munir Afzal ◽  
...  
Keyword(s):  
Clinical Features ◽  
Sinus Tachycardia ◽  
Sinus Bradycardia ◽  
Tertiary Care ◽  
Care Hospital ◽  
Inclusion Criteria ◽  
Control Effect ◽  
Study Results ◽  
Data Analysis Procedure ◽  
Tertiary Care Hospitals

Objectives: To determine the frequency of various clinical features of Guillian Barre Syndrome in patients presenting to a tertiary care hospital in Karachi. Study Design: Descriptive study. Period: July 2015 to December 2015. Setting: Tertiary care hospitals of Karachi. Material & Methods: Seventy five diagnosed case of GBS who fulfill the inclusion criteria irrespective of gender included in the study after informed consent. Data was collected on preformed proforma. Detailed history, physical examination was done on each patient, diagnosis was confirmed on NCV & EMGs.  Data analysis procedure was done with the help of SPSS version 16. Mean±SD was calculated for age of the patient and duration of clinical features. Frequency and percentages were calculated for different clinical features. Stratification was done with respect to age, gender and duration of clinical features to control effect modifiers in the study. Results: Mean age was 43.96±14.22 (ranging from 15 to 70) years, among 75 patients 51(68%) were male & 24(32%) were female, majority of patients (34) were >50 years of age, 45.3% of patients had pain in extremities; pain in back was reported by 49.3%. Dysphagia in 80%, Ophthalmoplegia in 20% and Dysarthria in 16% of patients Respiratory failure was prevalent in 34.7% patients. Sinus tachycardia occurred in 49.3%, Sinus bradycardia 14.7% patients and 20% patients had urinary dysfunction. Constipation was also a predominant feature affecting 80% of patients. Conclusion: We found that GBS occurred at all ages and was more common in males. There are various clinical features of GBS along with flaccid limbs weakness clinical features observed & these should be address promptly for better outcome.

scholarly journals Relationship between trajectories of post-stroke disability and self-rated health (NeuroAdapt): protocol for a prospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e049944
Author(s):  
Sarah K Schäfer ◽  
Robert Fleischmann ◽  
Bettina von Sarnowski ◽  
Dominic Bläsing ◽  
Agnes Flöel ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Functional Health ◽  
Care Hospital ◽  
Duration Of Symptoms ◽  
Post Stroke ◽  
Self Rated Health ◽  
Modifying Factors ◽  
Study Results

IntroductionStroke is the leading neurological cause of adult long-term disability in Europe. Even though functional consequences directly related to neurological impairment are well studied, post-stroke trajectories of functional health according to the International Classification of Functioning, Disability and Health are poorly understood. Particularly, no study investigated the relationship between post-stroke trajectories of activities of daily living (ADL) and self-rated health (SRH). However, such knowledge is of major importance to identify patients at risk of unfavourable courses. This prospective observational study aims to investigate trajectories of ADL and SRH, and their modifying factors in the course of the first year after stroke.Methods and analysisThe study will consecutively enrol 300 patients admitted to a tertiary care hospital with acute ischaemic stroke or transient ischaemic attack (TIA; Age, Blood Pressure, Clinical Features, Duration of symptoms, Diabetes score ≥3). Patient inclusion is planned from May 2021 to September 2022. All participants will complete an interview assessing ADL, SRH, mental health, views on ageing and resilience-related concepts. Participants will be interviewed face-to-face 1–5 days post-stroke/TIA in the hospital; and will be followed up after 6 weeks, 3 months, 6 months and 12 months via telephone. The 12-month follow-up will also include a neurological assessment. Primary endpoints are ADL operationalised by modified Rankin Scale scores and SRH. Secondary outcomes are further measures of ADL, functional health, physical activity, falls and fatigue. Views on ageing, social support, resilience-related concepts, affect, frailty, illness perceptions and loneliness will be examined as modifying factors. Analyses will investigate the bidirectional relationship between SRH and ADL using bivariate latent change score models.Ethics and disseminationThe study has been approved by the institutional review board of the University Medicine Greifswald (Ref. BB 237/20). The results will be disseminated through scientific publications, conferences and media. Moreover, study results and potential implications will be discussed with patient representatives.Trial registration numberNCT04704635.

Pediatric Drug-Related Problems in an Indian Tertiary Care Hospital

2021 ◽  
Vol 08 ◽  
Author(s):  
Qaiser Jahan ◽  
K. Pallavi ◽  
R. Hamshika ◽  
Varun Talla ◽  
Jupally Venkateshwar Rao ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Drug Related Problems ◽  
Cross Sectional ◽  
Pediatric Department ◽  
Root Cause ◽  
Patient Morbidity ◽  
Tertiary Care Hospitals

Background: Improper drug usages expose patients to drug-related problems (DRPs) and can be the cause of patient morbidity and even mortality, especially frequent in hospitalized patients and pediatric groups. Objective: The objective of the present study was to identify and assess the drug-related problems in the pediatric department of tertiary care hospitals. Methods: The cross-sectional, observational study was carried out for six months included pediatric in-patients of age ≤15 years of either gender in pediatric units of tertiary care hospitals of India. The enrolled pediatric patients were observed for any drug-related problem that were further recorded and classified using the DRP registration format taken from Cipolle et al. The assessment of therapy was done by using positional statements from standard organizations and guidelines. Main outcome measure: Incidences of drug-related problems and their assessment and root cause analysis. Results: A total of 970 DRPs were identified in 296 patients, with an overall incidence of 49.3%. The incidence of DRPs was maximum in the age group of 2-12 years of children (51.2%). Patients who took six or more drugs were around eight (OR:8.41 , 95% CI: 5.22 to 13.55) times more likely to have DRPs compared to those patients who took less than six drugs. The incidences of DRPs were more in patients who were hospitalized for ≥ 7 days. Conclusion: The present study revealed significantly higher incidences of DRPs in hospitalized pediatric patients necessitating the involvement of clinical pharmacists in the pediatric department of tertiary care hospitals.

scholarly journals Clinical Presentation of Preterm Neonates with Intraventricular Hemorrhage: Experience in a Tertiary Care Hospital in Dhaka

2017 ◽  
Vol 7 (3) ◽  
pp. 194-197
Author(s):  
Tasnima Ahmed ◽  
Abdul Baki ◽  
Tahmina Begum ◽  
Nazmun Nahar
Keyword(s):  
Clinical Features ◽  
Intraventricular Hemorrhage ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Sudden Onset ◽  
Morbidity And Mortality ◽  
Preterm Neonates ◽  
Cranial Ultrasound ◽  
Care Hospital ◽  
One Year

Background: Intraventricular hemorrhage (IVH) is common among preterm infants as many of them survive with the advancements in neonatal care. Severe IVH may lead to significant morbidity and mortality. The objective of our study is to find out the significant clinical signs of IVH in preterm neonate for early detection by ultrasonography.Methods: This prospective observational study was done in special care baby unit (SCABU), Bangladesh Institute of Research & rehabilitation of Diabetic, Endocrine & metabolic Disorder (BIRDEM) for a period of one year. Eighty five preterm neonates were included in this study. Clinical features of IVH like- convulsion, lethargy, irritability, bulged fontanelle, recurrent apnea, sudden onset of respiratory distress, sudden pallor and bradycardia were observed. Cranial ultrasound studies were done within 7 days of life in all cases to identify IVH.Result: Mean gestational age of these neonates was 31.31(±2.2) weeks & mean birth weight was 1413.42 (±330.55) gm. Among 85 preterm neonates 21(24.7%) developed IVH, confirmed by ultrasonography of brain. Clinical features like convulsion, bulged fontanel, repeated apnea & sudden pallor were significantly present in IVH group.Conclusion: Intraventricular Hemorrhage constitutes an important cause of morbidity and mortality in neonate. This study showed that clinical features like convulsion, bulged fontanel and sudden pallor had a significant relationship with intraventricular hemorrhage which will help for its early detection.Birdem Med J 2017; 7(3): 194-197

scholarly journals Halitosis: Its Aetiology and Psychosocial Impact- A Hospital Based Study

2021 ◽  
Vol 29 (2) ◽  
pp. 145-150
Author(s):  
Gopika Kalsotra ◽  
Monica Manhas ◽  
Sachin Gupta ◽  
Heemani Bhardwaj ◽  
Parmod Kalsotra ◽  
...  
Keyword(s):  
Social Life ◽  
Laryngopharyngeal Reflux ◽  
Systemic Disease ◽  
Tertiary Care ◽  
Neck Surgery ◽  
Psychosocial Impact ◽  
Care Hospital ◽  
Female Ratio ◽  
Study Results ◽  
A Prospective Study

Introduction Halitosis means bad or unpleasant odour from oral cavity. It causes embarrassment to the patients and affects their social life and communication. This study aims to find the causes of halitosis and to assess its psychosocial impact. Materials and Methods A prospective study was conducted in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care hospital. It included 165 patients, presenting to the ENT OPD with chief complains of oral malodour for at least 3 months. The patients in the age above 15 years and below 75 years, irrespective of gender, were included in the study. Results The age of the patients ranged from 15 to 75 years with a mean age of 52.24 ± 15.67 with male: female ratio of 7:10. The most common cause of halitosis in the present study included chronic rhinosinusitis (38.7%), gingivitis/periodontitis (19.39%), tonsillitis (4.84%), laryngopharyngeal reflux (2%), deep neck space infections (1.2%). In 23.56%, the halitosis was a symptom of an underlying malignancy. Conclusion Halitosis from an extra oral origin can be the sign of an underlying systemic disease or malignancy. The consultation should be done with the periodontist, ENT specialist and a physician.

scholarly journals Risk factors, clinico-epidemiological profile of tuberculosis among children attending a tertiary care hospital: a two year study

2018 ◽  
Vol 5 (3) ◽  
pp. 851
Author(s):  
Ravikumar Tenali ◽  
Naveen Kumar Badri ◽  
Jithendra Kandati ◽  
Munilakshmi Ponugoti
Keyword(s):  
Risk Factors ◽  
Clinical Features ◽  
Tertiary Care ◽  
Epidemiological Surveillance ◽  
P Value ◽  
Tuberculous Lymphadenitis ◽  
Care Hospital ◽  
Female Ratio ◽  
Extra Pulmonary ◽  
Epidemiological Profile

Background: TB remains as the one among the top 10 causes of death worldwide. In 2016, 10.4 million people fell ill with TB, and 1.7 million died from the disease with 0.4 million with HIV. At least 1 million children become ill with TB each year. Children represent about 10-11% of all TB cases. Having knowledge of the risk factors for tuberculosis infection in children is important to evaluate the level of ongoing transmission of infection and to help adapt activities within national TB control programs. The main objective is to study the risk factors and their association and variable clinical features in cases of pulmonary and extra pulmonary tuberculosis.Methods: The main objective is to study the risk factors and their association and variable clinical features in cases of pulmonary and extra pulmonary tuberculosis.Results: 98 cases of TB were confirmed out of total 628 with a prevalence of 17.07% in the   study with 78 PTB cases and 20 EPTB. Females were more with male to female ratio of 0.7:1.5-9 years was the most common age group in the study. Statistically significant association was found between old history of ATT, HIV positivity, contact with an open case of TB and malnutrition (p value<0.05). TB meningitis was the most common EPTB (10/20 cases) followed by tuberculous lymphadenitis (5/20). 69.39% (68/98 cases) were smear positive, radiologically 59.18% of cases were positive and Tuberculin skin test was positive in 46.94%.Conclusions: Childhood tuberculosis is a neglected entity in developing countries due to underreporting and difficulties in diagnosis due to variable clinical picture in children. Hence epidemiological surveillance studies in children are required to determine the actual prevalence of pulmonary and extra pulmonary cases of tuberculosis. Increased efforts are required to isolate TB bacilli from body fluids to identify early the childhood cases and manage them to prevent disease burden in the community.

scholarly journals Characteristics and clinical features of children presenting with acute myocarditis at a tertiary care hospital.

2021 ◽  
Vol 28 (12) ◽  
pp. 1701-1704
Author(s):  
Farhan Zahoor ◽  
Bushra Madni ◽  
Muhammad Imran ◽  
Muhammad Naveed ◽  
Fazal ur Rehman ◽  
...  
Keyword(s):  
Clinical Features ◽  
Rural Areas ◽  
Tertiary Care Hospital ◽  
Acute Myocarditis ◽  
Tertiary Care ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Clinical Feature ◽  
Care Hospital ◽  
Male Predominance

Objective: To find out characteristics and clinical features of children presenting with acute myocarditis at a tertiary care hospital. Study Design: Observational Study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan. Period: February 2020 to February 2021. Material & Methods: A total of 71 children aged 1 month to 15 years admitted with acute myocarditis were enrolled. Acute myocarditis was labeled as short history of illness in otherwise healthy child, echocardiography evident of left ventricular dysfunctioning, cardiac biomarkers showing cardiac damage as well as electrocardiography showing acute myocarditis. Age was represented as mean and standard deviation whereas qualitative variables like gender, area of residence and clinical features were shown as frequency and percentages. Results: Out of a total of 71 children, there were 38 (53.5%) were male. Median age was recorded to be 16.6 months. Majority of the cases, 42 (59.2%) belonged to rural areas of residence. Tachycardia was the commonest clinical feature noted in 65 (91.5%) children, irritability was seen in 50 (70.4%), tachypnea in 48 (67.6%) while poor feeding was noted 44 (62.0%) children. Hepatomegaly was noted in 39 (54.9%) children. Hypotension was recorded in 35 (49.3%) children. Conclusion: Male predominance was seen among children presenting with acute myocarditis. Tachycardia, irritability, tachypnea and poor feeding were the commonest clinical features observed.

Cardiac injury in organophosphate poisoning after acute ingestion

2021 ◽  
Author(s):  
Ashok Kumar Pannu ◽  
Ashish Bhalla ◽  
R I Vishnu ◽  
Sahil Garg ◽  
Deba Prasad Dhibar ◽  
...  
Keyword(s):  
Qt Interval ◽  
Cardiac Toxicity ◽  
Sinus Bradycardia ◽  
Tertiary Care ◽  
Cardiac Injury ◽  
Prognostic Significance ◽  
North India ◽  
Organophosphate Poisoning ◽  
Care Hospital ◽  
Corrected Qt Interval

Abstract Introduction Sparse data and conflicting evidence exist on the prevalence and prognosis of organophosphate (OP)-related cardiac toxicity. We aimed to characterize the cardiac abnormalities of OP after an acute cholinergic crisis in adults without previous cardiovascular conditions. Patients and Methods We did a prospective observational study in a tertiary-care hospital of north India (Postgraduate Institute of Medical Education and Research, Chandigarh) in 74 patients aged ≥ 13 years admitted with acute OP poisoning after self-ingestion. A systemic evaluation, including clinical characteristics, electrocardiography, and echocardiography, was performed to estimate the prevalence and prognosis of cardiac injury. A rate-corrected QT interval was calculated using Bazett’s method, and &gt;440 milliseconds was used to define prolongation. Results Chlorpyrifos was the most commonly ingested OP (n = 29). The patients had a similar occurrence of hypotension (n = 10) and hypertension (n = 9) at admission, and electrocardiography demonstrated sinus tachycardia in 38 (51.3%) and sinus bradycardia in one case. During the hospital stay, 3 out of 74 patients had a prolonged rate-corrected QT interval (457, 468, and 461 milliseconds), and one patient developed supraventricular tachycardia. Eight (10.8%) patients developed the intermediate syndrome, and six (8.1%) died. None of the hemodynamic or electrocardiographic abnormalities was associated with in-hospital mortality or intermediate syndrome development on univariant analysis. Baseline echocardiography at hospital discharge was performed in 27 patients (admitted during 2018) and normal in all except mild tricuspid regurgitation in one. At a 6-month follow-up, 23 cases were available for cardiovascular screening (including echocardiography) and had a normal evaluation. Conclusion Cardiac toxicity is uncommon after acute OP self-ingestion and lacks prognostic significance.

Barriers to efficient provision of healthcare facilities: an experience from a developing country.

2021 ◽  
Author(s):  
Fatima Fakir Musharraf ◽  
Anooja Rani
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Low Literacy ◽  
Healthcare Facilities ◽  
Large Tertiary Care ◽  
Care Facilities ◽  
Tertiary Healthcare ◽  
System 2 ◽  
Tertiary Care Hospitals

Pakistan has nearly 200 million people, of which almost 20 million people live in Karachi, which has 17 tertiary care hospitals, and it is no secret that they are overburdened (1). Despite the healthcare workers’ competency, several issues hinder administering proper care in a tertiary healthcare setup. Firstly, spatial distancing-spatial access to facilities within a hospital also proves a challenge for patients. Patients have little idea regarding specific departments in a large tertiary care hospital due to low literacy rates compounded with a lack of health literacy. At times many patients have reportedly circled the hospital twice and can still not find their desired specialist. A study conducted in Delhi that closely matches Karachi in demographics suggested that patients with one-time visits to secondary care facilities had lower follow-up rates than those who were more familiar with the system (2). Patients may take time to acclimatize to healthcare setup when visiting as first-timers, and if found too challenging to adapt, they may not make an effort again. Unsurprisingly, this renders many facilities- the administration spends, sometimes a fortune, procuring- useless. Continuous...

A STUDY ON ASSESSMENT OF RISK FACTORS, COMPLICATIONS AND QUALITY OF LIFE OF PATIENTS WITH HYPOTHYROIDISM IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 38-40
Author(s):  
CH. Sridev ◽  
Samhitha Karnati ◽  
Likhitha Madari ◽  
Liyaqath Ali ◽  
Raviteja Nethula
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Care Hospital ◽  
Inclusion Criteria ◽  
Total N ◽  
Sf 36 ◽  
High Bmi

Background: Hypothyroidism is a syndrome which results from decreased production of thyroid hormones from thyroid gland and hence it can also be termed as underactive thyroid disease. Objectives: To assess the quality of life in patients with denovo hypothyroidism. To assess risk factors, complications in patients with hypothyroidism. Materials and methods: There was a total (N=100) number of participants enrolled in the study and are evaluated for risk factors and complications and among 100, 40 patients are Denovo hypothyroid who are assessed for quality of life. This is a prospective observational study in which the risk factors, complications and quality of life of patients is evaluated for those patients who are willing to give informed consent and meet the inclusion criteria. Results and Discussion: Referring to the ndings, the patients with high BMI, females and age around 20-30 are more prevalent. Patients who do not adhere to medications develop complications such as goiter and cvs problems but mostly obesity is seen and QOL of patients was studied using SF-36 and HADS scales. The initial mean was found to be less compared to the nal mean in SF-36 whereas in HADS the initial mean is high compared to the nal mean. The Patient's BMI was high initially and then reduced to normal.This implies that after educating the patient about the disease and need of medication the nal result shows there is improvement in the patient's QOL. P values of SF 36 and HADS are 0.0001 and 0.0314 respectively, which by conventional criteria was found to be statistically signicant. Conclusion: This study simply showed that the females, patients with high BMI and age around 20-30 are the major risk factors. Proper patient education, care and medication adherence are the cornerstones to help avoid complications and improve patients quality of life.

Neuroimaging Spectrum of Severe Hypernatremia in Infants with Neurological Manifestations

2021 ◽  
Author(s):  
Arushi Gahlot Saini ◽  
Sameer Vyas ◽  
Amrit Kaur ◽  
Prabhjyot Singh ◽  
Muralidharan Jayashree ◽  
...  
Keyword(s):  
White Matter ◽  
Venous Thrombosis ◽  
Clinical Features ◽  
Tertiary Care ◽  
Background Variable ◽  
Care Hospital ◽  
Neurological Manifestations ◽  
White Matter Changes ◽  
Neurological Sequelae ◽  
Osmotic Demyelination

Abstract Background Variable neurological manifestations and imaging findings have been described in children with severe hypernatremia. We aimed to describe the spectrum of neuroimaging changes in infants with severe hypernatremia. Methods This retrospective study included infants with severe hypernatremia (serum sodium >160 mEq/L), abnormal neurological examination, and an abnormal magnetic resonance imaging (MRI) of the brain over a period of 2 years in a tertiary care hospital. Relevant clinical data, including the feeding practices, clinical features, complications, and biochemical and radiological parameters, were entered in a structured pro forma. MRI findings were classified as vascular (hemorrhages and cerebral sinus venous thrombosis), osmotic demyelination syndrome (pontine and extrapontine myelinolyses), and white matter changes. Results The common clinical features in the neonates were poor feeding (n = 4) and decreased urine output (n = 4); the older infants presented with gastrointestinal losses (n = 5). All cases had dehydration with encephalopathy. The patterns of radiological injury were vascular (hemorrhages, n = 5 and venous thrombosis, n = 3), osmotic demyelination (n = 8), and white matter changes (n = 7). Coagulopathy was correlated with the vascular complications (r = 0.8, p < 0.0001); the degree of dehydration was correlated with the venous thrombosis (r = 0.7, p < 0.04) and acute kidney injury (r = 0.8, p < 0.001). Neurological sequelae were seen in four cases and correlated with hypernatremia (r = 0.6, p = 0.03) and hyperosmolarity (r = 0.6, p = 0.03). Conclusion Characteristic neuroimaging findings are vascular changes in the form of venous thrombosis and hemorrhages, osmotic demyelination and white matter tract injury, and/or mostly combinations of these findings. Severe hypernatremia and resulting hyperosmolarity frequently cause neurological sequelae in neonates and infants.

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