To determine the outcome of isolated hemorrhagic TBI in a large tertiary care center in Karachi, Pakistan.

Objective: To assess the outcome of mild traumatic brain injury patients who have isolated intracranial hemorrhages. Study Design: Cross-sectional, Setting: Department of Neurosurgery, Abbasi Shaheed Hospital, Karachi. Period: 1st January 2018 to 31st January 2020. Material & Methods: The inclusion criteria were that all the patients have to be above the age of 18 years, presented to us with mild TBI cases and had observable intracranial hemorrhage on computer tomography (CT) scan. Patient demographics and the various types of interventions were recorded. Results: A total of n= 300 patients were included in the study, The average age was 50.5 +/- 20.6 years. There were n= 180 males and n= 120 females. We performed a total of n= 45 (15%) neurosurgical interventions, the most common intervention being craniotomies performed in n= 31 (68.66%) patients. Of all the patients who underwent an intervention 64.44% had immediate intervention 20% had planned intervention as non-emergency cases, and 15.55% had delayed intervention. A one point increment in the GCS score is associated with 50% lower odds of surgical intervention having a p value of <0.001. The mortality rate in our study population was 6%. Conclusion: We found that the length of stay and mortality are associated with an increased age and lower GCS score of the patients, care should be taken when evaluating the patients as some cases require delayed intervention hence monitoring is of prime importance.

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Transport Factors Affecting the Outcome of Referred Neonates Admitted in A Tertiary Care Hospital

Bangladesh Journal of Child Health ◽

10.3329/bjch.v41i3.36951 ◽

2018 ◽

Vol 41 (3) ◽

pp. 159-164 ◽

Cited By ~ 1

Author(s):

Madhabi Baidya ◽

Mahfuza Shirin ◽

Liton Chandra Saha

Keyword(s):

Perinatal Asphyxia ◽

Care Center ◽

Tertiary Care ◽

Preterm Neonates ◽

P Value ◽

Care Hospital ◽

Cross Sectional ◽

Neonatal Transport ◽

Group I ◽

Group Ii

Background: Adequate neonatal transport is a key component of care of the sick newborns who require referral to tertiary care center. Poor transportation is one of the iatrogenic factors associated with greater neonatal mortality. Neonatal transport is the greatest challenge faced today in our country. The purpose of this study was to find out characteristics of transport of referred neonates and to idention the factors that contribute to mortality.Methodology: This cross sectional study was conducted in Dhaka Shishu (Children) Hospital from June 2013 to November 2013. Both term and preterm neonates who were referred within first seven days of life were included and those with gross congenital abnormalities and left against medical advice were excluded from the study. After enrollment, data were collected using a structured questionnaire including birth details, interventions before transportation, reasons for referral, and details of transportation. Outcome & duration of hospital stay were also recorded. Neonates who were expired considered as group I and who were survived considered as group II. The study variables were analyzed for their association with immediate outcome by applying chi square test and t test. P value <0.05 was considered significant.Results: This study found that out of 332 neonates 181 were expired with 54.5% mortality rate. One eighty one neonates who were expired, considered as group I and one fifty one neonate were survived, considered as group II. The mortality was significantly high in male neonates [RR 0.80 (0.66-0.97)] and neonates those delivered at home [RR 1.34(1.10-1.64)] (p<0.05). Perinatal asphyxia, pre-term low birth weight, neonatal sepsis were the main causes of referral. It was found that transportation without any referral note [RR 1.40 (1.14- 1.71)], no advice regarding maintenance of airway[RR 1.50(1.17- 1.92)]and keeping warm [RR 1.51(1.17-1.950], resuscitation on admission [RR 1.63(1.23-2.17)] and transportation required > 3hours [RR 1.36(1.09-1.69)] were associated with significantly higher mortality among referred transported neonates(p<0.05).Conclusions: This study found that male neonates, home delivery, transportation without any referral note, no advice regarding maintenance of airway and keeping warm, resuscitation needed on admission and prolonged transportation time were significantly associated with mortality of referred transported neonates.Bangladesh J Child Health 2017; VOL 41 (3) :159-164

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Thyroid dysfunction in patients of metabolic syndrome: A study from a tertiary care center in India

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i10.38313 ◽

2021 ◽

Vol 12 (10) ◽

pp. 47-50

Author(s):

Ritu Gupta ◽

Akhil K Vijayan ◽

Sushma Choudhary

Keyword(s):

Metabolic Syndrome ◽

Thyroid Dysfunction ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Thyroid Stimulating Hormone ◽

P Value ◽

Overt Hypothyroidism ◽

Free T4 ◽

Cross Sectional

Background: Metabolic syndrome is characterized by hypertension, dyslipidemia, central obesity, glucose intolerance, insulin resistance. Thyroid hormone acts as general pacemaker, accelerating metabolic process and may be associated with metabolic syndrome. There is no information available in literature regarding the prevalence and association of thyroid dysfunction in metabolic syndrome in this central region of the country. Aims and Objective: To estimate the prevalence of thyroid dysfunction in patients of metabolic syndrome. Materials and Methods: It is a duration based prospective cross sectional study including 200 patients of metabolic syndrome. A detailed history, clinical examination and relevant investigations including serum Free T4 (FT4), Free T3 (FT3), Thyroid Stimulating Hormone (TSH) were done. Range, frequencies, percentage, mean, standard deviation and P value were calculated. P value of < 0.05 was taken as significant. Results: Prevalence of thyroid dysfunction in metabolic syndrome patients was 28.5%. Prevalence of subclinical and overt hypothyroidism was 18.5% and 8.5% respectively. In patients with both metabolic syndrome and thyroid dysfunction, most common components associated are diabetes mellitus and hypertriglyceridemia. Conclusion: Thyroid dysfunction is significantly common in metabolic syndrome patients. It should be aggressively detected and treated in these patients for better outcome.

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Study of clinical profile of dermatophytosis in a tertiary care center as per ECTODERM guidelines

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i10.37653 ◽

2021 ◽

Vol 12 (10) ◽

pp. 92-96

Author(s):

Shitij Goel ◽

Shivam Dr ◽

Azra Ferheen Chaudhary

Keyword(s):

Care Center ◽

Tertiary Care ◽

Family Members ◽

Previous Treatment ◽

Clinical Profile ◽

Cross Sectional ◽

Study Results ◽

Common Skin ◽

Study Population ◽

Chronic Dermatophytosis

Background: Dermatophytic infections are one of the most common skin infections encountered by dermatologists. A recent increase in incidence has been seen over the last few years with substantial change in the clinical profile of patients. Recently a group of dermatology experts published Expert Consensus on The Management of Dermatophytosis in India (ECTODERM India). The group agreed upon various definitions with respect to current dermatophytosis epidemic as well as gave recommendations for investigations and management. Clinical profile of dermatophytosis was done in present study on the basis of definitions agreed upon by ECTODERM consensus group. Aims and Objective: To assess the clinical profile, prevalence and severity of dermatophytic infection in study population. Materials and Methods: Cross-sectional observational study was conducted at out-patient department of Dermatology in, Sharda hospital, Greater Noida. A total of 317 patients presenting with clinical diagnosis of dermatophytosis were included in the study. Results: A total of 317 patients were recruited in the study, out of which 213 were males (67.2%). The most common age group presenting with superficial dermatophytosis was 21-30 years. Majority of the patient presented with chronic dermatophytosis with duration more than 6 months (76.6%) while more than 3 lesions of tinea were observed in 76.6% cases. 191 patients (60%) had moderate to severe involvement with more than 3% of BSA involved. Family members presenting with similar complaints were seen in 39% cases. Majority of patients (76 %) studies had received previous treatment topical, systemic or both. 62 patients presented with recurrence of disease within 6 weeks of complete antifungal treatment (19.6%). Conclusion: Our study concludes that dermatophytosis still remain a challenging issue for dermatologists. Chronicity of infection, moderate to severe BSA involvement and involvement of family members in a good proportion of our study cases were the main findings of our study.

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FEMALES HAVE EARLIER DISEASE ONSET THAN MALES AMONG HLA-CW6 POSITIVE PSORIASIS PATIENTS

10.36106/gjra/7600185 ◽

2021 ◽

pp. 1-2

Author(s):

Akhilesh Behra

Keyword(s):

Age Of Onset ◽

Care Center ◽

Tertiary Care ◽

Disease Onset ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Male And Female ◽

Female Patients ◽

Males And Females

Background- Psoriasis is a chronic inammatory relapsing skin disorder. Environmental and genetic factors play an important role in the development of disease. HLA-Cw6 most strongly associated with disease. There is also a difference in HLA-Cw6 positivity in respect to gender, which affect occurrence of disease in males and females. Aims & Objectives- This study was aimed to determine the association of HLA-Cw6 positive and negative psoriasis individuals had any signicant differences in respect to disease onset among male and female Materials & Methods- An Institute based Cross sectional study was done in a tertiary care center in eastern India. All patients attending skin OPD were included in the study. Detailed history and blood samples were collected from patients. HLA-Cw6 typing has done by sequence-specic PCR method. Results- HLA-Cw6 positive female patients had a signicantly early age of onset than male patients (p value-0.009334) (20.88 vs. 27.91yr), while HLA-Cw6 negative patients did not show any signicant difference of age of onset between male and female ( p value- 0.406905) Conclusion- Although men are more commonly affected than female, HLA-Cw6 positive psoriasis female patients show earlier disease onset. This results show that genetic variations in terms of HLA-Cw6 are reected in the age of onset among males and females.

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Prevalence of Head Injury of Patients Arriving in a Tertiary Care Center

Eastern Green Neurosurgery ◽

10.3126/egn.v2i1.27461 ◽

2020 ◽

Vol 2 (1) ◽

pp. 38-41

Author(s):

Arbindra Kumar Yadav ◽

Jagat Narayan Rajbanshi ◽

Saroj Kumar Kushwaha ◽

Pankaj Raj Nepal

Keyword(s):

Head Injury ◽

Severe Head Injury ◽

Traffic Accidents ◽

Road Traffic ◽

Care Center ◽

Tertiary Care ◽

Emergency Admission ◽

P Value ◽

Cross Sectional ◽

Severity Of Injury

Background and purpose: The prevalence of head injury is increasing with increasing number of automobiles, especially motorbike. With the objective to evaluate the prevalence of head injury and factors that could affect the severity of head injury, this study was performed in a tertiary hospital at far- eastern Nepal. Methodology: This is a cross-sectional study over the duration of one year. Association of age, gender, and mode of injury was checked with severity of injury using Chi-square test where P-value was kept significant at <0.01. Result: Total numbers of patient admitted through the emergency department, during the study period, were 832. Mean age of patient in the study group was 34.59 (SD 18.92) years. Majority of them falls in the category of 20-29 years. Among the different categories of head injuries, mild head injury (76%) was the most common presentation followed by moderate head injury and severe head injury, which were 14% and 10% respectively. Conclusion: Head injury seems to be the major cause of emergency admission in for eastern part of Nepal. Among them road traffic accidents seems to be the major burden which is more common in young gentlemen with significant number of severe head injury.

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Faktor Yang Mempengaruhi Pekerja Dalam Pemakaian Alat Pelindung Diri Pada PT. X

Jurnal Endurance ◽

10.22216/jen.v5i1.4578 ◽

2020 ◽

Vol 5 (1) ◽

pp. 1

Author(s):

Melda Yenni ◽

Ede Surya Darmawan

Keyword(s):

Personal Protective Equipment ◽

Sampling Technique ◽

P Value ◽

Protective Equipment ◽

Questionnaire Data ◽

Inclusion Criteria ◽

Chi Square ◽

Cross Sectional ◽

Purposive Sampling ◽

Study Population

Awareness of the benefits of using personal protective equipment (PPE) needs to be instilled in every workforce, because feeling uncomfortable (uncomfortable, hot, heavy, disturbed) is one reason why a worker does not use personal protective equipment (PPE). This study aims to look at the factors that influence workers in the use of Personal Protective Equipment (PPE) at PT. X This research is an analytic study with cross sectional approach. The study population was all workers at PT X while the study sample was workers at PT X as many as 77 workers. The sampling technique using purposive sampling technique based on inclusion criteria. The study was conducted in August to September 2017. The research instrument was a questionnaire. Data collection techniques with interviews. Data were analyzed using a statistical test that is chi square. The results showed that workers who are not compliant in usage are categorized as bad, that is 61.0%. Bivariate results indicate variables that influence workers in the use of PPE are supervision (p-value = 0.001). Variables that did not affect the behavior of PPE use were coworkers (p-value = 0.522) and punistment (p-value = 0.281). From the results above it can be concluded that the compliance of PPE usage in PT. X is influenced by supervision. Kesadaran akan manfaat penggunaan alat pelindung diri (APD) perlu ditanamkan pada setiap tenaga kerja, karena perasaan tidak nyaman (risih, panas, berat, terganggu) merupakan salah satu alasan mengapa seorang pekerja tidak menggunakan alat pelindung diri (APD). Penelitian ini bertujuan untuk melihat faktor yang mempengaruhi pekerja dalam pemakaian Alat Pelindung Diri (APD) pada PT. X .Penelitian ini merupakan penelitian analitik dengan pendekatan potong lintang (cross sectional). Populasi penelitian adalah seluruh pekerja di PT X sedangkan sampel penelitian adalah pekerja di PT X sebanyak 77 pekerja. Teknik pengambilan sampel dengan mengunakan teknik purposive sampling berdasarakan kriteria inklusi. Penelitian dilakukan pada bulan Agustus sampai dengan September 2017. Instrumen penelitian adalah kuesioner. Teknik pengumpulan data dengan wawancar. Data dianalisis mengunakn uji statistik yaitu chi square. Hasil penelitian diperoleh bahwa pekerja yang tidak patuh dalam pemakain dikategorikan buruk yaitu sebesar 61,0%. Hasil bivariat menunjukkan variabel yang mempengaruhi pekerja dalam pemakaian APD yaitu pengawasan (p-value=0,001). Variabel yang tidak mempengaruhi perilaku pemakaian APD adalah rekan kerja (p-value=0,522) dan punistment (p-value=0,281). Dari hasil diatas dapat disimpulkan bahwa kepatuhan pemakian APD di PT. X dipengaruhi oleh pengawasan.

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Assessment of Malnutrition in Chronic Liver Disease Patients with the Child Pugh Classification at a Large Tertiary Care Center in Karachi, Pakistan

Annals of Punjab Medical College ◽

10.29054/apmc/2021.1155 ◽

2021 ◽

Vol 15 (1) ◽

pp. 1-5

Author(s):

Aamna Qazi ◽

◽

Saqib Basar ◽

Keyword(s):

Liver Disease ◽

Hepatitis B ◽

Chronic Liver Disease ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Chronic Liver ◽

Cross Sectional ◽

Large Tertiary Care ◽

Class B

Background: Child Pugh classification is an easy-to-use method that allows Physicians to assess malnutrition in patients suffering from CLD. Objective: To determine the frequency of malnutrition at different stages of chronic liver disease in accordance with Child Pugh classification. Study Design: The type of study is a cross-sectional study. Settings: Medical Unit III Civil Hospital, Karachi Pakistan. Duration: Six months from 31st May 2016 to 30th November 2016. Methodology: All the patients between the age 30 to 60 years who are known cases of CLD secondary to hepatitis B, C or both, with active signs of CLD were included. All the patients having debilitating co-morbidities likes malignancy, TB, psychiatric, etc. were excluded. Anthropometric evaluation and lab investigation at the time of admission were performed for all the patients. Results: The average age was 48.12±8.521 years and duration of disease was 5.48±3.792 months. There were 61.54% male and 38.46% females. Hepatitis-B was observed in 19.91% (n=44) cases, Hepatitis-C was 62.44% (n=62.44) and both hepatitis B and C was observed in 17.65% (n=39) cases. According to Child Pugh score, 9.5% cases were in class A, 32.58% were in class B and 57.92% were in class C. Frequency of malnutrition in chronic liver disease patients was 62.44% (138/221). Rate of malnutrition was significantly high in class B and C (p=0.002). Rate of malnutrition was also observed to be significantly high in those cases who were positive for both hepatitis like B and C (p=0.001). Effect of duration of cirrhosis was also not statistically significant with malnutrition. Conclusion: Malnutrition was significantly common among chronic liver disease patients regardless of viral etiology. Child Pugh B & C patients were found to have more significant malnourished states.

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Clinical Profile and Outcomes in Patients with Acute Intracerebral Haemorrhage Presenting to the Emergency Department at a Tertiary Care Teaching Hospital, South India

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/329 ◽

2021 ◽

Vol 10 (21) ◽

pp. 1575-1582

Author(s):

Subramanyam Penubaku ◽

Madhusudhan Mukkara ◽

Kanchi Mitra Bhargav ◽

, Ramesh Chandra V.V. ◽

Sadasiva Raju S. ◽

...

Keyword(s):

Intracerebral Haemorrhage ◽

Tertiary Care ◽

Clinical Signs ◽

Intraventricular Haemorrhage ◽

World Health ◽

P Value ◽

Study Population ◽

Ich Score ◽

Gcs Score ◽

Time Of Admission

BACKGROUND World Health Organisation (WHO) defined stroke as rapidly developing clinical signs of focal disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin. Prognostic factors for predicting functional outcome and mortality play a major role in determining the treatment outcome. We intended to study the clinical charecteristics and outcome of patients with intracerebral bleeding coming to emergency room. METHODS Patients more than 18 years of age who were diagnosed to have intracerebral haemorrhage (ICH) on CT brain plain scan were included in the study. Age < 18 years, patients not willing to participate in the study were excluded from the study. Type of clinical presentation, imaging findings, ICH score, and Glasgow coma scale (GCS) score, were calculated for each patient at the time of admission. The condition of the patient, whether death / discharge (alive) was documented in all study population at the time of discharge. RESULTS Hypertension was the most common risk factor present in 68 % of study population. Most of the patients were between 41 - 70 years of age with a male preponderance. High ICH score, low GCS score at the time of admission, presence of intraventricular haemorrhage, and midline shift (P - value 0.000) were significantly associated with poor clinical outcome. Mortality was high in patients with infratentorial bleed and volume > 40 c.c. CONCLUSION Males in their sixth decade were the most affected in our study on ICH. Cerebellar and brainstem haemorrhages had higher mortality, though putamen is the commonest site of haemorrhage, low Glasgow Coma Scores and high ICH scores were associated with increased mortality. KEY WORDS Stroke, Haemorrhage, Intracerebral, Prognosis, Bleed

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Common misdiagnoses and prevalence of dermatological disorders at a pediatric tertiary care center

Journal of International Medical Research ◽

10.1177/0300060519873490 ◽

2019 ◽

Vol 48 (2) ◽

pp. 030006051987349

Author(s):

Witchuwan Onsoi ◽

Jitjira Chaiyarit ◽

Leelawadee Techasatian

Keyword(s):

Confidence Interval ◽

Care Center ◽

Tertiary Care ◽

Infantile Hemangioma ◽

Cross Sectional Study ◽

Cross Sectional ◽

Outpatient Unit ◽

Common Skin ◽

Study Population ◽

Dermatological Disorders

Objectives Dermatological disorders are common in general pediatric practice. This study aimed to examine common skin problems and the manner in which they tend to be misdiagnosed. Methods A cross-sectional study was conducted from January 2015 to December 2016 using medical record data from the Pediatric Dermatological Outpatient Unit at Khon Kaen University, Faculty of Medicine. Results A total of 1551 visits by 769 patients were documented during the study period. A total of 114 presenting diseases were recorded. The most common skin disease in the study population was dermatitis (unspecified) (88/769, 11.4%), followed by atopic dermatitis (76/769, 9.8%) and infantile hemangioma (72/769, 9.3%). There was a total of 55 (48.2%) misdiagnosed diseases. Some unique cutaneous diseases were undiagnosed because of their rarity. However, the percentages of common cutaneous diseases, such as tinea capitis and molluscum contagiosum, which had been misdiagnosed, were also high (62.50% [95% confidence interval = 24.49–91.48] and 71.43% [95% confidence interval = 29.04–96.33], respectively). Conclusion A large percentage of misdiagnoses of common cutaneous diseases may be due to general pediatricians being undereducated in the field of dermatology. Accurate recognition and appropriate management of these conditions should be emphasized for educating general pediatricians in the future.

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DEPRESSION;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.06.1204 ◽

2017 ◽

Vol 24 (06) ◽

pp. 904-911

Author(s):

Syed Rizwan Ali Bokhari ◽

Syed Arsalan Khalid ◽

Nida Nadeem ◽

Sidra Saleem ◽

Zumar Sardar ◽

...

Keyword(s):

Acute Kidney Injury ◽

Rating Scale ◽

Care Center ◽

Tertiary Care ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Cross Sectional Study ◽

Cross Sectional ◽

Study Population ◽

Severity Of Depression

Background: Acute kidney injury (AKI) in pregnant women is commonly seen indeveloping countries. It is associated with significant morbidity, social and personal implications.We conducted a study to assess the prevalence and severity of depression in patients withpregnancy related AKI (PRAKI) in a tertiary care center. Methodology: Patients with PRAKIadmitted from 1-16 to 6-16 under Nephrology service, Jinnah Hospital, Lahore were included inthis cross-sectional study. The Hamilton Rating scale for depression (HAM-D) version translatedand adapted in Urdu, was used to assess the study population. These patients were interviewedwith the HAM-D questionnaire on their first encounter with Nephrology department. Previoushistory of psychiatric illness was excluded. The diagnosis of AKI was based on the classificationof the Acute Kidney Injury Network group. Results: The mean age of the patients was 24±5years. Seventeen (57%) patients were multipara and 13(43%) patients were primigravida. Of the30 patients with AKI, 8 (27%) presented before 28 weeks and 22 (63%) presented after 28 weeksof gestation. The causes of AKI included postpartum hemorrhage in 9 (30%), sepsis in 8 (27%),preeclampsia/eclampsia in 6(20%), shock in 4 (13%) and coagulopathy in 3 (10%) patients.Alive and healthy fetus was found in only 15 (50%) patients. Twenty-one (70%) patients receivedaverage of 5-8 hemodialysis sessions during their hospital stay. Twenty-three (76%) had nodepression (0-7 score), 2 (7%) had mild (8-13 score), 3 (10%) had moderate (14-18 score) and2 (7%) had severe (19-22 score) depression according to HAM-D score. Conclusions: Ourstudy depicted considerable depression of varying degrees in women with PRAKI, increasedawareness and effective monitoring for depression should be integrated into regular maternalcare to decrease morbidity associated with it.

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