scholarly journals Resection Urethroplasty for Urethral Stricture: Preliminary Findings from a Tertiary Care Hospital of Central Nepal

2019 ◽  
Vol 15 (1) ◽  
pp. 1-4
Author(s):  
Sudeep Raj KC ◽  
Bhusan Raj Timilsina ◽  
Gaurav Devkota ◽  
Sulav Pradhan ◽  
Sabita Lamsal ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Average Length ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Care Hospital ◽  
Central Nepal ◽  
Complete Failure ◽  
End To End ◽  
Tract Infections ◽  
Patients Experience

Background: Urethral stricture is relatively common problem that we encounter in urological practice. As urethral stricture causes progressive narrowing of the urethral lumen, signs and symptoms of urinary  obstruction arise. These patients experience obstructive symptoms like poor stream, straining to urinate, incomplete voiding, end dribbling, urinary retention and recurrent urinary tract infections. Methods: A prospective cohort study was carried out in College of Medical Sciences, Chitwan, Nepal. All the patients who were operated with end to end anastomosis for urethral stricture with stricture length not more than 2.5cm from January 2015 to June 2016 was included in this study. These patients were followed up for two year period for recurrence of the stricture and complications. Results: Mean age of patient in this study was 50.55 years, average length of stricture was 1.3 cm. 66.67% (12 patients) had complete success with no    recurrence of the stricture. 33.33 % (6 patients) had recurrence of stricture. Out of those 6 patients, 3 had  undergone DVIU with no further recurrence of the stricture until the follow up period, one patient was treated with dilatation, two had complete failure and needed re-procedure. Conclusions: End to end anastomosis for short segment stricture had a fairly satisfactory result.

scholarly journals Incidence of tuberculosis and opportunistic respiratory infections in cases of human immunodeficiency virus: a one-year study at a tertiary care hospital

2020 ◽  
Vol 7 (7) ◽  
pp. 1068
Author(s):  
Chintha Venkata Subrahmanyam ◽  
Mahesh Vidavaluru
Keyword(s):  
Respiratory Infections ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Pulmonary Complications ◽  
Care Hospital ◽  
Cd4 Cell Count ◽  
Cd4 Counts ◽  
Management Protocol ◽  
One Year ◽  
Tract Infections

Background: Evaluation of respiratory signs and symptoms among HIV patients is a challenging task for a number of reasons. A definitive diagnosis is highly recommended before starting management protocol. Objectives of this study was to primarily evaluate the incidence of pulmonary tuberculosis and opportunistic respiratory infections among the cases of HIV and to estimate the CD4 counts of all the patients and correlate with the respiratory infections among the cases.Methods: The present study was a one-year study conducted at Narayana Medical College and all the cases of HIV presented with signs and symptoms of lower respiratory tract infections were included after obtaining consent. Relevant biochemical, microbiological investigations and CD4 counts of all the cases were done and noted. The data was entered in Microsoft excel spread sheet and analysed for any corrections. Mean, median and SD was calculated for all the continuous variables.Results: A total of 127 cases with 87 males and females 40 females with a ratio of 2.2:1 were included. Mean age of the total cases in the study was 46.12±8.3 years and 29.92% were above 60 years. Hetero sexual exposure was the commonest cause and 59.84% of cases were diagnosed with bacterial pneumonia. Prevalence of tuberculosis among the cases of this study was 22.05%. The mean CD4 cell count with SD among the study was 168.57±142.21.Conclusions: Knowledge of the pattern of pulmonary complications in patients with HIV infection in relation to CD4 count will help clinicians develop faster diagnostic and therapeutic approach to patient management.

FACTORS CAUSING DELAY IN TIME TO DOOR AT EMERGENCY DEPARTMENT(ED) IN CASES OF ACUTE STROKE AND IT'S IMPACT ON OUTCOME AT TERTIARY CARE CENTRE

2020 ◽  
pp. 67-70
Author(s):  
Yogender Kumar Yadav ◽  
Dina J Shah ◽  
Jyoti B Sharma ◽  
Nalini Bala Pandey
Keyword(s):  
Acute Stroke ◽  
Average Length ◽  
Tertiary Care ◽  
Onset Time ◽  
Signs And Symptoms ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
End Points ◽  
Exact Test

BACKGROUND: The effectiveness of stroke management is highly dependent on post onset time of treatment. The study hypothesized that perceptual, social and behavioral factors affect delay in seeking help after symptom onset and worsen the outcome and recovery. OBJECTIVE: To look at the causes of delay in arrival to denitive care hospital ED after symptoms of acute stoke and its impact on patient's clinical outcome. METHODS: An observational prospective study conducted on 63 patients with signs and symptoms of acute stroke (CPSS/NIHSS positive) reported to ED. Reasons for delay in arrival to ED observed. Patients divided into two groups, those who came within 4.5 hours of onset of acute stroke symptoms and those who came after 4.5 hours. Impact of delay on patient's outcome studied at time of discharge as primary end-points in terms of average length of stay (ALOS), complications and death. Secondary end-points evaluate in terms of improvement, deterioration and death within 30th day. Statistical analysis using Chi-square or Fisher's exact test applied to compare both the groups. Odds ratio with 95 % condence limit was also calculated. RESULTS: There were multiple overlapping causes of delay; most frequently was “rst went to physician who doesn't treat stroke (8; 38.1%) and non-availability of nearby stroke centre (8; 38.1%)”. Total 21 (33.34%) patients came after window period (4.5hours). Primary endpoints in terms of ALOS (8 days compared to 9 days, p=0.48), complications (OR=1.4, 95%CI:0.2-8.8, p=0.74) and death (OR=3, 95%CI:0.4-19.3, p=0.24) at time of discharge. Secondary endpoints in terms of improvement (OR=2.8, 95%CI:1.0-7.8, p=0.03), deterioration (OR=6.0, 95%CI:1.4-24.5, p=0.01) and death within 30 days (OR=1.2, 95%CI:0.2-5.5, p=0.81). CONCLUSION: Inadequate knowledge of stroke identication and management causes delay in arrival to hospital. This delay can cause signicant impact on patient outcome and recovery

Healthcare associated infections caused by non-fermenting Gram negative rods (NFGNR): six years of experience of a tertiary hospital

2013 ◽  
Vol 7 (2) ◽  
pp. 06-12
Author(s):  
Zahidul Hasan ◽  
Md. Kamrul Islam ◽  
Arifa Hossain
Keyword(s):  
Blood Stream Infection ◽  
Tertiary Care ◽  
Blood Stream ◽  
Tertiary Hospital ◽  
Healthcare Associated Infections ◽  
Care Hospital ◽  
Gram Negative ◽  
Acinetobacter Spp ◽  
Tract Infections ◽  
Healthcare Associated

Recently non-fermenting Gram negative rods (NFGNR) are playing an important role in healthcare associated infections. This observational study in a tertiary care hospital of Dhaka city conducted during 01August 2007 to 30 June 2013 found that 34.8% isolated organisms from patients with healthcare associated infections were NFGNR. Majority (74.3 %) of these infections were occurring inside critical care areas. Pseudomonas and Acinetobacter together constituted 79.6% of the total NFGNR whereas Burkholderia cephacia complex (15.4%), Stenotrophomonas (4.3%) and Chryseobacterium species (0.7%) combined constituted remaining 20.4%. Out of total NFGNRs, Pseudomonas was responsible for highest number of catheter associated urinary tract infections (55.6%), ventilator associated pneumonia (46.3%), respiratory tract infection (65.8%) and surgical site infection (70.6%). Blood stream infection was predominantly caused by Burkholderia cephacia complex (33.5%) and Acinetobacter spp. (39.5%). Other than colistin most of the organisms were resistant to antibiotics commonly recommended for NFGNR.DOI: http://dx.doi.org/10.3329/bjmm.v7i2.19326 Bangladesh J Med Microbiol 2013; 07(02): 6-12

scholarly journals Enteroviruses in Respiratory Samples from Paediatric Patients of a Tertiary Care Hospital in Germany

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 882
Author(s):  
Susanne Baertl ◽  
Corinna Pietsch ◽  
Melanie Maier ◽  
Mario Hönemann ◽  
Sandra Bergs ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Phylogenetic Analyses ◽  
Tertiary Care ◽  
Oxygen Demand ◽  
Care Hospital ◽  
Paediatric Patients ◽  
Enterovirus A71 ◽  
Coxsackievirus A6 ◽  
Enterovirus D68 ◽  
Tract Infections

Enteroviruses are associated with various diseases accompanied by rare but severe complications. In recent years, outbreaks of enterovirus D68 and enterovirus A71 associated with severe respiratory infections and neurological complications have been reported worldwide. Since information on molecular epidemiology in respiratory samples is still limited, the genetic diversity of enteroviruses was retrospectively analysed over a 4-year period (2013–2016) in respiratory samples from paediatric patients. Partial viral major capsid protein gene (VP1) sequences were determined for genotyping. Enteroviruses were detected in 255 (6.1%) of 4187 specimens. Phylogenetic analyses of 233 (91.4%) strains revealed 25 different genotypes distributed to Enterovirus A (39.1%), Enterovirus B (34.3%), and Enterovirus D (26.6%). The most frequently detected genotypes were enterovirus D68 (26.6%), coxsackievirus A6 (15.9%), and enterovirus A71 (7.3%). Enterovirus D68 detections were associated with lower respiratory tract infections and increased oxygen demand. Meningitis/encephalitis and other neurological symptoms were related to enterovirus A71, while coxsackievirus A6 was associated with upper respiratory diseases. Prematurity turned out as a potential risk factor for increased oxygen demand during enterovirus infections. The detailed analysis of epidemiological and clinical data contributes to the non-polio enterovirus surveillance in Europe and showed high and rapidly changing genetic diversity of circulating enteroviruses, including different enterovirus D68 variants.

scholarly journals The prevalence of the iutA and ibeA genes in Escherichia coli isolates from severe and non-severe patients with bacteremic acute biliary tract infection is significantly different

Gut Pathogens ◽  
2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Mahoko Ikeda ◽  
Tatsuya Kobayashi ◽  
Fumie Fujimoto ◽  
Yuta Okada ◽  
Yoshimi Higurashi ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Tract Infection ◽  
Biliary Tract ◽  
Iron Acquisition ◽  
Tertiary Care ◽  
Care Hospital ◽  
Biliary Tract Infection ◽  
E Coli ◽  
Severe Group ◽  
Tract Infections

Abstract Background Although Escherichia coli is the most frequently isolated microorganism in acute biliary tract infections with bacteremia, data regarding its virulence are limited. Results Information on cases of bacteremia in acute biliary tract infection in a retrospective study was collected from 2013 to 2015 at a tertiary care hospital in Japan. Factors related to the severity of infection were investigated, including patient background, phylogenetic typing, and virulence factors of E. coli, such as adhesion, invasion, toxins, and iron acquisition. In total, 72 E. coli strains were identified in 71 cases, most of which primarily belonged to the B2 phylogroup (68.1%). The presence of the iutA gene (77.3% in the non-severe group, 46.4% in the severe group, P = 0.011) and the ibeA gene (9.1% in the non-severe group, and 35.7% in the severe group, P = 0.012) was significantly associated with the severity of infection. Among the patient characteristics, diabetes mellitus with organ involvement and alkaline phosphatase were different in the severe and non-severe groups. Conclusions We showed that bacteremic E. coli strains from acute biliary tract infections belonged to the virulent (B2) phylogroup. The prevalence of the iutA and ibeA genes between the two groups of bacteremia severity was significantly different.

scholarly journals The Prevalence and Antimicrobial Susceptibility Pattern of Gram-Positive Pathogens: Three-Year Study at a Private Tertiary Care Hospital in Mumbai, India

2021 ◽  
Author(s):  
Sweta Shah ◽  
Ritika Rampal ◽  
Pooja Thakkar ◽  
Sushima Poojary ◽  
Shweta Ladi
Keyword(s):  
Antimicrobial Susceptibility ◽  
Tertiary Care Hospital ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Resistance Pattern ◽  
Steady Increase ◽  
Coagulase Negative Staphylococcus ◽  
Care Hospital ◽  
Gram Positive ◽  
Tract Infections

Abstract Introduction The growing resistance pattern of the gram-positive pathogens along with a steady increase in minimum inhibitory concentration of the currently available antibiotics have led to an increase in morbidity and mortality rates in India. This study aims to access the shifting antibiotic susceptibility paradigm of the gram-positive pathogens in various infections at a tertiary care center. Methods This is a 3-year retrospective observational study which was performed from January 2016 to December 2018 at a tertiary care hospital in Mumbai. All clinically significant gram-positive cocci isolated from a variety of clinical specimens were studied for their prevalence and antimicrobial susceptibility. Results Out of 4,428 gram-positive isolates, Staphylococcus aureus (35.3%) was the commonly encountered pathogen, followed by Enterococcus spp. (32.1%) and coagulase-negative Staphylococcus (CoNS) (25.7%). S. aureus was majorly isolated from skin and soft tissue infections (60.3%), followed by patients with respiratory tract infections (18.2%) and blood stream infections (13%). Among S. aureus, particularly methicillin-resistant S.aureus (MRSA), prevalence increased from 29.5% in 2016 to 35.1% in 2018, with an overall prevalence of 33.6%. All S. aureus isolates were 100% sensitive toward vancomycin, linezolid, tigecycline, and teicoplanin. However, the CoNS isolates showed a higher resistance rate with reduced susceptibility toward linezolid and teicoplanin. High prevalence of resistance was observed across gram-positive isolates with commonly used antibiotics such as ciprofloxacin, levofloxacin, and erythromycin. While the prevalence of linezolid-resistant enterococcus (LRE) was 3.6%, vancomycin (VRE) and teicoplanin resistance among the enterococcus species was as high as 7.7% and 7.5%, respectively. Conclusion Rising methicillin resistance among the Staphylococcal species (MRSA and MR-CoNS) along with reduced susceptibility toward currently available anti-MRSA agents is a matter of serious concern as it limits the therapeutic options for treating multidrug resistant (MDR) gram-positive infections.

Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

2021 ◽  
Author(s):  
Seema Sachdeva seema sachdeva ◽  
Akshay Kumar Akshay Kumar ◽  
Parveen Aggarwal Parveen Aggarwal
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Fish Bone ◽  
Quality Improvement Initiative ◽  
Care Hospital ◽  
Analysis Model ◽  
Post Intervention ◽  
Targeted Interventions ◽  
Administration Time

Abstract BackgroundSevere exacerbation of asthma are potentially life-threatening and therefore require prompt care and frequent management. Important elements of early treatment includes recognition of early signs and symptoms of breathing difficulty and timely prescription and administration of therapeutic agents. A subsequent delay in receiving nebulization during an acute exacerbation of asthma can leads to cardiac arrest and even death. AimTo reduce the gap in administration of nebulization from its prescription time among red triaged patients by 50% from its baseline. Setting and designThis interventional study was conducted among red triaged patients in emergency department of tertiary care hospital, India . Material and MethodsBaseline information was collected during first 4 weeks to find gap in administration of nebulization from its prescription time. Fish bone analysis and process map were laid down to analyse the situation. The intervention using targeted bundles was done via 3 PDSA (PDSA1: indenting the nebulizers, PDSA 2: training of doctors and nurses, PDSA 3; introducing equipment checklist) to reduce the gap . A run chart using time series analysis model was used to compare the pre and post intervention nebulization gap. ResultsTotal 74 patients (30 in pre- intervention, 44 in post intervention) admitted in red triaged area were observed for nebulization gap from prescription to administration. Median time for nebulization gap before intervention was 46.5 minutes which reduced to 15 minutes in post intervention phase. ConclusionThis bundles of targeted interventions was successful to reduce the nebulization gap. Key words: nebulization gap, prescription time, administration time

Evaluation of Parental Knowledge, Attitudes and Practices Regarding Antibiotic Use in Acute Upper Respiratory Tract Infections in Children in a Tertiary Care Hospital in Turkey

2021 ◽  
Author(s):  
Aslınur Albayrak ◽  
Nazmi Mutlu Karakaş ◽  
Bensu Karahalil
Keyword(s):  
Antibiotic Resistance ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Upper Respiratory Tract Infections ◽  
Care Hospital ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections

Abstract BackgroundUpper respiratory tract infections (URTIs) are common in children. Most URTIs have been shown to be of viral origin. Inappropriate use of antibiotics is one of the main causes of antibiotic resistance. The problem of unnecessary antibiotic use among children is a concern for antibiotic resistance in low- and middle-income developing countries.MethodsOur study is a cross-sectional survey study. It was carried out between 14 December 2020 and 1 April 2021 for parents over 18 years of age with a child under 18 years’ old who applied to the general pediatrics outpatient clinics of Gazi University Faculty of Medicine Hospital Department of Pediatrics.Results554 parents responded to the questionnaire. A total of 15.7% of parents stated to use antibiotics in any child with fever. 37% of parents believed that antibiotics could cure infections caused by viruses. 6.3% of parents declared that they put pressure on pediatricians to prescribe antibiotics. 85.6% of the parents stated that they never gave their children non-prescription antibiotics when they had a high fever. 80.9% of them declared that they never used past antibiotics in the presence of a new infection. Female gender, high level of education, high income level and low number of antibiotics used in the last 1 year were found to be statistically significant with the better knowledge level of the parents (p <0.05).ConclusionAccording to the results of our study of parents' lack of knowledge about antibiotics in Turkey, though generally it shows proper attitude and behavior. It shows that some of the restrictions imposed by the National Action Plan are partially working. However, it is still necessary to continue to inform parents, pediatricians and pharmacists about the use of antibiotics, and to be more sensitive about the prescribing of antibiotics, and if necessary, sanctions should be imposed by the state in order to prevent unnecessary antibiotic prescriptions.

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