Clinicomicrobiological profile of infective endocarditis in a tertiary care center of Nepal

Background Infective endocarditis is a common problem and data regarding its clinical and microbiological pattern from developing countries are sparse. We studied clinical features and the microbiological pathogens in patients with Infective Endocarditis in our Hospital. Objective To study the clinical profile and microbiological pathogens involved in patients with Infective Endocarditis, admitted under Department of Internal Medicine of B.P Koirala Institute of Health Sciences. Materials and methods A total of 54 patients with history of fever and underlying heart disease were studied. It was a hospital based cross sectional descriptive study done in patients with infective endocarditis presented to us from March 2007 to February 2008 in B.P Koirala Institute of Health Sciences. Results Out of 54 patients, 11 (20.4%) had Dukes definite IE. The male: female ratio was 1.2:1. The mean age of the study group was 27.3 years (range=16-55). In IE group, fever was present in 100% cases (n=11) as it was the inclusion criteria of the study, followed by SOB 81.8% (n=9). History of antibiotic therapy prior to the presentation was present in 36.7 % (n=4) patients. Pallor was the most common sign 63.6% (n=7). Splenomegaly was seen in 18.2% (n=2). Anaemia (Hb<10gm %) in 36.4% (n=4) and microscopic haematuria in 72.3% (n=8) cases. Blood culture positivity was seen in 36.4 %. The most common pathogens were Staphylococcus aureus in 27.3% (n=3) and Acinetobacter species in 9.1% (n=1). Conclusion In our study we found that the clinical spectrum of IE was different from the west in that the majority of patients being young in our study. However, RHD still is the commonest underlying heart disease and Staphylococcus aureus being the commonest isolate. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 34-41 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8698

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TO STUDY THE PREVALENCE AND CLINICAL PROFILE OF CHRONIC ATRIAL FIBRILLATION IN HOSPITALIZED PATIENTS

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703758 ◽

2014 ◽

Vol 04 (02) ◽

pp. 017-020

Author(s):

Dharma Rao V. ◽

Rajaneesh Reddy M. ◽

Srikanth K. ◽

Raj Kumar Prakash B. ◽

Satya Prasad A. ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Care Center ◽

Tertiary Care ◽

Chronic Atrial Fibrillation ◽

Hospitalized Patients ◽

Clinical Profile ◽

Female Dominance ◽

Elderly Age ◽

Female Ratio

Abstract: Objective: To determine the prevalence of chronic atrial fibrillation (AF) in a tertiary care center and to identify the clinical profile of chronic AF in hospitalized patients. Methods: All patients admitted to Mamata General Hospital in medicine/cardiology wards with chronic AF (persistent and permanent) during the period January 2012 to December 2012 were included into the study. The principal exclusion criteria were new onset AF and acute AF. Results: During the study period, 49 patients were admitted with chronic AF with an average of 45.44 years. A slight female dominance was seen with male: female ratio of 1:1.2. Half of the patients (51%) were below the age 50 years. The elderly age group comprised of only 16.3% of cases. The commonest presenting complaint was dyspnea followed by palpitation. Rheumatic valvular heart disease was seen more commonly in people below the age of 50 years whereas hypertension and ischemic heart disease after 50 years. Heart failure was the commonest condition associated with the chronic AF and was the cause of hospitalization in almost fifty percent of cases Conclusion: Chronic AF is still a cause of concern in India in people below the age of 50 years due to high prevalence of rheumatic fever inspite of advances in the medical field.

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Clinical and laboratory profiles of genital ulcers (sexually transmitted diseases) in a tertiary care center in northeastern India

Our Dermatology Online ◽

10.7241/ourd.20212.4 ◽

2021 ◽

Vol 12 (2) ◽

pp. 120-129

Author(s):

Romita Bachaspatimayum ◽

Zamzachin Guite ◽

Thangjam Bijayanti Devi

Keyword(s):

Care Center ◽

Tertiary Care ◽

Herpes Genitalis ◽

Tertiary Care Center ◽

Cross Sectional ◽

Female Ratio ◽

Ulcer Disease ◽

Sexually Transmitted ◽

Northeastern India ◽

Genital Ulcers

Background: Genital ulcers are defined as breaches in the continuity of the genital mucosa and/or skin. Sexually transmitted infections (STIs) that cause genital ulcer disease (GUD) are syphilis, chancroid, donovanosis, lymphogranuloma venereum (LGV), and herpes genitalis. This study aimed to investigate the clinical and laboratory profiles of STI-related genital ulcers. Materials and Methods: A cross-sectional two-year study was conducted on patients attending the Outpatient Department of Dermatology, Venereology and Leprosy in a tertiary care center in northeastern India. Selected were 95 patients who presented themselves with STI-related genital ulcers. Detailed history taking and examination were conducted with basic tests to assist the diagnosis. Results: The male-to-female ratio was 3.32:1, and the most common site was the glans and prepuce in males (28.77%) and the labia majora and minora in females (36.36%). 96.84% of patients had superficial ulcers. The KOH mount was positive in 26 patients. The Tzanck smear was positive in 31 patients. RPR was positive in four. HIV was positive in eleven. Herpes genitalis (96.84%) was the most common GUD. Mixed STIs were attested in 41.05% of patients. Conclusion: GUD can take various forms of presentation. The available laboratory tests should be utilized. The possibility of mixed infections should always be kept in mind.

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Clinical and pathogen features of infective endocarditis:A retrospective study of 111 episodes in a teaching hospital in southwest China

10.21203/rs.2.9194/v1 ◽

2019 ◽

Author(s):

Yuanfang Wang ◽

Mei Kang ◽

Ya Liu ◽

Siyin Wu ◽

Weili Zhang ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Heart Disease ◽

Infective Endocarditis ◽

Laboratory Data ◽

Clinical Manifestations ◽

Resistance Rate ◽

Native Valve ◽

Duke Criteria ◽

Preventive Medication ◽

History Of

Abstract Background Infective endocarditis (IE) is a health-threaten infectious disease. Diverse and complicated etiology and causative microorganisms make IE difficult to diagnose and treat. As we know, current investigations of clinical and pathogen features of IE in West china are scarce. In this study, we aimed to investigate the epidemiology and pathogen characteristic of IE in our region. Methods A retrospective analysis of clinical and laboratory data was performed from all blood culture positive IE patients between 2012 to 2017 in Westchina Hospital of Sichuan University。The diagnosis is traditionally based on the modified Duke criteria. Results The mean age of the patient cohort was 40.7±21.5 years (ranging from 2-78); 73 cases (65.2%) were males and 39 cases (34.8%) were females. Of the 111 cases, 100 were native valve endocarditis (NVE) while 11 were prosthetic valve endocarditis (PVE), 87 cases (78.4%) were left-heart infection. Congenital heart disease (28.6%) and rheumatic heart disease (11.6%) were most common history of heart disease. Primary clinical manifestations were fever (87.5%) and heart murmur (78.6%).Streptococci spp (20.7%) was the most common organism, followed by Staphylococcus spp(17.9%). Streptococcus viridians showed no resistance to penicillin, erythromycin and clindamycin resistance rate were 47.4% and 40%. Benzocillin resistance rate of staphylococcus aureus to was 26.3%. Vancomycin or linezolid resistance staphylococcus aureus were not found. 75 patients died while 36 patients survived at last. With respect to risk factors, history of heart disease was the only prognostic risk factor (OR: 0.239, 95%CI 0.08-0.68) Conclusions Epidemiological and clinical characteristics of infective endocarditis are various and complex, distribution of pathogen is regional difference. Our research of infective endocarditis with bloodstream infection verified regional characteristics of infective endocarditis. The variations we observed in the study will be of important value to clinical preventive medication in our region.

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Facts about the General Medical Care of Adults with Congenital Heart Defects: Experience of a Tertiary Care Center

Journal of Clinical Medicine ◽

10.3390/jcm9061943 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1943

Author(s):

Lavinia Seidel ◽

Kathrin Nebel ◽

Stephan Achenbach ◽

Ulrike Bauer ◽

Peter Ewert ◽

...

Keyword(s):

Heart Disease ◽

Medical Care ◽

Primary Care Physicians ◽

Congenital Heart ◽

Heart Defects ◽

Care Center ◽

Tertiary Care ◽

Care Practice ◽

Cross Sectional ◽

Almost All

Background: Due to the increase in survival rates for congenital heart disease (CHD) in the last decades, over 90% of patients today reach adulthood. Currently, there are more than 300,000 adults with CHD (ACHD) living in Germany. They have an increased need for specialized medical care, since almost all ACHD have chronic heart disease and suffer from specific chronic symptoms, risks, and sequelae. Primary care physicians (PCPs) play a crucial role in referring patients to ACHD specialists or specialized institutions. This cross-sectional study is intended to clarify the real-world care of ACHD from the PCP’s perspective. Methods: This analysis, initiated by the German Heart Centre Munich, was based on a 27-item questionnaire on actual ACHD health care practice in Germany from the PCP’s perspective. Results: In total, 767 questionnaires were considered valid for inclusion. The majority of the PCPs were general practitioners (95.9%), and 84.1% had cared for ACHD during the past year. A majority (69.2%) of the PCPs had cared for patients with simple CHD, while 50.6% and 33.4% had cared for patients with moderate and severe CHD, respectively, in all age groups. PCPs treated almost all typical residual symptoms and sequelae, and advised patients regarding difficult questions, including exercise capacity, pregnancy, genetics, and insurance matters. However, 33.8% of the PCPs did not even know about the existence of certified ACHD specialists or centers. Only 23.9% involved an ACHD-specialized physician in their treatment. In cases of severe cardiac issues, 70.8% of the PCPs referred patients to ACHD-certified centers. Although 52.5% of the PCPs were not sufficiently informed about existing structures, 64.2% rated the current care situation as either “very good” or “good”. Only 26.3% (n = 190) of the responding physicians were aware of patient organizations for ACHD. Conclusions: The present study showed that the majority of PCPs are not informed about the ACHD care structures available in Germany. The need for specialized ACHD follow-up care is largely underestimated, with an urgent need for optimization to reduce morbidity and mortality. For the future, solutions must be developed to integrate PCPs more intensively into the ACHD care network.

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Inducible Clindamycin Resistant Staphylococcus aureus among Patients Attending Tertiary Care Centre: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.6882 ◽

2021 ◽

Vol 59 (243) ◽

pp. 1111-1115

Author(s):

Shanti Shanti ◽

Sanjib Mani Regmi ◽

Nabina Shrestha

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Clinical Samples ◽

Tertiary Care Center ◽

Sectional Study ◽

Cross Sectional ◽

Inducible Clindamycin Resistance

Introduction: Staphylococcus aureus, a superbug, resistant to multiple antibiotics led to growing interest in the usage of macrolide-lincosamide-streptogramin B antibiotics, which are now rapidly developing resistance. This study aims to find the prevalence of inducible clindamycin-resistant Staphylococcus aureus among obtained clinical samples from in-patient and out-patient departments of a tertiary care center. Methods: This is a descriptive cross-sectional study done in clinical samples from the in-patient and out-patient departments of a tertiary care center from September 2020-May 2021. Ethical clearance was taken from the Institutional Review Committee (Ref: 068/2077/2078). Staphylococcus aureus were isolated and antibiotic susceptibility tests were performed by disc diffusion method. Inducible clindamycin and methicillin resistance Staphylococcus aureus were detected using D-test and cefoxitin disc according to Clinical and Laboratory Standards Institute guidelines. Convenient sampling was done and the data was analyzed using Statistical Package for Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Among a total of 141 Staphylococcus aureus isolated, the prevalence of inducible clindamycin resistant phenotype was 41 (29.1%) (21.6-36.59 at 95% Confidence Interval). Whereas, 30 (21.3%) were constitutive clindamycin resistant. The inducible 28 (47.5%) and 19 (32.2%) constitutive clindamycin resistance was higher among methicillin-resistant Staphylococcus aureus. Conclusions: The frequency of inducible clindamycin resistance among methicillin resistant Staphylococcus aureus was high, which alarms the use of macrolide-lincosamide-streptogramin B antibiotics in Staphylococcus aureus infections. Hence, D-test should be performed to detect inducible clindamycin resistance in routine testing to prevent treatment failure.

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Risks of Neoplasia and Malignancy in Surgically Resected Cystic Parotid Lesions

Otolaryngology ◽

10.1177/0194599819889699 ◽

2019 ◽

Vol 162 (1) ◽

pp. 79-86

Author(s):

Brian C. Boursiquot ◽

Nancy J. Fischbein ◽

Davud Sirjani ◽

Uchechukwu C. Megwalu

Keyword(s):

Care Center ◽

Tertiary Care ◽

Needle Aspiration ◽

Cross Sectional Study ◽

Preoperative Imaging ◽

Cross Sectional ◽

Risk Of Malignancy ◽

History Of ◽

Diagnostic Samples ◽

Cystic Masses

Objectives To evaluate the risks of neoplasm and malignancy in surgically treated cystic parotid masses compared with solid or mixed lesions and to evaluate the performance of fine-needle aspiration (FNA) in parotid cysts. Study Design Retrospective cross-sectional study. Setting Single-institution academic tertiary care center. Subjects and Methods Patients without a history of human immunodeficiency virus or head and neck cancer who underwent parotidectomy for parotid masses and had preoperative imaging to characterize lesions as cystic, solid, or mixed (ie, partially cystic and partially solid). We assessed the risks of neoplasia and malignancy, adjusting for age, sex, race/ethnicity, facial nerve weakness, and history of malignancy. We also evaluated the sensitivity and specificity of FNA. Results We included 308 patients, 27 of whom had cystic parotid masses (5 simple and 22 complex). Cystic masses were less likely to be neoplastic compared to solid or mixed masses (44% vs 97%; odds ratio [OR], 0.03; 95% confidence interval [CI], 0.01-0.07); however, there was no difference in the risk of malignancy (22% vs 26%; OR, 0.81; 95% CI, 0.32-2.10). Cystic masses were more likely to yield nondiagnostic FNA cytology results, but for diagnostic samples, FNA was 86% sensitive and 33% specific for diagnosing neoplasia and 75% sensitive and 83% specific for diagnosing malignancy. Conclusion In our population, cystic masses undergoing surgery were less likely to be neoplastic but had a similar risk of malignancy as solid masses. The risk of malignancy should be considered in the management of cystic parotid masses.

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Abstract WP221: Predictors of Stroke in a Sample of Patients With Infective Endocarditis

Stroke ◽

10.1161/str.48.suppl_1.wp221 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ives A Valenzuela ◽

Bradley Klein ◽

Lauren Dunn ◽

Robert Sorabella ◽

Sang Myung Han ◽

...

Keyword(s):

Ischemic Stroke ◽

Infective Endocarditis ◽

Chart Review ◽

Hemorrhagic Stroke ◽

Care Center ◽

Tertiary Care ◽

The United States ◽

High Morbidity ◽

History Of ◽

Prior Stroke

Background: Infective endocarditis (IE) affects up to 20,000 people per year in the United States. Stroke is a feared complication of IE and is associated with high morbidity and mortality. We aim to identify predictors of stroke in a large sample of patients treated at a tertiary care center. Methods: A retrospective chart review was carried out using ICD9 codes for IE and cerebrovascular events in patients admitted to the New York Presbyterian Hospital/Columbia University Medical Center from 2000 to 2015. Incident stroke was ascertained if imaging demonstrated an acute infarction during the hospital visit in which endocarditis was diagnosed using Duke’s criteria. Demographics, vascular risks and ancillary data were obtained by chart review. Generalized linear models were used to obtain the risk ratio (RR) and their 95% confidence intervals (95%CI) adjusting for age, sex, ethnicity, hypertension, diabetes, dyslipidemia, smoking, congestive heart failure (CHF), presence of cardiac vegetations, valvular abscesses, positive blood culture, and immunosuppression. Results: The sample included 727 IE subjects (mean age 61±18, range 18-101, 62% men, 62% non-white). Twelve percent of the sample were immunosuppressed. The majority of the patient had vegetations (61%) and positive blood cultures (87%, MRSA 13%) while valvular abscess were less frequent (13%). Of the 727 patients, 13% had an acute pre-surgical stroke (10% ischemic and 3% hemorrhagic). Meanwhile, of the 314 patient who underwent surgical intervention, only 0.5% had post-surgical strokes. The risk of pre-operative ischemic stroke was higher among patients with diabetes (RR 1.7, 1.1-2.8), cardiac vegetations (RR 2.8, 1.6-5.0), and history of prior stroke (RR 1.8, 1.8-2.9) while the risk of pre-surgical hemorrhagic stroke was higher among patients with history of prior stroke (RR 4.5, 1.7-11.9). Conclusions: Prior stroke was a risk factor for ischemic and hemorrhagic stroke, which suggests baseline brain vulnerability that may influence the risk of stroke in the setting of IE. Additionally, diabetes and the presence of vegetations increased the risk of ischemic stroke. Early identification of sub-populations with IE at risk of stroke may help stratify risk and test preventive interventions.

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Pattern of geriatric dermatoses at a tertiary care center in North-East India

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20175377 ◽

2017 ◽

Vol 3 (4) ◽

pp. 527 ◽

Cited By ~ 1

Author(s):

Sandhyarani Kshetrimayum ◽

Nandakishore Singh Thokchom ◽

Vanlalhriatpuii . ◽

N. A. Bishurul Hafi

Keyword(s):

Fungal Infections ◽

Care Center ◽

Tertiary Care ◽

Systemic Diseases ◽

Contributing Factors ◽

Self Medication ◽

Cross Sectional ◽

Female Ratio ◽

North East ◽

Lichen Simplex Chronicus

Background: The aging population is dramatically increasing with the increase in the average life. It is faced with different health problems which include skin as well. The aim was to study the clinical pattern of geriatric dermatoses and associated systemic diseases.Methods: A cross-sectional study was conducted for a period of 18 months to study the pattern of geriatric dermatoses on 250 geriatric patients aged above 60 years attending Dermatology OPD, RIMS, Imphal.Results: Out of 250 patients 136 were males and 114 were females. The mean age was 67.28 years and the male to female ratio was 1.19:1. Majority of the patients belonged to the 60-69 age group (66%). 63.2% had the dermatosis for more than 1 month before presentation. The most common dermatoses were: infections (26.4%), eczemas (22.4%), papulosquamous (10.4%), photodermatoses (8.0%) and infestations (6.8%). Herpes zoster (13.2%) and superficial fungal infections (7.6%) was the most common infections. Lichen simplex chronicus (6%). was the main form of eczema. Psoriasis (6%) and lichen planus (4.4%) were the common papulosquamous disorders. Chronic actinic dermatitis (6%) represented as the main pattern of photodermatoses. Uncommon disorders were tumors (4%), immunobullous (2.6%), drug reaction (2.4%), vitiligo (2%) and alopecia areata (0.8%). Main co-morbid systemic diseases were hypertension (16.4%) and diabetes mellitus (6.8%). Conclusions: Different disease entities in the elderly demands different approach to management. Contributing factors like neglect, delay in seeking treatment, co-morbidities have to be properly addressed. Health education on proper skin care, avoidance of irritants and self-medication etc would help reduce the incidence of common dermatoses.

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Patterns of Rheumatic Heart Disease and Treatment Practices at Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.5405 ◽

2020 ◽

Vol 58 (230) ◽

Author(s):

Rajesh Nepal ◽

Madhab Bista ◽

Sahadeb Prasad Dhungana

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Tertiary Care Center ◽

Sectional Study ◽

Cross Sectional ◽

Treatment Practices ◽

Rheumatic Heart

Introduction: Rheumatic heart disease is a sequel of rheumatic fever which causes heart valve damage. This study was conducted to look at the pattern of valve lesions and treatment practices in patients with rheumatic heart disease. Methods: A cross-sectional study conducted at the tertiary care center with a diagnosis of rheumatic heart disease from July 2018 to January 2020 by convenient sampling. Ethical clearance was obtained from the Institutional Review Committee (ref no. 55/2018). Data were analyzed by using Statistical package for social sciences version 20. Results: Out of 600 patients, 428 (71.3%) were female. The mean age was 44.24±14.24 years. The isolated mitral valve was affected in 280 (46.6%). Dual involvement of mitral and aortic valve was present in 294 (49%). Only 14 (2.3%) had involvement of isolated aortic valve involvement. Overall, mitral stenosis was the most common abnormality 508 (84.6%) followed by mitral regurgitation 418 (69.6%), aortic regurgitation 320 (53.3%), and aortic stenosis 63 (10.5%). Assessment of the severity of lesions showed that 247 (41.2%) patients had severe mitral stenosis, 119 (19.8%) severe mitral regurgitation, 14 (2.3%) severe aortic stenosis, and 11 (1.8%) severe aortic regurgitation. Majority 493 (82.2%) were treated with medical therapies. Surgical procedures were performed in 51 (8.5%). The use of anticoagulation was in 212 (35.3%) of eligible patients. Conclusions: Mitral valve was affected commonly both in isolation and combination. The majority of patients who were eligible for cardiac interventions were treated medically with suboptimal use of anticoagulation and secondary prophylaxis.

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Non-neoplastic Lesions of Gallbladder Among Cholecystectomy Specimens of a Tertiary Care Center: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.5861 ◽

2021 ◽

Vol 59 (242) ◽

pp. 834-838

Author(s):

Dilasma Ghartimagar ◽

Manish Kiran Shrestha ◽

Adarsh Jhunjhunwala ◽

Arnab Ghosh ◽

Sushma Thapa ◽

...

Keyword(s):

Confidence Interval ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Common Finding ◽

Tertiary Care Center ◽

Sectional Study ◽

Cross Sectional ◽

Female Ratio ◽

Neoplastic Lesions

Introduction: Gallbladder diseases are prevalent worldwide and present with a diverse histopathological spectrum. Mucosal irritation and chronic inflammation is considered as an important etiological factor for the mechanical or functional dysfunction of emptying of the gallbladder. This study aims to find the prevalence of non-neoplastic lesions of gallbladder among cholecystectomy specimens of a tertiary care center. Methods: A descriptive cross-sectional study was conducted in the Department of Pathology, of a tertiary care center from January 2005 to December 2020. Ethical approval was taken from the Institutional Review Committee. All the patients who had undergone cholecystectomy procedures which showed non-neoplastic lesions were enrolled in the study. Convenient sampling was done. Statistical Package for Social Sciences version 21 and Microsoft Excel were used for data analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion forbinary data. Results: Out of 4914 cholecystectomy specimens, 4852 (98.73%) (95% Confidence Interval= 98.42- 99.04) were non-neoplastic lesions. There were 1252 (25.8%) males and 3600 (74.2%) females with a male to female ratio of 1:2.87. Age ranged from 2 to 89 years with a mean age of 45±14.48 years. Gallbladder lesions were observed maximum in age group 41-50 years with 1200 (24.7%) cases. Among the non-neoplastic lesions, cholecystitis without any specific finding was the most common finding with 3028 (62.4%) cases followed by cholelithiasis with 1478 (30.5%) cases. Conclusions: The prevalence of non-neoplastic lesions of gallbladder is similar to other studies done in similar setings. Female predominance was noted in non-neoplastic lesions.

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