scholarly journals Clinical Profile of Children with Acute Febrile Encephalopathy in a Tertiary Health Care Center of Nepal

2016 ◽  
Vol 35 (3) ◽  
pp. 224-230 ◽  
Author(s):  
Poonam Sharma ◽  
BK Sarmah ◽  
Pawana Kayastha ◽  
Asim Shrestha ◽  
Damodar Tiwari
Keyword(s):  
Bacterial Meningitis ◽  
Viral Encephalitis ◽  
Hospital Admissions ◽  
Care Center ◽  
Clinical History ◽  
Clinical Findings ◽  
Respiratory Pattern ◽  
Health Care Center ◽  
Altered Sensorium ◽  
Geographical Regions

Background: Acute febrile encephalopathy is a common and severe neurological syndrome that is associated with significant morbidity and mortality in children. The etiologies differ according to geographical regions and appropriate and efficient protocols for investigations and management requires proper understanding of various potential etiologies.Methods: In this prospective observational study, 54 children of one month to 14 years presenting to the hospital with acute onset of fever with altered sensorium were clinically evaluated and investigated. Clinical examinations included temperature, pulse rate, heart rate, blood pressure, coma severity by GCS, respiratory pattern and detail systemic and CNS examination. Etiology of acute febrile encephalopathy was based on clinical history, examination and relevant laboratory investigations.Results:  The incidence of acute febrile encephalopathy was 5.5% of the total hospital admissions. There were 35(64.8%) boys and 19(35.2%) girls. The maximum number of children 24(44.4%) were between one to five years of age. The most common presenting complains besides fever and altered sensorium were seizures and vomiting which was present in 59.3% and 46.3% of children respectively. Signs of meningeal irritation, hypertonia, brisk deep tendon reflexes and extensor plantar response was present in 50%, 24%, 29.6%, and 44.4% respectively. The diagnosis based on clinical findings and laboratory investigations were viral encephalitis 34(63%), bacterial meningitis 12(22.2%), cerebral malaria 4(7.4), enteric encephalopathy 3(5.6%) and hepatic encephalopathy 1(1.9%).Conclusion: Viral encephalitis and bacterial meningitis are the most common cause of acute febrile encephalopathy. Preventive strategies can be done to decrease the incidence.J Nepal Paediatr Soc 2015;35(3):224-230

scholarly journals Prevention and therapy of acute and chronic wounds using NPWT devices during the COVID-19 pandemic, recommendation from The NPWT Working Group

2020 ◽  
Vol 7 (2) ◽  
Author(s):  
Tomasz Banasiewicz ◽  
Rolf Becker ◽  
Adam Bobkiewicz ◽  
Marco Fraccalvieri ◽  
Wojciech Francuzik ◽  
...  
Keyword(s):  
Wound Healing ◽  
Chronic Wounds ◽  
Hospital Admissions ◽  
Wound Care ◽  
Care Center ◽  
Management Strategies ◽  
Hospital Staff ◽  
Wound Management ◽  
Health Care Center ◽  
Single Use

Recent SARS-CoV-2 pandemic leading to a rapidly increasing number of hospitalizations enforced reevaluation of wound management strategies. The optimal treatment strategy for patients with chronic wounds and those recovering from emergency and urgent oncological surgery should aim to minimize the number of hospital admissions, as well as the number of surgical procedures and decrease the length of stay to disburden the hospital staff and to minimize viral infection risk. One of the potential solutions that could help to achieve these goals may be the extensive and early use of NPWT devices in the prevention of wound healing complications. Single-use NPWT devices are helpful in outpatient wound treatment and SSI prevention (ciNPWT) allowing to minimize in-person visits to the health care center while still providing the best possible wound-care. Stationary NPWT should be used in deep SSI and perioperative wound healing disorders as soon as possible. Patient’s education and telemedical support with visual wound healing monitoring and video conversations have the potential to minimize the number of unnecessary in-person visits in patients with wounds and therefore substantially increase the level of care.

scholarly journals Analysis of Social Determinants and the Utilization of Tele-Urgent Pediatrics Care During a Pandemic (Preprint)

2020 ◽  
Author(s):  
Saif Khairat ◽  
Phillip McDaniel ◽  
Matthew Jensen ◽  
Tia Francis ◽  
Barbara Edson ◽  
...  
Keyword(s):  
Vulnerable Populations ◽  
Care Center ◽  
Urgent Care ◽  
Pediatric Care ◽  
High Concentration ◽  
Cross Sectional ◽  
Low Concentration ◽  
Health Care Center ◽  
Geographical Regions ◽  
Before And After

BACKGROUND Telehealth is increasingly used to provide specialty consultations to infants and children receiving care. However, there is uncertainty if the Covid-19 pandemic has influenced the use of telehealth among vulnerable populations. OBJECTIVE The objective of this research was to compare the overall use of tele-urgent care visits for pediatric before and after the pandemic especially among vulnerable populations. METHODS We conducted a cross-sectional analysis of Pediatric tele-urgent care visits at a Virtual Care Center at a Southeastern Health Care Center. The main outcome of this study was the utilization of Pediatrics tele-urgent visits across geographical regions with different levels of social disparities and between 2019 and 2020. RESULTS Of 584 tele-urgent care visits, 388 (66.4%) visits occurred in 2020 during the pandemic compared to 196 (33.6%) visits in 2019. Among 808 NC zip codes, 181 (22%) consisted of a high concentration of vulnerable populations, where 17.7% of the tele-urgent care visits originated from. The majority (67.8%) of tele-urgent care visits originated from zip codes with a low concentration of vulnerable populations. There was a significant association between the rate of Covid19 cases and the concentration level of social factors in a given ZCTA area. CONCLUSIONS The use of tele-urgent visits for pediatric care doubled during the Covid19 pandemic. The majority of the tele-urgent care visits after Covid19 originated from regions where there is a low presence of vulnerable populations. In addition, our geospatial analysis found that geographic regions with a high concentration of vulnerable populations had a significantly higher rate of Covid19 confirmed cases and deaths compared to regions with a low concentration of vulnerable populations.

Complete versus Limited Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Cystic Fibrosis

2020 ◽  
Vol 162 (4) ◽  
pp. 572-580 ◽  
Author(s):  
Daniel J. Lee ◽  
Christopher M. K. L. Yao ◽  
Jenna Sykes ◽  
Leena Rizvi ◽  
Elizabeth Tullis ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Postoperative Period ◽  
Endoscopic Sinus Surgery ◽  
Hospital Admissions ◽  
Care Center ◽  
Sinus Surgery ◽  
Oral Antibiotic ◽  
Health Care Center ◽  
Pulmonary Exacerbations

Objective To examine the effects of the extent of endoscopic sinus surgery (ESS) on pulmonary health, including the pulmonary exacerbations and lung function in patients with cystic fibrosis (CF). Study Design Retrospective cohort study. Setting Tertiary health care center. Subjects and Methods A retrospective review of patients with CF who underwent ESS at St. Michael’s Hospital between 1999 and 2016 was performed. Two groups of patients were identified based on the surgical extent: (1) complete (maxillary antrostomy, complete ethmoidectomy, sphenoidotomy, and frontal sinusotomy) and (2) limited (any ESS that involved less than complete). Primary outcomes included the number of pulmonary exacerbations (the use of oral or intravenous [IV] antibiotics), number of hospital admissions and hospital days during a 2-year pre- and postoperative period, and pulmonary function outcomes during a 1-year pre- and postoperative period. Results There were 70 procedures (30 complete and 40 limited) among 57 patients. Baseline characteristics were similar between the groups. Complete ESS group had a significant reduction in the oral antibiotic use compared to the limited ESS group (median, –1.0 [interquartile range (IQR), –2 to 0] in complete vs 0 [IQR, –1 to 1] in limited, P = .028). There was no difference in the use of IV antibiotics, number and duration of admissions, or rate of lung function change between the 2 groups. Conclusion Complete ESS may reduce mild forms of pulmonary exacerbations as shown in the decreased use of oral antibiotics. Overall, ESS does not significantly modify pulmonary outcomes in patients with CF.

scholarly journals The Epidemiologic, Clinical and Laboratory Findings of Patients with Myasthenia Gravis in Southern Iran

2012 ◽  
Vol 1 (1) ◽  
pp. 20-23
Author(s):  
Abbas Rahimi Jaberi ◽  
Ali Reza Manafi ◽  
Hossein Movahhedan ◽  
Marzieh Zeighami ◽  
Sara Honarparvaran
Keyword(s):  
Myasthenia Gravis ◽  
Nicotinic Acetylcholine Receptors ◽  
Acetylcholine Receptors ◽  
Care Center ◽  
Age At Onset ◽  
Autoimmune Disorder ◽  
Iranian Population ◽  
Laboratory Findings ◽  
Health Care Center ◽  
Geographical Regions

Introduction: Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular junction associated with presence of antibodies against nicotinic acetylcholine receptors (nAChRs). The pattern of the MG varies in different ethnical and geographical regions. Data regarding the pattern of the disease in Iran is scarce. Thus we performed this study in order to describe the epidemiologic, clinical and laboratory characteristics of MG in Iranian population. Method and Material: This was a retrospective study being performed in Nemazee Hospital, a tertiary health care center affiliated with Shiraz University of Medical Sciences, from 2001 to 2010. The medical records were reviewed and the data were entered into a computer database. Data are presented as mean ± SD and proportions as appropriate. Result: Overall we included 208 patients with MG among whom there were 62 (29.8%) men and 146 (70.2%) women. The mean age of the patients was found to be 33.19 ± 15.75 (range 1-85) years. The median age at onset was 28±2.3 years. Eight (3.9%) patients had family history of MG, 1.9% and 2.4% of patients had a background of Diabetes Mellitus and Rheumatoid disease in family, respectively. Thymoma was observed in 9.1% of patients. The presenting symptom was found to be ocular ones detected in 67 (34.9%) patients out of which 59 (30.7%) had bulbar and 12 (6.3%) had appendicular involvement. Edrophonium test was done for 28 patients out of whom 78.6% tested positive. The most common histopathology finding was thymic hyperplasia and the second most common was thymoma. Conclusion: This is the first study describing MG in an Iranian population. The pattern of disease was found to be much more similar to North America and Europe. MG was found to be more common in females consistent with western studies. [GMJ. 2012;1(1):20 -23]

scholarly journals Nasal Dermoid Sinus Cyst expanding into Frontal Sinus: A Rare Presentation

2012 ◽  
Vol 5 (3) ◽  
pp. 123-126
Author(s):  
Ashok Gupta ◽  
Rijuneeta LNU ◽  
Grace Budhiraja ◽  
Abhilash Alex Francis
Keyword(s):  
Frontal Sinus ◽  
Care Center ◽  
Complete Removal ◽  
Clinical History ◽  
Sinus Tract ◽  
Combined Approach ◽  
Rare Presentation ◽  
Health Care Center ◽  
Dermoid Sinus ◽  
Rare Case Report

ABSTRACT Nasal dermoid sinus cysts are uncommon congenital anomalies that require interventions only when they present as complications. They frequently present in childhood as midline nasal masses requiring excision. They may present with intracranial as well as intraorbital extensions, making it necessary to subject the patient for proper radiological diagnosis preoperatively. Here, we present a rare case report of 28-year-old male patient who presented at our tertiary health care center with nasal dermoid cyst expanding into the frontal sinus causing proptosis and blurring of vision. The cyst was excised by combined approach, i.e. external nasal dermoid sinus tract excision and endoscopic nasofrontal sinusotomy for complete removal. The embryology, clinical history, diagnosis and surgical management are discussed. How to cite this article Gupta R, Gupta A, Budhiraja G, Francis AA. Nasal Dermoid Sinus Cyst expanding into Frontal Sinus: A Rare Presentation. Clin Rhinol An Int J 2012;5(3):123-126.

Non-Fatal Deliberate Self-Harm in Three Remote Indigenous Communities in Far North Queensland, Australia

Crisis ◽  
2019 ◽  
Vol 40 (6) ◽  
pp. 422-428 ◽  
Author(s):  
Chris Rouen ◽  
Alan R. Clough ◽  
Caryn West
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Care Center ◽  
Indigenous Communities ◽  
Indigenous Australians ◽  
Deliberate Self Harm ◽  
Health Care Center ◽  
Far North ◽  
Primary Health ◽  
Self Harm

Abstract. Background: Indigenous Australians experience a suicide rate over twice that of the general population. With nonfatal deliberate self-harm (DSH) being the single most important risk factor for suicide, characterizing the incidence and repetition of DSH in this population is essential. Aims: To investigate the incidence and repetition of DSH in three remote Indigenous communities in Far North Queensland, Australia. Method: DSH presentation data at a primary health-care center in each community were analyzed over a 6-year period from January 1, 2006 to December 31, 2011. Results: A DSH presentation rate of 1,638 per 100,000 population was found within the communities. Rates were higher in age groups 15–24 and 25–34, varied between communities, and were not significantly different between genders; 60% of DSH repetitions occurred within 6 months of an earlier episode. Of the 227 DSH presentations, 32% involved hanging. Limitations: This study was based on a subset of a larger dataset not specifically designed for DSH data collection and assesses the subset of the communities that presented to the primary health-care centers. Conclusion: A dedicated DSH monitoring study is required to provide a better understanding of DSH in these communities and to inform early intervention strategies.

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