scholarly journals Overview of Eclampsia at a Tertiary Care Hospital

2014 ◽  
Vol 8 (2) ◽  
pp. 46-49
Author(s):  
B Shakya ◽  
A Vaidya
Keyword(s):  
Hellp Syndrome ◽  
Cardiopulmonary Arrest ◽  
Tertiary Care ◽  
Organ Damage ◽  
Fetal Outcome ◽  
Common Symptom ◽  
Care Hospital ◽  
Blurred Vision ◽  
Urine Albumin ◽  
Time Of Admission

Aims: The aim was to study about the morbidity and mortality of eclampsia cases at Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal. Methods: This is a retrospective study undertaken at Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal on 45 eclampsia cases between14 April 2010 to 16 July 2011. Results: Out of 31,674 obstetric admissions, 45 (0.14%) were eclampsia cases of which 42.2% belonged to 20 - <25 years and 28.8% in 17- <20 years age group occurring mostly in primipara (71.1%). Antepartum and postpartum eclampsia were 77.7% and 22.2% respectively. Majority of them presented at 36-40 weeks’(46.6%), unbooked cases being 80% and 20% had antenatal check-up at this hospital. The diastolic blood pressure on admission recorded was 110-130 mmHg (55.5%), headache being the most common symptom(53.3%), blurred vision (22.2%), HELLP syndrome (4.4%) and urine albumin 3+ (46.6%) at the time of admission. Magnesium sulphate was used as anticonvulsant, loading and maintenance dose (40%) and only as loading dose (33.3%). Though fetal outcome was normal in 44.4% cases, rest were premature (24.4%), intrauterine growth restriction (17.7%) and intrauterine fetal demise (13.3%). Three (6.6%) cases were referred to multidisciplinary center. Maternal mortality occurred in two (4.4%) cases (cardiopulmonary arrest and prolonged hypoxia). Conclusions: When patients with eclampsia presented late, significant morbidity like HELLP syndrome, renal failure and central nervous disorder occurred and muti-organ damage leading to maternal mortality.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 46-49 DOI: http://dx.doi.org/10.3126/njog.v8i2.9770

Clinical prediction of bacteremia and early antibiotics therapy in patients with solid tumors

2021 ◽  
pp. 1-7
Author(s):  
Jonathan M. Hyak ◽  
Mayar Al Mohajer ◽  
Daniel M. Musher ◽  
Benjamin L. Musher
Keyword(s):  
Solid Tumors ◽  
Solid Tumor ◽  
Cardiopulmonary Arrest ◽  
Tertiary Care ◽  
Organ Transplant ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Tumor Patients ◽  
Binomial Regression ◽  
Sirs Criteria

Abstract Objective: To investigate the relationship between the systemic inflammatory response syndrome (SIRS), early antibiotic use, and bacteremia in solid-tumor patients. Design, setting, and participants: We conducted a retrospective observational study of adults with solid tumors admitted to a tertiary-care hospital through the emergency department over a 2-year period. Patients with neutropenic fever, organ transplant, trauma, or cardiopulmonary arrest were excluded. Methods: Rates of SIRS, bacteremia, and early antibiotics (initiation within 8 hours of presentation) were compared using the χ2 and Student t tests. Binomial regression and receiver operator curves were analyzed to assess predictors of bacteremia and early antibiotics. Results: Early antibiotics were administered in 507 (37%) of 1,344 SIRS-positive cases and 492 (22%) of 2,236 SIRS-negative cases (P < .0001). Of SIRS-positive cases, 70% had blood cultures drawn within 48 hours and 19% were positive; among SIRS negative cases, 35% had cultures and 13% were positive (19% vs 13%; P = .003). Bacteremic cases were more often SIRS positive than nonbacteremic cases (60% vs 50%; P =.003), but they received early antibiotics at similar rates (50% vs 49%, P = .72). Three SIRS components predicted early antibiotics: temperature (OR, 1.7; 95% CI, 1.31–2.29; P = .0001), tachycardia (OR, 1.4; 95% CI, 1.10–1.69; P < .0001), and white blood-cell count (OR, 1.8; 95% CI, 1.56–2.14; P < .0001). Only temperature (OR, 1.6; 95% CI, 1.09–2.41; P = .01) and tachycardia (OR, 1.5; 95% CI, 1.09–2.06; P = .01) predicted bacteremia. SIRS criteria as a composite were poorly predictive of bacteremia (AUC, 0.57). Conclusions: SIRS criteria are frequently used to determine the need for early antibiotics, but they are poor predictors of bacteremia in solid-tumor patients. More reliable models are needed to guide judicious use of antibiotics in this population.

First and second wave of COVID-19: A comparative study of tertiary care hospitalized patients in Jalgaon, Maharashtra

2021 ◽  
Vol 19 (3) ◽  
pp. 23-29
Author(s):  
Yogita G Bavaskar ◽  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical History ◽  
Care Hospital ◽  
Age Group ◽  
Number Of Patients ◽  
The Mean ◽  
Collection Form ◽  
Time Of Admission ◽  
Second Wave

Background: Most of the countries including India have witnessed two or more waves of Covid 19 pandemic. The present study was conducted to compare the differences in clinico-demographic characteristics and outcomes of Covid 19 patients admitted in first and second wave of Covid 19 pandemic in a tertiary care hospital at Jalgaon, Maharashtra. Methods: A retrospective observational study was conducted at a tertiary care Dedicated Covid hospital for Covid 19 at Jalgaon, Maharashtra. All microbiologically proven corona positive patients were included in the study. The demographic records and clinical history was extracted from the case history sheets of the patients from first as well as second wave using standardized data collection form. Clinical outcome of the patients, i.e., development of complications, death or discharge was also recorded for each enrolled subject. Results: 3845 patients of Covid-19 admitted in the hospital during the first wave of epidemic and 2956 patients during second wave of the epidemic were included in the study. The mean age of patients admitted in the second wave was significantly lower as compared to first [48.77(15.31) years vs 50.23 (14.33) years, P<0.005]. There is increase in proportion of patients in the age group of < 15 years in second wave as compared to first wave (74/2956, 2.5% vs 52/3845, 1.3%). The number of patients requiring admission in ICU at the time of admission increased by 13% in second wave as compared to first wave. [827/2956 (28%) vs 577/3845(15%), P<0.0001]. More than half of the patients who got admitted for Covid 19 in first as well as second wave were having one or more comorbidities.But the proportion of the patients with previous co-morbities was significantly higher in second wave (1684/2956, 57% vs 1960/ 3845, 51%, P= 0.0004). The mortality was also higher in second wave (533/2956, 18.03% vs 541/3845, 14%, P=0.0004). Conclusions: The demographic, clinical characteristics and outcome of Covid 19 patients was different in first and second wave of pandemic with involvement of younger patients, increased rates of admission to ICU and more mortality in the second wave as compared to first wave of the pandemic.

scholarly journals THROMBOCYTOPENIA

2011 ◽  
Vol 18 (01) ◽  
pp. 75-79
Author(s):  
ATIF SITWAT HAYAT ◽  
MOHAMMAD SAEED SIDDIQUI ◽  
NAILA SHAIKH ◽  
Muqeet Ullah
Keyword(s):  
Plasmodium Falciparum ◽  
Falciparum Malaria ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Blood Film ◽  
Falciparum Infection ◽  
Common Symptom ◽  
Severe Thrombocytopenia ◽  
Care Hospital ◽  
Cell Counts

Background: Malaria is usually associated with reduction in blood cell counts and mild to moderate thrombocytopenia is a common feature of falciparum infection. This study has been conducted to find out frequency and degree of thrombocytopenia in patients suffering from falciparum malaria at a tertiary care hospital of Abbottabad. Methods: It was a descriptive case-control study being carried out at Ayub teaching hospital and Northern institute of Medical Sciences (NIMS) Abbottabad over a period of ten months. All patients with acute febrile illness without localizing signs were considered for study. A total 250 patients having falciparum malaria diagnosed by peripheral blood film examination have been studied. Complete blood counts were performed by Automated Beckman Coulter Analyzer. Blood films were examined by clinical pathologist for plasmodium falciparum via light microscopy using oil-immersion lens. Results: Out of 250 patients, 155(62%) were females and 95(38%) males with M:F ratio of 1:1.5. Mean age was 36±1.2 years (range 17-58 years). Out of 250, 175(70%) had thrombocytopenia (p<0.05) while 75(30%) had normal platelet counts. Thus mild, moderate and severe thrombocytopenia had been observed in 121(48.4%), 41(16.4%) and 13(5.2%) respectively (p<0.05). Fever appeared to be most common symptom observed in all patients (100%) followed by vomiting and nausea (88%). Anemia was the commonest sign present (80%) during our study. Conclusions: We discovered high frequency of mild thrombocytopenia in falciparum malaria. Therefore, thrombocytopenia can be supportive in diagnosis of plasmodium falciparum infection.

scholarly journals Nasomaxillary swellings: our experience at tertiary care hospital

2021 ◽  
Vol 7 (3) ◽  
pp. 469
Author(s):  
Mukesh Rawat ◽  
Archana Lall ◽  
Kavita Sachdeva
Keyword(s):  
Tertiary Care Hospital ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Final Diagnosis ◽  
Inverted Papilloma ◽  
Nasal Endoscopy ◽  
Common Symptom ◽  
Fungal Sinusitis ◽  
Care Hospital ◽  
Malignant Lesions

<p class="abstract"><strong>Background:  </strong>A wide spectrum of lesions may present as nasomaxillary swellings ranges from benign to malignant lesions including fungal sinusitis and fibro vascular lesions example: JNA (Juvenile nasopharyngeal angiofibroma) and Inverted papilloma. Many Pathologies ranging from benign to malignant tumors may mimic a simple Nasomaxillary mass. It is diagnostic challenge to determine pathology behind it. A detailed clinical evaluation with nasal endoscopy and relevant pre-operative investigations including radiological imaging and histopathological examination is essential to reach up to final diagnosis. The aim of the study was to do clinicopathological evaluation of patients presenting with nasomaxillary swelling and correlation of clinical, radiological and Histopathological findings.</p><p class="abstract"><strong>Methods: </strong>This was a prospective observational study on 50 nasomaxillary swelling patients who are presented in the Department of ENT and Head and Neck Surgery of N.S.C.B. MCH Jabalpur, a tertiary care Hospital, between March 2018 to August 2019. A detailed history taking and clinical examination with nasal endoscopy and relevant preoperative investigations including CECT Nose and PNS and histopathological examination was done in all patients.</p><p class="abstract"><strong>Results: </strong>50 Nasomaxillary swelling patients were selected for this study. 30 patients were male and 20 were females. Ages of patients were varied from 12 years to 72 years. 23 patients (46%) were malignant and 27 (54%) were benign. Histopathological examination results shows benign lesions like JNA (6 cases), fungal sinusitis (6 cases), dermoid cyst (1 case), inverted papilloma (3 cases), sebaceous cyst (1 case), jaw lesions (10 cases), (odontogenic like radicular/ infected cyst, dentigerous cyst, cystic ameloblastoma and non-odontogenic like fibrous dysplasia) and malignant lesions like SCC (squamous cell carcinoma) (12 cases), spindle cell sarcoma (2 cases), undifferentiated carcinoma (3 cases), adenocarcinoma (3 cases), adenoid cystic carcinoma (1 case), Invasive pleomorphic sarcoma (1 case) and malignant melanoma (1 case). SCC was most common lesion f/b JNA and fungal sinusitis. Well differentiated SCC was most common histological type (10 out of 12 cases of SCC). Most common symptom was nasal obstruction (66% cases) f/b epistaxis (52% cases) but epitasis was most common symptom among malignant and JNA cases. In 6 cases (3 JNA, 1 inverted papilloma, 1 malignancy and 1 radicular cyst) radiological diagnosis were not correlated with histological findings.</p><p class="abstract"><strong>Conclusions: </strong>Most our cases were malignant nasomaxillary lesions followed by fungal sinusitis and JNA. Most patients presented in advanced stage of disease so rapidly evaluation including nasal endoscopy should be done. CECT scan is essential to determine tumors extent and bony lesions. All patients should undergo hisotopatholigical examination. The final diagnosis should be made on the basis of clinical, radiological and histopathological findings.</p>

scholarly journals Clinical spectrum of patients with posterior reversible encephalopathy syndrome

2020 ◽  
Vol 7 (10) ◽  
pp. 1537
Author(s):  
Sriramchandra Rahul Pulavarty ◽  
Nagabhushana Midathala
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Tertiary Care ◽  
Severe Anaemia ◽  
Sudden Onset ◽  
Common Symptom ◽  
Care Hospital ◽  
Imaging Features ◽  
Posterior Reversible Encephalopathy ◽  
Altered Sensorium ◽  
Reversible Encephalopathy

Background: Posterior reversible encephalopathy syndrome is a neurological disorder which can present with sudden onset headache, visual disturbances, seizures and altered sensorium which is potentially reversible with early detection and treatment of the precipitating factor. The range of presentations is being constantly widened and this endeavour is a step towards understanding the wide array of presentation and primary etiology.Methods: This is a prospective observational study of 25 patients presenting to a tertiary care hospital with symptoms and imaging features suggestive of PRES. Thorough clinical examination and MRI brain were performed in all patients.Results: Out of the 25 patients, 18 (72%) were females and 7 (28%) were males. Most common symptom was headache (84%) followed by seizures (56%), nausea (40%), visual blurring (36%) and altered sensorium (20%). In patients presenting with seizure, 28.57% had recurrent seizures.The most common precipitating cause was postpartum state without hypertension (40%) followed by accelerated hypertension (28%), eclampsia (16%), chronic kidney disease (12%) and one patient of chronic severe anaemia had PRES following blood transfusion (4%). Most of the patients improved with no residual neurological deficit.Conclusions: Good neurological outcomes can be achieved by early diagnosis and appropriate imaging in patients with PRES. In pregnant and postpartum patients, PRES should be always considered even with normal blood pressure. Rapid correction of chronic severe anaemia is a rare but preventable cause of PRES.

scholarly journals Thyroid dysfunction among Indian pregnant women and its effect on the maternal and fetal outcome

2021 ◽  
Vol 10 (3) ◽  
pp. 893
Author(s):  
Aditi Jain ◽  
Raksha M. ◽  
Kanakalatha D. Nakum
Keyword(s):  
Early Pregnancy ◽  
Tertiary Care ◽  
First Trimester ◽  
Antenatal Clinic ◽  
Fetal Outcome ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Care Hospital ◽  
Thyroid Disorder

Background: Screening of thyroid disorders in antenatal women during first trimester, to recommend management of thyroid disorder during pregnancy and to know the maternal and fetal outcome of such pregnancy.Methods: This is a prospective study for the incidence of thyroid disorder in early pregnancy and the outcome of such pregnancy. 100 cases were randomly selected from the antenatal clinic at a tertiary care hospital in India and after fulfilling the inclusion criteria they were subjected to screening for thyroid disorder till 13 weeks of pregnancy. TSH is often considered the “gold standard” for assessing thyroid function. If the participant had normal value then she was not subjected to follow up, but if abnormal, then follow up was done after 4-8 weeks, thyroid profile was repeated and if values were altered, they were medically managed and closely monitored. The obstetric and perinatal outcome of the pregnancy was noted.Results: In this screening study to detect and manage thyroid disorder, 100 antenatal women were selected randomly, from which 49 women where primigravidae and 51 women were multi-gravidae, 17 of them were of <20years, 54 were between 21 to 25 years. There was 5 percent incidence of thyroid disorder in the study group. There were 3 cases of hyperthyroidism and 2 cases of overt hypothyroidism which had poor fetal and maternal outcome on follow up.Conclusions: Our study shows that the evaluation of thyroid disorders in early pregnancy and timely intervention will lead to a decrease in the complications thereby improving the maternal and fetal outcome.

Incidence & Pattern of Valvular Heart Disease in Patients attended in Echo Lab at a tertiary care Hospital: A single Centre Study

2021 ◽  
Vol 13 (2) ◽  
pp. 144-153
Author(s):  
Masuma Jannat Shafi ◽  
Sahela Nasrin
Keyword(s):  
Heart Disease ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Valvular Heart Disease ◽  
Tertiary Care ◽  
Common Symptom ◽  
Care Hospital ◽  
Single Centre Study ◽  
Incidence Pattern ◽  
Valvular Lesion

Background: This echocardiographic study was undertaken to establish incidence, pattern & complications in patients of valvular heart disease. Methods: A total of 97 patients were enrolled among the patients attended in echo lab at Ibrahim cardiac hospital & Research Institute over a period of 1 year. Results: Mean age was 53.8±1.5 years. Male were predominant (58.76% vs 41.23%). Most common symptom was shortness of breath (60.8%) followed by palpitation (43.3%). 39.2% of patients had normal ECG & 12.4% revealed AF. The most common complication was pulmonary hypertension (54.6%) followed by pulmonary edema (26.8%), Stroke (10.3%), Left atrial thrombus (7.3%), & infective endocarditis (6.2%). MV was most commonly involved (72.2%) followed by aortic valve (AV) (66.0%), tricuspid valve (TV) (54.6%) & pulmonary valve (PV) was (20.6%). Rheumatic involvement (52.6%) constituted the dominant cause than degenerative & congenital (24.7% in each). Mitral stenosis (MS) was predominant (52.6%) & was rheumatic in origin; then aortic stenosis (AS) (48.5%) which was mostly degenerative followed by bicuspid aortic valve (8.2%). Mitral regurgitation (MR) was the most common valvular lesion (64.9%); then aortic regurgitation (AR) (51.5%) which was also rheumatic in etiology. Multiple valve involvement was also present. The most common variety was MS+MR (43.3%). Tricuspid stenosis (TS) was in association with MR+AR (1.03%). Tricuspid regurgitation (TR) was 58.8%, mostly secondary to rheumatic involvement of other valves. Severe TR (5.2%) was due to Ebstain anomaly and prolapse (4.1% & 3.1%). ventricular systolic & diastolic functions were normal mostly. Conclusion: Among the rheumatic heart disease patients’ mitral valve was the most commonly affected valve. Mitral regurgitation was the most common valvular lesion. Rheumatic involvement remains the dominant cause of valvular heart disease in Bangladesh. Cardiovasc. j. 2021; 13(2): 144-153

scholarly journals Study of clinical profile of cervical cancer patients: a hospital based study

2017 ◽  
Vol 6 (11) ◽  
pp. 4873
Author(s):  
Preeti Umate ◽  
Dhuldev S. Thengal ◽  
Dhundiraj Kurdukar
Keyword(s):  
Early Stage ◽  
Past History ◽  
Clinical Stage ◽  
Tertiary Care ◽  
Cost Effective ◽  
Educational Status ◽  
Clinical Staging ◽  
Common Symptom ◽  
Care Hospital ◽  
Quality Cancer Care

Background: As a consequence of growing and ageing populations, developing countries are disproportionately affected by the increasing number of cancers. Though the situation in India is gradually improving there still exists a disparity between the availability of quality cancer care. With this view, the present study was planned to undertake in this tertiary care institute to find out symptoms, clinical staging, complications and management of cases of carcinoma of cervix.Methods: This was a prospective observational study of carcinoma of cervix carried out at a tertiary care hospital catering services to the people of Maharashtra and neighbouring states. A thorough history including presenting complaints, demographic details, educational status and occupational details, details of menstrual and obstetric history along with any significant past history were recorded on a standard proforma.Results: Most common symptom was per vaginal bleeding which was found in 29 (69.04%). In the present study almost two third of cases i.e. 28 (66.6%) had advanced stage (IIB, III, IV) at the time of admission while the number of cases diagnosed at early stage were only 14 (33.3%). For Wertheim’s hysterectomy, most commonly used approach was transperitoneal 08 (61.53%) while 05 (38.46%) were operated by extraperitoneal approach. Pelvic lymph nodes were positive in 03 (23.07%).Conclusions: A high proportion of patients presented in stages III and IV. This emphasizes the need for early detection of Gynecological cancers in our population. Accordingly, the importance of detection of the pre-clinical stage of the diseases by considering the possibility of initiating cost-effective screening measures needs to be emphasized. 

scholarly journals Maternal and fetal outcome in placenta previa: our experience

2020 ◽  
Vol 9 (8) ◽  
pp. 3253
Author(s):  
G. D. Maiti ◽  
M. Adhikary ◽  
P. R. Lele ◽  
Shilpa Gupta ◽  
M. Saha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Fetal Outcome ◽  
Blood Component ◽  
Care Hospital ◽  
Potential Risks ◽  
Risks Factors

Background: Placenta previa contributes substantial maternal and neonatal morbidity including management challenges for obstetrician. This study was to evaluate the potential risks factors and feto-maternal, outcome in placenta previa. This study was done with the intent of developing insight into risk factors, clinical presentation, various interventions and management for overall improvement in maternal and fetal outcome in placenta previa.Methods: A prospective observational study, where 30 cases of placenta previa confirmed after 28 weeks POG, treated in a public sector tertiary care hospital from June 2016 to June 2018 were included. Authors analyzed the data to evaluate the potential risks factors and maternal and fetal outcome in placenta previa.Results: In this study, major contributing risk factors for placenta previa were associated with multiparity (76.7%), maternal age >30 in 50%, previous LSCS in 46.7%, repeated uterine procedure like suction evacuation/curretage. There was a high rate of maternal morbidity mainly due to haemorrhage. Perioperative uterine artery embolization (UAE) in 3 (10%), intra-operative procedures namely devascularization, internal iliac ligation in 66.6% cases, peripartum hysterectomy in 2 (6.66%) were done to control haemorrhage. Blood and blood products transfusion required in 26.7% of cases. Fetal morbidity included prematurity in 9 (33.3%), NICU admission in 11 (36.6%) majority of which included 8 (26.7%) babies of birth weight <2000 grams.Conclusions: Placenta previa contributes to significant maternal and neonatal morbidity. Multiparity, post LSCS pregnancy constitute major factor for placenta previa. Management requires high-risk obstetrical care with frequent antenatal visits. Serial ultrasonography in reported cases of low-lying placenta to mandatory exclude overdiagnosis or migration. All cases of placenta previa need to be managed in a higher centre facility of blood component therapy and neonatal intensive care unit. Prematurity and low birth weight remain a significant cause for neonatal morbidity.

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