scholarly journals Clinico-radiological Aspects of Neurocysticercosis in Pediatric Population in a Tertiary Hospital

2013 ◽  
Vol 52 (191) ◽  
Author(s):  
Bandana Shrestha ◽  
Prabha Mainali ◽  
Sujan Sayami ◽  
Om Kumar Shrestha
Keyword(s):  
Ct Scan ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Partial Seizures ◽  
Male Predominance ◽  
Perilesional Edema ◽  
Adequate Information ◽  
Clinical Presentations ◽  
The Mean

Introduction: Neurocysticercosis (NCC) is common in developing countries including Nepal. Clinical presentations vary depending on the CT scan findings of head. Adequate information of NCC in children from Western Nepal is lacking. This study was conducted with an objective of evaluating the most common clinical and radiological picture in children suffering from NCC at a tertiary care teaching hospital in Western Nepal. Methods: Hospital records of all pediatric inpatients, admitted from 16th June 2010 to 15th December 2012, consistent with the diagnosis of Neurocysticercosis were reviewed.Results: Among the 217 patients that either presented seizure or other neurological deficit, 49 were diagnosed as Neurocysticercosis. Their age varied between 2.6 years and 14 years with the mean age of 10.6 years and the peak age of 12 years among diagnosed inpatients. It also showed slight male predominance with the ratio of male and female being 1.22:1. Sorted based on geographical distribution, the maximum of 14 (28.6%) patients were from Kaski district, closely followed by Tanahun district with 13 (26.5%). 38 (77.5%) of the presentations were seizures, partial seizures being most common. 44 (89.8%) of the lesions were single, with 20 (40.8%) predominantly residing in the parietal region, 30 (61.22%) were in transitional stage. However, number of lesions discovered from CT scan of head showed no significance in association with seizure types (p=0.84). In addition, perilesional edema and scolex within the lesion were noted in 67.34% and 18.36% of the cases respectively._______________________________________________________________________________________Keywords: clinico-radiological profile; neurocysticercosis; pediatric population._______________________________________________________________________________________

scholarly journals Outcome of Primary Intracerebral Hemorrhage: A Study in Tertiary Care Center

2020 ◽  
Vol 2 (2) ◽  
pp. 35-40
Author(s):  
Jagat Narayan Rajbanshi ◽  
Pankaj Raj Nepal
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Systolic Blood Pressure ◽  
Care Center ◽  
Tertiary Care ◽  
Brain Parenchyma ◽  
Chronic Hypertension ◽  
Midline Shift ◽  
Male Predominance ◽  
The Mean

 Background: Intracerebral hemorrhage (ICH) is an irreversible phenomenon inside the brain parenchyma resulting in mild to severe neurological deficit. Based on etiology it is broadly divided into primary and secondary. Primary ICH is usually due to the rupture of Charcot-Bouchard aneurysm and chronic hypertension. Charcot – Bouchard aneurysms are supposed to get formed due to lipohyalinosis. With the aim to evaluate the outcome of primary ICH admitted to our institute this study is performed. Materials and methods: This is a prospective analytical study, where all the consecutive patients of the primary ICH were collected. Quantitative variables like age, the volume of hematoma, midline shift, GCS, and systolic blood pressure (SBP) were presented as mean and standard deviation (S.D). Whereas, qualitative variables like gender, site, and side of hematoma, type of treatment, best motor response were presented in frequency and percentage. The outcome of the patient was measured using the Glasgow outcome scale (GOS) and the association between qualitative/quantitative variables and GOS was done using the chi-square test or Fischer exact test whenever applicable in SPSS20. Results: There were a total of 31 patients with a mean age of 59.81(S. D 15.8) year and male predominance (74%). The mean volume of hematoma was 40 ml. Similarly, midline shift ranged from zero to 14 mm. The majority of primary ICH were located in basal ganglia (35%) and on the right side (52%). The mean GCS at presentation was 12.1 (S.D 2.166). Mean Systolic blood pressure was 163.77 mmHg (S.D 34.6 mmHg) with maximum SBP up to 240mmHg. There was a 14% mortality in this study group with favorable outcome (GOS 4 and 5) in 82%. GOS was significantly associated with the volume of hematoma and midline shift. Conclusion: The outcome of primary ICH is strongly associated with the volume of hematoma and midline shift. They were generally associated with hypertension with a mean systolic blood pressure of >160 mm Hg.

scholarly journals Outcome of a Low-Cost Glaucoma Implant versus the Baerveldt Glaucoma Implant for Paediatric Glaucoma in a Tertiary Hospital in Egypt

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Mahmoud F. Rateb ◽  
Hazem Abdel Motaal ◽  
Mohamed Shehata ◽  
Mohamed Anwar ◽  
Dalia Tohamy ◽  
...  
Keyword(s):  
Low Cost ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Glaucoma Drainage Device ◽  
Drainage Device ◽  
Group A ◽  
Baerveldt Glaucoma Implant ◽  
The Mean ◽  
Group B

Purpose. To compare safety and efficacy between a low-cost glaucoma drainage device (GDD), the Aurolab aqueous drainage implant (AADI), and the Baerveldt glaucoma implant (BGI) in refractory childhood glaucoma in Egypt. Methods. This is a retrospective study of patients who received either an AADI or BGI at a tertiary care postgraduate teaching institute. Children aged <16 years with uncontrolled intraocular pressure (IOP) with or without prior failed trabeculectomy who completed a minimum 6-month follow-up were included. The outcome measures were IOP reduction from preoperative values and postoperative complications. Results. Charts of 57 children (younger than 16 years old) diagnosed with refractory childhood glaucoma were included. Of these, 27 eyes received AADI implants (group A), while 30 received BGI implants (group B). The mean preoperative baseline IOP was 34 ± 5 mmHg in group A versus 29 ± 2 mmHg in group B (p=0.78) in patients on maximum allowed glaucoma medications. In group A versus group B, the mean IOP decreased to 13.25 ± 8.74 mmHg (p=0.6), 12.8 ± 5.4 mmHg (p=0.7), and 12.6 ± 5.6 mmHg (p=0.9) after 1 week, 3 months, and 6 months, respectively. However, in group A, an anterior chamber reaction appeared around the tube in 14 cases starting from the first month and resolved with treatment in only 4 cases. In the other 10 cases, the reaction became more severe and required surgical intervention. This complication was not observed in any eye in group B. Conclusion. AADI, a low-cost glaucoma implant, is effective in lowering IOP in patients with recalcitrant paediatric glaucoma. However, an intense inflammatory reaction with serious consequences developed in some of our patients; we believe these events are related to the valve material. We therefore strongly recommend against its use in children.

scholarly journals The Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ljiljana Crnobrnja ◽  
Manogna Metlapalli ◽  
Cathy Jiang ◽  
Mauli Govinna ◽  
Andy K. H. Lim
Keyword(s):  
Time Window ◽  
Critical Time ◽  
Tertiary Hospital ◽  
Multivariable Logistic Regression Model ◽  
Critical Window ◽  
Male Predominance ◽  
Factors Associated ◽  
Intravenous Insulin ◽  
The Mean ◽  
Pre Treatment

AbstractTreatment of hyperkalemia with intravenous insulin-dextrose is associated with a risk of hypoglycemia. We aimed to determine the factors associated with hypoglycemia (glucose < 3.9 mmol/L, or < 70 mg/dL) and the critical time window with the highest incidence. In a retrospective cohort study in a tertiary hospital network, we included 421 adult patients with a serum potassium ≥ 6.0 mmol/L who received insulin-dextrose treatment. The mean age was 70 years with 62% male predominance. The prevalence of diabetes was 60%, and 70% had chronic kidney disease (eGFR < 60 ml/min/1.73 m2). The incidence of hypoglycemia was 21%. In a multivariable logistic regression model, the factors independently associated with hypoglycemia were: body mass index (per 5 kg/m2, OR 0.85, 95% CI: 0.69–0.99, P = 0.04), eGFR < 60 mL/min/1.73 m2 (OR 2.47, 95% CI: 1.32–4.63, P = 0.005), diabetes (OR 0.57, 95% CI 0.33–0.98, P = 0.043), pre-treatment blood glucose (OR 0.84, 95% CI: 0.77–0.91, P < 0.001), and treatment in the emergency department compared to other locations (OR 2.53, 95% CI: 1.49–4.31, P = 0.001). Hypoglycemia occurred most frequently between 60 and 150 min, with a peak at 90 min. Understanding the factors associated with hypoglycemia and the critical window of risk is essential for the development of preventive strategies.

scholarly journals A Histomorphological Pattern Analysis of Pulmonary Tuberculosis in Lung Autopsy and Surgically Resected Specimens

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Mamta Gupta ◽  
Flora D. Lobo ◽  
Deepa Sowkur Anandarama Adiga ◽  
Abhishek Gupta
Keyword(s):  
Pulmonary Tuberculosis ◽  
Pattern Analysis ◽  
Surgical Intervention ◽  
Miliary Tuberculosis ◽  
Frequent Pattern ◽  
Male Predominance ◽  
Clinical Presentations ◽  
Age Of Diagnosis ◽  
The Mean ◽  
Necrotizing Granulomas

Background. Tuberculosis (TB) is a major cause of morbidity and mortality globally. Many cases are diagnosed on autopsy and a subset of patients may require surgical intervention either due to the complication or sequelae of TB. Materials and Methods. 40 cases of resected lung specimens following surgery or autopsy in which a diagnosis of pulmonary tuberculosis was made were included. Histopathological pattern analysis of pulmonary tuberculosis along with associated nonneoplastic changes and identification of Mycobacterium tuberculosis bacilli was done. Results. The mean age of diagnosis was 41 years with male predominance (92.5%). Tuberculosis was suspected in only 12.1% of cases before death. Seven cases were operated upon due to associated complications or suspicion of malignancy. Tubercular consolidation was the most frequent pattern followed by miliary tuberculosis. The presence of necrotizing granulomas was seen in 33 cases (82.5%). Acid fast bacilli were seen in 57.5% cases on Ziehl-Neelsen stain. Conclusion. Histopathology remains one of the most important methods for diagnosing tuberculosis, especially in TB prevalent areas. It should be considered in the differential diagnosis of all respiratory diseases because of its varied clinical presentations and manifestations.

scholarly journals Role of Biomarkers in Differentiating New-onset Seizures from Psychogenic Nonepileptic Seizures

2017 ◽  
Vol 08 (04) ◽  
pp. 581-584 ◽  
Author(s):  
Mahendra Javali ◽  
Purushottam Acharya ◽  
Shripal Shah ◽  
Rohan Mahale ◽  
Pushparaja Shetty ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Serum Prolactin ◽  
Review Of Literature ◽  
Partial Seizures ◽  
Psychogenic Nonepileptic Seizures ◽  
Nonepileptic Seizures ◽  
Clonic Seizures ◽  
The Mean ◽  
New Onset

ABSTRACT Introduction: Review of literature revealed very limited studies considering a combination of serum prolactin (PRL) and serum creatine kinase (CK) as markers for differentiating epileptic and psychogenic nonepileptic seizures (PNES). Therefore, in the present study, we analyzed the role of serum PRL and serum CK, individually and in combination. Methodology: This prospective study was conducted in a tertiary care medical teaching hospital over a period of 18 months. Patients aged over 15 years suspected to have new-onset seizures presenting within 5 h of ictus were included in this study. CK, serum PRL was measured at 0–1, 1–3, and 3–5 h after seizures. Results: Hundred subjects were studied for the role of serum PRL and serum CK in differentiating epileptic and PNES. The mean age was 42.24 years with a male:female ratio of 1.27:1. All patients of generalized tonic–clonic seizures (GTCS), who presented within 1 h, had elevated PRL, whereas 75% of patients with partial seizures had elevated PRL within 1 h of presentation. Nearly 91.66% of patients with GTCS who presented within 1 h had elevated CPK, whereas 70% of patients with partial seizures had elevated CPK. None of the patients diagnosed with PNES showed rise in either of the markers. Conclusion: In the present study, none of the patients with PNES showed raise in either serum PRL or CK. However, there was no correlation between the types of seizure and PRL or serum CK levels.

scholarly journals Prevalence of Atrial Fibrillation in patients attending emergency department of Shahid Gangalal National Heart Centre, Kathmandu, Nepal

2016 ◽  
Vol 13 (1) ◽  
pp. 1-4
Author(s):  
Krishna Prasad Adhikari ◽  
Rabi Malla ◽  
Deepak Limbu ◽  
Binaya Kumar Rauniyar ◽  
Sudhir Regmi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Western World ◽  
National Heart ◽  
Clinical Presentations ◽  
The Mean ◽  
Rheumatic Heart ◽  
Demographic Features

Background and Aims: Atrial fibrillation (AF) is the most common sustained arrhythmia. This study aims to evaluate its prevalence in patients attending emergency department of tertiary care cardiac centre.Methods: It was a prospective observational study of 1012 consecutive patients who attended emergency department of Shahid Gangalal National Heart Centre from September 2014 to November 2014. Electrocardiogram, demographic features, diagnosis and clinical presentations were reviewed.Results: Among the 1012 patients, 553 (54.6%) were male and 459(45.4%) were female. Mean age was 52.13} 17 years. A total of 140 patients (13.8%) patients had AF. The mean age of patients with AF was 55 years. The prevalence of AF was higher in female than male (19.2% Vs 9.4%). Among the Rheumatic heart disease patients, seventy percentages of them had AF. Dyspnea was the commonest symptom of patients with AF followed by palpitation.Conclusion: The prevalence of AF in our study is higher than in western world mainly because of endemic rheumatic heart disease.Nepalese Heart Journal 2016; 13(1): 1-4

scholarly journals Burden of herpes zoster among Brazilian adults – a hospital-based study

2021 ◽  
Vol 15 ◽  
Author(s):  
Ariane de Jesus Lopes de Abreu ◽  
Amanda Venys ◽  
Wilson Jacob ◽  
Thiago da Silva ◽  
Angela Henrique ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Clinical Features ◽  
Medical Records ◽  
Immunosuppressive Agents ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Hospital Length Of Stay ◽  
First Episode ◽  
Care Hospital ◽  
The Mean

OBJECTIVE: To describe the clinical features of herpes zoster in adult patients treated at a large tertiary care hospital in Brazil over a 5-year period. METHODS: The medical records of suspected herpes zoster cases (based on ICD-10 codes) were identified for full review. Convenience sampling was used to select the medical records from a tertiary hospital in São Paulo. We collected data about co-existing medical conditions, medication use, herpes zoster-related clinical features and outcomes, and healthcare resource utilization. RESULTS: A total of 249 individuals whose first episode of herpes zoster occurred between 2010 and 2014 were included. The mean patient age was 55 years (range 18–96), and the majority were women (63.05%) and aged ≥ 50 years (63.86%). Medical comorbidities were reported in 92.77%, including diabetes (19.68%) and HIV infection (7.63%). Current/recent use of immunosuppressive agents was reported in 31.73%. A total of 65.86% of the patients were hospitalized: 102 patients (40.96%) were admitted for herpes zoster management, while 62 (24.90%) were already receiving inpatient care. The mean hospital length of stay was 16.60 days. One-third (34.14%) were managed as outpatients. Postherpetic neuralgia was reported as a complication in 18.07%. CONCLUSIONS: This retrospective descriptive study found a high frequency of herpes zoster episodes in older adults with comorbidities who sought medical care at a tertiary hospital. These results also underscore the importance of understanding the epidemiology of this disease and developing control strategies for these at-risk populations in Brazil.

scholarly journals Non-islet cell tumor-induced hypoglycemia: a report of five cases and brief review of the literature

2013 ◽  
Vol 2013 ◽  
Author(s):  
Pinaki Dutta ◽  
Anuradha Aggarwal ◽  
Yashpal Gogate ◽  
Uma Nahar ◽  
Viral N Shah ◽  
...  
Keyword(s):  
Islet Cell ◽  
Clinical Laboratory ◽  
Islet Cell Tumor ◽  
Tertiary Care ◽  
Cell Tumor ◽  
List Type ◽  
Mesenchymal Tumors ◽  
Epithelial Tumor ◽  
Male Predominance ◽  
The Mean

Summary We describe the clinical presentation, diagnostic and management issues in five cases of non-islet cell tumor hypoglycemia (NICTH), diagnosed at a tertiary care institute over a period of 15 years. The clinical, laboratory, and histopathological findings of these patients along with diagnostic utility of IGF2:IGF1 ratio are discussed. The mean age of presentation was 52 years, with a male predominance (3:2). Three patients presented with recurrent episodes of fasting hypoglycemia and it was detected in other two patients during hospitalization. Two patients had acromegaloid features that regressed following treatment. One patient had hypokalemia. Low levels of insulin, C-peptide, GH, and IGF1 were invariably found in all. The IGF2 level was elevated in only one patient; however, IGF2:IGF1 ratio was more than 10 in four of the five patients. The mean tumor size was 16.4 cm and mean weight was 3.6 kg. Four patients had mesenchymal tumors and one had epithelial tumor. NICTH is a rare cause of hypoglycemia. Hypoinsulinemic hypoglycemia with low IGF1 and IGF2:IGF1 ratio more than 10 is suggestive of this entity. Learning points NICTH should be considered in patients presenting with tumor of mesenchymal origin and hypoglycemia. Hypoinsulinemic hypoglycemia with low IGF1 is a strong biochemical evidence of NICTH. IGF2:IGF1 ratio of more than 10 is a complementary investigation in the absence of an assay facility for IGF2.

scholarly journals Clinicopathologic Presentation and Management of Malignant Orbito-ocular Tumors at a Tertiary Care Hospital in Nepal

2021 ◽  
Vol 13 (2) ◽  
pp. 11-20
Author(s):  
Purnima Rajkarnikar Sthapit ◽  
Malita Amatya ◽  
Hom Bahadur Gurung ◽  
Rohit Saiju
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Excision ◽  
Care Hospital ◽  
Clinical Presentations ◽  
Different Types ◽  
The Mean ◽  
A Prospective Study ◽  
Incision Biopsy ◽  
Red Eyes

Introduction: This study was conducted to evaluate the clinical presentations and management of various Orbito-ocular malignancies in Nepal. Materials and methods: This is a prospective study of ocular malignant cases conducted at a tertiary care eye hospital in Kathmandu, Nepal. One hundred and seventeen newly diagnosed eyes with ocular malignancy of 106 patients presenting to the clinic in a year from September 2018 to August 2019 were included for analysis. Patients’ demography, clinical features, various types of malignancies seen in eyes and their management were evaluated. Results: The mean age of patients was 30.35 years with a range from 1 month to 84 years and standard deviation of 26.63. 56% of the total were male. Red eyes and visible mass were the most common symptoms in 23% with intraocular contents in 48% being the most common site involved. Different types of ocular malignancies were detected, among which retinoblastoma was the most common in 38% of patients. Diagnosis in most patients was clinical and/or radiological; incision biopsy was required in 1.7% patients only. Surgical excision of the tumor was the most common treatment done in 29% followed by enucleation in 27% of eyes.  Bilateral involvement of the eyes was seen in 10% of the patients.  Conclusion: Malignant orbito-ocular tumors can be seen in any age group. Retinoblastoma is the commonest malignancy seen. With the help of imaging, diagnosis is near accurate; hence biopsy is not required in most cases before commencing treatment.

scholarly journals Evaluation of Drug Use Patterns in Intensive Care Unit of Tertiary Care Hospital: A Descriptive Cross-Sectional Study

2021 ◽  
Vol 10 (1) ◽  
pp. 31-35
Author(s):  
Rinku Ghimire ◽  
Rupesh Kumar Shreewastav
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Prescription Patterns ◽  
Male Predominance ◽  
The Mean

Background: Prescription of rational drugs is needed to save critically ill patients. This study was conducted to assess the prescription patterns of drugs in the intensive care unit. Materials and Methods: A descriptive cross-sectional study among patients admitted in intensive care unit from March 2020 to February 2021 after approval from the Institutional Review Committee (ref no. 344 /2019). Demographic profile, prescription patterns, the average number of drugs used, route of administration, and duration of hospitalization were recorded based on the pre-structured questionnaires. Convenient sampling was chosen. Data were analyzed by SPSS, version 20. Results: Prescription patterns of 225 were analyzed. The mean age was 55.60 ± 20.16 years with a male predominance of 131(58.2%). Cardiac disorders 57(25.3%) were the most common admitting diagnosis followed by pulmonary, neurological, and kidney disorders. The average length of hospital stay was 4.14 days (range 1-38 days). A total of 887 drugs were prescribed. The mean number of drugs prescribed per patient was 7.71 ± 1.92. Parenteral drugs accounted for 81.39%. Antibiotics were prescribed to all patients. Intravenous fluids were given to 62.2% of patients, blood and blood products to 21.33%. Thromboprophylaxis was used in 15 (6.7%) patients. Seven hundred twenty-two (81.39%) drugs were injectables, 129(14.54%) were used by the oral or nasogastric route and 36 (4.05%) were inhaled drugs. Conclusion: Newer generations antibiotics were the most commonly prescribed drugs. Pantoprazole, Metoclopramide, and Hydrocortisone were the top three most commonly prescribed individual drugs. There was marked underuse of thromboprophylaxis, analgesics, and sedatives.  

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