Treatment practices and implementation of guidelines for hyperbilirubinemia and rebound hyperbilirubinemia

2021 ◽  
pp. 1-7
Author(s):  
V. So ◽  
F. Khurshid
Keyword(s):  
Management Practices ◽  
Treatment Guidelines ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neurological Complications ◽  
Total Serum ◽  
Tertiary Care Centre ◽  
Treatment Termination ◽  
Treatment Practices ◽  
Guideline Values

BACKGROUND: Hyperbilirubinemia (HB), defined as elevated total serum bilirubin (TSB) levels, commonly affects neonates and requires prompt treatment to prevent neurological complications. Up to 10%of neonates experience rebound hyperbilirubinemia (RHB), requiring re-initiation of treatment. Unfortunately, treatment guidelines lack practical recommendations surrounding subthreshold phototherapy, treatment termination, and RHB investigations. We examined local management practices for HB and RHB treatment in a well newborn nursery. As a secondary aim, we investigated the association between treatment practices and RHB rates. METHODS: Retrospective chart review identified neonates treated for hyperbilirubinemia between January 2015 and December 2019 during their birth hospitalization at a tertiary care centre. Standardized data collection sheets were used to record treatment parameters. RESULTS: Over the 5-year period, there were 9683 births and 305 (3.15%) neonates received phototherapy. Of the treated cases, 20–25%were subthreshold to practice guideline values. Upon treatment termination 25–55%of cases had TSB levels within 3 mg/dL, which may increase the risk of RHB. In our cohort, 20.3%of treated cases experienced one episode of RHB and 3.9%experienced two episodes of RHB. Although clinicians evaluated neonates for RHB 0–12 hours following treatment termination prior to discharge, many cases were identified in outpatient settings and required re-admission for phototherapy. CONCLUSION: When managing HB and RHB, treatment practices such as when to terminate treatment in relation to threshold values, and timing of RHB investigations, are largely inconsistent amongst clinicians. Future studies are required to better understand the landscape of hyperbilirubinemia treatment beyond initiation of phototherapy.

scholarly journals Characteristics of infective endocarditis in a cancer population

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001664
Author(s):  
Cullen Grable ◽  
Syed Yusuf ◽  
Juhee Song ◽  
George M Viola ◽  
Owais Ulhaq ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Mortality Data ◽  
Limited Information ◽  
Tertiary Care Centre ◽  
Indwelling Catheters ◽  
Patients With Cancer ◽  
Duke Criteria ◽  
Immunocompromised State

BackgroundInfective endocarditis (IE) is more common in patients with cancer as compared with the general population. Due to an immunocompromised state, the need for invasive procedures, hypercoagulability and the presence of indwelling catheters, patients with cancer are particularly predisposed to the development of IE.ObjectivesLimited information exists about IE in patients with cancer. We aimed to evaluate the characteristics of patients with cancer and IE at our tertiary care centre, including a comparison of the microorganisms implicated and their association with mortality.MethodsA retrospective chart review of patients with cancer who had echocardiography for suspicion of endocarditis was conducted. A total of 56 patients with a confirmed diagnosis of cancer and endocarditis, based on the modified Duke criteria, were included in the study. Baseline demographics, risk factors for developing IE, echocardiography findings, microbiology and mortality data were analysed.ResultsFollowing the findings of vegetations by echocardiography, the median survival time was 8.5 months. Staphylococcus aureus was the most common organism identified as causing endocarditis. The mitral and aortic valves were the most commonly involved sites of endocarditis. Patients with S. aureus endocarditis (SAE) had a significantly poorer survival when compared with patients without SAE (p=0.0217) over the 12-month period from diagnosis of endocarditis.ConclusionsOverall survival of patients with cancer and endocarditis is poor, with a worse outcome in patients with SAE.

scholarly journals Medications for Anxiety: A Drug utilization study in Psychiatry Inpatients from a Tertiary Care Centre of Western Nepal

1970 ◽  
Vol 1 (4) ◽  
pp. 119-125 ◽  
Author(s):  
Indrajit Banerjee ◽  
Bedanta Roy ◽  
Brijesh Sathian ◽  
Indraneel Banerjee ◽  
Sai Sailesh Kumar ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Physical Dependence ◽  
Tertiary Care ◽  
Psychiatric Inpatient ◽  
Common Disease ◽  
Utilization Pattern ◽  
Tertiary Care Centre ◽  
Prescribing Pattern ◽  
Study Results ◽  
Anxiolytic Drugs

Background   Anxiety is the most widespread psychiatric disorder and generalized anxiety disorder is the most common disease seen in the primary care setting. Currently there are a number of anxiolytic drugs commercially available in the market for treatment of these disorders such as Benzodiazepines like Diazepam, Chlordiazepoxide, Alprazolam, Betablockers like Propranolol and H1 Antihistaminics like Hydroxyzine. Some of the newer anxiolytics like Buspirone in Azapirone group is marketed as better anxiolytic drug than the traditional drugs.  Buspirone is promoted as a better drug for anxiety, as it does not cause any sedation, tolerance or physical dependence. A need for study further increases as there is no sufficient data on utilization pattern of anxiolytics on Nepalese population. This is the first study done in the utilization pattern of anxiolytic drugs in inpatient in Nepal.  Methods This is an observational study undertaken between 1st October 2009 and 31st March 2010 at the Psychiatric inpatient Department of Manipal Teaching Hospital. The prescribing pattern of Anxiolytic drugs was measured. Out of a total of 240 cases who were admitted to psychiatry inpatient ward, 38 cases have received Anxiolytic drugs. Those who were critically ill with anxiety were included in the study.  Results Out of 240 cases who were admitted to psychiatry inpatient, 130 were male patients (54.2%), 95% CI [47.9,60.5] and the rest were female patients (45.8%), CI [39.5,52.1] . In 38 cases of anxiety, the age of the patient <40 years 89.5% and >40 years 10.5%. Anxiety was more common in females 71.1% than in males 28.9%. 68.4% of the patients were unemployed whereas only 31.6% of the patients were employed. 78.9% of the drugs were prescribed by trade name. Among the anxiolytics, the commonest drug prescribed was Alprazolam (50%), followed by Clonazepam (31.6%), Chlordiazepoxide (15.8%) and Lorazepam (2.6%). Conclusion Utilization patterns of drugs for anxiolytics were according to treatment guidelines and suggested a trend towards the use of shorter acting Benzodiazepines such as Alprazolam. Continuous and prolonged use of longer acting Benzodiazepines has resulted in dependence and may have withdrawal symptoms when the dosage of these drugs is reduced or treatment is stopped.http://dx.doi.org/10.3126/nje.v1i4.5753 Nepal Journal of Epidemiology 2011;1(4):119-125

Spectrum of neurological complications in chikungunya fever: experience at a tertiary care centre and review of literature

2019 ◽  
Vol 49 (2) ◽  
pp. 79-84 ◽  
Author(s):  
Kuljeet Singh Anand ◽  
Arun Kumar Agrawal ◽  
Jyoti Garg ◽  
Rajinder K Dhamija ◽  
Rakesh Kumar Mahajan
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Tertiary Care ◽  
The Elderly ◽  
Acute Disseminated Encephalomyelitis ◽  
Neurological Complications ◽  
Review Of Literature ◽  
Tertiary Care Centre ◽  
Tunnel Syndrome ◽  
Age Range

Chikungunya (CHIK) has re-emerged as a potential neurotropic virus, with outbreaks recently being reported from many parts of India. The present study was conducted to study the spectrum and outcome of neurological complications in patients of CHIK during the 2016 outbreak in Delhi. A total of 42 cases seropositive for IgM CHIK antibodies by MAC-ELISA and developing neurological complications were enrolled. The male:female ratio was 1:2 (age range = 18–90 years). The neurological manifestations observed were encephalitis (n = 12), bulbar palsy (n = 3), acute disseminated encephalomyelitis (n = 1), cerebellitis (n = 1), myelopathy (n = 1), radiculoneuropathy (n = 3), carpal tunnel syndrome (n = 9) and tremors (n = 1). Ten patients reported worsening of pre-existing neuropathic symptoms of diabetic peripheral neuropathy (n = 4) and carpal tunnel syndrome (n = 6). One patient had aggravation of myasthenia gravis leading to respiratory failure. The majority of patients (n = 32) showed a good outcome; ten had a poor prognosis, out of which four died, all from the encephalitis group, particularly the elderly with co-morbidities.

scholarly journals Prevalence of surgical site infection in general surgery in a tertiary care centre in India

2017 ◽  
Vol 4 (9) ◽  
pp. 3101 ◽  
Author(s):  
Ansul Kumar ◽  
Arpita Rai
Keyword(s):  
Surgical Site Infection ◽  
General Surgery ◽  
Surgical Procedure ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Exploratory Laparotomy ◽  
Site Infection ◽  
Tertiary Care Centre ◽  
One Year

Background: Surgical site infection (SSI) can be defined as an infection that is present up to 30 days after a surgical procedure if no implants are placed and up to one year if an implantable device was placed in the patient. SSI is a significant problem associated with major surgeries and is the 3rd most frequently reported nosocomial infection. This study aims to study the prevalence of SSI in the Department of Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi.Methods: A retrospective study was undertaken at the Department of General Surgery for a period of one year. Retrospective chart review was conducted from the hospital database. The rate of SSI was studied in relation to its type, the type of surgical procedure and elective vs emergency surgeries.Results: The present study revealed 12.5% prevalence of SSI in Department of General Surgery, RIMS. Among the 3 types, superficial incision SSI was most prevalent followed by deep incisional SSI and finally by organ/space SSI. The surgical procedure most commonly associated with SSI was exploratory laparotomy. An alarming 17.7% of SSI was associated with emergency surgeries as compared to 12.5% of elective surgeries.Conclusions: The consequences of SSIs greatly impact patients and the healthcare systems. Prevention of SSI requires a multifaceted approach targeting pre-, intra-, and postoperative factors. It is imperative that facilities have open-minded management teams, regulatory agencies and medical associations that want to provide the foundation required to generate a culture of patient safety in our health care systems.

Evaluation of conventional troponin I testing for the detection of myocardial dysfunction in children

2020 ◽  
Author(s):  
Eimear McGovern ◽  
Christine Voss ◽  
Nicole M Hemphill ◽  
Shubhayan Sanatani ◽  
Vilte Barakauskas ◽  
...  
Keyword(s):  
Predictive Value ◽  
Myocardial Injury ◽  
Troponin I ◽  
Myocardial Dysfunction ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Healthy Children ◽  
Clinical Predictors ◽  
Tertiary Care Centre

Abstract Objectives Troponin is a marker of myocardial injury but is not well studied in children. Our primary objective was to ascertain the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional troponin I for the detection of acute myocardial dysfunction in previously healthy children. Our secondary objective was to identify clinical predictors of myocardial dysfunction in the setting of elevated troponin. Study Design This was a retrospective chart review in a single, paediatric, tertiary care centre of troponin tests performed in all admitted children over a 4-year period. Demographics, symptoms, signs, chest x-ray, ECG, and echocardiogram abnormalities were documented. Myocardial dysfunction was presumed to be absent when the patient had a normal cardiac assessment, with or without echocardiography, and did not re-present. Results From January 2014 through December 2017, 566 patients had troponin tested as a screen for myocardial injury. Troponin was positive in 38 of 566 cases (6.7%). Myocardial dysfunction was detected in 9 of 566 cases (1.6%). Troponin was elevated in six of nine cases of myocardial dysfunction. The sensitivity of conventional troponin I for detecting acute myocardial dysfunction was 66% (95% confidence interval [CI] 30 to 93%). The specificity was 94% (95% CI 92 to 96%). PPV was 16% (95% CI 6 to 31%) and NPV 99% (95% CI 98 to 100%). An abnormal ECG was more prevalent in patients with a true positive versus a false-positive troponin result (P=0.03). Conclusion Troponin testing identified few cases of myocardial dysfunction. We found the test to have only 66% sensitivity. Troponin testing as a screen for myocardial injury in children has limited utility.

P41 An audit of the screening and treatment of uveitis in children with juvenile idiopathic arthritis (jia) at a paediatric tertiary centre

2018 ◽  
Vol 103 (2) ◽  
pp. e1.46-e1
Author(s):  
Aragon Cuevas Octavio ◽  
Roughley Amy ◽  
Morecroft Charles
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Treatment Guidelines ◽  
Tertiary Care ◽  
Primary Objective ◽  
British Society ◽  
List Type ◽  
Tertiary Care Centre ◽  
Screening Guidelines ◽  
Junior Staff ◽  
Clinical Records

AimThe primary objective of this study was to audit the centre’s and its satellite clinics’ compliance with the British Society for Paediatric and Adolescent Rheumatology (BSPAR) and the Royal College of Ophthalmology (RCO) uveitis screening guidelines. The secondary objective of the study was to compare the centre’s compliance with the treatment guidelines of JIA and uveitis, as recommended by NHS England and following results from the SYCAMORE trial.MethodThe clinical records of 54 patients recruited from the Childhood Arthritis Prospective Study (CAPS) were analysed over a six-week period. The data collected included patient demographics, JIA sub-type, date of referral and uveitis screening, presence of uveitis and treatment (if applicable), and details of medication prescribed for JIA. Information was gathered from the centre’s EPMA system and paper records, and was requested from the satellite centres if needed. The raw data was inputted into the statistical software SPSS v23 to evaluate the categorical data. Chi-squared tests were performed on the data to detect any potential correlation between various demographic variables and primary and secondary outcomes.Results92.6% (50/54) of patients were referred for uveitis screening after being diagnosed with JIA. For 3 (5.6%) patients there was no evidence of referral and for 1 (1.9%) patient the documentation was not clear. 90% (45/50) of the referred patients were screened for uveitis. For the remaining 5 (10%) patients, there was no documentation of whether screening had taken place. The compliance of ophthalmology departments with the BSPAR/RCO guidelines was poor with only 17.8% (8/45) of patients being screened within six weeks of the ophthalmology referral. 8.9% of patients (4/45) were diagnosed with uveitis and 2 of these patients received adalimumab as part of the treatment regime. The treatment for JIA was documented for 75.9% (41/54) of patients and all treatments (100%) were in line with the current recommendations from NHS England. Statistical correlations could not be identified due to the low numbers of patients.ConclusionThe BSPAR/RCO guidelines suggest that all new patients are to be screened as soon as possible, no longer than 6 weeks after referral.1 As uveitis is commonly an asymptomatic condition2 with severe complications such as blindness,3 routine screening is imperative. Overall, the compliance of the tertiary care centre and satellite clinics with the BSPAR/RCO guidelines was poor. Immediate changes are required to improve patient care, focusing on facilitating sharing of documentation and communication between the primary centre and its satellite clinics. Raising awareness of targets recommended by BSPAR/RCO to emphasise the importance of timely uveitis screening via regional training days should take place. Ensuring all junior staff that might see JIA patients in clinic are aware of the need of uveitis screening via offering structured training during their rotation is recommended.ReferencesBSPAR: Guidelines for Screening for Uveitis in Juvenile Idiopathic Arthritis (JIA) (1st ed.)6 Oct 2016.Engelhard SB, Asima B, Ashvini RK. Causes of uveitis in children without juvenile idiopathic arthritis. Clinical Ophthalmology2015;9:1121–1128.Juvenile Idiopathic Arthritis (JIA). Cincinnatichildrens.org. N.p., 5 Oct 2016.

Emerging trends in the prenatal diagnosis of complex CHD and its influence on infant mortality in this cohort

2018 ◽  
Vol 29 (3) ◽  
pp. 270-276 ◽  
Author(s):  
Sudheer R. Gorla ◽  
Abhishek Chakraborty ◽  
Ashish Garg ◽  
Rubee A. Gugol ◽  
Richard E. Kardon ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Infant Mortality ◽  
Chart Review ◽  
Fetal Echocardiography ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Tertiary Care Centre ◽  
Prenatal Detection ◽  
Emerging Trends ◽  
Conotruncal Anomalies

AbstractBackgroundFetal echocardiography is the main modality of prenatal diagnosis of CHD. This study was done to describe the trends and benefits associated with prenatal diagnosis of complex CHD at a tertiary care centre.MethodsRetrospective chart review of patients with complex CHD over an 18-year period was performed. Rates of prenatal detection along with early and late infant mortality outcomes were studied.ResultsOf 381 complex CHD patients born during the study period, 68.8% were diagnosed prenatally. Prenatal detection rate increased during the study period from low-50s in the first quarter to mid-80s in the last quarter (p=0.001). Rate of detection of conotruncal anomalies increased over the study period. No infant mortality benefit was noted with prenatal detection.ConclusionsImproved obstetrical screening indications and techniques have contributed to higher proportions of prenatal diagnosis of complex CHD. However, prenatal diagnosis did not confer survival benefits in infancy in our study.

scholarly journals A125 SNARE TIP SPRAY COAGULATION FOR NON-CONTACT HEMOSTASIS: A SINGLE OPERATOR RETROSPECTIVE STUDY OF CLINICAL OUTCOMES.

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 107-108
Author(s):  
A Fetz ◽  
S Gan
Keyword(s):  
Clinical Outcomes ◽  
Argon Plasma Coagulation ◽  
Tertiary Care ◽  
Argon Plasma ◽  
Retrospective Chart Review ◽  
Radiation Proctitis ◽  
Vascular Lesions ◽  
Tertiary Care Centre ◽  
Endoscopic Method ◽  
Single Operator

Abstract Background An emerging non-contact endoscopic method for hemostasis is the use of spray coagulation (SC) using a polypectomy snare tip. Other non-contact options, such as argon plasma coagulation (APC), can be inconvenient and costly. Our current practice includes using SC where APC would be traditionally indicated. Aims The aim of this study was to characterize the clinical outcomes, including rates of successful hemostasis, rebleeding, and complications, for snare tip SC in hemostasis. Methods We conducted a retrospective chart review of all patients who underwent therapeutic endoscopy for hemostasis using snare tip SC by a single operator at a large Canadian tertiary care centre between January 2018 and September 2020. Results 14 patients, including 10 males and 4 females, were included. 5 (35%) patients received SC during an EGD, 5 (35%) patients during a colonoscopy, and 4 (29%) patients during a small bowel enteroscopy. Mean age was 74.4 (±11). All patients were referred for work-up of gastrointestinal bleeding or anemia. 5 (35%) patients were treated for vascular lesions including AVMs or angioectasias, 4 (29%) patients for GAVE, 3 (21%) patients for radiation proctitis, and 2 (14%) patients for bleeding ulcers. Adequate hemostasis, defined by cessation of bleeding symptoms, lack of a 10g/L or more decrease in hemoglobin post-procedure, and no further endoscopic therapies in the subsequent 28 days, was achieved in 11 patients (79%). 2 of the 3 patients in which adequate hemostasis was not achieved had additional investigations in which a second source of bleeding was found and treated. 1 patient with colonic AVMs and 1 patient with radiation proctitis required a repeat treatment in 2 weeks and 6 months, respectively. There were no incidence of prolonged abdominal pain, perforations or deaths. Conclusions Snare tip spray coagulation appears to be a safe and effective modality for non-contact hemostasis. Larger studies will help solidify its use in daily practice. Funding Agencies None

scholarly journals Diphtheria: a re-emerging infectious disease

2021 ◽  
Vol 7 (3) ◽  
pp. 475
Author(s):  
Shashidhar S. Suligavi ◽  
Divya K. Vishwanath ◽  
Shilpa Gokale ◽  
S. S. Doddamani
Keyword(s):  
Tertiary Care ◽  
Case Fatality ◽  
Signs And Symptoms ◽  
Neurological Complications ◽  
Tertiary Care Centre ◽  
Medical College ◽  
Gram Positive Bacteria ◽  
Immunization Status ◽  
The Relationship

<p class="abstract"><strong>Background: </strong>Diphtheria is a fatal bacterial infection which affects the mucous membranes of oropharyngeal and nasal cavity, caused by aerobic gram-positive bacteria Corynebacterium diphtheriae. Clinical diphtheria is on the increase worldwide, mainly affecting developing countries and leading cause of morbidity and mortality. We sought to understand its presentation among patients and also early intervention of the disease. The objective of the study was to study the clinico-demographic profile of cases, the relationship between immunization status and clinical disease, the role of microbiological investigations and to identify complications in diphtheria cases.</p><p class="abstract"><strong>Methods:</strong> This study is a hospital based observational study from September 2019 - September 2020 at a tertiary care centre, S.Nijalingappa Medical College and HSK hospital, Bagalkot, Karnataka. The cases were analysed with respect to demographic details, clinical features, immunization status, microbiological confirmation and complications of diphtheria cases.</p><p class="abstract"><strong>Results: </strong>32 cases were suspected to have diphtheria on clinical examination. The mean age of presentation was 15 years. Fever, sore throat, difficulty in swallowing, neck swelling and pseudomembrane in oral cavity were the common signs and symptoms. Airway compromise, myocarditis and neurological complications were noted. Antidiphtheritic serum (ADS) was tried in all 32 cases and 8 cases had adverse reactions. Case fatality rate was 12.5%.</p><p class="abstract"><strong>Conclusions: </strong>Shifting of occurrence of diphtheria in the age group of &gt;5 years suggest the need to improve and strengthen the immunization program specially the booster doses.</p>

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