scholarly journals Treatment Realities of Headache Disorders in Rural Germany by the Example of the Region of Western Pomerania

2021 ◽  
Vol 11 (7) ◽  
pp. 839
Author(s):  
Anne Thiele ◽  
Sebastian Strauß ◽  
Anselm Angermaier ◽  
Lara Klehr ◽  
Luise Bartsch ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Headache Disorders ◽  
National Guidelines ◽  
Tertiary Care Centre ◽  
Headache Patient ◽  
Headache Diagnosis ◽  
Headache Management ◽  
Headache Clinic ◽  
Demographic Background ◽  
First Time

(1) Background: Headache disorders are among the most disabling medical conditions but the supply with experienced providers is outpaced by the demand for service. It is unclear to what extent particularly patients in rural regions are affected by limited access to comprehensive care. Furthermore, it is unknown what role general practitioners (GPs) play in headache care. (2) Methods: First-time consultations to a specialised headache clinic at a tertiary care centre were asked to participate. Their socio-demographic background, general and headache-specific medical history, disability and quality of life (QoL) were assessed. Additionally, 176 GPs in neighbouring districts were contacted regarding headache management. (3) Results: We assessed 162 patients with first-time consultations (age 46.1 ± 17.0 years, 78.1% female), who suffered from migraine (72%), tension type, cluster and secondary headaches (each 5–10%). About 50% of patients received a new headache-diagnosis and 60% had treatment inconsistent with national guidelines. QoL was significantly worse in all domains compared to the general population. About 75% of GPs see headache patients at least several times per week, and mostly treat them by themself. (4) Conclusions: More than every second headache patient was neither correctly diagnosed nor received guideline adherent treatment. Headache-related disability is inferior to what is expected from previous studies. Access to specialised health care is more limited in rural than in urban regions in Germany and GPs request more training.

scholarly journals Clinical, laboratory profile & antibiotic use in first time Wheezers in the tertiary care centre in the rural area

2016 ◽  
Vol 3 (11) ◽  
pp. 818-825
Author(s):  
Dr M. Bala Gopal ◽  
◽  
Dr N. Shiva Ramakrishnan Babji ◽  
Dr Vinayagamoorthy Venugopal ◽  
Dr. Venkata Naveen Kumar ◽  
...  
Keyword(s):  
Rural Area ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Laboratory Profile ◽  
First Time

scholarly journals Appropriateness of the Empirical Antibiotics Prescribed and Their Concordance with National Guidelines for Three Selected Infections among Cancer Patients in a Tertiary Care Centre in Sri Lanka

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Gayashan Chathuranga ◽  
Thushari Dissanayake ◽  
Neluka Fernando ◽  
Chandanie Wanigatunge
Keyword(s):  
Sri Lanka ◽  
Cancer Patients ◽  
Antibiotic Prescription ◽  
Tertiary Care ◽  
Bacterial Isolates ◽  
National Guidelines ◽  
Tertiary Care Centre ◽  
Microbiological Methods ◽  
Empirical Antibiotics ◽  
Tract Infections

Background. Prophylactic and empirical antibiotic use is essential in cancer patients due to the underlying immune deficiencies. We examined the spectrum of causative bacteria and the appropriateness of empirical antibiotic prescription for three selected infections in cancer patients. Methodology. A descriptive cross-sectional study was conducted at the National Institute of Cancer (NIC), Sri Lanka, from June 2018 to February 2019. Bacterial isolates obtained from adult cancer patients with a diagnosis of lower respiratory tract infections (LRTI), skin and soft tissue infections (SSTI), or urinary tract infections (UTI) were included. Causative bacteria were identified and the antibiotic susceptibility was determined by standard microbiological methods. Empirical therapy was defined as appropriate if the isolated pathogen was susceptible in vitro to the given antibiotic. Results. A total of 155 bacterial isolates were included in the analysis. LRTI were the most prevalent infections (37.2%, 55/148) encountered during the study period. Majority (90.9%) of the isolated bacteria were ESKAPE pathogens. Klebsiella pneumoniae was the most frequent pathogen causing LRTI (42.4%, 25/59), whereas Escherichia coli (32%, 16/50) and Staphylococcus aureus (26.1%, 12/46) predominated in UTI and SSTI, respectively. Meropenem was the most prescribed empirical antibiotic for LRTI (29.1%, 16/55) and SSTI (26.6%, 11/43) while it was ceftazidime for UTI (36%, 18/50). Only 20.6% (32/155) of the isolated bacteria were susceptible to the empirical antibiotic prescribed while 48.4% (75/155) were resistant to them. The prescribed empirical antibiotic did not have the spectrum of activity for the isolated bacteria in 29% (45/155) of cases. Conclusion. High resistance rates were observed against the prescribed empirical antibiotics. National empirical antibiotic guidelines should be revised with updated data on causative organisms and their susceptibility patterns to ensure appropriate empirical antibiotic prescription.

scholarly journals The long and winding road: the journey taken by headache sufferers in search of help

2018 ◽  
Vol 20 ◽  
Author(s):  
Paul T.G. Davies ◽  
Russell J.M. Lane ◽  
Theresa Astbury ◽  
Manuela Fontebasso ◽  
Jill Murphy ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Headache Disorder ◽  
Tertiary Referral Centre ◽  
Headache Diagnosis ◽  
Headache Management ◽  
Seeking Help ◽  
Benign Nature ◽  
Headache Clinic

AbstractAimTo outline the pathways a cohort of first attendees to our headache clinics had taken over the years in search of explanations and treatment for their headaches. To establish a greater awareness of the shortcomings and failures in their medical journey in the hope that better headache management will emerge in primary care.BackgroundAt first attendance in primary care most headache sufferers will not receive a firm diagnosis. Treatments provided are often ineffective and so many patients embark on a somewhat random self-made journey searching for a remedy. If they reach a Headache Clinic the most common diagnoses are ‘chronic migraine’ and ‘medication overuse headache’. They are either no better or worse than when their headaches first started despite their efforts.MethodWe undertook a prospective questionnaire-based study of over 200 patients on first attendance at each of our headache clinics, three based in District General Hospitals and one in a tertiary referral centre. We documented the patients’ headache characteristics, the ‘burden’ of their headaches, functional handicap and the financial costs incurred seeking help before referral. We also documented what our patients understood about their headache disorder and the treatments previously tried.FindingsMost patients had not been given a formal diagnosis in primary care and many remained unconvinced of the benign nature of their headache problem and wanted further investigations. A few had sought help from headache charities. Many had unrealistic attitudes to their problem and medication overuse was rife. A few patients had been offered triptans in primary care. Key deficiencies in the primary care management of these patients included failure to provide a formal headache diagnosis, inadequate understanding of the nature and mechanism of headaches and failure to follow a resilient management strategy. We provide a more effective management pathway in primary care.

Facial pain in a Neurological Tertiary Care Centre — Evaluation of the International Classification of Headache Disorders

Cephalalgia ◽  
2005 ◽  
Vol 25 (9) ◽  
pp. 689-699 ◽  
Author(s):  
K Zebenholzer ◽  
C Wöber ◽  
M Vigl ◽  
P Wessely ◽  
CL Wöber-Bingöl
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Tertiary Care ◽  
International Classification ◽  
Care Centre ◽  
Headache Disorders ◽  
Tertiary Care Centre ◽  
Persistent Idiopathic Facial Pain ◽  
Number Of Patients

The aim of this study was to examine the diagnostic spectrum of facial pain and to evaluate the clinical features relevant to the differential diagnosis in a neurological tertiary care centre. This is the first investigation comparing the first with the second edition of the International Classification of Headache Disorders (ICHD-I, ICHD-II) in consecutively referred patients comprising a broad spectrum of disorders without restricting the inclusion to certain diagnoses. Studying 97 consecutive patients referred for facial pain, we found trigeminal neuralgia or other types of cranial neuralgia in 38% and 39% according to ICHD-I and ICHD-II, respectively; persistent idiopathic facial pain was diagnosed in 27% and 21%, respectively. The proportion of patients who could not be classified was 24% in ICHD-I and 29% in ICHD-II. Six per cent of the patients had cluster headache or chronic paroxysmal hemicrania, the remaining 5% had various other disorders. The agreement between ICHD-I and ICHD-II was very good to perfect. In ICHD-II, sensitivity and specificity were similar to ICHD-I, the specificity and negative predictive value were imrpoved in single features of trigeminal neuralgia, but were widely unchanged in persistent idiopathic facial pain. The number of patients who could not be classified was larger in ICHD-II than in ICHD-I. Modifying the diagnostic criteria for different types of facial pain, in particular changes in the criteria of persistent idiopathic facial pain, might be helpful in reducing the number of patients with unclassifiable facial pain.

P6254Care cascade of hypertension in people living with HIV

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Nascimento Costa ◽  
M B Bairronuevo ◽  
F Val ◽  
A R E Macedo ◽  
N C Vegas ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
National Guidelines ◽  
Early Screening ◽  
Tertiary Care Centre ◽  
Hiv Primary Care ◽  
Cascade Of Care ◽  
Steep Decline ◽  
Living With Hiv

Abstract Background Life expectancy of people living with HIV (PLHIV) has been increasing since the advent of antiretroviral therapy. However, prevalence of non-communicable diseases (NCD) and associated deaths has followed the same trend. From these NCDs, those of cardiovascular origin have become the most prevalent among PLHIV. Purpose In this study we delineate a cascade of care for hypertension screening, diagnosis, treatment, drug adherence and control in PLHIV. Methods Male and female patients diagnosed with HIV above 40 years of age attending to an outpatient clinic of a reference tertiary care centre for infectious diseases were cross-sectionally screened for hypertension through blood pressure (BP) measurement during outpatient consultation. Results A total of 298 subject were enrolled. Of these, 107 (35.9%) presented elevated BP consistent with hypertension according to national guidelines. Of these, only 36 (33.6%) were aware of the diagnosis, 19 (17.7%) were on regular cardiological follow-up, 17 (15.8%) were under treatment and 11 (10.2%) responded to be adherent to BP lowering medication. Care Cascade HIV_HTN Conclusions Steep decline was revealed in several steps of the cascade of care, especially regarding the awareness level. Integrative methods for NCD and HIV care are urgently needed. Early screening of hypertension, diagnosis, treatment, adherence and ongoing BP control should be equal targets in HIV care. Finally, there is an urgent need to encourage HIV primary care and infectious disease health professionals to early screen for cardiovascular outcomes. Acknowledgement/Funding Fundação de Amparo à Pesquisa do Estado do Amazonas – FAPEAM

scholarly journals Cleft lip & palate surgery "where do we stand in the 21st century?" based on study of referral patterns to a tertiary care centre

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Moazzam Nazeer Tarar ◽  
Farrukh Mahmood ◽  
Falak S Malik ◽  
Salman A Khan ◽  
Kamran Khalid ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Revisional Surgery ◽  
Tertiary Care ◽  
Multidisciplinary Care ◽  
Tertiary Care Centre ◽  
Cleft Lip Palate ◽  
Study Methodology ◽  
Draw Conclusion ◽  
A Prospective Study ◽  
First Time

A prospective study was carried out over the period of six years including 215 patients. The objective of this study has been to evaluate the types of the clefts, their predisposing factors, age at first presentation and need for revisional surgery and to compare these with published studies on the subject and to draw conclusion about the epidemiology and the facilities available for its surgical correction. Design: Prospective, observational study. Methodology: 215 patients were evaluated over a period of six years by filling a proforma, which was entered into database. Different parameters were evaluated. Conclusion: There are a significant number of cleft patients presenting for first time above the age of 10 years. A large number of inappropriately treated patients require revisional surgery because of lack of properly trained cleft surgeons. Due to lack of specialized cleft care teams in our country no patient in this study could get comprehensive care for this deformity. It is need of the hour to pr ovide multidisciplinary care to these patients.

A GENDER BASED COMPARISON TO STUDY THE PSYCHIATRIC COMORBIDITIES OF MIGRAINE ON THE BASIS OF ITS SEVERITY.

2021 ◽  
pp. 12-14
Author(s):  
Shilpi Kumari
Keyword(s):  
Depressive Symptoms ◽  
Tertiary Care ◽  
Female Gender ◽  
Tertiary Care Centre ◽  
Psychiatric Comorbidities ◽  
Female Population ◽  
Male And Female ◽  
The Difference ◽  
Headache Clinic ◽  
Gender Based

Background: There is lack of data from india on the difference of presenting psychiatric comorbidities of migraineurs among male and female population. Objectives: the objective of the study were to quantify the impairment i.e disability due to migraine severity, associated depression and anxiety among male and female migraineurs of comparable characteristics. Materials And Methods: we interviewed 105 consecutive newly diagnosed migraine patients (both male and female) visiting headache clinic in a tertiary care centre between September 2019 to march 2020.Age and sex matched healthy subjects (n=105, later 5 dropped) were used. PHQ9, MIDAS, and GAD7 scales were administered. Predictors were analysed using regression analysis. Result: both male and female migraineurs have shown similar result with preponderance of anxiety disorder more in female than male migraineurs. Prevalence of clinically signicant anxiety(48%) and depressive (41%) symptoms, higher among female than male. Female gender, headache related disability, and severity of anxiety and depressive symptoms predicted worse mental component summary scores. Conclusion: incidence of clinically signicant anxiety and depressive symptoms is much higher among migraineurs and the severity was comparatively higher among female than male. These ndings goes with studies from other parts of world and Indian prospects.

Abstract #1100: Tumor Induced Osteomalacia: Clinical; Biochemical and Radiological Features from a Single Tertiary Care Centre with Emphasis on Functional Imaging.

2017 ◽  
Vol 23 ◽  
pp. 289
Author(s):  
Vineet Surana ◽  
Rajesh Khadgawat ◽  
Nikhil Tandon ◽  
Chandrashekhar Bal ◽  
Kandasamy Devasenathipathy
Keyword(s):  
Functional Imaging ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Radiological Features

SEROPREVALENCE OF HIV AND HBsAg AMONGST BLOOD DONORS IN A TERTIARY CARE HOSPITAL, CHHATTISGARH.

2019 ◽  
Vol 3 (8) ◽  
Author(s):  
Anusha P ◽  
Bankar Nandkishor J ◽  
Karan Jain ◽  
Ramdas Brahmane ◽  
Dhrubha Hari Chandi
Keyword(s):  
Hepatitis B ◽  
Blood Donors ◽  
Hepatitis B Surface Antigen ◽  
Tertiary Care ◽  
Laboratory Diagnosis ◽  
Blood Bank ◽  
Care Hospital ◽  
Medical College ◽  
The World ◽  
First Time

INTRODUCTION: India being the second highly populated nation in the world. HIV/AIDS has acquired pandemic proportion in the world. Estimate by WHO for current infection rate in Asia. India has the third largest HIV epidemic in the world. HIV prevalence in the age group 15-49 yrs was an estimate of 0.2%. India has been classified as an intermediate in the Hepatitis B Virus (HBV) endemic (HBsAg carriage 2-7%) zone with the second largest global pool of chronic HBV infections. Safety assessment of the blood supply, the quality of screening measures and the risk of transfusion transmitted infectious diseases (TTIs) in any country can be estimated by scrutinizing the files of blood donors. After the introduction of the blood banks and improved storage facilities, it became more extensively used. Blood is one of the major sources of TTIs like hepatitis B, hepatitis C, HIV, syphilis, and many other blood borne diseases. Disclosure of these threats brought a dramatic change in attitude of physicians and patients about blood transfusion. The objective of this study is to determine the seroprevalence of transfusion transmitted infections amidst voluntary blood donors at a rural tertiary healthcare teaching hospital in Chhattisgarh. MATERIAL AND METHODS: This retrospective study was carried out in Chandulal Chandrakar Memorial Medical College, Kachandur, Durg. Blood donors were volunteers, or and commercial donors who donated the blood and paid by patients, their families, or friends to replace blood used or expected to be used for patients from the blood bank of the hospital. After proper donation of blood routine screening of blood was carried out according to standard protocol. Laboratory diagnosis of HIV 1 and HIV 2 was carried out by ELISA test. Hepatitis B surface antigen was screened by using ELISA. RESULTS: A total of 1915 consecutive blood donors’ sera were screened at Chandulal Chandrakar Memorial Medical College, blood bank during study period. Of these 1914 were male and 1 female. The mean age of patients was found to be 29.34 years with standard deviation (SD) of 11.65 Years. Among all blood donors in present study, 759(39.63%) were first time donors and 1156(60.37%) were repeated donors. 1 patient was HIV positive in first donation group while 3 (75%) were positive in repeat donation group. 7 (38.9%) were HBsAg positive in in first donation group while 11(61.1%) were positive in repeat donation group. Two patients in first donation group had dual infection of HIV and HBsAg. CONCLUSION: Seropositivity was high in repeated donors as compared to first time donors. The incidence of HIV is observed to be 0.2% and that of HBsAg is 0.94%. Strict selection of blood donors should be done to avoid transfusion-transmissible infections during the window period.

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