scholarly journals COVID-19-Associated Pulmonary Aspergillosis: A Single-Center Experience in Central Valley, California, January 2020–March 2021

2021 ◽  
Vol 7 (11) ◽  
pp. 948
Author(s):  
Geetha Sivasubramanian ◽  
Hebah Ghanem ◽  
Michele Maison-Fomotar ◽  
Ratnali Jain ◽  
Robert Libke
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Central Valley ◽  
Incidence Rates ◽  
Aspergillus Species ◽  
Medical Mycology ◽  
Pulmonary Aspergillosis ◽  
Single Center Experience ◽  
Study Population ◽  
The Mean

Reports of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) have been widely published across the world since the onset of the pandemic with varying incidence rates. We retrospectively studied all patients with severe COVID-19 infection who were admitted to our tertiary care center′s intensive care units between January 2020 and March 2021, who also had respiratory cultures positive for Aspergillus species. Among a large cohort of 970 patients admitted to the ICU with severe COVID-19 infections during our study period, 48 patients had Aspergillus species growing in respiratory cultures. Based on the 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus criteria, 2 patients in the study had proven CAPA, 9 had probable CAPA, and 37 had possible CAPA. The incidence of CAPA was 5%. The mean duration from a positive COVID-19 test to Aspergillus spp. being recovered from the respiratory cultures was 16 days, and more than half of the patients had preceding fever or worsening respiratory failure despite adequate support and management. Antifungals were given for treatment in 44% of the patients for a mean duration of 13 days. The overall mortality rate in our study population was extremely high with death occurring in 40/48 patients (83%).

scholarly journals Early Outcome of Surgery in Pediatric Head Injury: Experience From a Tertiary Care Center in Eastern Nepal

2020 ◽  
Vol 42 (2) ◽  
pp. 16-20
Author(s):  
Babita Khanal ◽  
Prakash Kafle ◽  
Sandip K Singh ◽  
Sunil K Yadav ◽  
Bishomber Neupane ◽  
...  
Keyword(s):  
Brain Injury ◽  
Head Injury ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Early Outcome ◽  
Pediatric Head Injury ◽  
Study Population ◽  
The Mean ◽  
Pediatric Tbi

Introduction Head injuries among the pediatric age group remain an unwelcomed source of morbidity and mortality resulting from falls, motor vehicle accidents, assaults, and child abuse. Early identification and management of traumatic brain injury (TBI) are crucial in halting the progress of the primary insult and preventing or reducing secondary brain injury. The present study aims to investigate the major cause of pediatric TBI and analyze the early outcome and serve as a reference study from a tertiary care center in eastern Nepal. MethodsThis is a prospective cohort study conducted in the Department of Pediatric Medicine and Neurosurgery from February 2018 to January 2020. All the pediatric head injury cases that were managed surgically in the center were included in the study. Presenting Glasgow coma scale (GCS) was correlated with the Glasgow outcome scale (GOS). ResultsThe study population comprised of 65 patients fulfilling the study inclusion criteria. The mean age of the study population was 10.86±4.72 years, fall was the commonest mode of injury (52.3%), 50.8% had mild TBI, 43.1% had moderate TBI and 6.2% had severe TBI. Depressed skull fracture with underlying extradural hematoma (EDH) or contusion was the commonest pathological diagnosis seen in 30.8 % (20) cases. The mean duration of hospital stay was 2.6 days. The presenting GCS correlated well with the outcome. ConclusionThis study concluded that the timely management of pediatric TBI can prevent grave prognosis and the patients presenting GCS and the pupillary reaction has strong correlation with the outcome.

scholarly journals Clinical profiles of diabetic foot ulcer patients undergoing major limb amputation at a tertiary care center in North-eastern Tanzania

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ahmed Shabhay ◽  
Pius Horumpende ◽  
Zarina Shabhay ◽  
Andrew Mganga ◽  
Jeff Van Baal ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Diabetic Foot ◽  
Care Center ◽  
Tertiary Care ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Random Blood Glucose ◽  
North Eastern ◽  
The Mean

Abstract Background Diabetic foot ulcers complications are the major cause of non-traumatic major limb amputation. We aimed at assessing the clinical profiles of diabetic foot ulcer patients undergoing major limb amputation in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC), a tertiary care hospital in North-eastern Tanzania. Methods A cross—sectional hospital-based study was conducted from September 2018 through March 2019. Demographic data were obtained from structured questionnaires. Diabetic foot ulcers were graded according to the Meggitt-Wagner classification system. Hemoglobin and random blood glucose levels data were retrieved from patients’ files. Results A total of 60 patients were recruited in the study. More than half (31/60; 51.67%) were amputated. Thirty-five (58.33%) were males. Fifty-nine (98.33%) had type II diabetes. Nearly two-thirds (34/60; 56.67%) had duration of diabetes for more than 5 years. The mean age was 60.06 ± 11.33 years (range 30–87). The mean haemoglobin level was 10.20 ± 2.73 g/dl and 9.84 ± 2.69 g/dl among amputees. Nearly two thirds (42/60; 70.00%) had a haemoglobin level below 12 g/dl, with more than a half (23/42; 54.76%) undergoing major limb amputation. Two thirds (23/31; 74.19%) of all patients who underwent major limb amputation had mean hemoglobin level below 12 g/dl. The mean Random Blood Glucose (MRBG) was 13.18 ± 6.17 mmol/L and 14.16 ± 6.10 mmol/L for amputees. Almost two thirds of the study population i.e., 42/60(70.00%) had poor glycemic control with random blood glucose level above 10.0 mmol/L. More than half 23/42 (54.76%) of the patients with poor glycemic control underwent some form of major limb amputation; which is nearly two thirds (23/31; 74.19%) of the total amputees. Twenty-eight (46.67%) had Meggitt-Wagner classification grade 3, of which nearly two thirds (17:60.71%) underwent major limb amputation. Conclusion In this study, the cohort of patients suffering from diabetic foot ulcers treated in a tertiary care center in north-eastern Tanzania, the likelihood of amputation significantly correlated with the initial grade of the Meggit-Wagner ulcer classification. High blood glucose levels and anaemia seem to be also important risk factors but correlation did not reveal statistical significance.

Trend of Hospital Admission and Outcome Study of Patients Admitted in a Neurology Unit at a Tertiary Care Neuroscience Hospital in Bangladesh

2018 ◽  
Vol 4 (2) ◽  
pp. 69-74
Author(s):  
Md Tauhidul Islam Chowdhury ◽  
Mohammad Shah Jahirul Hoque Choudhury ◽  
KM Ahasan Ahmed ◽  
Mohammad Sadekur Rahman Sarkar ◽  
Md Abdullah Yusuf ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Neurological Diseases ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Total Death ◽  
Neurological Patients ◽  
Study Population ◽  
The Mean ◽  
Day By Day

Background: Neurological disorders is becoming a growing concern both for developed and developing countries. Magnitude of the problem is increasing day by day. Among all neurological disorders, stroke is the leading cause of morbidity and mortality globally.Objectives: The purpose of the study was to see the trend of admission of patients with neurological diseases and to study the outcome of patients at referral neurology hospital in Bangladesh.Methodology: This retrospective chart review was conducted in the blue unit of the Department of Neurology at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from 1st January to 31st December 2016 for a period of one (01) year. All the admitted patients with both sexes were selected as study population. The outcome was observed among the study population.Result: A total number of 1044 patients were admitted during the study period. Majority of the patients were in the age group of the 41 to 50 years which was 417(39.9%) cases. Both male and female were in highest number in the month of May which was 63 and 48 cases respectively. The total death of the study population was 146(14.0%) cases. The mean length of hospital stay was 8.4±2.31 days.Conclusion: Middle aged male is the main bulk of the neurological patients, admitted in a referral neurology hospital in Bangladesh. Highest admission and mortality was observed in stroke patients.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 69-74

scholarly journals Daily Quality Control in CD3+and CD4+T Cell Estimation by the FACSCount System at a Tertiary Care Center in South India

2012 ◽  
Vol 19 (10) ◽  
pp. 1693-1696 ◽  
Author(s):  
Veena V. Ramalingam ◽  
Monika Mani ◽  
Vijayanand C. Sundaresan ◽  
Ramesh J. Karunaiya ◽  
Jaiprasath Sachithanandham ◽  
...  
Keyword(s):  
Quality Control ◽  
T Cell ◽  
South India ◽  
Care Center ◽  
Tertiary Care ◽  
Cd4 T Cell ◽  
Internal Quality ◽  
Cell Counts ◽  
Resource Poor ◽  
The Mean

ABSTRACTCD4+T cell count estimations are subject to high variations; hence, in this study, the previous day's tested samples were included routinely as the internal quality controls. The percentages of variation of the 2-day values were analyzed for 280 observations and the mean variation for CD4+and CD3+T cell counts ranged from 5.21% to 9.66%. This method is a good internal quality control (IQC) procedure for the estimation of CD3+and CD4+T cell counts in resource-poor settings.

A study of peripartum cardiomyopathy in a tertiary care center in India

2017 ◽  
Vol 6 (2) ◽  
pp. 523 ◽  
Author(s):  
Aditi V. Joshi ◽  
Michelle N. Fonseca ◽  
Deepali S. Kharat-Kapote
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Fetal Outcome ◽  
Peripartum Cardiomyopathy ◽  
Early Interventions ◽  
Tertiary Care Center ◽  
Common Risk Factor ◽  
The Mean ◽  
Time Of Presentation ◽  
Underlying Pathogenesis

Background: Peripartum cardiomyopathy is an idiopathic and reversible form of dilated cardiomyopathy. The aim of the study was to study the mean age of presentation of peripartum cardiomyopathy in pregnant patients over a period of 1 year in a tertiary health care and study the maternal and fetal outcome of patients with peripartum cardiomyopathy.Methods: A retrospective observational study with total of 22 patients with peripartum cardiomyopathy was diagnosed in a total of 10,279 deliveries conducted at LTMMC, Sion hospital between September 2014 to February 2016.Results: Our study revealed that most of the affected patients were young with the mean age at presentation being 26.8±4.29 years. Most of the patients were diagnosed in the postpartum period (63.6%). the most common risk factor was pre-eclampsia (22.7%) followed by anemia (18.2%). The mean Ejection fraction at the time of presentation was 25.3±9.8%. There were 2 (9.1%) intrauterine fetal deaths and 1 neonatal death.Conclusions: There is a need for more multi-centric studies in order to understand the underlying pathogenesis and to determine the possible early interventions to help provide better pregnancy outcome.

scholarly journals Thyroid status and Treatment Response of Hypothyroid Infertile Women in Tertiary Care Center of Bangladesh

2017 ◽  
Vol 31 (2) ◽  
pp. 86-89
Author(s):  
Farzana Deeba ◽  
Parveen Fatima ◽  
Jesmine Banu ◽  
Shakeela Ishrat ◽  
Nurjahan Begum ◽  
...  
Keyword(s):  
Subclinical Hypothyroidism ◽  
Early Stage ◽  
Care Center ◽  
Tertiary Care ◽  
Target Population ◽  
Fertility Treatment ◽  
Tertiary Care Centre ◽  
Infertile Women ◽  
The Mean ◽  
Tsh Levels

Objective(s): Aim of this study was to find out the prevalence of hypothyroidism in infertile women as well as to assess their response to treatment.Materials and methods: This descriptive study was conducted in Infertility unit of Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Bangladesh, a tertiary care centre from January 2014 to December 2014. Four hundred women who visited infertility clinic of the department for fertility treatment were the target population for this study. Routine investigations such as CBC, Blood sugar 2 hours postparandial or GTT, TSH and Prolactin was done. Subclinical hypothyroidism was diagnosed when there was increased TSH and normal FT4. Hypothyroid patients were given Levothyroxin depending upon TSH levels and continued until end of the study. Patients were followed up for six months even if pregnancy was attained.Results: Out of 400 women 55% were primary and 45% were secondary subfertility. Mean duration of infertility was 4.5 ± 1.2 years. Ninety two (23%) patients were hypothyroid. Among them 66 (16.5%) were subclinical hypothyroid and 26 (6.5%) were frank hypothyroid. The mean TSH levels were 7.34 ± 2.13 ìIU/ml, and the mean PRL levels were 52.46 ± 11.17 ng/ml. Out of 92 infertile women diagnosed as hypothyroidism 75 (81.52%) women conceived after treatment with drugs for hypothyroidism (dose depending upon severity of hypothyroidism, i.e. TSH levels). More than 90% women had regular ovulation for consecutive three cycles after initiation of treatment.Conclusion: The normal TSH levels are the pre-requisite for fertilization. The decision to initiate thyroid replacement therapy in both clinical and subclinical hypothyroidism at early stage is justified in infertile women.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 86-89

scholarly journals Factors Affecting Radiation Dose in Computed Tomography Angiograms for Pulmonary Embolism: A Retrospective Cohort Study

2020 ◽  
Vol 10 ◽  
pp. 74
Author(s):  
Prashant Nagpal ◽  
Sarv Priya ◽  
Ali Eskandari ◽  
Aidan Mullan ◽  
Tanya Aggarwal ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Radiation Dose ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Analysis ◽  
Factors Affecting ◽  
Model Based ◽  
Pulmonary Angiogram ◽  
The Mean

Objectives: Computed tomography pulmonary angiogram (CTPA) is one of the most commonly ordered and frequently overused tests. The purpose of this study was to evaluate the mean radiation dose to patients getting CTPA and to identify factors that are associated with higher dose. Material and Methods: This institutionally approved retrospective study included all patients who had a CTPA to rule out acute pulmonary embolism between 2016 and 2018 in a tertiary care center. Patient data (age, sex, body mass index [BMI], and patient location), CT scanner type, image reconstruction methodology, and radiation dose parameters (dose-length product [DLP]) were recorded. Effective dose estimates were obtained by multiplying DLP by conversion coefficient (0.014 mSv•mGy−1•cm−1). Multivariate logistic regression analysis was performed to determine the factors affecting the radiation dose. Results: There were 2342 patients (1099 men and 1243 women) with a mean age of 58.1 years (range 0.2–104.4 years) and BMI of 31.3 kg/m2 (range 12–91.5 kg/m2). The mean effective radiation dose was 5.512 mSv (median – 4.27 mSv; range 0.1–43.0 mSv). Patient factors, including BMI >25 kg/m2, male sex, age >18 years, and intensive care unit (ICU) location, were associated with significantly higher dose (P < 0.05). CT scanning using third generation dual-source scanner with model-based iterative reconstruction (IR) had significantly lower dose (mean: 4.90 mSv) versus single-source (64-slice) scanner with filtered back projection (mean: 9.29 mSv, P < 0.001). Conclusion: Patients with high BMI and ICU referrals are associated with high CT radiation dose. They are most likely to benefit by scanning on newer generation scanner using advance model-based IR techniques.

scholarly journals Usefulness of the Non-Contact Tonometry in Out-Patient Screening

2016 ◽  
Vol 15 (2) ◽  
Author(s):  
Satheesh Solomon T Selvin ◽  
Chris Elsa Samson Jacob ◽  
Thomas Kuriakose
Keyword(s):  
Central Corneal Thickness ◽  
Care Center ◽  
Corneal Thickness ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Applanation Tonometry ◽  
Cross Sectional ◽  
Significant Difference ◽  
Iop Measurement ◽  
The Mean

Purpose: Goldmann applanation tonometry (GAT) is considered the gold standard for Intraocular Pressure (IOP) measurement. It has the disadvantages of being a contact device, need for a slit-lamp, non-portability and need of a skilled examiner. Many hospitals are using a Non Contact Tonometry (NCT) as a screening device to save clinician time, however the usefulness is not proved in terms of reliability. This study was aimed to determine the usefulness of the Air-puff tonometer (TONOREF NIDEK II, NIDEK CO., LTD., JAPAN) over a GAT in a tertiary care center. Design: Cross-sectional Study Methods: This was a cross-sectional, non interventional observational study conducted on 224 eyes (right eye) from 224 patients. All patients underwent the IOP measurement with both methods and a central corneal thickness (CCT) measured. The data was analyzed using SPSS 20.0 software. Results: The mean age of the patients was 40.3±11.29 years. There was a statistically significant difference (p<0.001) between the mean NCT and GAT readings which persisted even after correction for central corneal thickness. The correlation between NCT and GAT using Pearson’s correlation coefficient was strong irrespective of the corrections for their corneal thickness (r = 0.751 and 0.718 for uncorrected and corrected values respectively). The correlation of the individual clinicians for the readings varied from moderate to strong. The ROC curve showed the best sensitivity and specificity to occur at around 13 to 14 mmHg. Conclusion: NCT seems to overestimate the IOP at low ranges as compared to the GAT and underestimate at higher ranges. The crossover of the values is seen between 12 to 13 mmHg.  The clinician should do an individualized analysis of his/her GAT measurements to the readings of the NCT machine at the clinic to obtain clinician specific nomogram. 

scholarly journals A study of patients with acute poison: a single center experience

2018 ◽  
Vol 6 (4) ◽  
pp. 1450
Author(s):  
Ashvin Chaudhari ◽  
Dalchand C. Kumawat
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Epidemiological Studies ◽  
Acute Poisoning ◽  
Health Care Facilities ◽  
Organophosphate Poisoning ◽  
Socioeconomic Class ◽  
Young Males ◽  
Medical College ◽  
Single Center Experience

Background: Periodic experimental and epidemiological studies are essential to understand the pattern of poisoning in society. These studies are useful for planning of providing better and fast health care facilities to decrease poisoning connected mortality. This study was intended to assess the pattern & consequence of acute poisoning cases.Methods: This study was conducted with 100 patients admitted at a Geetanjali Medical college and hospital from June 2015 to December 2017 were studied. We retrospectively analyzed the gender, age, causes of poisoning, types of poisons, poisoning route, emergency diagnoses, outcomes, and prognoses of these patients.Results: Most of the patients were from the age group of 21 - 30 years (49 %) followed by 31-40 years (33%). Males (59%) prevailed females (41%). Out of all subjects, 53% belonged to middle socioeconomic class, whereas only 19% were from high socioeconomic class. Out of all patients, 62% were from illiterate class and 38% were literate. Suicide (77%) was the most communal nature of poisoning. Phenyl (19%) was the most commonly used poison. Mortality was found to be 4% and was mainly related to organophosphate compounds.Conclusions: Poisoning is further common in young males so they should be emotionally maintained in stressful conditions. Mortality was found significantly to organophosphate poisoning. Easy availability of this compound should be checked. Early care in tertiary care center may assistance to reduce mortality in India.

scholarly journals Proposing an Endotracheal Tube Selection Tool Based on Multivariate Analysis of Airway Imaging

2020 ◽  
pp. 014556131990039
Author(s):  
Yousef Aljathlany ◽  
Abdullah Aljasser ◽  
Abdullah Alhelali ◽  
Manal Bukhari ◽  
Mohammed Almohizea ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Regression Analysis ◽  
Endotracheal Tube ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Transverse Diameter ◽  
Cross Sectional ◽  
The Mean

Objectives: We aimed to comprehensively investigate different upper airway segments in adults, determine the predictors of the size of each segment, and identify an appropriate endotracheal tube (ETT) size chart. Study Design: Retrospective chart review. Setting: Tertiary care center. Materials and Methods: The data for patients aged >18 years who underwent neck computed tomography were screened. Patients with existing tumors, trauma, or any pathology that can alter the normal airway anatomy and those with intubation, tracheostomy, or nasogastric tubes were excluded. Computed tomography software was used to measure the anteroposterior diameter (APD), transverse diameter (TD), and cross-sectional area (CSA) at the glottic, proximal subglottic, distal subglottic, and tracheal levels. Multiple regression analysis was used to identify the predictors of the airway size. Results: One hundred patients were reviewed. The TD was consistently smaller than or equal to the APD at each level in all but 3 patients. The mean CSA and TD (170 mm2 and 11.3 mm, respectively) of the glottis indicated that the glottis was most often the narrowest level, followed by the proximal subglottis where the mean CSA and TD were 192.1 mm2 and 12.7 mm, respectively. Moreover, the mean APD was the smallest at the level of the trachea (20.1 mm). Multiple regression analysis confirmed that height and sex were the predominant predictors of measurements for the 4 airway segments. In addition, age was associated with the TD and CSA of the distal subglottic and tracheal segments, respectively. Conclusion: One-third of our participants exhibited a proximal subglottic diameter that was equal to or smaller than the glottic diameter. Our findings also suggested that the height and sex of the patients are important variables for the selection of an appropriate ETT size.

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