scholarly journals RETROSPECTIVE OBSERVATIONAL STUDY OF 448 CEREBRAL CONTUSIONS IN A TERTIARY CARE TRAUMA CENTRE: ANALYSIS OF THEIR CLINICAL & RADIOLOGICAL PROGRESSION AND OUTCOME

2020 ◽  
pp. 1-3
Author(s):  
Sambuddha Dhar ◽  
Barnava Pal ◽  
Anurag Sahu ◽  
Kulwant Singh
Keyword(s):  
Ct Scan ◽  
Tertiary Care ◽  
Clinical History ◽  
Trauma Centre ◽  
Secondary Surgery ◽  
Radiological Progression ◽  
Cerebral Contusion ◽  
Antiplatelet Medication ◽  
Coagulation Defects ◽  
History Of

Introduction: Traumatic cerebral contusion is one of the leading cause of morbidity and mortality in Neurosurgery. Patients can be either treated conservatively or surgically. Many patients who are treated conservatively may have CT scan progression and need surgery secondarily. This retrospective study was designed to study the clinical presentation and interventions predicting CT progression of hematoma and final outcome. Material and Methods: The study was conducted from April 2017 to December 2019 on all the patients of traumatic cerebral contusions, diagnosed by CT scan. Patients received either conservative treatment initially or underwent upfront surgery, and had at least one other CT scan during the acute hospitalization. Patients clinical history, CT progression and any intervention were noted. The patient’s disposition status was classified as discharged home, or to another institution, or whether the patient died. Results: Among the total 448 patients, 78.5% patients required surgery at presentation. 53.3% had a CT progression after repeat CT scan, among them 109 (48.8%) were operated. CT progression was seen more frequently in patients with coagulation abnormalities. Among patients with history of antiplatelet medication receiving platelet therapy, only 31% patients had CT progression. Patients who has poor initial GCS (Glasgow coma scale), underwent tracheostomy and had secondarily operated due to CT progression were discharged late. Conclusion: Coagulation defects was an important risk factor for CT progression. Platelet replacement therapy significantly decreased surgical intervention in patients with antiplatelet therapy. Poor initial GCS, secondary surgery and tracheostomy lengthened the hospital stay.

Managing Incidentalomas Safely: Do Computed Tomography Requisitions Tell Us What We Need to Know?

2017 ◽  
Vol 68 (4) ◽  
pp. 387-391
Author(s):  
Matthew Walker ◽  
Joy Borgaonkar ◽  
Daria Manos
Keyword(s):  
Computed Tomography ◽  
Incidental Findings ◽  
Tertiary Care ◽  
Clinical History ◽  
Patient Questionnaire ◽  
Prior History ◽  
Care Hospital ◽  
History Of ◽  
Patient’S History ◽  
History Of Cancer

Purpose Technological advancements and the ever-increasing use of computed tomography (CT) have greatly increased the detection of incidental findings, including tiny pulmonary nodules. The management of many “incidentalomas” is significantly influenced by a patient's history of cancer. The study aim is to determine if CT requisitions include prior history of malignancy. Methods Requisitions for chest CTs performed at our adult tertiary care hospital during April 2012 were compared to a cancer history questionnaire, administered to patients at the time of CT scan. Patients were excluded from the study if the patient questionnaire was incomplete or if the purpose of the CT was for cancer staging or cancer follow-up. Results A total of 569 CTs of the chest were performed. Of the 327 patients that met inclusion criteria, 79 reported a history of cancer. After excluding patients for whom a history of malignancy could not be confirmed through a chart review and excluding nonmelanoma skin cancer, dysplasia, and in situ neoplasm, 68 patients were identified as having a history of malignancy. We found 44% (95% confidence interval [0.32-0.57]) of the chest CT requisitions for these 68 patients did not include the patient's history of cancer. Of the malignancies that were identified by patient questionnaire but omitted from the clinical history provided on the requisitions, 47% were malignancies that commonly metastasize to the lung. Conclusions A significant number of requisitions failed to disclose a history of cancer. Without knowledge of prior malignancy, radiologists cannot comply with current guidelines regarding the reporting and management of incidental findings.

scholarly journals Death due to sickle cell anemia: autopsy diagnosis

2017 ◽  
Vol 5 (7) ◽  
pp. 3185
Author(s):  
Manjusha Shripad Dhawle ◽  
Ashwini Radhakrishan Tangde ◽  
Santosh Govind Rathod ◽  
Rajan S. Bindu
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Tertiary Care ◽  
Medical Officer ◽  
Clinical History ◽  
Care Hospital ◽  
Cell Disease ◽  
Unexpected Death ◽  
Mortality And Morbidity ◽  
History Of

Background: Sickle cell disease (SCD) is well known and is the commonest hereditary hematological disorder which is associated with increased mortality and morbidity.  They are group of inherited haemoglobinopathies caused by the occurrence of hemoglobin S (Hbs) in homozygous or heterozygous form or in combinations of Hbs with another hemoglobin such as Hbsc or beta thalassaemia (Hbs-thal). Sickle cell syndromes are remarkable for their clinical heterogenecity including their presentations as sudden and unexpected death due to sickle cell crises. While doing autopsy in cases of deaths with no apparent cause and physical over activity medical officer must keep in mind the possibility of death due to vasoocclusive crisis in sickle cell disease. Aim of the study was to create awareness among the physicians and relatives / public and to minimize future unexpected death from complications or crisis from SCD.Methods: This is a retrospective study of 10 cases carried in the department of pathology, in tertiary care hospital and covers a period from January 2009 to December 2016. These cases were brought dead to the casualty with a history of sudden death. After post mortem examination, the specimens were sent for histopathological examination.Results: The record of 10 cases was reviewed. Out of our ten cases 7 were male and 3 were females. The youngest person was 17-year female and oldest was 65 years male. In clinical history 3 cases had complains of chest pain (30%), 3 others had complained of breathlessness (30%), 2 had history of unconsciousness (20%), one case had complained of abdominal pain (10%) and one case had a history of fall and injury (10%). Microscopic examination of each organ was carried out.  Organs like lungs, liver, spleen, kidneys, heart and brain showed wide spread congested vessels which were stuffed with RBC.Conclusions: We present this study to emphasize that sickle cell crisis is one of the cause of sudden unexplained death and highlight the importance of considering sickle cell disease as a cause of death in cases with no apparent cause.

scholarly journals Epidemiology and drug allergy results in children investigated in allergy unit of a tertiary-care paediatric hospital setting

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
A. Piccorossi ◽  
G. Liccioli ◽  
S. Barni ◽  
L. Sarti ◽  
M. Giovannini ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Hospital Setting ◽  
Clinical History ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Drug Reactions ◽  
Positive Skin ◽  
History Of ◽  
Work Up ◽  
Immediate Reactions

Abstract Background and objective Drug Hypersensitivity Reactions (DHRs) are considered adverse effects of medications that resemble allergy symptoms. The reported positive clinical history of pediatric drug reactions is about 10%, however, after allergy investigations, only a small percent is confirmed as hypersensitivity. The aim of this study was to analyze the clinical history, allergy work-up results and sensitization profile of children and adolescents referred to our Allergy Unit for suspected DHRs. Methods The study evaluated data related to a group of children with a positive history of drug reactions during a two-year period. The allergy work-up consisted of in vivo and in vitro tests, in accordance with the recommendations of the ENDA/EAACI guidelines. Results Data from a group of 637 patients [348 M (54.6%); 289 F (45.4%)] were retrospectively analyzed. Beta lactams (BLs) were the most common drugs involved in the reported clinical history, followed by non-steroidal anti-inflammatory drugs (NSAIDs). Severe cutaneous adverse reactions (SCARs) were most frequently observed during BL treatment. The confirmation of BL hypersensitivity was higher for immediate reactions (IRs) [9.4%; 5.1% through positive skin tests (STs) and 5.5% through drug provocation test (DPT)] compared to non-immediate reactions (non-IRs) (8.1%; 2.2% through STs and 6.2% through DPT). A higher number of positive results was obtained for BLs and macrolides when the tests were performed within 12 months after the index reaction (p < 0.05). During DPTs with amoxicillin-clavulanic acid, four hypersensitivity reactions (including one anaphylaxis) occurred despite negative STs. Conclusion Our data demonstrated that only 9.1% of patients resulted in being positive to allergy tests which is in line with the data in literature. An allergy work-up is mandatory for excluding suspected hypersensitivity.

A Cross-Sectional Evaluation of Illness Perception About Asthma Among Asthma Patients at a Referral Tertiary Care Public Chest Hospital in Delhi, India

2012 ◽  
Vol 2 (3) ◽  
pp. 32-43
Author(s):  
Sushil Shendge ◽  
Barnali Deka ◽  
Anita Kotwani
Keyword(s):  
Inhaled Corticosteroids ◽  
Tertiary Care ◽  
Illness Perception ◽  
Clinical History ◽  
Self Management ◽  
Cross Sectional ◽  
The Public ◽  
Co Morbidity ◽  
Asthma Patients ◽  
History Of

Adult patients visiting emergency room (March 2009-December 2009) of the public chest hospital for asthma exacerbation completed interviewer-administered questionnaires on sociodemographics, clinical history, disease beliefs, use of inhaled corticosteroids (ICS), and self-management of asthma after stabilization of their condition. Overall 87% patients believed that they had asthma when they are having symptoms, which is called as no symptoms, no asthma belief. No association was found between no symptoms, no asthma belief with gender, income, family history of asthma, and co-morbidity. Younger patients in the age group 18-29 years had four to five-fold greater odds and patients with education above 10th grade had three to four-fold greater odds of having the no symptoms, no asthma belief or the acute episodic belief. Acute episodic belief was negatively associated with beliefs about always having asthma, asthma being a serious condition, having lung inflammation, or the importance of using ICS, and was positively associated with expecting to be cured. All patients irrespective of their belief of acute or chronic nature of asthma had poor adherence to the treatment and other self-management behaviors.

scholarly journals DERMATOPHYTOSIS PROFILE IN A MADHUBANI MEDICAL COLLEGE AND TERTIARY CARE HOSPITAL

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Dr. Shahid Hassan
Keyword(s):  
Demographic Data ◽  
Tertiary Care ◽  
Clinical History ◽  
Epidemiologic Studies ◽  
World Population ◽  
Care Hospital ◽  
Indirect Contact ◽  
Medical College ◽  
Number Of Patients ◽  
History Of

INTRODUCTION: The current perception among dermatologists based on their experience in the outpatient’s clinics is that there is a huge change in clinical profile, both qualitative and quantitative, in the patients presenting with dermatophytosis. The prevalence of superficial mycotic infection is about 20%–25% of the world population, and dermatophytes is the leading microorganism responsible. Now there is a changing trend in the dermatophytic infections, the cases are presenting as chronic, not responding to usual treatment and also there are recurrent cases. Dermatophytosis is a contagious disease that spreads by direct or indirect contact. Until a few years ago, it had been a disease treated with ease using antifungal agents. In the recent past, there has been a failure of treatment with conventional therapy and emergence of an epidemic of recurrent and chronic dermatophytosis in India. MATERIAL AND METHODS: Our study population included 112 patients who were clinically diagnosed as dematophytosis in the Outpatient department (OPD). Clinical history of all patients was taken. Demographic data such as age, sex, occupation, duration of disease, history of recurrence, habits and associated diseases was recorded. Culture were done in all suspected cases. Nail scrapings, clippings and sub-ungual debris were collected. RESULTS: In present study there were in all 112 patients among which maximum number of patients about 33% belonged to age group 11 to 20, majority of which were males 66.96% whereas 33.04% were females. 50% were culture positive among all patients and microscopy was positive in 58.93% of cases. Trichophytonrubrum species was isolated predominantly in 57.1% cases, Trichophytonmentagrophyte was found in 23.2% of patients followed by microscoporumgypsium isolated in 12.5% cases and E.floccosum was seen isolated in 7.1% among all clinical types. Percentage of tineacorporis, tineacapitis and tineacruris was 39.3%, 18.8% and 13.4% respectively. CONCLUSION: Dermatophytosis was found to be common in second decade of life and male were commonly affected. T. rubrum was most common isolate. The need of the hour is carry out multicentric large epidemiologic studies that can effectively establish the prevalence of fungal isolates and its antifungal resistance status.

scholarly journals A study of febrile convulsions with a bacteremia incidence in a tertiary care teaching hospital in Andhra Pradesh

2020 ◽  
Vol 7 (9) ◽  
pp. 1885
Author(s):  
Shaik Ateal Saheb
Keyword(s):  
Family History ◽  
Tertiary Care ◽  
Positive Family History ◽  
Febrile Convulsion ◽  
Clinical History ◽  
Health Issues ◽  
Febrile Convulsions ◽  
Medical College ◽  
History Of ◽  
History Of Epilepsy

Background: A febrile convulsion is linked with high temperature but without significant underlying health issues. These occur most often in children aged six months to five years. Most of the convulsions last less than five minutes, and within an hour of the occurrence, the child is entirely back to normal.Methods: Sixty children aged 3 months to 5 years admitted to the emergency pediatric ward with a history of convulsion fever with convulsions, in Narayana Medical College and Hospital were taken up for the study with clinical history, clinical examination, laboratory Investigations.Results: Among 60 children in the study group, 15 (25%) of them were aged between 3 months to 12 months, 21 (35%) of them were between 13 months to 24 months. Gender 36 (60%) are male children. 24 (40%) are female children. Family history of convulsions was positive in 18 (30%) of the 60 (100%) cases, and 7 had family history of epilepsy. 42 (70%) are negative. Most of the cases (85%) showed no growth in blood culture.Conclusions: Blood culture should be performed in all children by febrile convulsions, especially those under the stage of two years. Streptococcus pneumonia was the organism isolated from respiratory tract infection in a child with febrile convulsion with significant bacteremia. The symptoms that present can be as harmless as rhinorrhea or cough. Children with a positive family history of afebrile convulsion should be closely monitored and test, as they can develop epilepsy later.

scholarly journals OVARIAN TUMORS

2018 ◽  
Vol 25 (09) ◽  
pp. 1334-1337
Author(s):  
Jawad Ali Memon ◽  
Zubair Ali
Keyword(s):  
Ct Scan ◽  
Case Series ◽  
Clinical History ◽  
Ovarian Tumors ◽  
Ca 125 ◽  
Wall Thickening ◽  
Case Series Study ◽  
Ca 19.9 ◽  
History Of ◽  
Marker Study

Background: It is mandatory to distinguish between primary ovarian tumorsand metastases, as the treatment and prognoses are wide apart. Immunohistochemistry ismost frequently method being used to distinct these. Multiple studies showed that CDX2 ishallmark of the gut epithelium and is highly sensitive and specific immunohistochemical markerfor neoplasms of gastrointestinal origin. Objectives: In this case series study we have clinicallyand radiologically evaluated the cases of ovarian tumors referred to our institute, which arereported metastatic from colon based on expression of CDX2 marker. Study Design: Crosssectional observational study. Setting: Peoples University of Medical and Health Sciences forWomen (PUMHSW). Shaheed Benazir Abad. Period: Aug 2017 to September 2017. Patientsand Methods: 12 patients which were undergone oophrectomy and biopsy reported asmetastatic ovarian carcinoma from colon origin, based on histopathology features and CDX+immunohistochemistry marker, were included in our study. All the patients evaluated throughdetailed clinical history and examination, upper and lower GI endoscopy, CT scan wholeabdomen with contrast and tumor markers including CA 125, CEA, CA 19.9 and AFP). Results:No history of GIT specific symptoms like vomiting, constipation, diarrhea, bleeding per rectumwere noted in any patient. Upper and lower GIT endoscopies failed to identify any suspiciouslesion. No bowel related mass or wall thickening noted in CT scan abdomen with contrast.The serum level of CA 125 and CEA were only mildly raised in most patients. No evidence ofprimary colon lesion was noted in these patients inspite of extensive workup. Eventually thepatients were labeled and treated as primary carcinoma of ovary. Conclusions: CDX2 cannotbe used as sole indicator of colon origin and panel of the markers should always be employed,and clinical as well as radiological features should also be considered during interpretation ofIHC results.

scholarly journals Pattern of head injuries in patients admitted in tertiary trauma Centre.

2020 ◽  
Vol 27 (05) ◽  
pp. 921-928
Author(s):  
Muhammad Ali ◽  
Muzamil Dilber ◽  
Moti Ram Bhatia ◽  
Abdul Razaque Mari ◽  
Hamid Akbar Shaikh ◽  
...  
Keyword(s):  
Head Injury ◽  
Ct Scan ◽  
Head Injuries ◽  
Tertiary Care ◽  
Trauma Centre ◽  
University Hospital ◽  
Trauma Unit ◽  
Bone Window ◽  
Medical University

Objectives: The aim of study to know the pattern of injury in terms of severity & outcome in patients with head injuries admitted in trauma unit of a tertiary care Centre. Study Design: Descriptive Study. Setting: Trauma Centre, Peoples medical university hospital Nawabshah. Period: From June, 2018 to May, 2019. Material & Methods: This included 385 patients admitted in trauma unit of Neurosurgery Department of Peoples medical university hospital Nawabshah, through emergency Department with head injury sustained due to road traffic accident, fall, sports related injuries or Assault etc as evident on CT scan brain (plain) with bone window. Patients with poly trauma, bleeding disorders, previously operated and those who failed to turn up in OPD for follow up were excluded.  Glasgow Coma Scale (GCS) was used for categorizing the subjects with head injury into mild (GCS 14-15), moderate (GCS 9-13) and severe injury (GCS 3-8). CT scan brain with bone window was done in all patients. These were then managed accordingly according to the severity of the injuries. Follow up Glasgow Coma Outcome scale was used to assess the outcome in these patients. Results: Regarding nature of traumatic injuries in these patients commonest were contusion (21.8%), extradural hematoma (27.5%), subdural hematoma (22.3%), diffuse axonal injury (13.2%), and subarachnoid hemorrhage (4.2%). This was followed by skull fracture (7.3%) and intracerebral hemorrhage (3.6%). Majority of the patients were with severe head injury. Glasgow Outcome Scale of Patients at Follow- up reveled complete recovery in 106 (27.5 %), Mild disability in 81(21.0%), Moderate Disability in 64 (16.6%), Severe Disability in 72 (18.7%), Persistent Vegetative state in 36 (9.4%), and death in 26 (6.8 %). Conclusion: Good outcome is observed in patients who are properly treated by continuous monitoring & timely surgical intervention in a tertiary care hospital.

Preliminary Assessment of Dynamic Voice CT in Post–Airway Reconstruction Patients

2018 ◽  
Vol 159 (3) ◽  
pp. 516-521 ◽  
Author(s):  
Mathieu Bergeron ◽  
Robert J. Fleck ◽  
Caleb Middlebrook ◽  
Stephanie Zacharias ◽  
Shea Tolson ◽  
...  
Keyword(s):  
Ct Scan ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Case ◽  
Reconstruction Procedure ◽  
Laryngeal Function ◽  
Additional Tool ◽  
Airway Reconstruction ◽  
History Of

Objectives To compare the ability of the dynamic voice computed tomography (CT) scan to characterize laryngeal function in airway reconstruction patients vs bedside endoscopic nasopharyngolaryngoscopy and videolaryngostroboscopy. Study Design Case series with chart review. Settings Pediatric tertiary care center. Subjects and Methods Retrospective case series of children and young adults with a history of complex airway surgeries with subsequent dysphonia. We analyzed clinical data for all patients who underwent an airway reconstruction procedure between January 1, 2010, and April 30, 2016, and also had a dynamic voice CT and bedside endoscopic exam during the same period. Results Twenty-four patients were analyzed (4 male, 20 female) with a mean age of 15.1 years (95% confidence interval [CI], 12.9-17.22). Patients had a mean of 2.2 airway surgeries (95% CI, 1.8-2.6), with 62.5% of them being open procedures. Laryngotracheoplasty with a cartilage graft was the most common procedure (40.0%). The pattern of laryngeal closure could be detected in all cases with the dynamic CT scan (n = 24/24, 100%) compared to 87.5% (21/24) with the standard endoscopic examination ( P = .04). The location of gap closure could be detected in all cases (24/24) with the dynamic voice CT while 20.8% (5/24 patients) could not be rated with standard endoscopy/stroboscopy ( P = .02). Dynamic voice CT was able to assess the vertical closure pattern of the glottis 100% (24/24) while it could be detected in 83.3% (20/24) cases with endoscopic study ( P = .04). Conclusion Dynamic voice CT shows promise as an additional tool for evaluation of patients with a history of complex airway procedures by providing complementary information.

Component resolved diagnostics in peanut sensitized children with and without a history of clinical reaction

2020 ◽  
Vol 41 (5) ◽  
pp. 336-340
Author(s):  
Yasmin Hamzavi Abedi ◽  
Cristina P. Sison ◽  
Punita Ponda
Keyword(s):  
Retrospective Chart Review ◽  
Clinical History ◽  
Specific Ige ◽  
Exact Test ◽  
Ara H 1 ◽  
Sige Level ◽  
History Of ◽  
Laboratory Procedures ◽  
Ige Mediated ◽  
The Relationship

Background: Serum Peanut-specific-IgE (PN-sIgE) and peanut-component-resolved-diagnostics (CRD) are often ordered simultaneously in the evaluation for peanut allergy. Results often guide the plans for peanut oral challenge. However, the clinical utility of CRD at different total PN-sIgE levels is unclear. A commonly used predefined CRD Ara h2 cutoff value in the literature predicting probability of peanut challenge outcomes is 0.35kUA/L. Objective: To examine the utility of CRD in patients with and without a history of clinical reactivity to peanut (PN). Methods: This was a retrospective chart review of 196 children with PN-sIgE and CRD testing, of which, 98 patients had a clinical history of an IgE-mediated reaction when exposed to PN and 98 did not. The Fisher's exact test was used to assess the relationship between CRD and PN-sIgE at different cutoff levels, McNemar test and Gwet’s approach (AC1 statistic) were used to examine agreement between CRD and PN-sIgE, and logistic regression was used to assess differences in the findings between patients with and without reaction history. Results: Ara h 1, 2, 3, or 9 (ARAH) levels ≤0.35 kUA/L were significantly associated with PN-sIgE levels <2 kUA/L rather than ≥2 kUA/L (p < 0.0001). When the ARAH threshold was increased to 1 kUA/L and 2 kUA/L, these thresholds were still significantly associated with PN-sIgE levels of <2, <5, and <14 kUA/L. These findings were not significantly different in patients with and without a history of clinical reactivity. Conclusion: ARAH values correlated with PN-sIgE. Regardless of clinical history, ARAH levels are unlikely to be below 0.35, 1, or 2 kUA/L if the PN-sIgE level is >2 kUA/L. Thus, if possible, practitioners should consider PN-sIgE rather than automatically ordering CRD with PN-sIgE every time. Laboratory procedures that allow automatically and reflexively adding CRD when the PN-sIgE level is ≤5 kUA/L can be helpful. However, further studies are needed in subjects with challenge-proven PN allergy.

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