THYROTOXIC PERIODIC PARALYSIS AND COMPLICATED THYROTOXICOSIS, TWO PRESENTATIONS OF HYPERTHYROIDISM WITH NOTABLE DIFFERENCES IN THEIR CLINICAL MANIFESTATIONS: AN EXPERIENCE FROM A TERTIARY CARE HOSPITAL IN THE UNITED STATES

2020 ◽  
Vol 26 (7) ◽  
pp. 699-706
Author(s):  
Ana M. Rivas ◽  
Subhanudh Thavaraputta ◽  
Menfil Andres Orellana-Barrios ◽  
John Drew Payne ◽  
David Sotello ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
The United States ◽  
Periodic Paralysis ◽  
Admission Diagnosis ◽  
Care Hospital ◽  
Qtc Prolongation ◽  
Free Triiodothyronine ◽  
Thyrotoxic Periodic Paralysis

Objective: Thyrotoxic periodic paralysis (TPP) is a muscular disorder characterized by sudden episodes of muscle weakness and hypokalemia in the setting of thyrotoxicosis. We aimed to report our experience with TPP in West Texas and compare its clinical presentation to that of patients admitted for complicated thyrotoxicosis. Methods: Retrospective review of records of adult patients with admission diagnosis of hyperthyroidism, thyrotoxicosis, and/or discharge diagnosis of periodic paralysis seen at our institution in a 6-year period. Results: Patients admitted for complicated thyrotoxicosis were more commonly females of a mean age of 44 years. Patients with TPP were more commonly Hispanic males of a mean age of 27 years. Despite no significantly different thyroid hormone levels, patients with TPP presented with less-severe signs and symptoms of hyperthyroidism, as reflected by lower Burch-Wartofsky score on admission (19 vs. 35; P<.001) and lower occurrence of atrial fibrillation in the TPP group (0% vs. 36%; P<.001). Finally, 89% of TPP patients presented with corrected QT (QTc) prolongation, whereas only 19% of thyrotoxic patient presented with a prolonged QTc. Conclusion: Hispanic patients with TTP seems to have relative resistance to the actions of thyroid hormones and commonly present with QTc prolongation, a risk factor for cardiac arrhythmias. Abbreviations: BWS = Burch-Wartofsky point scale; EKG = electrocardiogram; FT3 = free triiodothyronine; FT4 = free thyroxine; ICD = International Classification of Diseases; QTc = corrected QT; TPP = thyrotoxic periodic paralysis

scholarly journals Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s263-s264
Author(s):  
Jordan Polistico ◽  
Avnish Sandhu ◽  
Teena Chopra ◽  
Erin Goldman ◽  
Jennifer LeRose ◽  
...  
Keyword(s):  
Influenza Season ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Turnaround Time ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Rapid Pcr ◽  
The Impact

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

scholarly journals Safety huddles to proactively identify and address electronic health record safety

2016 ◽  
Vol 24 (2) ◽  
pp. 261-267 ◽  
Author(s):  
Shailaja Menon ◽  
Hardeep Singh ◽  
Traber D Giardina ◽  
William L Rayburn ◽  
Brenda P Davis ◽  
...  
Keyword(s):  
Situational Awareness ◽  
Tertiary Care ◽  
The United States ◽  
Care Hospital ◽  
Design Data ◽  
Software Application ◽  
Safety Concerns ◽  
Hardware System ◽  
Error Taxonomy ◽  
Electronic Health

Objective: Methods to identify and study safety risks of electronic health records (EHRs) are underdeveloped and largely depend on limited end-user reports. “Safety huddles” have been found useful in creating a sense of collective situational awareness that increases an organization’s capacity to respond to safety concerns. We explored the use of safety huddles for identifying and learning about EHR-related safety concerns. Design: Data were obtained from daily safety huddle briefing notes recorded at a single midsized tertiary-care hospital in the United States over 1 year. Huddles were attended by key administrative, clinical, and information technology staff. We conducted a content analysis of huddle notes to identify what EHR-related safety concerns were discussed. We expanded a previously developed EHR-related error taxonomy to categorize types of EHR-related safety concerns recorded in the notes. Results: On review of daily huddle notes spanning 249 days, we identified 245 EHR-related safety concerns. For our analysis, we defined EHR technology to include a specific EHR functionality, an entire clinical software application, or the hardware system. Most concerns (41.6%) involved “EHR technology working incorrectly,” followed by 25.7% involving “EHR technology not working at all.” Concerns related to “EHR technology missing or absent” accounted for 16.7%, whereas 15.9% were linked to “user errors.” Conclusions: Safety huddles promoted discussion of several technology-related issues at the organization level and can serve as a promising technique to identify and address EHR-related safety concerns. Based on our findings, we recommend that health care organizations consider huddles as a strategy to promote understanding and improvement of EHR safety.

Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

2021 ◽  
Author(s):  
Seema Sachdeva seema sachdeva ◽  
Akshay Kumar Akshay Kumar ◽  
Parveen Aggarwal Parveen Aggarwal
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Fish Bone ◽  
Quality Improvement Initiative ◽  
Care Hospital ◽  
Analysis Model ◽  
Post Intervention ◽  
Targeted Interventions ◽  
Administration Time

Abstract BackgroundSevere exacerbation of asthma are potentially life-threatening and therefore require prompt care and frequent management. Important elements of early treatment includes recognition of early signs and symptoms of breathing difficulty and timely prescription and administration of therapeutic agents. A subsequent delay in receiving nebulization during an acute exacerbation of asthma can leads to cardiac arrest and even death. AimTo reduce the gap in administration of nebulization from its prescription time among red triaged patients by 50% from its baseline. Setting and designThis interventional study was conducted among red triaged patients in emergency department of tertiary care hospital, India . Material and MethodsBaseline information was collected during first 4 weeks to find gap in administration of nebulization from its prescription time. Fish bone analysis and process map were laid down to analyse the situation. The intervention using targeted bundles was done via 3 PDSA (PDSA1: indenting the nebulizers, PDSA 2: training of doctors and nurses, PDSA 3; introducing equipment checklist) to reduce the gap . A run chart using time series analysis model was used to compare the pre and post intervention nebulization gap. ResultsTotal 74 patients (30 in pre- intervention, 44 in post intervention) admitted in red triaged area were observed for nebulization gap from prescription to administration. Median time for nebulization gap before intervention was 46.5 minutes which reduced to 15 minutes in post intervention phase. ConclusionThis bundles of targeted interventions was successful to reduce the nebulization gap. Key words: nebulization gap, prescription time, administration time

Abstract TP226: Vertebral Artery Dissection is More Common Than Carotid Artery Dissection and More Difficult to Detect on Non-invasive Imaging

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Mohammad O Nakawah ◽  
John Volpi
Keyword(s):  
Tertiary Care ◽  
Vertebral Artery Dissection ◽  
Clinical Manifestations ◽  
Carotid Artery Dissection ◽  
Vascular Imaging ◽  
Noninvasive Testing ◽  
Artery Dissection ◽  
Care Hospital ◽  
Anterior Circulation ◽  
Cerebral Angiogram

Background: Cervical artery dissections (CAD) are among the most common causes of stroke in young and middle-aged adults. In contrast to carotid dissections (CD) and anterior circulation ischemia, the clinical manifestations of vertebral dissections (VD) and posterior circulation ischemia are often nonspecific (e.g. dizziness and ataxia), and thus a high index of suspicion is necessary for diagnosis. Therefore, the reported incidence of VD in the medical literature is likely to be an underestimation. Methods: With IRB approval, we conducted a retrospective chart review study using the Neurology Database of Houston Methodist Neurological Institute to identify all patients diagnosed with CAD between August 2011 and March 2015. All patients presented with cerebral ischemia (TIA or stroke). The diagnosis of CAD was made by a stroke neurologist and was based on clinical presentation and appropriate vascular imaging studies. Patients with incidental CAD and those with questionable diagnosis of CAD clinically and radiographically were excluded. Over the studied period (32 months), a total of 677 TIA patients and 3230 stroke patients were admitted to our tertiary-care hospital. Results: Of 52 patients with CAD-related TIA or ischemic stroke, there were 34 patients (65.4%) with VD and 18 patients (34.6%) with CD. The average age of presentation is 47 years (range: 18 to 75 years) for VD patients and 51 years (range: 34 to 78 years) for CD patients. CAD was slightly more common in males, with 18 VD patients (52.9%) and 10 CD patients (55.5%) in our studied population were males. Out of 30 patients with VD who underwent both noninvasive vascular imaging (MRA or CTA) and cerebral angiogram, dissection was detected on noninvasive imaging in 10 patients (33.3%). On the other hand, out of 13 patients with CD who had both types of imaging modalities, dissection was detected on noninvasive testing in 8 patients (61.5%). Conclusions: VD was detected approximately twice as frequently as CD in our study. Both conditions are slightly more common in men with an average age of presentation is about 50 years. In addition, our data suggest that noninvasive testing is more likely to diagnose carotid dissection (in two-third of cases) than vertebral dissection (in one-third of cases).

scholarly journals Species identification of Candida isolated from clinical specimens in a tertiary care hospital

2016 ◽  
Vol 9 (1) ◽  
pp. 20 ◽  
Author(s):  
Lsmet Nigar ◽  
Shirin Tarafder ◽  
Rehana Razzak Khan ◽  
S. M. Ali Ahmed ◽  
Ahmed Abu Saleh
Keyword(s):  
Candida Albicans ◽  
Candida Species ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Common Species ◽  
Blood Stream ◽  
Care Hospital ◽  
Emerging Pathogens ◽  
Predisposing Factor ◽  
Clinical Specimens

<p><strong>Background:</strong> Candida species are responsible for various clinical manifestations from mucocutaneous overgrowth to blood stream infections especially in immunocompromized situations. Although C. albicans is the most prevalent species, high incidence of non-albicans Candida species with antifungal resistance are emerging which is posing a serious threat to the patients care.</p><p><strong>Objective:</strong> This study aimed to isolate and identify different species of Candida from different clinical specimens. Methods: A total of 100 different clinical specimens were studied of which 35 were oral swab, 28 were high vaginal swab, 15 were urine, 14 were nail, 04 were bronchoalveolar lavage and peritoneal fluid were 04. Among 100 clinical specimens, Candida isolates were identified in 64 specimens. Isolation of Candida species was done by primary culture in SDA. Subsequent identification of species were performed by germ tube test, subculture in chromo­genic agar medium and carbohydrate assimilation test with commonly used twelve sugars.</p><p><strong>Results:</strong> Out of 64 isolated Candida species, Candida albicans were 51.56% and the non-albicans Candida species were 48.44%. The most prevalent Candida species was C. albicans 33 (51.53%) followed by C. tropicalis 17 (26.56%). C. glabrata 4 (6.25%), C. parapsilo­sis 4 (6.25%), C. krusei 3 (4.68%) and C. guilliermondii 2 (3.2%). One of the isolated Candida species was unidentified.</p><p><strong>Conclusion:</strong> Though Candida albicans was found as the most common species, but non-albicans Candida species are appearing as emerging pathogens as well. Exposure to chemotherapy appeared to be the commonest predisposing factor for Candida infection followed by indwelling urinary catheter in situ for prolong period.</p>

scholarly journals Commonest modes of presentation of bone and soft tissue tumors at sarcoma services of A Tertiary Care Hospital of KPK.

2020 ◽  
Vol 27 (12) ◽  
pp. 2744-2748
Author(s):  
Muhammad Ibrahim ◽  
Zeeshan Khan ◽  
Muhammad Saeed ◽  
Israr Ahmad ◽  
Salik Kashif ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Tertiary Care ◽  
Sampling Technique ◽  
Signs And Symptoms ◽  
Soft Tissue Tumors ◽  
Care Hospital ◽  
Duration Of Symptoms ◽  
Mode Of Presentation ◽  
Number Of Patients ◽  
Delays In Diagnosis

Objectives: The aim of this study is to assess the commonest mode of presentation at our sarcoma unit and the duration from onset of symptoms till presentation. Study Design: Retrospectively study. Setting: Sarcoma Unit of Hayatabad Medical Complex, Peshawar. Period: June 2016 to December 2019. Material & Methods: Two hundred and eighty two patients were included in this study of which 172 patients were male and 110 were female. Sample size was calculated through non-probability consecutive sampling technique. Results: Average age of patients presenting to us was 30.2years (±18.5) ranging from 3years to 83years. Highest numbers of patients fell into the age group category of 11-20years i.e. 94 (33.33%). The average duration of symptoms among our patients was 19.6 months (±26.09) ranging from 0.1months (3 days) to 168 months (14years). Highest number of patients fell into the 7months-12months category i.e. 86 patients (30.5%). The commonest mode of presentation among our patients was painful lump i.e. 128(45.3%) while patients presenting with painless lump were 57(20.2%) and those presenting with only pain were 28(9.9%). Conclusion: The study concluded that there is a need of greater awareness amount general population and health care professionals regarding red flag signs and symptoms in order to avoid the delays in diagnosis which may leads to poor prognosis.

scholarly journals Incidence of tuberculosis and opportunistic respiratory infections in cases of human immunodeficiency virus: a one-year study at a tertiary care hospital

2020 ◽  
Vol 7 (7) ◽  
pp. 1068
Author(s):  
Chintha Venkata Subrahmanyam ◽  
Mahesh Vidavaluru
Keyword(s):  
Respiratory Infections ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Pulmonary Complications ◽  
Care Hospital ◽  
Cd4 Cell Count ◽  
Cd4 Counts ◽  
Management Protocol ◽  
One Year ◽  
Tract Infections

Background: Evaluation of respiratory signs and symptoms among HIV patients is a challenging task for a number of reasons. A definitive diagnosis is highly recommended before starting management protocol. Objectives of this study was to primarily evaluate the incidence of pulmonary tuberculosis and opportunistic respiratory infections among the cases of HIV and to estimate the CD4 counts of all the patients and correlate with the respiratory infections among the cases.Methods: The present study was a one-year study conducted at Narayana Medical College and all the cases of HIV presented with signs and symptoms of lower respiratory tract infections were included after obtaining consent. Relevant biochemical, microbiological investigations and CD4 counts of all the cases were done and noted. The data was entered in Microsoft excel spread sheet and analysed for any corrections. Mean, median and SD was calculated for all the continuous variables.Results: A total of 127 cases with 87 males and females 40 females with a ratio of 2.2:1 were included. Mean age of the total cases in the study was 46.12±8.3 years and 29.92% were above 60 years. Hetero sexual exposure was the commonest cause and 59.84% of cases were diagnosed with bacterial pneumonia. Prevalence of tuberculosis among the cases of this study was 22.05%. The mean CD4 cell count with SD among the study was 168.57±142.21.Conclusions: Knowledge of the pattern of pulmonary complications in patients with HIV infection in relation to CD4 count will help clinicians develop faster diagnostic and therapeutic approach to patient management.

scholarly journals EVALUATION OF C - REACTIVE PROTEIN AS A PROGNOSTICATOR OF THE COURSE OF COVID 19 DISEASE

2021 ◽  
Vol 9 (10) ◽  
pp. 1379-1385
Author(s):  
Rani Kumaravelu ◽  
Priyadarshini Shanmugam ◽  
Nirupa Soundararajan ◽  
Alice Peace R. ◽  
Perumal Jayaraman
Keyword(s):  
Tertiary Care ◽  
Rna Extraction ◽  
Clinical Manifestations ◽  
Surrogate Marker ◽  
Significant Rise ◽  
Care Hospital ◽  
Icu Patients ◽  
Reactive Protein ◽  
Elder Patients ◽  
Early Rise

Diagnosis of COVID 19 is based on clinical manifestations, history of exposure, positive CT scan findings and laboratory tests. Inflammation plays a key role in pathogenesis of COVID 19. CRP is an acute phase protein in the serum and is also a surrogate marker for the pro inflammatory cytokine IL 6. Significant rise in CRP indicates clinically relevant inflammation. Aim and Objectives: To analyse the CRP levels in COVID 19 infected patients and to validate CRP as an indicator of the severity of SARS CoV 2 infection. Materials and Methods: This retrospective study was carried out at Chettinad Hospital and Research Institute, a tertiary care hospital situated on the outskirts of Chennai, India, for a period of 4 months. A total of 10263 patients were tested for COVID-19 by RT PCR. Viral RNA Extraction was automated and SARS CoV2 RTPCR performed with ROTOR GENE Q(QIAGEN) using SD Biosensor Real Time PCR kit. The CRP levels were measured using QDx Instacheck Fluorescence immunoassay system, Indianapolis, IN. Results: Among 10263 patients, 2694 (26.2%) patients tested SARS CoV-2 positive. CRP levels were measured for 1472 SARS CoV 2 patients (including both OP and IP). Among them 745 (50.6%) patients were found to be CRP reactive. Of the CRP reactive patients, 7 patients (0.9%) were <18 years, 190 patients (25.5%) were between 18 - 45 years and 548 patients (73.5%) were >45 years. Of the 592 patients with elevated CRP levels, 167 patients were from ICU and 425 patients were from non-ICU. Highly elevated CRP levels of >100mg/L were found in 65% (n=109) of the COVID positive ICU patients and 23% (n=101) of the non-ICU patients. Increased CRP levels were noted in SARS CoV- 2 infected individuals. Elevated CRP was common among elder patients aged >45 years and in males. Conclusion This study concludes that the significant rise of CRP levels was noted in hospitalized SARS CoV 2 positive patients aged > 45 years. Thus, estimating the early rise of serum CRP levels in SARS CoV-2 patients is a well affordable and less invasive parameter to guide the clinicians that is readily available in all the health care centers.

scholarly journals Susceptibility of Clinical Isolates of Staphylococcus aureus to Ceftaroline

2021 ◽  
Author(s):  
Harsha Sreedharan ◽  
KB Asha Pai
Keyword(s):  
Staphylococcus Aureus ◽  
Tertiary Care Hospital ◽  
Methicillin Resistance ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
The United States ◽  
Clinical Isolates ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Care Hospital

Introduction: Methicillin-Resistant Staphylococcus aureus(MRSA) infection is a major global healthcare problem, the prevalence of which varies from 25-50% in India. It is known to cause Skin and Soft tissue Infections (SSI), endovascular infections, endocarditis, pneumonia, septic arthritis, osteomyelitis, and sepsis. Vancomycin is the drug of choice for treating severe MRSA infections. Ceftaroline, a fifth-generation cephalosporin has been approved by the United States Food and Drug Administration (US FDA) for treating acute bacterial SSI caused by susceptible micro-organisms including MRSA, Community acquired respiratory tract infection, MRSA bacteremia and endocarditis. Aim: To assess the susceptibility of clinical isolates of S. aureusto ceftaroline, in a Tertiary Care Hospital. Materials and Methods: This prospective study was conducted in the Department of Microbiology of a Tertiary Care Hospital over a period of two months from June 2019 to July 2019. S.aureus isolates from various clinical samples were screened for methicillin resistance by disc diffusion method using cefoxitin disc and ceftaroline susceptibility of these isolates was assessed by E-strip method. The isolates were classified as ceftaroline susceptible, Susceptibility Dose Dependent (SDD) and ceftaroline resistant respectively as per CLSI guidelines. A descriptive analysis of the data was done and the results were presented as frequencies and percentages. Results: All the S.aureus isolates were found to be susceptible to ceftaroline. Methicillin Sensitive Staphylococcus aureus(MSSA) isolates had lower Minimum Inhibitory Concentration (MIC) when compared to MRSA. The highest MIC among MRSA was 0.5 μg/mL. Conclusion: Ceftaroline can be considered as an effective alternative for treatment of infections caused by MRSA.

scholarly journals Frequency and Pattern of Bronchiectasis in Patients with Chronic Obstructive Pulmonary Disease Presenting in a Tertiary Care Hospital

2021 ◽  
Vol 35 (3) ◽  
pp. 54-57
Author(s):  
Asifa Karamat
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Tertiary Care ◽  
Lower Lobe ◽  
The United States ◽  
Diagnostic Tools ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Care Hospital ◽  
Obstructive Pulmonary Disease

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a high burden respiratory issue all over the world. It has high morbidity and mortality in the United States. Bronchiectasis is associated with chronic obstructive pulmonary disease (COPD) and is under diagnosed as diagnostic tools like HRCT though easily available but an expensive test in developing countries like Pakistan. We aim to establish the frequency and patterns of bronchiectasis in patients of COPD. Aims and Objectives: To establish the frequency and pattern of bronchiectasis in COPD in our population so that we can improve patient care and quality of life of these patients. Place and duration of study: We did a cross sectional survey in Department of Pulmonology, Gulab Devi Hospital, Lahore. Study was completed from 1st September 2017 to 28th February 2018. Material & Methods: After taking an informed consent 150 already diagnosed COPD patients were included. Bronchiectasis was seen on high resolution CT scan (HRCT). Data was collected on a structured proforma and analyzed on SPSS version 20. Results: Bronchiectasis was observed in 76 (50.6%) patients of COPD while 74 patients had no bronchiectasis. Out of 76, cylindrical bronchiectasis was seen in 82%. Lower lobe and bilateral involvement was more common. Means of age, gender, exacerbations of COPD, and history of pulmonary tuberculosis were not related to bronchiectasis while pack years of smoking, duration of illness and Modified Medical Research Council (MMRC) Dyspnea Scale were significantly related to bronchiectasis. Conclusion: This is observed that bronchiectasisis quite common (50.6%) in patients of COPD in our population.

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