scholarly journals An illustration of delays in Mucormycosis: A case Study

2021 ◽  
Vol 33 (3) ◽  
pp. 515-518
Author(s):  
Neelam Anupama Toppo ◽  
Aditya Thakur ◽  
Deepali Soni ◽  
Priyanka Dubey ◽  
Sapna Tiwari
Keyword(s):  
Fungal Infection ◽  
Blood Sugar ◽  
Economic Status ◽  
Tertiary Care ◽  
Successful Outcome ◽  
Care Hospital ◽  
Health Service Provider ◽  
Case File ◽  
Local Trauma ◽  
Three Delays

Background: Mucormycosis is an opportunistic fungal infection with a high fatality rate and is the third most common fungal infection that is invasive in nature, next to candidiasis and aspergillosis. It is attributed to the poor socio-economic status and triggered by the local trauma due to unhygienic setup or poor health care. The pathway of pathogenesis is not clearly understood in immunocompetent patients and therefore becomes a matter of great concern.Aim& Objective: To explore the pathway of  mucormycosis in a case of post SARS-CoV-2 infection Settings and Design: Tertiary Care hospital of Jabalpur DistrictMethods and Material: Interview with the case and care taker and case file review.Results: We could conclude this as a case of rhino- orbital mucormycosis attributed to uncontrolled blood sugar during treatment of SARS-CoV-2 infection,  three delays that have occurred during the disease progression like ignorance from health service provider, late diagnosis, non compliance to the advice given by health facility,  poor oral and nasal hygiene and no use of distilled water in humidifier. Conclusions: The early diagnosis, prompt Treatment , surgical intervention , proper blood sugar monitoring and rational use of steroids are important steps of successful outcome of the disease.

scholarly journals DILEMMAS IN MANAGEMENT OF PREGNANT PATIENTS WITH MECHANICAL PROSTHETIC VALVES IN RURALAND SEMI-URBAN NORTH INDIAN POPULATION AT A TERTIARY CARE INSTITUTION.

2020 ◽  
pp. 44-45
Author(s):  
Amrit Gupta ◽  
Varuna Varma ◽  
Indrani Ghosh ◽  
Nirmal Kumar Gupta ◽  
Neeraj Kumar
Keyword(s):  
Pregnant Women ◽  
Heart Valves ◽  
Economic Status ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
Mechanical Heart Valves ◽  
Successful Outcome ◽  
Congenital Defects ◽  
Care Hospital ◽  
In Pregnancy

Pregnancy is a prothrombotic stage, and in women with mechanical heart valves, anticoagulation is a challenge to attain an optimal outcome in mother and fetus. The use of combinations coumadin derivatives and various heparins is still in inconclusive stage due to various socioeconomic and demographic situation. In developing countries due to the cost of surgery, and compliance with lifelong anticoagulation there is contradiction for efficient outcome. Hence a safe protocol is necessary for implementation. Objectives: To evaluate the most effective, practical and uniform “Anticoagulation Regimen” suited to rural and semi-urban Indian pregnant women with mechanical heart valves with low socio-economic status and to observe its impact on the pregnancy outcomes. Methodology: Retrospective observational cohort study carried out at tertiary institute, between July 2006 to June 2015. 69 women became pregnant during the period from 2006 to 2015 on 1 or multiple occasions. 21(30.43%) pregnancies ended in early abortions and 46 (66.7%) pregnancies were continued. Anticoagulation protocol that was followed in these women was H-A-H protocol. These pregnancies were managed by obstetric team of tertiary care hospital under same consultant. Outcome measures were analyzed. Data was expressed as mean with standard deviation or frequency with percentage as appropriate. Results: Of 292 women, who underwent valve replacement surgery, 69 pregnancies were reported during this period on 1 or multiple occasions. 46 women had successful deliveries and rest 23 had single or multiple pregnancy failure. Incidence of stillbirth in those who delivered successfully was lower (2.89%). Fetal morbidity was 37.68% and none of the pregnant women had valve thrombosis. In 46 women majority had successful outcome except 6(13.04%) children out of 46 who developed anticoagulation related congenital defects. This was mainly seen in those women who presented late in pregnancy. Conclusion: Our Experience showed that Heparin-Acitrome-Heparin protocol is effective and safe in pregnancy than heparin alone, or acitrome alone regimen. The fetal outcome was good, maternal compliance was better and this protocol is widely recommended.

scholarly journals Prognostic Factors for the Outcome of Salivary Gland Holmium: YAG Laser Intraductal Lithotripsy

2021 ◽  
pp. 014556132110100
Author(s):  
Shuo-Jen Wang ◽  
Lung-Che Chen ◽  
Yi-Chih Lin ◽  
Yen-Chun Chen ◽  
Luong Huu Dang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Salivary Gland ◽  
Success Rate ◽  
Operative Time ◽  
Tertiary Care ◽  
Operation Time ◽  
Laser Lithotripsy ◽  
Successful Outcome ◽  
Care Hospital ◽  
Yag Laser

Objectives: Holmium: YAG laser has gained its popularity throughout the years and is used to treat sialolithiasis, which helps to overcome the limitations of traditional sialendoscopic lithotripsy for larger-sized salivary stones. However, little information is available regarding factors predicting the success rate of Holmium: YAG laser intraductal lithotripsy. The purpose of this study is to investigate the factors affecting the success rates of Holmium: YAG laser lithotripsy for salivary stones treatment in a tertiary care hospital. Methods: A retrospective study conducted in patients receiving sialolithiasis surgery under sialendoscopy from May 2013 to March 2015 at Mackay Memorial Hospital, Taiwan. Data on various factors, including patients’ age, gender, glands, size of largest stone, multiple stones (≥2 stones), location of the stone (distal duct, middle duct, proximal duct, and hilum), and operative time. The success of the surgery defined as patients without any complaints such as swelling or tenderness. Logistic regression and Fisher exact tests were employed to examine these factors on the success rate. Results: Fifty-four patients who received sialendoscopy surgery with a mean age of 35.74 years old recruited. Logistic regression identified the operation time exceeding 210 minutes showed 23.497 folds higher odd ratio of having a result of operation failure ( P < .05). Conclusion: The prolonged operation time is the sole independent factor affecting the successful outcome for salivary gland intraductal laser lithotripsy. We recommend operative time be no more than 210 minutes to increase the success rate in salivary gland Holmium: YAG laser intraductal lithotripsy.

scholarly journals Satisfaction of women with health service provider in outpatient department of Obstetrics and Gynecology at a Tertiary care hospital

2017 ◽  
Vol 6 (2) ◽  
pp. 79-81 ◽  
Author(s):  
Ashia Khatun ◽  
Khairun Nahar ◽  
Mst Nurunnahar Aktar ◽  
Fatema Mahbooba Akter ◽  
Habibur Rahman
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Hospital Environment ◽  
Obstetrics And Gynecology ◽  
Care Hospital ◽  
Health Service Provider ◽  
College Hospital ◽  
Cross Sectional ◽  
Patient’S Satisfaction ◽  
Medical College

Background: Patient's satisfaction over the health care services is very important issue in Bangladesh.Objective: The purpose of present study was to find out the level of satisfaction of women attending in the OPD of Obstetrics and Gynecology department at a tertiary care hospital in Dhaka.Methodology: This descriptive type of cross sectional study was carried out in the OPD of Obstetrics and Gynecology department at Dhaka Medical College from September 2011 to October 2011 for a period of one month. All the women attending in Obstetrics and Gynecology department in outdoor service at Dhaka Medical College Hospital, Dhaka with the age group of 22 to 40 years were selected as study population. A purposive sampling method was used to collect the data.Results: A total number of 200 cases were taken for this study. Highly satisfied over the services delivered by the doctors was reported in 135 (65.8%) cases and service of nurses was satisfied 111(55.8%) of cases. Satisfactory waiting time (two hours) was 143(7l.9%) of cases and the satisfactory hospital environment was 127 (63.8%) of cases.Conclusion: In conclusion most of the women are satisfied to the treatment delivered by the doctors at the OPD of a tertiary care hospital.J Shaheed Suhrawardy Med Coll, 2014; 6(2):79-81

scholarly journals Gestational Age Specific Postnatal Growth Curves for Singleton Babies in Tertiary Hospital of Western Nepal

2017 ◽  
Vol 56 (207) ◽  
pp. 325-330
Author(s):  
Santosh Pathak ◽  
Nagendra Chaudhary ◽  
Prativa Dhakal ◽  
Shyam Kumar Mahato ◽  
Sandeep Shrestha ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Economic Status ◽  
Tertiary Care ◽  
Growth Curves ◽  
Tertiary Hospital ◽  
Care Hospital ◽  
Cross Sectional ◽  
Intrauterine Growth ◽  
Geographical Regions

Introduction: Measurement of birth weight (BW), crown heel length (CHL), head circumference (HC) and chest circumference used to assess the intrauterine growth of a baby vary with altitude, race, gender, socio economic status, maternal size, and maternal diseases. The study aimed to construct centile charts for BW, CHL and HC for new born at different gestational ages in western Nepal. Methods:  This was a descriptive cross sectional study done over a period of 15 months in a tertiary care hospital of western Nepal. BW, length, HC and CC were measured within 12-24 hours of birth. Gestational age was estimated from first day of last menstrual period, maternal ultrasonology and New Ballard’s scoring system. Microsoft 2007 Excel and SPSS-16 was used for data analysis. Cole’s Lambda Mu Sigma method was used for constructing centile curves. Results: Out of 2000 babies analysed, 1910 samples were used to construct smoothed intrauterine growth curve of BW, CHL, and HC from 33-42 weeks of gestation. 57.35% (1147) were male, mean gestational age was 38.13 ±2.44 weeks, where 21.5% were preterm and 1.7% post term. The means of BW, CHL, HC and CC were 2744.78 gm, 47.80 cm, 33.18 cm, and 30.20 cm with standard deviations of 528.29, 3.124, 1.78, and 2.35 respectively. These data vary as compared to the Kathmandu data, in case of birth weight for 10th and 90th centiles, and at 90th centile in case of length. Conclusions: This necessitates the update in the existing growth charts and develop in different geographical regions of a country.

scholarly journals MALNUTRITION, SEPSIS AND TUMOR LYSIS SYNDROME ARE ASSOCIATED WITH INCREASED RATE OF ACUTE MORTALITY IN MATURE B CELL NON-HODGKIN LYMPHOMA IN PEDIATRIC POPULATION- STUDY FROM TERTIARY CARE HOSPITAL IN PAKISTAN

2019 ◽  
Vol 11 (1) ◽  
pp. 02019043
Author(s):  
Raheela Mansoor
Keyword(s):  
Risk Factors ◽  
Fungal Infection ◽  
B Cell ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Tumor Lysis Syndrome ◽  
Significant Risk ◽  
Early Death ◽  
Care Hospital ◽  
Tumor Lysis

Background:            Outcomes of pediatric mature B cell NHL in resource challenged countries are negatively affected by increased rate of early and toxic deaths. Aim of this study is to assess rate of acute mortality and define significant risk factors present in children with mature B Cell NHL. Methods: A retrospective analysis was done of patients with B cell NHL from January 2012 till December 2016. Risk factors studied for acute mortality were malnutrition, stage, prior surgery with open laparotomy, LDH levels, tumor lysis syndrome, sepsis and fungal infection Results: Total 233 patients were enrolled in the study. Eighty five (36.4%) were below 15th percentile.  Treatment was started in 226 patients. Eighty eight percent children showed 20% response after COP pre-phase. Tumor lysis syndrome was developed in 20.6 % (n = 48) children and 42.9% (n = 100) patients had sepsis, 71/100 patients had culture proven sepsis. 19.7% (n = 46) patients developed fungal infection. There was 19.7% (n = 46) acute mortality.  Most common cause of death was sepsis (n = 22, 47.8%) followed by acute renal failure secondary to tumor lysis syndrome. On multivariate analysis, three independent variables found significant for early death are malnutrition, sepsis and tumor lysis syndrome. Conclusion: Rate of acute mortality in B cell NHL is high in our set up and significant risk factors are tumor lysis syndrome, sepsis and malnourishment at time of presentation.

scholarly journals Telephonic follow-up to assess compliance to advice regarding lifestyle modification and confirmation of diagnosis given during a diabetes screening camp

2017 ◽  
Vol 4 (6) ◽  
pp. 2080
Author(s):  
Geeta S. Pardeshi ◽  
Shailaja Daral ◽  
Timiresh Das ◽  
Mukesh Kumar ◽  
Pragyan Parija ◽  
...  
Keyword(s):  
Blood Sugar ◽  
Blood Sugar Level ◽  
Formal Education ◽  
Lifestyle Modification ◽  
Tertiary Care ◽  
Care Hospital ◽  
Diabetes Screening ◽  
Random Blood Sugar ◽  
Antidiabetic Treatment

Background: Compliance to the advice given in the diabetes screening camp will ensure timely diagnosis and lifestyle modification in high risk individuals. The objective of the study was to determine factors associated with follow up telephonic contacts and compliance to advice regarding lifestyle modification and confirmation of diagnosis. Methods: A prospective cohort study was conducted among persons aged more than 30 years attending a diabetes screening camp in outpatient department of a tertiary care hospital. Follow up telephonic contact to assess compliance was done among those with random blood sugar level >140mg/dl. Fisher’s exact test and relative risk with 95% confidence interval were calculated. Results: Out of the 1798 individuals attending the screening camp, 170 (9.4%) had raised random blood sugar level. Of these, 113 (66%) could be contacted telephonically. Male gender (RR=1.45, 95% CI=1.12-1.89; p=0.002), formal education (RR=1.85, 95% CI=1.20-2.86; p=0.00), gainful employment (RR=1.31, 95% CI=1.002-1.72; p=0.04) and perception of diabetes as serious and fatal disease (RR=1.26, 95% CI=1.02-1.55;p=0.04) were significantly associated with successful follow up contact. Of the 103 eligible individuals followed up for assessment of compliance, 82 (80%), 63 (61%) and 50 (49%) were compliant to advice regarding diet, physical activity and follow up visits for confirmation of diagnosis respectively. None of the independent factors were significantly associated with compliance. Confirmation of diagnosis of diabetes and initiation of antidiabetic treatment was reported by 33 respondents. Conclusions: A robust and holistic follow up mechanism to ensure better compliance to lifestyle modification and confirmation of diagnosis after a diabetes screening camp is needed. 

scholarly journals Prevalence and correlates of psychological distress among cancer patients in a tertiary care hospital in northern India

2019 ◽  
Vol 6 (5) ◽  
pp. 2223 ◽  
Author(s):  
Amita Mason ◽  
Ruchi Juyal ◽  
Sai Chandan Das ◽  
Deep Shikha ◽  
Sunil Saini ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Cancer Patients ◽  
Formal Education ◽  
Economic Status ◽  
Tertiary Care ◽  
Depression Scale ◽  
Care Hospital ◽  
Cross Sectional ◽  
Female Ratio ◽  
Female Patients

Background: Patients diagnosed with cancer are usually exposed to high level of mental stress and hence invariably lend in psychological distress. This study aimed to estimate the prevalence of psychological distress amongst cancer patients and determine its association with socio-demographic factors.Methods: This hospital based cross-sectional study was conducted at a cancer research institute of district Dehradun. Purposive sampling was used to select the hospital and recruiting patients. All eligible patients, giving written consent for the study were interviewed and distress related information was gathered using the Hospital Anxiety and Depression Scale (HADS). The data were collected for two months and sample size of 208 was achieved. Data was entered in SPSS 22.0 and association of different variables with psychological distress was determined by chi-square test..Results: The mean age of the surveyed cancer patients was 51.05±15.68 years and the male female ratio was 1.7. Prevalence of psychological distress was found to be 38.5% and significantly more female patients than male patients (47.4% and 33.3% respectively) had distress. The association between psychological distress and increasing age, sex, literacy and employment status was found to be significant.Conclusions: Approximately 39% of cancer patients had psychological distress (anxiety/ depression/ both). The prevalence of psychological distress was found to be significantly higher in female patients, older age, patients with no formal education, unemployment and lower socio-economic status. Appropriate psychiatric interventions/ counselling following diagnosis and during therapy may be effective in reducing distress and improving quality of life in cancer patients.

scholarly journals Incidental Hyperglycemia and Detection of Diabetes in Patients Presenting to the Emergency Department of a Tertiary Care Hospital

2020 ◽  
Vol 3 (1) ◽  
pp. 26-31
Author(s):  
Ashish Thapa ◽  
Anugya Amatya ◽  
Roshan Parajuli
Keyword(s):  
Emergency Department ◽  
Diagnostic Criteria ◽  
Blood Sugar ◽  
Tertiary Care ◽  
Data Entry ◽  
Adverse Outcomes ◽  
Final Outcome ◽  
Undiagnosed Diabetes ◽  
Care Hospital ◽  
Cross Sectional

Introduction: Nearly half of people with diabetes don’t know they have it. It is often not diagnosed until complications appear. The aim of the study was to determine the prevalence of diabetes mellitus and prediabetes in patients presenting to the Emergency Department with incidental hyperglycemia, because the duration of hyperglycemia is a predictor of adverse outcomes, and there are effective interventions to prevent disease progression and to reduce complications. Methods: It was an observational cross-sectional study, 720 patients from Emergency Department of Kathmandu Medical College, Sinamangal were screened from December 2018 to March 2019 and a total of 128 patients with incidental hyperglycemia (>140mg/dl) were included. Patients with a previous diagnosis of diabetes, unstable patients and pregnant patients were excluded. Incidental hyperglycemia, fasting blood sugar, 2 hours postprandial blood sugar and HbA1c were noted, data entry was done in Microsoft Excel and analysis was done using the SPSS 24. Results: Total of 128 patients were enrolled for the study.10% of the patients had hyperglycemia and 34% among the hyperglycemic had the finding in the absence of history of diabetes. Incidental hyperglycemia ranged from 150-500 mg/dl. Among the incidental hyperglycemic, 29% and 36% had prediabetes and diabetes respectively. Incidental hyperglycemia was divided into four groups; <159, 160-179, 180-199 and >200 mg/dl, and each group was analyzed with the diagnostic criteria and the final outcome. It was found that each group correlated well with the diagnostic criteria and final outcome and was found to be statistically significant with p<0.0001 based on the Chi square test. Conclusions: Following the patients with incidental hyperglycemia in the Emergency Department, a significant number of undiagnosed diabetes or prediabetes can be diagnosed, early intervention can be started that can prevent progression from prediabetes to diabetes and risk of complications can be reduced.

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