HEARING LOSS IN BLAST TRAUMA VICTIMS. A MULTICENTRE RETROSPECTIVE STUDY

Objective: To describe the resultant Otologic morbidity and report on the early outcomes following blasts occurring in twin cities of Quetta and Peshawar. Study Design: Case series. Place and Duration of Study: ENT department Tertiary Care Centre Quetta and Tertiary Care Hospital Peshawar. Study period was, from Jan 2013 to Dec 2013. Methodology: All bomb blast patients brought to the hospitals were included in study. Participants completed Symptom Assessment Forms followed by detailed ENT examination and Pure Tone Audiograms on arrival and after 6 weeks. Results: A total of 504 patients were included initially of which 80% of the patients were male. About 57.8% of the patients complained of ear injury, 21.6% of the total patients had tympanic membrane perforation on initial presentation. Chances of spontaneous closure of perforation were 20.9% in our study. Chances of hearing improvement were 17.9% in our study at the end of the study period. Conclusion: Blast related otologic injuries constituted a major source of morbidity The most common type of hearing loss following a blast trauma was mild to moderate conductive type. Chances of recovery of hearing following blast do exist (17.9%). Suspected patients should be regularly assessed and followed up. Much work needs to be done to study the impact of blast trauma on hearing in our country.

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Acute kidney injury requiring dialysis in obstetric patients: management and clinical outcome in case series of 30 patients in a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172923 ◽

2017 ◽

Vol 6 (7) ◽

pp. 2997

Author(s):

Molina U. Patel ◽

Yuvraj Jadeja ◽

Niket Patel ◽

Nayana Patel ◽

Smruti Vaishnav ◽

...

Keyword(s):

Acute Kidney Injury ◽

Tertiary Care ◽

Case Series ◽

Kidney Injury ◽

Therapeutic Interventions ◽

Risk Category ◽

Care Hospital ◽

Tertiary Care Centre ◽

Significant Difference ◽

The Impact

Background: Acute Kidney Injury is a common medical problem affecting approximately 5% of all hospitalized and 30% of critically ill patients. The incidence in obstetric patients ranges from 1 in 2000 to 1 in 25000 pregnancies. In India till date, the impact of AKI on fetomaternal outcome and pertaining therapeutic interventions is only sparsely studied.Methods: It is a retrospective cross-sectional study. All obstetric patients with AKI on dialysis, admitted to Shree Krishna Hospital, a tertiary care hospital in Karamsad village in Gujarat from January 2013 to August 2015. Multivariate statistical analysis of clinical and laboratory parameters was performed using SPSS program to obtain the results.Results: The incidence of dialysis was 1.6%. HELLP syndrome and pre-eclampsia (80%) was found to be the most common etiology of AKI followed by Congestive cardiac failure (34.5%), hemorrhage and sepsis in 30% resp. All patients were admitted to ICU care. No significant difference was found between SAP II and SOFA monitoring system. Mechanical ventilation was done to support 53.3% and inotropic support was needed by 56.7% patients. According to the RIFLE criteria, majority of the patients fall under risk category followed by injury. 18% of the patients developed End Stage Renal Disease.Conclusions: In view of the multifaceted etiologies and complexity of management of AKI, a multi-disciplinary approach involving nephrologist, intensivists, obstetricians and neonatologists is extremely important.

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An overview of endoscopic stapedotomy in a tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202207 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1102

Author(s):

Atish B. Gujrathi ◽

Siddharth A. Shroff ◽

Nishikant Gadpayale ◽

Naman Agarwal

Keyword(s):

Hearing Loss ◽

Intraoperative Complications ◽

Adult Population ◽

Tertiary Care ◽

Case Series ◽

Anatomical Variations ◽

Common Symptom ◽

Tertiary Care Centre ◽

Female Ratio ◽

Endoscopic Stapedotomy

Background: Stapedotomy is now one of the most popular and common surgeries done worldwide. Otosclerosis remains the most common single cause of conducting hearing loss in adult population. Females are more frequently affected than males with an approximate 2:1 ratio.Methods: This study consists of 30 patients who underwent stapedotomy for otosclerosis. This study was conducted at Dr Shankarrao Chavan Government Medical College, Nanded, during the period of 2 years (2017-2019). Patients were evaluated and operated. The various anatomical variations, diagnostic dilemmas, intraoperative complications, its management and follow-up were done systematically. Results: Age of patients included in this study ranged from 15 to 50 years. Youngest patient was a 17-year-old male. Age of presentation was most commonly seen in third decade of life. Male to female ratio was 1:2. The most common symptom was hard of hearing followed by tinnitus. In this study, 76.67% of the patient’s had bilateral disease. 66.66% of patients had hearing loss between 41-55 dB with mean pre-operative pure tone average was 51.16 dB. About 80% of patients had successful air bone closure between 0-10 dB after the surgery.Conclusions: Endoscopic stapedotomy seems a feasible and relatively safe surgical technique in limited case series. Cosmetically this procedure was more compliant by the patients however endoscopic stapedotomy requires a significant learning curve and an extreme expertise.

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Tympanoplasty Type-I using tragal perichondrium graft: Our experience

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.4.421 ◽

2019 ◽

Vol 35 (4) ◽

Cited By ~ 2

Author(s):

Fazali Wahid ◽

Sajid Rashid Nagra

Keyword(s):

Tertiary Care ◽

Case Series ◽

Pure Tone Audiometry ◽

Neck Surgery ◽

Tympanic Membrane Perforation ◽

P Value ◽

Type I ◽

Care Hospital ◽

Female Ratio ◽

Case Series Study

Objective: To determine the efficacy of tragal perichondrium graft used in tympanoplasty Type-I at a tertiary care hospital. Methods: This descriptive case-series study was performed at the department of E.N.T, Head and Neck Surgery, Medical Teaching Institution/Lady Reading Hospital (MTI/LRH), Peshawar, Pakistan from June 2017 to May 2018. After approved from IREB, a well informed consent was taken. Pure Tone Audiometry (PTA) was performed before surgery and post-operatively at three and six months interval. The mean ± SD Air-Bone Gap (ABG) was calculated in pre- and postoperative PTA. The data were analyzed using SPSS (version 20). Chi-square (X2) test of significance was used taking confidence interval at 95%. The p-value ≤0.05 was considered significant. Results: Total patients were 36; male 21 (58.3%), female 15(41.7%) with male: female ratio of 1.4:1. Mean ± SD age was 27.14 ± 7.49 years (Range 15 – 50Years). Tympanic membrane perforation was commonly found on right side 22 (61.1%), predominantly involving anterioinferior site 19 (52.8%) and medium sized perforation outnumbered 22 (61.1%). Mean pre-operative air-conduction of 49.72 dB was significantly reduced to 18.27 dB with pvalue of <0.05. Similarly the pre-operative mean air bone gap on PTA of 45.63 ± 8.35dB was also reduced to statistically significant level of 7.41 ± 3.51 dB on post-operative PTA with p-value of <.05. Graft was taken up well in 34 cases (94.4%). Conclusion: Tragal perichondrial graft is an effective grafting material used for tympanoplasty due to its possessing qualities. doi: https://doi.org/10.12669/pjms.35.4.421 How to cite this:Wahid FI, Nagra SR. Tympanoplasty type I using tragal perichondrium graft: Our experience. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.421 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital: A Case Series

Global Advances in Health and Medicine ◽

10.1177/2164956119835778 ◽

2019 ◽

Vol 8 ◽

pp. 216495611983577

Author(s):

Carolyn Bernstein ◽

Peter M Wayne ◽

Pamela M Rist ◽

Kamila Osypiuk ◽

Audrey Hernandez ◽

...

Keyword(s):

Tertiary Care ◽

Case Series ◽

Chiropractic Care ◽

Care Plan ◽

Care Hospital ◽

Coordinated Care ◽

Face To Face ◽

Team Meetings ◽

Migraine Headaches ◽

The Impact

This case series illustrates an integrated model of care for migraine that combines standard neurological care with chiropractic treatment. For each patient, we describe the rationale for referral, diagnosis by both the neurologist and chiropractor, the coordinated care plan, communication between the neurologist and chiropractor based on direct face-to-face “hallway” interaction, medical notes, team meetings, and clinical outcomes. Findings are evaluated within the broader context of the multicause nature of migraine and the impact of integrative chiropractic. Suggestions for future areas of research evaluating integrative approaches are discussed.

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A Clinical Study on Initial Experience of COVID-19 ARDS in Obstetric Patients at a Tertiary Care Centre in India

Case Reports in Obstetrics and Gynecology ◽

10.1155/2021/5591041 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Sheeba Marwah ◽

Reenu Kanwar ◽

Shahida Naghma ◽

Anjali Dabral ◽

Nitesh Gupta

Keyword(s):

Clinical Presentation ◽

Respiratory Infections ◽

Tertiary Care ◽

Case Series ◽

Respiratory Illness ◽

Response To Therapy ◽

Care Hospital ◽

Physiological Changes ◽

Tertiary Care Centre ◽

In Pregnancy

Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) which causes severe viral pneumonia rapidly leading to acute respiratory distress syndrome (ARDS). Pregnant women are considered more vulnerable to severe viral respiratory infections owing to the physiological changes in pregnancy. In COVID-19, patient can present with a variety of symptoms of which dyspnoea is one that is also commonly seen in the late stages of pregnancy. The clinical presentation as well as response to therapy is highly variable, and since no conclusive proven treatment is available yet, prevention and symptomatic treatment remains the mainstay of management. Thus, we report a case series of four SARS-CoV-2-positive obstetric patients who presented with severe ARDS in a tertiary care hospital, posing diagnostic and therapeutic challenges to the clinician, and were managed with a holistic multidisciplinary stepwise approach. Through this, an effort has been made to sensitize the attending obstetrician on diverse presentation of COVID-19 disease and to emphasize the importance of prevention, early pick up, and timely optimal management of pneumonia in pregnant females with COVID-19. The clinical presentation of respiratory illness due to SARS-CoV-2 in pregnancy can be mistaken for exaggerated physiological changes of pregnancy leading to delay in seeking medical care. During the current pandemic, high suspicion for COVID-19 should be kept. If found symptomatic, immediate care should be sought in a designated facility and managed accordingly preferably with a multidisciplinary approach.

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P132: Development and implementation of an intubation registry within a Canadian tertiary-care hospital

CJEM ◽

10.1017/cem.2017.334 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S122-S123

Author(s):

J.H. Yoo ◽

J. Trojanowski ◽

M. Laberge ◽

D. Griesdale ◽

J.R. Brubacher

Keyword(s):

Tertiary Care ◽

Published Data ◽

Preparation Technique ◽

Care Hospital ◽

Tertiary Care Centre ◽

Emergency Airway ◽

Additional Information ◽

Constructive Feedback ◽

Abstract Submission ◽

The Impact

Introduction: Intubation is a high-risk procedure that is frequently performed within the ED. Few Canadian centres have a system in place to monitor intubation frequency, indications, methods used, operator characteristics, first-pass success, and adverse event rates. There are no published data on the frequency of success or complications of emergency airway management in Canada. An airway registry would be a valuable quality improvement (QI) tool for assessing the impact of practice changes such as pre-intubation checklists and for identifying patients with “difficult airways.” We describe the development and implementation of an airway registry in a Canadian tertiary-care centre. Methods: We created a collaborative working group with staff from EM, ICU, Respiratory Therapy (RT), and Privacy. An airway data form was created. Over a 3 month trial period, the form was completed by RTs following each non-OR intubation. At our centre, RTs are present at every intubation outside of the OR. If a patient was intubated outside of the hospital, forms were completed using verbal handover. RTs also provided constructive feedback and after 3 months the form was revised and finalized. Medical student volunteers entered data from the forms and from chart reviews into a secure online database created for this purpose. Results: We have enrolled 373 patients over the first 5 months with ongoing enrolment at the time of abstract submission. The airway form captures the seniority and discipline of the intubator, preparation, technique, and any airway manoeuvres that were used. The form also captures Cormack-Lehane airway grading, confirmation techniques, complications, and the option to identify the patient as a “Difficult Airway.” Privacy permission was granted to include patient identifiers in the airway registry so that additional information from chart reviews could be obtained at a later date. Preliminary results will be presented at the conference. Conclusion: Our airway registry tracks intubation performance and may identify factors associated with adverse patient outcomes, which could prompt system-wide changes. Comparison of intubation performance to other Canadian institutions may be possible if similar airway registries are implemented. The development and implementation of an airway registry requires multi-disciplinary collaboration, engagement, and user feedback.

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Hearing loss and ossicular status in cholesteatoma

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182716 ◽

2018 ◽

Vol 4 (4) ◽

pp. 1072

Author(s):

S. S. Doddamani ◽

Yasha C.

Keyword(s):

Hearing Loss ◽

Bone Erosion ◽

Tertiary Care ◽

Bone Conduction ◽

Case Series ◽

Pure Tone Audiometry ◽

Tertiary Care Centre ◽

Case Series Study ◽

The Status ◽

Operative Notes

Background: Chronic otitis media with cholesteatoma is associated with hearing loss. Cholesteatoma causes bone erosion leading to ossicular chain defects. These ossicular lesions are only detected intraoperatively. If the ossicular status could be detected preoperatively by audiometric parameters, it would aid in better information to the patient, surgeon and preparation for the surgery. The aim of this study is to describe the intraoperative ossicular status, preoperative hearing status and to correlate them in patients with cholesteatoma.Methods: This is a retrospective case series study conducted in a tertiary care centre. Data was collected from inpatient files of 47 patients who underwent surgery for cholesteatoma from January 2016 to December 2017. Air and bone conduction thresholds, air- bone gaps from pure tone audiometry (PTA) reports were collected. The status of the ossicles was collected from the operative notes. Results: PTA revealed hearing loss in all the patients, predominantly conductive loss (83%). Ossicular defects were noted in 87% with incus most frequently involved (78.7%). Ossicular lesions were significantly associated with worse air conduction, bone conduction thresholds and air bone gap.Conclusions: Cholesteatoma is frequently associated with ossicular defects. PTA shows worse parameters in ossicular defects. But, it doesn’t reflect the status of ossicle involved or the number of ossicles involved.

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Impact of Covid-19 on Surgical Training in a Tertiary Care Centre in Tirupati, Andhra Pradesh, India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/233 ◽

2021 ◽

Vol 8 (18) ◽

pp. 1212-1216

Author(s):

Roja Ramani Kumbha ◽

Venkata Prakash Gandikota ◽

Venkata Ramanaiah Nannam ◽

Ganesh Reddy Elluru

Keyword(s):

Surgical Training ◽

Elective Surgery ◽

Human Life ◽

Tertiary Care ◽

Surgical Care ◽

Care Hospital ◽

Tertiary Care Centre ◽

Surgical Practice ◽

The Future ◽

The Impact

BACKGROUND Covid-19 pandemic has a devastating effect on many aspects of human life. The health care sector is the most affected, and surgical disciplines are no exception. Surgery has an essential role in human life, given its curative potential, and its dearth would cause much morbidity and even mortality in many cases. Surgery cannot wait even for a pandemic. Against this backdrop, it becomes essential to examine the effect of the pandemic on surgical disciplines. Here we study the impact of Covid-19 on the general surgery department in a tertiary care hospital. METHODS A retrospective observational study comparing data of outpatient department (OPD), admissions, and surgical activity in two different periods was done. RESULTS There was a significant impact on the number of surgical outpatients seen, admissions done, and surgeries conducted when compared between the two periods. In 2019 vs. 2020, 19,983 vs. 4481 OPD’s were seen. Similarly, 4274 admissions occurred during 2019 vs. only 506 in the 2020 period. Likewise, the impact on both elective and emergency surgery was also significant, 1102 elective surgeries were conducted in 2019. In contrast, Covid lead to complete cessation of elective surgery in 2020, increasing the risk of complication of various surgical conditions to the patients. Emergency surgeries in 2019, 694 vs. 220 in 2020 signified how the Covid pandemic had led human life to a standstill. Covid-19 pandemic resulted in abrupt cessation of various academic activities conducted in the department, but it also has seen the adoption of newer teaching methods. CONCLUSIONS Surgical care is quintessential in the fact that no other remedy can produce its results. There is no parallel. Lack of surgical care can lead to complications, avoidable morbidity, and mortality and can profoundly impact human life quality. Surgical education, which requires an apprenticeship, direct involvement, also took a hard hit, which has implications for future surgeons and patients alike. In this backdrop, our study highlights the need for more information on the future of surgical practices to make surgery safe in pandemic times. The existing lockdown had a significant impact on routine surgical practice and will require dedicated efforts for the resumption of "New Normal" in the future of all surgical disciplines. KEYWORDS Covid-19, Pandemic, Impact, Surgical Practice, Surgical Training

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IMPACT OF SOCIO-DEMOGRAPHIC VARIABLES AND MORBID CONDITIONS ON PERCEIVED MENTAL HEALTH COMPONENTS USING SF-36 QUESTIONNAIRE

SRMS Journal of Medical Science ◽

10.21761/jms.v1i1.10935 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

S. K. Sharma ◽

V. P. Shrotriya ◽

D. Imtiaz ◽

S. B. Gupta

Keyword(s):

Mental Health ◽

Diabetes Mellitus ◽

Social Functioning ◽

Tertiary Care ◽

Perceived Health ◽

Subjective Assessment ◽

Care Hospital ◽

Sf 36 ◽

The Social ◽

The Impact

<bold>Introduction:</bold> Perceived Health is a subjective assessment of the physical as well as mental health and includes so many aspects as mentioned in SF-36 form that are difficult to capture clinically such as incipient disease, physiological, psychological reserves and social functions. To assess the impact of Diabetes Mellitus, Hypertension and other socio-demographic factors on the Social Functioning component of mental health of the patients attending a tertiary care hospital in Bareilly. <bold>Material and Methods:</bold> Perceived health status of the patients was assessed by the Social Functioning dimension of the Mental Component Summary (MCS) using the SF-36 form. <bold>Results:</bold> The presence of both Diabetes Mellitus and Hypertension was associated with lower Social Functioning scores compared to those with diabetes (p = 0.013) and hypertension alone. Age was negatively related with Social Functioning scores (p<0.001) but male gender (p>0.000) and higher income (p<0.424) were all associated with higher Social Functioning scores. Rural subjects were found to have better SF score compared to urban. <bold>Conclusion:</bold> Age, gender and morbidity was found to have profound influence on Social Functioning scoring of the subjects. However, the results should be interpreted in terms of the study’s limitations.

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Peripartum hysterectomy: a five year review at a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173490 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3590

Author(s):

Deepak A. V. ◽

K. J. Jacob ◽

Sumi P. Maria

Keyword(s):

Tertiary Care ◽

Case Series ◽

Case Fatality ◽

Tertiary Care Centre ◽

Retrospective Case ◽

College Hospital ◽

Peripartum Hysterectomy ◽

Medical College ◽

Obstetric Haemorrhage ◽

Suboptimal Care

Background: Peripartum hysterectomy is a life-saving procedure resorted to when conservative measures fail to control obstetric haemorrhage. Several predisposing factors, suboptimal care and lack of infrastructure may lead to this emergency procedure. We wanted to find out factors associated with peripartum hysterectomy and the adverse maternal outcomes at our centre.Methods: A retrospective case series analysis of 40 cases of peripartum hysterectomy performed over a period of 5 years from January 2010 to December 2014 at Government Medical College Hospital, Thrissur, Kerala was done.Results: The incidence of peripartum hysterectomy was 0.29%. The most common indication for peripartum hysterectomy was hysterectomy was uterine atony (50%). Thirty-five women (88%) were between 20 and 35 years. Most of the subjects were unbooked. There were two maternal deaths (case fatality rate of 5%) following peripartum hysterectomy during this period. All the subjects required blood transfusion.Conclusions: Prompt performance hysterectomy before the patient’s clinical condition deteriorates is the key to success. The incidence of adherent placenta is increasing, so every effort should be taken to reduce the caesarean section rates globally.

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