scholarly journals Outcomes of flexible fiberoptic laryngoscopy in patients with stridor: a cross-sectional study in a tertiary care pediatric center in Saudi Arabia

2021 ◽  
Vol 41 (4) ◽  
pp. 216-221
Author(s):  
Ghada Alsowailmi ◽  
Jaber Alshammari ◽  
Abdullah Saud Arafat ◽  
Amal Alotaibi ◽  
Afnan Alsahli ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Conflicts Of Interest ◽  
Laryngopharyngeal Reflux ◽  
Care Center ◽  
Tertiary Care ◽  
Choanal Atresia ◽  
Common Finding ◽  
Cross Sectional ◽  
Adenotonsillar Hypertrophy ◽  
Common Diagnosis

BACKGROUND: Successful evaluation of a patient with stridor requires a thorough history and physical examination followed by a flexible fiberoptic laryngoscopy (FFL), which provides visualization of the upper airway. OBJECTIVES: Estimate the prevalence of causes of stridor in children who underwent FFL and compare different age groups. Find any significant associations between symptoms and laryngoscopic findings. Identify patients who needed further evaluation using direct laryngobronchoscopy (DLB). DESIGN: Retrospective, cross-sectional. SETTING: Tertiary care center in Riyadh. PATIENTS AND METHODS: We included all pediatric patients aged 1 month to 14 years who underwent fiberoptic laryngoscopy for stridor evaluation from January 2015 to January 2018 (37 months). Patients older than the age of 14 years, and patients with a workable diagnosis with adenotonsillar hypertrophy, choanal atresia, or laryngotracheo-bronchitis (croup) were excluded. MAIN OUTCOME MEASURES: Findings of FFL. SAMPLE SIZE: 217 pediatric patients. RESULTS: The median (interquartile range) age of the patients was 5 (8) months. Laryngomalacia was the most common diagnosis (n=149, 69%) followed by laryngopharyngeal reflux (n=42, 19%). Subglottic stenosis was the most common finding in patients who underwent DLB for further evaluation (n=19, 49%). Laryngomalacia was more frequent in children ≤12 months of age (83% vs 43% in children >12 months, P <.001). Vocal cord paralysis was more common in children >12 months of age (27% vs 9%, P <.001). FFL was effective in finding the diagnosis in 178 (82%) patients; only 39 (18%) patients needed further assessment using DLB. CONCLUSION: FFL is an effective and important tool for evaluating patients with stridor. LIMITATIONS: Retrospective design and single-centered. CONFLICTS OF INTEREST: None.

scholarly journals Pediatric Dental Emergency Pattern and Dental Care Provided during COVID-19 Pandemic Lockdown at a Tertiary Care Center in Kathmandu, Nepal

2021 ◽  
Vol 2 (1) ◽  
pp. 3-11
Author(s):  
Senchhema Limbu ◽  
Parajeeta Dikshit ◽  
Manisha Malla ◽  
Lokesh Verma ◽  
Anju Khapung
Keyword(s):  
Dental Care ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Definitive Treatment ◽  
Age Group ◽  
Cross Sectional ◽  
Common Diagnosis ◽  
Dental Hospital ◽  
Dental Emergency

 Introduction: Pediatric dental management is difficult in its own way which was even more challenging during COVID-19 outbreak and lockdown period. Constrained dental providing clinics and hospitals severely compromised the pediatric dental needs and services. Objective: The aim of this study was to describe pattern of dental emergencies encountered and services provided to the pediatric patients visiting a dental hospital during the first lockdown period in Kathmandu, Nepal. Methods: A cross sectional study was done from 24 March 2020 to 21 July 2020 among the pediatric patients who visited dental hospital during lockdown. Data was collected from questionnaire and dental case history sheet, and statistically analyzed in Statistical Package of Social Sciences (SPSS) version 20. Results: Of the total 172 pediatric patients of mean age 8.3± 2.60 years, majority were males (59.3%) and of 6-12 age group (76.2%). Major complain was mobile/retained teeth (38.4%) and most common diagnosis was exfoliating mobility (23.3%). According to American Dental Association (ADA, 2020) guidelines, urgent dental care (46.5%) followed by non-emergency dental care (43.6%) were mostly found. The predominant procedures were emergency (68.6%) and least was elective (9.3%) and treatment given to majority was extraction (51.8%).There was a statistically significant association between age group and pediatric dental care (ADA). Conclusions: The findings of this study regarding dental emergency encountered and definitive treatment received even during pandemic lockdown can be helpful in finding out how dental care was provided and can be applicable in similar future pandemics.

scholarly journals Non-neoplastic Lesions of Gallbladder Among Cholecystectomy Specimens of a Tertiary Care Center: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (242) ◽  
pp. 834-838
Author(s):  
Dilasma Ghartimagar ◽  
Manish Kiran Shrestha ◽  
Adarsh Jhunjhunwala ◽  
Arnab Ghosh ◽  
Sushma Thapa ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Common Finding ◽  
Tertiary Care Center ◽  
Sectional Study ◽  
Cross Sectional ◽  
Female Ratio ◽  
Neoplastic Lesions

Introduction: Gallbladder diseases are prevalent worldwide and present with a diverse histopathological spectrum. Mucosal irritation and chronic inflammation is considered as an important etiological factor for the mechanical or functional dysfunction of emptying of the gallbladder. This study aims to find the prevalence of non-neoplastic lesions of gallbladder among cholecystectomy specimens of a tertiary care center. Methods: A descriptive cross-sectional study was conducted in the Department of Pathology, of a tertiary care center from January 2005 to December 2020. Ethical approval was taken from the Institutional Review Committee. All the patients who had undergone cholecystectomy procedures which showed non-neoplastic lesions were enrolled in the study. Convenient sampling was done. Statistical Package for Social Sciences version 21 and Microsoft Excel were used for data analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion forbinary data. Results: Out of 4914 cholecystectomy specimens, 4852 (98.73%) (95% Confidence Interval= 98.42- 99.04) were non-neoplastic lesions. There were 1252 (25.8%) males and 3600 (74.2%) females with a male to female ratio of 1:2.87. Age ranged from 2 to 89 years with a mean age of 45±14.48 years. Gallbladder lesions were observed maximum in age group 41-50 years with 1200 (24.7%) cases. Among the non-neoplastic lesions, cholecystitis without any specific finding was the most common finding with 3028 (62.4%) cases followed by cholelithiasis with 1478 (30.5%) cases. Conclusions: The prevalence of non-neoplastic lesions of gallbladder is similar to other studies done in similar setings. Female predominance was noted in non-neoplastic lesions.

scholarly journals Outcome of Endoscopic Retrograde Cholangio-Pancreatography at Nobel Medical College Teaching Hospital: A Single Centre Experience

2020 ◽  
Vol 9 (2) ◽  
pp. 8-11
Author(s):  
Rohit Prasad Yadav ◽  
Kamal Raj Subedi ◽  
Bibek Kumar Purbey ◽  
Manish Gautam ◽  
Amit Bhattarai ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
College Teaching ◽  
Common Finding ◽  
Biliary Disease ◽  
Endoscopic Retrograde ◽  
Therapeutic Success ◽  
Cross Sectional ◽  
Medical College

Background: Endoscopic retrograde cholangiopancreatography is a technically demanding endoscopic procedure for both diagnostic and therapeutic purpose in treating various pancreaticobiliary diseases. This service is very limited in tertiary care center of our country Nepal mostly limited to Kathmandu valley and Dhulikhel hospital. Materials and Methods: This is a descriptive cross-sectional study patients who underwent ERCP with therapeutic intent in Nobel Medical College Teaching Hospital, Biratnagar from April 2019 to April 2020. Total 148 patients were included in this study for analysis. Results: The most common finding was choledocholithiasis in 132(89.2%) patients. Benign biliary stricture was found in 7 (4.7%). Biliary obstruction due to periampullary growth was found in 7 (4.7%) patients. Bile duct injury was found in 1(0.7%) and chronic pancreatitis in 1 (0.7%) patient. The therapeutic success of ERCP was for choledocholithiasis, Stone Clearance in 1st attempt 68.9%, in multiple attempts18.2%, failed stone extraction in 3 cases (2.0%) only biliary stenting was done in 15 (10.3%) patients of various biliary disease for therapeutic and palliative reason. Pancreatic stenting was done in1 (0.7%) patient. The most common complication was Acute Pancreatitis in 6(4.1%), Post-Sphincterotomy bleeding in 1 (0.7%), biliary septic shock in 1 (0.7%) and 1 death (0.7%). Conclusion: ERCP can be continued in Nobel Medical College Teaching Hospital as it has lots of benefits with minimal acceptable complications.

scholarly journals Typhoid Fever among Admitted Pediatric Patients in a Tertiary Care Center: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (241) ◽  
pp. 871-874
Author(s):  
Gajendra Prasad Rauniyar ◽  
Shrawanti Bhattacharya ◽  
Kumud Chapagain ◽  
Gauri Shankar Shah ◽  
Basudha Khanal
Keyword(s):  
Confidence Interval ◽  
Typhoid Fever ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Occurrence Rate ◽  
Tertiary Care Center ◽  
Sectional Study ◽  
Cross Sectional

Introduction: Typhoid fever, an acute systemic febrile illness caused by Salmonella Typhi & Paratyphi, is an important public health problem in developing countries. It requires frequent observation regarding proper diagnostic protocol and treatment practices. The aim of the study is to find the prevalence of typhoid fever among admitted pediatric patients in a tertiary care center. Methods: This is a descriptive cross-sectional study conducted among the admitted patients of pediatric and adolescent medicine of a tertiary care center from August 2016 to May 2018 after obtaining ethical clearance (IRC/609/015). Convenience sampling was used and data was analyzed using the Statistical Package of Social version 11.5. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 7450 patients, 151 (2.03%) at 95% Confidence Interval (1.71-2.35) patients were diagnosed with enteric fever of which 85 (56.29%) were male and 66 (43.71%) were female. Common symptoms were fever 151 (100%), and abdominal pain 94 (62.25%). Azithromycin 54 (38.03%) was the most common antibiotic received before presenting to hospital and ceftriaxone 151 (100%) was prescribed to all the patients after admission. Two-third of the patients (96/151) was hospitalized for at least 6 days, with the longest hospital stay of 14 days and shortest of 3 days. Conclusions: Occurrence rate of Typhoid Fever was similar to other studies. Antibiotic susceptibility could not be well established; further surveillance on typhoid fever and the antimicrobial susceptibility pattern is recommended.

Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

2021 ◽  
pp. 1-4
Author(s):  
Ruo S. Chen ◽  
Laurel O’Connor ◽  
Matthew R. Rebesco ◽  
Kara L. LaBarge ◽  
Edgar J. Remotti ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Endotracheal Tube Cuff ◽  
Cross Sectional ◽  
Tube Cuff ◽  
Respiratory Therapists ◽  
Significant Difference

Abstract Introduction: Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O. Objectives: While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers. Methods: This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded. Results: In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients. Conclusion: An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon.

Relationship between Clinical and Biologic Variables and Chloramphenicol Pharmacokinetic Parameters in Pediatric Patients with Sepsis

2000 ◽  
Vol 34 (3) ◽  
pp. 393-397 ◽  
Author(s):  
Gustavo Lugo Goytia ◽  
Ismael Lares-Asseff ◽  
María Gabriela Pérez Guillé ◽  
Adrián Guillé Pérez ◽  
Cynthia Larios Mejía
Keyword(s):  
Population Model ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Pharmacokinetic Parameters ◽  
Pharmacokinetic Data ◽  
Study Group ◽  
Validation Group ◽  
Wbc Count ◽  
Biologic Factors

OBJECTIVE: To evaluate the influence of several clinical and biologic factors on the disposition kinetics of oral chloramphenicol in pediatric patients and to determine the usefulness of this information to predict chloramphenicol serum concentrations. STUDY DESIGN: The clinical, biologic, and pharmacokinetic data of 30 consecutive pediatric patients diagnosed with sepsis and admitted to a tertiary care center were analyzed retrospectively. The patients were randomly assigned to a study group and a validation group. The model was developed by a three-step approach involving Bayesian estimation of pharmacokinetic parameters, selection of covariates by principal component analysis, and final selection by stepwise multiple linear regression. The model was tested in the study group and compared with a general population model using a prediction error analysis. RESULTS: Regression analysis revealed that weight, albumin, and white blood cell (WBC) count were the most important determinants for chloramphenicol distribution volume, whereas age, WBC count, and serum creatinine were the most important determinants for chloramphenicol clearance. The performance of the constructed population model improved significantly in terms of both bias and precision compared with the general model when tested in the validation group. CONCLUSIONS: Clinical and biologic factors may significantly influence chloramphenicol's disposition in pediatric patients with sepsis and therefore should be considered in programming dosage regimens.

Pediatric Drug-Related Problems in an Indian Tertiary Care Hospital

2021 ◽  
Vol 08 ◽  
Author(s):  
Qaiser Jahan ◽  
K. Pallavi ◽  
R. Hamshika ◽  
Varun Talla ◽  
Jupally Venkateshwar Rao ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Drug Related Problems ◽  
Cross Sectional ◽  
Pediatric Department ◽  
Root Cause ◽  
Patient Morbidity ◽  
Tertiary Care Hospitals

Background: Improper drug usages expose patients to drug-related problems (DRPs) and can be the cause of patient morbidity and even mortality, especially frequent in hospitalized patients and pediatric groups. Objective: The objective of the present study was to identify and assess the drug-related problems in the pediatric department of tertiary care hospitals. Methods: The cross-sectional, observational study was carried out for six months included pediatric in-patients of age ≤15 years of either gender in pediatric units of tertiary care hospitals of India. The enrolled pediatric patients were observed for any drug-related problem that were further recorded and classified using the DRP registration format taken from Cipolle et al. The assessment of therapy was done by using positional statements from standard organizations and guidelines. Main outcome measure: Incidences of drug-related problems and their assessment and root cause analysis. Results: A total of 970 DRPs were identified in 296 patients, with an overall incidence of 49.3%. The incidence of DRPs was maximum in the age group of 2-12 years of children (51.2%). Patients who took six or more drugs were around eight (OR:8.41 , 95% CI: 5.22 to 13.55) times more likely to have DRPs compared to those patients who took less than six drugs. The incidences of DRPs were more in patients who were hospitalized for ≥ 7 days. Conclusion: The present study revealed significantly higher incidences of DRPs in hospitalized pediatric patients necessitating the involvement of clinical pharmacists in the pediatric department of tertiary care hospitals.

A Comparison of Falls and Dizziness Handicap by Vestibular Diagnosis

2021 ◽  
pp. 1-10
Author(s):  
Ryan J. Huang ◽  
Sherri L. Smith ◽  
Libor Brezina ◽  
Kristal M. Riska
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Demographic Variables ◽  
Vestibular Migraine ◽  
Cross Sectional ◽  
Positional Vertigo ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Paroxysmal Positional Vertigo

Purpose There is a paucity of data that directly compares the falls rate and dizziness handicap of different vestibular diagnoses. The purpose of this study is to compare the falls rate and dizziness handicap of common vestibular diagnoses encountered among a cohort of vestibular patients at a single institution. Method We conducted a retrospective cross-sectional study of patients evaluated for dizziness at a tertiary care center vestibular clinic between August 1, 2017, and March 19, 2019. Vestibular diagnosis, demographic variables, comorbidities, falls status, and Dizziness Handicap Inventory (DHI) were extracted from the medical record for analysis. Associations between vestibular diagnosis and falls history or DHI were evaluated using multivariate logistic and linear regression, respectively. Results A total of 283 patients met our inclusion criteria with the following diagnoses: benign paroxysmal positional vertigo (BPPV; n = 55), acoustic neuroma ( n = 30), Ménière's disease ( n = 28), multiple vestibular diagnoses ( n = 15), vestibular migraine ( n = 135), or vestibular neuritis ( n = 20). After adjusting for age, sex, race, medications, and comorbidities, the odds of falling was 2.47 times greater (95% CI [1.08, 6.06], p = .039) and the DHI score was 11.66 points higher (95% CI [4.99, 18.33], p < .001) in those with vestibular migraine compared to those with BPPV. Other diagnoses were comparable to BPPV with respect to odds of falling and dizziness handicap. Conclusions Patients with vestibular migraine may suffer an increased risk of falls and dizziness handicap compared to patients with BPPV. Our findings highlight the need for timely evaluation and treatment of all patients with vestibular disease.

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