scholarly journals Complications of intravascular intrauterine transfusion for Rh alloimmunization

2021 ◽  
Vol 41 (6) ◽  
pp. 313-317
Author(s):  
Asma Alkhaibary ◽  
Mohannad Ali ◽  
Maha Tulbah ◽  
Maha Al-Nemer ◽  
Rubina M. Khan ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Survival Rates ◽  
Case Series ◽  
Intrauterine Fetal Death ◽  
High Survival ◽  
Safe Procedure ◽  
Fetal Bradycardia ◽  
Intrauterine Transfusion ◽  
Record Review

BACKGROUND: Intravascular intrauterine transfusion (IUT) is considered a safe procedure, but complications still occur, including fatalities. OBJECTIVE: Review the outcomes of Rh alloimmunization, including indications and possible complications. DESIGN: Retrospective cohort (medical record review). SETTING: Tertiary care center. PATIENTS AND METHODS: We retrieved the records for all mothers who had an IUT for Rh alloimmunization between January 2009 and August 2019. We collected data on complications, post-transfusion hemoglobin and antibody combinations. MAIN OUTCOME MEASURE: Complications of IUT. SAMPLE SIZE: 119 mothers with 154 fetuses (154 different pregnancies). RESULTS: The 154 fetuses had 560 intrauterine transfusions. The median pre-IUT hemoglobin was a median of 8.0 g/dL while the median post-IUT hemoglobin 16 g/dL. Immediate procedure-related complications included fetal bradycardia in 2.7%, significant bleeding from the cord puncture site (for more than 2 minutes in 0.9%), and contractions in 0.9%. Eight (5.2%) were delivered by cesarean delivery due to IUT-specific complications such as post-procedure fetal bradycardia. Intrauterine fetal death complicated 8.4% of the pregnancies (13 fetuses). Phototherapy was required in 76 (49.4%), postnatal blood transfusions in 17 (11%), and exchange transfusion in 11 (7.1%). Neonatal death occurred 8 (5.2%). Data were insufficient to assess associations of complications with antibody combinations. CONCLUSIONS: Intrauterine transfusion is an effective treatment with high survival rates (around 90% for cases of Rh alloimmunization). LIMITATIONS: Case series. CONFLICT OF INTEREST: None.

scholarly journals Unusual Cases of Pure Malignant Germ Cell Tumors of the Ovary: A Case Series on 10 Years Experience at a Tertiary Care Center

2021 ◽  
Author(s):  
Lajya Devi Goyal ◽  
Balpreet Kaur ◽  
Gitanjali Goyal ◽  
Parveen Rajora
Keyword(s):  
Germ Cell ◽  
Care Center ◽  
Tertiary Care ◽  
Survival Rates ◽  
Germ Cell Tumors ◽  
Case Series ◽  
Immature Teratoma ◽  
Surgical Removal ◽  
Fertility Sparing ◽  
Bep Chemotherapy

Background: Malignant ovarian germ cell tumors (MOGCTs) are rare female cancers, constituting  up to 10% of ovarian cancers. Dysgerminoma is the most common histological variant. Surgical removal of the tumor with optimal debulking is the treatment of choice. Multidrug chemotherapy following surgery offers high remission rates. Considering the prevalence of these tumors in adolescent and young females, fertility-sparing treatment is of paramount importance. Methods: The data of all patients with ovarian malignancy admitted at a tertiary-care-teaching hospital from September 2009-March 2019 were analyzed. Ten patients of MOGCTs were treated in this period. The clinical features, radiological and biochemical findings, and management and treatment outcome were evaluated. Results: The median age of patients was 23 years. Histological subtypes included immature teratoma (n=3), endodermal sinus tumor (n=4), and dysgerminoma (n=3). Tumor markers namely AFP, βHCG, and LDH increased in all except the patients with immature teratoma. Two patients with dysgerminoma were in the second trimester of pregnancy. All patients except one underwent surgery followed by BEP chemotherapy. Two patients had developed metastasis within six months of treatment and died. In seven patients, no evidence of disease was reported till date. Conclusion: Management of antenatal patients with dysgerminoma by surgery followed by BEP chemotherapy has favorable prognosis. Fertility-sparing surgery with adjuvant chemotherapy offers great advantage in young girls. However, risk stratification based on prognostic factors should be implemented in order to individualize the treatment for achieving higher survival rates. The option for oocyte-cryopreser-vation prior to surgery must be discussed with patients desiring future fertlity.

Left Pulmonary Artery Sling: Postoperative Outcomes for Patients at a Single Center

2021 ◽  
Vol 12 (6) ◽  
pp. 715-727
Author(s):  
Laura Carlson ◽  
Mahwish Haider ◽  
Hua Liu ◽  
Christopher Baird ◽  
John E. Mayer ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Care Center ◽  
Tertiary Care ◽  
Survival Rates ◽  
Left Lung ◽  
Case Series ◽  
Left Pulmonary Artery ◽  
Retrospective Case ◽  
Tracheal Surgery ◽  
Intracardiac Repair

Background Left pulmonary artery (LPA) sling is a rare anomaly characterized by the origin of the LPA from the right pulmonary artery with a course between the trachea and esophagus. It is often associated with airway and cardiac anomalies. Methods This is a retrospective case series of consecutive patients who underwent LPA sling repair (LPASR) at a tertiary care center over a 35-year period with a focus on tracheal and/or LPA reinterventions and survival. Results Between June 1983 and July 2018, 42 patients were identified: isolated LPASR was performed in 16 (38%), LPASR/intracardiac repair in 10 (24%), and LPASR/tracheal repair in 16 (38%). There were 5 (12%) in-hospital and 4 (10%) late deaths. Survival rates (15 years) were as follows: 100% (isolated LPASR), 65% (concomitant intracardiac repair), and 52% (concomitant tracheal surgery). Preoperative intensive care unit (ICU) hospitalization was associated with future intervention on the LPA/trachea (61%, 11/18). The median distribution of blood flow to the left lung post-index surgery was 38%. Freedom from isolated LPA intervention was 100% after isolated LPASR, 93% after LPASR/tracheal surgery, and 69% after LPASR/intracardiac repair. Freedom from isolated tracheal intervention was 92% after isolated LPASR, 73% after LPASR/tracheal surgery, and 78% after LPASR/intracardiac repair. Conclusions ICU hospitalization prior to index surgery may indicate the severity of associated cardiac/tracheal abnormalities as this is associated with increased morbidity and mortality. Patients who underwent LPASR/intracardiac surgery were more likely to undergo isolated LPA intervention and those who underwent LPASR/tracheal surgery were more likely to undergo isolated tracheal intervention.

scholarly journals Vitamin C Deficiency in Inflammatory Bowel Disease: The Forgotten Micronutrient

2021 ◽  
Author(s):  
Katie A Dunleavy ◽  
Ryan C Ungaro ◽  
Laura Manning ◽  
Stephanie Gold ◽  
Joshua Novak ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Vitamin C ◽  
Bowel Disease ◽  
Fruits And Vegetables ◽  
Nutritional Assessment ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Vitamin C Deficiency ◽  
Inflammatory Bowel

Abstract Background Micronutrient deficiencies are common in patients with inflammatory bowel disease (IBD). To date, the literature has focused on vitamin D, vitamin B12, and iron deficiencies. Methods We report a case series of 20 patients with IBD and vitamin C deficiency treated at a single tertiary care center. Results Sixteen (80%) patients had symptoms of clinical scurvy, including arthralgia, dry brittle hair, pigmented rash, gingivitis, easy bruising and/or brittle nails. Eighteen patients underwent a nutritional assessment, 10 (56%) patients reported complete avoidance of fruits and vegetables, and 3 (17%) reported reduced intake of fruits and vegetables. Conclusions Vitamin C deficiency should be considered in IBD patients, particularly those with reduced fruit/vegetable intake, as it can lead to significant signs and symptoms.

scholarly journals Accidental tramadol ingestion in children admitted in tertiary care centre

2019 ◽  
Vol 8 (12) ◽  
pp. 2661
Author(s):  
Vadlakonda Sruthi ◽  
Annaladasu Narendra
Keyword(s):  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Hemodynamic Instability ◽  
Tertiary Care Centre ◽  
Medical College ◽  
History Of

Background: Tramadol use has been increasing in the adult and pediatric population. Practitioners must be alert because Tramadol misuse can lead to severe intoxication in which respiratory failure and seizures are frequent. Overdoses can lead to death. We report 47 pediatric cases with history of accidental tramadol exposure in children.Methods: An observational, retrospective, single center case -series of children with a history of accidental tramadol exposure in children admitted in pediatric intensive care unit of tertiary care center, Niloufer Hospital (Osmania Medical College) Hyderabad, Telangana India.Results: Of 47 children, 22 (47%) are male and 25 (53%) were female. At presentation 11 (23%) had loss of consciousness, 14 (29%) seizures, 17 (36%) hypotonia was noted. Pupils were miotic in 22 (47%) mydriatic in 2 (4.2%) normal in rest of children. Hemodynamic instability noted in 13 (27.6%). Serotonin syndrome (tachycardia, hyperthermia, hypertension, hyper reflex, clonus) was noted on 5 (10.6%) children. Respiratory depression was seen in 4 (8%) children who needed ventilatory support. Antidote Naloxone was given in 7 children. No adverse reaction was noted with Naloxone. All 47 children were successfully discharged.Conclusions: Overdoses can lead to death and practitioners must be alert because of the increasing use of tramadol in the adult and pediatric population. The handling of the tramadol should be explained to parents and general population and naloxone could be efficient when opioid toxicity signs are present.

Association of Antenatal Terbutaline and Respiratory Support Requirements in Preterm Neonates

2021 ◽  
Author(s):  
Buranee Yangthara ◽  
Visanu Kittiarpornpon ◽  
Pitiporn Siripattanapipong ◽  
Walaiporn Bowornkitiwong ◽  
Ratchada Kitsommart ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Lung Compliance ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Non Invasive ◽  
Antenatal Steroids ◽  
Respiratory Outcomes ◽  
Record Review ◽  
Retrospective Medical Record Review

Background: Before the advent of antenatal steroids, early non-invasive respiratory support (NIV) and intratracheal surfactant, antenatal terbutaline was also used to improve lung compliance and reduce the incidence of respiratory distress syndrome (RDS). Objectives: To study the association between antenatal terbutaline and endotracheal intubation (ET) within the first 24 hours of life, RDS, bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) in infants with gestational age (GA) of < 32 weeks. And to study the association between antenatal terbutaline, and ET or NIV within the first 24 hours of life, and RDS in infants with GA of 32 to 36 weeks. Method: A retrospective medical record review of preterm infants delivered at a single tertiary care center from October 2016 to December 2020. Multivariable logistic regression was used to explore the association between antenatal terbutaline and neonatal respiratory support. Result: 1,794 infants were included, 234 (13.0%) had GA < 32 weeks and 1,560 (86.9%) had GA 32 to 36 weeks. Antenatal terbutaline, corticosteroid, or both agents were administered in 561 (31.3%), 1,461 (81.4%), and 555 (30.9%), respectively. Antenatal terbutaline was significantly associated with a reduction in ET (adjusted odds ratio (aOR) = 0.40, 95% confident interval (CI) 0.19 to 0.82, p = 0.012) in infants of GA < 32 weeks, but not in infants with GA 32 to 36 weeks. Antenatal terbutaline was not associated with RDS or BPD, but was significantly associated with a reduction in grade III-IV IVH (aOR 0.11, CI 0.01 to 0.98; p = 0.048), in infants of GA < 32 weeks. Conclusion: In a state-of-the-art neonatal care setting, antenatal terbutaline was associated with a reduction in ET during the first 24 hours in infants of GA < 32 weeks. The use of antenatal terbutaline to improve acute neonatal respiratory outcomes merits reconsideration.

Disseminated Tuberculosis: A 3-Year Case-Series Experience in a Tertiary Care Center

2021 ◽  
Vol 22 (5) ◽  
pp. 358-363
Author(s):  
Canan Gunduz Gurkan ◽  
◽  
Hamide Sekerbay ◽  
Aylin Babalik ◽  
◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Tertiary Care Center ◽  
Disseminated Tuberculosis

scholarly journals Cerebrovascular Injury Following Scorpion Sting and Snake Envenomation: A Case Series

2018 ◽  
Vol 45 (6) ◽  
pp. 669-674 ◽  
Author(s):  
Ajay Mishra ◽  
Aditya Binu ◽  
George Abraham ◽  
Harshad Vanjare ◽  
Tina George ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Neurological Complications ◽  
Neurological Deficits ◽  
Neurological Involvement ◽  
Scorpion Sting ◽  
Male Predominance ◽  
Cerebrovascular Injury ◽  
Snake Envenomation

AbstractBackgroundNeurological complications following snake and scorpion bite are diverse. Literature regarding patterns of cerebrovascular injury (CVI) and outcomes among these patients is scarce. This is a descriptive study of the clinical profile, brain imaging findings, mechanisms of injury, vascular territory involvement and outcomes of CVI following scorpion and snake envenomation, in a tertiary care center in South India.MethodologyPatients with scorpion sting- and snake envenomation-related complications were retrospectively enrolled. Neuroimaging was performed on five patients with each envenomation, and they were found to have neurological involvement. On imaging, three patients were found to have a CVI. Clinical, radiological parameters and outcomes of these patients were studied. We also performed a review of the literature and analyzed the finding of all the cases.ResultIn all, three patients each had evidence of CVI in imaging. An additional 32 reports of scorpion sting-related CVI and 35 reports of snake envenomation-related CVI were identified from the literature. There was a male predominance among these patients. Mean age of the patients with scorpion sting was 42.8 years as compared with 33 years for the patients with snake envenomation. Features of severe envenomation were present in all patients. Persistently depressed sensorium and new-onset focal neurological deficits were seen in 70% of all patients. Infarcts were seen in 88% of patients with snake envenomation and 53% of patients with a scorpion sting. Mortality was 28% among patients with a scorpion sting as compared with 8% with snake envenomation.ConclusionCerebrovascular injuries are uncommon neurological manifestations following scorpion and snake envenomation. These tend to occur in younger patients. Infarcts are more common than bleeds.

Surgical ICU Underutilization Does not Significantly Discourage Discharge

1996 ◽  
Vol 9 (4) ◽  
pp. 238-242 ◽  
Author(s):  
F. Dexter ◽  
K. Pearson ◽  
D. L. Griffiths ◽  
P. Jebson
Keyword(s):  
Discharge Rate ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Patient Discharge ◽  
Poor Quality ◽  
Excess Capacity ◽  
Admission Rates ◽  
Discharge Rates ◽  
Number Of Patients

An SICU must have sufficient capacity to handle peak weekly demand to prevent re-admission and/or poor quality of care. Excess capacity may, however, encourage unnecessary SICU utilization. The goal of this study was to assess the influence of availability of SICU beds on patient discharge and re-admission rates. The case series included 1,492 days, 36,816 patient days, 8,821 discharges, and 186 re-admissions within 3 days from a 24-bed multidisciplinary SICU at a tertiary care center. Census was defined to equal the total number of patients in the SICU each day. We found low census levels were not associated with significantly lower discharge rates. Decreasing the census from 19–24 to 13–18 patients per day decreased discharge rates from 31% to 30%. Odds ratio that a decrease in census by five from 24 decreased discharge rate equaled 1.01 (95% confidence interval 0.96 to 1.06). We conclude that when hospital managers choose an appropriate SICU capacity they need not be concerned that intermittent excess capacity will prompt physicians to significantly decrease their discharge rates.

Sign in / Sign up

Export Citation Format

Share Document