Nasal Mucormycosis: Our experience with 24 cases

2020 ◽  
Vol 74 (4) ◽  
pp. 37-40
Author(s):  
Satvinder Singh Bakshi ◽  
Soumyajit Das ◽  
Seepana Ramesh ◽  
Suriyanarayanan Gopalakrishnan
Keyword(s):  
Liposomal Amphotericin ◽  
Chart Review ◽  
Hematologic Malignancy ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
First Line ◽  
The Past ◽  
Increased Risk ◽  
Shed Light

<b>Background:</b> Mucormycosis is a rare fungal infection affecting people with impaired immunity. The aim of this study is to shed light on the epidemiology, incidence, and outcome of patients with mucormycosis hospitalized at a tertiary care center in Pondicherry. <br><b>Methods:</b> We conducted a retrospective chart review between January 2008 and January 2018. All patients with proven or probable mucormycosis were included. <br><b>Results:</b> A total of 24 patients were included. Their median age was 49 years and the majority were males. Comorbidities included mainly hematologic malignancy and diabetes mellitus. A liposomal amphotericin B formulation alone or in combination with other antifungals was used as a first line agent in all patients. <br><b>Conclusion:</b> The incidence of mucormycosis has significantly increased over the past 10 years at our institution, most likely due to increased risk factors.

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

Abstract 092: No Change in Peripartum Cardiomyopathy Outcomes or Risk Factors Over the Past Decade

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Nivedita Basu ◽  
Madeline Mahowald ◽  
Kris Kawamoto ◽  
Melinda Davis
Keyword(s):  
Risk Factors ◽  
Maternal Age ◽  
Care Center ◽  
Tertiary Care ◽  
Temporal Trends ◽  
Peripartum Cardiomyopathy ◽  
Icd Implantation ◽  
The Past ◽  
Increased Risk

Background: Few studies have evaluated temporal trends in outcomes and risk factors for peripartum cardiomyopathy (PPCM). Prior research using administrative data could only assess short-term in-hospital adverse events. It has also been hypothesized that the incidence of PPCM is rising due to advancing maternal age and increased risk factors. Therefore, we examined long-term outcomes and prognostic factors to determine if there has been any change over the past decade. Methods: Patients seen at a tertiary care center between 2000 and 2011 with a diagnosis of PPCM were identified by ICD9 code 674.5x and confirmed by manual chart review. Year of diagnosis, clinical and demographic variables, echocardiographic data, and outcomes including myocardial recovery (defined as EF>=55%), ICD placement, LVAD, transplant, and death were reviewed for follow-up through November 2016. Results: Of 60 patients, 31 (52%) were diagnosed recently (2006-2011) and 29 (48%) were diagnosed prior to 2006 (1996-2005). There were no significant differences in the recent group compared to the past group in initial EF (19% vs 22%), final EF (39% vs 39%), and final recovery status (52% vs 48%). Similarly, there were no differences in rates of ICD implantation, LVAD/transplant, mortality, and years of survival. There were no differences in age at diagnosis or in rates of hypertension, smoking, or diabetes. Few patients in either category underwent a subsequent pregnancy. Mean years of follow-up (through 2016) were longer for those diagnosed prior to 2006 (8.3 years vs 3.4 years, p<0.001). Conclusions: There has been no improvement in outcomes for patients diagnosed with PPCM in the past decade. Maternal age and risk factors do not appear to be increasing. Despite advances in heart failure treatment and increased awareness of PPCM, more research about the management and follow-up of young mothers with PPCM is needed.

scholarly journals Trichotillomania in Children and the Different Approaches between Dermatological and Behavioral Health Professionals at an Urban Tertiary Care Center

2020 ◽  
pp. 1-7
Author(s):  
Sneha Rangu ◽  
Leslie Castelo-Soccio
Keyword(s):  
Behavioral Health ◽  
Chart Review ◽  
Complex Disease ◽  
Behavioral Therapy ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Psychosocial Impairment ◽  
Epidemiologic Features

<b><i>Background:</i></b> Trichotillomania (TTM) is a complex disease with varying clinical characteristics, and psychosocial impairment is noted in many TTM patients. Despite its prevalence in childhood, there is limited research on pediatric TTM. <b><i>Objective:</i></b> To analyze the clinical and epidemiologic features of TTM in children evaluated by dermatologists and behavioral health specialists. <b><i>Method:</i></b> We performed a retrospective chart review of 137 pediatric patients seen at the Children’s Hospital of Philadelphia with initial presentation of TTM at age 17 or younger. Patients were treated by dermatology or behavioral health. <b><i>Results:</i></b> The majority of the patients were females, with an average diagnosis age around 8 years. Over half had a psychiatric comorbidity, and over a quarter had a skin disorder. Skin disorders were more commonly present in those evaluated by dermatology, and psychiatric comorbidities were more commonly present in those evaluated by behavioral health. The most common form of treatment was behavioral therapy, with medications prescribed more often by dermatologists. <b><i>Conclusions:</i></b> TTM patients choose to present to behavioral health or dermatology; however, there are distinctive differences between the two cohorts. With behavioral and pharmacologic treatment options, a relationship between dermatologists and behavioral health specialists is necessary for multifactorial management of TTM.

scholarly journals Mapping Pediatric Tetanus Cases in Central Pennsylvania and Analyzing Hospital Costs Associated with Treatment

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S323-S323
Author(s):  
Bilaal Ahmed ◽  
Michael Beck ◽  
Parvathi Kumar
Keyword(s):  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Costs ◽  
Population Level ◽  
Microsoft Excel ◽  
Vaccine Preventable Diseases ◽  
The Past ◽  
Central Pennsylvania ◽  
Preventable Infection

Abstract Background Pennsylvania is home to Amish and Mennonite communities with an estimated combined population of over 90,000 people. Under-immunization is common with vaccine preventable diseases, including tetanus, periodically presenting among children from these communities. Nearly 20% of nationally reported pediatric tetanus cases in the past 10 years were treated at our institution, the tertiary care center which serves these unique populations. We characterize demographics and costs of treating this rare, but largely preventable infection. Methods Chart review based on ICD-9 codes for tetanus infection in patients aged 0–17 years treated for clinically diagnosed tetanus infection between January 2006 and December 2015. Cost data were extracted from Horizon Business Insight software and analyzed in Microsoft Excel. Cases were mapped using UDS Mapper. Results Four cases of pediatric tetanus infection were identified with 100% occurring in unimmunized patients and 3 of 4 (75%) in Amish individuals. Treatment costs amounted to $121,170 with estimated payment of $80,664 resulting in a net loss to the hospital of $40,506 over the course of 10 years. Each case treated resulted in a median loss of $4,402 to the hospital. Conclusion The costs of treating this vaccine preventable disease for both hospitals and under-immunized Amish and Mennonite communities, who tend to pay out-of-pocket, should be emphasized in targeted outreach and education programs at the population level. Disclosures All authors: No reported disclosures.

A 10-Year Review of Necrotizing Fasciitis in the Pediatric Population: Delays to Diagnosis and Management

2016 ◽  
Vol 56 (7) ◽  
pp. 627-633 ◽  
Author(s):  
Heather VanderMeulen ◽  
Jeffrey M. Pernica ◽  
Madan Roy ◽  
April J. Kam
Keyword(s):  
Necrotizing Fasciitis ◽  
Chart Review ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Causative Organism ◽  
Antibiotic Administration ◽  
Large Variability

Objective. To assess the promptness and appropriateness of management in pediatric cases of necrotizing fasciitis (NF). Methods. A retrospective chart review examined cases of pediatric NF treated at a pediatric tertiary care center over a 10-year period. Results. Twelve patients were identified over the 10-year period. The median (25th to 75th centile) times to appropriate antibiotic administration, infectious disease consults, surgical consults and debridement surgeries were 2.6 (2.1-3.2), 7.7 (3.4-24.4), 4.6 (1.7-21.0), and 22.1 (10.3-28.4) hours following assessment at triage. The initial antibiotic(s) administered covered the causative organism in 9 of 12 cases. The median (25th to 75th centile) length of hospital stay was 21 (14.0-35.5) days. Conclusions. The large variability in the care of these patients speaks to the range of their presenting symptomatology. The lack of a standardized approach to the pediatric patient with suspected NF results in delays in management and suboptimal antibiotic choice.

The risk of thrombotic events in patients with primary versus secondary hepatic malignancies who are undergoing surgical resection

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15178-15178
Author(s):  
T. J. Yates ◽  
M. Abouljoud ◽  
A. Lambing ◽  
P. Kuriakose
Keyword(s):  
Surgical Resection ◽  
Metastatic Disease ◽  
Chart Review ◽  
Malignant Disease ◽  
Retrospective Chart Review ◽  
Secondary Malignancies ◽  
The Past ◽  
Increased Risk ◽  
Thrombotic Complications ◽  
Hepatic Malignancies

15178 Background: The increased risk of thromboses is well documented in patients with malignancies, and those undergoing abdominal surgery. Furthermore, patients requiring hepatic resection for underlying malignant disease have been reported to be at increased risk for thrombotic complications. However, guidelines for thromboprophylaxis in this patient population are still under investigation. A cursory review performed at our institution determined the incidence of thrombotic events to be comparable to that reported in the literature. We, therefore, went further to study if there was a difference in the risk of thromboses between those undergoing resection for primary hepatic cancer, versus metastatic disease. Methods: We performed a retrospective chart review of patients undergoing surgical resection for hepatic malignancies. The primary end point was to determine whether there was a difference in the incidence of thrombotic events between primary and secondary malignancies. Results: A total of 99 patients at our institution underwent surgical resection for either primary or secondary hepatic malignancies in the past 5 years. There were 7 patients who developed thrombotic events within three months of their resection. Of these patients, all 7 underwent resection for secondary hepatic malignancies. Based on the nature of this study, and its lack of standardized thromboprophylaxis, statistical analysis was not performed. Conclusions: Patients undergoing surgical resection of hepatic malignancies appear to be at increased risk of thrombotic events, and may require more specific standardization of their thromboprophylaxis. Furthermore, based on our observation it appears those associated with metastatic disease may derive an even greater benefit from this. Future prospective studies will be required to evaluate this difference in thromboses, and to better define the guidelines for thromboprophylaxis. No significant financial relationships to disclose.

Accuracy of oncologist assessments of psychiatric problems in cancer inpatients

2017 ◽  
Vol 16 (1) ◽  
pp. 41-49
Author(s):  
Daisuke Yasugi ◽  
Hidetaka Tamune ◽  
Jitsuki Sawamura ◽  
Katsuji Nishimura
Keyword(s):  
Cancer Patients ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Analysis Of Means ◽  
Chi Squared ◽  
Psychiatric Problems ◽  
Mental And Behavioral Disorders

ABSTRACTObjective:Our objective was to examine the accuracy of non-psychiatrist assessments of psychiatric problems in cancer patients.Method:We conducted a retrospective chart review of cancer patients who were admitted and referred to the consultation–liaison (C–L) team between January of 2011 and December of 2012. The agreement between non-psychiatrist assessments and final diagnoses by attending C–L psychiatrists was estimated for every category of referral assessment using codes from the International Classification of Mental and Behavioral Disorders (10th revision). The data were obtained from the consultation records of 240 cancer inpatients who were referred to the C–L service at a tertiary care center in Tokyo.Results:The agreement ratio between referring oncologists and psychiatrists differed according to the evaluation categories. The degrees of agreement for the categories of “delirious,” “depressive,” “dyssomnia,” “anxious,” “demented,” “psychotic,” and “other” were 0.87, 0.43, 0.51, 0.50, 0.27, 0.55, and 0.57, respectively. The agreement for all patients was 0.65. Significant differences were observed among seven categories (chi-squared value = 42.454 at p < 0.001 and df = 6). The analysis of means for proportions showed that the degree of agreement for the “delirious” category was significantly higher and that that for the “depressive” category was lower than that for all patients, while for the “demented” category it was close to the lower decision limit but barely significant. One half of the 20 cases who were referred as depressive were diagnosed with delirium, with one quarter of those having continuously impaired consciousness. Some 7 of the 11 cases who were referred as demented were diagnosed as having delirium.Significance of Results:The accuracy of non-psychiatrist assessments for psychiatric problems in cancer patients differs by presumed diagnosis. Oncologists should consider unrecognized delirium in cancer inpatients who appear depressed or demented.

Diagnosis Discordance and Neonatal Transport: A Single-Center Retrospective Chart Review

2018 ◽  
Vol 36 (05) ◽  
pp. 522-525
Author(s):  
Tatiana Sampaio ◽  
Margo Wilson ◽  
Cheryl Aubertin ◽  
Stephanie Redpath
Keyword(s):  
Birth Weight ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neonatal Transport ◽  
Outreach Education ◽  
Potential Risk Factors ◽  
Patient Variables ◽  
Neonatal Population

Introduction In Canada, more than 4,000 critically ill newborns per year require transfer. Transports are initially managed based on information conveyed by referral practitioners. Objectives To identify the frequency of diagnostic discordance between the referring facility, transport team, and tertiary care center in our outborn neonatal population and to verify the association between discordance events (DEs), prolonged transport stabilization times, and potential risk factors to further inform and facilitate the development of future outreach education initiatives. Study Design In this retrospective chart review, we identified and categorized DEs for patients transported by our service in a 1-year period. Associations between DE, transport stabilization times, and patient variables were studied using univariate and multivariable approaches. Results From 233 eligible patients, 10.7% of patients had referral to discharge discordance events. No significant association was identified between stabilization time and DE. Birth weight and presence of a neurologic diagnosis were associated with DE. Conclusion Diagnostic discordance was identified in 1 of every 10 neonates transported and found to be associated with patients with higher birth weight and the presence of neurologic diagnoses. Outreach initiatives will be developed and adapted accordingly, with a focus on this population.

Impact of 24/7/365 Attending Radiologist Coverage on the Turnaround Time in an Emergency and Trauma Radiology Department

2020 ◽  
pp. 084653711989932
Author(s):  
Sabeena Jalal ◽  
Hugue Ouellette ◽  
Zharmaine Ante ◽  
Peter Munk ◽  
Faisal Khosa ◽  
...  
Keyword(s):  
Chart Review ◽  
Emergency Radiology ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Turnaround Time ◽  
Radiology Department ◽  
Tertiary Care Center ◽  
Imaging Studies ◽  
The Impact

Objective: To study the impact of 24/7/365 attending radiologist coverage on the turnaround time (TAT) of trauma and nontrauma cases in an emergency and trauma radiology department. Patients and Methods: This was a retrospective chart review in which TAT of patients coming to the emergency department between 2 periods: (1) December 1, 2012, to September 30, 2013, and (2) January 1, 2017, to January 30, 2018, and whose reports were read by an attending emergency and trauma radiologist was noted. Results: The 24/7/365 radiology coverage was associated with a significant reduction in TAT of computed tomography reports, and the time reduction was comparable between trauma and nontrauma cases. In adjusted models, the extension of radiology coverage was associated with an average of 7.83 hours reduction in overall TAT (95% confidence interval [CI]: 7.44-8.22) for reports related to trauma, in which 2.73 hours were due to reduction in completion to transcription time (TC; 95% CI: 2.53-2.93), and 5.10 hours were due to reduction in transcription to finalization time (TF; 95% CI: 4.75-5.44). For reports related to nontrauma cases, 24/7/365 coverage was associated with an average of 6.07 hours reduction in overall TAT (95% CI: 3.54-8.59), 2.91 hours reduction in TC (95% CI: 1.55-4.26), and 3.16 hours reduction in TF (95% CI: 0.90-5.42). Conclusion: Our pilot study demonstrates that the implementation of on-site 24/7/365 attending emergency radiology coverage at a tertiary care center was associated with a reduced TAT for trauma and nontrauma patients imaging studies. Although the magnitude and precision of estimates were slightly higher for trauma cases as compared to nontrauma cases. Trauma examinations stand to benefit the most from 24/7/365 attending level radiology coverage.

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