scholarly journals Plantar Papules and Plaques: A Dermoscopic-Histopathological Correlation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Balachandra Suryakant Ankad ◽  
Varsha R Koti ◽  
Balkrishna P Nikam ◽  
Manjula Rangappa
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Daily Practice ◽  
Cross Sectional ◽  
Plantar Wart ◽  
Plantar Surface ◽  
Histopathological Correlation ◽  
Plantar Aspect ◽  
Cross Sectional Design ◽  
Atypical Presentations

Background: Painful lesions affecting the plantar aspect of the foot are routinely encountered in daily practice, and plantar wart, corn, and callus are the most common conditions. Although the clinical examination is sufficient to clinch an accurate diagnosis, atypical presentations indicate the need for invasive investigations like skin biopsy. Here we evaluated dermoscopic patterns of painful lesions affecting the plantar surface. Objectives: The current study aimed to, firstly, investigate the dermoscopic patterns and differentiate between painful papules and plaques on the foot, and, secondly, to analyze the histopathological correlation of these dermoscopic patterns. Methods: Following a cross-sectional design, the current study was carried out on patients with the clinical diagnosis of painful lesions of foot suggestive of plantar wart, corn, and callus referring to a tertiary care center from June 2019 to Jan 2020. Dermoscopy analysis and biopsy were performed for all participants. Results: Among 92 patients with painful plantar lesions, 56, 22, and 15 had a plantar wart, corn, and callus, respectively. Dermoscopy of warts revealed red dots (89.28%) and yellow halo (82.14%). A translucent central core (100%) and whitish ring (81.81%) on dermoscopy of patients with corn. Dermoscopy of callus demonstrated opaque yellow area in all (100%) the patients. Dermatoglyphics were absent in plantar wart in contrast to corn and callus, wherein they were preserved. Conclusions: Dermoscopy can be considered as a rapid, non-invasive, diagnostic tool in the daily practice of a dermatologist. Here, it assisted in distinguishing clinically akin painful plantar papules and plaques. These dermoscopic patterns also were well correlated histopathologically.

Indian Nurses’ Attitudes Toward Euthanasia

2017 ◽  
Vol 78 (2) ◽  
pp. 143-160 ◽  
Author(s):  
P. Vijayalakshmi ◽  
Nagarajaiah ◽  
P. Dharma Reddy ◽  
B. M. Suresh
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Nutrition Support ◽  
Work Place ◽  
Cross Sectional ◽  
Men And Women ◽  
Professional Boundaries ◽  
Nurses Role ◽  
Cross Sectional Design ◽  
Nurses Perceptions

The debate about euthanasia continues worldwide, with nurses’ attitudes becoming increasingly more important. The aim of this study is to investigate gender differences among nurses’ perceptions of attitudes toward euthanasia. A nonprobability quantitative, cross-sectional design was carried out among nurses working at a tertiary care center. Data were collected through self-reported questionnaires at their work place. Significant differences were found between men and women to the items such as “Fear of death shows differences due to religious beliefs” (χ2 = 10.550, p < 0.05), “If patient wants euthanasia, nutrition support should be stopped” (χ2 = 12.209, p < 0.05), “CPR should not be applied in case of sudden respiration and heart stop” (χ2 = 9.591, p < 0.05), and “burden for relatives to take care of a patient who is in terminal period and who will die” (χ2 = 9.069, p < 0.05). The present study depicts that gender plays an important role in euthanasia; hence, the researchers strongly suggest that there is an urgent need to draft uniform guidelines after wide consultation with all the stake holders regarding nurses’ role in taking care of patients who request euthanasia, to face these situations effectively and competently within professional boundaries.

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.

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.

scholarly journals Transport Factors Affecting the Outcome of Referred Neonates Admitted in A Tertiary Care Hospital

2018 ◽  
Vol 41 (3) ◽  
pp. 159-164 ◽  
Author(s):  
Madhabi Baidya ◽  
Mahfuza Shirin ◽  
Liton Chandra Saha
Keyword(s):  
Perinatal Asphyxia ◽  
Care Center ◽  
Tertiary Care ◽  
Preterm Neonates ◽  
P Value ◽  
Care Hospital ◽  
Cross Sectional ◽  
Neonatal Transport ◽  
Group I ◽  
Group Ii

Background: Adequate neonatal transport is a key component of care of the sick newborns who require referral to tertiary care center. Poor transportation is one of the iatrogenic factors associated with greater neonatal mortality. Neonatal transport is the greatest challenge faced today in our country. The purpose of this study was to find out characteristics of transport of referred neonates and to idention the factors that contribute to mortality.Methodology: This cross sectional study was conducted in Dhaka Shishu (Children) Hospital from June 2013 to November 2013. Both term and preterm neonates who were referred within first seven days of life were included and those with gross congenital abnormalities and left against medical advice were excluded from the study. After enrollment, data were collected using a structured questionnaire including birth details, interventions before transportation, reasons for referral, and details of transportation. Outcome & duration of hospital stay were also recorded. Neonates who were expired considered as group I and who were survived considered as group II. The study variables were analyzed for their association with immediate outcome by applying chi square test and t test. P value <0.05 was considered significant.Results: This study found that out of 332 neonates 181 were expired with 54.5% mortality rate. One eighty one neonates who were expired, considered as group I and one fifty one neonate were survived, considered as group II. The mortality was significantly high in male neonates [RR 0.80 (0.66-0.97)] and neonates those delivered at home [RR 1.34(1.10-1.64)] (p<0.05). Perinatal asphyxia, pre-term low birth weight, neonatal sepsis were the main causes of referral. It was found that transportation without any referral note [RR 1.40 (1.14- 1.71)], no advice regarding maintenance of airway[RR 1.50(1.17- 1.92)]and keeping warm [RR 1.51(1.17-1.950], resuscitation on admission [RR 1.63(1.23-2.17)] and transportation required > 3hours [RR 1.36(1.09-1.69)] were associated with significantly higher mortality among referred transported neonates(p<0.05).Conclusions: This study found that male neonates, home delivery, transportation without any referral note, no advice regarding maintenance of airway and keeping warm, resuscitation needed on admission and prolonged transportation time were significantly associated with mortality of referred transported neonates.Bangladesh J Child Health 2017; VOL 41 (3) :159-164

scholarly journals Usefulness of the Non-Contact Tonometry in Out-Patient Screening

2016 ◽  
Vol 15 (2) ◽  
Author(s):  
Satheesh Solomon T Selvin ◽  
Chris Elsa Samson Jacob ◽  
Thomas Kuriakose
Keyword(s):  
Central Corneal Thickness ◽  
Care Center ◽  
Corneal Thickness ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Applanation Tonometry ◽  
Cross Sectional ◽  
Significant Difference ◽  
Iop Measurement ◽  
The Mean

Purpose: Goldmann applanation tonometry (GAT) is considered the gold standard for Intraocular Pressure (IOP) measurement. It has the disadvantages of being a contact device, need for a slit-lamp, non-portability and need of a skilled examiner. Many hospitals are using a Non Contact Tonometry (NCT) as a screening device to save clinician time, however the usefulness is not proved in terms of reliability. This study was aimed to determine the usefulness of the Air-puff tonometer (TONOREF NIDEK II, NIDEK CO., LTD., JAPAN) over a GAT in a tertiary care center. Design: Cross-sectional Study Methods: This was a cross-sectional, non interventional observational study conducted on 224 eyes (right eye) from 224 patients. All patients underwent the IOP measurement with both methods and a central corneal thickness (CCT) measured. The data was analyzed using SPSS 20.0 software. Results: The mean age of the patients was 40.3±11.29 years. There was a statistically significant difference (p<0.001) between the mean NCT and GAT readings which persisted even after correction for central corneal thickness. The correlation between NCT and GAT using Pearson’s correlation coefficient was strong irrespective of the corrections for their corneal thickness (r = 0.751 and 0.718 for uncorrected and corrected values respectively). The correlation of the individual clinicians for the readings varied from moderate to strong. The ROC curve showed the best sensitivity and specificity to occur at around 13 to 14 mmHg. Conclusion: NCT seems to overestimate the IOP at low ranges as compared to the GAT and underestimate at higher ranges. The crossover of the values is seen between 12 to 13 mmHg.  The clinician should do an individualized analysis of his/her GAT measurements to the readings of the NCT machine at the clinic to obtain clinician specific nomogram. 

scholarly journals An observational study on patient compliance and adverse drug reactions of antihypertensives drugs in a tertiary care center of Bihar

2021 ◽  
Vol 6 (4) ◽  
pp. 190-193
Author(s):  
Mrityunjay Kumar Pandit ◽  
Kumar Gaurav ◽  
Jeetendra Kumar
Keyword(s):  
Blood Pressure ◽  
Combination Therapy ◽  
Antihypertensive Drugs ◽  
Care Center ◽  
Adult Population ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
High Dose ◽  
Cross Sectional ◽  
Institutional Ethics

Hypertension is among the most common non-communicable and lifestyle disease in our country that affects adult population of both the genders from all socio-economic backgrounds and urban and rural population. In-spite of this, early diagnosis and appropriate treatment are suboptimal. Adherence of prescribed treatment has been studied in patients of hypertension in this study. : An observational and cross-sectional study was conducted in the Department of Pharmacology, Jawahar Lal Nehru Medical College and Hospital, Bhagalpur, Bihar. Prior to the initiation of the study, clearance was obtained from the Institutional Ethics Committee. Study period was between January 2021 and June 2021.A predesigned pretested interview schedule was used to collect the data from the 247 study participants. This schedule contained information related to socio-demographic variables, comorbidity, a format to assess the compliance to antihypertensive drugs prescribed and any adverse event. : A significant improvement in maintain optimal in blood pressure was observed in patients treated with one pill per day as compared to patients prescribed with two and three pills per day. Compliance was significantly better in patients in combination therapy as compared to monotherapy. : Low dose combination therapy has been stated to be more effective than high dose monotherapy in controlling blood pressure. It shows better compliance and lesser incidence of side-effects.

scholarly journals Metabolic syndrome in alopecia areata: an observational study at a tertiary care center

2021 ◽  
Vol 7 (5) ◽  
pp. 647
Author(s):  
Subrata Kumar Das ◽  
Saptadipa Das
Keyword(s):  
Metabolic Syndrome ◽  
Observational Study ◽  
Alopecia Areata ◽  
Care Center ◽  
Tertiary Care ◽  
Age Group ◽  
Tertiary Care Center ◽  
Cross Sectional ◽  
Laboratory Parameters ◽  
Number Of Patients

<p class="abstract"><strong>Background:</strong> The aim was to evaluate the parameters of metabolic syndrome (MS) in patients of alopecia areata and to investigate the possibility of an existing relationship between MS and alopecia areata (AA).</p><p class="abstract"><strong>Methods:</strong> This cross-sectional observational study included 50 patients with AA who attended OPD of department of dermatology at a tertiary care center during a period of 1 year. Clinical and laboratory parameters were noted in each patient.<strong></strong></p><p class="abstract"><strong>Results:</strong> This study included 50 patients with AA (33 males and 17 females). In the present study maximum number of patients belonged to the age group 20-30 years with 23 patients, followed by 30-40 years with 17  patients. Most of the study subjects, 17 were college students and number of employees were 15. Out of 50 patients 44  had patch(es) and 2 patient had alopecia totalis. In this study out of 50 patients, 38 had mild AA, 7 had AA and 5 patients had severe AA. No significant derangement of clinical and laboratory parameters of MS observed in patients of AA.</p><p class="abstract"><strong>Conclusions:</strong> In the present study we did not observe any significant derangement of clinical and laboratory parameters of  MS  in patients of alopecia areata.</p>

scholarly journals Clinical and laboratory profiles of genital ulcers (sexually transmitted diseases) in a tertiary care center in northeastern India

2021 ◽  
Vol 12 (2) ◽  
pp. 120-129
Author(s):  
Romita Bachaspatimayum ◽  
Zamzachin Guite ◽  
Thangjam Bijayanti Devi
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Herpes Genitalis ◽  
Tertiary Care Center ◽  
Cross Sectional ◽  
Female Ratio ◽  
Ulcer Disease ◽  
Sexually Transmitted ◽  
Northeastern India ◽  
Genital Ulcers

Background: Genital ulcers are defined as breaches in the continuity of the genital mucosa and/or skin. Sexually transmitted infections (STIs) that cause genital ulcer disease (GUD) are syphilis, chancroid, donovanosis, lymphogranuloma venereum (LGV), and herpes genitalis. This study aimed to investigate the clinical and laboratory profiles of STI-related genital ulcers. Materials and Methods: A cross-sectional two-year study was conducted on patients attending the Outpatient Department of Dermatology, Venereology and Leprosy in a tertiary care center in northeastern India. Selected were 95 patients who presented themselves with STI-related genital ulcers. Detailed history taking and examination were conducted with basic tests to assist the diagnosis. Results: The male-to-female ratio was 3.32:1, and the most common site was the glans and prepuce in males (28.77%) and the labia majora and minora in females (36.36%). 96.84% of patients had superficial ulcers. The KOH mount was positive in 26 patients. The Tzanck smear was positive in 31 patients. RPR was positive in four. HIV was positive in eleven. Herpes genitalis (96.84%) was the most common GUD. Mixed STIs were attested in 41.05% of patients. Conclusion: GUD can take various forms of presentation. The available laboratory tests should be utilized. The possibility of mixed infections should always be kept in mind.

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