Severe COVID-19 Case with HRCT Score of 25/25: A Survival Story

With the rapid spread of severe acute respiratory syndrome SARS-CoV2, the incidence of the disease is increasing each day with a higher infectivity rate and unpredictable morbidity and mortality. The second wave in India has higher morbidity and mortality compared to the previous wave of SARS-Cov2. With the increasing trend of screening hypoxic patients with high resolution computed tomography (HRCT) of thorax, treatment modalities, and investigational approaches have changed drastically. Here we report a case of a 31-year-old female who presented to a tertiary care centre in the rural area with a history of fever five days back and a history of breathlessness of 3 days duration and dry cough of 3 days duration. She was hypoxic on admission and later on diagnosed with SARS-Cov2 infection. HRCT thorax revealed a CT severity score of 25/25. She was treated according to standard treatment protocols. The patient was discharged after 46 days with normal oxygen saturation on room air. The aim of this case study is to emphasize the wholesome approach in the management of COVID-19.

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PAEDIATRIC POSTERIOR FOSSA TUMORS : AN EPIDEMIOLOGICAL AND ANALYTICAL STUDY AT TERTIARY CARE CENTRE IN EASTERN INDIA

10.36106/ijar/6409694 ◽

2021 ◽

pp. 54-56

Author(s):

S. I. Sadique ◽

Md. Shahid Alam ◽

S. Chatterjee ◽

S. Ghosh

Keyword(s):

Early Diagnosis ◽

Posterior Fossa ◽

Tertiary Care ◽

Male Dominance ◽

Morbidity And Mortality ◽

Posterior Fossa Tumors ◽

Tertiary Care Centre ◽

Therapeutic Modalities ◽

Common Location ◽

Group 5

Introduction: Posterior fossa is the commonest site of primary intracranial tumors in children, accounting for 45-60% of 1 all pediatric tumors . The aims and objectives of the study is to analyse the incidence, clinical features, surgical outcome and complications in paediatric patients with posterior fossa tumor. Material and Methods: The present study is a non-randomized prospective observational study, conducted in the department of neurosurgery, Bangur Institute of Neurosciences (B.I.N), IPGME & R, Kolkata from January 2019 to December 2020. Sample size is 50. Observations & Results: Out of 480 cases of total CNS tumors who presented in the study period, 96 cases(20%) were of paediatric posterior fossa tumors. Male dominance was seen i.e. 32 cases(64%). Most of them were in the age group 5-12 years i.e. 30 cases(60%). Headache and vomiting was the most common presenting complain present in 41 cases(82%). Fourth Ventricle was the most common location, 30 cases(60%) with Medulloblastoma being the most common tumor, 24 cases(48%). Brainstem involvement was seen in 22 cases(44%). Post-op hydrocephalus and cerebellar mutism were seen in 6 cases(12%) each. Overall mortality was 8%(4 cases). Conclusion: Posterior fossa tumors are critical brain lesions with signicant neurological morbidity and mortality. Early diagnosis of posterior fossa tumors is vital to prevent potential risks of Brain stem compression, herniation, hydrocephalus and death. With rapid advancement in radiology and the advent of modern therapeutic modalities, early diagnosis and treatment reduced the morbidity and mortality rate and improved prognosis among the patients.

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Cutting the chorda tympani: not just a matter of taste

The Journal of Laryngology & Otology ◽

10.1017/s0022215110000733 ◽

2010 ◽

Vol 124 (9) ◽

pp. 999-1002 ◽

Cited By ~ 15

Author(s):

N Guinand ◽

T Just ◽

N W Stow ◽

H Cao Van ◽

B N Landis

Keyword(s):

Middle Ear ◽

Tertiary Care ◽

Case Series ◽

Salivary Flow ◽

Middle Ear Surgery ◽

Chorda Tympani ◽

Tertiary Care Centre ◽

Ear Surgery ◽

Salivary Function ◽

History Of

AbstractIntroduction:Chorda tympani injury as a complication of middle-ear surgery has been extensively studied with regard to its effects upon taste. However, the chorda tympani also carries parasympathetic fibres to the salivary glands of the oral cavity. To date, little has been reported about the effect of chorda tympani section upon salivary function.Setting:Tertiary care centre.Material and methods:We report a case series of three patients with bilateral chorda tympani lesions. Chorda tympani function was assessed using ‘taste strips’ and unstimulated sialometry. A careful history of oral symptoms was taken.Results:All patients showed transient or permanent bilateral ageusia of the anterior two-thirds of the tongue, and a decreased resting salivary flow rate. In addition, all patients suffered from transient or persistent, distressing xerostomia.Conclusion:Taste disorders may occur after middle-ear surgery but they are mostly transient, even when the chorda tympani nerves are sectioned bilaterally. In contrast, bilateral chorda tympani lesions may lead to severe, persistent and distressing xerostomia. Based on this neglected aspect of chorda tympani function, we emphasise the importance of preserving the chorda tympani whenever possible.

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Study of incidence and prevalence of hypokalemic periodic paralysis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20190928 ◽

2019 ◽

Vol 7 (3) ◽

pp. 810

Author(s):

Ajith Dungdung ◽

Vishwanath Malkappa Jalawadi ◽

Upendra Prasad Yadav

Keyword(s):

Tertiary Care ◽

Medical Science ◽

Periodic Paralysis ◽

High Carbohydrate Diet ◽

Strenuous Exercise ◽

Hypokalemic Periodic Paralysis ◽

Tertiary Care Centre ◽

Carbohydrate Diet ◽

High Carbohydrate ◽

History Of

Background: Hypokalemic periodic paralysis (HPP) is a rare autosomal dominant channelopathy characterised by muscle weakness or paralysis when there is a fall of potassium level in the blood. In individuals with mutation, attack begins during adolescents and most commonly occurs after sleep on awakening, rest after strenuous exercise, high carbohydrate diet and meal with high sodium content. This study was conducted to analyse the age of incidence and prevalence of HPP with various clinical presentations, diagnosis and its effective treatment.Methods: A retrospective analysis of 50 patients of Hypokalemic periodic paralysis was analysed in tertiary care centre “Rajendra institute of medical science” Ranchi, Jharkhand, India, with reference to its clinical presentation, age of incidence and prevalence with laboratory parameters and treatment outcomes.Results: Incidence of attack is more common in men between 26-35 years of age. Sudden onset of flaccid quadriparesis was the most common presentation with history of high carbohydrate diet on the background of strenuous work during summer season. Around 60% had similar history of attacks in the past and most of the patients had serum potassium levels between 2.1-3.0mEq/L. Electrocardiography (ECG) abnormalities associated with hypokalemia had been observed in 90% of patients, and also significant clinical, biochemical changes have been observed as well.Conclusions: Early diagnosis not only helps in definitive management with potassium replacement, but also prevents patient going for life threatening respiratory failure. Patients recover completely without any clinical sequelae. Therefore, it is imperative for physicians, particularly those working in acute care settings, to be aware of this condition. Further management depends on the cause, frequency of attacks, severity of symptoms and the duration of the illness.

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Accidental tramadol ingestion in children admitted in tertiary care centre

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20195200 ◽

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.

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CLINICAL PROFILE AND MANAGEMENT OF PATIENTS OF AMOEBIC LIVER ABSCESS IN A TERTIARY CARE CENTRE

10.36106/ijsr/5406508 ◽

2020 ◽

pp. 5-7

Author(s):

Rakesh Mishra ◽

Debabrata Banerjee ◽

Debarshi Jana

Keyword(s):

Drug Treatment ◽

Liver Abscess ◽

Tertiary Care ◽

Clinical Manifestations ◽

Needle Aspiration ◽

Intestinal Disease ◽

Amoebic Liver Abscess ◽

Treatment Modalities ◽

Tertiary Care Centre ◽

Early Recovery

Introduction: Amoebiasis is caused by the protozoan Entamoeba histolytica. Most infections are asymptomatic; clinical manifestations include amoebic dysentery and extra intestinal disease. Amoebic liver abscess is the most common extraintestinal manifestation of amoebiasis. Amoebae establish hepatic infection by ascending the portal venous system. Aim: To study various aspects of Amoebic Liver Abscess like demographic profiles, clinical presentations, association with intestinal disease, radiological and laboratory findings, treatment modalities and complications. Materials and Methods: A hospital based prospective observational study was performed in the Department of Internal Medicine, Command Hospital (Eastern Command), Kolkata, from Jan 2018 to Jun 2019. All confirmed cases of amoebic liver abscess above the age of 18 years admitted in Command Hospital (EC) were included in this study. The patient were then subsequently followed up for 01 year with USG abdomen every 03 monthly. Results: Total 40 patients of Amoebic Liver Abscess with age more than 18 year were enrolled in the study. The age ranged from 26 to 70 years (mean age 46.2 year). Male patients were dominated over female. 80.0 % were from rural background. About 55% patients were addicted to alcohol & 25.0 % were known diabetics at presentation. In all, 07 (17.5%) patients with abscess size of 6 cm to 10 cm (Vol> 300 cc) were treated by needle aspiration and drug therapy. Remaining 17(42.5%) patients with abscess size more than 10 cm were treated with pigtail drainage and drug. Conclusion: There is significant advantage of pigtail drainage with drug treatment over needle aspiration with drug and only with drug treatment in terms of decrease in lesion size and early recovery.

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Lower Genital Tract Trauma in a Tertiary Care Centre in Mid-Western Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.3056 ◽

2017 ◽

Vol 56 (205) ◽

pp. 137-140

Author(s):

Anil Kumar Adhikari ◽

Mahuya Dutta ◽

Chittra Ranjan Das

Keyword(s):

Genital Tract ◽

Surgical Intervention ◽

Tertiary Care ◽

Morbidity And Mortality ◽

Age Group ◽

Care Centre ◽

Tertiary Care Centre ◽

Lower Genital Tract ◽

Clinical Presentations ◽

Fall From Height

Introduction: The study of lower genital tract trauma has become important in gynaecological practice. There is paucity of reports on this clinical entity from our settings. The main aim of this study is to document injuries in female lower genital tract in Mid-Western Nepal. Methods: Sixty female patients admitted to the hospital with genital tract injuries caused by coitus or accidents were included in the study. Details of the causes of trauma clinical presentations and management were recorded. Results: These injuries were grouped according to etiological factors. This study included 33 (55%) coital injuries and 27 (45%) non- coital injuries. Out of coital injury, 12 cases were criminal assault (rape) in age group of 4 to 18 years. Four unmarried girls had consensual sex. Non-coital injuries were due to fall from height, cattle horn injuries, straddle type of trauma, vulvar haematoma and anorectal injuries. Conclusions: Appropriate surgical intervention can avert morbidity and mortality. Keywords: accident; lower genital tract; Nepal; trauma.

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Ectopic pregnancy: an observational study in a tertiary care centre of Southern Rajasthan, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20200062 ◽

2020 ◽

Vol 9 (2) ◽

pp. 516

Author(s):

Shrusti Parmar ◽

Nalini Sharma ◽

Vimla Dhakar

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Tertiary Care ◽

First Trimester ◽

Treatment Modalities ◽

Public Health Issue ◽

Care Centre ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Early Presentation

Background: One among the three chief obstetric causes of bleeding in first trimester, ectopic pregnancy is the first thing to rule out as a gestation is suspected. The present study observes and analyses sociodemographic distribution, risk factors, presentation, diagnosis and treatment modalities in a tertiary care centre.Methods: An observational cross-sectional study, conducted among patients who were diagnosed and managed in department of obstetrics and gynaecology of a tertiary care centre. Data analyzed and explained as frequency, percentage, mean and standard deviation.Results: Age group between 21 to 30 years (69.9%) and multigravida (68.5%) are high risk for ectopic pregnancy (EP). Menstrual history was regular in 86.3%. Risk factors identified were previous abortion (30%) and history of pelvic inflammatory disease (30%). In 80.9% pain in abdomen was presenting complaints followed by bleeding per vaginum (60%), amenorrhoea (60%) and nausea and vomiting (32.9%). Right salpingectomy was most common in 43.8%, followed by left salpingectomy in 28.8%, methotrexate in 15.1%, left salpingo-ophorectomy in 5.5%, right salpingo-opherectomy in 5.5% and removal of tubal abortion in 1.3% patients. Laparoscopy was chosen route in majority 64.4% patients.Conclusions: Ectopic pregnancy - a gynecological catastrophe as well as a major challenge to the reproductive performance of women worldwide, should be considered a relevant public health issue. By providing adequate materials, manpower, well-equipped health facilities as well as a prompt and efficient referral system, good access roads and efficient transportation, will ensure early presentation in hospitals and prompt management of cases.

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Pregnancy outcome in women with previous preeclampsia versus women normotensive in previous pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184964 ◽

2018 ◽

Vol 7 (12) ◽

pp. 5045

Author(s):

Jayshree Mulik ◽

Snehalata Suresh

Keyword(s):

Pregnancy Outcome ◽

Perinatal Outcome ◽

Tertiary Care ◽

Subsequent Pregnancy ◽

Care Centre ◽

Tertiary Care Centre ◽

Previous Pregnancy ◽

Index Pregnancy ◽

History Of ◽

Adverse Pregnancy

Background: Women with history of preeclampsia have reportedly higher risk of development of preeclampsia in subsequent pregnancies, along with other adverse pregnancy outcomes. Authors aimed to study the incidence of recurrent preeclampsia and compare the pregnancy outcome in women with history of preeclampsia in previous pregnancy with those who were normotensive in previous pregnancy and further compare outcomes in women with recurrent preeclampsia between their previous and index pregnancy.Methods: Pregnancy outcome was studied in women with preeclampsia in previous pregnancy (cases) and compared with women normotensive in previous pregnancy (controls). Further analysis of cases was done by dividing them into subgroups: those with recurrent preeclampsia in index pregnancy (A1) and those normotensive in index pregnancy despite being pre-eclamptic in previous pregnancy (A2). Total 100 cases and 100 controls were enrolled in the study, which was conducted at present tertiary care centre from January 2012 to June 2013.Results: Out of total 200 participants (100 cases, 100 controls) enrolled in the study; 58 out of 100 cases had recurrent preeclampsia and remaining 42 remained normo-tensive in index pregnancy. Among 100 controls, 93 were normotensive in index pregnancy.Conclusions: Women with history of preeclampsia in previous pregnancy had adverse maternal and perinatal outcome in subsequent pregnancy when compared to the women who were normotensive in the previous pregnancy. But when compared with their own previous preeclamptic pregnancy, they had better pregnancy outcome with good perinatal outcome in their index pregnancy.

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Incidence of and Factors Associated with New-Onset Insomnia Among Lebanese Hospitalised Patients

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2021.21.02.009 ◽

2021 ◽

Vol 21 (2) ◽

pp. e210-220

Author(s):

Nour Sakr ◽

Souheil Hallit ◽

Hanna Mattar

Keyword(s):

Tertiary Care ◽

Previous History ◽

Severity Index ◽

Cardiac Monitoring ◽

Sleep Wake Disorders ◽

Tertiary Care Centre ◽

Post Discharge ◽

Hospitalised Patients ◽

History Of ◽

New Onset

Objectives: This study aimed to determine the incidence and post-discharge resolution of new-onset insomnia in hospitalised patients with no previous history of insomnia, as well as to define major correlates of in-hospital insomnia. Methods: This prospective observational study was conducted between November 2019 and January 2020 at a tertiary care centre in Lebanon. All hospitalised patients >18 years of age with no history of insomnia were screened for new-onset insomnia using the Insomnia Severity Index (ISI) scale. Subsequently, patients were re-assessed two weeks after discharge to determine insomnia resolution. Results: A total of 75 patients were included in the study. Of these, nine (12%) had no insomnia, 34 (45.3%) had subthreshold insomnia, 22 (29.3%) had moderate insomnia and 10 (13.3%) had severe insomnia. The mean ISI score was 14.95 ± 6.05, with 88% of patients having ISI scores of >7 (95% confidence interval: 0.822–0.965). The frequency of new-onset insomnia was significantly higher among patients who shared a room compared to those in single-bed rooms (95.7% versus 75%; P = 0.011). Other factors were not found to be associated with new-onset insomnia, including the administration of medications known to cause insomnia, in-hospital sedative use, overnight oxygen, cardiac monitoring and self-reported nocturnal toilet use. Overall, insomnia resolution occurred in 78.7% of patients two weeks after discharge. Conclusion: There was a high incidence of acute new-onset insomnia among hospitalised patients at a tertiary centre in Lebanon. Additional research is recommended to further examine inhospital sleep disturbance factors and to seek convenient solutions to limit insomnia. Keywords: Sleep Wake Disorders; Insomnia; Hospitalization; Incidence; Risk Factors; Lebanon.

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Aural foreign bodies and their management: our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201076 ◽

2020 ◽

Vol 6 (4) ◽

pp. 646

Author(s):

Padma Harini ◽

Suneel Kudamala

Keyword(s):

Foreign Bodies ◽

Incidental Finding ◽

Tertiary Care ◽

Age Groups ◽

Paediatric Population ◽

Outpatient Department ◽

Tertiary Care Centre ◽

Female Ratio ◽

History Of ◽

Male To Female

Background: Aural foreign bodies (FB) are a common presentation at ENT outpatient department mostly seen in paediatric population. Some are easily managed while others should be dealt with caution and extreme care. The objectives of the study were to analyze the types of aural FB, their incidence in different age groups and evaluate management methods.Methods: This is a prospective descriptive study on patients of all age groups with aural FB presenting to the ENT Outpatient Department in a tertiary care centre for a period of 1 year. The clinical presentation, type of FB, incidence in different age groups and management methods were analyzed. Results: 200 patients aged 2-78 years were evaluated. Age group of under 15 years was most affected (70%). Male to female ratio was 1:1.326. Majority (104 out of 200) presented with a history of FB insertion in the ear while others presented with aural pain and discharge. In 10 cases, ear foreign body was an incidental finding. Most common FB was seeds in children and cotton buds, bird feathers in adults. Most of the cases were managed without anaesthesia with use of headlight. Ear probes were used in 45% cases followed by forceps, suction and syringing in remainder.Conclusions: Most of the aural foreign bodies can be managed in the outpatient department itself without any anaesthesia under direct vision of headlight with the help of simple instruments without any complications.

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