5851
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Prudhvi K, Rao VDS, Jain RK, Jiwani PA, Padmanabhan TNC, Ravikanth G, Srinath VS, Tavva NVRPK. Study on incidence of bleeding in hospitalized patients after antithrombotic therapy at a tertiary care hospital. J Assoc Physicians India 2013; 61:110-113. [PMID: 24471249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To monitor the different antithrombotic drug combinations, determine the incidence, magnitude of bleeding and the association of HAS-BLED risk scoring schema with the magnitude of bleeding as defined using TIMI bleeding criteria. METHODS A prospective observational study in a cohort of patients for a period of 8 months, at one of the tertiary care center-Krishna Institute of Medical Sciences, Hyderabad, was conducted. Consecutive patients were enrolled and followed from the date of admission till the adverse events are perceived/date of discharge. Pearson Correlation Statistics (Fisher's z Transformation) is applied to assess the association between HAS-BLED risk factors and the total risk score with bleeding criteria. RESULTS A total of 400 cases were collected during the 8-month study period, of which 372 satisfied the inclusion criteria. Among them 34 (9.1%) bleeding cases were reported with mean (+/- SD) age of 57.8 (+/- 14.19) years. Bleeding occurred mostly in males 79.4% and a HAS-BLED Score of > or = 3 has been observed in 67.6% (n = 23) patients out of 34 bled patients. Two antiplatelets + One anticoagulant is the most common combination which caused bleeding in 41.2% (n = 14). Stroke history, bleeding predisposition, labile INR's are the HAS-BLED risk factors which are significant (< 0.05) with the TIMI Bleeding Criteria. CONCLUSION There was a linear correlation between the HAS-BLED risk score and the TIMI bleeding criteria-higher the risk score the more frequent is the incidence of major bleeding. A HAS-BLED risk score of > or = 3 is associated with TIMI major bleeding.
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Affiliation(s)
- K Prudhvi
- Department of Hospital and Clinical Pharmacy, Bharat Institute of Pharmacy, Hyderabad 501510, Andhra Pradesh
| | | | - R K Jain
- Krishna Institute of Medical Sciences, Hyderabad
| | - P A Jiwani
- Krishna Institute of Medical Sciences, Hyderabad
| | | | - G Ravikanth
- Krishna Institute of Medical Sciences, Hyderabad
| | - V S Srinath
- Krishna Institute of Medical Sciences, Hyderabad 500003, Andhra Pradesh
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5852
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Domingo P, Pomar V, Benito N, Coll P. The changing pattern of bacterial meningitis in adult patients at a large tertiary university hospital in Barcelona, Spain (1982-2010). J Infect 2013; 66:147-54. [PMID: 23168216 DOI: 10.1016/j.jinf.2012.10.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 10/26/2012] [Accepted: 10/31/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND We conducted a prospective, observational study in Barcelona (Spain) to determine changes in the spectrum of adult patients with bacterial meningitis (BM) over a 29-year period. METHODS The observation was divided into two periods: 1982-1995 (I) and 1996-2010 (II). All patients underwent clinical examination on admission and at discharge following a predefined protocol. RESULTS We evaluated 635 episodes of BM. The most frequent etiologic agents were Neisseria meningitidis and Streptococcus pneumoniae in periods I and II, respectively. Patients in period II were older (Median: 47.5 [95%CI: 23.0-64.5] vs. 58.0 [39.0-73.0] years, P<0.0001), had a longer interval from admission to therapy (Median: 2.3 [95%CI: 1.0-5.0] vs. 4.0 [2.0-12.0] hours, P<0.0001), and more frequently had co-morbid conditions (39.1% vs. 62%, P<0.0001). Meningococcal meningitis decreased by 66% (P<0.0001), whereas meningitis by Listeria monocytogenes increased by 110% (P=0.0007) in period II. There were no differences in the overall case-fatality and post-meningitic sequelae rates between both periods. CONCLUSIONS BM in adult patients has substantially changed over 29 years in terms of population affected, aetiology, and management, but not in terms of its overall mortality rate and appearance of post-meningitic sequelae.
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Affiliation(s)
- Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Av. Sant Antoni M(a) Claret 167, 08025 Barcelona, Spain.
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5853
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Al-Otaibi FE, Bukhari EE. Clinical and laboratory profiles of urinary tract infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in a tertiary care center in central Saudi Arabia. Saudi Med J 2013; 34:171-176. [PMID: 23396464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE To study the clinical and laboratory characteristics of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (E. coli). METHODS A retrospective clinical and laboratory study was performed at the Bacteriology Unit, Department of Pathology/Microbiology, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from June 2009 to June 2011. A total of 339 adults and pediatric patients with UTI was included in the study. Two groups of patients (ESBL E. coli UTI and non-ESBL E. coli UTI) were studied. Symptoms and signs of illness, comorbidities, outcomes, and urine analysis results were analyzed. RESULTS There was 339 episodes of culture-verified UTI, 113 (33.3%) cases were caused by ESBL E. coli, and 226 (66.7%) cases were caused by non-ESBL E. coli. Non-ESBL E. coli UTI was more commonly found in children, and ESBL E. coli was more predominant in female patients. Identified risk factors for acquisition of ESBL E. coli UTI included patients who had underlying renal disease and renal transplant (p=0.017), children with vesicoureteric reflux (p=0.044), surgical intervention, recurrent UTI (p<0.004), and in inpatients. Non-ESBL E. coli patients are more likely to present with UTI. The ESBL E. coli uropathogen are resistant to antibiotics, including the third generation cephalosporin, gentamicin, and ciprofloxacin, whereas the non-ESBL E. coli were more resistant to antibiotics Ampicillin and cotrimoxazole. CONCLUSION Identifying the risk factors and the antimicrobial resistance patterns associated with ESBL producing E. coli UTI is necessary for the development of an appropriate empirical antibiotic treatment.
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Affiliation(s)
- Fawzia E Al-Otaibi
- Bacteriology Unit, Department of Pathology/Microbiology, College of Medicine and King Saud University, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
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5854
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Joshi S, Ray P, Manchanda V, Bajaj J, Chitnis D, Gautam V, Goswami P, Gupta V, Harish B, Kagal A, Kapil A, Rao R, Rodrigues C, Sardana R, Devi KS, Sharma A, Balaji V. Methicillin resistant Staphylococcus aureus (MRSA) in India: prevalence & susceptibility pattern. Indian J Med Res 2013; 137:363-9. [PMID: 23563381 PMCID: PMC3657861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND & OBJECTIVES Methicillin resistant Staphylococcus aureus (MRSA) is endemic in India and is a dangerous pathogen for hospital acquired infections. This study was conducted in 15 Indian tertiary care centres during a two year period from January 2008 to December 2009 to determine the prevalence of MRSA and susceptibility pattern of S. aureus isolates in India. METHODS All S. aureus isolates obtained during the study period in the participating centres were included in the study. Each centre compiled their data in a predefined template which included data of the antimicrobial susceptibility pattern, location of the patient and specimen type. The data in the submitted templates were collated and analysed. RESULTS A total of 26310 isolates were included in the study. The overall prevalence of methicillin resistance during the study period was 41 per cent. Isolation rates for MRSA from outpatients, ward inpatients and ICU were 28, 42 and 43 per cent, respectively in 2008 and 27, 49 and 47 per cent, respectively in 2009. The majority of S. aureus isolates was obtained from patients with skin and soft tissue infections followed by those suffering from blood stream infections and respiratory infections. Susceptibility to ciprofloxacin was low in both MSSA (53%) and MRSA (21%). MSSA isolates showed a higher susceptibility to gentamicin, co-trimoxazole, erythromycin and clindamycin as compared to MRSA isolates. No isolate was found resistant to vancomycin or linezolid. INTERPRETATION & CONCLUSIONS The study showed a high level of MRSA in our country. There is a need to study epidemiology of such infections. Robust antimicrobial stewardship and strengthened infection control measures are required to prevent spread and reduce emergence of resistance.
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Affiliation(s)
| | | | - Pallab Ray
- Department of Microbiology, Postgraduate of Medical Education & Research, Chandigarh, India
| | - Vikas Manchanda
- Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Jyoti Bajaj
- Department of Microbiology, Government Medical College, Aurangabad, India
| | - D.S. Chitnis
- Department of Microbiology, Choithram Hospital & Research Center, Indore, India
| | - Vikas Gautam
- Department of Microbiology, Postgraduate of Medical Education & Research, Chandigarh, India
| | - Parijath Goswami
- Department of Microbiology, Gujarat Cancer & Research Institute, Ahmedabad, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College & Hospital, Chandigarh, India
| | - B.N. Harish
- Department of Microbiology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Anju Kagal
- Department of Microbiology, B.J. Medical College, Pune, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ratna Rao
- Department of Microbiology, Apollo Health City, Hyderabad, India
| | - Camilla Rodrigues
- Department of Microbiology, Hinduja National Hospital & MRC, Mumbai, India
| | - Raman Sardana
- Department of Microbiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Kh Sulochana Devi
- Deaprment of Microbiology, Regional Institute of Medical Sciences, Imphal, India
| | - Anita Sharma
- Department of Microbiology, Fortis Hospital, Chandigarh, India
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5855
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Bresani CC, Braga MC, Felisberto DF, Tavares-de-Melo CEL, Salvi DB, Batista-Filho M. Accuracy of erythrogram and serum ferritin for the maternal anemia diagnosis (AMA): a phase 3 diagnostic study on prediction of the therapeutic responsiveness to oral iron in pregnancy. BMC Pregnancy Childbirth 2013; 13:13. [PMID: 23324362 PMCID: PMC3599566 DOI: 10.1186/1471-2393-13-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/08/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pregnancy anemia remains as a public health problem, since the official reports in the 70's. To guide the treatment of iron-deficiency anemia in pregnancy, the haemoglobin concentration is the most used test in spite of its low accuracy, and serum ferritin is the most reliable test, although its cutoff point remains an issue. METHODS/DESIGN The aim of this protocol is to verify the accuracy of erythrocyte indices and serum ferritin (studied tests) for the diagnosis of functional iron-deficiency in pregnancy using the iron-therapy responsiveness as the gold-standard. This is an ongoing phase III accuracy study initiated in August 2011 and to be concluded in April 2013. The subjects are anemic pregnant women (haemoglobin concentration < 11.0 g/dL) attended at a low-risk prenatal care center in the Northeast of Brazil. The sample size (n 278) was calculated to estimate sensitivity of 90% and 80% of specificity with relative error of 10% and power of 95%. This study has a prospective design with a before-after intervention of 80 mg of daily oral iron during 90 days and will be analyzed as a delayed-type cross-sectional study. Women at the second trimester of pregnancy are being evaluated with clinical and laboratorial examinations at the enrollment and monthly. The 'responsiveness to therapeutic test with oral iron' (gold-standard) was defined to an increase of at least 0.55 Z-score in haemoglobin after 4 weeks of treatment and a total dose of 1200 mg of iron. At the study conclusion, sensitivities, specificities, predictive values, likelihood ratios and areas under the ROC (Receiver Operating Characteristic) curves of serum ferritin and erythrocyte indices (red blood cell count, haematocrit, haemoglobin concentration, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red blood cell distribution width, reticulocyte count) will be tested. The compliance and adverse effects are considered confounding variables, since they are the main obstacles for the iron-therapy responsiveness. DISCUSSION This study protocol shows a new approach on iron-deficiency anemia in pregnancy from a functional point of view that could bring some insights about the diagnostic misclassifications arising from the dynamic physiologic changes during the gestational cycle. TRIAL REGISTRATION WHO International Clinical Trials Registry Platform U1111-1123-2605.
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Affiliation(s)
- Cristiane Campello Bresani
- Nutrition Research Group at Instituto de Medicina Integral Prof Fernando Figueira – IMIP, Rua dos Coelhos, 300, Boa Vista, Recife, PE CEP: 50.070-550, Brazil
- Instituto Nacional do Seguro Social/Ministério da Previdência Social – INSS/MPS, Av Jorn Mário Melo, 343, Santo Amaro, Recife, PE CEP: 50.040-010, Brazil
| | - Maria Cynthia Braga
- Postgraduate Program in Maternal and Child Health of IMIP, Rua dos Coelhos, 300, Boa Vista, Recife, PE CEP: 50.070-550, Brazil
- Postgraduate Program in Public Health at Centro de Pesquisas Aggeu Magalhães – Fundação Oswaldo Cruz – CPQAM/FIOCRUZ, Av. Professor Moraes Rego, s/n - Campus da UFPE - Cidade Universitária, Recife, PE CEP: 50.670-420, Brazil
| | - Daniel Falcão Felisberto
- Faculdade Pernambucana de Saúde – FPS, Av. Jean Emile Favre, 422 Imbiribeira, Recife, PE CEP: 51.200-060, Brazil
| | | | - Debora Bresani Salvi
- Nutrition Research Group at Instituto de Medicina Integral Prof Fernando Figueira – IMIP, Rua dos Coelhos, 300, Boa Vista, Recife, PE CEP: 50.070-550, Brazil
| | - Malaquias Batista-Filho
- Nutrition Research Group at Instituto de Medicina Integral Prof Fernando Figueira – IMIP, Rua dos Coelhos, 300, Boa Vista, Recife, PE CEP: 50.070-550, Brazil
- Postgraduate Program in Maternal and Child Health of IMIP, Rua dos Coelhos, 300, Boa Vista, Recife, PE CEP: 50.070-550, Brazil
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5856
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Shamszad P, Khan MS, Rossano JW, Fraser CD. Early surgical therapy of infective endocarditis in children: a 15-year experience. J Thorac Cardiovasc Surg 2013; 146:506-11. [PMID: 23312102 DOI: 10.1016/j.jtcvs.2012.12.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 09/14/2012] [Accepted: 12/04/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Infective endocarditis is rare in children but potentially carries high mortality and morbidity. Few data exist regarding surgical therapy and the associated outcomes in children with infective endocarditis. The aim of the present study was to describe the characteristics and outcomes of children undergoing surgery for infective endocarditis. METHODS A retrospective review of all patients aged 21 years or younger diagnosed with definitive infective endocarditis at a single center from 1996 to 2010 was performed. RESULTS Of 76 identified patients with infective endocarditis (median age, 8.3 years; 73.9% boys), 46 patients (61%) required surgical intervention. Staphylococcus aureus was most commonly isolated (18 patients, 24%) followed by Streptococcus (17 patients, 22%). Common surgical indications included severe valvular insufficiency in 13 patients, septic embolization in 12, concomitant severe valvular insufficiency and ventricular dysfunction in 9, persistent vegetations in 9, and persistent bacteremia in 3. Although early surgery was performed within 7 days of diagnosis in 35 patients (76%), 25 (54%) underwent surgery within 3 days or less. The factors associated with surgery included the presence of ventricular dysfunction, left-sided vegetation, severe valvular insufficiency, septic embolization, and S aureus. Surgery within 3 days or less was associated with the presence of ventricular dysfunction and S aureus. Native valve repair was performed in 50% of patients with native-valve disease. Postoperatively, no septic embolization events occurred and recurrence was low (2%). The 1-, 5-, and 10-year survival was 98% ± 2%, 90% ± 8%, and 81% ± 11%, respectively. CONCLUSIONS Children with infective endocarditis can undergo successful early surgical therapy with a low risk of septic embolization, recurrence, and operative mortality.
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Affiliation(s)
- Pirouz Shamszad
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex 77030, USA.
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5857
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Spinoit AF, Poelaert F, Groen LA, Van Laecke E, Hoebeke P. Hypospadias repair at a tertiary care center: long-term followup is mandatory to determine the real complication rate. J Urol 2013; 189:2276-81. [PMID: 23306089 DOI: 10.1016/j.juro.2012.12.100] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 12/21/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE The field of reconstructive surgery for hypospadias is lacking standard techniques and followup. Most published series include complication rates after a short followup. We report and analyze the long-term outcome of primary hypospadias repair at a single tertiary care center. MATERIALS AND METHODS We reviewed 1,061 operations performed at our institution between 1997 and 2010 and registered as hypospadias repair. The operations were performed in 543 patients born between June 1997 and June 2005. A retrospective database was created with information about hypospadias characteristics, surgery and followup. RESULTS A total of 474 primary repairs were selected, excluding incomplete/incorrect files. Distal penile hypospadias was reported in 366 patients (77.2%), mid penile hypospadias in 54 (11.4%) and proximal hypospadias in 54 (11.4%). Initial repair technique was based on incised plate in 189 patients (39.9%), meatal advancement in 171 (36%), onlay flap in 82 (17.3%) and other or combined techniques in 25 (5.3%). Insufficient information was reported for 7 patients (1.5%). Mean age at first operation was 22.6 months (range 4 to 134) and mean followup after first operation was 34.0 months (0 to 145). Of the children 360 (75.9%) had a good long-term outcome and required only 1 procedure. Reoperation was needed in 114 patients (24.1%), of whom 54 (47.4%) underwent reoperation in the first year of followup. CONCLUSIONS Overall a good long-term outcome without further complication was achieved in 75.9% of our cases. Of the 24.1% of patients who needed reoperation only 47.4% presented within the first year postoperatively, indicating the need for long-term followup when reporting outcomes of hypospadias repair.
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5858
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Abstract
BACKGROUND Amyloidosis results from the accumulation of unique extracellular proteins which are not able to be degraded via the usual mechanism of lysosomal proteolysis. Isolated collections of amyloid within the bladder are extremely uncommon, and a cytopathologic description in voided urine has not been described to date. METHODS A retrospective review was performed at a tertiary-care hospital, and 3 patients with isolated bladder amyloidosis and corresponding voided urine specimens were identified. The following clinical data were collected for each case: age, gender, treatment and follow-up information. RESULTS The patient age range was 76-84 years, with 2 males and 1 female. Amyloidosis was never clinically suspected. In 1 patient, a urinary amyloid manifested, which was thought to represent extraneous debris at the time of original diagnosis. Two patients never manifested signs of systemic amyloidosis or multiple myeloma, and the third was found to have a monoclonal gammopathy. CONCLUSIONS Our results show the difficulty of diagnosing urinary amyloid in the absence of clinical suspicion. Further, the presence of urinary amyloid is unlikely in patients with bladder amyloidosis as the cohesive nature of the protein makes spontaneous shedding uncommon. Testing for systemic amyloidosis is warranted and if the disease is localized, a favorable outcome can be expected.
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Affiliation(s)
- Adam D Toll
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Md. 21287, USA
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5859
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Oliveira CMC, Timbó PS, Pinheiro SR, Leite JGS, Timbó LS, Esmeraldo RM. Post-transplant anemia and associated risk factors: the impact of steroid-free therapy. SAO PAULO MED J 2013; 131:369-76. [PMID: 24346775 PMCID: PMC10871816 DOI: 10.1590/1516-3180.2013.1316523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 02/08/2013] [Accepted: 02/15/2013] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE The prevalence of post-renal transplant anemia (PTA) reported in the literature is variable and several factors contribute towards its pathophysiology. This study aimed to investigate the prevalence of PTA, its associated risk factors and the impact of therapy without steroids. DESIGN AND SETTING Retrospective cohort study in a renal transplantation unit at a tertiary hospital. METHODS Anemia was defined as hemoglobin (Hb) < 12 g/dl in female adult recipients and < 13 g/dl in males. Donor and recipient age and gender, type of donor, creatinine, delayed graft function, acute rejection, use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) and therapy without steroids were investigated as risk factors for PTA through multivariate logistical regression analysis. RESULTS Evaluations were performed on 258 recipients (mean age: 38.8 years; 60.5% males; 35.7% did not receive steroids). Anemia was diagnosed in 38% of the patients (at the sixth month, M6), 28% (M12), 32% (M24) and 45% (at last follow up). Donor age > 50 years was associated with greater risks of PTA at M6 (odds ratio (OR) = 4.68) and M24 (OR = 6.57), as well as with therapy without steroids at M6 (OR = 2.96). Delayed graft function was independently associated with PTA at M6 (OR = 3.66) and M12 (OR = 2.85). CONCLUSION The lowest prevalence of PTA was observed between M9 and M24 after renal transplantation. Delayed graft function, donor age and therapy without steroids were the most important factors associated with PTA.
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Affiliation(s)
- Claudia Maria Costa Oliveira
- MD, PhD. Nephrologist in the Transplantation Department, Hospital Geral de Fortaleza, and Associate Professor, Discipline of Nephrology, Faculdade de Medicina Christus, Fortaleza, Ceará, Brazil
| | - Paula Sátiro Timbó
- Medical Student in the Nephrology Department, Faculdade de Medicina Christus, Fortaleza, Ceará, Brazil
| | - Sanna Roque Pinheiro
- Medical Student in the Nephrology Department, Faculdade de Medicina Christus, Fortaleza, Ceará, Brazil
| | | | - Luciana Sátiro Timbó
- Medical Student in the Nephrology Department, Faculdade de Medicina Christus, Fortaleza, Ceará, Brazil
| | - Ronaldo Matos Esmeraldo
- MD. Director of the Transplantation Department, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
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5860
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Shah JN, Pokhrel Y, Hassan K, Thapa G, Manandhar K, Maharjan SB. Is routine hospital visit after day case inguinal hernia surgery in children necessary? J Nepal Health Res Counc 2013; 11:35-39. [PMID: 23787523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND To observe the prospects of day case inguinal hernia surgery in children without routine postoperative hospital visits. The aim was to access the advantages, acceptability and safety of this change in practice in low resource country like Nepal. METHODS This was a cross-sectional study in a tertiary care general teaching hospital. Thirty children aged 6 months to 14 years who had elective day case Inguinal Hernia surgery from May 2011 to Oct 2011 were prospectively observed. Children with obstructed hernia, un-descended testis were excluded. Parents were counseled for omission of routine hospital visit after surgery. Main outcome measures were to observe unplanned hospital visit, reasons for visit, post-operative pain, wound infection and overall satisfaction of parents interviewed by telephone. Study was approved by institutional review committee. RESULTS There were 28 boys and two girls. Average age was five years. Right Inguinal Hernia patients were 19 in number while 11 patients had left sided hernia. None of the children visited health facility for pain or wound problem. Two children were brought to outpatient because they were mistakenly given appointment slip. Mother noticed recurrence and brought one child to surgical outpatient. All 30 parents responded to telephone enquiry and were satisfied. CONCLUSIONS Routine follow up visit after day care Inguinal Hernia surgery in children is not necessary. This practice is safe, economic and well accepted by children and parents.
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Affiliation(s)
- J N Shah
- Department of surgery, Patan Hospital, Patan Academy of Health Sciences, Kathmandu, Nepal.
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5861
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Ughasoro MD, Ikefuna AN, Emodi IJ, Ibeziako SN, Nwose SO. AUDIT OF BLOOD TRANSFUSION PRACTICES IN THE PAEDIATRIC MEDICAL WARD OF A TERTIARY HOSPITAL IN SOUTHEAST NIGERIA. East Afr Med J 2013; 90:5-11. [PMID: 26862624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To determine the indications, practices and outcomes of transfusion on children. DESIGN A descriptive retrospective study. SETTING Paediatric wards of University of Nigeria Teaching Hospital, Enugu, Nigeria. SUBJECTS Children one month to 18 years that received blood transfusion. MAIN OUTCOME MEASURES Indications for the transfusion, haemoglobin rise, vital signs, duration of transfusion and adverse events. RESULTS The two hundred and thirty eight transfusions reviewed were given amongst 95 patients, at a ratio of 2.5 transfusions per patient. The indicators of the transfusion were: malignancy (31.7%), sepsis (15.1%), sickle cell anaemia (12.1%), malaria (10.0%), hyperbilirubinaemia (10.0%), HIV/AIDS (8.3%), nephrotic syndrome (7.2%) and malnutrition (5.4%). Whole blood (56.4%) and sedimented cells (36.3%) were the main types of blood transfused. About 96.4% were transfused appropriate volume of blood. The mean Haemoglobin concentration (Hb) increase was 3.1g/dl and 12.8% of the recipients recorded an Hb increase of 5g/dl. The mean duration of transfusion was 4.6 hours and 59.7% of the transfusions exceeded the recommended four hours. Pulse and respiratory rates returned to normal post transfusion in 26.1 and 21.8% of the recipients respectively. In 10% of the transfusions there were minor adverse events; chills/fever (5.1%), itching (3.4%), hypothermia (1.0%) and vomiting (0.5%). CONCLUSION Blood transfusion in this tertiary institution is not common and mainly due to non-communicable diseases. The expected optimal rise in Hb and normalising of vitals sign are not always the case. The duration of most transfusions was unduly prolonged and transfusion-related adverse events are rare.
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Affiliation(s)
- M D Ughasoro
- University of Nigeria, Enugu Campus, University of Nigeria Teaching Hospital, P. O. Box 1093, Enugu, Nigeria
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5862
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McAfee JS, Demarcantonio M, Fine BR, Beydoun H, Derkay CS. Prevalence of ventilation tubes in children with a tracheostomy tube. Int J Pediatr Otorhinolaryngol 2013; 77:65-8. [PMID: 23131201 DOI: 10.1016/j.ijporl.2012.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 09/20/2012] [Accepted: 09/22/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To estimate the prevalence of operative ear disease in pediatric patients with tracheostomy tubes, as well as to identify risk factors predictive of operative otologic interventions in this patient cohort. METHODS We hypothesize that the prevalence of operative middle ear disease in patients with a tracheostomy tube is greater than that of the population at large. To validate our anecdotal observations, we queried the CHCA hospital database (PHIS) regarding the association between tympanostomy tube placements in children with tracheostomies. To further investigate, a retrospective chart review was undertaken at our regional tertiary care children's hospital to determine the frequency at which tympanostomy tubes were placed in children who have a tracheostomy. Risk factors were analyzed, applying independent samples t-tests and Pearson's Chi-square test. Univariate and multivariate logistic regression models were constructed to estimate odds ratios (OR) and 95% confidence intervals (CI) for predictors of operative ear disease. Institutional review board (IRB) approval was obtained. RESULTS Of a population of 181 patients with tracheostomies, 37 (or 20%, 95% CI 15-26%) have undergone placement of ventilation tubes in the past 3 years. No statistically significant difference was noted with regards to gender or race. The operative group had an average age of 23.0 months at the time of tracheostomy, compared to 52.5 months in the non-operative group (p=0.0022). In addition, home living situation, term birth, and craniofacial abnormalities were more frequently observed in the operative versus the non-operative group. Multivariate logistic regression models revealed the same factors as predictors of operative ear disease. CONCLUSION The presence of a tracheostomy is associated with an increased risk of requiring ventilation tube placement over the population at large. Risk factors for operative middle ear disease among these children include age at time of the tracheostomy, craniofacial abnormalities, term birth, and home living situation.
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Affiliation(s)
- J Seth McAfee
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, United States
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5863
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Ha SY, Lee YK, Oh YL. Effectiveness of the ThinPrep Imaging System in the detection of abnormal cervicovaginal cytology: a practical experience in Korea. Acta Cytol 2013; 57:159-63. [PMID: 23406895 DOI: 10.1159/000345103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/01/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study is to report our experience with the implementation of the ThinPrep Imaging System (TIS) in a tertiary hospital in Korea and to evaluate the effectiveness of the TIS compared to manual methods in the screening of cervical cytology. STUDY DESIGN Detection rates of cervical abnormalities in the pre- and post-TIS periods (January 2009 to February 2010 and March 2010 to December 2010, respectively) were compared. Follow-up cytological and histological results with concurrent or subsequent human papillomavirus (HPV) tests were retrieved. RESULTS ASC-US, ASC-H, LSIL, and HSIL were more frequently detected in the post-TIS period than in the pre-TIS period (p < 0.005). The proportions of correlated cases of ASC-US were 42.2 and 40.4% in the pre- and post-TIS periods, respectively. The detection rates of high-risk types of HPV in ASC-US were not significantly different between the two groups. The proportion of correlated biopsy for ASC-H, LSIL, and HSIL was similar in both periods. HPV positivity for ASC-H, LSIL, and HSIL showed no significant change between the two periods. CONCLUSION The TIS is potentially useful for the detection of abnormal cervical cytology on the basis of the increased detection rate of squamous cell abnormalities, with a relatively similar proportion of correlated cases compared to the manual screening method.
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Affiliation(s)
- Sang Yun Ha
- Department of Pathology, Sungkyunkwan University School of Medicine, Seoul, Korea
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5864
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Abstract
BACKGROUND AND OBJECTIVES Tuberculosis (TB) remains a global health problem. There is limited data on pediatric central nervous system tuberculosis (CNSTB) in Saudi Arabia on diagnosis and therapy. DESIGN AND SETTING Retrospective review of health record of pediatric patients < 14 years old who were diagnosed as having CNSTB or spinal TB and admitted to a tertiary care center. PATIENTS AND METHODS Health records and microbiology data of pediatric patients diagnosed with CNSTB were over 20-year period were reviewed. Data on demographics, clinical presentation, surgical interventions, neuroimaging, mycobacterial cultures and susceptibility and treatment were collected. RESULTS Thirteen children were diagnosed with CNSTB or spinal TB. Tuberculoma was the most frequent in 8 cases (62%), followed by TB of the spine in 4 cases (31%), and one case of meningitis. Six patients had a history of TB contact (46%) and 8 (62%) patients had a positive tuberculin skin test (TST). Seizure and weakness was the most frequent symptoms (38% each), while fever was less frequently encountered (23%). Tissue cultures (brain tissues/spinal tissues) showed a high yield (92%) of Mycobacterium tuberculosis with positive cultures for 11 surgical specimens out of 12 for whom cultures were done. There were no surgical complications from biopsies. All of MTB isolates were sensitive to first-line agents. CONCLUSIONS Brain or spinal biopsy is safe and has a high culture yield for MTB so it is advisable to perform a biopsy for any child in whom CNSTB is suspected and when there is no other less risky involved site for biopsy. All MTB isolates in this series were sensitive to first-line anti-tubercular agents.
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Affiliation(s)
| | - Suliman Al Jumaah
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre
| | - Essam AlShail
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre
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5865
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Bakshi SMH. A study of patient satisfaction at a tertiary care hospital in Hyderabad, India. World Hosp Health Serv 2013; 49:26-29. [PMID: 24228345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The health care industry is fast changing and rapid transformation is required to meet the ever-increasing needs and demands of its patient population. Hospitals and health care providers are shifting from viewing patients as uneducated with few health care choices to educated consumers with many service demands and health care choices available. Modern health care organizations have identified the patient as an ultimate consumer of hospital services and understand the importance of patient satisfaction, establishing this as the yardstick. The present study is explorative in nature. This cross sectional study is aimed at collecting data regarding attitude of patients, assessing their satisfaction levels towards ease of getting care, facilities offered at the hospital, attitude of the staff at the hospital and overall status of the hospital. The research study revealed many insights regarding attributes that are important for doctors, nurses and hospitals which would match patient expectation and lead to satisfaction.
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5866
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Adekola OO, Irurhe NK, Meka IA, Akanmu NO, Menkiti ID, Udenze IC, Awolola NA. The agreement of point-of-care and standard laboratory electrolyte and glucose analysis in critically ill patients in a sub-Saharan tertiary teaching hospital. Nig Q J Hosp Med 2013; 23:58-64. [PMID: 24579497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The critically ill patient undergoes rapid changes in the internal milieu requiring quick intervention. Point of care testing has been shown to be valuable in the early diagnosis and management of such patients. OBJECTIVE This study determined the agreement between I-STAT Abbot point of care testing with standard laboratory testing in the analysis of electrolytes and glucose concentrations in critically ill patients. METHODS The study was performed in a Sub-Saharan Tertiary Teaching Hospital in critically ill patients. Electrolyte and glucose analysis were measured with I-STAT Abbot Analyzer unit with parallel blood specimens (n = 30) tested in the laboratory on an ion-selective electrode, SFRI analyzer ISE 6000. RESULTS There was no significant difference in mean sodium, potassium, chloride and glucose between I-STAT POCT and standard laboratory measurements. The agreement between POCT and laboratory glucose was good p(c) = 0.967, mean difference of 0.79 and 95% limit of agreement from -3.83 to +5.107 mmol/L, p = 0.733. Bicarbonate was moderate (p) = 0.637, mean difference of 1.95 and 95% limit of agreement from -4.294 to +0.394 mmol/L, p = 0.101. There was moderate agreement for sodium (p(c)) = 0.32, mean difference of 5.8 and 95% limit of agreement from -0.378 to +11.98 mmol/L, p = 0.064. Agreement for potassium was moderate (p(c)) = 0.439, mean difference of 0.15 and limit of agreement from -0.401 to +0.701 mmol/L, p = 0.588. There was, however, a significant difference in mean chloride, and BUN values; chloride (p(c)) = 0.0796, mean difference of 13.8 and 95% limit of agreement from -7.55 to + 20.015 mmol/L. Blood urea nitrogen (p(c)) = 0.064, mean difference of 18.55 and 95% limit of agreement from -30.126 to +6.974 mmol/L. CONCLUSION The mean sodium, potassium, glucose and bicarbonate were comparable with moderate to good agreement between I-STAT POCT and ISE 6000 Analyzer. Though, the mean BUN and chloride levels between the analytical methods differ significantly.
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Affiliation(s)
- O O Adekola
- Department of Anaesthesia and Intensive care unit, College of Medicine University of Lagos & Lagos University Teaching Hospital, P.M.B 12003 Lagos Nigeria.
| | - N K Irurhe
- Department of Radiodiagnosis and Radiography, College of Medicine University of Lagos & Lagos University Teaching Hospital, P.M.B 12003 Lagos Nigeria
| | - I A Meka
- Department of Clinical Pathology, College of Medicine University of Lagos, P.M.B 12003 Lagos Nigeria
| | - N O Akanmu
- Department of Anaesthesia and Intensive care unit, College of Medicine University of Lagos & Lagos University Teaching Hospital, P.M.B 12003 Lagos Nigeria
| | - I D Menkiti
- Department of Anaesthesia and Intensive care Unit, Lagos University Teaching Hospital, P.M.B 12003 Lagos Nigeria
| | - I C Udenze
- Department of Clinical Pathology, College of Medicine University of Lagos, P.M.B 12003 Lagos Nigeria
| | - N A Awolola
- Department of Morbid Anatomy and Histopathology, Lagos University Teaching Hospital, P.M.B 12003 Lagos Nigeria
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5867
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Mishra MN, Kalra R, Rohatgi S. Clinical profile, common thrombophilia markers and risk factors in 85 young Indian patients with arterial thrombosis. SAO PAULO MED J 2013; 131:384-8. [PMID: 24346777 PMCID: PMC10871819 DOI: 10.1590/1516-3180.2013.1316369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/16/2012] [Accepted: 03/06/2013] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Arterial thrombosis may occur consequent to hereditary thrombophilia and increased lipoprotein(a) [Lp(a)] and fibrinogen. Our aim was to study the prevalence of common thrombophilia markers in 85 consecutive cases of arterial thrombosis. DESIGN AND SETTING A retrospective study was conducted from 85 consecutive young patients treated as outpatients or admitted due to stroke or myocardial infarction at a tertiary care hospital. METHODS Eighty-five Indian patients (age < 45 years) presenting ischemic stroke (n = 48) or myocardial infarction (n = 37) and 50 controls were studied for seven thrombophilia markers including antithrombin (AT), factor V, protein C, protein S, activated protein C resistance (APC-R), fibrinogen and Lp(a). Functional assays for protein C, protein S, factor V and APC-R were performed using clotting-based methods. Semi-quantitative estimation of fibrinogen was done using Clauss's method and Lp(a) using immunoturbidimetry. Statistical analysis was done using the Epi Info 6 software. RESULTS Thirty-three samples (38.8%) tested positive for one or more thrombophilia markers. The three commonest abnormalities were elevated Lp(a) (20%), fibrinogen (17.6%) and low APC-R (14.2%). Low levels of protein C, protein S and AT were present in 4.7, 9.4 and 7% of the patients, respectively. Overall, the risk factor profile was: smoking (33%), positive family history (15.3%), hyperlipidemia (7%), hypertension, diabetes mellitus and obesity (2.3% each). CONCLUSIONS An association was found between low levels of protein C, protein S and AT and arterial thrombosis, but only elevated fibrinogen levels, smoking, positive family history and hyperlipidemia showed statistical significance.
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Affiliation(s)
- Mahendra Narain Mishra
- MD. Specialist in Pathology and Immunopathology, Department of Pathology, Dr. Lal Path Labs Pvt Ltd., New Delhi, India
| | - Ravi Kalra
- MD, PhD. Department of Cardiology, Indian Naval Hospital Ship Asvini, Colaba, Mumbai, Maharashtra, India
| | - Shalesh Rohatgi
- MD, PhD. Department of Neurology, Command Hospital (WC), Chandimandir, Haryana, India
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5868
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Persy B, Ieven M. Four-year analysis of microbial aetiology and antimicrobial sensitivity patterns of peritoneal-dialysis related peritonitis in a tertiary care facility. Acta Clin Belg 2013; 68:48-53. [PMID: 23627195 DOI: 10.2143/acb.68.1.2062720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Peritonitis related to peritoneal dialysis increases morbidity and mortality and is the main reason for switching to haemodialysis. In this study, we analysed the dialysate of 164 peritoneal dialysis patients that was sent to our laboratory between January 2005 and August 2009. There were 196 peritonitis episodes identified in 78 patients. For all episodes, microbial aetiologies and in-vitro antimicrobial sensitivities were determined in addition to parameters such as the leukocyte count (WBC) and the result of the Gram stain. Results in children were analysed separately because of previously described differences in aetiology. In both groups, Gram positives were most commonly isolated, followed by Gram negatives and fungi or yeasts. In children, the proportion of coagulase-negative staphylococci compared to S. aureus is smaller than in adults. Gram stain showed predominant morphotypes concordant with culture results in 28% of episodes. A significant difference in WBC count was found between culture-positive (mean=3117 x 10(9)/L) and culture-negative (mean=981 x 10(9)/L) episodes in adults (p=0.001). The WBC count in episodes caused exclusively by CNS (mean=1502x10(9)/L) was also on average significantly lower (p=0.001) compared to all culture positive episodes. Resistance to methicillin was registered in 33% of cultures, positive for staphylococci. All Gram-positives were sensitive to vancomycin. Coverage of Gram-negatives by ceftazidim and quinolones was excellent (89%). Based on local sensitivity data and known characteristics of antimicrobials, a first-line empirical combination of intraperitoneal vancomycin with orally administered ciprofloxacin seems indicated in our population. Pathogens of positive aerobic cultures were sensitive in-vitro to their combined antimicrobial effect in 90% of cases.
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Affiliation(s)
- B Persy
- Department of Medical Microbiology, University Hospital Antwerp, Antwerp, Belgium.
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5869
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Bawazir W, Saddik B, El-Masri S. Investigating the impact of an emergency information system on patient's length of stay in the emergency department of a tertiary hospital in Saudi Arabia. Stud Health Technol Inform 2013; 192:1216. [PMID: 23920990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The emergency department has a crucial role in saving patient's lives. Efficient and reliable information through reliable information systems contribute to effective communication in these situations and ultimately shorter lengths of stay (LOS). This exploratory, cross-sectional study evaluates a current legacy emergency system in a tertiary hospital and investigates its impact on patient's length of stay (LOS) in the emergency department. A significantly shorter LOS was found between patients whose information was available and was communicated effectively in comparison to patients whose data were not available. Furthermore, longer LOS was associated with patients who required clinical services (pathology, radiology) due to the manual retrieval of results. This study has found that future implementation of a comprehensive electronic information system will facilitate effective communication workflow and timely access to patient data in the emergency department.
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Affiliation(s)
- Warda Bawazir
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia
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5870
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Kiani J, Agarwal SK, Kamireddy S, Adelstein E, Saba S. Relationship of electro-mechanical remodeling to survival rates after cardiac resynchronization therapy. Tex Heart Inst J 2013; 40:268-273. [PMID: 23914016 PMCID: PMC3709225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Cardiac resynchronization therapy, when added to optimal medical therapy, increases longevity in symptomatic congestive heart failure patients with left ventricular ejection fractions (LVEF)≤0.35 and QRS durations>120 ms. Cardiac resynchronization therapy is also associated with electrical and mechanical reverse remodeling. We examined whether reverse remodeling predicts increased survival rates in non-trial settings. Recipients of cardiac resynchronization therapy and defibrillators (n=112; 78 men; mean age, 69±11 yr) underwent repeat echocardiography and electrocardiography at least 90 days after device implantation. Forty patients had mechanical responses of at least 0.05 improvement in absolute LVEF; 56 had electrical responses (any narrowing of biventricular-paced QRS duration compared with the electrocardiogram immediately after therapy). During a mean follow-up period of 3.1±1.7 years, 55 patients died. The average death rate per 100 person-years was lower among mechanical responders than nonresponders (9.2% vs 23.9%; P=0.009); the unadjusted hazard ratio was 0.39 (95% confidence interval [CI], 0.19-0.79). In a multivariate model adjusted for age, sex, baseline LVEF, and QRS duration, mechanical responders had 60% better survival than nonresponders (hazard ratio=0.40; 95% CI, 0.21-0.79; P=0.008). No difference in survival was observed in electrical response. In our association of absolute change in LVEF over the observed range with death (using restricted cubic splines), we observed a linear relationship with survival. In patients given cardiac resynchronization therapy, mechanical but not electrical remodeling was associated with better survival rates, suggesting that mechanical remodeling underlies this therapy's mechanism of conferring a survival benefit.
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Affiliation(s)
- Jawad Kiani
- Cardiac Electrophysiology Section, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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5871
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Smith HM, Shirey RS, Thoman SK, Jackson JB. Prevalence of clinically significant red blood cell alloantibodies in pregnant women at a large tertiary-care facility. Immunohematology 2013; 29:127-130. [PMID: 24689681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
More than 50 red blood cell (RBC) alloantibodies are known to cause hemolytic disease of the fetus and newborn (HDFN).Although Rh immune globulin (RhiG) prophylaxis has significantly reduced the incidence of pregnancies complicated by anti-D, the need to detect and monitor maternal allo antibodies capable of causing HDFN is still a concern. The prevalence and specificity of these alloantibodies were determined. In this retrospective study, the prevalence and specificities of unexpected RBC alloantibodies known to cause HDFN in pregnant women at a tertiary-care facility during a 5-year period were compiled and analyzed. Patient selection was carried out by computerized search of patient data based on an obstetric location and the presence or history of RBC antibody between January 1, 2007,and December 31, 2011. The information was organized by ABO and D status of the patient, antibody specificity, and transfusion needs. Of the 8894 obstetric patients identified during the 5-year period, 264 (3.0%) had one or more unexpected RBC antibodies.Of these 264 women, 107 (40.5%), or 1.2 percent overall, had an alloantibody known to cause HDFN, with a total of 15 different alloantibodies identified. The most common alloantibody found was anti-E (n = 33), followed by anti-M (n = 26) and anti-D (n= 20). In pregnancies of D- women, the most common clinically significant antibodies found were anti-D (n = 20), anti-C (n = 11),and anti-E (n = 2). In pregnancies of D+ women, the most common antibodies were anti-E (n = 31), anti-M (n = 25), and anti-K (n= 16). A total of eight pregnancies with alloantibodies required intrauterine transfusions with the specificities of anti-D; anti-D,-C(n = 2); anti-D,-C,-E; anti-D,-C,-K; anti-D,-C,-Jkb; anti-D,-S; and anti-E,-c. At a large academic tertiary-care center, approximately 1 in 83 obstetric patients had one or more RBC alloantibodies capable of causing HDFN. Anti-E, -M, and -D were the most frequent specificities, respectively.
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Affiliation(s)
| | | | | | - Jay B Jackson
- MD, MBA (corresponding author), Baxley Professor and Director of Pathology, Carnegie Building Room 417, Division of Transfusion Medicine, Department of Pathology, Johns Hopkins Hospital, Baltimore, MD 21287
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5872
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Andreevski V, Nojkov B, Krstevski M, Genadieva Dimitrova M, Joksimovik N, Serafimoski V. Short and medium-term therapeutic effects of pneumatic dilatation for achalasia: a 15-year tertiary centre experience. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2013; 34:15-22. [PMID: 24285349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Pneumatic dilatation (PD) is a commonly used endoscopic technique to weaken the lower oesophageal sphincter in patients with achalasia. It is considered as the most effective non-surgical therapeutic option for achalasia, but further data on the overall effectiveness and rate of complications is needed. AIMS To determine the short- and medium-term therapeutic effectiveness of PD for achalasia and estimate the cumulative probability of remaining in remission over one year after a single treatment. The study also aimed to identify clinical predictors of therapeutic outcome achieved by PD and assess for PD-related complications. METHODS A total of 26 patients with achalasia who were treated with PD between 1997 and 2011 at a tertiary care centre were followed for up to 1 year. Data related to demographics, clinical symptoms and PD-related complications were collected. Short (1 and 3 months) and medium (1 year) term therapeutic effectiveness of PD was assessed with the use of the Eckhart scoring system for evaluation of clinical symptoms. The probability of staying in remission one year after a single PD was determined by using a Kaplan-Meier estimator. In order to prevent major complications, limited maximal pressure of no more than 11 PSI was used during PD. RESULTS Twenty-six patients with symptomatic achalasia (mean age 47.1±18.5 years, 82% males) underwent 44 PD procedures (mean 1.7/patient). Thirteen patients (50%) had a single PD, 10 patients (38%) had two dilatations, and 3 patients (12%) had three or more dilatations over one year. Nineteen out of the 26 patients (73%) were in remission at one and three months each, following the initial PD. Seventeen out of the 26 patients (65%) remained in remission after one year. A total of 5 patients (19%) were referred for surgery over 1 year due to lack of success of the endoscopic treatment. The mean Eckhart symptom scores, at 1 month (3.2±1.2), 3 months (3.5±1.3) and 1 year (1.8±0.6) after the initial PD, were significantly lower when compared to the mean initial Eckhart symptom score (9.7±4.4, P<0.05). Using a symptom score above 3 as a cutoff value for treatment failure, the probability of remaining in remission (relapse-free) after a single dilatation was 35% at one year. Patient gender appeared as an important treatment outcome predictor. Namely, 4 of the 5 patients (80%) with PD treatment failure were males. There were no major complications from the 44 PDs. One patient (3.8%) developed significant heartburn. The majority of PDs (33/44, 75%) were followed with minor, subclinical oesophageal mucosal bleeding from the dilation site as seen on post-dilation oesophagoscopy. CONCLUSION Pneumatic dilatation is an effective short and medium term treatment option for the majority of patients with achalasia without significant related complications. Further studies are warranted to assess the possible role of limited maximal pressure use of no more than 11 PSI during PD in preventing oesophageal perforations.
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Affiliation(s)
- Vladimir Andreevski
- University Gastroenterohepatology Clinic, Medical Faculty, Ss. Cyril and Methodius University, Skopje, R. Macedonia
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5873
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Berry PA, Thomson SJ. The patient presenting with decompensated cirrhosis. Acute Med 2013; 12:232-238. [PMID: 24364057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The rates of liver disease in the UK are rising and hence more patients than ever are presenting to acute medical units with potentially life threatening sequelae. Early recognition and treatment of sepsis, kidney injury, bleeding and alcoholic hepatitis can significantly improve outcomes, but requires a comprehensive approach to assessment. This patient cohort often suffers from a perceived uniform poor prognosis, especially in alcohol related disease, but evidence for this is changing and reassessment of prognosis after 48 hours of organ support may be more accurate than that made 'at the front door'. This article summarises the most important complications of decompensated cirrhosis, their early management, and presents a targeted system of care: 'RING Liver'--Renal failure, Infection, Nutrition, Gastrointestinal bleeding and transit, Liver dysfunction/transplantation. Factors favouring transfer to tertiary units are also explored.
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Affiliation(s)
- P A Berry
- Consultant Gastroenterologist and Hepatologist, Frimley Park Hospital NHS Foundation Trust
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5874
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Abera A, Assefa G. Diagnostic performance of transvesical ultrasound in clinically suspected ectopic pregnancy in a public and tertiary hospital setup. Ethiop Med J 2013; 51:49-57. [PMID: 23930491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Ectopic pregnancy consists 1.2 to 1.4% of all reported pregnancies and an increasing accordance has been documented in many parts of the world OBJECTIVE To evaluate the performance of transvesical ultrasound (TVS) in the diagnosis of ectopic pregnancy in the public hospital setup. METHODS Review of medical records of 117 patients who were admitted to St Paul's Hospital with the diagnosis of ectopic pregnancy between the years 2005 and 2008 was made. Data on demographic & clinical information, and laboratory investigations done and transvesical ultrasound records were collected. Outcomes after Laparatomy were used as confirmations or gold standard for final diagnosis. RESULTS Of the 117 admitted patients for ectopic pregnancy, 99 (84.6%) had transvesical ultrasound done & in 65 (65.9%) of those 99 patients, it suggested diagnosis of ectopic pregnancy. Sixty-four (55%) had pervaginal bleeding and lower abdominal pain as presenting complaint. Documentation of uterine, adnexal & cul-de-sac findings fall the three diagnostic variables) was noted in 71/99 (71.7%) two of the three and only one of the three diagnostic variables were seen 20.2% and 8.1% of the sonographic studies respectively. Of patients whose ultrasound report suggested ectopic pregnancy, in 46 (70.8%) a complex adnexal mass and in 33 (50.8%) moderate to large amount of cul-de-sac fluid, and in 9 (19.8%) patients fluid in the uterine cavity were detected The overall sensitivity and specificity of transvesical ultrasound study in the diagnosis of ectopic pregnancy were 83.3% and 33.3% respectively, with positive & negative predictive values of 73.5% and 47.4% respectively and accuracy of 68%. CONCLUSION About 83.3% of admitted patients were diagnosed sonographically to have ectopic gestation prior to surgery. Quality of the ultrasound report with respect to completeness in number of sonographic diagnostic variables has a statistically significant (P < 0.05) role in enhancing the accuracy of transvesical ultrasonography in the diagnosis and exclusion of ectopic pregnancy.
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Affiliation(s)
- Ashenafi Abera
- Department of Radiology, Addis Ababa University, Medical Faculty. Addis Ababa, Ethiopia
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5875
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Dalloul G, Feldman D, Haddad N, Amruthlal Jain SK, Zarghami J, Zughaib M. Carotid artery stenting in a community hospital: a success story. J Invasive Cardiol 2013; 25:3-6. [PMID: 23293167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is an effective procedure for reducing the risk of stroke in patients with carotid artery atherosclerosis. The evolution of carotid artery stenting (CAS) has made this a viable alternative to CEA in appropriate patient populations. We sought to evaluate the safety and efficacy of CAS in a high-risk population, in an effort to report such results in a medium-size community hospital. The data were then compared with the results published in the CREST and SAPPHIRE trials. METHODS The records of 280 consecutive patients undergoing carotid artery stenting between January 2005 and December 2011 were reviewed. A total of 271 patients were included in the final analysis. The clinical endpoints included cerebrovascular accident, myocardial infarction, and death in the perioperative period. RESULTS A total of 155 men (57.2%) and 116 women (42.8%) underwent CAS. A total of 259 carotid interventions (95.6%) were successful. Two of 271 patients (0.7%) experienced a minor neurologic event post procedure, with 1 patient death (0.35%) recorded. No perioperative myocardial infarctions were encountered. CONCLUSION Our findings indicate that our institution has been able to safely and effectively introduce and carry out CAS as a substitute to CEA in patients that are at high risk for surgery with results comparable to those published in large-scale clinical trials. Further studies are needed to verify whether these results can be generalized to other community hospitals, as well as to refine qualification criteria for performing physicians. Furthermore, the applicability of these results to normal-risk patients is currently being investigated.
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Affiliation(s)
- Ghassan Dalloul
- Division of Cardiology, Providence Hospital and Medical Center, Southfield, MI 48075 USA.
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Boonyaarunnate T, Olson MT, Bishop JA, Yang GCH, Ali SZ. Cribriform morular variant of papillary thyroid carcinoma: clinical and cytomorphological features on fine-needle aspiration. Acta Cytol 2013; 57:127-33. [PMID: 23406819 DOI: 10.1159/000345879] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 11/13/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cribriform-morular variant of papillary thyroid carcinoma (CMV-PTC) is a rare tumor that may arise in patients with familial adenomatous polyposis (FAP), although sporadic instances of this tumor have been reported. When it arises in FAP, CMV-PTC may present before colonic manifestations are apparent, so proper identification and classification are essential for prompt assessment of the colonic disease status and genetic and familial counseling. METHODS Nine cases of PTC with cribriform morular cytomorphology were identified at 2 large tertiary-care hospitals; 6 were true CMV-PTC with positive β-catenin and 3 were CMV-like PTC with negative β-catenin. A review of the cytomorphology and a cytology-histology correlation were performed. RESULTS Only 1 patient presented with a known history of FAP. Patients presented with a median age of 41 years (range 19-64 years). There was a clear female predilection; 8 of 9 patients (89%) were female. All cases demonstrated the classical nuclear and architectural features of PTC. In addition, the most salient features were large tissue fragments with cribriform architecture and dense cellular morules. The elongated cellular shape of the tumor cells led to the misclassification of one tumor as a tall-cell variant of PTC on the FNA material. CONCLUSION CMV-PTC or CMV-like PTC demonstrate cytomorphological features that overlap with classic PTC. β-Catenin immunostaining plays an important role in making a definitive diagnosis.
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5877
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Robertson T, Carter D. Oral intensity: reducing non-ventilator-associated hospital-acquired pneumonia in care-dependent, neurologically impaired patients. Can J Neurosci Nurs 2013; 35:10-17. [PMID: 24180207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The purpose of this point-of-care study was to test the efficacy of a prevention-based oral care protocol in reducing non-ventilator-associated hospital-acquired pneumonia in a neurosurgical population outside the critical care environment. The researchers hypothesized that an enhanced oral care protocol would decrease the incidence of pneumonia. METHODS This quasi-experimental, comparative study took place on an acute neurosurgical unit at a tertiary care trauma hospital in Western Canada. Subjects were non-intubated, care-dependent adults with a primary diagnosis of neurologic injury/insult, and at high risk for pneumonia. The prospective study group comprised 34 subjects; two subjects were excluded from the study analysis. The retrospective study group comprised 51 subjects. Data were collected for both groups for a six-month period. Retrospective data were collected through chart review. The prospective group were eligible neurosurgical patients who received the enhanced oral care protocol. Data collection tools were developed and diagnostic criteria for hospital-acquired pneumonia were determined. The pneumonia rates between subjects who received standard oral care (retrospective group) and those who received an enhanced, prevention-based, oral care protocol (prospective group) were compared. RESULTS A statistically significant decrease in the pneumonia rate occurred in the prospective group (p < 0.05). DISCUSSION An enhanced oral care protocol was beneficial in reducing the incidence of non-ventilator-associated hospital-acquired pneumonia. IMPLICATIONS Nurses play a vital role in preventing hospital-acquired pneumonia. Foundational nursing practices, such as regular oral hygiene, are important aspects of care in preventing nosocomial infections and related costs, optimizing health, and promoting quality care.
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5878
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Sebbag I, Carmona MJC, Gonzalez MMC, Alcântara HM, Lelis RGB, Toledo FDO, Aranha GF, Nuzzi RXDP, Auler JOC. Frequency of intraoperative cardiac arrest and medium-term survival. SAO PAULO MED J 2013; 131:309-14. [PMID: 24310799 PMCID: PMC10876325 DOI: 10.1590/1516-3180.2013.1315507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 12/27/2012] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Although advances in surgical and anesthetic techniques have reduced perioperative morbidity-mortality, the survival rate following cardiac arrest remains low. The aim of this study was to evaluate, over the course of one year, the prevalence of intraoperative cardiac arrest and the 30-day survival rate after this event in a tertiary teaching hospital. DESIGN AND SETTING Prospective cohort study in a tertiary teaching hospital. METHODS Following approval by the institutional ethics committee, anesthetic procedures and cases of intraoperative cardiac arrest between January and December 2007 were evaluated. Patients undergoing cardiac surgery were excluded. The data were gathered prospectively using the modified Utstein model, with evaluation of demographic data, pre-arrest conditions, intraoperative care, care during arrest and postoperative outcome up to the 30th day. The data were recorded by the attending anesthesiologist. RESULTS During the study period, 40,379 anesthetic procedures were performed, and 52 cases of intraoperative cardiac arrest occurred (frequency of 13:10,000). Among these, 69% presented spontaneous return of circulation after the initial arrest, and only 25% survived for 30 days after the event. The following factors were associated with shorter survival: American Society of Anesthesiologists physical status IV and V, emergency surgery, hemorrhagic events, hypovolemia as the cause of arrest and use of atropine during resuscitation. CONCLUSIONS Although the frequency of cardiac arrest in the surgical environment has declined and resources to attend to this exist, the survival rate is low. Factors associated with worst prognosis are more frequent in critical patients.
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Affiliation(s)
- Ilana Sebbag
- MD. Attending Anesthesiologist, Instituto Central (IC), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Maria José Carvalho Carmona
- MD, PhD. Assistant Professor, Discipline of Anesthesiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Maria Margarita Castro Gonzalez
- MD, PhD. Cardiologist, Instituto do Coração (InCOR), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Hermes Marcel Alcântara
- MD. Resident Physician in Psychiatry, Instituto de Psiquiatria (IPq), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Rolison Gustavo Bravo Lelis
- MD. Attending Anesthesiologist, Instituto de Ortopedia (IOT), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Flavia de Oliveira Toledo
- MD. Attending Anesthesiologist, Instituto do Câncer do Estado de São Paulo (ICESP), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Gustavo Fábio Aranha
- MD. Resident Physician in Anesthesiology, Instituto Central (IC), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Rafael Ximenes do Prado Nuzzi
- MD, PhD. Head Professor of Discipline of Anesthesiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - José Otávio Costa Auler
- MD, PhD. Head Professor of Discipline of Anesthesiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
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Mendez MP, Lazar MH, Digiovine B, Schuldt S, Behrendt R, Peters M, Jennings JH. Dedicated multidisciplinary ventilator bundle team and compliance with sedation vacation. Am J Crit Care 2013; 22:54-60. [PMID: 23283089 DOI: 10.4037/ajcc2013873] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND How compliance with a ventilator bundle is monitored varies from institution to institution. Some institutions rely on the primary intensive care unit team to review the bundle during their rounds; others rely on a separate team of health care personnel that may include representatives from disciplines such as nursing, respiratory therapy, and pharmacy. OBJECTIVES To compare rates of compliance with ventilator bundle components between a dedicated ventilator bundle rounding team and the primary intensive care unit rounding team in a 68-bed medical intensive care unit. METHODS A query of the medical intensive care unit's database was used to retrospectively determine rates of compliance with specific ventilator bundle components at a tertiary care hospital in an urban community for 1 year. RESULTS Compared with the intensive care unit rounding team, the ventilator bundle rounding team had better compliance with sedation vacation (61.7% vs 54.0%, P < .001). Rates of compliance with spontaneous breathing trials and prophylaxis of peptic ulcer disease were similar in both study groups. CONCLUSIONS A dedicated ventilator bundle rounding team improves compliance with sedation vacation, but not with spontaneous breathing trials and prophylaxis of peptic ulcer disease. In a large-volume tertiary center, a dedicated ventilator bundle rounding team may be more effective than the primary rounding team in achieving compliance with some bundle components.
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Affiliation(s)
- Michael P Mendez
- Division of Pulmonary and Critical Care Medicine at Henry Ford Health System, Detroit, MI 48202, USA
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5880
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Moryl N, Pope J, Obbens E. Hypoglycemia during rapid methadone dose escalation. J Opioid Manag 2013; 9:29-34. [PMID: 23709301 DOI: 10.5055/jom.2013.0144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 10/11/2012] [Accepted: 12/19/2012] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To answer a question whether or not rapid methadone dose increase can be associated with onset of hypoglycemia. This hypothesis is based on the previously reported case reports of hypoglycemia with rapid methadone increase and our clinical experience of a number of cases when symptomatic hypoglycemia during rapid methadone escalation was initially mistaken for methadone overdose. METHODS A retrospective chart review of 59 consecutive opioid-tolerant patients with cancer who received methadone for pain while inpatients in a tertiary cancer center within 1 year was performed. In patients who also had hypoglycemia during the admission, blood glucose levels were analyzed in relationship to the time of methadone titration. Use of steroid, presence of fever, renal insufficiency, and periods of fasting were recorded. RESULTS Eleven patients (19 percent) had hypoglycemia while receiving methadone, of them two patients had at least two episodes of hypoglycemia. In the 11 cases of documented hypoglycemia, mean methadone dose was nearly doubled (92 percent increase) within 2 days before the onset of hypoglycemia. None of the other recorded factors correlated with glucose level in this group of patients. CONCLUSIONS Present report is the first reported series of patients with hypoglycemic episodes associated with rapid methadone dose escalation. Based on our results, a patient who develops unexplained sweating, palpitations, or lethargy during methadone titration may benefit from blood glucose monitoring.
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Affiliation(s)
- Natalie Moryl
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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5881
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Dorbeker-Azcona R, Mogica-Martìnez MD, Becerril-Ngeles M, Guevara-Cruz M, Espinosa-Padilla S, Yamazaki-Nakashimada MA, Blancas-Galicia L. [Clinical and therapeutic features in patients with common variable immunodeficiency from two third-level care hospitals from Mexico City]. Rev Alerg Mex 2013; 60:26-30. [PMID: 24008066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Common variable immunodeficiency (CVID) is one of the most common antibody deficiencies, is characterized by low serum immunoglobulins, defective antibody response and increased susceptibility to chronic and recurrent infections. OBJECTIVE we present the clinical findings of patients with CVID in two hospitals in Mexico City. METHODS We performed a retrospective study of patients who filled CVID criteria. We collected the following information, demographic data, age at onset, age at diagnosis, family history, infection, autoimmunity, lymphoproliferative disease, allergy, malignancy, immunoglobulin levels at diagnosis, route of administration, dosage and frequency of IVIG of each patient. Data were analyzed with descriptive statistics. RESULTS Amongst 26 patients who filled CVID criteria, 14 were men and 12 women. The mean diagnosis delay was 48 months (22-128), serum immunoglobulins at diagnosis in mg/dL were IgG 216 (114-316), IgM 21 (12-121), IgA 21 (6-26) and IgE 4.6 (1.8) IU/mL. 81% of patients suffered pneumonia. There was a decrease in the number of pneumonias before and after treatment with gammaglobulin (p = 0.028). 27% of the patients had autoimmune diseases, 35% allergies, 35% chronic diarrhea, 62% bronchiectasis, 73% chronic cough, 50% lymphadenopathy. One patient had lymphoproliferative disease and none developed malignancy. CONCLUSIONS We found that the delay in the diagnosis and initiation of gammaglobulin replacement affects the occurrence of complications such as bronchiectasis.
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Affiliation(s)
- Raul Dorbeker-Azcona
- Unidad de InvestigaciÛn en Inmunodeficiencias, Instituto Nacional de PediatrÌa, MÈxico D.F
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5882
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Bradley E, Parker J, Novak E, Ludbrook P, Billadello J, Cedars A. Cardiovascular disease in late survivors of tetralogy of fallot: a tertiary care center experience. Tex Heart Inst J 2013; 40:418-423. [PMID: 24082371 PMCID: PMC3783145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Patients with tetralogy of Fallot can survive to late adulthood; however, there are few data on cardiovascular outcomes in this population. We conducted a single-center retrospective analysis of cardiovascular outcomes and risk factors in 208 patients with tetralogy of Fallot to better evaluate the burden of cardiovascular disease in this group. Descriptive statistics were used to determine the prevalence of relevant cardiovascular risk factors and outcomes, including a composite analysis of cardiovascular disease. Rates and mean values from the American Heart Association 2011 Heart Disease and Stroke Statistics Update were used as population estimates for comparison. In tetralogy of Fallot patients, cardiovascular disease prevalence was not different from that found in the general population (40% vs. 36%, P=0.3). However, there was significantly more cardiovascular disease in tetralogy of Fallot men aged 20 to 39 years (30% vs. 14%, P < 0.05) and in tetralogy of Fallot men aged 40 to 59 years (63% vs. 29%, P < 0.0001). This was due to higher prevalence of coronary disease (12% vs. 7%, P < 0.05) and heart failure (16% vs. 2%, P < 0.0001). In particular, the increased prevalence of heart failure (regardless of pulmonary valve disease) accounts for the frequency of cardiovascular disease in tetralogy of Fallot men aged 20 to 59 years. These data support the need to routinely screen young adult male survivors of tetralogy of Fallot for asymptomatic heart failure. Further studies are needed to determine the incidence, severity, and long-term effects of cardiovascular disease in the adult congenital heart disease population.
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Affiliation(s)
- Elisa Bradley
- Division of Cardiovascular Medicine, Washington University, St. Louis, Missouri 63110
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5883
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Jabeen A, Dawood NS, Riaz S, Tanveer S. Methods and complications of septic induced abortion in patients managed at a tertiary care hospital. J Ayub Med Coll Abbottabad 2013; 25:12-15. [PMID: 25098042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND To study the methods used for the termination of pregnancy and associated complications of induced abortion. METHODS This descriptive study was conducted in the department of obstetrics and gynaecology, Fauji Foundation Hospital Rawalpindi. One Hundred patients were included in the study who was admitted with the history of induced abortion. The patients were assessed by detailed history and thorough clinical examination according to the study protocol. Data was collected on a specially designed Performa. Patients were interviewed in privacy and factors contributing to termination of pregnancy like age, parity, socioeconomic status and contraceptive failure were determined. Methods used for the procedure, status of abortionist were asked. Complications were determined by history, clinical examination and ultrasound examination. In view of all above data recommendations of preventing unwanted pregnancies were made. RESULTS All patients were married and 57% of women belonged to age group of 31-40 years. Fifty-four 54% were grand multipara. In 63% of patients, induced abortion was carried out by Dai's. Most commonly used method was instrumentation (72%). Financial problems (46.7% ) and high parity (40%) were the most common factors contributing to termination of pregnancy. Serious complications like uterine perforation with or without bowel injury were accounted in 13% of women, septicaemia in 61%, peritonitis in 15% and DIC in 2%. During the study period illegally induced abortion accounted for 2% maternal deaths. CONCLUSION Prevalence of poverty, illiteracy, grand multiparity and non-compliance of contraception were strong determinants of induced abortion, instrumentation being the most commonly used procedure resulting in high morbidity and mortality.
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5884
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Abstract
BACKGROUND Crohn's disease (CD) and intestinal Behcet's disease (BD) are transmural inflammatory diseases with fluctuating courses characterized by repeated episodes of relapse and remission that often require operation or reoperation. However, no study has directly compared the long-term prognoses of these two diseases. METHODS We reviewed the medical records of 332 patients with CD and 276 patients with intestinal BD who were regularly followed up at a single tertiary academic medical center in Korea between March 1986 and July 2010. The clinical outcomes after diagnosis and surgery were analyzed using the Kaplan-Meier method and log-rank test. RESULTS There were no significant differences in the cumulative probabilities of surgery (29.4% and 36.0% vs. 31.6% and 44.4% at 5 and 10 years, respectively: P = 0.287) or admission (66.1% and 73.8% vs. 59.0% and 69.2%, P = 0.259) between CD and intestinal BD. Furthermore, no differences were observed between the two diseases for the cumulative probabilities of postoperative clinical recurrence (P = 0.724) and reoperation (P = 0.770). However, the cumulative probabilities of corticosteroid use (63.8% and 76.6% vs. 42.6% and 59.4% at 5 and 10 years, respectively: P < 0.001) and immunosuppressant use (49.1% and 65.5% vs. 27.1% and 37.7%, P < 0.001) were significantly higher in CD patients than in intestinal BD patients. CONCLUSIONS There were no significant differences in the long-term clinical outcomes and postoperative prognoses between CD and intestinal BD, although CD patients required corticosteroid or immunosuppressant therapy more often than intestinal BD patients.
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Affiliation(s)
- Yoon Suk Jung
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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5885
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Toll AD, Wakely PE, Ali SZ. Acral myxoinflammatory fibroblastic sarcoma: cytopathologic findings on fine-needle aspiration. Acta Cytol 2013; 57:134-8. [PMID: 23406831 DOI: 10.1159/000345901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 11/14/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acral myxoinflammatory fibroblastic sarcoma (AMFS) is a rare low-grade sarcoma with somewhat unique morphologic characteristics. While recurrences are relatively common, distant metastases are infrequent. Cytopathologic descriptions of AMFS are limited, prompting the current study. METHODS A retrospective review was performed at two tertiary-care hospitals, and 3 patients with this diagnosis were identified. The cytopathologic and clinical features were reviewed. The following clinical data was collected for each case: age, gender, site of lesion, treatment, and follow-up information. RESULTS Pertinent cytologic features included large atypical epithelioid cells with occasional macronucleoli and lipoblast-like features in a background of bland spindle cells, myxoid stroma, and inflammation. All patients presented with acral mass lesions. Metastatic disease to an inguinal lymph node was found in 1 patient. CONCLUSIONS AMFS is a low-grade sarcoma which shows some characteristic cytologic features. However, due to the presence of occasional bizarre and pleomorphic giant cells, there can be overlap with higher-grade sarcomas, and correlation with histology, immunohistochemistry, and imaging are required to make this diagnosis.
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Affiliation(s)
- Adam D Toll
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA
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5886
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Rashid ZZ, Bahari N, Othman A, Jaafar R, Mohamed NA, Jabbari I, Sulong A, Hashim R, Ahmad N. Community-acquired methicillin-resistant Staphylococcus aureus in a Malaysian tertiary centre. Southeast Asian J Trop Med Public Health 2013; 44:104-108. [PMID: 23682444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Abstract. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a pathogen recognized to be distinct in both phenotype and genotype from hospital-acquired MRSA. We have identified CA-MRSA cases in Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, including their antibiotic susceptibility patterns and genotypic characteristics. Cases were identified during January to December 2009 from routine clinical specimens, where culture and antibiotic susceptibility results yielded pauci-resistant MRSA isolates suspected as being CA-MRSA. The patients' clinical data were collected and their specimens were sent for molecular confirmation and analysis. Five cases of CA-MRSA were identified, which had a multi-sensitive pattern on antibiotic susceptibility tests and were resistant to only penicillin and oxacillin. All cases were skin and soft-tissue infections, including diabetic foot with gangrene, infected scalp hematoma, philtrum abscess in a healthcare worker, thrombophlebitis complicated with abscess and infected bedsore. All five cases were confirmed MRSA by detection of mecA. SCCmec typing (ccr and mec complex) revealed SCCmec type IV for all cases except the infected bedsore case. Panton-Valentine leukocidin gene was positive in all isolates. As clinical features among methicillin-sensitive Staphylococcus aureus, CA-MRSA and "nosocomial CA-MRSA" are indistinct, early recognition is necessary in order to initiate appropriate antibiotics and infection control measures. Continual surveillance of pauci-resistant MRSA and molecular analysis are necessary in order to identify emerging strains as well as their epidemiology and transmission, both in the community and in healthcare setting.
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Affiliation(s)
- Zetti Zainol Rashid
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
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5887
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Farzana R, Shamsuzzaman SM, Mamun KZ, Shears P. Antimicrobial susceptibility pattern of extended spectrum beta-lactamase producing gram-negative bacteria isolated from wound and urine in a tertiary care hospital, Dhaka City, Bangladesh. Southeast Asian J Trop Med Public Health 2013; 44:96-103. [PMID: 23682443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
From a total of 320 bacterial samples from wound swab and urine 169 (53%) gram-negative bacteria were isolated, of which 42 (25%) extended-spectrum beta-lactamase (ESBL) producers were detected by double-disk synergy test. ESBL producers were significantly more resistant against amoxiclav, Co-trimoxazole, ciprofloxacin, amikacin and gentamicin than non-ESBL producers. Among the 42 ESBL producers, 76% were positive for blaCTX-M and 43% were positive for blaOXA, with blaCTX-M predominantly (97%) observed in E. coli and blaOXA predominantly (80%) in Pseudomonas spp. Class 1 integron was found in 75% of blaCTX-M positive and 56% of blaOXA positive strains. Combinations of ESBL genes and class 1 integron were observed in 29 (69%) of the ESBL producers. The findings of this study infer that CTX-M and OXA producers are emerging in Bangladesh and we report the presence of blaOXA for the first time in Bangladesh.
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Affiliation(s)
- Refath Farzana
- Department of Microbiology, Dhaka, Medical College, Dhaka, Bangladesh.
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5888
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Gupta A, Kapil A, Lodha R, Sreenivas V. Knowledge, attitude and practice towards infection control among healthcare professionals. Natl Med J India 2013; 26:59-60. [PMID: 24067011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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5889
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Rajasekhar M, Sreelakshmi K, Gopinath PM, Satyamoorthy K. Cytogenetic study in recurrent pregnancy loss: an experience from tertiary care centre. Genet Couns 2013; 24:347-349. [PMID: 24341152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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5890
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Kumar R, Samrongthong R, Shaikh BT. Knowledge, attitude and practices of health staff regarding infectious waste handling of tertiary care health facilities at metropolitan city of Pakistan. J Ayub Med Coll Abbottabad 2013; 25:109-112. [PMID: 25098070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Health Care Waste (HCW) is considered as the second dangerous waste in the World that needs to be properly disposed by trained health care staff. Good knowledge, positive attitude and safe practices of medical staff is very imperative while managing this infectious waste. This assessment has been conducted to determine the situation and KAP of infectious waste management in health care workers working at tertiary care settings health facilities of Rawalpindi, Pakistan. METHODS This study was part of an ongoing quasi-experimental with control and intervention design and was conducted in tertiary care governmental hospitals of Rawalpindi by interviewing healthcare workers (HCWs) who were selected randomly after the sample size calculation. The participants were selected according to the proportional size of the each HCWs for their equal representation from all the groups. Self-administered valid and reliable questionnaire were adapted after taking the written consent. Ethical consideration was taken from ethical committee of Health Services Academy Pakistan. RESULTS Total 275 HCWs including doctors, nurses, paramedics and sanitary workers were interviewed during this baseline survey. The mean age of the health workers were 30 +/- 5 years. Infectious waste management practices with in both hospitals were not found statistically significant (p = 0.33). However, the sociodemographic information like age, gender, level of education and experience, when compared with the practices were found statistically significant (p < 0.05). Doctors and nurses have better knowledge, positive attitude and good practices compare to paramedics and sanitary staff regarding infectious waste management and was found statistically significant (p < 0.05). CONCLUSIONS Practices among HCWs were not found up to the standards in these tertiary care hospitals of Pakistan and were not following the proper guidelines and WHO rules.
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5891
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Alam K, Snover A, Sultana N, Munir TA, Shah SS. Emergency contraception: knowledge, attitude and practices among doctors of a tertiary care hospital. J Ayub Med Coll Abbottabad 2013; 25:141-144. [PMID: 25098079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND In Pakistan maternal mortality rate (MMR) is very high and more than one in five women die from pregnancy related causes; solution to this is to have low fertility rate. The emergency contraceptives (ECs) can be used to prevent unwanted pregnancies. The aim of this study was to assess the knowledge, attitude and practice about ECs among doctors. METHODS Institution-based cross-sectional descriptive study on knowledge, attitude and practice of ECs was conducted at Rawal Hospital from Feb to May, 2012. Data was collected using structured questionnaire and analysed using SPSS-16. RESULTS Fifty-seven percent of the respondents were > 30 years of age, 94% were Muslim, 81% were married and 51% were women. Ninety-seven percent had heard of ECs before, only 17% knew Intra-uterine contraceptive device (IUCD) a method of EC. Sixty-one percent responded that IUCD should be removed if patient gets pregnant (p = 0.007) and according to 31% ECs were not abortifacient (p = 0.045). Regarding attitude, 55.5% of the participants supported its use (p = 0.027) and agreed to its easy accessibility (p = 0.004). Thirty-eight percent responded an increased dose of birth control pills as a form of EC (p = 0.008), while 40% did not agree that ECs are effective when taken before intercourse (p = 0.011). CONCLUSION Knowledge and practice of ECs is very low among doctors but a positive attitude is there. Evidence-based knowledge to family physicians regarding emergency contraception is strongly recommended to reduce the chances of MMR.
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5892
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Okoye O, Ojogwu L, Unuigbe E, Oviasu E. Frequency and risk factors of contrast-induced nephropathy after contrast procedures in a Nigerian tertiary centre. West Afr J Med 2013; 32:19-25. [PMID: 23613290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Contrast-induced nephropathy (CIN) is a significant yet underestimated problem in clinical practice. The increasing use of contrast media in diagnostic and interventional procedures over the last 30 years has resulted in CIN becoming the third leading cause of hospital-acquired acute renal failure (ARF) in developed countries. Despite this, there is still a paucity of data on the incidence of CIN following intravenous contrast media especially in developing countries. The goals of this study were to determine the frequency and risk factors of CIN amongst patients receiving intravenous contrast in a tertiary health institution. This is a hospital-based prospective observational study. One hundred and eighty (180) consenting patients were recruited consecutively over a 6-month period. Venous blood and urine were collected for haematocrit, serum urea, electrolytes and creatinine estimation and urinalysis, before contrast exposure and up to 72 hours post-exposure. The frequency of CIN was 35.9% and one patient required haemodialysis. Baseline renal insufficiency, anaemia and age >55 years were significant risk factors for CIN and predictive of CIN in univariate but not multivariate analysis.
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Affiliation(s)
- O Okoye
- Nephrology Unit, Department of Medicine, University of Benin Teaching Hospital.Benin City, Edo State
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5893
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Barman TK, Shahidullah M, Debnath CR, Hasan I, Alam NA, Paul GK, Pandit H. Demographics and cell types of bronchial carcinoma of a tertiary care hospital in Bangladesh. Mymensingh Med J 2013; 22:15-19. [PMID: 23416802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Geographical and socio-economic factors such as climate, culture, ethnic origin, diet and life style such as smoking have been noted to influence the occurrence of bronchial carcinoma. We conducted this study to document the frequency of various histological types of bronchial carcinoma and correlated it with their demographic characteristics. This descriptive study was carried out among admitted patient with the suspicion of Bronchial carcinoma from January 2010 to January 2011 in medicine units of Mymensingh Medical College Hospital, Mymensingh. Among those only 30 consecutive histopathologically &/or cytological confirmed cases of Bronchial carcinoma were included in the study. No age, gender, environmental or occupational limits were applied for the selection of patients. Patients already diagnosed by some other hospital presenting to our unit with complications were not included in the study. Age rang were 26-70 years. Majority of patients i.e. 63.33% (n=19) were found to be in their fourth and sixth decade of life. Males were 86.66% (n=26) as compared to females 13.44% (n=4) and male to female ratio were 6.5:1. The majority of the patients were belonged to urban areas 63.34% (n=19), while 36.66% (n=11) came from the Rural population. In this study smokers were 86.66% (n=26) and nonsmokers were 13.33% (n=4). In Occupational distribution farmers were 33.33% (n=10), service holders were 20% (n=6), businessman were 16.66% (n=5), all the female were house wife 13.33% (n=4). Specimens for histopathological study were collected by trans-thoracic needle aspiration under CT or ultrasono-guided. The results of cell types in histopathologically proven 30 Bronchial carcinoma patients were; 10(33.36%) adenocarcinoma, 7(23.33%) squamous cell carcinoma, 6(20%) small cell carcinoma, 4(13.33%) large cell carcinoma and 3(10%) non-small cell carcinoma.
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Affiliation(s)
- T K Barman
- Department of Medicine, Mymensingh Medical College, Mymensingh, Bangladesh
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5894
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Bartsch DK, Albers M, Knoop R, Kann PH, Fendrich V, Waldmann J. Enucleation and limited pancreatic resection provide long-term cure for insulinoma in multiple endocrine neoplasia type 1. Neuroendocrinology 2013; 98:290-8. [PMID: 24356648 DOI: 10.1159/000357779] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/06/2013] [Indexed: 12/25/2022]
Abstract
AIM To assess the characteristics and long-term outcome after surgery in patients with multiple endocrine neoplasia type 1 (MEN1)-associated insulinoma. METHODS Retrospective analysis of prospectively collected data of MEN1 patients with organic hyperinsulinism at a tertiary referral center. RESULTS Thirteen (17%) of 74 patients with MEN1 had organic hyperinsulinism. The median age at diagnosis was 27 (range 9-48) years. In 7 patients insulinoma was the first manifestation of the syndrome. All patients had at least one pancreatic neuroendocrine neoplasm (pNEN) upon imaging, including CT, MRI or endoscopic ultrasonography. Seven patients had solitary lesions upon imaging, 4 patients had one dominant tumor with coexisting multiple small pNENs, and 2 patients had multiple lesions without dominance. Eight patients had limited resections (1 segmental resection, 7 enucleations), 4 subtotal distal pancreatectomies, and 1 patient a partial duodenopancreatectomy. There was no postoperative mortality. Six patients experienced complications, including pancreatic fistula in 5 patients. Pathological examination revealed median three (range 1-14) macro-pNENs sized between 6 and 40 mm, and a total of 14 potentially benign insulinomas were detected in the 13 patients. After median follow-up of 156 months, only 1 patient developed recurrent hyperinsulinism after initial enucleation. Twelve patients developed new pNENs in the pancreatic remnant and 4 patients underwent reoperations (3 for metastatic ZES, 1 for recurrent hyperinsulinism). One of 5 patients with an initial extended pancreatic resection developed insulin-dependent diabetes mellitus. CONCLUSION Enucleation and limited resection provide long-term cure for MEN1 insulinoma in patients with solitary or dominant tumors. Subtotal distal pancreatectomy should thus be preserved for patients with multiple pNENs without dominance given the risk of exocrine and endocrine pancreas insufficiency in the mostly young patients.
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Affiliation(s)
- Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany
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5895
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Aung AK, Skinner MJ, Lee FJ, Cheng AC. Changing epidemiology of bloodstream infection pathogens over time in adult non-specialty patients at an Australian tertiary hospital. Commun Dis Intell (2018) 2012; 36:E333-E341. [PMID: 23330707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The epidemiology of bloodstream infections (BSI) has been changing over time in developed countries. However, overview reports of BSI trends are limited in Australia. This descriptive epidemiological study analysed general and age-group specific trends, and antimicrobial susceptibility patterns of blood culture isolates between 2001 and 2009 in non-specialty adult patients at an Australian tertiary referral centre. A total of 3,051 isolates from 2,172 patients (60% males) were analysed. Both community onset (1,790 isolates, 59%) and hospital onset (1,261 isolates, 41%) BSIs were included. The mean age of patients was 59 ± 20 years; 930 patients (43%) were 70 years of age or over. Overall, 1,493 (49%) gram positive bacteria, 1,389 (46%) gram negative bacteria and 169 (5.5%) fungi were isolated. The proportion of gram negative isolates increased over the 9 years, (44% to 53%, P = 0.006) whilst gram positives decreased (49% to 45%, P = 0.045). These trends were significant in community onset infections but not hospital onset infections, and also in adult patients aged 20 years to less than 70 years but not in the elderly (≥70 years). Gram negative pathogens were most prevalent amongst the elderly (53% in the ≥70 years age group, P<0.0001 vs. 41% in the ≥20 to <70 years age group), attributable to an age-dependent increase in Escherichia coli infections and a decrease in Staphylococcus aureus infections (P<0.0001 for both). Most gram negative isolates remained susceptible to commonly prescribed antibiotics. By contrast, methicillin-resistant S. aureus rates decreased from 54% in 2001 to 28% in 2009 (P=0.007). This study found that gram negative BSIs appeared to be re-emerging, particularly in community onset infections and also amongst the younger patients at the study institution. Such epidemiological trends have important implications for antimicrobial choices for the treatment of undifferentiated sepsis.
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Affiliation(s)
- Ar Kar Aung
- Department of Infectious Diseases and Microbiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia and General Medical Unit, The Alfred, Prahran, Victoria.
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5896
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Critselis E, Nastos PT, Theodoridou K, Theodoridou M, Tsolia MN, Hadjichristodoulou C, Papaevangelou V. Time trends in pediatric hospitalizations for varicella infection are associated with climatic changes: a 22-year retrospective study in a tertiary Greek referral center. PLoS One 2012; 7:e52016. [PMID: 23284855 PMCID: PMC3532345 DOI: 10.1371/journal.pone.0052016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 11/08/2012] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND/AIMS The transmission rate of air-borne infectious diseases may vary secondary to climate conditions. The study assessed time trends in the seasonality of hospitalized varicella cases in a temperate region in relation to climatic parameters prior to the implementation of universal varicella immunization. METHODS A retrospective descriptive study was conducted among all pediatric and adolescent varicella patients (n = 2366) hospitalized at the "Aghia Sophia" Children's Hospital during 1982-2003 in Athens, Greece. Date of infection was computed based on hospital admission date. Seasonal and monthly trends in the epidemiology of varicella infection were assessed with time series analysis (ARIMA modeling procedure). The correlation between the frequency of varicella patients and the meteorological parameters was examined by the application of Generalized Linear Models with Gamma distribution. RESULTS During 1982-2003, the occurrence of hospitalized varicella cases increased during summer (p = 0.025) and decreased during autumn (p = 0.021), and particularly in September (p = 0.003). The frequency of hospitalized varicella cases was inversely associated with air temperature (p<0.001). In contrast, the occurrence of hospitalized varicella cases was positively associated with wind speed (p = 0.009). CONCLUSIONS Pediatric hospitalizations for varicella infection rates have increased during summer and decreased during autumn in the examined temperate region. Time trends in hospitalized varicella cases are associated with climatic variables.
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Affiliation(s)
- Elena Critselis
- Second University Department of Pediatrics, “P. & A. Kyriakou” Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Panagiotis T. Nastos
- Laboratory of Climatology and Atmospheric Environment, Department of Geology and Geoenvironment, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Theodoridou
- First University Department of Pediatrics, “Aghia Sophia” Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Maria Theodoridou
- First University Department of Pediatrics, “Aghia Sophia” Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Maria N. Tsolia
- Second University Department of Pediatrics, “P. & A. Kyriakou” Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Vassiliki Papaevangelou
- Second University Department of Pediatrics, “P. & A. Kyriakou” Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
- * E-mail:
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5897
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Shehata SMK, El Attar AA, Attia MA, Hassan AM. Laparoscopic herniotomy in children: prospective assessment of tertiary center experience in a developing country. Hernia 2012; 17:229-34. [PMID: 23269403 DOI: 10.1007/s10029-012-1031-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 12/08/2012] [Indexed: 12/29/2022]
Abstract
PURPOSE We aimed to assess prospectively the feasibility and outcome of laparoscopic herniotomy (LH) in children in a tertiary center with limited resources. METHODS Fifty-six children with unilateral pediatric inguinal hernia (PIH) were treated for an 18-month period. All cases were subjected to LH in a way similar to the classic open technique following exploration of the contralateral patent processus vaginalis (CPPV) without ligation of the sac. Exclusion criteria included prematurity, age <6 months, irreducible or recurrent hernia, and cases with internal ring diameter >2 cm. Operative findings, postoperative results, and complications were assessed. RESULTS We have 56 cases presented with unilateral PIH, and they are aged between 6 months and 15 years. Thirty-two presented with Rt hernia including 12 associated with CPPV and 24 cases Lt hernia with 10 associated with CPPV. Two cases showed adhesions and 2 cases showed direct defects that were repaired in the same session. Hydrocele of the hernia sac was reported once. In the total of 78 hernias, the mean operative time was 20.5 min in unilateral cases and 42.5 min in bilateral cases. No conversion was reported. Postoperative pain lasts for a mean time of 11.2 h. Patients regained peristalsis by a mean of 7 h. Two cases developed wound infection and were treated conservatively. No case of recurrence, testicular atrophy, or hydrocele was reported in the mean follow-up period of 20.5 months. CONCLUSIONS Laparoscopic herniotomy is feasible and safe for PIH. It provides a superior tool to diagnose CPPV or rare hernias that can be managed in the same session with minimal postoperative complications reported even in developing countries. Laparoscopic herniotomy is proved to be beneficial for PIH since it provides an excellent view on the cord structures, and they can be guarded well during the procedure. Larger studies and longer follow-up are needed to support our encouraging results.
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Affiliation(s)
- S M K Shehata
- Department of Pediatric Surgery, Tanta University Hospital, 12th El-Motawakel Street, Flat No.1, Tanta El-Gidida, Tanta, 31111, Egypt.
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5898
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Pai S, Aliyu SH, Enoch DA, Karas JA. Five years experience of Clostridium difficile infection in children at a UK tertiary hospital: proposed criteria for diagnosis and management. PLoS One 2012; 7:e51728. [PMID: 23300561 PMCID: PMC3530496 DOI: 10.1371/journal.pone.0051728] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 11/05/2012] [Indexed: 12/16/2022] Open
Abstract
Background Clostridium difficile infection (CDI) is associated with significant morbidity and mortality in adults. There is increasing evidence of the pathogenic role of C. difficile in the paediatric population. We sought to ascertain the clinical presentation and severity of CDI in children at our institution and develop criteria to aid management. Methods Clinical data was retrospectively collected from all children (0–16 yrs) with a positive C. difficile toxin result over a 5-year period. National adult guidelines were used to assess the severity and management of CDI. Results Seventy-five patients were included with a mean age of 2.97 years. Forty-nine were hospital onset, 22 community onset and 4 healthcare-associated. The most common co-morbidity among the hospital onset infections was malignancy. Gastrointestinal conditions were most common among community onset infections. Fifty-five cases (73.3%) had received antibiotics in the preceding month, 7 (9.3%) had cow’s milk intolerance and 9 (12%) had co-infection with another gut pathogen. According to national adult guidelines 57 cases (76%) were categorised as severe. Thirty cases received oral metronidazole, two patients required intensive care and one patient had a sub-total colectomy for pseudomembranous colitis. No mortality was observed. Discussion We confirm the association of paediatric CDI with co-morbidities such as haematological and solid organ malignancies, recent antibiotic use and hospitalisation. We observed an association between cows milk protein intolerance and C. difficile. The use of adult criteria overestimated severity of disease in this cohort, as most cases experienced a mild course of illness with low morbidity and no mortality. This indicates that adult scoring criteria are not useful in guiding management and we propose specific criteria for children.
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Affiliation(s)
- Sumita Pai
- Clinical Microbiology & Public Health Laboratory, Health Protection Agency, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Sani Hussaini Aliyu
- Clinical Microbiology & Public Health Laboratory, Health Protection Agency, Addenbrookes Hospital, Cambridge, United Kingdom
| | - David Andrew Enoch
- Peterborough & Stamford Hospitals NHS Foundation Trust, Peterborough City Hospital, Bretton Gate, Peterborough, United Kingdom
| | - Johannis Andreas Karas
- Clinical Microbiology & Public Health Laboratory, Health Protection Agency, Addenbrookes Hospital, Cambridge, United Kingdom
- * E-mail:
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5899
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Diaz OM, Rangel-Castilla L, Barber S, Mayo RC, Klucznik R, Zhang YJ. Middle cerebral artery aneurysms: a single-center series comparing endovascular and surgical treatment. World Neurosurg 2012; 81:322-9. [PMID: 23238101 DOI: 10.1016/j.wneu.2012.12.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 11/23/2012] [Accepted: 12/07/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The optimal treatment for middle cerebral artery (MCA) aneurysms is controversial. MCA aneurysms have been considered more conducive to surgical treatment. Recent technology has led to successful endovascular treatment of MCA aneurysms. The objective of this study was to analyze the outcomes of endovascular and surgical treatment of MCA aneurysms as experienced by a single tertiary center. METHODS We retrospectively reviewed 90 MCA aneurysms in 84 patients treated from 2005 to 2010. They were separated into 2 groups: endovascular coiling, with 50 (59.5%) patients, and surgical clipping, with 34 (40.5%) patients. Outcome was based on complications, procedural morbidity and mortality, clinical and angiographic outcomes, and retreatment rates. Patients were further separated into ruptured and unruptured aneurysm groups. RESULTS Ruptured aneurysms were 10 of 50 (20%) and 9 of 34 (26.5%) patients in the endovascular and surgical groups, respectively. Procedure-related complications were 16% and 0% for the endovascular and surgical groups (P = .01), respectively. Overall rate of complete or near-complete occlusion at angiographic follow-up was 86% and 95% for the endovascular and surgical groups (P = .16), respectively. Proportion of patients with modified Rankin scale of 3 to 6 at 6 months follow-up was 10% and 5.9% for the endovascular and surgical groups (P = .5), respectively. The mean angiographic follow-up was 9.02 months (range 0 to 5.2 years). Retreatment rates were 14% and 0% for the endovascular and surgical groups, respectively (P = .01). CONCLUSIONS In this nonrandomized sample of 90 MCA aneurysms treated with endovascular coiling or neurosurgical clipping, we observed a similar clinical outcome based on the modified Rankin scale and angiographic occlusion. Complication and retreatment rates were higher but not significant for the endovascular group. Both treatment modalities are good alternatives and should be individualized based on aneurysm angioarchitecture and the patient's general conditions.
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Affiliation(s)
- Orlando M Diaz
- Department of Radiology, Endovascular Interventional Neuroradiology, The Methodist Hospital, Houston, Texas, USA
| | | | - Sean Barber
- Department of Neurosurgery, The Methodist Neurological Institute, Houston, Texas, USA
| | - Ray C Mayo
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Richard Klucznik
- Department of Radiology, Endovascular Interventional Neuroradiology, The Methodist Hospital, Houston, Texas, USA
| | - Yi Jonathan Zhang
- Department of Neurosurgery, The Methodist Neurological Institute, Houston, Texas, USA
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5900
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Gilbert AV, Patel B, Morrow M, Williams D, Roberts MS, Gilbert AL. Providing community-based health practitioners with timely and accurate discharge medicines information. BMC Health Serv Res 2012; 12:453. [PMID: 23228183 PMCID: PMC3556303 DOI: 10.1186/1472-6963-12-453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 12/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate and timely medication information at the point of discharge is essential for continuity of care. There are scarce data on the clinical significance if poor quality medicines information is passed to the next episode of care. This study aimed to compare the number and clinical significance of medication errors and omission in discharge medicines information, and the timeliness of delivery of this information to community-based health practitioners, between the existing Hospital Discharge Summary (HDS) and a pharmacist prepared Medicines Information Transfer Fax (MITF). METHOD The study used a sample of 80 hospital patients who were at high risk of medication misadventure, and who had a MITF completed in the study period June - October 2009 at a tertiary referral hospital. The medicines information in participating patients' MITFs was validated against their Discharge Prescriptions (DP). Medicines information in each patient's HDS was then compared with their validated MITF. An expert clinical panel reviewed identified medication errors and omissions to determine their clinical significance. The time between patient discharge and the dispatching of the MITF and the HDS to each patient's community-based practitioners was calculated from hospital records. RESULTS DPs for 77 of the 80 patients were available for comparison with their MITFs. Medicines information in 71 (92%) of the MITFs matched that of the DP. Comparison of the HDS against the MITF revealed that no HDS was prepared for 16 (21%) patients. Of the remaining 61 patients; 33 (54%), had required medications omitted and 38 (62%) had medication errors in their HDS. The Clinical Panel rated the significance of errors or omissions for 70 patients (16 with no HDS prepared and 54 who's HDS was inconsistent with the validated MITF). In 17 patients the error or omission was rated as insignificant to minor; 23 minor to moderate; 24 moderate to major and 6 major to catastrophic. 28 (35%) patients had their HDS dispatched to their community-based practitioners within 48 hours post discharge compared to 80 (100%) of MITFs. CONCLUSION The MITF is an effective approach for the timely delivery of accurate discharge medicines information to community-based practitioners responsible for the patient's ongoing care.
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Affiliation(s)
- Alice V Gilbert
- Pharmacy Department, Royal Darwin Hospital, Rocklands Drive, Darwin 0810, Australia
| | - Bhavini Patel
- Pharmacy Department, Royal Darwin Hospital, Rocklands Drive, Darwin 0810, Australia
| | - Melanie Morrow
- Pharmacy Department, Royal Darwin Hospital, Rocklands Drive, Darwin 0810, Australia
| | - Desmond Williams
- School of Pharmacy and Medical Science, University of South Australia, North Terrace, Adelaide, Australia
| | - Michael S Roberts
- School of Medicine, Queensland University, Sir Fred Schonell Drive, Queensland, 4072, Australia
| | - Andrew L Gilbert
- School of Pharmacy and Medical Science, University of South Australia, North Terrace, Adelaide, Australia
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