WorldWideScience

Sample records for european tertiary center

  1. Robot-assisted Partial Nephrectomy: 5-yr Oncological Outcomes at a Single European Tertiary Cancer Center.

    Science.gov (United States)

    Vartolomei, Mihai Dorin; Matei, Deliu Victor; Renne, Giuseppe; Tringali, Valeria Maria; Crisan, Nicolae; Musi, Gennaro; Mistretta, Francesco Alessandro; Russo, Andrea; Cozzi, Gabriele; Cordima, Giovani; Luzzago, Stefano; Cioffi, Antonio; Di Trapani, Ettore; Catellani, Michele; Delor, Maurizio; Bottero, Danilo; Imbimbo, Ciro; Mirone, Vincenzo; Ferro, Matteo; de Cobelli, Ottavio

    2017-10-27

    Nowadays, there is a debate about which surgical treatment should be best for clinical T1 renal tumors. If the oncological outcomes are considered, there are many open and laparoscopic series published. As far as robotic series are concerned, only a few of them report 5-yr oncological outcomes. The aim of this study was to analyze robot-assisted partial nephrectomy (RAPN) midterm oncological outcomes achieved in a tertiary robotic reference center. Between April 2009 and September 2013, 123 consecutive patients with clinical T1-stage renal masses underwent RAPN in our tertiary cancer center. Inclusion criteria were as follows: pathologically confirmed renal cell carcinomas (RCCs) and follow-up for >12 mo. Eighteen patients were excluded due to follow-up of <12 mo and 15 due to benign final pathology. Median follow-up was 59 mo (interquartile range 44-73 mo). Patients were followed according to guideline recommendations and institutional protocol. Outcomes were measured by time to disease progression, overall survival, or time to cancer-specific death. Kaplan-Meier method was used to estimate survival; log-rank tests were applied for pair-wise comparison of survival. From the 90 patients included, 66 (73.3%) had T1a, 12 (13.3%) T1b, three (3.3%) T2a, and nine (10%) T3a tumors. Predominant histological type was clear cell carcinoma: 67 (74.5%). Fuhrmann grade 1 and 2 was found in 73.3% of all malignant tumors. Two patients (2.2%) had positive surgical margins, and complication rate was 17.8%. Relapse rate was 7.7%, including two cases (2.2%) of local recurrences and five (5.5%) distant metastasis. Five-year disease-free survival was 90.9%, 5-yr cancer-specific survival was 97.5%, and 5-yr overall survival was 95.1%. Midterm oncological outcomes after RAPN for localized RCCs (predominantly T1a tumors of low anatomic complexity) were shown to be good, adding significant evidence to support the oncological efficacy and safety of RAPN for the treatment of this type of

  2. Financial impact of tertiary care in an academic medical center.

    Science.gov (United States)

    Huber, T S; Carlton, L M; O'Hern, D G; Hardt, N S; Keith Ozaki, C; Flynn, T C; Seeger, J M

    2000-06-01

    To analyze the financial impact of three complex vascular surgical procedures to both an academic hospital and a department of surgery and to examine the potential impact of decreased reimbursements. The cost of providing tertiary care has been implicated as one potential cause of the financial difficulties affecting academic medical centers. Patients undergoing revascularization for chronic mesenteric ischemia, elective thoracoabdominal aortic aneurysm repair, and treatment of infected aortic grafts at the University of Florida were compared with those undergoing elective infrarenal aortic reconstruction and carotid endarterectomy. Hospital costs and profit summaries were obtained from the Clinical Resource Management Office. Departmental costs and profit summary were estimated based on the procedural relative value units (RVUs), the average clinical cost per RVU ($33.12), surgeon charges, and the collection rate for the vascular surgery division (30.2%) obtained from the Faculty Group Practice. Surgeon work effort was analyzed using the procedural work RVUs and the estimated total care time. The analyses were performed for all payors and the subset of Medicare patients, and the potential impact of a 15% reduction in hospital and physician reimbursement was analyzed. Net hospital income was positive for all but one of the tertiary care procedures, but net losses were sustained by the hospital for the mesenteric ischemia and infected aortic graft groups among the Medicare patients. In contrast, the estimated reimbursement to the department of surgery for all payors was insufficient to offset the clinical cost of providing the RVUs for all procedures, and the estimated losses were greater for the Medicare patients alone. The surgeon work effort was dramatically higher for the tertiary care procedures, whereas the reimbursement per work effort was lower. A 15% reduction in reimbursement would result in an estimated net loss to the hospital for each of the tertiary

  3. Characteristics and risk factors of preterm births in a tertiary center in ...

    African Journals Online (AJOL)

    Characteristics and risk factors of preterm births in a tertiary center in Lagos, Nigeria. ... Introduction: preterm birth is a dire complication of pregnancy that poses ... to a tertiary center for prenatal care in order to significantly reduce adverse birth ...

  4. Xeroderma pigmentosum at a tertiary care center in Saudi Arabia.

    Science.gov (United States)

    Alwatban, Lenah; Binamer, Yousef

    2017-01-01

    Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder caused by defective DNA repair that results in extreme sensitivity to ultraviolet (UV) rays. Depending on the type of XP, the disease may affect the skin, eyes and nervous system. Describe the dermatologic manifestations in patients suffering from XP. Retrospective, descriptive review of medical records. Dermatology clinic at tertiary care center in Riyadh. This study included Saudi patients with clinically confirmed XP. Demographic and clinical data including pathology and associated conditions and outcomes. Of 21 patients with XP, the most common manifestation was lentigines, affecting 18 patients (86%). The most common skin cancer was basal cell carcinoma followed by squamous cell carcinoma (SCC) affecting 15 (71.4%) and 9 (42.8%), respectively. Other skin findings included neurofibroma, trichilemmoma and seborrheic keratosis. Ocular involvement included photophobia, which was the most common finding followed by dryness and ocular malignancies. Two patients showed neurological involvement, which correlated with the type of mutation. Considering that XP is a rare genetic disease, this description of our patient population will aid in early recognition and diagnosis. Retrospective and small number of patients. Genetic analyses were done for only 5 of the 21 patients.

  5. Patient Understanding of Hypoglycemia in Tertiary Referral Centers

    Directory of Open Access Journals (Sweden)

    Nan Hee Cho

    2018-02-01

    Full Text Available BackgroundHypoglycemia is an important complication in the treatment of patients with diabetes. We surveyed the insight by patients with diabetes into hypoglycemia, their hypoglycemia avoidance behavior, and their level of worry regarding hypoglycemia.MethodsA survey of patients with diabetes, who had visited seven tertiary referral centers in Daegu or Gyeongsangbuk-do, Korea, between June 2014 and June 2015, was conducted. The survey contained questions about personal history, symptoms, educational experience, self-management, and attitudes about hypoglycemia.ResultsOf 758 participants, 471 (62.1% had experienced hypoglycemia, and 250 (32.9% had experienced hypoglycemia at least once in the month immediately preceding the study. Two hundred and forty-two (31.8% of the participants had received hypoglycemia education at least once, but only 148 (19.4% knew the exact definition of hypoglycemia. Hypoglycemic symptoms identified by the participants were dizziness (55.0%, sweating (53.8%, and tremor (40.8%. They mostly chose candy (62.1%, chocolate (37.7%, or juice (36.8% as food for recovering hypoglycemia. Participants who had experienced hypoglycemia had longer duration of diabetes and a higher proportion of insulin usage. The mean scores for hypoglycemia avoidance behavior and worry about hypoglycemia were 21.2±10.71 and 23.38±13.19, respectively. These scores tended to be higher for participants with higher than 8% of glycosylated hemoglobin, insulin use, and experience of emergency room visits.ConclusionMany patients had experienced hypoglycemia and worried about it. We recommend identifying patients that are anxious about hypoglycemia and educating them about what to do when they develop hypoglycemic symptoms, especially those who have a high risk of hypoglycemia.

  6. Patient Understanding of Hypoglycemia in Tertiary Referral Centers.

    Science.gov (United States)

    Cho, Nan Hee; Kim, Nam Kyung; Han, Eugene; Hong, Jun Hwa; Jeon, Eon Ju; Moon, Jun Sung; Seo, Mi Hae; Lee, Ji Eun; Seo, Hyun Ae; Kim, Mi Kyung; Kim, Hye Soon

    2018-02-01

    Hypoglycemia is an important complication in the treatment of patients with diabetes. We surveyed the insight by patients with diabetes into hypoglycemia, their hypoglycemia avoidance behavior, and their level of worry regarding hypoglycemia. A survey of patients with diabetes, who had visited seven tertiary referral centers in Daegu or Gyeongsangbuk-do, Korea, between June 2014 and June 2015, was conducted. The survey contained questions about personal history, symptoms, educational experience, self-management, and attitudes about hypoglycemia. Of 758 participants, 471 (62.1%) had experienced hypoglycemia, and 250 (32.9%) had experienced hypoglycemia at least once in the month immediately preceding the study. Two hundred and forty-two (31.8%) of the participants had received hypoglycemia education at least once, but only 148 (19.4%) knew the exact definition of hypoglycemia. Hypoglycemic symptoms identified by the participants were dizziness (55.0%), sweating (53.8%), and tremor (40.8%). They mostly chose candy (62.1%), chocolate (37.7%), or juice (36.8%) as food for recovering hypoglycemia. Participants who had experienced hypoglycemia had longer duration of diabetes and a higher proportion of insulin usage. The mean scores for hypoglycemia avoidance behavior and worry about hypoglycemia were 21.2±10.71 and 23.38±13.19, respectively. These scores tended to be higher for participants with higher than 8% of glycosylated hemoglobin, insulin use, and experience of emergency room visits. Many patients had experienced hypoglycemia and worried about it. We recommend identifying patients that are anxious about hypoglycemia and educating them about what to do when they develop hypoglycemic symptoms, especially those who have a high risk of hypoglycemia. Copyright © 2018 Korean Diabetes Association

  7. Glaucoma Blindness at a Tertiary Eye Care Center.

    Science.gov (United States)

    Stone, Jordan S; Muir, Kelly W; Stinnett, Sandra S; Rosdahl, Jullia A

    2015-01-01

    Glaucoma is an important cause of irreversible blindness. This study describes the characteristics of a large, diverse group of glaucoma patients and evaluates associations between demographic and clinical characteristics and blindness. Data were gathered via retrospective chart review of patients (N = 1,454) who were seen between July 2007 and July 2010 by glaucoma service providers at Duke Eye Center. Visual acuity and visual field criteria were used to determine whether patients met the criteria for legal blindness. Descriptive and comparative statistical analyses were performed on the glaucoma patients who were not blind (n = 1,258) and those who were blind (n = 196). A subgroup analysis of only those patients with primary open-angle glaucoma was also performed. In this tertiary care population, 13% (n = 196) of glaucoma patients met criteria for legal blindness, nearly one-half of whom (n = 94) were blind from glaucoma, and another one-third of whom (n = 69) had glaucoma-related blindness. The most common glaucoma diagnosis at all levels of vision was primary open-angle glaucoma. A larger proportion of black patients compared with white patients demonstrated vision loss; the odds ratio (OR) for blindness was 2.25 (95% CI, 1.6-3.2) for black patients compared with white patients. The use of systemic antihypertensive medications was higher among patients who were blind compared with patients who were not blind (OR = 2.1; 95% CI, 1.4-3.1). A subgroup analysis including only patients with primary open-angle glaucoma showed similar results for both black race and use of systemic antihypertensive medications. The relationship between use of systemic antihypertensive medications and blindness was not different between black patients and white patients (interaction P = .268). Data were based on chart review, and associations may be confounded by unmeasured factors. Treated systemic hypertension may be correlated with blindness, and the cause cannot be explained solely

  8. Oral food challenge outcomes in a pediatric tertiary care center

    OpenAIRE

    Abrams, Elissa M.; Becker, Allan B.

    2017-01-01

    Background Oral food challenges are the clinical standard for diagnosis of food allergy. Little data exist on predictors of oral challenge failure and reaction severity. Methods A retrospective chart review was done on all pediatric patients who had oral food challenges in a tertiary care pediatric allergy clinic from 2008 to 2010. Results 313 oral challenges were performed, of which the majority were to peanut (105), egg (71), milk (41) and tree nuts (29). There were 104 (33%) oral challenge...

  9. Encapsulating peritoneal sclerosis: experience of a tertiary referral center.

    LENUS (Irish Health Repository)

    Phelan, P J

    2010-05-01

    Encapsulating peritoneal sclerosis (EPS) is arguably the most serious complication of chronic peritoneal dialysis (PD) therapy with extremely high mortality rates. We aimed to establish the rates of EPS and factors associated with its development in a single center.

  10. Oral food challenge outcomes in a pediatric tertiary care center.

    Science.gov (United States)

    Abrams, Elissa M; Becker, Allan B

    2017-01-01

    Oral food challenges are the clinical standard for diagnosis of food allergy. Little data exist on predictors of oral challenge failure and reaction severity. A retrospective chart review was done on all pediatric patients who had oral food challenges in a tertiary care pediatric allergy clinic from 2008 to 2010. 313 oral challenges were performed, of which the majority were to peanut (105), egg (71), milk (41) and tree nuts (29). There were 104 (33%) oral challenge failures. Children were more likely to fail an oral challenge if they were older (P = .04), had asthma (P = .001) or had atopic dermatitis (P = .03). Risk of challenge failure was significantly different between food allergens, with more failures noted for peanut than for tree nuts, milk or egg (P = .001). Among challenge failures, 19% met criteria for anaphylaxis. Significantly more tree nut and peanut challenges met criteria for anaphylaxis than milk or egg (P Skin test size and specific IgE level were significantly higher in those who failed oral challenges (P < .001). The highest rate of challenge failure and severity of failure was to cashew, with 63% of cashew challenges reacting, of which 80% met clinical criteria for anaphylaxis. The risk of challenge failure differed with type of food studied, with peanut and tree nut having a higher risk of challenge failure and anaphylaxis. Cashew in particular carried a high risk and caution must be exercised when performing these types of oral challenges in children.

  11. Mortality and causes of death in children referred to a tertiary epilepsy center.

    Science.gov (United States)

    Grønborg, Sabine; Uldall, Peter

    2014-01-01

    Patients with epilepsy, including children, have an increased mortality rate when compared to the general population. Only few studies on causes of mortality in childhood epilepsy exist and pediatric SUDEP rate is under continuous discussion. To describe general mortality, incidence of sudden unexpected death in epilepsy (SUDEP), causes of death and age distribution in a pediatric epilepsy patient population. The study retrospectively examined the mortality and causes of death in 1974 patients with childhood-onset epilepsy at a tertiary epilepsy center in Denmark over a period of 9 years. Cases of death were identified through their unique civil registration number. Information from death certificates, autopsy reports and medical notes were collected. 2.2% (n = 43) of the patient cohort died during the study period. This includes 9 patients with SUDEP (8 SUDEP cases per 10,000 patient years). 9 patients died in the course of neurodegenerative disease and 28 children died of various causes. Epilepsy was considered drug resistant in more than 95% of the deceased patients, 90% were diagnosed with intellectual disability. Mortality of patients that underwent dietary epilepsy treatment was slightly higher than in the general cohort. There were no epilepsy-related deaths due to drowning. This study confirms that SUDEP must not be disregarded in the pediatric age group. The vast majority of SUDEP cases in this study displays numerous risk factors similar to those described in adult epilepsy patients. Including SUDEP, only 30% of the mortality was directly seizure related. Copyright © 2013 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  12. Factors influencing teamwork and collaboration within a tertiary medical center.

    Science.gov (United States)

    Chien, Shu Feng; Wan, Thomas Th; Chen, Yu-Chih

    2012-04-26

    To understand how work climate and related factors influence teamwork and collaboration in a large medical center. A survey of 3462 employees was conducted to generate responses to Sexton's Safety Attitudes Questionnaire (SAQ) to assess perceptions of work environment via a series of five-point, Likert-scaled questions. Path analysis was performed, using teamwork (TW) and collaboration (CO) as endogenous variables. The exogenous variables are effective communication (EC), safety culture (SC), job satisfaction (JS), work pressure (PR), and work climate (WC). The measurement instruments for the variables or summated subscales are presented. Reliability of each sub-scale are calculated. Alpha Cronbach coefficients are relatively strong: TW (0.81), CO (0.76), EC (0.70), SC (0.83), JS (0.91), WP (0.85), and WC (0.78). Confirmatory factor analysis was performed for each of these constructs. Path analysis enables to identify statistically significant predictors of two endogenous variables, teamwork and intra-organizational collaboration. Significant amounts of variance in perceived teamwork (R(2) = 0.59) and in collaboration (R(2) = 0.75) are accounted for by the predictor variables. In the initial model, safety culture is the most important predictor of perceived teamwork, with a β weight of 0.51, and work climate is the most significant predictor of collaboration, with a β weight of 0.84. After eliminating statistically insignificant causal paths and allowing correlated predictors1, the revised model shows that work climate is the only predictor positively influencing both teamwork (β = 0.26) and collaboration (β = 0.88). A relatively weak positive (β = 0.14) but statistically significant relationship exists between teamwork and collaboration when the effects of other predictors are simultaneously controlled. Hospital executives who are interested in improving collaboration should assess the work climate to ensure that employees are operating in a setting conducive

  13. Factors influencing teamwork and collaboration within a tertiary medical center

    Science.gov (United States)

    Chien, Shu Feng; Wan, Thomas TH; Chen, Yu-Chih

    2012-01-01

    AIM: To understand how work climate and related factors influence teamwork and collaboration in a large medical center. METHODS: A survey of 3462 employees was conducted to generate responses to Sexton’s Safety Attitudes Questionnaire (SAQ) to assess perceptions of work environment via a series of five-point, Likert-scaled questions. Path analysis was performed, using teamwork (TW) and collaboration (CO) as endogenous variables. The exogenous variables are effective communication (EC), safety culture (SC), job satisfaction (JS), work pressure (PR), and work climate (WC). The measurement instruments for the variables or summated subscales are presented. Reliability of each sub-scale are calculated. Alpha Cronbach coefficients are relatively strong: TW (0.81), CO (0.76), EC (0.70), SC (0.83), JS (0.91), WP (0.85), and WC (0.78). Confirmatory factor analysis was performed for each of these constructs. RESULTS: Path analysis enables to identify statistically significant predictors of two endogenous variables, teamwork and intra-organizational collaboration. Significant amounts of variance in perceived teamwork (R2 = 0.59) and in collaboration (R2 = 0.75) are accounted for by the predictor variables. In the initial model, safety culture is the most important predictor of perceived teamwork, with a β weight of 0.51, and work climate is the most significant predictor of collaboration, with a β weight of 0.84. After eliminating statistically insignificant causal paths and allowing correlated predictors1, the revised model shows that work climate is the only predictor positively influencing both teamwork (β = 0.26) and collaboration (β = 0.88). A relatively weak positive (β = 0.14) but statistically significant relationship exists between teamwork and collaboration when the effects of other predictors are simultaneously controlled. CONCLUSION: Hospital executives who are interested in improving collaboration should assess the work climate to ensure that employees are

  14. Assessment of chronic diarrhea in early infancy in Tehran Tertiary Care Center; Tehran-Iran

    OpenAIRE

    Farzaneh Motamed; Naheid Kazemi; Raheleh Nabavizadeh

    2015-01-01

    Introduction Chronic diarrhea of infancy is a heterogeneous syndrome that includes several diseases with different etiologies. The aim of this study was investigating chronic diarrhea, its etiologies, clinical features and outcomes in infancy.Materials and Methods Retrospective study investigating infants hospitalized in the gastroenterology department of Tehran tertiary care center.The main demographic data, etiology, characteristics of diarrhea, and outcome were evaluated. Data were analyze...

  15. Maternal and Neonatal Outcomes of Women with Preeclampsia and Eclampsia at a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Hediye Dağdeviren

    2015-12-01

    Full Text Available Aim: Preeclampsia is a multisystem disorder of unknown etiology and one of the leading causes of maternal, fetal and neonatal mortality and morbidity. Adverse outcomes can be improved by early identification of the disease and timely referral to a tertiary center. The aims of this study were to evaluate the outcomes of preeclampsia-eclampsia cases and share our experiences in a tertiary center. Methods: The study conducted by retrospectively analyzing the data of 350 women who gave birth between 2008 and 2013 at a tertiary care center. Results: The mean age of the enrolled women was 35 years, the mean gestational age at delivery-36 weeks, the mean birth weight-2.73 kg, and the mean platelet count was 204.000/ mm3. The incidence of preterm deliveries was 66.6%. Severe preeclampsia was noted in 29.4% of cases. Neonatal intensive care unit admissions were seen in 10.6% of cases. A total of 22.9% of these women had vaginal deliveries, while the other 77.1% underwent cesarean section. High systolic blood pressure and elevated serum alanine and aspartate aminotransferase values had significant independent effects of differentiating between mild and severe preeclampsia. Conclusion: Fetomaternal morbidity and mortality rates associated with hypertensive disorders are alarming, especially in developing countries. As such, the high-risk obstetric population should be screened earlier in pregnancy. A system allowing early referral in these cases should be created. (The Medical Bulletin of Haseki 2015; 53:143-6

  16. Neuropathy in the hemodialysis population: a review of neurophysiology referrals in a tertiary center.

    LENUS (Irish Health Repository)

    O'Regan, John

    2012-01-01

    This was a retrospective observational study of neurophysiology referrals over 8 years from a tertiary referral center in Ireland. A total of 68 of the 73 referrals yielded one or more abnormalities. Thirty-nine (53%) patients had one or more mononeuropathies; iatrogenic mononeuropathies believed to be associated with arterio-venous fistula creation occurred in 15 patients. Polyneuropathy was identified in 43 patients (59%). Access to an experienced neurophysiology department offers valuable insight into dialysis-associated neuropathies, especially when associated with arterio-venous fistulae.

  17. Contemporary Parenteral Antiplatelet Bridging Strategies: A Single-Center Real-World Experience at a Tertiary Care Center.

    Science.gov (United States)

    Stern, Gretchen; Rimsans, Jessica; Qamar, Arman; Vaduganathan, Muthiah; Bhatt, Deepak L

    2018-03-13

    Oral antiplatelet therapy may require interruption soon after percutaneous coronary intervention (PCI) or acute coronary syndrome. The optimal parenteral antiplatelet bridge strategy with glycoprotein IIb/IIIa inhibitors or cangrelor, a P2Y12 inhibitor, is unclear. We explore real-world use of cangrelor or eptifibatide for antiplatelet bridging at a large tertiary-care center. Thirty-one patients (9 eptifibatide, 20 cangrelor, and 2 both) received bridge therapy from October 2015 to June 2017. Primary bridge therapy indications included surgery (68%), limited enteral access/absorption (16%), and high-perceived bleed risk (16%). Median duration of bridge therapy was 61 (20-100) hours for cangrelor and 83 (19-98) hours for eptifibatide. Severe/life-threatening bleeding or stent thrombosis was not observed. GUSTO-defined bleeding occurred in 30% (cangrelor) and 27% (eptifibatide). Initial dosing errors occurred in 23% of patients. Death during hospitalization occurred in 16% of patients. Parenteral antiplatelet bridging was used for ~3 days in this single-center, tertiary care experience, commonly for unplanned surgery following PCI. Despite high-risk presentations with >15% in-hospital mortality, efficacy profiles were reassuring with no identified stent thrombosis, but bleeding and dosing errors were common. Antiplatelet bridging should only be used in well-selected patients at the appropriate dose for the minimal necessary duration.

  18. Prevalence of cardiovascular risk factors among workers at a private tertiary center in Angola.

    Science.gov (United States)

    Paquissi, Feliciano Chanana; Manuel, Valdano; Manuel, Ana; Mateus, Guiomar Lote; David, Bruna; Béu, Gertrudes; Castela, Anselmo

    2016-01-01

    The burden of cardiovascular diseases (CVD) is increasing in most countries of sub-Saharan Africa. However, as there is a scarcity of data, little is known about CVD in Angola. This study aimed to determine the prevalence of prehypertension, hypertension, prediabetes, diabetes, overweight, and obesity among workers at a private tertiary center in Angola. A cross-sectional study was conducted among 781 workers of Clínica Girassol, a tertiary health care center in Angola, during the month of November 2013. Demographic, anthropometric, and clinical variables were analyzed. Of the 781 participants studied, 50.44% were males and 78.11% were under 40 years old. The prevalence of hypertension and prehypertension was 17.93% (95% confidence interval [CI]: 15.24%-20.74%) and 54.03% (95% CI: 50.58%-57.62%), respectively. Among hypertensive subjects, 83.57% (117) were unaware of the diagnosis. Hypertension was associated with age (≥40 years) (odds ratio [OR]: 6.21; 95% CI: 4.18-9.24; P Angola.

  19. The status of pediatric cardiology at a tertiary center in Lebanon.

    Science.gov (United States)

    Arabi, Mariam; Majdalani, Marianne; El Hajj, Maria Atoui; Nemer, Georges; Sawaya, Fadi; Obeid, Mounir; Bitar, Fadi F

    2011-01-01

    Cardiac disease, both congenital and acquired, contributes significantly to morbidity and mortality in children. This article describes the status of pediatric cardiology at the Children's Heart Center in the American University of Beirut Medical Center. It addresses the available clinical services as well as the research and educational activities that are present at a tertiary center in Lebanon, a developing country with a population of 4 million. Lebanon has witnessed major developments in the field of pediatric cardiology over the past few years. About 650 babies are born with heart disease every year, with more than 425 needing treatment. Nearly all types of interventional catheterization procedures are currently being performed. About 300 open and closed pediatric cardiac surgeries are performed per year in Lebanon. In 2008, the in-hospital surgical mortality rate at our center was 2.6%, reflecting the good level of care in the treatment of children with congenital heart disease (CHD) in Lebanon. Basic research in the field of pediatric cardiology is emerging at our center. Our team has been studying the effect of chronic hypoxemia on the neonatal myocardium in an animal model of chronic hypoxia, as well as the study of molecular basis of CHD. Appropriate identification of cardiac disease, its epidemiology, and outcome is of utmost importance in guiding adequate care. Centralization of facilities is important to improve results and level of care.

  20. Prevalence of cardiovascular risk factors among workers at a private tertiary center in Angola

    Directory of Open Access Journals (Sweden)

    Paquissi FC

    2016-12-01

    Full Text Available Feliciano Chanana Paquissi,1 Valdano Manuel,2 Ana Manuel,2 Guiomar Lote Mateus,1 Bruna David,2 Gertrudes Béu,3 Anselmo Castela3 1Department of Medicine, 2Cardio-Thoracic Center, 3Service of Endocrinology, Department of Medicine, Clínica Girassol, Luanda, Angola Background: The burden of cardiovascular diseases (CVD is increasing in most countries of sub-Saharan Africa. However, as there is a scarcity of data, little is known about CVD in Angola. This study aimed to determine the prevalence of prehypertension, hypertension, prediabetes, diabetes, overweight, and obesity among workers at a private tertiary center in Angola. Methods: A cross-sectional study was conducted among 781 workers of Clínica Girassol, a tertiary health care center in Angola, during the month of November 2013. Demographic, anthropometric, and clinical variables were analyzed. Results: Of the 781 participants studied, 50.44% were males and 78.11% were under 40 years old. The prevalence of hypertension and prehypertension was 17.93% (95% confidence interval [CI]: 15.24%–20.74% and 54.03% (95% CI: 50.58%–57.62%, respectively. Among hypertensive subjects, 83.57% (117 were unaware of the diagnosis. Hypertension was associated with age (≥40 years (odds ratio [OR]: 6.21; 95% CI: 4.18–9.24; P<0.001 and with overweight and obesity (OR: 2.32; 95% CI: 1.56–3.44; P<0.001. The prevalence of diabetes and prediabetes was 2.69% (95% CI: 1.54%–3.97% and 7.94% (95% CI: 6.02%–9.99%, respectively. The prevalence of overweight was 34.44% (95% CI: 31.11%–37.90% and 19.85% (95% CI: 17.03%–22.79% for obesity. There was an association between overweight and obesity and the female sex (OR: 1.71; 95% CI: 1.29–2.28; P<0.001. The prevalence of family history of CVD, smoking, and alcoholism was 52.24%, 4.87%, and 45.33%, respectively. Conclusion: There was a high prevalence of cardiovascular risk factors in apparently healthy workers at the private tertiary center in Angola

  1. Prevalence of Nontuberculous Mycobacteria among Extrapulmonary Tuberculosis Cases in Tertiary Care Centers in Northern India

    Directory of Open Access Journals (Sweden)

    A. K. Maurya

    2015-01-01

    Full Text Available The reports of nontuberculous mycobacteria (NTM associated with extrapulmonary diseases are increasing in tertiary care hospitals. Despite a significant increase in knowledge about NTM infections, they still represent a diagnostic and therapeutic challenge. The aim of this study is to know the prevalence of NTN among extrapulmonary tuberculosis cases in tertiary care centers in Northern India. A total of 227 culture positive isolates from 756 cases were tested for niacin production and catalase assay. BIO-LINE SD Ag MPT64 TB test and final identification and differentiation between MTBC and different species of NTM were further confirmed by GenoType Mycobacterium CM/AS assay. 71 cases (9.3% were positive for AFB by ZN staining and 227 cases (30.1% were positive for mycobacteria by culture. Niacin production and catalase activity were negative in 62/227 (27.4% strains and after using a panel of different biochemicals and final confirmation by GenoType Mycobacterium CM assay. Out of 227 cultures tested, 165 (72.6% strains were confirmed as M. tuberculosis complex, and 62 (27.4% were confirmed as NTM. The most common NTM species identified were M. fortuitum 17 (27.5% and M. intracellulare 13 (20.9%. The rapid identification of NTM species may help in targeted therapy and management of the diseases.

  2. Assessment of chronic diarrhea in early infancy in Tehran Tertiary Care Center; Tehran-Iran

    Directory of Open Access Journals (Sweden)

    Farzaneh Motamed

    2015-03-01

    Full Text Available Introduction Chronic diarrhea of infancy is a heterogeneous syndrome that includes several diseases with different etiologies. The aim of this study was investigating chronic diarrhea, its etiologies, clinical features and outcomes in infancy.Materials and Methods Retrospective study investigating infants hospitalized in the gastroenterology department of Tehran tertiary care center.The main demographic data, etiology, characteristics of diarrhea, and outcome were evaluated. Data were analyzed by SPSS software,version 16.Results In this study, 63/9% of cases were female and 36/1% were male. 24 cases (66/7% had osmotic diarrhea and 11 (30/6% had secretory diarrhea. In this study there was no significant statistical correlation between type of diarrhea and sex, gestational Age, severity of dehydration, birth weight and nutrition. The majority of patients with osmotic (58/3% and secretory diarrhea (63/6%, had weight percentile below 3%, which showed a significant statistical difference (p value

  3. Mortality and causes of death in children referred to a tertiary epilepsy center

    DEFF Research Database (Denmark)

    Grønborg, Sabine; Uldall, Peter

    2014-01-01

    BACKGROUND: Patients with epilepsy, including children, have an increased mortality rate when compared to the general population. Only few studies on causes of mortality in childhood epilepsy exist and pediatric SUDEP rate is under continuous discussion. AIM: To describe general mortality......, incidence of sudden unexpected death in epilepsy (SUDEP), causes of death and age distribution in a pediatric epilepsy patient population. METHODS: The study retrospectively examined the mortality and causes of death in 1974 patients with childhood-onset epilepsy at a tertiary epilepsy center in Denmark...... that underwent dietary epilepsy treatment was slightly higher than in the general cohort. There were no epilepsy-related deaths due to drowning. CONCLUSIONS: This study confirms that SUDEP must not be disregarded in the pediatric age group. The vast majority of SUDEP cases in this study displays numerous risk...

  4. Epilepsy diagnostic and treatment needs identified with a collaborative database involving tertiary centers in France.

    Science.gov (United States)

    Chipaux, Mathilde; Szurhaj, William; Vercueil, Laurent; Milh, Mathieu; Villeneuve, Nathalie; Cances, Claude; Auvin, Stéphane; Chassagnon, Serge; Napuri, Sylvia; Allaire, Catherine; Derambure, Philippe; Marchal, Cécile; Caubel, Isabelle; Ricard-Mousnier, Brigitte; N'Guyen The Tich, Sylvie; Pinard, Jean-Marc; Bahi-Buisson, Nadia; de Baracé, Claire; Kahane, Philippe; Gautier, Agnès; Hamelin, Sophie; Coste-Zeitoun, Delphine; Rosenberg, Sarah-Dominique; Clerson, Pierre; Nabbout, Rima; Kuchenbuch, Mathieu; Picot, Marie-Christine; Kaminska, Anna

    2016-05-01

    To obtain perspective on epilepsy in patients referred to tertiary centers in France, and describe etiology, epilepsy syndromes, and identify factors of drug resistance and comorbidities. We performed a cross-sectional analysis of the characteristics of 5,794 pediatric and adult patients with epilepsy included in a collaborative database in France between 2007 and 2013. Comparisons between groups used Student's t-test or Fisher's exact test for binary or categorical variables. Factors associated with drug resistance and intellectual disability were evaluated in multi-adjusted logistic regression models. Mean age at inclusion was 17.9 years; children accounted for 67%. Epilepsy was unclassified in 20% of patients, and etiology was unknown in 65%, including those with idiopathic epilepsies. Etiologies differed significantly in adult- when compared to pediatric-onset epilepsy; however, among focal structural epilepsies, mesial temporal lobe epilepsy with hippocampal sclerosis began as often in the pediatric as in adult age range. Drug resistance concerned 53% of 4,210 patients evaluable for seizure control and was highest in progressive myoclonic epilepsy (89%), metabolic diseases (84%), focal cortical dysplasia (70%), other cortical malformations (69%), and mesial temporal lobe epilepsy with hippocampal sclerosis (67%). Fifty-nine percent of patients with focal structural epilepsy and 69% with epileptic encephalopathies were drug resistant; however, 40-50% of patients with West syndrome and epileptic encephalopathy with continuous spike-and-waves during sleep were seizure-free. Ages at onset in infancy and in young adults shared the highest risk of drug resistance. Epilepsy onset in infancy comprised the highest risk of intellectual disability, whereas specific cognitive impairment affected 36% of children with idiopathic focal epilepsy. Our study provides a snapshot on epilepsy in patients referred to tertiary centers and discloses needs for diagnosis and treatment

  5. A review of 151 cases of pediatric noncystic fibrosis bronchiectasis in a tertiary care center

    Directory of Open Access Journals (Sweden)

    Banjar Hanaa

    2007-01-01

    Full Text Available Objective: This study was conducted to review the etiological factors and diseases associated with pediatric noncystic fibrosis bronchiectasis in a tertiary care center in Saudi Arabia. Materials and Methods: A retrospective review of all patients with confirmed noncystic fibrosis (Non-CF bronchiectasis by chest X-ray and/or CT chest in a pulmonary clinic during the period 1993-2005 at a tertiary care center in Riyadh. Results: A total of 151 cases were diagnosed as Non-CF bronchiectasis. Seventy-five (49.7% were male, 76 (50.3% were female; 148 (98% are alive and 3 (2% died. The southwestern regions constituted 72 (50% of the cases. There was a period of (5 ± 3.2 years between the start of symptoms and diagnosis of bronchiectasis. More than two-thirds of the patients had cough, tachypnea, wheezing, sputum production and failure to thrive. Ninety-one (60% had associated diseases: Pulmonary diseases in 48 (32%, immunodeficiency in 27 (18%, central nervous system anomalies in 10 (7%, cardiac in 10 (7% and asthma in 103 (68% of the patients. Left lower lobe was commonly involved in 114 (76% patients. Sixty-eight (67% were found to have sinusitis. More than two-thirds of patients had two or more associated diseases. Forty-nine (32% developed gastroesophageal reflux. Hemophilus influenza was cultured in 56 (37%, strept pneumoniae in 25 (17% and pseudomonas aeruginosa in 24 (16% of the patients. Eighty percent of the patients who had pulmonary function test had abnormal changes. Disease progression was related to development of symptoms before 5 years of age, persistent atelectasis and right lower lobe involvement ( P < 0.05. Conclusion: Non-CF bronchiectasis should be included in the differential diagnosis of recurrent chest infection in Saudi Arabia. Early diagnosis and identification of associated diseases is needed to prevent progression of the disease.

  6. Non-albicans Candida Vulvovaginitis: Treatment Experience at a Tertiary Care Vaginitis Center.

    Science.gov (United States)

    Powell, Anna M; Gracely, Edward; Nyirjesy, Paul

    2016-01-01

    The aims of this study are to analyze a cohort of women with vulvovaginal symptoms and positive cultures for non-albicans Candida (NAC) to determine whether yeast was responsible for their symptoms and to evaluate the mycological effectiveness of various regimens. This observational study was performed from retrospective chart review of patients with positive NAC cultures between April 1, 2008, and January 31, 2011, at a tertiary care vaginitis center. Patient intake demographics were entered into a database. Follow-up visits were analyzed for data about patient treatments and outcomes. Patients were considered a clinical cure if their symptoms were significantly improved and mycologic cure (MC) if later yeast cultures were negative. If clinical symptoms improved at the same time as MC, the isolate was considered the proximate cause for the symptoms. One hundred eight patients meeting entry criteria were analyzed. Boric acid was effective at obtaining MC in 32 (78%) of 41 patients with C. glabrata, 3 of 3 patients with C. tropicalis, and 3 of 3 patients with C. lusitaniae. Fluconazole was effective as initial treatment for 3 (60%) of 5 patients with C. glabrata and 13 (81%) of 16 patients with C. parapsilosis. In 52.7% of C. glabrata, 66.7% of C. parapsilosis, and 57.1% of C. tropicalis cases, effective antifungal therapy led to symptom improvement. In a tertiary care vaginitis center, NAC, when isolated on culture, caused clinically significant infections in approximately half of symptomatic patients. A majority of infections can be effectively treated with boric acid or fluconazole regardless of the non-albicans Candida species.

  7. An Audit on the Appropriateness of Coronary Computed Tomography Angiography Referrals in a Tertiary Cardiac Center.

    Science.gov (United States)

    Alderazi, Ahmed Ali; Lynch, Mary

    2017-01-01

    In response to growing concerns regarding the overuse of coronary computed tomography angiography (CCTA) in the clinical setting, multiple societies, including the American College of Cardiology Foundation, have jointly published revised criteria regarding the appropriate use of this imaging modality. However, previous research indicates significant discrepancies in the rate of adherence to these guidelines. To assess the appropriateness of CCTA referrals in a tertiary cardiac center in Bahrain. This retrospective clinical audit examined the records of patients referred to CCTA between the April 1, 2015 and December 31, 2015 in Mohammed bin Khalifa Cardiac Center. Using information from medical records, each case was meticulously audited against guidelines to categorize it as appropriate, inappropriate, or uncertain. Of the 234 records examined, 176 (75.2%) were appropriate, 47 (20.1%) were uncertain, and 11 (4.7%) were inappropriate. About 74.4% of all referrals were to investigate coronary artery disease (CAD). The most common indication that was deemed appropriate was the detection of CAD in the setting of suspected ischemic equivalent in patients with an intermediate pretest probability of CAD (65.9%). Most referrals deemed inappropriate were requested to detect CAD in asymptomatic patients at low or intermediate risk of CAD (63.6%). This audit demonstrates a relatively low rate of inappropriate CCTA referrals, indicating the appropriate and efficient use of this resource in the Mohammed bin Khalifa Cardiac Center. Agreement on and reclassification of "uncertain" cases by guideline authorities would facilitate a deeper understanding of referral appropriateness.

  8. Characteristics of Keratoconus Patients at a Tertiary Eye Center in India

    Directory of Open Access Journals (Sweden)

    Vinay B Agrawal

    2011-01-01

    Full Text Available Purpose: To evaluate the presentation and characteristics of patients with keratoconus at a tertiary eye care center in Mumbai, India. Methods: This single center, non-comparative, retrospective cohort analysis was performed on patients with keratoconus who presented to the Clear Vision Eye Center clinic from April 2007 to March 2009. Data was collected to characterize correlations among visual acuity, corneal biomicroscopic findings, and refractive and topographic findings in keratoconus. Results: Records of 274 patients including 189 male and 85 female subjects with mean age of 20.1±3.5 (range, 13 to 29 years at the time of diagnosis were assessed. There was history of skin allergy in 73 (26.6%, symptomatic ocular allergy in 67 (24.45% and asthma in 31 (11.31% patients. The most frequent corneal sign was Fleischer′s ring which was observed in 81% of cases. Corneal topography revealed mean simK (simulated keratometry of 53.3±6.1 (range, 41.2 to 69.0 diopters. Corneal topography analysis with the Cone Location Magnitude Index disclosed the presence of inferior cones in 93% of patients. Conclusion: This group of patients had younger age at presentation and more severe keratoconus as compared to western populations; contact lenses were used only in a minority of patients.

  9. Cost of practice in a tertiary/quaternary referral center: is it sustainable?

    Science.gov (United States)

    Cologne, K G; Hwang, G S; Senagore, A J

    2014-11-01

    Third-party payers are moving toward a bundled care payment system. This means that there will need to be a warranty cost of care-where the cost of complexity and complication rates is built into the bundled payment. The theoretical benefit of this system is that providers with lower complication rates will be able to provide care with lower warranty costs and lower overall costs. This may also result in referring riskier patients to tertiary or quaternary referral centers. Unless the payment model truly covers the higher cost of managing such referred cases, the economic risk may be unsustainable for these centers. We took the last seven patients that were referred by other surgeons as "too high risk" for colectomy at other centers. A contribution margin was calculated using standard Medicare reimbursement rates at our institution and cost of care based on our administrative database. We then recalculated a contribution margin assuming a 3 % reduction in payment for a higher than average readmission rate, like that which will take effect in 2014. Finally, we took into account the cost of any readmissions. Seven patients with diagnosis related group (DRG) 330 were reviewed with an average age of 66.8 ± 16 years, American Society of Anesthesiologists score 2.3 ± 1.0, body mass index 31.6 ± 9.8 kg/m(2) (range 22-51 kg/m(2)). There was a 57 % readmission rate, 29 % reoperation rate, 10.8 ± 7.7 day average initial length of stay with 14 ± 8.6 day average readmission length of stay. Forty-two percent were discharged to a location other than home. Seventy-one percent of these patients had Medicare insurance. The case mix index was 2.45. Average reimbursement for DRG 330 was $17,084 (based on Medicare data) for our facility in 2012, with the national average being $12,520. The total contribution margin among all cases collectively was -$19,122 ± 13,285 (average per patient -$2,731, range -$21,905-$12,029). Assuming a 3 % reimbursement reduction made the overall

  10. Quality of working life of nurses in a tertiary cancer center in Qatar

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    Santhirani Nagammal

    2017-01-01

    Full Text Available Background Nurses are the largest segment of professionals working in the healthcare industry, and a satisfactory quality of working life will empower them to provide the highest quality care to their patients. Aim To assess the quality of working life among nurses in a tertiary cancer care center in Qatar concerning the following variables; control at work, employee engagement, general well-being, home-work interface, job/career satisfaction, stress at work, and working conditions. Methods A cross-sectional, descriptive study was conducted to assess the QoWL among 146 Staff Nurses working in different units of a tertiary cancer center in Qatar. A Quality of Work life Scale, a seven-point Likert’s scale was used, were nurses self-reported their QoWL. Results The mean age of the study participants were 36.48 years ± 6.74, and mean total years of clinical experience in nursing and clinical experience at the center was 14.16 years and 7.65 years respectively. The majority (69.9% of the nurses who participated in the study were working in inpatient units. Around fifty-four percentage were graduate nurses. A vast majority (89.7% of the respondents were married and among them, 84.2% of nurses lived with their family. Nurses’ perception of the factors associated with QoWL including control and stress at work were found average, and others such as employee engagement, general well-being, homework interface, job/career satisfaction, working condition, and overall quality of work life were considered good. There was no statistically significant difference in the QoWL scores and participants’ characteristics (P>0.05. Conclusion The overall QoWL was found to be good for the Oncology Nurses working at a cancer center in Qatar. However, Nurses reported having varying degrees of stress at work. Nurses require highly specialized clinical competencies to accurately determine patients' states and predict and cope with difficulties that may occur during

  11. Stroke Mortality in Intensive Care Unit from Tertiary Care Neurological Center

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    Lekhjung Thapa

    2013-06-01

    Full Text Available Introduction: Stroke is the second most common cause of death and major cause of disability worldwide. About a quarter of stroke patients are dead within a month, about a third by 6 months, and a half by 1 year. Although the most substantial advance in stroke has been the routine management of patients in stroke care units, intensive care unit has remained the choice for stroke patients’ care in developing countries. This study explores the mortality of stroke patients in intensive care unit setting in tertiary care neurological centre in a developing country. Methods: We collected data of stroke patients admitted in our ICU from August 2009 to Aug 2010 and analyzed. Results: Total 44 (10.25% patients were admitted for acute stroke. Age ranged from 17-93 years. Low GCS (Glasgow Coma Scale, uncontrolled hypertension and aspiration pneumonia were common indications for admission in ICU. Total 23 (52.3% patients had hemorrhagic stroke and 21(47.7% patients had ischemic stroke. 13 (29.54% patients of stroke died within 7 days, 9 (69.23% patients of hemorrhagic stroke died within 6 days, and 4 patients (30.76% of ischemic stroke died within 7 days. 6 (13.63% patients left hospital against medical advice. All of these patients had ischemic stroke. Conclusions: Stroke mortality in intensive care unit remains high despite of care in tertiary neurological center in resource poor settings. Stroke care unit, which would also help dissemination of knowledge of stroke management, is an option for improved outcome in developing countries Keywords: intensive care unit; mortality; stroke; stroke care unit.

  12. Quality assessments for cancer centers in the European Union.

    Science.gov (United States)

    Wind, Anke; Rajan, Abinaya; van Harten, Wim H

    2016-09-07

    Cancer centers are pressured to deliver high-quality services that can be measured and improved, which has led to an increase of assessments in many countries. A critical area of quality improvement is to improve patient outcome. An overview of existing assessments can help stakeholders (e.g., healthcare professionals, managers and policy makers) improve the quality of cancer research and care and lead to patient benefits. This paper presents key aspects of assessments undertaken by European cancer centers, such as: are assessments mandatory or voluntary? Do they focus on evaluating research, care or both? And are they international or national? A survey was sent to 33 cancer centers in 28 European Union member states. Participants were asked to score the specifics for each assessment that they listed. Based on the responses from 19 cancer centers from 18 member states, we found 109 assessments. The numbers have steadily increased from 1990's till 2015. Although, a majority of assessments are on patient-care aspects (n = 45), it is unclear how many of those include assessing patient benefits. Only few assessments cover basic research. There is an increasing trend towards mixed assessments (i.e., combining research and patient-care aspects) The need for assessments in cancer centers is increasing. To improve efforts in the quality of research and patient care and to prevent new assessments that "reinvent the wheel", it is advised to start comparative research into the assessments that are likely to bring patient benefits and improve patient outcome. Do assessments provide consistent and reliable information that create added value for all key stakeholders?

  13. Causes of prolonged hospitalization among general internal medicine patients of a tertiary care center.

    Science.gov (United States)

    Ruangkriengsin, Darat; Phisalprapa, Pochamana

    2014-03-01

    Unnecessary days of prolonged hospitalization may lead to the increase in hospital-related complications and costs, especially in tertiary care center Currently, there have not been many studies about the causes of prolonged hospitalization. Some identified causes could, however, be prevented and improved. To identify the prevalence, causes, predictive factors, prognosis, and economic burden of prolonged hospitalization in patients who had been in general internal medicine wards of the tertiary care center for 7 days or more. Retrospective chart review study was conducted among all patients who were admitted for 7 days or more in general internal medicine wards of Siriraj Hospital, the largest tertiary care center in Thailand. The period of this study was from 1 August 2012 to 30 September 2012. Demographic data, principle diagnosis, comorbid diseases, complications, discharge status, total costs of admission and percentage of reimbursement were collected. The causes of prolonged hospitalization at day 7, 14, 30, and 90 were assessed. Five hundred and sixty-two charts were reviewed. The average length of stay was 25.9 days. The two most common causes of prolonged admission at day 7 were treatment of main diagnosed disease with stable condition (27.6%) and waiting for completion of intravenous antibiotics administration with stable condition (19.5%). The causes of prolonged hospitalization at day 14 were unstable condition from complications (22.6%) and those waiting for completion of intravenous antibiotics administration with stable condition (15.8%). The causes of prolonged admission at day 30 were unstable conditions from complications (25.6%), difficulty weaning or ventilator dependence (17.6%), and caregiver problems (15.2%). The causes of prolonged hospitalization at day 90 were unstable condition from complications (30.0%), caregiver problems (30.0%), and palliative care (25.0%). Poor outcomes were shown in the patients admitted more than 90 days. Percentage

  14. Project 'European Research Center for Air Pollution Abatement Measures'

    International Nuclear Information System (INIS)

    1985-04-01

    During the 5-7th of March 1985 the first status report of the project 'European Research Center for Air Pollution Control Measures' took place in the Nuclear Research Center, Karlsruhe. Progress reports on the following topics assessment and analysis of the impacts of airborne pollutants on forest trees; distinction from other potential causes of recent forest dieback, research into atmospheric dispersion, conversion and deposition of airborne pollutants, development and optimization of industrial-technical processes to reduce or avoid emissions and providing instruments and making recommendations to the industrial and political sectors were presented. This volume is a collection of the work reported there. 42 papers were entered separately. (orig./MG) [de

  15. Transfusion of blood and blood component therapy for postpartum haemorrhage at a tertiary referral center

    International Nuclear Information System (INIS)

    Hussain, N.; Shah, T.; Shah, N.; Khan, N.H.

    2011-01-01

    Objective: To determine the practice of transfusion of blood and blood products in cases of postpartum haemorrhage, at a tertiary referral center. Methods: A retrospective study was conducted where medical records were reviewed for women, who either delivered or were admitted in labour suite with diagnosis of postpartum haemorrhage. The study period extended from Jan 2008 to Oct 2009. During a period of 22 months, records were reviewed for transfusion of blood and blood products in above group of women. Data were analyzed for descriptive statistics. Results: During the study period, a total of 4744 patients were admitted in the labour suite. A total of 113 (2.36%) women were diagnosed with Post partum haemorrhage. Uterine atony was the commonest cause of PPH, followed by genital tract trauma. A total of 81(71%) women received transfusion of blood and blood components (1.6%). The mean blood loss was 1088 ml (+- 584ml). Transfusion of blood and blood component therapy was significantly more in women who underwent caesarean section, compared to those women who delivered vaginally. There was one case of acute tubular necrosis due to PPH, and seven maternal deaths. The mean hospital stay was of +- 3 days. Conclusion: In this hospital based study, the prevalence of PPH was 2.36 +- %, and the rate of transfusion of blood and blood products was 1.6%.

  16. Perceptions of focused prenatal care among women attending two tertiary centers in Nigeria.

    Science.gov (United States)

    Eleje, George U; Onwusulu, Daniel N; Ezeama, Chukwuemeka O; Afiadigwe, Evaristus A; Eke, Ahizechukwu C; Ikechebelu, Joseph I; Ugboaja, Joseph O; Okwuosa, Ayodele O

    2015-11-01

    To determine women's perceptions and expectations of focused prenatal care visits. The present questionnaire-based, cross-sectional survey was performed among pregnant women in their third trimester attending two tertiary health centers in southern Nigeria between January and March 2012. Obstetric data, histories, and information on preferences for prenatal visits were obtained using questionnaires. A total of 353 questionnaires were appropriately completed. Among 277 participants who stated a preference for the number of prenatal care visits, 241 (87.0%) reported a preference of more than four. Among 203 parous women, 132 (65.0%) had no previous negative obstetric experience. Only previous stillbirth (odds ratio [OR] 2.67, 95% confidence interval [CI] 1.05-6.77; P = 0.039) among multiparous women, and HIV/AIDS (OR 0.27, 95% CI 0.06-1.17; P = 0.048) among all women were significantly associated with a preference for more prenatal visits. Previous negative obstetric experiences did not generally affect preference for prenatal visits. However, pregnant women expressed dissatisfaction with a reduced number of visits. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  17. Analysis of 88 nephrectomies in a rural tertiary care center of India

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    Biswajit Datta

    2012-01-01

    Full Text Available Nephrectomy is not an uncommon surgery in day-to-day practice of urology. Trauma is the most common cause of emergency nephrectomy. On the other hand, elective nephrectomy is done for both benign and malignant diseases of the kidney. This study has been performed to know the different causes of nephrectomy in a rural, tertiary care center of India. In our series, we have studied all the elective nephrectomies done in our hospital during a period of eight years. We have analyzed 88 cases of nephrectomies regarding their age, sex, laterality of disease, and histopathologic report of the nephrectomy specimens. Out of 88 cases, 61 were males and 27 were females. In our series, 62.5% cases of nephrectomies were done for benign causes and 37.5% cases for malignant causes. Among the benign causes, neglected pelviureteric junction obstruction was the leading cause, followed by calculus disease resulting in obstruction. On the other hand, renal cell carcinoma was the most common malignant pathology requiring nephrectomy.

  18. Cross cultural comparison of constipation profiles at tertiary care centers between India and USA.

    Science.gov (United States)

    Singh, P; Surana, R; Soni, S; Agnihotri, A; Ahuja, V; Makharia, G K; Staller, K; Kuo, B

    2018-03-09

    Despite potential differences in patient perception of chronic constipation (CC) in geographically and culturally distinct regions, head-to-head studies comparing the clinical profile, constipation severity, impact on quality of life (QOL) and economic impact are lacking. We conducted a cross-sectional cohort study of patients presenting with CC to tertiary care centers in the USA and India. Standardized instruments were used to assess constipation subtype, disease severity, disease-specific QOL, somatization, and psychiatric comorbidities. We used multivariable linear regression to determine the predictors of QOL and number of healthcare visits. Sixty-six and 98 patients with CC were enrolled in the USA and India, respectively. Indian patients with CC had significantly more frequent bowel movements/week compared to their USA counterparts (Median 5 vs 3, P USA compared to India (65.5% vs 48%, P = .04). Higher depression score (P = .001), more severe constipation symptoms (P = .001) and site of the study being USA (P = .008) independently predicted worse QOL. Indian patients (P USA suggesting significant differences in perception of CC in different geographic and cultural settings. QOL and economic impact related to constipation varies with geographic/cultural setting irrespective of other clinical and psychosomatic features. © 2018 John Wiley & Sons Ltd.

  19. Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil.

    Science.gov (United States)

    Schweiger, Cláudia; Manica, Denise; Becker, Carolina Fischer; Abreu, Larissa Santos Perez; Manzini, Michelle; Sekine, Leo; Kuhl, Gabriel

    Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015. 123 children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%), followed by subglottic stenosis (16%) and pharyngomalacia (11%). The mortality rate was 31%. By the end of this review, 35 children (28.4%) had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77±0.84 vs. 1.7±1.00 comorbidities; pneurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  20. Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil,

    Directory of Open Access Journals (Sweden)

    Cláudia Schweiger

    Full Text Available Abstract Introduction: Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. Objective: To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. Methods: Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015. Results: 123 children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%, followed by subglottic stenosis (16% and pharyngomalacia (11%. The mortality rate was 31%. By the end of this review, 35 children (28.4% had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77 ± 0.84 vs. 1.7 ± 1.00 comorbidities; p < 0.001. Conclusion: Tracheostomy in children is a relatively frequent procedure at our hospital. The most common indications are glossoptosis and subglottic stenosis. A high mortality rate was found, potentially substantiated by the high number of critical care patients with chronic neurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities.

  1. Activities of an ethics consultation service in a Tertiary Military Medical Center.

    Science.gov (United States)

    Waisel, D B; Vanscoy, S E; Tice, L H; Bulger, K L; Schmelz, J O; Perucca, P J

    2000-07-01

    The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to have a mechanism to address issues of medical ethics. Most hospitals, especially those in the military, have an ethics committee composed solely of members who serve as an additional duty. To enhance the ethics consultation service, the 59th Medical Wing created a position under the chief of the medical staff for a full-time, fellowship-trained, medical ethicist. After establishment of this position, the number of consultations increased, a systematic program for caregiver education was developed and delivered, and an organizational presence was achieved by instituting positions on the institutional review board, the executive committee of the medical staff, and the credentials committee. Issues in medical care are becoming increasingly complicated, due in large part to financial stresses and technological advancements. Ethics consultation can help prevent and resolve many of these problems. This report discusses the activities of the first year of a full-time ethicist in a tertiary military medical center.

  2. Perception on Informed Consent Regarding Nursing Care Practices in a Tertiary Care Center.

    Science.gov (United States)

    Paudel, B; Shrestha, G K

    Background Consent for care procedures is mandatory after receipt of adequate information. It maintains patient's rights and autonomy to make thoughtful decisions. Poor communication often leads to poor health quality. Objective To assess hospitalized patients' perception on informed consent regarding nursing care practices in a tertiary care center. Method This is a descriptive cross-sectional study among 113 admitted patients conducted in February 2012 at Dhulikhel Hospital, Nepal. Patients of various wards were selected using purposive non-probability sampling with at least 3 days of hospitalization. Close ended structured questionnaire was used to assess patients' perception on three different areas of informed consent (information giving, opportunity to make decision and taking prior consent). Result Among the participants 71.6% perceived positively regarding informed consent towards nursing care practices with a mean score of 3.32 ± 1.28. Patients' perception on various areas of informed consent viz. information giving, opportunities to make specific decision and taking prior consent were all positive with mean values of 3.43±1.12, 2.88±1.23, 3.65±1.49 respectively. Comparison of mean perception of informed consent with various variables revealed insignificant correlation (p-value >0.05) for age, educational level and previous hospitalization while it was significant (p-value perception on informed consent towards nursing care practices. Communication skills of nurses affect the perception of patients' regardless of age, education level and past experiences.

  3. [Assessment of patients with pressure sores admitted in a tertiary care center].

    Science.gov (United States)

    Moro, Adriana; Maurici, Alice; do Valle, Juliana Barros; Zaclikevis, Viviane Renata; Kleinubing, Harry

    2007-01-01

    To determine the prevalence and analyze the profile of patients with pressure sores, focusing on risk factors, the patients' clinical characteristics at a tertiary care center, as well as stage and location of the lesions on the body. This was a cross sectional not controlled observational study, all patients admitted from April to June of 2005 were observed daily to identify all cases of pressure sores. The affected patients were evaluated by a standard questionnaire and the Scale of Braden was applied to define the risk of developing ulcers. Of the 690 patients admitted during the referred period, a prevalence of 5.9% of patients with lesions was observed, equivalent to 41 patients 63.9% of which were elderly and the average length of stay was 18 days. In the sample studied 41.5% of patients were found in the internal medicine section and the intensive care unit, ICU. The most common location for sores was the sacral area, corresponding to 73.1% of the patients, and stage II was the most frequent, observed in 58.5% of those patients. According to the Braden scale, most patients, 80.4%, had a high risk of developing pressure ulcers, compared to 9.7% of patients with moderate risk and 7.4% with low risk. The affected patients were at high risk of developing pressure sores. Prevalence of these lesions and the clinical and demographic profile of the affected patients are in accordance with the data in literature.

  4. Are clinical features able to predict Helicobacter pylori gastritis patterns? Evidence from tertiary centers.

    Science.gov (United States)

    Carabotti, Marilia; Lahner, Edith; Porowska, Barbara; Colacci, Enzo; Trentino, Paolo; Annibale, Bruno; Severi, Carola

    2014-12-01

    Outcome of Helicobacter pylori infection is different according to gastritis extension (i.e. antrum-restricted gastritis or pangastritis). The aim of this study is to evaluate whether different gastritis patterns are associated with specific gastrointestinal symptoms or clinical signs that could be suggestive of the topography of gastritis. 236 consecutive symptomatic outpatients were recruited in two tertiary centers. They filled in a validated and self-administered Rome III modular symptomatic questionnaire, and underwent gastroscopy with histological sampling. 154 patients with Helicobacter pylori infection were included. Clinical presentation did not differ between antrum-restricted gastritis and pangastritis, gastro-esophageal reflux disease being present in 48.2 and 54.1 % of patients and dyspepsia in 51.8 and 45.9 %, respectively. However, pangastritis statistically differed from antrum-restricted gastritis in that the presence of clinical signs (p gastritis pattern whereas their association with signs, accurately detected, is indicative for the presence of pangastritis.

  5. Indications and outcomes of pediatric keratoplasty in a tertiary eye care center: A retrospective review.

    Science.gov (United States)

    Gulias-Cañizo, Rosario; Gonzalez-Salinas, Roberto; Hernandez-Zimbron, Luis Fernando; Hernandez-Quintela, Everardo; Sanchez-Huerta, Valeria

    2017-11-01

    To evaluate indications and outcomes of pediatric keratoplasty in a tertiary eye center, and identify factors that affect visual outcomes.We performed a retrospective review of penetrating keratoplasty in children aged 0 to 18 years between 1995 and 2011 in the Asociación para Evitar la Ceguera en México IAP, Hospital "Dr. Luis Sánchez Bulnes".A total of 574 penetrating keratoplasties were performed during the study interval. Median follow-up was 5.0 years. Main indications included keratoconus (55.58%), postherpetic scarring (9.58%), traumatic opacities (7.49%), and bullous keratopathy (6.09%). Rejection rates at 5 years were 27% overall, and among indications, keratoconus showed the best graft survival at 60-months follow-up (85%). The percentage of patients with best corrected visual acuity (BCVA) posttransplant >20/400 at 5 years in the nonrejection group was 81.25% and 82.74% in 10 years of age (YOA) groups, respectively, versus a BCVA posttransplant > 20/400 at 5 years in the rejection group of 53.68% and 51.72% in 10 YOA groups, respectively. There was a statistically significant reduced rejection rate between genders at 18 months of follow-up, favoring males.Despite being considered a high-risk procedure in children, penetrating keratoplasty can achieve good results, especially in patients with keratoconus. It can achieve significative improvements of visual acuity, provided there is an adequate follow-up and treatment adherence.

  6. TB Risk Perceptions among Medical Residents at a Tertiary Care Center in India

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    Geeta S. Pardeshi

    2017-01-01

    Full Text Available Setting. Government tertiary health care center in India. Objective. To understand the perceptions of medical residents about their risk of developing TB in the workplace. Design. Cross-sectional study in which a semistructured questionnaire which included an open-ended question to assess their main concerns regarding TB in workplace was used to collect data. Results. Out of 305 resident doctors approached, 263 (94% completed a structured questionnaire and 200 of these responded to an open-ended question. Daily exposure to TB was reported by 141 (64% residents, 13 (5% reported a prior history of TB, and 175 (69% respondents were aware of TB infection control guidelines. A majority reported concerns about acquiring TB (78% and drug-resistant TB (88%. The key themes identified were concerns about developing drug-resistant TB (n=100; 50%; disease and its clinical consequences (n=39; 20%; social and professional consequences (n=37; 19%; exposure to TB patients (n=32; 16%; poor infection control measures (n=27; 14%; and high workload and its health consequences (n=16; 8%. Conclusion. Though many resident doctors were aware of TB infection control guidelines, only few expressed concern about lack of TB infection control measures. Doctors need to be convinced of the importance of these measures which should be implemented urgently.

  7. Prevalence of Clostridium difficile toxinotypes in infected patients at a tertiary care center in Lebanon.

    Science.gov (United States)

    Moukhaiber, Romy; Araj, George F; Kissoyan, Kohar Annie B; Cheaito, Katia A; Matar, Ghassan M

    2015-07-30

    Due to the increase in the incidence of Clostridium difficile associated diseases at a tertiary care center in Lebanon, this study was undertaken to determine the prevalent C. difficile toxinotypes. The immunocard method was used to test for toxins A and B in 88 collected stool samples, followed with API 20A to confirm for C. difficile. PCR amplification of the triose phosphate isomerase (tpi) gene, the toxin encoding genes tcdA, and tcdB, followed by toxinotyping, were performed on recovered isolates and stool specimens. Out of the 88 stool samples obtained, 30 (65.2%) were Immunocard positive, culture and or tpi positive for C. difficile. Of the 30 isolates, 4 were PCR negative for the tcdA and tcdB genes (A-B-), and 26 were PCR positive for the tcdA and / or tcdB genes with 4 being A+B+, 1 A+B-, and 21 A-B+. The results of toxinotyping showed that 2 isolates belonged to toxinotype 0, 4 to toxinotype XI, 2 to toxinotype XII, 1 to toxinotype XVI, 1(A+B-) and twenty (A-B+) designated as toxinotype 0-like. C. difficile was detected in 65.2% of patients' stools with prevalence of toxinotype 0-like. Identification of toxinotypes of C. difficile is important to determine the virulence potential of strains and control their spread.

  8. Drug utilization profile in adult patients with refractory epilepsy at a tertiary referral center

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    Priscila de Freitas-Lima

    2013-11-01

    Full Text Available Objective To evaluate the utilization profile of antiepileptic drugs in a population of adult patients with refractory epilepsy attending a tertiary center. Method Descriptive analyses of data were obtained from the medical records of 112 patients. Other clinical and demographic characteristics were also registered. Results Polytherapies with ≥3 antiepileptic drugs were prescribed to 60.7% of patients. Of the old agents, carbamazepine and clobazam were the most commonly prescribed (72.3% and 58.9% of the patients, respectively. Among the new agents, lamotrigine was the most commonly prescribed (36.6% of the patients. At least one old agent was identified in 103 out of the 104 polytherapies, while at least one new agent was prescribed to 70.5% of the population. The most prevalent combination was carbamazepine + clobazam + lamotrigine. The mean AED load found was 3.3 (range 0.4–7.7. Conclusion The pattern of use of individual drugs, although consistent with current treatment guidelines, is strongly influenced by the public health system.

  9. Acute pancreatitis during pregnancy, 7-year experience of a tertiary referral center.

    Science.gov (United States)

    Vilallonga, Ramón; Calero-Lillo, Aránzazu; Charco, Ramón; Balsells, Joaquim

    2014-01-01

    Acute pancreatitis is a common cause of acute abdomen in pregnant women. The purpose of this study was to determine the frequency at our institution and its management and outcomes. A retrospective analysis of a database of cases presented in 7 consecutive years at a tertiary center was performed. Between December 2002 and August 2009, there were 19 cases of acute pancreatitis in pregnant women, 85% with a biliary etiology. The highest frequency was in the third trimester of pregnancy (62.5% cases). In cases of gallstone pancreatitis, 43.6% of pregnant women had had previous episodes before pregnancy. A total of 52.6% of the patients were readmitted for a recurrent episode of pancreatitis during their pregnancy. Overall, 26.3% of the patients received antibiotic treatment and 26.3% parenteral nutrition. Laparoscopic cholecystectomy was performed during the 2nd trimester in two patients (10.5%). There was no significant maternal morbidity. Acute pancreatitis in pregnant women usually has a benign course with proper treatment. In cases of biliary origin, it appears that a surgical approach is suitable during the second trimester of pregnancy. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  10. Prevalence of Falls and Its Associated Factors among Elderly Diabetes in a Tertiary Center, Malaysia

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    A. K. Azidah

    2012-01-01

    Full Text Available The purpose of this study is to determine the prevalence of falls and its associated factors among elderly diabetes type 2 patients attending a tertiary center in Malaysia. We conducted a cross-sectional study among 288 elderly diabetes type 2. The data collected includes data on sociodemographic, diabetes history, comorbid diseases, drug use, and activity of daily living (Barthel’s index. The patient also was examined physically, and balance and gait assessment was carried out. Prevalence of falls among elderly diabetes was 18.8%. Female gender (OR: 2.54, P<0.05, age group more than 75 (OR: 2.97, P<0.05, retinopathy (OR: 2.19, P<0.05, and orthostatic hypotension (OR: 2.87, P<0.05 were associated with higher risk for falls. High balance and gait score was associated with reduced risk of fall in elderly diabetes (OR: 0.89, P<0.05. In conclusion, the factors that are associated with higher risk for falls among elderly diabetes were female sex, age group more than 75, presence of retinopathy, and orthostatic hypotension. Those who had higher balance and gait score were found to be less likely to fall compared with those with lower score.

  11. Building the Nonuniversity, Tertiary Care Center Hepatobiliary and Pancreatic Surgery Practice: Structural and Financial Considerations.

    Science.gov (United States)

    Baker, Erin H; Siddiqui, Imran; Vrochides, Dionisios; Iannitti, David A; Martinie, John B; Rorabaugh, Lauren; Jeyarajah, D Rohan; Swan, Ryan Z

    2016-12-01

    Early in their careers, many new surgeons lack the background and experience to understand essential components needed to build a surgical practice. Surgical resident education is often devoid of specific instruction on the business of medicine and practice management. In particular, hepatobiliary and pancreatic (HPB) surgeons require many key components to build a successful practice secondary to significant interdisciplinary coordination and a scope of complex surgery, which spans challenging benign and malignant disease processes. In the following, we describe the required clinical and financial components for developing a successful HPB surgery practice in the nonuniversity tertiary care center. We discuss significant financial considerations for understanding community need and hospital investment, contract establishment, billing, and coding. We summarize the structural elements and key personnel necessary for establishing an effectual HPB surgical team. This article provides useful, essential information for a new HPB surgeon looking to establish a surgical practice. It also provides insight for health-care administrators as to the value an HPB surgeon can bring to a hospital or health-care system.

  12. The Pattern of Juvenile Idiopathic Arthritis in a Single Tertiary Center in Saudi Arabia

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    Mohammad H. Al-Hemairi

    2016-01-01

    Full Text Available Introduction. Juvenile Idiopathic Arthritis (JIA is the most common chronic arthritis in children. Our aim is to describe demographic, clinical, and laboratory characteristics and treatment of JIA patients followed up in Pediatric Rheumatology clinic in a tertiary center in Saudi Arabia. Methods. Medical records of all patients who are followed up between January 2007 and January 2015 were retrospectively reviewed. Data were collected about demographic, clinical, and laboratory features and treatment. Results. Total patients were 82, males were 31 (37.8%, and mean age of JIA onset was 7.1 ± 3.6 yr. Mean follow-up duration was 2.67±1.6 yr. Systemic onset JIA (SoJIA was the commonest (36.5%, followed by polyarticular in 29.2% and oligoarticular in 28%. Large and small joints are involved in 76 (92% and 30 (36.6%, respectively. Main extra-articular feature was fever in 34 (41.4%. Uveitis was diagnosed in 7 (8.5% and in 5 (21.7% of oligoarticular JIA. Anemia was found in 49 (59.7%, high ESR in 45 (54.8%, and leukocytosis and thrombocytosis in 33 (40.2%. Positive ANA was found in 30 (36.5% mainly in oligoarticular subtype as 12 (52% patients (out of 23 had this positive test. 9 patients (10.9% required NSAIDs only, 6 patients (7.3% required NSAIDs and intra-articular steroids only, and 19 (23% required NSAIDs, methotrexate, steroids, and biologics. Conclusion. SoJIA is the most common JIA subtype in our study. A population based rather than a single center study will give more details about JIA characteristics in Saudi Arabia

  13. Extremely elevated erythrocyte sedimentation rate. Etiology at a tertiary care center in Saudi Arabia

    International Nuclear Information System (INIS)

    Muhammad Yousuf; Javed Akhter; Khalid Al-Khairy; Mohammed A. Al-Saadan; Salih Bin-Salih

    2010-01-01

    To evaluate the etiology of extremely elevated erythrocyte sedimentation rate (ESR) in adolescents and adults at a tertiary care center. This retrospective, cross-sectional, observational study was carried out at King Abdulaziz Medical City, Riyadh, Saudi Arabia using the Westergren method of determining ESR in adolescents and adults aged >/=12 years. The patients included inpatients and outpatients with medical, surgical, and gynecological problems. During a period from June 2007 to October 2008, consecutive, non-repetitive patients with ESR >/=100 mm/hour were evaluated for possible etiology by checking the electronic and paper data file of each patient. During the study period, out of the 44,366 ESR tests carried out at this center, 1864 (4.2%) had an ESR >/=100 mm/hour belonging to 567 patients. Out of 508 patients fulfilling the study criteria, the main associated causes included: infections (38.6%), autoimmune diseases (15.9%), malignancy (15.4%), miscellaneous causes (10.2%), ischemic tissue injury or trauma (8.7%), and renal diseases (8.4%). Ten common individual causes included: rheumatoid arthritis (7.3%), osteomyelitis (6.9%), tuberculosis (5.5%), trauma (5.3%), lymphoma and sepsis of unknown origin (5.1%) each, urinary tract infection (4.7%), septic arthritis (3.1%), abscesses (2.8%), and pregnancy (2.2%). Fourteen (2.4%) patients had no known cause. Most of the patients with extreme ESR elevation have an underlying cause and a focused evaluation of such patients needs to be carried out to reach a diagnosis.

  14. A Three-Year Experience of Medical Thoracoscopy at A Tertiary Care Center of Himalayan Region

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    Rakhee Sodhi

    2016-03-01

    Full Text Available Introduction: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases. Despite its proven role in diagnostic and therapeutic purposes, it is infrequently used, which could be because of cost of equipment and lack of training. We analyzed our initial 3 years record of thoracoscopy at Himalayan Institute of Medical Sciences, a tertiary care center in Himalayan region of north India. Materials and Methods: This cross-sectional study was to analyze our experience of medical thoracoscopy which was started in Jan 2011 at our center. All patients who underwent thoracoscopy during the period between Jan 2011 to Dec 2013 were included in the study. Thoracoscopy was performed for diagnosis of undiagnosed pleural effusions. Clinical, radiological, cytological & histopathological data of the patients were collected prospectively and analysed. Results: The diagnostic yield for a pleuroscopic pleural biopsy in our study was 87.23% (41/47. Malignancy was diagnosed histopathologically in 70.2% (33/47 patients (both primary & metastatic pleural carcinoma and tuberculosis in 10.6% (5/47. There was no mortality related to procedure. Only three patients had minor complications like subcutaneous emphysema which was mild and resolved by second post-procedure day. Pain at intercostal drain site was observed in some patients. Conclusion: Thoracoscopy is an easy outpatient procedure and an excellent diagnostic tool for pleural effusion of uncertain etiology. It has low complication rate even in settings where the procedure is just started. It should be included in the armamentarium of tools for management of pleural effusion.

  15. HIV-associated hematologic malignancies: Experience from a Tertiary Cancer Center in India.

    Science.gov (United States)

    Reddy, Rakesh; Gogia, Ajay; Kumar, Lalit; Sharma, Atul; Bakhshi, Sameer; Sharma, Mehar C; Mallick, Saumyaranjan; Sahoo, Ranjit

    2016-01-01

    Data on HIV associated hematologic malignancies is sparse from India. This study attempts to analyze the spectrum and features of this disease at a tertiary cancer center in India. Retrospective study from case records of patients registered with a diagnosis of hematologic malignancy and HIV infection between January 2010 and June 2015. Thirteen cases of HIV associated hematologic malignancies were identified, six of them pediatric. HIV diagnosis was concurrent to diagnosis of cancer in 12 and preceded it in one of them. ECOG PS at presentation was >1 in all of them. All patients, except one, had B symptoms. Six of the patients had bulky disease and six are stage 4. Predominant extranodal disease was seen in 67% of them. NHL accounted for 10 of 13 patients and DLBCL-Germinal center was the most common subtype. Mean CD4+ cell count was 235/μL (range, 32-494). HAART could be given along with chemotherapy to 11 patients. Two-thirds of patients received standard doses of therapy. Chemo-toxicity required hospitalization in 58%. CR was achieved in 45% and 36% had progressive disease with first-line therapy. At the time of last follow up, 3 patients were alive with responsive disease, 2 in CR and 1 in PR. None of the pediatric patients were long time responders. These malignancies were of advanced stage and higher grade. Goal of therapy, in the HAART era, is curative. Pediatric patients had dismal outcome despite good chemotherapy and HAART. There is an urgent need to improve data collection for HIV related cancers in India.

  16. Pap Smear Abnormalities in Women Admitted to a Tertiary Health Center in Southeast Turkey

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    Alev Ozer

    2014-12-01

    Full Text Available Aim: To analyze the cervical cytological abnormalities which are detected in women undergoing Pap screening in a tertiary health care center within Siirt, a southeastern province of Turkey. Material and Method: A total of 3000 women who underwent Pap screening at the study center between January 1, 2009 and December 31, 2009 were recruited for the study. The women who were diagnosed with benign epithelial changes, infectious alterations, as well as atypical squamous cells with undetermined significance (ASC-US, atypical squamous cells of high significance (ASC-H, and low-grade squamous intraepithelial lesion (LSIL were included. Results: Benign epithelial alterations, infectious changes, ASCUS, ASC-H, and LSIL were detected in 83.7%, 15.3%, 0.8%, 0.1% and 0.1% of the Pap smears respectively. A significant correlation was found between the patient age and the histopathological alterations in the Pap smears (r=0.072, p=0.001. Although no correlation could be detected between gravidity and Pap smear results (r=0.033, p=0.067, a significant correlation existed between parity and the histopathological findings within the Pap smears (r=0.051, p=0.005. Interestingly, the Pap smear results were found to be unrelated to socioeconomic status (r=0.088, p=0.168, education level (r=0.048, p=0.257, and smoking habit (r=0.086, p=0.077. Discussion: The present study has reported a value of 1.0% for the overall prevalence of cervical cytological abnormalities, which is much lower than in western countries. Thus, rather than being dependent on the data reported by clinical studies that have been conducted in western countries, Turkish health care policy should be based on the data obtained from national studies.

  17. Reverse Stage Shift at a Tertiary Care Center: Escalating Risk in Men Undergoing Radical Prostatectomy

    Science.gov (United States)

    Silberstein, Jonathan L.; Vickers, Andrew J.; Power, Nicholas E.; Fine, Samson W.; Scardino, Peter T.; Eastham, James A.; Laudone, Vincent P.

    2011-01-01

    Purpose To evaluate changes in clinical and pathological characteristics of prostate cancer in patients treated surgically at a large tertiary care center in the context of increased use of active surveillance (AS) and minimally invasive surgery (MIS). Materials We performed retrospective review of 6,624 patients with localized prostate cancer who underwent radical prostatectomy from 2000–2010 at Memorial Sloan-Kettering Cancer Center. Patients were stratified by surgical approach (open, laparoscopic or robotic) and risk categories (low, intermediate, or high). Patients with low-risk disease, without intervention and minimum followup of 6 months were considered to have elected AS. Results AS cases increased from <20 per year between 2000–2004 to ≥100 per year between 2007–2009. Over the same decade MIS cases (laparoscopic or robotic) increased from zero to 63% of all surgical cases. The percentage of patients in intermediate- and high-risk categories increased over time, while the percentage in the low-risk category decreased (OR per year 0.91, 95% CI 0.89, 0.92, p <0.0005). The proportion of surgery patients with Gleason 6 tumors decreased over time (OR per year 0.87, 95% CI 0.85, 0.88; p <0.0005) while pathologic stage and Gleason score increased (p <0.0005). The proportion of low-risk cases decreased across all types of surgery, with the largest decrease in robotic surgery (p <0.0005). Conclusions We observed a reverse stage shift in patients undergoing radical prostatectomy since 2000 despite the introduction and rapid proliferation of MIS. These findings may be due to increased use of AS and institutional focus on treatment of higher-risk disease. PMID:21484780

  18. Assessment of ocular toxoplasmosis patients reported at a tertiary center in the northeast of Iran.

    Science.gov (United States)

    Hosseini, Seyedeh Maryam; Moghaddas, Elham; Sharifi, Karim; Dadgar Moghaddam, Malihe; Shamsian, Seyed Aliakbar

    2018-01-15

    Ocular toxoplasmosis, which is caused by the single-cell parasite Toxoplasma gondii, is currently the most significant cause of posterior uveitis in the world. No previous studies have described the prevalence and clinical features of ocular toxoplasmosis in the northeast of Iran. The purpose of the current study was to address this gap. In this retrospective study, the medical records of 488 uveitis patients who presented to the Khatam-al-Anbia Eye Hospital of Mashhad University of Medical Sciences, a tertiary ophthalmology center in the northeast of Iran, between January 2013 and December 2015 were evaluated. The clinical features and risk factors of 99 (20%) consecutive patients with ocular toxoplasmosis were extracted. Ninety-nine including 53 (53.5%) female and 46 (46.5%) male patients with ocular toxoplasmosis were included in the analysis. Reduced vision (77%) and floaters (15.2%) were the most common presenting symptoms. The age category that was most affected by ocular toxoplasmosis was 20-40 years (range: 11-65 years) with a mean age of 27.2. All patients had retinochoroiditis, but just two had anterior uveitis. All of the extracted patients, with the exception of three patients, had unilateral involvement. None of the patients had any other medical disorders with the exception of one woman, who had diabetes. Only four recurring ocular toxoplasmosis patients were referred to the education hospital during the study. Serology data were available for just 32 patients, of which 31 (96.8%) were IgG positive, and 1 (3.2%) was IgM positive. Toxoplasma gondii was responsible for 20% of the patients of uveitis that presented to the largest ophthalmology center in the northeast of Iran. There is a high incidence of patients of ocular toxoplasmosis in the northeast of Iran, and it is a significant cause of uveitis and visual impairment in this area.

  19. Indications for Corneal Transplantation at a Tertiary Referral Center in Tehran

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    Mohammad Zare

    2010-01-01

    Full Text Available Purpose: To report the indications and techniques of corneal transplantation at a tertiary referral center in Tehran over a 3-year period. Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran from March 2004 to March 2007 were reviewed to determine the indications and types of corneal transplantation. Results: During this period, 776 eyes of 756 patients (including 504 male subjects with mean age of 41.3±21.3 years underwent corneal transplantation. The most common indication was keratoconus (n=317, 40.8% followed by bullous keratopathy (n=90, 11.6%, non-herpetic corneal scars (n=62, 8.0%, infectious corneal ulcers (n=61, 7.9%, previously failed grafts (n=61, 7.9%, endothelial and stromal corneal dystrophies (n=28, 3.6%, and trachoma keratopathy (n=26, 3.3%. Other indications including Terrien′s marginal degeneration, post-LASIK keratectasia, trauma, chemical burns, and peripheral ulcerative keratitis constituted the rest of cases. Techniques of corneal transplantation included penetrating keratoplasty (n=607, 78.2%, deep anterior lamellar keratoplasty (n=108, 13.9%, conventional lamellar keratoplasty (n=44, 5.7%, automated lamellar therapeutic keratoplasty (n=8, 1.0%, and Descemet stripping endothelial keratoplasty (n=6, 0.8% in descending order. The remaining cases were endothelial keratoplasty and sclerokeratoplasty. Conclusion: In this study, keratoconus was the most common indication for penetrating keratoplasty which was the most prevalent technique of corneal transplantation. However, deep anterior lamellar keratoplasty is emerging as a growing alternative for corneal pathologies not involving the endothelium.

  20. A STUDY OF PERINATAL OUTCOME IN TWIN GESTATION IN A TERTIARY CARE CENTER

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    Rinku Girija

    2017-02-01

    Full Text Available BACKGROUND Perinatal mortality is an index of obstetric care. Twin pregnancy is a high-risk pregnancy since most often the foetus in born prematurely or retarded physically; it may turn out to be a dreaded event, especially in rare instances of simultaneous death of twins or death of one twin in mid trimester thereby worsening the prognosis of the surviving twin. The aim of the study is to study the perinatal mortality and morbidity of twin gestation and factors affecting the same in a tertiary care center. MATERIALS AND METHODS This is a prospective study. 100 successive cases of multiple pregnancy beyond 28 weeks of gestation admitted during the study period were followed from the antenatal period upon their admission to the antenatal ward and the labour room. 100 cases of singleton pregnancies during the same period taken as control. Detailed obstetric history, family history of twins, intake of ovulation inducing agents, time of diagnosis of twin pregnancy confirmed by USS examination were noted. Maternal antenatal complications like anaemia, hypertension, jaundice, etc. noted. The mode of onset of labour, presentation of foetus noted and if possible confirmed by USS, routine and special investigation like PIH profile, FBS, PPBS. Doppler USS done wherever necessary. Study Setting and Design- It is a prospective observational study of 100 consecutive twin gestations of gestational age 28 weeks and above at a tertiary care hospital attached to Government Medical College, Thiruvananthapuram, for a period of 6 months. Perinatal outcome including perinatal morbidity and mortality in relation to gestational age, mode of delivery, chorionicity, birth weight of the baby and NICU admission were analysed. RESULTS Data collected was analysed with descriptive statistics like percentage, proportion, rates, ratio and chi-square test. CONCLUSION In spite of so many advances in Obstetrics and Neonatology, the perinatal mortality and morbidity in twin

  1. Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single center experience.

    Science.gov (United States)

    Manjunath, C N; Srinivas, P; Ravindranath, K S; Dhanalakshmi, C

    2014-01-01

    Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with rheumatic heart disease (RHD) being the dominant form of valvular heart disease (VHD) in developing nations. The current study was undertaken at a tertiary care cardiac center with the objective of establishing the incidence and patterns of VHD by Echocardiography (Echo). Among the 136,098 first-time Echocardiograms performed between January 2010 and December 2012, an exclusion criterion of trivial and functional regurgitant lesions yielded a total of 13,289 cases of organic valvular heart disease as the study cohort. In RHD, the order of involvement of valves was mitral (60.2%), followed by aortic, tricuspid and pulmonary valves. Mitral stenosis, predominantly seen in females, was almost exclusively of rheumatic etiology (97.4%). The predominant form of isolated MR was rheumatic (41.1%) followed closely by myxomatous or mitral valve prolapse (40.8%). Isolated AS, more common in males, was the third most common valve lesion seen in 7.3% of cases. Degenerative calcification was the commonest cause of isolated AS (65.0%) followed by bicuspid aortic valve (BAV) (33.9%) and RHD (1.1%). Multiple valves were involved in more than a third of all cases (36.8%). The order of involvement was MS + MR > MS + AR > MR + AR > AS + AR > MR + AS > MS + AS. Overall, 9.7% of cases had organic tricuspid valve disease. RHD contributed most to the burden of VHD in the present study with calcific degeneration, myxomatous disease and BAV being the other major forms of VHD. Multiple valves were affected in more than a third of all cases. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  2. Combined Neutron Center for European Research and Technology

    International Nuclear Information System (INIS)

    Lagniel, Jean-Michel

    2002-01-01

    High-power proton linacs are needed as driver for several applications, namely transmutation of nuclear waste using Accelerator Driven Systems (ADS), spallation neutron sources (ESS in Europe) and other fields of basic and applied research (next generation of radioactive ion beam facilities, neutrino factories, muon colliders, irradiation facilities for material testing...). The possible synergies among these projects will be pointed out and the feasibility study of high-power proton linac used as driver of a multi-user facility (CONCERT) will be presented. There was excellent scientific, technical and economic reasons to study a Combined Neutron Center for European Research and Technology (CONCERT) based on a high-power proton accelerator. Such an installation would serve condensed matter studies by spallation neutron scattering, a technological irradiation tool and R and D facility for an hybrid reactor demonstrator, a radioactive ion beam facility for nuclear physics, R and D developments for a muon/neutrino facility. The installation could therefore constitute a European center of excellence in the field of neutronics where a large number of scientific and technical executives could be trained. The CONCERT Project Team has performed the feasibility study of such a multi-user facility with: - a review of the beam needs for the different applications, - an analyze of their compatibility, - the definition of the scope of a site-independent project, - a selection of the most appropriate options regarding scientific, technical, financial, organizational and administrative aspects, - an estimation of the costs for construction, operation and the needs in manpower. The conceptual design report [17] is sufficiently detailed to minimize contingencies on those parts of the project having a large potential impact in terms of performances, costs or delays. (author)

  3. Risk Factors Predicting Mortality in Patients with Lung Abscess in a Public Tertiary Care Center in Karachi, Pakistan

    OpenAIRE

    Shaista Ghazal; Ashok Kumar; Binav Shrestha; Sana Sajid; Maria Malik; Nadeen Rizvi

    2013-01-01

    Introduction: Lung abscess is a commonly encountered entity in South-East Asia but not much data regarding its outcome is available. The objective of this study was to identify the factors associated with increased mortality in patients diagnosed with lung abscess in a tertiary care center of Karachi, Pakistan. Methods: A retrospective case analysis was performed via hospital records, on patients admitted with lung abscess between January 2009 and January 2011 at the largest state...

  4. Impact of an Infection Control Program on the Prevalence of Nosocomial Infections at a Tertiary Care Center in Switzerland

    OpenAIRE

    Ebnöther, Corina; Tanner, Beate; Schmid, Flavia; Rocca, Vittoria La; Heinzer, Ivo; Bregenzer, Thomas

    2017-01-01

    Objective. To study the impact of a multimodal infection control program on the rate of nosocomial infections at a 550-bed tertiary care center. Methods. Before and after the implementation of an infection control program, the rate of nosocomial infection was recorded in time-interval prevalence studies. Hand hygiene compliance was studied before and after the intervention. As a surrogate marker of compliance, the amount of alcohol-based hand rub consumed before the intervention was compared ...

  5. Day-Case Treatment of Peripheral Arterial Disease: Results from a Multi-Center European Study

    Energy Technology Data Exchange (ETDEWEB)

    Spiliopoulos, Stavros, E-mail: stavspiliop@med.uoa.gr, E-mail: stavspiliop@upatras.gr; Karnabatidis, Dimitrios, E-mail: karnaby@med.upatras.gr [Patras University Hospital, Department of Interventional Radiology (Greece); Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Diamantopoulos, Athanasios, E-mail: adiamantopoulos@gmail.com [Guy’s and St Thomas’ Hospitals, NHS Foundation Trust, King’s Health Partners, Department of Interventional Radiology (United Kingdom); Ali, Tariq, E-mail: tariq.ali@addenbrookes.nhs.uk [Addenbrooke’s University Hospital, NHS Foundation Trust, Department of Interventional Radiology (United Kingdom); Kitrou, Panagiotis, E-mail: panoskitrou@gmail.com [Patras University Hospital, Department of Interventional Radiology (Greece); Cannavale, Alessandro, E-mail: alessandro.cannavale@hotmail.com; Krokidis, Miltiadis, E-mail: miltiadis.krokidis@addenbrookes.nhs.uk [Addenbrooke’s University Hospital, NHS Foundation Trust, Department of Interventional Radiology (United Kingdom)

    2016-12-15

    PurposeThe purpose of the study was to investigate safety and feasibility of day-case endovascular procedures for the management of peripheral arterial disease.Materials and MethodsThis was a multi-center, retrospective study including all patients treated over a 30-month period with endovascular angioplasty or stenting for intermittent claudication (IC) or critical limb ischemia (CLI) on a day-case basis, in Interventional Radiology (IR) departments of three European tertiary hospitals. Exclusion criteria were not related to the type of lesion and included unavailability of an adult able to take care of patient overnight; high bleeding risk and ASA score ≥4. Primary efficacy outcome was the rate of procedures performed on an outpatient basis requiring no further hospitalization and primary safety outcome was freedom from 30-day major complications’ rate.ResultsThe study included 652 patients (male 75 %; mean age 68 ± 10 years; range: 27–93), 24.6 % treated for CLI. In 53.3 % of the cases a 6Fr sheath was used. Technical success was 97.1 %. Haemostasis was obtained by manual compression in 52.4 % of the accesses. The primary efficacy outcome occurred in 95.4 % (622/652 patients) and primary safety outcome in 98.6 % (643/652 patients). Major complications included five (0.7 %) retroperitoneal hematomas requiring transfusion; one (0.1 %) common femoral artery pseudoaneurysm successfully treated with US-guided thrombin injection, two cases of intra-procedural distal embolization treated with catheter-directed local thrombolysis and one on-table cardiac arrest necessitating >24 h recovery. No major complication was noted after same-day discharge.ConclusionsDay-case endovascular procedures for the treatment of IC or CLI can be safely and efficiently performed in experienced IR departments of large tertiary hospitals.

  6. Management of Placenta Invasion Anomaly and Cesarean Hysterectomy: Eight-year Experience of A Tertiary Center

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    İbrahim Kalelioğllu

    2013-09-01

    Full Text Available Objective: We aimed to present our experience with the management of placenta invasion anomaly by reviewing clinical and operative features of the cases of cesarean hysterectomy performed due to placenta invasion anomaly. Methods: In this retropective study, the charts of all patients who underwent cesarean hysterectomy with an indication of placenta invasion anomaly in Istanbul Faculty of Medicine Department of Obstetrics and Gynecology between 2005 and 2012 were reviewed. Results: In this period a total of 85 patients underwent cesarean hysterectomy. 81 (95.3% cases had experienced at least one cesarean delivery before. Majority of the operations (82.4% were performed in elective conditions. In 16 (18.8% cases bilateral hypogastric artery ligation was carried out because of profuse bleeding. There were no mortalities in the intra- or postoperative period. In 18 (21.2% cases, intraoperative urology consultation was needed. Full- thickness bladder laceration occured in 17 patients, and partial cyctectomy was performed in one patient due to the placenta percreata invading posterior wall of the bladder. Transfusion was needed in 72 (84.7% cases during and 50 (58.8% patients after operation. Dilutional trombocytopenia developed in 17 (20% patients due to massive transfusion. Histopathologically the diganosis was placenta accreata in 55 (64.7%, placenta increata in 1 (1.2% and placenta percreata in 25 (29.4% patients. The incidence of placenta invasion anomaly rose from 0.2% (7/3435 in 2005-2006 up to 0.8% (37/4344 in 2011-2012. Conclusion: The incidence of placenta invasion anomaly is increasing progressively. Cesarean hysterectomy being its classical treatment is an operation with a high risk of morbidity and it should be performed by experienced teams after appropriate preparations in tertiary centers where multidiciplinary approach is possible.

  7. Quality of Care of Hospitalized Infective Endocarditis Patients: Report from a Tertiary Medical Center.

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    Kashef, Mohammad Amin; Friderici, Jennifer; Hernandez-Montfort, Jaime; Atreya, Auras R; Lindenauer, Peter; Lagu, Tara

    2017-06-01

    There have been no recent studies describing the management and outcomes of patients with infective endocarditis (IE). We conducted a retrospective cohort study of adult patients admitted to a tertiary medical center from 2007 to 2011 with a Duke criteria consistent discharge diagnosis of IE. We examined concordance with guideline recommendations. Outcomes included embolic events, inhospital and 1-year mortality, length of stay (LOS) and cardiac surgery. We used descriptive statistics to describe the cohort and Fisher exact and unpaired t tests to compare native valve endocarditis (NVE) with prosthetic valve endocarditis (PVE). Of 170 patients, definite IE was present in 135 (79.4%) and possible IE in 35 (20.6%); 74.7% had NVE, and 25.3% had PVE. Mean ± standard deviation age was 60.0 ± 17.9 years. Comparing PVE to NVE, patients with PVE were less likely to have embolic events (14.0% vs. 32.3%; P = 0.03), had shorter LOS (median 12.0 days vs. 14.0 days; P = 0.047), but they did not show a statistically significant difference in inhospital mortality (20.9% vs. 12.6%; P = 0.21). Of 170, patients 27.6% (n = 47) underwent valve surgery. Most patients received timely blood cultures and antibiotics. Guideline-recommended consults were underused, with 86.5%, 54.1%, and 47.1% of patients receiving infectious disease, cardiac surgery, and cardiology consultation, respectively. As the number of consultations increased (from 0 to 3), we observed a nonsignificant trend toward reduction in 6-month readmission and 12-month mortality. IE remains a disease with significant morbidity and mortality. There are gaps in the care of IE patients, most notably underuse of specialty consultation. Journal of Hospital Medicine 2017;12:414-420. © 2017 Society of Hospital Medicine

  8. Improving patient safety in cardiothoracic surgery: an audit of surgical handover in a tertiary center.

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    Bauer, Natasha Johan

    2016-01-01

    Novel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of England and the British Medical Association. A 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month. Just over half (52%) of the time, no handover took place. The majority of handovers (64%) occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient's age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care. These findings were presented to the department, and a handover proforma was implemented. Recommendations included the need for a new face-to-face handover. A reaudit will evaluate the effects of these changes.

  9. Emergent Awake tracheostomy--The five-year experience at an urban tertiary care center.

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    Fang, Christina H; Friedman, Remy; White, Priscilla E; Mady, Leila J; Kalyoussef, Evelyne

    2015-11-01

    There are few studies that discuss the issues surrounding emergent awake tracheostomy. We aim to review the indications, anesthesia used, complications, and outcomes of patients undergoing urgent awake tracheostomy. Chart review. Medical charts of patients who underwent an emergent awake tracheostomy at our institution-affiliated tertiary care center over a 5-year period from 2009 to 2014 were reviewed. Data were collected from inpatient, outpatient, and operative records. Sixty-eight patients underwent emergent awake tracheostomy. Over half presented with hoarseness (n=37, 54.4%) and/or stridor (n=37, 54.4%). Acute upper airway obstruction secondary to malignancy was the most common indication and accounted for 58 cases (85.3%). Thirty-nine (70.1%) of the 55 patients with squamous cell carcinoma presented with advanced disease (stage III or IV). Other indications included glottic or subglottic stenosis (4.4%), failure to intubate (2.9%), and other (7.4%). Local anesthesia was used alone in 35.3% of cases and in combination with conscious sedation in 64.7% of cases. Mild bleeding occurred postoperatively in five patients (7.4%). There were no other postoperative complications. Nineteen patients were lost to follow-up. The mean follow-up of 49 patients was 7.2 weeks, ranging from 2 to 261 weeks. Long-term complications occurred in three patients and included tracheitis 7.4% and suprastomal granuloma 2.9%. Eleven patients (22%) were decannulated at a mean of 11.8 months following tracheostomy. Emergent awake tracheostomy should be considered in patients with impeding airway obstruction and is a safe and effective method to secure an airway in these patients. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  10. A Retrospective Study on Snakebite Victims in a Tertiary Referral Center

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    Nasim Zamani

    2016-06-01

    Full Text Available Background: Snakebite is a serious public health problem in the world. The annual incidence of snakebites ranges from 4.5-9.1 in 100,000 population in Iran. With regard to diversity of envenomation profiles in different geographical parts of Iran, the aim of this study was to determine the demographical data, clinical and laboratory findings, and the outcome of the snakebite victims referred to a tertiary referral hospital. Methods: In this retrospective, cross-sectional study in Loghman Hakim Hospital Poisoning Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, during a four-year period from March 2007 to March 2011. The demographic data, clinical manifestations, paraclinical findings, treatments performed before hospital admission, time elapsed between the bite and hospital admission, total dose of antivenom and the patients’ outcomes were investigated. Results: Seventy cases (58 males, 12 females were evaluated. Most of the cases (79% were older than 20 year old. The most common bite site was upper extremity (67%. Most of the patients were admitted within 5 h after the snakebite. The most common local and systemic manifestations were swelling (90%, pain (81.4%, nausea and vomiting (24.3%. Leukocytosis (35.7% and thrombocytopenia (25.7% were the most common laboratory abnormalities. Most of the patients (97.1% were treated with antivenom. Fifty percent of the patients only received 3-5 vials of antivenom. The mortality rate was 1.4%. Necrosis of the toes and compartment syndrome were the only serious complications. Conclusion: The findings emphasize the importance of early admission to the hospital and treatment with antivenom to avoid morbidity and mortality.

  11. Hypophyseal Involvement in Immunoglobulin G4-Related Disease: A Retrospective Study from a Single Tertiary Center

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    Yang Liu

    2018-01-01

    Full Text Available This study aims to outline the clinical features and outcomes of IgG4-related hypophysitis (IgG4-RH patients in a tertiary medical center. We reviewed clinical manifestations and imaging and pituitary function tests at baseline, as well as during follow-up. Ten patients were included. The mean age at diagnosis of IgG4-RH was 48.4 (16.0–64.0 years. An average of 3 (0–9 extrapituitary organs were involved. Five patients had panhypopituitarism, three had only posterior hypopituitarism, one had only anterior hypopituitarism, and one had a normal pituitary function. One patient in our study had pituitary mass biopsy, lacking IgG4-positive cells despite lymphocyte infiltration forming an inflammatory pseudotumor. Five patients with a clinical course of IgG4-RH less than nine months and a whole course of IgG4-RD less than two years were managed with glucocorticoids, while three patients with a longer history were administered glucocorticoids plus immunosuppressive agents. One patient went through surgical excision, and one patient was lost to follow-up. All patients showed a prompt response clinically, but only three patients had normalized serum IgG4 levels. Two patients who took medications for less than six months relapsed. Conclusions. IgG4-RD is a broad disease, and all physicians involved have to be aware of the possibility of pituitary dysfunction. Younger patients should be expected. The histopathological feature of pituitary gland biopsy could be atypical. For patients with a longer history, the combination of GC and immunosuppressive agents is favorable. Early and adequate courses of treatment are crucial for the management of IgG4-RH. With GC and/or immunosuppressant treatment, however, pituitary function or diabetes insipidus did not improve considerably.

  12. Discharge against medical advice at a tertiary center in southeastern Nigeria: sociodemographic and clinical dimensions

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    Boniface Eze

    2010-09-01

    Full Text Available Boniface Eze1, Kenneth Agu2, Jones Nwosu31Department of Ophthalmology, 2Department of Surgery, 3Department of Otorhinolaryngology, University of Nigeria Teaching Hospital (UNTH, Ituku-Ozalla, Enugu, Enugu State, Nigeria Objective: To assess the sociodemographic and clinical characteristics of patients discharged against medical advice (DAMA at the University of Nigeria Teaching Hospital (UNTH, Enugu, Nigeria.Methods: The UNTH’s admission and discharge records between 1997 and 2006 were examined. Patients DAMA were identified; relevant sociodemographic and clinical data were extracted from their recalled clinical charts. Data were analyzed to generate rates, percentages, and proportions, and a level of P < 0.05 (one degree of freedom was considered statistically significant.Results: Of the 64,856 admissions (45.2% male, 54.8% female, 113 (0.002%; males: 54%, females: 46% were discharged against medical advice. DAMA rate was highest in Surgery (0.4%, and lowest in Obstetrics and Gynecology (0.1% and Pediatrics (0.1%. Infections (32.7%, trauma (29.2%, and cancer (16.8% were the leading diagnoses in patients DAMA. Financial constraints (37.2%, unsatisfactory response to treatment (17.7%, and dissatisfaction with hospital environment (15.0% were the main reasons for patients choosing to discharge themselves. DAMA was associated with a short admission period (P < 0.05, patients having high levels of formal education (P < 0.05, and those who had not been previously hospitalized (P < 0.05; but not with age (P = 0.398, gender (P = 0.489, or employment (P = 0.091.Conclusion: Comparatively, the rate of DAMA at UNTH is low. The causes of DAMA are preventable; for example, strengthening of the national health insurance scheme, enhancement of doctor-patient communication, and improvement of hospital environment would further reduce DAMA rate. Keywords: discharge against medical advice, tertiary center, sociodemographic characteristics, clinical

  13. Profile of angle closure in a tertiary care center in north India

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    Ichhpujani Parul

    2010-01-01

    Full Text Available Purpose: To study the demographic and clinical profile of the types of primary angle closure patients presenting at a tertiary care center in North India. Materials and Methods: Clinic records of patients diagnosed as primary angle closure were reviewed. International Society of Geographical and Epidemiological Ophthalmology (ISGEO classification scheme was used to categorize patients. Demographic and clinical data including prior management was collected and analyzed. Main Outcome measures were age, sex, symptomatology, best corrected visual acuity (BCVA, intraocular pressure (IOP, gonioscopy, optic disc assessment and visual field defects. Logistic regression model and receiver operating curve (ROC were calculated for predictors of type of glaucoma. Results: Eight hundred and fourteen patients (1603 eyes; males: 380, females: 434 were diagnosed to have various subtypes of angle closure. Mean (±SD age at presentation was significantly higher for males (57.57 ± 11.62 years as compared to females (53.64 ± 10.67 years ( P < 0001. Primary angle closure glaucoma (PACG was most frequently diagnosed subtype (49.38% followed by Primary angle closure (PAC (39.68% and Primary angle closure suspect (PACS (10.93% respectively. The three subtypes differed significantly among their mean IOP (on ANOVA, F = 14.04; P < 0001 using Greenhouse-Geisser correction. Univariate analysis was done to find significant predictors for the outcome of PACG. Logistic regression model and ROC containing the significant predictors yielded a very high AUC of 0.93 with strong discriminatory ability for PACG. Conclusion: In our hospital-based study, the significant predictors for the outcome of PACG included male gender, diminution of vision, the presence of pain and worsening grades of BCVA. Nearly half of PACG presented with advanced disease. In spite of one-third of the patients being diagnosed as angle closure prior to referral, only 8.34% had iridotomy (laser or surgical

  14. Long-term sequelae after lung abscess in children - Two tertiary centers' experience.

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    Wojsyk-Banaszak, I; Krenke, K; Jończyk-Potoczna, K; Ksepko, K; Wielebska, A; Mikoś, M; Bręborowicz, A

    2018-05-01

    The aim of the study was to describe the epidemiology and clinical characteristic of children hospitalized with pneumonia complicated by lung abscess, as well as to evaluate the long-term sequelae of the disease. A retrospective review of medical records of all patients treated for pulmonary abscess in two tertiary centers was undertaken. Pulmonary function tests and lung ultrasound were performed at a follow-up. During the study period, 5151 children with pneumonia were admitted, and 49 (0.95%) cases were complicated with lung abscess. In 38 (77.5%) patients, lung abscess was treated solely with antibiotics, and in nine cases (16.3%) surgically. In 21 (51.21%) children complete radiological regression was documented. The mean time for radiological abnormalities regression was 84.14 ± 51.57 days, regardless of the treatment mode. Fifteen patients were followed up at 61.6 ± 28.3 months after discharge. Lung ultrasound revealed minor residual abnormalities: pleural thickening, subpleural consolidations and line B artefacts in 11 (73.3%) children. Pulmonary function tests results were abnormal in eight (53.3%) patients, the most frequent abnormality being hyperinflation. We did not find a restrictive disorder in any of the children. There were no deaths in our study. Lung abscess is a rare but severe complication of pneumonia in children. Most children recover uneventfully with no significant long-term pulmonary sequelae. Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  15. Pregnancy Outcomes in HIV-Infected Women: Experience from a Tertiary Care Center in India.

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    Dadhwal, Vatsla; Sharma, Aparna; Khoiwal, Kavita; Deka, Dipika; Sarkar, Plaboni; Vanamail, P

    2017-01-01

    There is conflicting data on the effect of HIV infection as well as antiretroviral therapy (ART) on pregnancy outcome. The objectives of this study were to compare pregnancy outcomes in women with and without HIV infection, and to evaluate the effect of HAART on pregnancy in HIV-infected women. This is a prospective case record analysis of 212 HIV-infected women delivering between 2002 and 2015, in a tertiary health care center in India. The pregnancy outcome in HIV-infected women was compared to 238 HIV-uninfected controls. Women received ART for prevention of mother to child transmission as per protocol which varied during the period of study. Effect of use of ART on preterm birth (PTB) and intrauterine growth restriction (IUGR) was analyzed. HIV-infected women were more likely to have PTB, IUGR, and anemia (9.4%, 9.9%, 5.2%) compared to uninfected women (7.6%, 5%, 3.8%), this did not reach statistical significance (P-value = >0.05). The incidence of PIH, diabetes mellitus and intrahepatic cholestasis of pregnancy was similar in both groups. Mean birth weight was significantly lower in neonates of HIV-infected women (2593.60±499g) than HIV-uninfected women (2919±459g) [P-value=0.001]. neonatal intensive care unit admissions were also significantly higher in infants born to HIV-infected women (P-value=0.002). HIV-infected women on ART had decreased incidence of PTB and IUGR. Good antenatal care and multidisciplinary team approach can optimize pregnancy outcomes in HIV-infected women.

  16. Neurological complications of dengue fever: Experience from a tertiary center of north India

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    Rajesh Verma

    2011-01-01

    Full Text Available Introduction: Dengue, an acute viral disease transmitted by Aedes mosquitoes, is highly endemic in many tropical and subtropical areas of the world. Neurological complications of dengue infection have been observed more frequently in the recent past and some studies highlighted varied neurological complications arising in the course of dengue illness. In this retrospective study, we report various neurological complications observed during the last 2 years in patients of dengue fever. Materials and Methods: The patients presenting with neurological complications with positive serology (IgM antibody for dengue infection were consecutively recruited from the Department of Neurology/Medicine from a tertiary center of Lucknow, India. These patients were subjected to a detailed clinical evaluation, laboratory assessment including blood count, hematocrit, coagulation parameters, biochemical assays, serology for dengue fever, enzyme-linked immunosorbent assay for human immunodeficiency virus and other relevant investigations. Results: Twenty-six patients with neurological complications associated with confirmed dengue infection were observed during the last 2 years. Eighteen of these patients were male. Of the 26 patients, 10 patients were suffering from brachial neuritis, four patients had encephalopathy, three patients were consistent with the diagnosis of Guillain Barre syndrome, three patients had hypokalemic paralysis associated with dengue fever and two patients had acute viral myositis. Opsoclonus-myoclonus syndrome was diagnosed in two patients, myelitis in one patient and acute disseminated encephalo-myelitis also in one patient. Conclusion: Dengue fever was associated with widespread neurological complications. Brachial neuritis and opsoclonus-myoclonus syndrome were observed for the first time in this study.

  17. Perinatal Outcomes in Women with Preeclampsia: Experience of a Tertiary Referral Center

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    Semra Eroglu

    2015-11-01

    , pregestational medical evaluation and regular antenatal follow-up visits especially for high-risk women should be emphasized. Whenever possible, women diagnosed with severe preeclampsia or HELLP syndrome should be transferred to a tertiary medical center with adequate capabilities for maternal and neonatal intensive care in order to decrease perinatal morbidities.

  18. Four years prospective study of the maxillofacial trauma at a tertiary center in Western Nepal

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    Rajib Khadka

    2014-01-01

    Full Text Available Purpose: This study was conducted to find the epidemiological characteristics of maxillofacial trauma in the Western region of Nepal. Materials and Methods: All the trauma patients attending the Department of Oral and Maxillofacial surgery in 4 years period at a tertiary center in Western Nepal were included in the study. The incidence, prevalence, age and sex distribution, etiologies and types as well as seasonal and daily variation of maxillofacial trauma were studied. Results: Maxillofacial trauma with male (71.55% predominance was seen. Road traffic accidents (RTA, 46.5% were the most common cause, and 41.65% of fracture cases due to RTA were under the influence of alcohol. Accidents were more common on the rural roads (38.9%, and majorities (43.3% were due to motorcycle accidents. They were more common on Friday (36.7% and in winter seasons (51.2%. The mandible fractures (65.85% were more common than midface fractures (53.58% and 19.44% of the fractures were combined fractures. Parasymphysis in mandible (32.16% and zygoma (39.09% in midface were the most common type of fracture. Conclusion: The increased incidence of maxillofacial trauma following RTA under the influence of alcohol noted in this study reveals the need for formulating preventive measures in the Western region of Nepal. Need to aware people to avoid drink and drive proper traffic management, prevention of carrying excessive passengers, especially on the rooftop of vehicles on the highway and disposal of out of date vehicles and timely maintenance of faulty roads is a must.

  19. Relationship between socioeconomic status and HIV infection in a rural tertiary health center

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    Ogunmola OJ

    2014-04-01

    Full Text Available Olarinde Jeffrey Ogunmola,1 Yusuf Olatunji Oladosu,2 Michael Adeyemi Olamoyegun31Cardiac Care Centre, Department of Internal Medicine, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria, 2Department of Internal Medicine, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria, 3Endocrinology, Diabetes and Metabolism Unit, Department of Internal Medicine, Ladoke-Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, NigeriaBackground: There is a scarcity of data in rural health centers in Nigeria regarding the relationship between socioeconomic status (SES and HIV infection. We investigated this relationship using indicators of SES.Methods: An analytical case-control study was conducted in the HIV clinic of a rural tertiary health center. Data collection included demographic variables, educational attainment, employment status, monthly income, marital status, and religion. HIV was diagnosed by conventional methods. Data were analyzed with the SPSS version 16 software.Results: A total of 115 (48.5% HIV-negative subjects with a mean age of 35.49±7.63 years (range: 15–54 years, and 122 (51.5% HIV-positive subjects with a mean age of 36.35±8.31 years (range: 15–53 years were involved in the study. Participants consisted of 47 (40.9% men and 68 (59.1% women who were HIV negative. Those who were HIV positive consisted of 35 (28.7% men and 87 (71.3% women. Attainment of secondary school levels of education, and all categories of monthly income showed statistically significant relationships with HIV infection (P=0.018 and P<0.05, respectively after analysis using a logistic regression model. Employment status did not show any significant relationship with HIV infection.Conclusion: Our findings suggested that some indicators of SES are differently related to HIV infection. Prevalent HIV infections are now concentrated among those with low incomes. Urgent measures to improve HIV prevention among low income earners are

  20. Improving patient safety in cardiothoracic surgery: an audit of surgical handover in a tertiary center

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    Bauer NJ

    2016-05-01

    Full Text Available Natasha Johan Bauer Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, UK Background: Novel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of ­England and the British Medical Association. Methods: A 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month. Results: Just over half (52% of the time, no handover took place. The majority of handovers (64% occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient’s age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care. Conclusion: These findings were presented to the department, and a handover proforma

  1. Continuous palliative sedation for patients with advanced cancer at a tertiary care cancer center.

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    Prado, Bernard Lobato; Gomes, Diogo Bugano Diniz; Usón Júnior, Pedro Luiz Serrano; Taranto, Patricia; França, Monique Sedlmaier; Eiger, Daniel; Mariano, Rodrigo Coutinho; Hui, David; Del Giglio, Auro

    2018-01-04

    Palliative sedation (PS) is an intervention to treat refractory symptoms and to relieve suffering at the end of life. Its prevalence and practice patterns vary widely worldwide. The aim of our study was to evaluate the frequency, clinical indications and outcomes of PS in advanced cancer patients admitted to our tertiary comprehensive cancer center. We retrospectively studied the use of PS in advanced cancer patients who died between March 1st, 2012 and December 31st, 2014. PS was defined as the use of continuous infusion of midazolam or neuroleptics for refractory symptoms in the end of life. This study was approved by the Research Ethics Committee of our institution (project number 2481-15). During the study period, 552 cancer patients died at the institution and 374 met the inclusion criteria for this study. Main reason for exclusion was death in the Intensive Care Unit. Among all included patients, 54.2% (n = 203) received PS. Patients who received PS as compared to those not sedated were younger (67.8 vs. 76.4 years-old, p sedation were dyspnea (55%) and delirium (19.7%) and the most common drugs used were midazolam (52.7%) or midazolam and a neuroleptic (39.4%). Median initial midazolam infusion rate was 0.75 mg/h (interquartile range - IQR - 0.6-1.5) and final rate was 1.5 mg/h (IQR 0.9-3.0). Patient survival (length of hospital stay from admission to death) of those who had PS was more than the double of those who did not (33.6 days vs 16 days, p palliative care team was involved in the care of 12% (n = 25) of sedated patients. PS is a relatively common practice in the end-of-life of cancer patients at our hospital and it is not associated with shortening of hospital stay. Involvement of a dedicated palliative care team is strongly recommended if this procedure is being considered. Further research is needed to identify factors that may affect the frequency and outcomes associated with PS.

  2. Diagnostic yield in the evaluation of dysphagia: experience at a single tertiary care center.

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    Bill, J; Rajagopal, S; Kushnir, V; Gyawali, C P

    2018-05-24

    Evaluation of dysphagia typically starts with esophagogastroduodenoscopy (EGD); further testing is pursued if this is negative. When no mucosal, structural, or motor esophageal disorders are identified with persisting symptoms, functional dysphagia is considered. We evaluated outcomes in patients undergoing EGD for dysphagia, and estimated prevalence of functional dysphagia. The endoscopy database at single tertiary care center was interrogated to identify EGDs performed for an indication of 'dysphagia' over a 12-month period (2008-09). Electronic medical records were reviewed over the next 8 years to assess if an etiology was identified. Data were analyzed to assess the diagnostic yield of endoscopy and subsequent tests in the evaluation of dysphagia. Of 5486 EGDs, 822 (15.0%) were performed for dysphagia in 694 patients (58.4 ± 0.6 year, range: 18-95 year, 55.8% female). Of these, 529 (76.2%) had EGD findings that explained dysphagia; another 22 (3.2%) had findings on histopathology. Of the remainder 143 patients (20.6%) with normal index EGD, 38 (26.6%) patients underwent barium esophagram with 15 (39.5%) having abnormal studies. 19 patients (13.3%) underwent esophageal high resolution manometry with 12 (63.2%) being abnormal, and 7 had a mechanism for dysphagia on alternate testing. A repeat EGD was abnormal in 6 patients, while 45 patients were lost to follow-up. 42 patients had complete resolution of symptoms despite normal endoscopy, of which 30 were treated empirically with a proton pump inhibitor (PPI). Only 16 patients had no findings on evaluation, and had continued dysphagia symptoms, representing true functional dysphagia in 2.3% of all dysphagia patients and 11.2% of patients with normal EGD. Endoscopy remains the test with the highest yield (over 75%) for a diagnosis in patients presenting with dysphagia; secondary tests are useful when endoscopy does not provide a diagnosis. Benign strictures and GERD-related etiologies are leading causes; PPI

  3. Characteristics and risk factors of preterm births in a tertiary center in Lagos, Nigeria.

    Science.gov (United States)

    Butali, Azeez; Ezeaka, Chinyere; Ekhaguere, Osayame; Weathers, Nancy; Ladd, Jenna; Fajolu, Iretiola; Esezobor, Christopher; Makwe, Christian; Odusanya, Bukola; Anorlu, Rose; Adeyemo, Wasiu; Iroha, Edna; Egri-Okwaji, Mathias; Adejumo, Prisca; Oyeneyin, Lawal; Abiodun, Moses; Badejoko, Bolaji; Ryckman, Kelli

    2016-01-01

    pregnancy should be referred to a tertiary center for prenatal care in order to significantly reduce adverse birth outcomes such as PTBs.

  4. Evaluation of recombinant activated protein C for severe sepsis at a tertiary academic medical center

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    Anger KE

    2013-06-01

    Full Text Available Kevin E Anger,1 Jeremy R DeGrado,1 Bonnie C Greenwood,1 Steven A Cohen,2 Paul M Szumita1 1Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA; 2Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA Purpose: Early clinical trials of recombinant human activated protein C (rhAPC for severe sepsis excluded patients at high risk of bleeding. Recent literature suggests bleeding rates are higher in clinical practice and may be associated with worsened outcomes. Our objective was to evaluate baseline demographics; incidence, and risk factors for major bleeding; and mortality of patients receiving rhAPC for severe sepsis at our institution. Methods: A retrospective study was performed for all patients receiving rhAPC for treatment of severe sepsis at a tertiary academic medical center from January 2002 to June 2009. Demographic information, clinical variables, intensive care unit, and hospital outcomes were recorded. Results: Of the 156 patients that received rhAPC, 54 (34.6% did not meet institutional criteria for safe use at baseline due to bleeding precaution or contraindication. Twenty-three (14.7% patients experienced a major bleeding event. Multivariate analysis demonstrated baseline International Normalized Ratio ≥2.5 (odds ratio [OR] 3.68, 95% confidence interval [CI]: 1.28–10.56; P = 0.03 and platelet count ≤100 × 103/mm3 (OR 2.86, 95% CI: 1.07–7.67; P = 0.01 as significant predictors of a major bleed. Overall hospital mortality was 57.7%. Multivariate analysis demonstrated the presence of ≥3 organ dysfunctions (OR 2.46, 95% CI: 1.19–5.09; P < 0.05 and medical intensive care unit admission (OR 1.99, 95% CI: 1.00–3.98; P = 0.05 were independent variables associated with hospital mortality. Conclusion: Patients receiving rhAPC at our institution had higher APACHE II scores, mortality, and major bleeding events than published

  5. Diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern india

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    Rautaraya Bibhudutta

    2011-12-01

    Full Text Available Abstract Background Mycotic keratitis is an important cause of corneal blindness world over including India. Geographical location and climate are known to influence the profile of fungal diseases. While there are several reports on mycotic keratitis from southern India, comprehensive clinico-microbiological reports from eastern India are few. The reported prevalence of mycotic keratitis are 36.7%,36.3%,25.6%,7.3% in southern, western, north- eastern and northern India respectively. This study reports the epidemiological characteristics, microbiological diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India. Methods A retrospective review of medical and microbiology records was done for all patients with laboratory proven fungal keratitis. Results Between July 2006 and December 2009, 997 patients were clinically diagnosed as microbial keratitis. While no organisms were found in 25.4% (253/997 corneal samples, 23.4% (233/997 were bacterial, 26.4% (264/997 were fungal (45 cases mixed with bacteria, 1.4% (14/997 were Acanthamoeba with or without bacteria and 23.4% (233/997 were microsporidial with or without bacteria. Two hundred fifteen of 264 (81.4%, 215/264 samples grew fungus in culture while 49 corneal scrapings were positive for fungal elements only in direct microscopy. Clinical diagnosis of fungal keratitis was made in 186 of 264 (70.5% cases. The microscopic detection of fungal elements was achieved by 10% potassium hydroxide with 0.1% calcoflour white stain in 94.8%(238/251 cases. Aspergillus species (27.9%, 60/215 and Fusarium species (23.2%, 50/215 were the major fungal isolates. Concomitant bacterial infection was seen in 45 (17.1%, 45/264 cases of mycotic keratitis. Clinical outcome of healed scar was achieved in 94 (35.6%, 94/264 cases. Fifty two patients (19.7%, 52/264 required therapeutic PK, 9 (3.4%, 9/264 went for evisceration, 18.9% (50/264 received glue application with bandage

  6. Young Vs Old Colorectal Cancer in Indian Subcontinent: a Tertiary Care Center Experience.

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    Pokharkar, Ashish B; Bhandare, Manish; Patil, Prachi; Mehta, Shaesta; Engineer, Reena; Saklani, Avanish P

    2017-12-01

    This study aims to compare patient, tumor, treatment-related factors and survival between young (45 years) Indian colorectal cancer (CRC) patients. Total 778 patients of CRC were registered at tertiary cancer center in India between 1 August 2013 and 31 July 2014. Patients were followed up for median period of 27.73 months. Data regarding patient, tumor, treatment and survival-related factors were collected. Patients were divided in young (≤45 years) and old (>45 years) age groups. Statistical analysis was done with SPSS software version 23. Young age group patients presented more commonly with poor histology, node-positive disease, and rectal site. Younger age group patients received multiple lines of neoadjuvant treatment. There was no significant overall survival difference in both groups of patients. On stratified stage-wise analysis, no significant overall survival (OS) difference was found between two groups (young vs old-1- and 3-year OS: 85.2 and 61.5% vs 81.5 and 64.5%, respectively; P  = 0.881). On univariate analysis, gender, performance status, site, stage, differentiation, TRG, CRM status, signet ring type, and CEA level were significant prognostic factors. In disease-free survival (DFS) analysis, it is found that there is statistically significant difference in DFS (young vs old: 1 and 3 years; 77.6 and 62.8% vs 85.8 and 74.1%, respectively; P value, 0.02), but when OS was analyzed for same group of patient, there was no statistical difference ( P  = 0.302). This study confirms the high incidence rates of CRC in young Indian patients. There is no OS difference between two age groups. In operated group of patients, there is higher DFS in older patients but no OS advantage at 3 years follow-up. Further long-term follow-up is required to see any OS difference.

  7. ECTOPIC CUSHING SYNDROME: A 10-YEAR EXPERIENCE FROM A TERTIARY CARE CENTER IN SOUTHERN INDIA.

    Science.gov (United States)

    Sathyakumar, Samantha; Paul, Thomas Vizhalil; Asha, Hesargatta Shyamsunder; Gnanamuthu, Birla Roy; Paul, M J; Abraham, Deepak Thomas; Rajaratnam, Simon; Thomas, Nihal

    2017-08-01

    Ectopic adrenocorticotropic hormone (ACTH) secretion is a less common cause of Cushing syndrome and is seen in 5 to 10% of cases with endogenous hypercortisolemia. We hereby describe our experience of patients with ectopic ACTH syndrome, who have been managed over the past 10 years at a tertiary care center in Southern India. The inpatient and outpatient records of patients from 2006 to 2015 were retrospectively reviewed. The clinical features, clinical history, biochemical values, imaging features, including radiologic findings and positron emission tomography scans, management, details of follow-up, and outcomes, were documented. We compared the biochemical findings in these patients with 20 consecutive patients with Cushing disease (Cushing syndrome of pituitary origin). A total of 21 patients were studied. The median age at presentation was 34 years (range, 19 to 55 years). Seven patients had thymic carcinoid, 7 had bronchial carcinoid, 3 had lung malignancies, 2 had medullary carcinoma thyroid, 1 patient had a pancreatic neuroendocrine tumor, and 1 patient had an occult source of ACTH. The most common clinical features at presentation were muscle weakness (95%), hyperpigmentation (90%), facial puffiness (76%), easy bruising (61%), edema (57%), and striae (52%). Extensive acne was seen in a large number of patients (43%). Only 3 patients (14%) had central obesity. The median 8 am cortisol was 55.5 μg/dL (range, 3.8 to 131 μg/dL), median 8 am ACTH was 207 pg/mL (range, 31.1 to 703 pg/mL), and the median 24-hour urinary free cortisol was 2,484 μg (range, 248 to 25,438 μg). Basal cortisol and ACTH, as well as midnight cortisol and ACTH level, were markedly higher in patients with ectopic Cushing syndrome as compared to patients with Cushing disease. Twelve of 21 patients had developed life-threatening infections by follow-up. Nine patients had undergone surgical intervention to address the primary tumor. However, only 1 patient exhibited a complete cure on

  8. Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil,

    OpenAIRE

    Schweiger, Cláudia; Manica, Denise; Becker, Carolina Fischer; Abreu, Larissa Santos Perez; Manzini, Michelle; Sekine, Leo; Kuhl, Gabriel

    2017-01-01

    Abstract Introduction: Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. Objective: To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. Methods: Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care cen...

  9. Comparison of optimal cardiovascular risk factor management in patients with Type 2 diabetes who attended urban medical health center with those attended a tertiary care center: Experiences from Tehran, Iran

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    Sedighe Moradi

    2016-01-01

    Conclusions: Both centers have failure in target achievement in some risk factors; however, the inability of the primary care center in controlling hyperlipidemia in comparison with the tertiary center is a serious warning to provide training about managing dyslipidemia in these centers.

  10. Depressive Symptoms in Patients Referred to a Tertiary Lyme Center: High Prevalence in Those Without Evidence of Lyme Borreliosis.

    Science.gov (United States)

    Zomer, Tizza P; Vermeeren, Yolande M; Landman, Gijs W; Zwerink, Marlies; van Hees, Babette C; van Bemmel, Thomas; van Kooten, Barend

    2017-10-30

    Controversy exists whether mood disorders, such as depression, are associated with Lyme borreliosis (LB). The study objective was to assess prevalence of depressive symptoms in subgroups of patients referred to a tertiary Lyme center, to investigate whether depressive symptoms can be used in clinical practice to discriminate for LB. This cohort study included adult patients who visited a tertiary Lyme center between January 2008 and December 2014. Prior to medical consultation, serum samples were taken and the Beck Depression Inventory II was completed to assess depressive symptoms. Lyme diagnosis was retrospectively extracted from the patient's medical record. Patients were classified based on clinical LB and serology results. Prevalence of moderate/severe depressive symptoms was calculated. Using logistic regression, odds ratios with 95% confidence intervals (CIs) were calculated for moderate/severe depressive symptoms. In total, 1454 patients were included. Prevalence of moderate/severe depressive symptoms was lowest in patients with no clinical LB and positive serology (15.3%), higher in patients with clinical LB with positive and negative serology (19.3% and 20.9% respectively), and highest in patients with no clinical LB and negative serology (29.3%). The odds ratio for moderate/severe depressive symptoms in patients with LB and positive serology was 0.71 (95% CI, .50-1.03) compared to patients with no LB and negative serology. The prevalence of depressive symptoms was similar in patients with LB compared to patients with no evidence of infection. This suggests that depressive symptoms cannot be used to discriminate for LB in a tertiary Lyme center. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  11. European Virtual Atomic And Molecular Data Center - VAMDC

    Science.gov (United States)

    Dimitrijevic, M. S.; Sahal-Brechot, S.; Kovacevic, A.; Jevremovic, D.; Popovic, L. C.

    2010-07-01

    Reliable atomic and molecular data are of great importance for different applications in astrophysics, atmospheric physics, fusion, environmental sciences, combustion chemistry, and in industrial applications from plasmas and lasers to lighting. Currently, very important resources of such data are highly fragmented, presented in different, nonstandardized ways, available through a variety of highly specialized and often poorly documented interfaces, so that the full exploitation of all their scientific worth is limited, hindering research in many topics like e.g. the characterization of extrasolar planets, understanding the chemistry of our local solar system and of the wider universe, the study of the terrestrial atmosphere and quantification of climate change; the development of the fusion rersearch, etc. The Virtual Atomic and Molecular Data Centre (http://www.vamdc.eu, VAMDC) is an European Union funded FP7 project aiming to build a secure, documented, flexible and interoperable e-science environment-based interface to existing atomic and molecular data. It will also provide a forum for training potential users and dissemination of expertise worldwide. Partners in the Consortium of the Project are: 1) Centre National de Recherche Scientifique - CNRS (Paris, Reims, Grenoble, Bordeaux, Dijon, Toulouse); 2) The Chancellor, Masters and Scholars of the University of Cambridge - CMSUC; 3) University College London - UCL; 4) Open University - OU; (Milton Keynes, England); 5) Universitaet Wien - UNIVIE; 6) Uppsala Universitet - UU; 7) Universitaet zu Koeln - KOLN; 8) Istituto Nazionale di Astrofisica - INAF (Catania, Cagliari); 9) Queen's University Belfast - QUB; 10) Astronomska Opservatorija - AOB (Belgrade, Serbia); 11) Institute of Spectroscopy RAS - ISRAN (Troitsk, Russia); 12) Russian Federal Nuclear Center - All-Russian Institute of Technical Physics - RFNC-VNIITF (Snezhinsk, Chelyabinsk Region, Russia; 13) Institute of Atmospheric Optics - IAO (Tomsk, Russia

  12. Clinical course of a cohort of children with non-neurogenic daytime urinary incontinence symptoms followed at a tertiary center

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    Adrienne Lebl

    2016-04-01

    Full Text Available Abstract Objective: To characterize a cohort of children with non-neurogenic daytime urinary incontinence followed-up in a tertiary center. Methods: Retrospective analysis of 50 medical records of children who had attained bladder control or minimum age of 5 years, using a structured protocol that included lower urinary tract dysfunction symptoms, comorbidities, associated manifestations, physical examination, voiding diary, complementary tests, therapeutic options, and clinical outcome, in accordance with the 2006 and 2014 International Children's Continence Society standardizations. Results: Female patients represented 86.0% of this sample. Mean age was 7.9 years and mean follow-up was 4.7 years. Urgency (56.0%, urgency incontinence (56.0%, urinary retention (8.0%, nocturnal enuresis (70.0%, urinary tract infections (62.0%, constipation (62.0%, and fecal incontinence (16.0% were the most prevalent symptoms and comorbidities. Ultrasound examinations showed alterations in 53.0% of the cases; the urodynamic study showed alterations in 94.7%. At the last follow-up, 32.0% of patients persisted with urinary incontinence. When assessing the diagnostic methods, 85% concordance was observed between the predictive diagnosis of overactive bladder attained through medical history plus non-invasive exams and the diagnosis of detrusor overactivity achieved through the invasive urodynamic study. Conclusions: This subgroup of patients with clinical characteristics of an overactive bladder, with no history of urinary tract infection, and normal urinary tract ultrasound and uroflowmetry, could start treatment without invasive studies even at a tertiary center. Approximately one-third of the patients treated at the tertiary level remained refractory to treatment.

  13. Frequency and risk factors associated with dry eye in patients attending a tertiary care ophthalmology center in Mexico City

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    Martinez JD

    2016-07-01

    Full Text Available Jaime D Martinez,1 Anat Galor,2,3 Nallely Ramos-Betancourt,1 Andrés Lisker-Cervantes,1 Francisco Beltrán,1 Jorge Ozorno-Zárate,1 Valeria Sánchez-Huerta,1 Marco-Antonio Torres-Vera,1 Everardo Hernández-Quintela1 1Cornea and External Diseases Service, Asociación Para Evitar la Ceguera en Mexico (Association to prevent blindness in Mexico, Universidad Nacional Autónoma de México, Mexico City, Mexico; 2Department of Ophthalmology, Miami Veterans Affairs Medical Center, 3Cornea and External Diseases Division, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA Purpose: The purpose of this study was to ascertain the frequency and risk factors of dry eye (DE among patients attending a tertiary care ophthalmology center in Mexico.Methods: Approximately 338 consecutive new patients attending a tertiary care ophthalmology center in Mexico City underwent an ocular surface examination, which included tear film break-up time, fluorescein corneal staining, Schirmer’s test, and evaluation of meibum quality. Symptoms of DE were evaluated by the Ocular Surface Disease Index and Dry Eye Questionnaire-5. Information on demographics, exposures, past medical and ocular history, and medications was also collected.Results: The frequency of severe DE symptoms was found to be 43% based on the Ocular Surface Disease Index and 30% based on Dry Eye Questionnaire-5. Risk factors significantly associated with increased DE symptoms included dry mouth and gastrointestinal ulcer medications. With regard to signs, aqueous tear deficiency was a less-frequent finding (22% in our population than evaporative deficiency (94%. Risk factors associated with aqueous tear deficiency were dry mouth and diuretic use. No risk factors were associated with evaporative deficiency. Risk factors associated with meibomian gland dysfunction included old age, male sex, arthritis, and use of an antihypertensive. The only risk factor associated with corneal staining was dry

  14. Role of Retinopathy of Prematurity (ROP) Tertiary Centers of Excellence in Capacity-building.

    Science.gov (United States)

    Rani, Padmaja Kumari; Balakrishnanan, D; Padhi, T R; Jalali, Subhadra

    2016-11-07

    Tertiary Centres of Excellence in India have been at the forefront of the efforts against Retinopathy of Prematurity (ROP) - associated blindness. The epidemic of blindness from ROP; however, has now spread rapidly into large parts of interiors of developing countries due to improved newborn care facilities. Due to their knowledge and experience of more than a decade, these centres of excellence, both from child care and Ophthalmology care, now need to come forward in substantial measures and need to be supported by funds and programs so that concerns of neonatal eye-health, training, screening, prevention and treatment can get integrated and embedded into newborn critical care and health programs. This will protect newborn preterm survivors from losing the potentially good vision that they are born with, reduce the rapidly rising blindness epidemic, and also protect staff from potential high-value litigations.

  15. Pancreaticoduodenectomy in a tertiary referral center in Saudi Arabia: A retrospective case series

    International Nuclear Information System (INIS)

    Aziz, A.M.; Gad, H.; Leung, K; Abbas, A.; Al-Saif, O.H.; Meshikhes, A.N.

    2012-01-01

    Context: Perioperative outcome of pancreaticoduodenectomy is related to work load volume and to whether the procedure is carried out in a tertiary specialized hepato-pancreatico-biliary (HPB) unit. Objective: To evaluate the perioperative outcome associated with pancreaticoduodenectomy in a newly established HPB unit. Patients: Analysis of 32 patients who underwent pancreaticoduodenectomy (PD) for benign and malignant indications. Design: Retrospective collection of data on preoperative, intraoperative and postoperative care of all patients undergoing PD. Results: Thirty-two patients (16 male and 16 female) with a mean age of 59.5 ± 12.7 years were analyzed. The overall morbidity rate was high at 53%. The most common complication was wound infection (n = 11; 34.4%). Pancreatic and biliary leaks were seen in 5 (15.6%) and 2 (6.2%) cases, respectively, while delayed gastric emptying was recorded in 7 (21.9%). The female sex was not associated with increased morbidity. Presence of co-morbid illness, pylorus-preserving PD, intra-operative blood loss > 1 L, and perioperative blood transfusion were not associated with significantly increased morbidity. The overall hospital mortality was 3.1% and the cumulative overall (OS) and disease free survival (DFS) at 1 year were 80% and 82.3%, respectively. The cumulative overall survival for pancreatic cancer vs ampullary tumor at 1 year were 52% vs 80%, respectively. Conclusion: PD is associated with a low risk of operative death when performed by specialized HPB surgeons even in a tertiary referral hospital. However, the postoperative morbidity rate remains high, mostly due to wound infection. Further improvement by reducing postoperative infection may help curtail the high postoperative morbidity

  16. Developing the European Center of Competence on VVER-Type Nuclear Power Reactors

    Science.gov (United States)

    Geraskin, Nikolay; Pironkov, Lyubomir; Kulikov, Evgeny; Glebov, Vasily

    2017-01-01

    This paper presents the results of the European educational projects CORONA and CORONA-II which are dedicated to preserving and further developing nuclear knowledge and competencies in the area of VVER-type nuclear power reactors technologies (Water-Water Energetic Reactor, WWER or VVER). The development of the European Center of Competence for…

  17. Spectrum of interstitial lung diseases at a tertiary center in a developing country: A study of 803 subjects.

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    Sahajal Dhooria

    Full Text Available The spectrum of interstitial lung diseases (ILDs have mainly been reported from the developed countries; data from developing countries is sparse and conflicting. The aim of this study is to describe the distribution of various ILDs from a developing country.This is an analysis of prospectively collected clinical, radiological and histological data of consecutive subjects (age >12 years with ILDs from a single tertiary care medical center. The diagnosis of the specific subtype of ILD was made according to standard criteria for various ILDs.A total of 803 subjects (mean age, 50.6 years; 50.2% women were enrolled between March 2015 to February 2017 of which 566 (70.5% were diagnosed during the study period (incident cases. Sarcoidosis (42.2%, idiopathic pulmonary fibrosis (IPF, 21.2%, connective tissue disease (CTD-related ILDs (12.7%, hypersensitivity pneumonitis (10.7%, and non-IPF idiopathic interstitial pneumonias (9.2% were the most common ILDs. The spectrum of ILDs was not significantly different (p = 0.87 between incident and prevalent cases. A histopathological specimen was obtained in 49.9% of the subjects yielding a histologically confirmed diagnosis in 40.6%. A diagnostic procedure was not performed in 402 subjects; the most common reasons were presence of definite usual interstitial pneumonia pattern on high resolution computed tomography and patients' unwillingness to undergo the procedure.Sarcoidosis, IPF and CTD-ILDs were the most common ILDs seen at a tertiary center in northern India similar to the spectrum reported from developed countries. More studies are required from developing countries to ascertain the spectrum of ILDs in different geographic locales.

  18. Conventional versus molecular methods for diagnosis of tuberculosis in a tertiary care center: A study from Punjab

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    Shavi Nagpal

    2016-01-01

    Full Text Available Background: A fast and accurate diagnosis is necessary to control and eliminate tuberculosis (TB. There have been various studies evaluating the efficacy of polymerase chain reaction (PCR testing in clinical practice. Most of these studies have found PCR as a useful tool to diagnose TB and more so for the extra-pulmonary cases. Aims and Objectives: The aim of the study was to evaluate the results of TB by real-time PCR versus the conventional methods of diagnosis in a tertiary care center in Punjab. Materials and Methods: This study was done in a tertiary care center of Punjab to look for the results of clinical samples tested for TB using PCR, Ziehl–Neelsen staining and culture on Lowenstein–Jensen medium. 16S rRNA gene was used for Mycobacterium tuberculosis detection in PCR. This study included all samples tested for TB from July 2015 to October 2015. Results: A total of 214 samples were tested for TB using smear microscopy, culture and PCR (including 194 [90.6%] extra-pulmonary and 20 [9.3%] pulmonary samples. These included 76 cerebrospinal fluid, 30 pleural fluid, 42 tissues, 17 ascitic fluid, 13 urine, 15 bronchoalveolar lavage (BAL, 16 pus, and 5 sputum samples. Smear microscopy was positive in a total of 4 samples out of 214 (1.8%, which included 2 sputum, 1 tissue, and 1 ascitic fluid samples, while culture was positive for 6 samples (2.8% which included 2 sputum, 1 pus, 1 BAL, 1 tissue, and 1 ascitic fluid sample. The TB PCR results were positive in a total of 71 (33.1% samples out of 214. In addition, three samples also tested positive for Mycobacteria other than TB. Conclusion: PCR is a very rapid and accurate diagnostic tool for early detection of TB in particularly for extrapulmonary TB.

  19. Snoring habits among healthy persons attending a tertiary care center in Chittagong, Bangladesh: A questionnaire-based study

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    Rajat Sanker Roy Biswas

    2017-01-01

    Full Text Available Introduction: Snoring is a common health condition which is unexplored in the context of Bangladesh. Hence, the objective of the present study is to find out the frequency of snoring among the healthy Bangladeshi people attending tertiary care center in Chittagong using a questionnaire. Methods: It was a single center, cross-sectional study conducted in the Department of Internal Medicine of a tertiary care hospital of Bangladesh among 119 apparently healthy adults who were the attendants of patients. A “Snore Survey” questionnaire adopted from an Indian study which was based on Berlin questionnaire was used. Results: With a 88.1% valid response rate, present study included 63 (52.94% male and 56 (47.06% female. Among all, 47.9% of (57 individuals were <30 years of age. Majority (82.4% were recruited from urban locality. Frequency of snoring was 28 (23.5% of total individuals. Nearly 33.3% of males and 12.5% of females were snorers. The frequency of snoring ranged from daily (25.0% to monthly (28.6% episodes. Some had very loud (25.0% sound during sleep, and others had variable loudness. Male snorers were significantly taller, weighed more and had broader neck circumference than female (P < 0.05. Conclusion: Snoring is not an uncommon medical condition among healthy young people in Bangladesh. Considering the population of Bangladesh, the sample size is very small and a large scale study would certainly help create awareness among the patients as well as healthcare professionals about this neglected but very significant health problem.

  20. CLINICOPATHOLOGICAL CHARACTERISTICS OF SOLITARY NODULE OF THYROID- A CROSS-SECTIONAL STUDY IN A TERTIARY CENTER

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    T. V. Haridas

    2017-04-01

    Full Text Available BACKGROUND Solitary Thyroid Nodules (STN occur in 4-7% of the adult population. Owing to increasing incidence of malignancy, it is necessary to differentiate patients with benign STN from malignant ones for early intervention and better patient management. The aim of the study is to study the clinicopathological characteristics of STN for better diagnosis, evaluation and management; evaluate the efficacy of FNAC in preoperative diagnostics of solitary thyroid nodules. MATERIALS AND METHODS The study was conducted over a period of one year at a tertiary healthcare institution in South India. One hundred patients with solitary nodule of thyroid were studied by taking detailed history and conducting clinical examination, thyroid hormone assay, ultrasonogram, FNAC and histopathological examination. The chances of malignancy and age, sex and site distribution were also analysed. RESULTS Solitary thyroid nodule cases showed female preponderance (81%, presented mostly as neck swelling followed by dysphagia (11%. Most common FNAC report was of colloid nodule (61%, followed by follicular neoplasm (20% and papillary carcinoma (9%. Final HPR showed 53% as colloid nodule and 27% as papillary carcinoma. CONCLUSION Differentiating between benign and malignant lesions and their comprehensive management are the challenges presented by STN. Fine Needle Aspiration Cytology (FNAC is the diagnostic tool of choice for the initial evaluation of STN.

  1. Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital.

    Science.gov (United States)

    Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha

    2014-10-01

    Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments.

  2. Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital

    International Nuclear Information System (INIS)

    Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha

    2014-01-01

    Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments

  3. Spectrum of goitrous lesions in patients at a tertiary care center of Sikkim

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    Subhabrata Sengupta

    2014-01-01

    Full Text Available Background: Sikkim is declared as a goitre endemic state with an estimated prevalence of 54%. The spectrums of diseases include simple goitre, thyroiditis, adenoma, carcinoma, multinodular goitre and Graves′ disease. The present study aims to determine the pattern of thyroid swelling in a hospital setup at Sikkim. Materials and Methods: This study is a retrospective analysis of records of all patients presenting with thyroid swelling in a tertiary care hospital at Gangtok, Sikkim during the period of 4 years between 1 st January 2008 and 31 st December 2011. Patients were diagnosed by clinical examination, FNAC, USG, CT scan and hormone estimation. Histopatholgical confirmation was done in surgical cases. Clinic opathological and demographic data of 166 such patients were obtained and analyzed for the present study. Results: The most common goitrous disease was simple goitre (69.27% followed by thyroiditis (10.24%, toxic goitre (7.83% and malignancy (12.65%. Papillary variant was the commonest carcinoma. Overall female:male ratio was 4.9:1. The prevalence goitrous lesion was highest in the middle age group between 30-39 years, while the extremes of age (below 10 years and above 70 years were rarely involved. Conclusions: The prevalence of goitre in Sikkim is still very high despite iodisation programs by the Government. There is urgent need for more data on autoimmunity and goitrogens status to explain the high prevalence of goitre in this population.

  4. Interdisciplinary expert consultation via a teleradiology platform. Influence on therapeutic decision-making and patient referral rates to an academic tertiary care center

    International Nuclear Information System (INIS)

    Helck, Andreas; Matzko, M.; Trumm, C.G.; Grosse, C.; Reiser, M.; Ertl-Wagner, B.; Piltz, S.

    2009-01-01

    In addition to teleradiological reporting as a nighthawking or a regular service, teleradiological communication can be used for interdisciplinary expert consultation. We intended to evaluate an interdisciplinary consultation system based on a teleradiology platform with regard to its impact on therapeutic decision-making, directed patient referrals to an academic tertiary care center and the economic benefit for the hospital providing the service. Therefore, consultations from five secondary care centers and consecutive admissions to an academic tertiary care center were prospectively evaluated over a time period of six months. A total of 69 interdisciplinary expert consultations were performed. In 54% of the cases the patients were consecutively referred to the university hospital for further treatment. In all acutely life-threatening emergencies (n=9), fast and focused treatment by referral to the academic tertiary care center was achieved (average time to treat 130 min). The admissions to the academic tertiary care center led to improved utilization of its facilities with additional revenue of more than 1 000 000 Euro p.a. An interdisciplinary expert consultation via a teleradiology platform enables fast and efficient expert care with improved and accelerated patient management and improved utilization of the service providing hospital. (orig.)

  5. Analysis of differences in outcome of two European liver transplant centers

    NARCIS (Netherlands)

    Nemes, B; Polak, W; Ther, G; Hendriks, H; Kobori, L; Porte, RJ; Sarvary, E; de Jong, KP; Doros, A; Gerlei, Z; van den Berg, AP; Fehervari, [No Value; Gorog, D; Peeters, PM; Jaray, J; Slooff, MJH

    Authors analyzed the differences in the outcome of two European liver transplant centers differing in case volume and experience. The first was the Transplantation and Surgical Clinic, Semmelweis University, Budapest, Hungary (SEB) and the second the University Medical Center Groningen, Groningen,

  6. Outcomes of the treatment of head and neck sarcomas in a tertiary referral center

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    Andrew eLindford

    2015-05-01

    Full Text Available Head and neck sarcomas are a rare and heterogeneous group of tumors that pose management challenges. We report our experience with these tumors. Forty consecutive patients treated for 44 head and neck sarcomas between 1997 and 2014 were culled from our prospectively maintained head and neck database. Five patients were excluded. The adult cohort consisted 29 (83% patients of a mean age of 57.7 years, with 33 sarcomas. The most common diagnoses were undifferentiated pleomorphic sarcoma (27% and chondroblastic osteosarcoma (21%. Clear surgical margins were achieved in 24/33 (73% lesions. Twenty-two patients received radiotherapy and/or chemotherapy. Fourteen patients developed local (n=6, regional (n=1 and distant (n=7 recurrence. The overall 5-year survival was 66% with a mean survival interval of 66.5 months. Recurrent sarcoma, close (<1mm or involved surgical margins and advanced age were associated with statistically significantly reduced survival. The pediatric cohort consisted 6 (17% patients, with a mean age of nine years. Five patients had primary embryonal rhabdomyosarcomas and one had chondroblastic osteosarcoma. Clear surgical margins were achieved in 5 (83% patients. All patients received adjuvant radiotherapy and/or chemotherapy. Mean survival interval was 102 months. Three patients developed local (n=1 or distant (n=2 recurrence. Twenty-three free and 8 pedicled flaps were performed in 25 patients. 11/39 (28% lesions in 11 patients developed a complication. In conclusion, head and neck sarcomas are best managed by a multidisciplinary team at a tertiary head and neck referral centre and resection with clear margins is vital for disease control.

  7. Characteristics of dysphagia in older patients evaluated at a tertiary center.

    Science.gov (United States)

    Kocdor, Pelin; Siegel, Eric R; Giese, Rachel; Tulunay-Ugur, Ozlem E

    2015-02-01

    To determine laryngoscopic and videofluoroscopic swallowing study (VFSS) findings in geriatric patients with dysphagia; to evaluate management. Retrospective chart review. Patients over 65 years old complaining of dysphagia, seen at a tertiary laryngology clinic, were included. Head and neck cancer and stroke patients were excluded. Demographics, laryngoscopic findings, swallowing studies, and treatment modalities were reviewed. Sixty-five patients were included. Mean age was 75 years old (range = 66-97) with female predominance of 67.6%. Weight loss was seen in 9.2% of the patients. Whereas 52.3% of the patients complained of solid food dysphagia, 53.8% were choking on food. On laryngoscopy, 15.3% of the patients had pooling in the pyriform sinuses, 30.7% had glottic gap, 18.4% had vocal fold immobility, and 3% had hypomobility. VFSS showed that 38.4% of the patients had pharyngoesophageal dysphagia, 20% had oropharyngeal dysphagia, 20% had pharyngeal dysphagia, and 20% had a normal study. In addition, 41.5% of the patients showed laryngeal penetration and 18.4% showed aspiration. Surgical intervention was employed in 29.2% of the patients in the form of botulinum toxin injection, esophageal dilatation, cricopharyngeal myotomy, vocal fold injection, diverticulectomy, and percutaneous endoscopic gastrostomy. Whereas 21.5% of the patients received swallowing therapy, 61.5% underwent diet modification. As a result, 80% of the patients needed some type of treatment. Swallowing problems in older patients are not uncommon. The clinician needs to be diligent to inquire about dysphagia because a large number of these patients will require treatment. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  8. Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center.

    Science.gov (United States)

    Vosler, Peter S; Kass, Jason I; Wang, Eric W; Snyderman, Carl H

    2016-11-01

    We compare the management of patients with severe epistaxis before and after the implementation a clinical care pathway (CCP) to standardize care, minimize hospital stay, and decrease cost. Single prospective analysis with historical control. Tertiary academic hospital. Patients treated for epistaxis between October 2012 to December 2013 were compared with a prospective analysis of patients treated for severe epistaxis after implementation of a CCP from June 2014 to February 2015. Severe epistaxis was defined as nasal bleeding not able to be controlled with local pressure, topical vasoconstrictors, or simple anterior packing. Severe epistaxis was similar in the pre- and post-CCP cohorts: 24.7% (n = 42) vs 18.9% (n = 22), respectively. Implementation of early sphenopalatine artery ligation resulted in decreased number of days packed (3.2 ± 1.6 to 1.4 ± 1.6; P = .001), decreased hospital stay (5.2 ± 3.9 to 2.1 ± 1.3 days; P vs 54.5%; P = .035), admission to an appropriate hospital location with access to key resources (41.7% vs 83.3%; P = .007), and decreased overall cost of hospitalization by 66% ($9435 saved). No patients received embolization after the CCP was implemented. Implementation of a CCP decreased hospital stay and days of packing, facilitated definitive care in patients with severe epistaxis, improved patient safety, and decreased cost. The results of this study can serve as a model for the management of severe epistaxis and for future quality improvement measures. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  9. Risk factors predicting mortality in patients with lung abscess in a public tertiary care center in Karachi, Pakistan.

    Science.gov (United States)

    Ghazal, Shaista; Kumar, Ashok; Shrestha, Binav; Sajid, Sana; Malik, Maria; Rizvi, Nadeen

    2013-01-01

    Lung abscess is a commonly encountered entity in South-East Asia but not much data regarding its outcome is available. The objective of this study was to identify the factors associated with increased mortality in patients diagnosed with lung abscess in a tertiary care center of Karachi, Pakistan. A retrospective case analysis was performed via hospital records, on patients admitted with lung abscess between January 2009 and January 2011 at the largest state-owned tertiary care centre in Karachi, Pakistan. Out of the 41 patients hospitalized, 17 could not survive and were evaluated for clinical, radiological and microbiological factors to determine association with heightened mortality. Mortality due to lung abscess stood at 41.4% (17 of 41 cases). Adult male patients were found to have higher mortality with 13 out of 17 (43%) dead patients being male. A majority (21/41, 51.2%) of the cases belonged to the 41-60 year old age group. Highest mortality was seen in patients200 mg/dL (56%) succumb to disease. Patients with a positive history of smoking, diabetes mellitus, and alcohol intake expressed mortality rates of 44%, 56%, and 50% respectively; while 29.4% of the mortalities were positive for Pseudomonas aeruginosa on sputum culture. A significant association was found with elevated mortality and low haemoglobin levels at time of admission; mortality was 58% (p=0.005) in patients with Hb less than or equal to 10 mg/dL. The risk factors involved with heightened mortality included male gender and history of smoking, diabetes and alcohol intake. High blood sugar levels and detection of Pseudomonas aeruginosa on sputum cultures were also implicated. Anemia (Hb level less than or equal to 10 mg/dl) was statistically significant predictive factor for increased mortality.

  10. Fully digital data processing during cardiovascular implantable electronic device follow-up in a high-volume tertiary center.

    Science.gov (United States)

    Staudacher, Ingo; Nalpathamkalam, Asha Roy; Uhlmann, Lorenz; Illg, Claudius; Seehausen, Sebastian; Akhavanpoor, Mohammadreza; Buchauer, Anke; Geis, Nicolas; Lugenbiel, Patrick; Schweizer, Patrick A; Xynogalos, Panagiotis; Zylla, Maura M; Scholz, Eberhard; Zitron, Edgar; Katus, Hugo A; Thomas, Dierk

    2017-10-11

    Increasing numbers of patients with cardiovascular implantable electronic devices (CIEDs) and limited follow-up capacities highlight unmet challenges in clinical electrophysiology. Integrated software (MediConnect ® ) enabling fully digital processing of device interrogation data has been commercially developed to facilitate follow-up visits. We sought to assess feasibility of fully digital data processing (FDDP) during ambulatory device follow-up in a high-volume tertiary hospital to provide guidance for future users of FDDP software. A total of 391 patients (mean age, 70 years) presenting to the outpatient department for routine device follow-up were analyzed (pacemaker, 44%; implantable cardioverter defibrillator, 39%; cardiac resynchronization therapy device, 16%). Quality of data transfer and follow-up duration were compared between digital (n = 265) and manual processing of device data (n = 126). Digital data import was successful, complete and correct in 82% of cases when early software versions were used. When using the most recent software version the rate of successful digital data import increased to 100%. Software-based import of interrogation data was complete and without failure in 97% of cases. The mean duration of a follow-up visit did not differ between the two groups (digital 18.7 min vs. manual data transfer 18.2 min). FDDP software was successfully implemented into the ambulatory follow-up of patients with implanted pacemakers and defibrillators. Digital data import into electronic patient management software was feasible and supported the physician's workflow. The total duration of follow-up visits comprising technical device interrogation and clinical actions was not affected in the present tertiary center outpatient cohort.

  11. Intermediate uveitis: pattern of etiology, complications, treatment and outcome in a tertiary academic center.

    Science.gov (United States)

    Ness, Thomas; Boehringer, Daniel; Heinzelmann, Sonja

    2017-04-27

    Patients with intermediate uveitis (IU) represent a heterogenous group characterized by a wide spectrum of etiologies and regional differences. Aim of the study was to analyze the characteristics of patients with IU examined in an academic center in Germany. We conducted a retrospective analysis of the clinical records of all patients with intermediate uveitis referred to the Eye Center, University of Freiburg from 2007 to 2014. Diagnosis followed the Standardization in Uveitis Nomenclature (SUN) criteria. Data analysis included: etiology of IU, demographics, complications, treatment and visual acuity. We identified 159 patients with intermediate uveitis during that period. Mean age at diagnosis was 35 years. Most are female (64%), and the mean duration of IU was 6.1 years (range 1 month - 35 years). Etiology of IU was idiopathic in 59%. Multiple sclerosis (MS) (20%) and sarcoidosis (10%) were frequent systemic causes of IU. Other etiologies including infectious diseases (tuberculosis, borreliosis) or immune-mediated conditions (eg, after vaccination) were present in 11%. The pattern of complications included macular edema (CME) (36%), cataract (24%), secondary glaucoma (7%), and epiretinal membrane formation (19%). Periphlebitis and optic neuritis were more frequent in conjunction with MS. Treatment comprised local and systemic steroids, immunosuppressive agents, biologics, and surgery. Best corrected visual acuity was better than 20/25 in 60% of the eyes after more than 10 years of follow-up. In our German academic center, most IU cases were idiopathic or associated with MS or sarcoidosis. In contrast to other countries, infectious cases were rare. Patients' overall visual prognosis is favorable even when the duration of IU has been long and and despite numerous complications.

  12. Spectrum of Neuro-Sjogren′s syndrome in a tertiary care center in south India

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    Yadav Ravi

    2011-01-01

    Full Text Available Background: Neurological affection in Sjogren′s syndrome (SS can occur in the central and peripheral nervous system. Literature describing the neurological involvement in SS among Indian patients is lacking. Materials and Methods: Six patients of SS fulfilling the histological or serological criteria of the American European Consensus Group for SS were studied prospectively. The patients underwent clinical examination and laboratory investigations. Their clinical and investigation features are described. Results: The age of the patients ranged from 26 to 48 years, with a male to female ratio of 2:4. In our series, peripheral sensori-motor neuropathy and sensory ataxic neuropathy was seen in 3/6, mononeuritis multiplex in 2/6, cranial neuropathy in 2/6, autonomic neuropathy in 1/6, myelopathy in 4/6, optic neuropathy in 2/6, with presence of classical sicca features in 5/6 patients. Positive lip biopsy was seen in three, altitudinal field defect in one and positive Schirmer′s test in five patients. Nerve conduction study abnormalities were seen in three and evidence of vasculitis was seen in nerve biopsy of one patient and chronic nonuniform axonopathy was seen in another. Antibody to Ro (SSA or La (SSB was positive in five patients. Conclusions: SS involves different parts of the nervous system with varied presentations. Clinical suspicion and adequate laboratory testing helps to diagnose and manage this disorder that is relatively rare in Indian patients.

  13. Quality of care indicators in inflammatory bowel disease in a tertiary referral center with open access and objective assessment policies.

    Science.gov (United States)

    Gonczi, Lorant; Kurti, Zsuzsanna; Golovics, Petra Anna; Lovasz, Barbara Dorottya; Menyhart, Orsolya; Seres, Anna; Sumegi, Liza Dalma; Gal, Alexander; Ilias, Akos; Janos, Papp; Gecse, Krisztina Barbara; Bessisow, Talat; Afif, Waqqas; Bitton, Alain; Vegh, Zsuzsanna; Lakatos, Peter Laszlo

    2018-01-01

    In the management of inflammatory bowel diseases, there is considerable variation in quality of care. The aim of this study was to evaluate structural, access/process components and outcome quality indicators in our tertiary referral IBD center. In the first phase, structural/process components were assessed, followed by the second phase of formal evaluation of access and management on a set of consecutive IBD patients with and without active disease (248CD/125UC patients, median age 35/39 years). Structural/process components of our IBD center met the international recommendations. At or around the time of diagnosis usual procedures were full colonoscopy in all patients, with ileocolonoscopy/gastroscopy/CT/MRI in 81.8/45.5/66.1/49.6% of CD patients. A total of 86.7% of CD patients had any follow-up imaging evaluation or endoscopy. The median waiting time for non-emergency endoscopy/CT/MRI was 16/14/22 days. During the observational period patients with flares (CD/UC:50.6/54.6%) were seen by specialist at the IBD clinic within a median of 1day with same day laboratory assessment, abdominal US, CT scan/surgical consult and change in therapy if needed. Surgery and hospitalization rates were 20.1/1.4% and 17.3/3.2% of CD/UC patients. Our results highlight that structural components and processes applied in our center are in line with international recommendations, including an open clinic concept and fast track access to specialist consultation, endoscopy and imaging. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  14. Obstetric and perinatal outcomes in IVF versus ICSI-conceived pregnancies at a tertiary care center--a pilot study.

    Science.gov (United States)

    Nouri, Kazem; Ott, Johannes; Stoegbauer, Lucia; Pietrowski, Detlef; Frantal, Sophie; Walch, Katharina

    2013-08-31

    Although most pregnancies after IVF result in normal healthy outcomes, an increased risk for a number of obstetric and neonatal complications, compared to naturally conceived pregnancies, has been reported. While there are many studies that compare pregnancies after assisted reproductive techniques with spontaneously conceived pregnancies, fewer data are available that evaluate the differences between IVF and ICSI-conceived pregnancies. The aim of our present study was, therefore, to compare obstetric and perinatal outcomes in pregnancies conceived after in vitro fertilization (IVF) versus intracytoplasmatic sperm injection (ICSI). Three-hundred thirty four women who had become pregnant after an IVF or ICSI procedure resulted in a total of 530 children referred between 2003 und 2009 to the Department of Obstetrics and Gynecology of the Medical University of Vienna, a tertiary care center, and were included in this retrospective cohort study. We assessed maternal and fetal parameters in both groups (IVF and ICSI). The main study outcomes were preterm delivery, the need for neonatal intensive care, and congenital malformations. Moreover, we compared the course of pregnancy between both groups and the occurrence of complications that led to maternal hospitalization during pregnancy. There were 80 children conceived via ICSI and 450 children conceived via IVF.Mean gestational age was significantly lower in the ICSI group (p = 0.001). After ICSI, the birth weight (p = 0.008) and the mean APGAR values after 1 minute and after 10 minutes were lower compared to that of the IVF group (p = 0.016 and p = 0.047, respectively). Moreover, ICSI-conceived children had to be hospitalized more often at a neonatal intensive care unit (p = 0.004). There was no difference in pH of the umbilical artery or in major congenital malformations between the two groups. Pregnancy complications (i.e., premature rupture of membranes, cervical insufficiency, and premature

  15. Pediatric urinary tract infections in a tertiary care center from north India.

    Science.gov (United States)

    Taneja, Neelam; Chatterjee, Shiv Sekhar; Singh, Meenakshi; Singh, Surjit; Sharma, Meera

    2010-01-01

    Paediatric urinary tract infections (UTI) are associated with high morbidity and long term complications like renal scarring, hypertension, and chronic renal failure. A cause of occult febrile illness, they often remain undiagnosed. We studied the clinical and microbiologic profile and antibiotic resistance profile of such infections in paediatric UTI patients at our center. Clean catch mid-stream urine samples for culture were received from 1974 children agedinfections. Common uropathogens isolated were Escherichia coli (47.1%), Klebsiella spp. (15.6%), Enterococcus fecalis (8.7%), members of tribe Proteae (5.9%), Pseudomonas aeruginosa (5.9%) and Candida spp. (5.5%). Against lactose fermenting Enterobacteriaceae, in-vitro resistance was least against amikacin (32.5%), nitrofurantoin (26.7%) and imipenem (3.7%). Among enterococci, vancomycin resistant enterococci constituted 12 per cent of the strains. 93.4 per cent of the UTI detected was nosocomial. Paediatric UTI was common in children with male gender, ageresistant pathogens.

  16. Management of complications arising from transvaginal mesh kit procedures: a tertiary referral center's experience.

    Science.gov (United States)

    Hurtado, Eric A; Appell, Rodney A

    2009-01-01

    This case series' purpose is to review a referral center's experience with complications from mesh kits. A chart review of 12 patients who presented with complications associated with transvaginal mesh kit procedures was performed. All patients underwent complete surgical removal of the mesh to treat mesh exposure, pain, or vaginal bleeding/discharge followed by an anterior or posterior repair. The mean follow-up time after surgery was 3.4 months. Eight of 12 patients had mesh that had formed a fibrotic band. Six of 12 patients had complete resolution of pain. Of the nine patients with mesh exposure, all required significant resection of the vaginal wall. No further mesh exposure occurred. The use of transvaginal mesh kits may cause previously undescribed complications such as pelvic/vaginal pain or large extrusions requiring complete removal. Removal of all mesh except the arms may cure or significantly improve these problems.

  17. The Incidence of Nosocomial Toxigenic Clostridium difficile Associated Diarrhea in Tehran Tertiary Medical Centers

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    Norakhoda Sadeghifard

    2010-09-01

    Full Text Available "nClostridium difficile is the most common cause of nosocomial diarrhea. It is usually a consequence of antibiotic treatment, But sporadic cases can occur. This study was aimed to determine the frequency of the nosocomial Clostridium difficile (C. difficile associated diarrhea in Tehran University of Medical Sciences hospitals and study of antibacterial susceptibility of isolates. In this study a total of 942 stool samples from patients with nosocomial diarrhea that were hospitalized in Imam Khomeini hospital, Shariati hospital and Children clinical center were collected. The samples were cultured on a selective cycloserine cefoxitin fructose agar (CCFA and incubated in anaerobic conditions, at 37°C for 5 days. Isolates were characterized to species level by conventional biochemical tests. Bacterial cytotoxicity was assayed on tissue culture (vero. Antimicrobial sensitivity of isolated toxigenic C. difficile were investigated by kirby Beuer method (disk diffusion. Our findings show that, of the total patients, 57 toxigenic C. difficile (6.1% were isolated. Results of statistical analysis show significant differences between the rate of isolated toxigenic C. difficile and age group of patients (P<0.05. Among the wards of selected hospitals, in gastroenterology of Children clinical center, Toxigenic C. difficile was isolated from patients most frequently. The sensitivity of isolates to vancomycin, Chloramphenicol and ceftriaxone were higher than other antibiotics. Toxigenic C. difficile is a common hospital-acquired infection. The organism was found in 6.1% hospitalized patients. Further studies to evaluate the rate and role of toxigenic C. difficile in nosocomial diarrheal processes, ecological and pathogenic terms are suggested.

  18. An audit of consent refusals in clinical research at a tertiary care center in India

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    S J Thaker

    2015-01-01

    Full Text Available Background and Rationale: Ensuring research participants′ autonomy is one of the core ethical obligations of researchers. This fundamental principle confers on every participant the right to refuse to take part in clinical research, and the measure of the number of consent refusals could be an important metric to evaluate the quality of the informed consent process. This audit examined consent refusals among Indian participants in clinical studies done at our center. Materials and Methods: The number of consent refusals and their reasons in 10 studies done at our center over a 5-year period were assessed. The studies were classified by the authors according to the type of participant (healthy vs patients, type of sponsor (investigator-initiated vs pharmaceutical industry, type of study (observational vs interventional, level of risk [based on the Indian Council of Medical Research (ICMR "Ethical Guidelines for Biomedical Research on Human Participants"], available knowledge of the intervention being studied, and each patient′s disease condition. Results: The overall consent refusal rate was 21%. This rate was higher among patient participants [23.8% vs. healthy people (14.9%; P = 0.002], in interventional studies [33.6% vs observational studies (7.5%; P < 0.0001], in pharmaceutical industry-sponsored studies [34.7% vs investigator-initiated studies (7.2%; P < 0.0001], and in studies with greater risk (P < 0.0001. The most common reasons for consent refusals were multiple blood collections (28%, inability to comply with the study protocol (20%, and the risks involved (20%. Conclusion: Our audit suggests the adequacy and reasonable quality of the informed consent process using consent refusals as a metric.

  19. Survey of Opioid and Barbiturate Prescriptions in Patients Attending a Tertiary Care Headache Center.

    Science.gov (United States)

    Minen, Mia T; Lindberg, Kate; Wells, Rebecca E; Suzuki, Joji; Grudzen, Corita; Balcer, Laura; Loder, Elizabeth

    2015-10-01

    To educate physicians about appropriate acute migraine treatment guidelines by determining (1) where headache patients were first prescribed opioids and barbiturates, and (2) the characteristics of the patient population who had been prescribed opioids and barbiturates. Several specialty societies issued recommendations that caution against the indiscriminate use of opioids or barbiturate containing medications for the treatment of migraine. These medications are still being prescribed in various medical settings and could put headache specialists in a difficult position when patients request these agents. Patients presenting to a headache center comprised of eight physicians were asked to complete a survey that assessed headache types, comorbid conditions, and whether they had ever been prescribed opioids or barbiturates. If they responded affirmatively to the latter question, they were asked about the prescribing doctor, medication effectiveness, and whether they were currently on the medication. Data collection took place over a one month period. Two hundred forty-four patients were given the survey and 218 of these patients completed it. The predominant diagnosis was migraine (83.9%). More than half of the patients reported having been prescribed an opioid (54.8%) or a barbiturate (56.7%). About one fifth were on opioids (19.4%) or barbiturates (20.7%) at the time of completing the survey. Most patients reported being on opioids for more than 2 years (24.6%) or less than one week (32.1%). The reasons most frequently cited for stopping opioids were that the medications did not help (30.9%) or that they saw a new doctor who would not prescribe them (29.4%). Among patients who had previously been on barbiturates, 32.2% had been on these for over 2 years. Most patients (61.8%) stopped barbiturates because they did not find the medication helpful, while 17.6% said they saw a new doctor who would not prescribe them. The physician specialty most frequently cited as

  20. Cardiovascular disease in late survivors of tetralogy of fallot: a tertiary care center experience.

    Science.gov (United States)

    Bradley, Elisa; Parker, Jeff; Novak, Eric; Ludbrook, Philip; Billadello, Joseph; Cedars, Ari

    2013-01-01

    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 tetralogy of Fallot men aged 40 to 59 years (63% vs. 29%, P 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.

  1. Cutaneous metastasis: clinicopathological study of 72 patients from a tertiary care center in Lebanon.

    Science.gov (United States)

    El Khoury, Jinane; Khalifeh, Ibrahim; Kibbi, Abdul-Ghani; Abbas, Ossama

    2014-02-01

    Cutaneous metastasis is the result of malignant cell spread from primary malignancy to the skin. This is not uncommon, and rates reported in the literature are as high as 10.4%. To the best of our knowledge, there are no studies assessing the epidemiologic, clinical, and histopathological features of cutaneous metastasis in our region. To assess the clinical and histopathological findings of all patients diagnosed with cutaneous metastasis at the American University of Beirut - Medical Center (AUB-MC) and to compare our findings with those published in the literature. Retrospective clinical and histopathologic evaluation of all cases diagnosed as cutaneous metastasis at AUB-MC between 1992 and 2010. A total of 72 patients (50 females and 22 males) were identified. The mean age at diagnosis was 55.2 years. The most common primary cancer was breast cancer in women and laryngeal cancer in men. The most common clinical presentation was a single nodule in 27% of cases followed by multiple nodules in 23%. Cutaneous metastasis lesions were asymptomatic in the majority. The chest was the most commonly affected site. On microscopy, the majority of metastatic cases were adenocarcinomas (74%). This is, to our knowledge, the first study characterizing the epidemiological, clinical, and histopathological features of cutaneous metastasis in the Lebanese population. The clinical and histopathological features observed were in concordance with the published literature, with minor differences. © 2013 The International Society of Dermatology.

  2. Bacteriological profile of burn wound isolates in a burns center of a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Amankwa Richcane

    2017-01-01

    Full Text Available Objective: To determine the bacteriological profile and antimicrobial susceptibility patterns of burn wound isolates.Methods: Swabs were taken from burn wound of patients admitted to Ward D2C and Burns Intensive Care Unit (BICU from December 2014 to November 2015. Samples were processed at the Microbiology Laboratory for identification and sensitivity. Bacteria isolated were identified using their morphological characteristics, Gram staining reaction and biochemical tests. The antimicrobial susceptibility testing was done using Kirby-Bauer disc diffusion method. Questionnaires were also administered to study participants to obtain information on demography, kind of first aid received, antibiotics received prior to culture and sensitivity.Results: A total of 86 patients comprising 45 patients from Ward D2C and 41 from BICU participated in the study. Males were 51(59.3% and females 35 (40.7%. Age of participants ranged from 0–56+ years. Pseudomonas aeruginosa was the commonest pathogen isolated 26(30.2%, followed by Pseudomonas spp. 21(24.4%, Escherichia coli 17(19.8%, Klebsiella spp. 12(14.0%. Coagulase negative Staphylococcus accounted for 2(2.3%. Overall prevalence of infection in the study was 90.7%.Conclusions: Burn wound infection continues to be a major challenge in burn centers. Regular surveillance of commonly identified pathogens in the ward and their antimicrobial susceptibility will guide proper empiric selection of antibiotics for management of burn wounds.

  3. The Incidence of Nosocomial Toxigenic Clostridium difficile Associated Diarrhea in Tehran Tertiary Medical Centers

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    Norakhoda Sadeghifard

    2010-10-01

    Full Text Available Clostridium difficile is the most common cause of nosocomial diarrhea. It is usually a consequence of antibiotic treatment, But sporadic cases can occur. This study was aimed to determine the frequency of the nosocomial Clostridium difficile (C. difficile associated diarrhea in Tehran University of Medical Sciences hospitals and study of antibacterial susceptibility of isolates. In this study a total of 942 stool samples from patients with nosocomial diarrhea that were hospitalized in Imam Khomeini hospital, Shariati hospital and Children clinical center were collected. The samples were cultured on a selective cycloserine cefoxitin fructose agar (CCFA and incubated in anaerobic conditions, at 37°C for 5 days. Isolates were characterized to species level by conventional biochemical tests. Bacterial cytotoxicity was assayed on tissue culture (vero. Antimicrobial sensitivity of isolated toxigenic C. difficile were investigated by kirby Beuer method (disk diffusion. Our findings show that, of the total patients, 57 toxigenic C. difficile (6.1% were isolated. Results of statistical analysis show significant differences between the rate of isolated toxigenic C. difficile and age group of patients (P

  4. PATTERN OF EXTRA PULMONARY TUBERCULOSIS AS SEEN IN A TERTIARY CARE CENTER IN SOUTH INDIA

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    Supriya Adiody

    2017-12-01

    Full Text Available BACKGROUND Tuberculosis is one of the major infectious diseases affecting the global population. It ranks alongside HIV as a leading cause of death worldwide. Around 9.6 million people were estimated to be suffering from TB in 2014, out of which 480000 were cases of multi drug resistant TB (MDR-TB. Tuberculosis most commonly affects the lungs. It can involve almost any organ system of the body, the so called extra pulmonary TB. EPTB possess a diagnostic challenge for the clinicians because of lack of specific and usual symptoms of cough. In this study, we have analysed the pattern of EPTB in our center. MATERIALS AND METHODS It was a prospective observational study. 60 patients suffering from EPTB were included and these patients were selected on basis of radiological or histological confirmation of TB with or without AFB positivity source of data included physician prescribing records, patient medication profile, laboratory investigations and presentations. Study was conducted over a period of one year. Patients with Pulmonary Tuberculosis (PTB and HIV were excluded. CONCLUSION Maximum number of patients were in the age group of 21 to 40 years. Males predominantly suffered from the disease. Lymph node TB was the commonest form of EPTB followed by pleural effusion RESULTS There was a slight male preponderance. Lymph node was the commonest site of involvement in EPTB, followed by pleural effusion.

  5. Chronic pancreatitis in Eastern India: Experience from a tertiary care center.

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    Jha, Ashish Kumar; Goenka, Mahesh Kumar; Goenka, Usha

    2017-03-01

    There is a wide variation in the clinical presentation of chronic pancreatitis (CP) in the different parts of India. Data regarding the clinical profile of CP from eastern India are scarce. We describe the clinical and demographic profiles of patients with CP in eastern India. Consecutive patients were evaluated for the clinical presentation, etiology and complication of CP. One hundred and thirty-nine patients with CP (mean age 39.57±14.88 years; M/F 3.48:1) were included. Idiopathic CP (50.35%) was the most common etiology followed by alcohol (33.81%); 68.34% had calcific CP and 31.65% had noncalcific CP. The median duration of symptoms was 24 (1-240) months. Pain was the most common symptom, being present in 93.52% of the patients. Diabetes, steatorrhea and pseudocyst were present in 45.32%, 14.38% and 7.19% of the cases, respectively. Moderate to severe anemia was revealed in 16.53% of the patients. Benign biliary stricture was diagnosed in 19.42% of the cases (symptomatic in 6.47%). The common radiological findings were the following: pancreatic calculi (68.34%), dilated pancreatic duct (PD) (58.99%), parenchymal atrophy (25.89%) and PD stricture (23.74%). In our center, idiopathic CP followed by alcoholic CP was the most frequent form of CP. Tropical CP was distinctly uncommon.

  6. Ventricular septal defect in children and adolescents in Angola: experience of a tertiary center.

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    Manuel, Valdano; Morais, Humberto; Manuel, Ana; David, Bruna; Gamboa, Sebastiana

    2014-10-01

    This is the first study in Angola with the aim of characterizing ventricular septal defect (VSD) among children and adolescents. A cross-sectional study based on echocardiographic records of the largest pediatric cardiology center in Angola included all children and adolescents (0 to 18 years old) with VSD between April 2010 and March 2011. The diagnosis was made by transthoracic and Doppler echocardiography with a Medison SA 8000 system. The sample was divided into two groups: Group 1, isolated VSD; and Group 2, VSD associated with other congenital heart defects (CHDs). Age, gender, type of VSD, associated CHDs and genetic syndromes were assessed. A total of 490 CHDs were diagnosed, of which 283 were VSDs. In Group 1 (140, 49%) the mean age was 29±36 months. The most frequent age (mode) at diagnosis was 24 months. There was no predominance of gender (ratio 1:1). The majority (127, 91%) had perimembranous VSD. In Group 2 (143, 51%) 113 patients (79%) had one, 27 patients (19%) had two and three patients (2%) had three other CHDs. Trisomy 21 was the most common genetic syndrome (23, 96%). The study shows that VSD is the most common CHD in childhood, the diagnosis is made late and almost half of VSDs are associated with other CHDs. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  7. Cones, Seeds, and Foliage of Tetraclinis Salicornioides (Cupressaceae) from the Oligocene and Miocene of Western North America: A Geographic Extension of the European Tertiary Species.

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    Kvacek; Manchester; Schorn

    2000-03-01

    The cupressaceous genus Tetraclinis is recognized from the Oligocene and Miocene of western North America on the basis of co-occurring seed cones, seeds, and foliage branches. Morphological and anatomical comparisons with the two previously recognized European Tertiary species indicate that the North American specimens are morphologically inseparable from Tetraclinis salicornioides (Unger) Kvacek. The North American taxon is treated as a new variety, T. salicornioides (Unger) Kvacek var. praedecurrens (Knowlton) comb. et stat. nov., and is distinguished from the European representatives, T. salicornioides (Unger) Kvacek var. salicornioides, by slight anatomical differences in the leaf epidermis. Although cones and seeds of the fossil species are closely similar to those of extant Tetraclinis articulata, the foliage is more "spreading," composed of flattened segments with fused facial and lateral leaves that are apparently adaptive for a more mesic climate. The recognition of T. salicornioides in western North America along with the absence of Tetraclinis in the fossil and recent flora of eastern Asia provide evidence for communication of the species across the North Atlantic during the early or middle Tertiary.

  8. Indicators of malnutrition in children with cancer: A study of 690 patients from a tertiary care cancer center.

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    Srivastava, R; Pushpam, D; Dhawan, D; Bakhshi, S

    2015-01-01

    Large data pertaining to indicators of malnutrition in children with cancer is lacking from India. In view of this, we prospectively analyzed consecutive de novo childhood patients with cancer presenting at a tertiary care center. Height and weight of each child (n = 690) were compared with World Health Organization child growth standards-2006 for that particular age and sex to get weight-for-age, height-for-age, and weight-for-height indices and below 2SD of the reference median on these indices were considered as underweight, stunted, and wasted, respectively. Body mass index (BMI) for age was also analyzed for thinness and obesity. Prevalence of malnutrition based on Z-score for weight-for-age, height-for-age, weight-for-height, and BMI-for-age was 30%, 31%, 35%, and 41%, respectively. Weight-for-age (underweight) was significantly associated (P = 0.018) with solid tumors. Height-for-age, weight-for-age, and BMI-for-age were significantly associated (P = 0.007, P = 0.016, and P ≤ 0.001, respectively) with rural community. Malnutrition was observed in approximately one-third of children with cancer. Malnutrition is associated with solid tumors and those coming from rural community. Wasting has a higher prevalence in children with cancer in <5 years of age group.

  9. Pediatric Mortality in a Rural Tertiary Care Center in Liberia

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    Carmelle Tsai

    2017-01-01

    Full Text Available Liberia is a low‐income country in West Africa that has faced significant challenges, including a civil war and the recent Ebola epidemic. Little data exists on the more current post‐war and pre‐Ebola trends of child health in Liberia in the rural setting. This study is a retrospective chart review of pediatric mortality in 2013 at a rural tertiary care center in Liberia, 10 years post‐war. From January 2013 to December 2013, there were 50 pediatric deaths, or 5.4% of the 920 total pediatric admissions. The most common cause of neonatal death was sepsis, and the most common cause of death under five years of age was malaria. The majority (82.0% of the deaths were in children under five. Pediatric mortality at this hospital was similar to other reported mortality six years post‐war, and lower than that reported immediately post‐war. Neonatal sepsis and malaria are two significant causes of pediatric mortality in this community and, therefore, further efforts to decrease childhood mortality should focus on these causes.

  10. Thyroid Fine-Needle Aspiration under Ultrasound Guidance: Experience from an Academic Tertiary Care Center in Lebanon

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    Rita Hajj Boutros

    2017-07-01

    Full Text Available Thyroid nodules are common. Malignancy was reported in only 5-15% of cases. Fine needle aspiration under US guidance (USG-FNA proved to be accurate for the detection of thyroid cancer. This is a retrospective review of 400 radiology and cytology USG-FNA reports, randomly selected among those done at the Radiology Department at a tertiary care center in Beirut during the last five years. The specimen was inadequate in 60 (12% of cases but FNA was repeated in 10 cases only. The final diagnosis was benign in 76.7% of cases, mostly in women. 35% of the malignant and 19% of the benign nodules were hypoechoic, p=0.03. No significant correlation was observed between malignancy and other ultrasonic characteristics. Hypoechogenecity was also more common in nodules with inadequate specimen (40% versus 21.4%, p=0.01. Age, gender, location and size of the nodule did not differ between groups of adequate and inadequate specimen. In conclusion, 3 out of 4 thyroid nodules referred for USG-FNA are benign, mostly in women. Inadequate specimen was observed in 12% of cases. Hypoechogenecity but not other ultrasonic characteristics was associated with malignancy and with test failure.   Key words: Thyroid nodule, fine needle aspirate, ultrasound guidance, thyroid cancer, inadequate.

  11. Do Syrian refugees have increased risk for worser pregnancy outcomes? Results of a tertiary center in İstanbul.

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    Güngör, Emre Sinan; Seval, Olcay; İlhan, Gülşah; Verit, Fatma Ferda

    2018-03-01

    To compare obstetric and perinatal outcomes of Syrian refugee pregnants and Turkish counterparts who gave birth at a tertiary center in İstanbul. A retrospective study including the birth records of 704 Syrian refugees and 744 Turkish pregnant women between January 2016 and May 2017 were analyzed. Demographic data, obstetric and neonatal outcomes were compared. The primary aims of this study were to evaluate the pregnancy outcomes and cesarean rates between the groups. The secondary outcomes were the use of antenatal vitamin supplementation, hemoglobin-hematocrit values, and maternal complications. Our results showed that the use of folic acid and iron supplementation rates during pregnancy were similar between the groups (folic acid supplementation 8.1% vs 6.5%, p=0.264; iron supplementation 20.7% vs 19.6%, p=0.125; respectively for Turkish women and Syrian refugees). Cesarean rates were significantly higher for Turkish patients than in Syrian refugees (42.7% vs 32.7%; pyrian refugees (37.7±2.3 vs 36.4±2.3 weeks, pyrian refugees, respectively, p=0.105). Although obstetric complications were seen more often in Syrian refugees, it did not reach statistical difference (9.7% vs 8.1%, respectively, p=0.285). Syrian refugees use antenatal vitamin supplementations at similar rates to Turkish citizens and obstetric and perinatal outcomes are similar between the groups.

  12. A retrospective comparison of VLBW outcomes before and after implementing new delivery room guidelines at a regional tertiary care center.

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    Wlodaver, A; Blunt, M; Satnes, K; Escobedo, M; Hallford, G; Szyld, E

    2016-03-01

    To evaluate the impact of implemented protocol changes on delivery room interventions and very low birth weight (VLBW) health outcomes. Retrospective study comparing birth characteristics, interventions and health outcomes of VLBW infants born in a tertiary care center before (calendar years 2008 to 2009) and after (calendar years 2012 to 2013) implementing new protocols using Chi-square analyses. Four hundred and nine were born before and 303 after changes were implemented. Postimplementation infants had more use of antenatal steroids (P=0.02), gestational age ⩽24 weeks (P=0.03) and birth weights between 501 and 750 g (P=0.04) and less oxygen administration (P=0.002), face mask ventilation (P=0.0001), surfactant use (P=0.0001), chest compressions (P=0.0001), intubation (P=0.002), epinephrine use (P=0.011), hypothermia (P=0.0001) and discharges home on supplemental oxygen (P=0.05). Changes creating a new delivery team, adopting new delivery practice guidelines and updating delivery room equipment resulted in positive outcomes for delivery room practices and patient outcomes.

  13. Demographic characteristics of chronic pancreatitis patients in the era of endosonography: Experience of a single tertiary referral center in Turkey.

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    Şişman, Gürhan; Köroğlu, Emine; Erzin, Yusuf; Hatemi, İbrahim; Tuncer, Murat; Şentürk, Hakan

    2016-05-01

    There are no clinical data available about chronic pancreatitis (CP) on a series of patients of sufficient number in Turkey. In this study, the etiology and clinical features of CP were evaluated in one center, which is a tertiary referral hospital. The files of 168 patients who had been diagnosed with CP in our Medical Faculty between October 2007 and May 2013 were retrospectively analyzed. The etiological factors, symptoms, complications, and treatment methods were analyzed. The most common etiological factor was alcohol abuse (39%). The average age±SD was 46±15.2 years, and the male:female ratio was 4.2:1 (it was 2.6:1 for other etiologies except alcohol abuse and 15.5:1 in alcoholic CP patients, ppancreatic calcification (ppancreatic cancer was detected in four patients (2.3%). In majority of the CP patients, the etiology is alcohol abuse in Turkey. The development of diabetes is the most frequent complication of CP, which is independent of the etiology.

  14. Clinical characteristics of acute hepatitis A outbreak in Taiwan, 2015-2016: observations from a tertiary medical center.

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    Chen, Nan-Yu; Liu, Zhuo-Hao; Shie, Shian-Sen; Chen, Tsung-Hsing; Wu, Ting-Shu

    2017-06-20

    Acute hepatitis A is a fecal-oral transmitted disease related to inadequate sanitary conditions. In addition to its traditional classification, several outbreaks in the men who have sex with men (MSM) population have resulted in acute hepatitis A being recognized as a sexually transmitted disease. However, few studies have clarified the clinical manifestations in these outbreaks involving the MSM population. Beginning in June 2015, there was an outbreak of acute hepatitis A involving the MSM population in Northern Taiwan. We conducted a 15-year retrospective study by recruiting 207 patients with the diagnosis of acute hepatitis A that included the pre-outbreak (January 2001 to May 2015) and outbreak (June 2015 to August 2016) periods in a tertiary medical center in Northern Taiwan. Using risk factors, comorbidities, presenting symptoms, laboratory test results and imaging data, we aimed to evaluate the clinical significance of acute hepatitis A in the MSM population, where human immunodeficiency virus (HIV) coinfection is common. There was a higher prevalence of reported MSM (p hepatitis A during the outbreak period. The outbreak population had more prominent systemic symptoms, was more icteric with a higher total bilirubin level (p hepatitis A relapse. The clinical course of acute hepatitis A during an outbreak involving the MSM and HIV-positive population is more symptomatic and protracted than in the general population.

  15. Sociodemographic profile, clinical factors, and mode of attempt in suicide attempters in consultation liaison psychiatry in a tertiary care center

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    Santosh Ramdurg

    2011-01-01

    Full Text Available Background: The objective was to study the sociodemographic data, psychiatric disorder, precipitating events, and mode of attempt in suicide attempted patients referred to consultation liaison psychiatric services. Settings and Design: A prospective study of 6-month duration was done in a tertiary care center in India. Materials and Methods: During the 6-month period all referrals were screened for the presence of suicide attempters in consultation liaison services. Those who fulfilled the criteria for suicide attempters were evaluated by using semistructured pro forma containing sociodemographic data, precipitating events, mode of attempt, and psychiatric diagnosis by using ICD-10. Results: The male-to-female ratio was similar. Adult age, urban background, employed, matriculation educated were more represented in this study. More than 80% of all attempters had psychiatric disorder. Majority had a precipitating event prior to suicide attempt. The most common method of attempt was by use of corrosive. Conclusions: Majority of suicide attempter patients had mental illness. Early identification and treatment of these disorders would have prevented morbidity and mortality associated with this. There is a need of proper education of relatives about keeping corrosive and other poisonous material away from patients as it was being commonest mode of attempt.

  16. Role of endoscopic ultrasonography in evaluation of metastatic lesions to the pancreas: a tertiary cancer center experience.

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    Atiq, Muslim; Bhutani, Manoop S; Ross, William A; Raju, Gottumukkala S; Gong, Yun; Tamm, Eric P; Javle, Milind; Wang, Xuemei; Lee, Jeffrey H

    2013-04-01

    Metastatic lesions to the pancreas pose diagnostic challenges with regards to their differentiation from primary pancreatic cancer. Data on the yield of endoscopic ultrasonography (EUS)-guided fine-needle aspiration in detection of these lesions are limited. This is a retrospective review of 23 patients referred to a tertiary referral center for further evaluation of suspected pancreatic metastases. Main outcome measures were diagnostic yield of endoscopic ultrasonography-guided fine-needle aspiration in evaluation of metastatic lesions to the pancreas. Of 644 patients, 23 (3.6%) undergoing EUS of the pancreas were diagnosed to have metastatic disease to the pancreas based on clinical, radiological, and cytological results. Mean (SD) age was 64.3 (11.7) years. Of the 23 patients, 18 (78.3%) were asymptomatic. Mean (SD) size of lesion on EUS was 39.1 (19.9) mm. A diagnosis of malignant lesion was made in 21 of 23 cases, with a diagnostic accuracy of 91.3%. Metastatic lesions to the pancreas present as incidental, solitary mass lesions on staging or surveillance imaging. Endoscopic ultrasonography-guided fine-needle aspiration is an important tool in the characterization and further differentiation of metastatic lesions to the pancreas from primary pancreatic cancer.

  17. Epidemiology of Staphylococcus aureus in a burn unit of a tertiary care center in Ghana.

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    Amissah, Nana Ama; van Dam, Lieke; Ablordey, Anthony; Ampomah, Opoku-Ware; Prah, Isaac; Tetteh, Caitlin S; van der Werf, Tjip S; Friedrich, Alexander W; Rossen, John W; van Dijl, Jan Maarten; Stienstra, Ymkje

    2017-01-01

    In developing countries, hospitalized burn victims are at high risk of nosocomial infections caused by Staphylococcus aureus. Risk factors include poor infection control practices, prolonged hospitalisation and limited capacity for laboratory microbiological analyses. These problems are compounded by widespread use of antibiotics that drives the spread of multi-drug resistant bacteria. During the study period (November 2014-June 2015), nasal and invasive S. aureus isolates were collected consecutively from patients and healthcare workers (HCWs) within the burn unit of the Reconstructive Plastic Surgery and Burn Center of Korle Bu Teaching Hospital in Ghana. Antibiotic prescription, antibiotic susceptibility and bacterial typing were used to assess antibiotic pressure, antibiotic resistance, and possible transmission events among patients and HCWs. Eighty S. aureus isolates were obtained from 37 of the 62 included burn patients and 13 of the 29 HCWs. At admission, 50% of patients carried or were infected with S. aureus including methicillin resistant S. aureus (MRSA). Antibiotic use per 100 days of hospitalization was high (91.2 days), indicating high selective pressure for resistant pathogens. MRSA isolates obtained from 11 patients and one HCW belonged to the same spa-type t928 and multi-locus sequence type 250, implying possible transmission events. A mortality rate of 24% was recorded over the time of admission in the burn unit. This study revealed a high potential for MRSA outbreaks and emergence of resistant pathogens amongst burn patients due to lack of patient screening and extended empirical use of antibiotics. Our observations underscore the need to implement a system of antibiotic stewardship and infection prevention where microbiological diagnostics results are made available to physicians for timely and appropriate patient treatment.

  18. Epidemiology of Staphylococcus aureus in a burn unit of a tertiary care center in Ghana.

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    Nana Ama Amissah

    Full Text Available In developing countries, hospitalized burn victims are at high risk of nosocomial infections caused by Staphylococcus aureus. Risk factors include poor infection control practices, prolonged hospitalisation and limited capacity for laboratory microbiological analyses. These problems are compounded by widespread use of antibiotics that drives the spread of multi-drug resistant bacteria.During the study period (November 2014-June 2015, nasal and invasive S. aureus isolates were collected consecutively from patients and healthcare workers (HCWs within the burn unit of the Reconstructive Plastic Surgery and Burn Center of Korle Bu Teaching Hospital in Ghana. Antibiotic prescription, antibiotic susceptibility and bacterial typing were used to assess antibiotic pressure, antibiotic resistance, and possible transmission events among patients and HCWs.Eighty S. aureus isolates were obtained from 37 of the 62 included burn patients and 13 of the 29 HCWs. At admission, 50% of patients carried or were infected with S. aureus including methicillin resistant S. aureus (MRSA. Antibiotic use per 100 days of hospitalization was high (91.2 days, indicating high selective pressure for resistant pathogens. MRSA isolates obtained from 11 patients and one HCW belonged to the same spa-type t928 and multi-locus sequence type 250, implying possible transmission events. A mortality rate of 24% was recorded over the time of admission in the burn unit.This study revealed a high potential for MRSA outbreaks and emergence of resistant pathogens amongst burn patients due to lack of patient screening and extended empirical use of antibiotics. Our observations underscore the need to implement a system of antibiotic stewardship and infection prevention where microbiological diagnostics results are made available to physicians for timely and appropriate patient treatment.

  19. Correlates of Complementary and Alternative Use in a Pediatric Tertiary Pain Center

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    Vinson, Rachel; Yeh, Gloria; Davis, Roger B.; Logan, Deirdre

    2014-01-01

    Objective To examine correlates of Complementary and Alternative Medicine (CAM) use in a pediatric population with chronic pain. To determine if CAM use is positively correlated with adaptive coping skills. Methods We examined patient data from children ages 7–18 (n=1175) with chronic pain who completed the intake assessment at the time of initial evaluation at Boston Children’s multidisciplinary Pain Treatment Service between 2003–2011. The intake assessment included validated measures of anxiety, depression, pain coping skills and functional disability. Parents were also asked whether their child had tried CAM modalities in the past. We used a multivariable logistic regression model to determine correlates of CAM use and a multivariable linear regression model to determine the relationship between bio-behavioral CAM (relaxation training, hypnosis, and biofeedback) and accommodative coping. Results In our multivariable model, we found that female gender (OR 1.47, CI 1.07–2.01), parental education (OR 1.11 per year, CI 1.06–1.16), greater pain intensity (OR 1.06 per point on an 11-point numerical analog scale, CI 1.01–1.11), and more functional disability (OR 1.19 per 10 point increment on the Functional Disability Inventory, CI 1.06–1.34) were independently associated with CAM use. Bio-behavioral CAM was found to have a statistically significant correlation with accommodative coping skills (β 0.2 p-value .003). Conclusion In a pediatric chronic pain center, CAM users tended to have higher pain intensity, and greater functional disability. Exposure to bio-behavioral CAM techniques was associated with adaptive coping skills. PMID:25169161

  20. Correlates of complementary and alternative medicine use in a pediatric tertiary pain center.

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    Vinson, Rachel; Yeh, Gloria; Davis, Roger B; Logan, Deirdre

    2014-01-01

    To examine correlates of complementary and alternative medicine (CAM) use in a pediatric population with chronic pain, and to determine whether CAM use is positively correlated with adaptive coping skills. We examined patient data from 1175 children aged 7 to 18 years with chronic pain who completed the intake assessment at the time of initial evaluation at Boston Children's multidisciplinary Pain Treatment Service between 2003 and 2011. The intake assessment included validated measures of anxiety, depression, pain coping skills, and functional disability. Parents were also asked whether their child had tried CAM modalities in the past. We used a multivariable logistic regression model to determine correlates of CAM use and a multivariable linear regression model to determine the relationship between biobehavioral CAM (relaxation training, hypnosis, and biofeedback) and accommodative coping. In our multivariable model, we found that female gender (odds ratio [OR] 1.48, 95% confidence interval [95% CI] 1.07-2.02), level of parental education (OR 1.11 per year, 95% CI 1.06-1.16), greater pain intensity (OR 1.06 per point on an 11-point numerical analog scale, 95% CI 1.01-1.11), and more functional disability (OR 1.19 per 10-point increment on the Functional Disability Inventory, 95% CI 1.06-1.34) were independently associated with CAM use. Biobehavioral CAM was found to have a statistically significant correlation with accommodative coping skills (β = 0.2, P = .004). In a pediatric chronic pain center, CAM users tended to have higher pain intensity and greater functional disability. Exposure to biobehavioral CAM techniques was associated with adaptive coping skills. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  1. "WhatsApp"ening in orthopedic care: a concise report from a 300-bedded tertiary care teaching center.

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    Khanna, Vishesh; Sambandam, Senthil N; Gul, Arif; Mounasamy, Varatharaj

    2015-07-01

    Smartphones have emerged as essential tools providing assistance in patient care, monitoring, rehabilitation, communication, diagnosis, teaching, research and reference. Among innumerable communication apps, WhatsApp has been widely popular and cost effective. The aim of our study was to report the impact of introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool on (1) awareness of patient-related information, (2) efficiency of the handover process and (3) duration of traditional morning handovers among orthopedic residents in a 300-bedded tertiary care teaching center. Written handovers and paging used for communication at our center led to occasional inefficiencies among residents. Widespread use, low cost, availability and double password protection (phone lock and WhatsApp lock) made WhatsApp's group conversation feature an ideal tool for intradepartmental patient-related communication. Twenty-five consecutive admissions before and after WhatsApp (BW, AW) were included in the study. Eight orthopedic residents attempted fifty randomly arranged questions based on the twenty-five patients in each study period. A null hypothesis that introduction of WhatsApp group would neither increase the awareness of patient-related information nor improve the efficiency of the handovers among residents was assumed. A significant improvement observed in scores obtained by residents in the AW group led to rejection of the null hypothesis. The residents also reported swifter and efficient handovers after the introduction of WhatsApp. Our results indicate that the introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool can bring about an improvement in patient-related awareness, communication and handovers among orthopedic residents.

  2. Hypertensive crisis in children: an experience in a single tertiary care center in Korea.

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    Lee, Geum Hwa; Lee, I Re; Park, Se Jin; Kim, Ji Hong; Oh, Ji Young; Shin, Jae Il

    2015-01-01

    Hypertensive crisis is a medical emergency that can cause acute damage to multiple end-organs. However, relatively little is known on the etiology, treatment, and outcomes of hypertensive crisis in Korean children. The aim of this study was to determine the etiologies and efficacy of drugs for hypertensive crisis in children during the past 5 years at a single center in Korea. We analyzed data from 51 children with hypertensive crisis during the period between January 1, 2010 and April 1, 2014. The patients were divided into two groups: those diagnosed with a hypertensive emergency (hypertension with organ injury, n = 31) and those diagnosed with a hypertensive urgency (hypertension without organ injury, n = 20). Baseline etiologies and risk factors were compared between the two groups. In addition, systolic and diastolic blood pressures were evaluated at 1, 2, 4, and 5 hours after the administration of intravenous antihypertensive drugs. Kidney injury and cancer were the common causes in patients with hypertensive crisis. Cardiovascular complications (cardiac hypertrophy) (p = 0.002), central nervous system complications (p = 0.004), and retinopathy (p = 0.034) were more frequently observed in children with hypertensive emergency than those with hypertensive urgency. However, the proportion of renal complications was similar in both groups. Hydralazine was most commonly used in both groups to control acute increasing blood pressure at first. However, it was often ineffective for controlling abrupt elevated blood pressure. Therefore, intravenous antihypertensive drugs were changed from hydralazine to nicardipine, labetalol, or nitroprusside to control the high blood pressure in 45.1 % of the patients. Particularly, in patients with hypertensive crisis, there was no significant difference in reduction of systolic and diastolic blood pressure and in improvement of clinical outcomes between nicardipine and labetalol administration. Close blood

  3. Barrett's esophagus: Ten years of experience at a tertiary care hospital center in Mexico.

    Science.gov (United States)

    Valdovinos-Andraca, F; Bernal-Méndez, A R; Barreto-Zúñiga, R; Briseño-García, D; Martínez-Lozano, J A; Romano-Munive, A F; Elizondo-Rivera, J; Téllez-Ávila, F I

    The prevalence of Barrett's esophagus has been calculated at between 1.3 and 1.6%. There is little information with respect to this in Mexico. To determine the frequency and characteristics of Barrett's esophagus in patients that underwent endoscopy at a national referral center, within a 10-year time frame. The databases of the pathology and gastrointestinal endoscopy departments of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" were analyzed, covering the period of January 2002 to December 2012. Patients with a histologic diagnosis of Barrett's esophagus were included. The variables of age, sex, the presence of dysplasia/esophageal adenocarcinoma, Barrett's esophagus length, and follow-up were analyzed. Of 43,639 upper gastrointestinal endoscopies performed, 420 revealed Barrett's esophagus, corresponding to a frequency of 9.6 patients for every 1,000 endoscopies. Of those patients, 66.9% (n=281) were men, mean patient age±SD was 57.2±15.3 years, 223 patients (53%) presented with long-segment Barrett's esophagus, and 197 (47%) with short-segment Barrett's esophagus. Dysplasia was not present in 339 patients (80.7%). Eighty-one (19.3%) patients had some grade of dysplasia or cancer: 48/420 (11.42%) presented with low-grade dysplasia, 20/420 (4.76%) with high-grade dysplasia, and 13/420 (3.1%) were diagnosed with esophageal cancer arising from Barrett's esophagus. Mean follow-up time was 5.6 years. The frequency of Barrett's esophagus was 9.6 cases for every 1,000 upper gastrointestinal endoscopies performed. Dysplasia was not documented in the majority of the patients with Barrett's esophagus and they had no histopathologic changes during follow-up. A total of 19.3% of the patients presented with dysplasia or cancer. Copyright © 2017 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  4. Surgeon-performed endoscopic retrograde cholangiopancreatography. Outcomes of 2392 procedures at two tertiary care centers.

    Science.gov (United States)

    Al-Mansour, Mazen R; Fung, Eleanor C; Jones, Edward L; Zayan, Nichole E; Wetzel, Timothy D; Martin Del Campo, Sara E; Jalilvand, Anahita D; Suzo, Andrew J; Dettorre, Rebecca R; Fullerton, James K; Meara, Michael P; Mellinger, John D; Narula, Vimal K; Hazey, Jeffrey W

    2018-06-01

    Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure that, in the United States, is traditionally performed by gastroenterologists. We hypothesized that when performed by well-trained surgeons, ERCP can be performed safely and effectively. The objectives of the study were to assess the rate of successful cannulation of the duct of interest and to assess the 30-day complication and mortality rates. We retrospectively reviewed the charts of 1858 patients who underwent 2392 ERCP procedures performed by five surgeons between August 2003 and June 2016 in two centers. Demographic and historical data, indications, procedure-related data and 30-day complication and mortality data were collected and analyzed. The mean age was 53.4 (range 7-102) years and 1046 (56.3%) were female. 1430 (59.8%) of ERCP procedures involved a surgical endoscopy fellow. The most common indication was suspected or established uncomplicated common bile duct stones (n = 1470, 61.5%), followed by management of an existing biliary or pancreatic stent (n = 370, 15.5%) and acute biliary pancreatitis (n = 173, 7.2%). A therapeutic intervention was performed in 1564 (65.4%), a standard sphincterotomy in 1244 (52.0%), stent placement in 705 (29.5%) and stone removal in 638 (26.7%). When cannulation was attempted, the rate of successful cannulation was 94.1%. When cannulation was attempted during the patient's first ERCP the cannulation rate was 92.4%. 94 complications occurred (5.4%); the most common complication was post-ERCP pancreatitis in 75 (4.2%), significant gastrointestinal bleeding in 7 (0.4%), ascending cholangitis in 11 (0.6%) and perforation in 1 (0.05%). 11 mortalities occurred (0.5%) but none of which were ERCP-related. When performed by well-trained surgical endoscopists, ERCP is associated with high success rate and acceptable complication rates consistent with previously published reports and in line with societal guidelines.

  5. Outcomes of very low birth weight infants in a newborn tertiary center in Turkey, 1997-2000.

    Science.gov (United States)

    Atasay, Begüm; Günlemez, Ayla; Unal, Sevim; Arsan, Saadet

    2003-01-01

    Our purpose was to determine mortality and morbidity rates and selected outcome variables for infants weighing less than 1500 g, who were admitted to the neonatal intensive care unit of our hospital from 1997 to 2000. The ultimate goal of the study was to define a model for developing a regional database. Information on all very low birth weight (VLBW) admissions to a tertiary level neonatal intensive care unit (NICU) in Ankara between January 1997 and December 2000 was prospectively collected by three neonatologists using a standard manual of operation and definitions. The data consisted of patient information including sociodemographic characteristics; antenatal history; mode of delivery; APGAR scores; need for resuscitation; admission illness severity (Clinical Risk Index for Babies-CRIB) and therapeutic intensity (Neonatal Therapeutic Intensity Scoring System-NTISS); selected NICU parameters and procedures such as respiratory support, surfactant therapy, and postnatal corticosteroid therapy; and selected patient outcomes such as intraventricular hemorrhage, septicemia, necrotizing enterecolitis, retinopathy of prematurity, and chronic lung disease. The number of VLBW admissions to the NICU was 133, with 51 (28.6%) referrals from other maternity centers. The mean birth weight and gestational age of the infants were 1175 +/- 252 g and 30.3 +/- 2.9 weeks, respectively. One hundred and seventeen of 133 cases (88.7%) received at least one antenatal care visit. The median CRIB and NTISS scores were 4.5 and 31, respectively. Antenatal steroids had been given to 74 (55.6%) infants. Surfactant treatment and respiratory support were given to 33 (24.8%) and 73 (54.8%) infants, respectively. Among selected outcomes, chronic lung disease (CLD), threshold retinopathy of prematurity (ROP), severe intraventricular hemorrhage (IVH > or = grade III), nosocomial infection and necrotizing enterocolitis (NEC) were encountered in 14 (12.6%), 9 (8.1%), 3 (2.2%), 34 (25.5%) and 35 (26

  6. Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Søholm, Helle; Kjaergaard, Jesper; Bro-Jeppesen, John

    2015-01-01

    (OR, 10 [5.3-22] and 3.8 [2.5-5.7]), neurophysiological examination (OR, 1.8 [1.3-2.6]), and brain computed tomography (OR, 1.9 [1.4-2.6]), whereas no difference in therapeutic hypothermia was noted. Patients at tertiary centers were more often consulted by a cardiologist (OR, 8.6 [5.0-15]), had...

  7. Factors associated with high stress levels in adults with diabetes mellitus attending a tertiary diabetes care center, Chennai, Tamil Nadu, India.

    OpenAIRE

    Sendhilkumar, M; Tripathy, JP; Harries, AD; Dongre, AR; Deepa, M; Vidyulatha, A; Poongothai, S; Venkatesan, U; Anjana, RM; Mohan, V

    2017-01-01

    Objective: We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM) in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. Methods: A mixed-methods (triangulation design) study with quantitative methodology (survey) and qualitative methodology (interviews) was carried out. Stress levels w...

  8. Changing indications and techniques for corneal transplantations at a tertiary referral center in Turkey, from 1995 to 2014

    Directory of Open Access Journals (Sweden)

    Altay Y

    2016-06-01

    Full Text Available Yesim Altay, Ayse Burcu, Gozde Aksoy, Evin Singar Ozdemir, Firdevs Ornek Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey Background: Indications for corneal transplantation in developed and developing nations differ according to the different spectrum of corneal disease in each country. Objective: The purpose of this study is to analyze the changing indications and surgical techniques for corneal transplantation over the past 20 years at a tertiary referral center in Turkey. Methods: We retrospectively reviewed the records of patients who underwent keratoplasty from January 1995 to December 2014 (between 1995 and 2004, period 1, and between 2005 and 2014, period 2. Patients’ demographic data, indications for corneal transplantation, and the type of surgery were recorded. Results: The number of keratoplasties performed ranged from 548 in period 1 to 782 in period 2. Between 1995 and 2004, the leading indications were keratoconus (34.1%, bullous keratopathy (17%, and non-herpetic corneal scar (13.3%, and between 2005 and 2014, they were keratoconus (33.8%, corneal stromal dystrophy (14.2%, and bullous keratopathy (12.7%. All the keratoplasties performed in the 1995–2004 period were penetrating keratoplasty (PKP. During the period 2005–2014, PKP accounted for 93%, automated lamellar keratoplasty 5.8%, and deep anterior lamellar keratoplasty 1.2% of all corneal transplantations. Conclusion: Keratoconus was the leading indication for keratoplasty in both periods. In the 2005–2014 period, corneal stromal dystrophy increased significantly. All the keratoplasties performed in period 1 and 93% of all keratoplasties performed in period 2 were PKP. Keywords: corneal transplantation, indication, keratoconus, keratoplasty technique, pene­trating keratoplasty

  9. Risk factors, microbiological findings, and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland.

    LENUS (Irish Health Repository)

    Saeed, Ayman

    2012-02-01

    AIM: To identify the risk factors for, and to report the microbiological findings and clinical outcomes of, severe microbial keratitis (MK). METHODS: This was a retrospective study of all cases of presumed MK admitted to a tertiary referral center over a 2-year period (September 2001 to August 2003). Data recorded included demographic data, details relating to possible risk factors, results of microbiological studies, clinical findings at presentation, and clinical and visual outcomes. RESULTS: Ninety patients were admitted with a diagnosis of presumed MK during the study period. The mean age of patients was 45 +\\/- 32 years, and the male to female ratio was 47:43 (52.2%:47.7%). Predisposing risk factors for MK included contact lens wear (37; 41.1%), anterior segment disease (19; 21.1%), ocular trauma (13; 14.4%), systemic disease (5; 5.6%), and previous ocular surgery (1; 1.1%). Cultured organisms included gram-negative bacteria (17; 51.5%), gram-positive bacteria (11, 33.3%), acanthamoeba (2; 6.1%), and fungi (1; 3%). Visual acuity improved significantly after treatment [mean best-corrected visual acuity (+\\/-standard deviation) at presentation: 0.76 (+\\/-0.11); mean best-corrected visual acuity at last follow-up: 0.24 (+\\/-0.07); P < 0.001]. Secondary surgical procedures were required in 18 (20%) cases, and these included punctal cautery (1; 1.1%), tissue glue repair of corneal perforation (2; 2.2%), tarsorrhaphy (9; 9.9%), Botulinum toxin-induced ptosis (1; 1.1%), penetrating keratoplasty (3; 3.3%), and evisceration (2; 2.2%). CONCLUSIONS: Contact lens wear remains a significant risk factor for severe MK. MK remains a threat to vision and to the eye, but the majority of cases respond to prompt and appropriate antimicrobial therapy.

  10. Time trends in Staphylococcus aureus bacteremia, 1988-2010, in a tertiary center with high methicillin resistance rates.

    Science.gov (United States)

    Yahav, Dafna; Shaked, Hila; Goldberg, Elad; Yassin, Sharief; Eliakim-Raz, Noa; Paul, Mical; Bishara, Jihad; Leibovici, Leonard

    2017-02-01

    Changes in the epidemiology of Staphylococcus aureus bacteremia (SAB) have been described in recent decades. Decreased mortality has been reported over time, mostly from countries with low methicillin resistance rates. We aimed to describe time trends in SAB in a tertiary center with high methicillin resistance rates. We retrospectively analyzed 1692 patients with SAB, and compared between three time periods: 1988-1994 (342 patients), 1998-2004 (597 patients) and 2005-2010 (753 patients). In our cohort, 30 days mortality increased significantly with time, reaching 42.9 % during 2005-2010. The latter period was characterized by higher rates of older patients (35.1 % aged 80 years and older), with lower functional capacity (46.5 % bedridden) and higher rates of comorbidities (33.6 % renal disease, 24.8 % heart failure, 19.0 % dementia). These patients were more likely to be ventilated (18.7 %) and carry a urinary catheter at presentation (46.6 %); present with septic shock (15.9 %) and have pneumonia (20.5 %) or endocarditis (7.2 %) as source. Similar characteristics were found among patients younger than 50 years and with independent functional status. No significant increase in methicillin resistant Staph aureus (MRSA) rates or inappropriate empirical therapy was demonstrated during 2005-2010. In our cohort, increased mortality in recent years in patients with SAB can be explained by baseline condition of patients. MRSA or inappropriate empiric therapy did not explain the increase in mortality. The patients afflicted with SAB changed over time. Epidemiology and outcomes of SAB vary with time and according to geographical location. External validity of studies should be taken into consideration.

  11. Radiological imaging features and clinicopathological correlation of hemosiderotic fibrolipomatous tumor: experience in a single tertiary cancer center

    Energy Technology Data Exchange (ETDEWEB)

    O' Driscoll, Dearbhail; Athanasian, Edward; Hameed, Meera; Hwang, Sinchun [Memorial Sloan Kettering Cancer Center, New York, NY (United States)

    2015-05-01

    To determine the imaging features of hemosiderotic fibrolipomatous tumor (HFLT), which has a propensity towards local recurrence and the potential to transform into myxoinflammatory fibroblastic sarcoma (MIFS). The study included 8 patients with a diagnosis of HFLT and imaging at a tertiary cancer center. Imaging studies included radiographs (n = 2), ultrasound (n = 3), and MRI (n = 16). Imaging features were evaluated including location, calcification, sonographic echogenicity, vascular flow, size, border, signal characteristics, contrast enhancement, and blooming on MRI. The HFLT was located in the ankle/foot in 4 out of 8 and was subcutaneous in 8 out of 8, ranging in size from 2 to 18 cm. Histology at initial diagnosis was HFLT in 5 out of 8 and HFLT with MIFS in 3 out of 8. None was calcified on radiography. On ultrasound 2 out of 3 were heterogeneously echogenic with ≥10 foci of vascular flow. Two out of 8 patients had MRI only at local recurrence. The tumor border was infiltrative in 4 out of 6 at initial diagnosis and in 2 patients with MRI at recurrence only. Fat and septae were present in 7 out of 8 at initial diagnosis and at recurrence. Signal intensity was iso-/hypointense to muscle on T1-weighted sequences in more than two thirds of the tumor in 4 out of 7 and hyperintense to muscle in at least one third of the tumor on fluid-sensitive sequences in 6 out of 8. Contrast enhancement was heterogeneous in 7 out of 7; blooming in two thirds of the tumor on gradient-echo sequence MRI indicated hemorrhage. The HFLT commonly presents as a mass with an infiltrative border, interspersed fat and septations at initial diagnosis and local recurrence on MRI regardless of histology of HFLT alone or with MIFS. Hemosiderin deposits may be detected as blooming on gradient-echo sequences. (orig.)

  12. A clinico-etiological study of dermatoses in pediatric age group in tertiary health care center in South Gujarat region

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    Sugat A Jawade

    2015-01-01

    Full Text Available Background: Dermatologic conditions have different presentation and management in pediatric age group from that in adult; this to be studied separately for statistical and population based analysis. Objective: To study the pattern of various dermatoses in infants and children in tertiary health care center in South Gujarat region. Materials and Methods: This is a prospective study; various dermatoses were studied in pediatric patients up to 14 years of age attending the Dermatology OPD of New Civil Hospital, Surat, Gujarat over a period of 12 months from June 2009 to June 2010. All patients were divided into four different study groups: 1 to 6 years and 7 to 14 years. Results: There were 596 boys and 425 girls in total 1021 study populations. Majority of the skin conditions in neonates were erythema toxicum neonatorum (12.97%, scabies (9.92%, mongolian spot (9.16%, and seborrheic dermatitis (7.63%. In > 1 month to 14 years age group of children among infectious disorder, children were found to be affected most by scabies (24.49%, impetigo (5.96%, pyoderma (5.62%, molluscum contagiosum (5.39%, tinea capitis (4.49%, leprosy (2.02%, and viral warts (1.35% while among non-infectious disorders, they were affected by atopic dermatitis (4.27%, pityriasis alba (4.16%, seborrheic dermatitis (3.60%, pityriasis rosea (3.15%, others (3.01%, phrynoderma (2.70%, lichen planus (2.58%, contact dermatitis (1.57% and ichthyosis (1.45%. Conclusion: There is a need to emphasize on training the management of common pediatric dermatoses to dermatologists, general practitioners and pediatricians for early treatment.

  13. Symptoms of central sensitization and comorbidity for juvenile fibromyalgia in childhood migraine: an observational study in a tertiary headache center.

    Science.gov (United States)

    de Tommaso, Marina; Sciruicchio, Vittorio; Delussi, Marianna; Vecchio, Eleonora; Goffredo, Marvita; Simeone, Michele; Barbaro, Maria Grazia Foschino

    2017-12-01

    Central sensitization is an important epiphenomenon of the adult migraine, clinically expressed by allodynia, pericranial tenderness and comorbidity for fibromyalgia in a relevant number of patients. This study aimed to evaluate the frequency and the clinical characteristics of allodynia, pericranial tenderness, and comorbidity for Juvenile Fibromialgia (JFM) in a cohort of migraine children selected in a tertiary headache center. This was an observational cross-sectional study on 8-15 years old migraine patients. Allodynia was assessed by a questionnaire. Pericranial tenderness and comorbidity for JFM as well as their possible association with poor quality of life and migraine related disability, and with other clinical symptoms as anxiety, depression, sleep disorders and pain catastrophizing, were also evaluated. One hundred and fifty one patients were selected, including chronic migraine (n°47), migraine without aura (n° 92) and migraine with aura (n° 12) sufferers. Allodynia was reported in the 96,6% and pericranial tenderness was observed in the 68.8% of patients. Pericranial tenderness was more severe in patients with more frequent migraine and shorter sleep duration. Allodynia seemed associated with anxiety, pain catastrophizing and high disability scores. Comorbidity for JFM was present in the 0.03% ofpatients. These children presented with a severe depression and a significant reduction of quality of life as compared to the other patients. This study outlined a relevant presence of symptoms of central sensitization among children with migraine. Severe allodynia and comorbidity for JFM seemed to cause a general decline of quality of life, which would suggest the opportunity of a routine assessment of these clinical features.

  14. Psychological Factors Associated with Chronic Migraine and Severe Migraine-Related Disability: an Observational Study in a Tertiary Headache Center

    Science.gov (United States)

    Seng, Elizabeth K.; Buse, Dawn C.; Klepper, Jaclyn E.; Mayson, Sarah Jo; Grinberg, Amy S.; Grosberg, Brian M.; Pavlovic, Jelena M.; Robbins, Matthew S.; Vollbracht, Sarah E.; Lipton, Richard B.

    2016-01-01

    Objective To evaluate relationships among modifiable psychological factors and chronic migraine and severe migraine-related disability in a clinic-based sample of persons with migraine. Background Evidence evaluating relationships between modifiable psychological factors and chronic migraine and severe migraine-related disability is lacking in people with migraine presenting for routine clinical care. Methods Adults with migraine completed surveys during routinely scheduled visits to a tertiary headache center. Participants completed surveys assessing chronic migraine (meeting criteria for migraine with ≥15 headache days in the past month), severe migraine disability (Migraine Disability Assessment Scale score ≥ 21), and modifiable psychological factors [depressive symptoms (Patient Health Questionnaire-9), anxious symptoms (Generalized Anxiety Disorder-7), Pain Catastrophizing Scale and Headache Specific Locus of Control]. Logistic regression evaluated relationships between modifiable psychological factors and chronic migraine and severe migraine disability. Results Among 90 eligible participants the mean age was 45.0 (SD = 12.4); 84.8% were women. One-third (36.0%) met study criteria for chronic migraine; half of participants (51.5%) reported severe migraine-related disability. Higher depressive symptoms (OR = 1.99, 95% CI = 1,11, 3.55) and chance HSLC (OR = 1.85, 95% CI = 1.13, 1.43) were associated with chronic migraine. Higher depressive symptoms (OR = 3.54, 95%CI = 1.49, 8.41), anxiety symptoms (OR = 3.65, 95% CI = 1.65, 8.06), and pain catastrophizing (OR = 1.95, 95% CI = 1.14, 3.35), were associated with severe migraine-related disability. Conclusions Psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance locus of control were associated with chronic migraine. This study supports the need for longitudinal observational studies to evaluate relationships among naturalistic

  15. Clinical management of chronic hepatitis B infection: results from a registry at a German tertiary referral center.

    Science.gov (United States)

    Demir, M; Nigemeier, J; Kütting, F; Bowe, A; Schramm, C; Hoffmann, V; Waldschmidt, D; Goeser, T; Steffen, H-M

    2015-04-01

    We studied a cohort of adult patients with chronic hepatitis B (CHB) infection, followed at a tertiary referral liver center in Germany over 12.5 years to analyze the clinical features and impact of management on disease progression and survival of CHB patients in general and of those with CHB and HCC in particular. We retrospectively evaluated the medical records of 242 adult (age ≥ 18 years) patients. CHB was defined as positive hepatitis B surface antigen (HBsAg) and/or HBV-DNA levels >10 IU/mL for at least 6 months. Patient demographics, HBV markers, antiviral treatment, laboratory parameters, liver imaging and histology were recorded for each visit. HCC patients were divided into two groups and separately analyzed (group 1: n = 24, HCC at first visit and group 2: n = 11, HCC during surveillance). The mean age was 44 years in CHB patients without HCC (63% male) and about 59 years in patients with HCC (77% male). Antiviral therapy was given to 59% of patients without HCC compared to only 25% in group 1 and 18% in group 2 with comparable median HBV DNA levels of approximately 36,000 IU/mL. There was no statistically significant difference concerning the HCC stages (Milan, UCSF, BCLC) at first diagnosis. Five-year survival was 19% in group 1 vs. 64% in group 2 (p = 0.019), with LTx performed in 12 vs. 45%, respectively. Surveillance of CHB patients did not result in early stage detection of HCC but in a higher likelihood to receive potentially curative treatments.

  16. Metastasis in central nervous system: Clinicopathological study with review of literature in a tertiary care center in South India

    Directory of Open Access Journals (Sweden)

    Rashmi Patnayak

    2013-01-01

    Full Text Available Background: Secondary central nervous system (CNS tumors are common in Western countries, but in Indian literature, scant data are available. With the advent of newer imaging techniques, the confirmatory histopathological diagnosis has become comparatively easier. Hereby, we have analyzed our data from a single tertiary care center in south India. Materials and Methods: In this retrospective study from January 2000 to December 2010, histopathologically diagnosed secondary CNS tumors were reviewed along with clinical, imaging, and relevant immunohistochemical findings. Meningeal, lymphoproliferative, and myeloproliferative tumors and autopsy data were not included in the study group. Results: There were 40 secondary CNS tumors. Male to female ratio was 2.3:1. Age range was wide (28-75 years. Majority of cases were seen in the fourth and fifth decade. Imaging-wise, (computed tomography and magnetic resonance imaging majority were single lesions ( n = 34, 85%. Most commonly, these single lesions were present in the cerebral hemisphere ( n = 20, 50% followed by cerebellum ( n = 10, 25%. Adenocarcinoma accounted for maximum number of cases ( n = 25, 62.5% with lungs being the most common primary. Conclusion: We have noted 25% metastatic adenocarcinomas in cerebellar location, which is higher when compared with available world literature. However, we also encountered a good number of cases (30% due to unknown primary. Though histopathological examination with use of immunohistochemical markers can reliably distinguish primary from secondary CNS tumors in addition to available clinical and imaging data, particularly in developing countries, still a better work-up with an array of immunohistochemical markers and newer imaging modalities is desirable.

  17. PREVALENCE OF PAEDIATRIC DERMATOSES IN THE AGE GROUP OF 5-14 YEARS AT A TERTIARY CARE CENTER IN SALEM

    Directory of Open Access Journals (Sweden)

    Prasanna Kanniah Baskara

    2017-01-01

    Full Text Available BACKGROUND Skin diseases in pediatric age group are common all over the world. Pediatric dermatoses require separate view from adult dermatoses as there are differences in their clinical presentation and treatment. OBJECTIVE The aim of our study was to determine the prevalence of pediatric dermatoses attending our tertiary care center. MATERIALS AND METHODS This was a cross-sectional study conducted in 100 consecutive children with dermatoses between 5-14 years of age attending dermatology outpatient department at Vinayaka Missions Kirupananda Variyar medical college, Salem. The study was conducted over a period of 6 months from February 2016 to August 2016. Demographic parameters, detailed history, clinical features and diagnosis were recorded and analyzed. RESULTS In our short term study, we examined 100 pediatric cases with 106 dermatoses. The incidence of infections and infestations (43.39% was more prevalent in our study. The most common non-infectious dermatoses in our study was insect bite reactions (17.9%. Dermatitis and eczema (9.39%, disorders of sweat and sebaceous glands (6.6%, pigmentary disorders (5.66%, disorders of hair and nails (3.77%, genetic disorders (2.88%, immune and allergic disorders (2.8%, psoriasis (2.8%, nutritional disorders (0.9%, Polymorphic light eruption (0.9%, pearly penile papule (0.9%, aphthous ulcer (0.9% and pityriasis rosea (0.9% were the other dermatoses seen in the study.CONCLUSION Fungal infections (tinea versicolor and tinea corporis, scabies and insect bite reactions were the common dermatoses observed in our study. Most of the pediatric patients attending our hospital came from rural areas belonging to low socioeconomic strata. Health education, proper sanitation and improved nutrition will help to reduce the incidence of pediatric dermatoses.

  18. Implantable cardioverter defibrillator therapy in pediatric and congenital heart disease patients: a single tertiary center experience in Korea

    Directory of Open Access Journals (Sweden)

    Bo Kyung Jin

    2013-03-01

    Full Text Available Purpose: The use of implantable cardioverter defibrillators (ICDs to prevent sudden cardiac death is increasing in children and adolescents. This study investigated the use of ICDs in children with congenital heart disease. Methods: This retrospective study was conducted on the clinical characteristics and effectiveness of ICD implantation at the department of pediatrics of a single tertiary center between 2007 and 2011. Results: Fifteen patients underwent ICD implantation. Their mean age at the time of implantation was 14.5±5.4 years (range, 2 to 22 years. The follow-up duration was 28.9±20.4 months. The cause of ICD implantation was cardiac arrest in 7, sustained ventricular tachycardia in 6, and syncope in 2 patients. The underlying disorders were as follows: ionic channelopathy in 6 patients (long QT type 3 in 4, catecholaminergic polymorphic ventricular tachycardia [CPVT] in 1, and J wave syndrome in 1, cardiomyopathy in 5 patients, and postoperative congenital heart disease in 4 patients. ICD coils were implanted in the pericardial space in 2 children (ages 2 and 6 years. Five patients received appropriate ICD shock therapy, and 2 patients received inappropriate shocks due to supraventricular tachycardia.During follow-up, 2 patients required lead dysfunction-related revision. One patient with CPVT suffered from an ICD storm that was resolved using sympathetic denervation surgery. Conclusion: The overall ICD outcome was acceptable in most pediatric patients. Early diagnosis and timely ICD implantation are recommended for preventing sudden death in high-risk children and patients with congenital heart disease.

  19. Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: A single center experience

    Science.gov (United States)

    Manjunath, C.N.; Srinivas, P.; Ravindranath, K.S.; Dhanalakshmi, C.

    2014-01-01

    Background Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with rheumatic heart disease (RHD) being the dominant form of valvular heart disease (VHD) in developing nations. The current study was undertaken at a tertiary care cardiac center with the objective of establishing the incidence and patterns of VHD by Echocardiography (Echo). Methods Among the 136,098 first-time Echocardiograms performed between January 2010 and December 2012, an exclusion criterion of trivial and functional regurgitant lesions yielded a total of 13,289 cases of organic valvular heart disease as the study cohort. Results In RHD, the order of involvement of valves was mitral (60.2%), followed by aortic, tricuspid and pulmonary valves. Mitral stenosis, predominantly seen in females, was almost exclusively of rheumatic etiology (97.4%). The predominant form of isolated MR was rheumatic (41.1%) followed closely by myxomatous or mitral valve prolapse (40.8%). Isolated AS, more common in males, was the third most common valve lesion seen in 7.3% of cases. Degenerative calcification was the commonest cause of isolated AS (65.0%) followed by bicuspid aortic valve (BAV) (33.9%) and RHD (1.1%). Multiple valves were involved in more than a third of all cases (36.8%). The order of involvement was MS + MR > MS + AR > MR + AR > AS + AR > MR + AS > MS + AS. Overall, 9.7% of cases had organic tricuspid valve disease. Conclusion RHD contributed most to the burden of VHD in the present study with calcific degeneration, myxomatous disease and BAV being the other major forms of VHD. Multiple valves were affected in more than a third of all cases. PMID:24973838

  20. Evaluation of How Integrative Oncology Services Are Valued between Hematology/Oncology Patients and Hematologists/Oncologists at a Tertiary Care Center

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    D. M. Hansra

    2018-01-01

    Full Text Available Evidence regarding opinions on integrative modalities by patients and physicians is lacking. Methods. A survey study was conducted assessing how integrative modalities were valued among hematology/oncology patients and hematologists and oncologists at a major tertiary medical center. Results. 1008 patients and 55 physicians were surveyed. With the exception of support groups, patients valued nutrition services, exercise therapy, spiritual/religious counseling, supplement/herbal advice, support groups, music therapy, and other complimentary medicine services significantly more than physicians (P≤0.05. Conclusion. With the exception of support groups, patients value integrative modalities more than physicians. Perhaps with increasing education, awareness, and acceptance by providers and traditional institutions, integrative modalities could be equally valued between patients and providers. It is possible that increased availability and utilization of integrative oncology modalities at tertiary hospital sites could improve patient satisfaction, quality of life, and other clinical endpoints.

  1. Predictors of caregivers’ burden of Parkinson’s disease in India: experience of a tertiary care center in India

    Directory of Open Access Journals (Sweden)

    Agrawal V

    2012-11-01

    Full Text Available Vikas Agrawal,1 Vinay Goyal,2 Garima Shukla,2 Madhuri Behari21Department of Neurology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India; 2Department of Neurology, All India Institute of Medical Sciences, New Delhi, IndiaIntroduction: Parkinson’s disease (PD is a progressive neurodegenerative disorder characterized by increasing dependence on caregivers for activities of daily living that imposes a major burden upon the patients’ caregiver. Caregiver burden (CB refers to the physical, mental, and socioeconomic problems experienced by the caregivers of chronic patients.Patients and methods: This is a onetime cross-sectional observational study carried out in the movement disorder clinic of a tertiary referral center in India. Persons with PD were interviewed and information was collected regarding demographic and clinical details, treatment taken, and presence of non-motor features such as dementia, psychosis, depression, etc, on a pre-tested format and their caregivers were interviewed for self-perceived burden using Zerit’s caregivers’ burden inventory.Results: We interviewed 91 persons with PD (71 [78%] men, 20 [22%] women with their primary caregivers. The age of the patients ranged from 25 to 75 years (mean 56.66 ± 11.83 years. After regression analysis, depression in patients (beta = 0.352, 95% confidence interval [CI]: 0.275 to 0.790, high UPDRS-motor scores (beta = 0.255, 95% CI: 0.108 to 0.532, and presence of sleep disturbances in the atient (beta = 0.206, 95% CI: 0.817 to 11.823 were associated with increased caregiver burden and the presence of multiple caregivers was associated with lower caregiver burden (beta = −0.311, 95% CI: −10.155 to −3.436.Conclusion: The total number of caregivers was found to be an important predictor for reducing CB. Multiple caregivers is a phenomenon which has not been studied till now. Other factors which were found to have adverse predictive effect on caregiver burden are presence of

  2. The role of endorectal ultrasound and magnetic resonance imaging in the management of early rectal lesions in a tertiary center.

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    Patel, Rikesh Kumar; Sayers, Adele Elizabeth; Kumar, Prashanth; Khulusi, Sam; Razack, Abdul; Hunter, Iain Andrew

    2014-12-01

    In early rectal cancer, ERUS has a vital role in determining radical or local excision based on identification of T-stage. Transanal endoscopic microsurgery (TEMs) has a reduced morbidity and mortality compared with radical surgery. Correct identification of lesions that can be managed with TEMs is therefore imperative. Our aim was to assess the accuracy of ERUS in identifying mucosal/submucosal lesions and thus their suitability for TEMs. A retrospective analysis of a prospectively maintained database of patients who underwent ERUS was carried out over an initial 25-month period at a tertiary colorectal center. Our main outcome measures were T-stage measured using ERUS or magnetic resonance imaging (MRI) (indicating suitability for local excision, ie, ≤ T1) with correlation with that of the subsequent surgical specimen and improvement in accuracy over time. After data analysis and review, the study was repeated over the subsequent 12 months to establish whether there was a learning curve with the use of ERUS. Over the initial period, 52 patients who met the inclusion criteria underwent ERUS. T-staging was accurate in 73.1% (38/52) with identification of ≤ T1 lesions having a sensitivity of 70.8% and a specificity 100%. The accuracy, sensitivity, and specificity of MRI was similar to that of ERUS (72.7%, 70.0%, and 100% respectively). Over the subsequent period, 23 patients underwent ERUS with T-staging accuracy improving to 78.3% (18/23) (P = .777). In our experience, ERUS is a useful adjunct to clinical assessment and pelvic MRI in determining suitability for local excision. Its 100% specificity in determining that a lesion is limited to the mucosa or submucosa aids in the assessment of lesions that are being considered for submucosal resection. Over the time periods assessed, improvement in T-staging accuracy was demonstrated, which might be due to the presence of a learning curve. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Lessons Learned from Delayed Versus Immediate Microsurgical Reconstruction of Complex Maxillectomy and Midfacial Defects: Experience in a Tertiary Center in Mexico.

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    Santamaria, Eric; de la Concha, Erika

    2016-10-01

    Microsurgical reconstruction of complex midfacial and maxillectomy defects is among the most challenging procedures in plastic surgery, and it often requires composite flaps to improve functional and aesthetic results. Various factors have been identified as having influence in the outcome of microsurgical reconstruction. In this article, the authors present their experience with immediate and delayed reconstruction of complex maxillectomy defects in a tertiary center in Mexico. The authors present a total of 37 patients with microsurgical reconstruction of a complex maxillectomy defect; 13 patients had immediate and 24 had delayed reconstructions. The authors recommend doing immediate reconstruction when feasible. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. European type NPP electric power and vent systems. For safety improvement and proposal of international center

    International Nuclear Information System (INIS)

    Sugiyama, Kenichiro

    2011-01-01

    For prevention of reactor accidents of nuclear power plants, multiplicity and redundancy of emergency power would be most important. At station blackout accident, European type manually operated vent operation could minimize release amount of radioactive materials and keep safety of neighboring residents. After Fukushima Daiichi accident, nuclear power plants could not restart operation even after completion of periodical inspection. This article introduced European type emergency power and vent systems in Swiss, Sweden and Germany with state of nuclear power phaseout for reference at considering to upgrade safety and accident mitigation measures for better understanding of the public. In addition, it would be important to recover trust of nuclear technology to continue to disseminate latest information on new knowledge of accident site and decontamination technologies to domestic and overseas people. As its implementation, establishment of Fukushima international center was proposed. (T. Tanaka)

  5. A Case Series of the Probability Density and Cumulative Distribution of Laryngeal Disease in a Tertiary Care Voice Center.

    Science.gov (United States)

    de la Fuente, Jaime; Garrett, C Gaelyn; Ossoff, Robert; Vinson, Kim; Francis, David O; Gelbard, Alexander

    2017-11-01

    To examine the distribution of clinic and operative pathology in a tertiary care laryngology practice. Probability density and cumulative distribution analyses (Pareto analysis) was used to rank order laryngeal conditions seen in an outpatient tertiary care laryngology practice and those requiring surgical intervention during a 3-year period. Among 3783 new clinic consultations and 1380 operative procedures, voice disorders were the most common primary diagnostic category seen in clinic (n = 3223), followed by airway (n = 374) and swallowing (n = 186) disorders. Within the voice strata, the most common primary ICD-9 code used was dysphonia (41%), followed by unilateral vocal fold paralysis (UVFP) (9%) and cough (7%). Among new voice patients, 45% were found to have a structural abnormality. The most common surgical indications were laryngotracheal stenosis (37%), followed by recurrent respiratory papillomatosis (18%) and UVFP (17%). Nearly 55% of patients presenting to a tertiary referral laryngology practice did not have an identifiable structural abnormality in the larynx on direct or indirect examination. The distribution of ICD-9 codes requiring surgical intervention was disparate from that seen in clinic. Application of the Pareto principle may improve resource allocation in laryngology, but these initial results require confirmation across multiple institutions.

  6. Integrated marketing sphere of physical culture and sports in terms of European integration Regional Center Research

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    Oleksandr Popov

    2015-06-01

    Full Text Available Purpose: exposure of conceptual and strategic positions of the complex marketing of sphere of physical culture and sport in the conditions of European integration of regional center. Material and Methods: analysis of literary sources, analysis of documents of legislative, normatively-legal and programmatic maintenance, analysis of the systems, questioning as a questionnaire. Results: the analysis of the systems of terms of development of sphere of physical culture and sport is carried out by the study of modern tendencies, interests of young people and habitants of regional center; complex description of conceptual and strategic positions of the relatively complex marketing of sphere of physical culture and sport is presented in the conditions of European integration of regional center. Conclusions: it is set that the decision of tasks in relation to conditioning for development of sphere of physical culture and sport must come true with the observance of certain principles; got founding in relation to development of marketing plan of forming of sporting image Kharkiv.

  7. Pressure ulcer and patient characteristics--A point prevalence study in a tertiary hospital of India based on the European Pressure Ulcer Advisory Panel minimum data set.

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    Mehta, Chitra; George, Joby V; Mehta, Yatin; Wangmo, Namgyal

    2015-08-01

    Pressure ulcers is a frequent problem in hospitalized patients. Several prevalence studies have been conducted across the globe. Little information is available regarding prevalence of pressure ulcers in India. The aim was to identify the prevalence of pressure ulcers in one of the tertiary hospital in northern India and the factors associated with its development. A cross sectional point prevalence study. European Pressure Ulcer Advisory Panel (EPUAP) data collection form. Ethics approval was obtained prior to start of the study. Total of 358 patients were enrolled in the study. All patients above 18 years of age admitted in intensive care units and wards were included in the study. Patients admitted in emergency, day care, coronary care unit were excluded because of their short duration of hospital stay (varies from 24 to 72 h usually). All patients admitted before midnight on the predetermined day were included. The Braden scale was used to identify the risk of developing pressure ulcers. European Pressure ulcer advisory panel (EPUAP) minimum data set was used to collect prevalence data. The overall prevalence rate was 7.8%.The sacrum and heel were more commonly affected. Grade III pressure ulcers were the most common (42.8%). The pressure ulcer prevalence rate in our hospital was lower than that published in international studies. Severe forms of pressure ulcers were commonly encountered This data provides background information that may help us in developing protocols for applying effective practices for prevention of pressure ulcers. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  8. Comparison of quality control for trauma management between Western and Eastern European trauma center

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    Gambale Giorgio

    2008-11-01

    Full Text Available Abstract Background Quality control of trauma care is essential to define the effectiveness of trauma center and trauma system. To identify the troublesome issues of the system is the first step for validation of the focused customized solutions. This is a comparative study of two level I trauma centers in Italy and Romania and it has been designed to give an overview of the entire trauma care program adopted in these two countries. This study was aimed to use the results as the basis for recommending and planning changes in the two trauma systems for a better trauma care. Methods We retrospectively reviewed a total of 182 major trauma patients treated in the two hospitals included in the study, between January and June 2002. Every case was analyzed according to the recommended minimal audit filters for trauma quality assurance by The American College of Surgeons Committee on Trauma (ACSCOT. Results Satisfactory yields have been reached in both centers for the management of head and abdominal trauma, airway management, Emergency Department length of stay and early diagnosis and treatment. The main significant differences between the two centers were in the patients' transfers, the leadership of trauma team and the patients' outcome. The main concerns have been in the surgical treatment of fractures, the outcome and the lacking of documentation. Conclusion The analyzed hospitals are classified as Level I trauma center and are within the group of the highest quality level centers in their own countries. Nevertheless, both of them experience major lacks and for few audit filters do not reach the mmum standard requirements of ACS Audit Filters. The differences between the western and the eastern European center were slight. The parameters not reaching the minimum requirements are probably occurring even more often in suburban settings.

  9. Frequency of color blindness in pre-employment screening in a tertiary health care center in Pakistan.

    Science.gov (United States)

    Chhipa, Shaukat Ali; Hashmi, Farzeen K; Ali, Shehreen; Kamal, Mustafa; Ahmad, Khabir

    2017-01-01

    To describe the frequency of color vision deficiency among Pakistani adults presenting for pre-employment health screening in a tertiary care hospital. The cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, and the data was collected for color vision deficiency, age, gender, and job applied for from pre-employment examination during 2013-2014. IBM SPSS 20 was used for statistical analysis. Three thousand four hundred and thirty seven persons underwent pre-employment screening during 2013 and 2014; 1837 (53.44%) were males and 1600 (46.65%) females. The mean age was 29.01 (±6.53) years. A total of 0.9% (32/3437) persons had color vision deficiency with male being 1.4% and female 0.4%. Color vision deficiency was observed in 0.9% of candidates screened for pre-employment health check up in a tertiary care hospital. The color vision deficiency was predominantly present in male individuals.

  10. The need for unique risk adjustment for surgical site infections at a high-volume, tertiary care center with inherent high-risk colorectal procedures.

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    Gorgun, E; Benlice, C; Hammel, J; Hull, T; Stocchi, L

    2017-08-01

    The aim of the present study was to create a unique risk adjustment model for surgical site infection (SSI) in patients who underwent colorectal surgery (CRS) at the Cleveland Clinic (CC) with inherent high risk factors by using a nationwide database. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who underwent CRS between 2005 and 2010. Initially, CC cases were identified from all NSQIP data according to case identifier and separated from the other NSQIP centers. Demographics, comorbidities, and outcomes were compared. Logistic regression analyses were used to assess the association between SSI and center-related factors. A total of 70,536 patients met the inclusion criteria and underwent CRS, 1090 patients (1.5%) at the CC and 69,446 patients (98.5%) at other centers. Male gender, work-relative value unit, diagnosis of inflammatory bowel disease, pouch formation, open surgery, steroid use, and preoperative radiotherapy rates were significantly higher in the CC cases. Overall morbidity and individual postoperative complication rates were found to be similar in the CC and other centers except for the following: organ-space SSI and sepsis rates (higher in the CC cases); and pneumonia and ventilator dependency rates (higher in the other centers). After covariate adjustment, the estimated degree of difference between the CC and other institutions with respect to organ-space SSI was reduced (OR 1.38, 95% CI 1.08-1.77). The unique risk adjustment strategy may provide center-specific comprehensive analysis, especially for hospitals that perform inherently high-risk procedures. Higher surgical complexity may be the reason for increased SSI rates in the NSQIP at tertiary care centers.

  11. Psycho-oncology: structure and profiles of European centers treating patients with gynecological cancer.

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    Hasenburg, Annette; Amant, Frederic; Aerts, Leen; Pascal, Astrid; Achimas-Cadariu, Patriciu; Kesic, Vesna

    2011-12-01

    Psycho-oncological counseling should be an integrated part of modern cancer therapy. The aim of this study was to assess the structures and interests of psycho-oncology services within European Society of Gynecological Oncology (ESGO) centers. In 2010, a survey, which consisted of 15 questions regarding organization of psycho-oncological services and interests in training and research, was sent to all ESGO-accredited centers (n = 41). The response rate was 65.8% (27 centers). 96.3% (n = 26) of the surveys came from universities, and 3.7% (n = 1) came from nonacademic institutions. Most of the institutions (92.6%, n = 25) offer psycho-oncological care, mainly by psychologists (64%, n = 16) or psycho-oncologists (48%, n = 12). Fifty-two percent of patients are evaluated for sexual dysfunction as sequelae of their disease or treatment-related adverse effects. Fifty-two percent (n = 14) of institutions offer psychological support for cancer care providers. Eighty-five percent (n = 23) of all centers are interested in psycho-oncological training, and the preferred teaching tools are educational workshops (87%). The main issues of interest are sexual problems in patients with cancer, communication and interpersonal skills, responses of patients and their families, anxiety and adjustment disorders, and palliative care. Eighty-five percent (n = 17) of the 20 institutions look for research in the field of psycho-oncology, and 55% (n = 11) of those are already involved in some kind of research. Although psycho-oncological care is provided in most of the consulted ESGO accredited centers, almost 50% of women lack information about sexual problems. The results of the survey show the need for and interest in psycho-oncology training and research, including sexual dysfunction. Furthermore, psychological support should be offered to all cancer care providers.

  12. Ventilator-associated pneumonia at a tertiary-care center in a developing country: incidence, microbiology, and susceptibility patterns of isolated microorganisms.

    Science.gov (United States)

    Kanafani, Zeina A; Kara, Layla; Hayek, Shady; Kanj, Souha S

    2003-11-01

    Ventilator-associated pneumonia (VAP) complicates the course of up to 24% of intubated patients. Data from the Middle East are scarce. The objective of this study was to evaluate the incidence, microbiology, and antimicrobial susceptibility patterns of isolated microorganisms in VAP in a developing country. Prospective observational cohort study. The American University of Beirut Medical Center, a tertiary-care center that serves as a major referral center for Lebanon and neighboring countries. All patients admitted to the intensive care and respiratory care units from March to September 2001, and who had been receiving mechanical ventilation for at least 48 hours, were included in the study. Results of samples submitted for culture were recorded and antimicrobial susceptibility testing of isolated pathogens was performed. Seventy patients were entered into the study. The incidence of VAP was 47%. Gram-negative bacilli accounted for 83% of all isolates. The most commonly identified organism was Acinetobacter anitratus, followed by Pseudomonas aeruginosa. Fifty percent of all gram-negative bacterial isolates were classified as antibiotic resistant. Compared with patients without VAP, patients with VAP remained intubated for a longer period and stayed in the intensive care unit longer. VAP was not associated with an increased mortality rate. Compared with other studies, the results from this referral center in Lebanon indicate a higher incidence of VAP and a high prevalence of resistant organisms. These data are relevant because they direct the choice of empiric antibiotic therapy for VAP.

  13. TERRITORIAL DISPARITIES REGARDING THE DISTRIBUTION OF HEALTH SERVICE PROVIDERS IN ROMANIA AFTER JOINING THE EUROPEAN UNION STUDY CASE: MEDICAL STAFF WITH TERTIARY LEVEL OF EDUCATION

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    Babucea Ana-Gabriela

    2017-02-01

    Full Text Available In Romania 90ˈs, there was a relatively low level of regional disparities compared with western economies in all fields, but inequalities have emerged and widened rapidly because only certain areas, especially urban areas have benefited from inflows of capital and specialized human resources. Currently, Romania has a low level of development between EU countries, five of the eight NUTS 2 regions being the most underdeveloped in Europe. The aim of this research is a comparative analysis of developments and trends manifested in the public health system in terms of distribution of health services providers at the regional level in Romania. For the analysis of regional disparities, the research seeks to highlight a comprehensive image of the level and dynamics of the Romania territorial inequalities regarding the personnel with tertiary education, which includes physicians, dentists, and pharmaceutical chemists, as professional providers of the health services. Were took into account statistical indicators that describe the distribution of such as healthcare providers, at level of the eight Romanian NUTS2 regions, highlighting inequalities in access to health services for the population. We used available data, accessed from National Institute of Statistics of Romania, regarding Romania, and itˊs eight regions. We appeal also to statistical publications at the national and European level, other data analysis, and experts' opinions expressed in recent articles in the field. In order to identify the factors that can reduce the disparities, and ensure the equity for disadvantaged population, in terms of ensuring the health system of medical services in parallel with a homogeneous distribution of resources and services in this area, we apply specific statistics for territorial analysis and comparisons.

  14. Bioinformatics Meets Virology: The European Virus Bioinformatics Center's Second Annual Meeting.

    Science.gov (United States)

    Ibrahim, Bashar; Arkhipova, Ksenia; Andeweg, Arno C; Posada-Céspedes, Susana; Enault, François; Gruber, Arthur; Koonin, Eugene V; Kupczok, Anne; Lemey, Philippe; McHardy, Alice C; McMahon, Dino P; Pickett, Brett E; Robertson, David L; Scheuermann, Richard H; Zhernakova, Alexandra; Zwart, Mark P; Schönhuth, Alexander; Dutilh, Bas E; Marz, Manja

    2018-05-14

    The Second Annual Meeting of the European Virus Bioinformatics Center (EVBC), held in Utrecht, Netherlands, focused on computational approaches in virology, with topics including (but not limited to) virus discovery, diagnostics, (meta-)genomics, modeling, epidemiology, molecular structure, evolution, and viral ecology. The goals of the Second Annual Meeting were threefold: (i) to bring together virologists and bioinformaticians from across the academic, industrial, professional, and training sectors to share best practice; (ii) to provide a meaningful and interactive scientific environment to promote discussion and collaboration between students, postdoctoral fellows, and both new and established investigators; (iii) to inspire and suggest new research directions and questions. Approximately 120 researchers from around the world attended the Second Annual Meeting of the EVBC this year, including 15 renowned international speakers. This report presents an overview of new developments and novel research findings that emerged during the meeting.

  15. Prevalence of methicillin-resistant Staphylococcus aureus based on culture and PCR in inpatients at a tertiary care center in Tokyo, Japan.

    Science.gov (United States)

    Taguchi, Hirokazu; Matsumoto, Tetsuya; Ishikawa, Hiroki; Ohta, Shoichi; Yukioka, Tetsuo

    2012-10-01

    We investigated active screening for colonization with methicillin-resistant Staphylococcus aureus (MRSA) on admission and weekly follow-up surveillance after admission to a tertiary care center (TCC) between June 2007 and 31 December 2007. Eleven percent (30/267) of patients were found to be positive for MRSA by polymerase chain reaction (PCR) and/or culture on admission; 5% (12/267) became positive during the TCC stay. The major primary diagnoses in MRSA-positive patients were pneumonia and cerebrovascular diseases. Twenty-two (52%) of 42 patients were found to be MRSA positive by both PCR and culture, compared with 19 (45%) of 42 who were PCR positive and culture negative. These findings suggest that active surveillance with PCR is highly sensitive and useful for the detection of MRSA colonization. To our knowledge, this is the first report of active surveillance of MRSA by PCR and bacterial culture in critically ill inpatients in Japan.

  16. Non-Escherichia coli versus Escherichia coli community-acquired urinary tract infections in children hospitalized in a tertiary center: relative frequency, risk factors, antimicrobial resistance and outcome.

    Science.gov (United States)

    Marcus, Nir; Ashkenazi, Shai; Yaari, Arnon; Samra, Zmira; Livni, Gilat

    2005-07-01

    Currently hospitalization for children with urinary tract infections (UTIs) is reserved for severe or complicated cases. Changes may have taken place in the characteristics and causative uropathogens of hospital-treated community-acquired UTI. To study children hospitalized in a tertiary center with community-acquired UTI, compare Escherichia coli and non-E. coli UTI, define predictors for non-E. coli UTI and elucidate the appropriate therapeutic approach. A prospective clinical and laboratory study from 2001 through 2002 in a tertiary pediatric medical center. Patients were divided by results of the urine culture into E. coli and non-E. coli UTI groups, which were compared. Of 175 episodes of culture-proved UTI, 70 (40%) were caused by non-E. coli pathogens. Non-E. coli UTI was more commonly found in children who were male (P = 0.005), who had underlying renal abnormalities (P = 0.0085) and who had received antibiotic therapy in the prior month (P = 0.0009). Non-E. coli uropathogens were often resistant to antibiotics usually recommended for initial therapy for UTI, including cephalosporins and aminoglycosides; 19% were initially treated with inappropriate empiric intravenous antibiotics (compared with 2% for E. coli UTI, P = 0.0001), with a longer hospitalization. Current treatment routines are often inappropriate for hospitalized children with non-E. coli UTI, which is relatively common in this population. The defined risk factors associated with non-E. coli UTIs and its antimicrobial resistance patterns should be considered to improve empiric antibiotic therapy for these infections.

  17. Clinical profile of dermatological emergencies and intensive care unit admissions in a tertiary care center - an Indian perspective.

    Science.gov (United States)

    Samudrala, Suvarna; Dandakeri, Sukumar; Bhat, Ramesh M

    2018-05-01

    Although dermatology is largely considered as an outpatient specialty, dermatological conditions comprise 5-8% of cases presenting to the emergency department. The need for a dermatological intensive care unit is widely acknowledged due to the increasing incidence of acute skin failure. Very few studies have been done to characterize the common conditions seen in the emergency department and intensive care units. We undertook this study to analyze the spectrum of dermatological conditions presenting to the emergency department and the clinical profile of patients admitted to the intensive care unit. A prospective study was conducted for 9 months. Patients requiring primary dermatological consultation in the emergency department and patients admitted in the dermatology intensive care unit were examined, and their clinical variables were statistically analyzed. A total of 248 cases were seen in the emergency department, out of which 72 (29.1%) cases were admitted and 176 (70.9%) were treated in the emergency department on an outpatient basis. The most common condition seen in non-admitted patients was acute urticaria (28.9%). The most common cause for admission in patients presenting to the emergency department was erythroderma (23.6%). Sixty-two patients were admitted to the intensive care unit, the most common diagnosis being erythroderma (40.3%). This prospective study aimed to provide an insight into the types of cases evaluated in the emergency department by dermatologists in a large tertiary care hospital in coastal Karnataka in South India. © 2018 The International Society of Dermatology.

  18. Study of clinical spectrum of pediatric dermatoses in patients attending a Tertiary Care Center in North Kerala

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    Venkata Subba Reddy

    2016-01-01

    Full Text Available Introduction: Skin diseases are a major health problem in the pediatric age group. Aim: To determine the prevalence and clinical characteristics of different pediatric dermatoses in a tertiary care centre in Kerala. Materials and Methods: Children with age 18 years and below with clinical evidence of cutaneous disorders were studied. Results: 500 cases were studied which showed a female preponderance of 51.4%. The most common dermatoses was infections and infestations (33.8% followed by eczemas (32.6%, disorders of sweat and sebaceous glands (7.4%, keratinisation and paulosquamous disorders (4%. Nutritional disorders were seen in 1% of children. 3.6% had photodermatoses, 2.6% had hair and nail disorders and 0.4 % had adverse cutaneous drug reactions. Conclusions: Fungal infection was the most common infection noted in the study, followed by viral and bacterial infection. Allergic contact dermatitis was the commonest exogenous eczema and juvenile plantar dermatosis was the commonest endogenous eczemas. Acne, insect bite reaction and miliaria were the other common dermatoses.

  19. Long-term treatment outcomes of acromegaly patients presenting biochemically-uncontrolled at a tertiary pituitary center.

    Science.gov (United States)

    Carmichael, John D; Broder, Michael S; Cherepanov, Dasha; Chang, Eunice; Mamelak, Adam; Said, Qayyim; Neary, Maureen P; Bonert, Vivien

    2017-08-04

    Acromegaly is a rare, slowly progressive disorder resulting from excessive growth hormone (GH) production by a pituitary somatotroph tumor. The objective of this study was to examine acromegaly treatment outcomes during long-term care at a specialized pituitary center in patients presenting with lack of biochemical control. Data came from an acromegaly registry at the Cedars-Sinai Medical Center Pituitary Center (center). Acromegaly patients included in this study were those who presented biochemically-uncontrolled for care at the center. Biochemical control status, based on serum insulin-like growth factor-1 values, was determined at presentation and at study end. Patient characteristics and acromegaly treatments were reported before and after presentation by presenting treatment status and final biochemical control status. Data on long-term follow-up were recorded from 1985 through June 2013. Seventy-four patients presented uncontrolled: 40 untreated (54.1%) and 34 (45.9%) previously-treated. Mean (SD) age at diagnosis was 43.2 (14.7); 32 (43.2%) were female patients. Of 65 patients with tumor size information, 59 (90.8%) had macroadenomas. Prior treatments among the 34 previously-treated patients were pituitary surgery alone (47.1%), surgery and medication (41.2%), and medication alone (11.8%). Of the 40 patients without prior treatment, 82.5% achieved control by study end. Of the 34 with prior treatment, 50% achieved control by study end. This observational study shows that treatment outcomes of biochemically-uncontrolled acromegaly patients improve with directed care, particularly for those that initially present untreated. Patients often require multiple modalities of treatment, many of which are offered with the highest quality at specialized pituitary centers. Despite specialized care, some patients were not able to achieve biochemical control with methods of treatment that were available at the time of their treatment, showing the need for additional

  20. Role of biofilm in cerebrospinal fluid shunt infections: A study at tertiary neurocare center from South India

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    Kirtilaxmi K Benachinmardi

    2017-01-01

    Full Text Available Introduction: Biofilms are the source of persistent infections of many pathogenic microbes. They are responsible for nosocomial infection and also associated with many surgical conditions including indwelling medical devices such as ventriculoperitoneal shunt. A significant problem encountered in shunt procedures is obstruction followed by infection, with infection rate ranging from 2% to 27%, often with poor outcome. Materials and Methods: This study was conducted in the Department of Neuromicrobiology at a tertiary neuroinstitute for 6 months from July 1 to December 31, 2014. The samples comprised cerebrospinal fluid (CSF from suspected cases of shunt infections. Laboratory diagnosis of causative agent was established by adopting standard procedures. Then, isolates were evaluated for production of biofilm by tissue culture plate (TCP method and tube method. Results: Of the 1642 shunt CSF samples obtained from neurosurgery, 14.79% were culture positive which yielded 254 isolates. About 51.97% were Gram-negative bacilli (GNB, 46.46% were Gram-positive cocci (GPC, and 1.57% were Candida albicans. Among GNB, nonfermenters were the most common (51.52% followed by Pseudomonas aeruginosa (15.9%. Among GPC, coagulase-negative Staphylococci were 88.13%, out of which 43.26% were methicillin-resistant. Other GPC were Enterococcus spp. (4.24%, Staphylococcus aureus (5.08%, and Streptococcus spp. (2.54%. Among all isolates, 120 were tested for biofilm production, out of which 57.5% were biofilm producers and 42.5% were nonproducers. Conclusions: TCP was the better method to detect biofilm. Most of the biofilm producers were resistant pathogens.

  1. Use of internet for accessing healthcare information among patients in an outpatient department of a Tertiary Care Center

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    Lakshmi Renganathan

    2017-01-01

    Full Text Available Background: Health information is one of the most accessed topics online. Worldwide, about 4.5% of all Internet searches are for health-related informationand more than 70, 000 websites disseminate health information. However, critics question the quality and credibility of online health information as contents are mostly a result of limited research or are commercialised. There is a need to train people to locate relevant websites where they can efficiently retrieve evidence based information and evaluate the same. The study was conducted with the objectives of determining the prevalence of use of internet for accessing healthcare information amongst literate adult population in an urban area and to assess the association between the demography and the reasons of internet use. Methodology: We used an anonymous, cross sectional survey completed by a sample of out patients of 408 individuals who came to a tertiary care centre at Pune during the year 2015. The survey consisted of 17 questions related to behavioural, attitudinal and demographic items. Results: Out of the total of 408 individuals, 256 (63.2% individuals used internet for health information though 332 (82.4% of them were aware of authorised websites for health information and 69 (16.9% thought information available in the internet can be harmful. Also, 63 out of 256 (24.6% agreed to the fact that they ask questions to their doctors based on the information that they acquired from internet while surfing about that particular disease/ ailment. More individuals (p<0.05 who were working and who were educated, graduates and above, were using internet for health information. Conclusion: Our results suggest the great potential for using the internet to disseminate the information and awareness to the public about health and healthcare facilities. However, it is important to disseminate credible information from reliable and authorised websites assigned for health since online healthcare

  2. Penile Cancer in Cali, Colombia: 10 Years of Casuistry in a Tertiary Referral Center of a Middle-Income Country

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    Lina M. Rengifo

    2015-10-01

    Full Text Available Background: Penile cancer is a rare disease in Colombia; in Cali, it represents 0.7% of all cancers. Penile cancer has been associated with old age, bad hygiene, smoking and lack of circumcision. This study aimed to describe the sociodemographic and clinical characteristics of patients with penile cancer who consulted to a tertiary referral hospital. Methods: A case series of all penile cancer cases at a reference institution in Cali during 2001-2010. Socioeconomic, demographic and clinical features of patients were described, and bivariate analyses were carried out. Results: There were 46 penile cancer cases. The average age was 60 ± 16.9 years. The main reason for consultation was an exophytic mass on the penis (75.0%. The most common location was the glans (69.6%, and the more frequent histology type was the squamous cell carcinoma (95.7%. With regard to risk factors, 65.5% of the patients had history of smoking and 90.9% did not have circumcision. Patients who underwent radical amputation had higher rates of positive nodes (55% vs. 13.5%, p=0.015 and ulcerative lesions (77.8% vs. 29.7%, p=0.018 than those who did not have the procedure done. Recurrence was associated with the presence of lymphadenopathy (p=0.02 and history of circumcision (p=0.015. Conclusion: Most of the patients with penile cancer found in this study had old age, history of tobacco use and lack of circumcision. Patients who presented with lymph node metastasis had to undergo more radical procedures and suffered a greater rate of recurrence compared with those without lymph node involvement. Robust studies to determine the risk factors among low-income populations are required.

  3. Weekend versus weekday hospital deaths: analysis of in-patient data in a Nigerian tertiary healthcare center.

    Science.gov (United States)

    Nwosu, B O; Eke, N O; Obi-Nwosu, A; Osakwe, O J; Eke, C O; Obi, N P

    2013-01-01

    This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria. This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95% confidence intervals. A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded, giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females, respectively was noted. The labor ward, followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 ( P = 0.0461) and 1.41:1 ( P = 0.1440), respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1 ( P = 0.7360). The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths, especially in the labor ward, in order to identify and prevent avoidable deaths.

  4. Sociodemographic profile and psychiatric diagnosis of patients referred to consultation-liaison psychiatric services of general hospital psychiatric unit at a Tertiary Care Center

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    Shri Gopal Goyal

    2017-01-01

    Full Text Available Context: Previous studies have reported high psychiatric comorbidity with physical illness. However, referral rate to consultation-liaison (C-L psychiatry from other departments is very low. There is a paucity of literature from India in this subspecialty of psychiatry. Aims: This study was conducted to assess the sociodemographic profile and psychiatric diagnosis of patients referred to C-L psychiatric services at a tertiary care center. Settings and Design: This was a descriptive cross-sectional study conducted in a tertiary care multispecialty teaching institution. Patients and Methods: The study population comprised all the patients who were referred for psychiatric consultation from other departments to C-L services of psychiatry department for 2 months. Information was collected using semi-structured pro forma, and diagnosis was made based on the International Classification of Diseases-10 criteria. Results: A total of 160 patients were referred for C-L psychiatric services. Majority of the patients were in the age group of 31–45 years, married, educated matriculation or beyond, belonged to Hindu religion, nuclear family, and residing in urban area. The maximum referrals were from internal medicine department (17.5 followed by nephrology (15.0% and neurology (10.6%. The most common psychiatric diagnosis was depression (12% followed by delirium (8%. The most common reason for seeking psychiatric consultation was psychiatric clearance of prospective kidney donor and bone marrow transplant/stem cell transplant recipient. Conclusions: Psychiatric comorbidity may present with chronic physical illness. The C-L psychiatry would play a major role in the management of psychiatric comorbidity.

  5. Endocrine profile of β-thalassemia major patients followed from childhood to advanced adulthood in a tertiary care center

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    Vincenzo De Sanctis

    2016-01-01

    Full Text Available Aim: Chronic iron overload resulting from frequent transfusions, poor compliance to efficient chelation therapy and chronic liver disease is basically responsible for the most severe complications of thalassemia major (TM. Before conventional treatment, TM was entirely childhood disease with a very short survival. Today, survival improved to 40–50 years and becomes a prevalent disease of adulthood and in the near future it will be one of senility. Furthermore, clinical phenotype of TM is changing with age and appearance of severe complications from the heart and endocrine glands that require special health care from well-informed specialists. Objectives: The aims of our study were to: (1 Imprint the clinical profile of long-lived TM patients; (2 evaluate retrospectively the cumulative incidence of endocrine diseases; (3 identify potential risk factors; and (4 orient the physicians in the modified clinical phenotype and the relative patients' health needs. Design: A retrospective cross-sectional study followed from childhood to adulthood by the same physician in a tertiary thalassemia clinic. Participants: Forty-three long-lived TM patients (mean age: 50.3 ± 10.8 years; range: 45.8–59.5 years; 23 females were studied. Patients and Methods: An extensive medical history, with detailed clinical and laboratory data, endocrine complications, and current treatments, was obtained. Results: The data indicate that 88.4% of adult TM patients suffered from at least one endocrine complication. The majority of patients developed endocrine complications in the second decade of life when serum ferritin level was very high (12/23 TM female and 8/20 TM male patients, the serum ferritin levels at the diagnosis were above 5.000 ng/ml. Conclusions: These data underline that endocrine and bone complications in adult TM patients are highly prevalent and necessitate close monitoring, treatment, and follow-up. Physicians' strategies to optimize chelation therapy

  6. Acute kidney injury due to overcorrection of hypovitaminosis D: A tertiary center experience in the Kashmir Valley of India

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    Abdul Majeed Chowdry

    2017-01-01

    Full Text Available Vitamin D deficiency state is endemic in the Kashmir valley of the Indian subcontinent. Clinicians frequently treat patients with Vitamin D for diverse clinical symptoms to improve the general health and to reduce the frailty of elderly and these doses may at times be inappropriately high. Vitamin D toxicity-induced acute kidney injury (AKI, often considered rare, can be life-threatening and associated with substantial morbidity if not identified promptly. We aimed to describe clinical and biochemical features, risk factors, and management of AKI patients with Vitamin D toxicity seen at a single tertiary care centre in Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India, between January 2014 and January 2016. Evaluation included detailed clinical history and biochemical tests including serum calcium, phosphorus, creatinine, intact parathyroid hormone, and 25-hydroxyvitamin D [25(OHD]. Nineteen patients with Vitamin D toxicity-induced AKI could be identified. Clinical manifestations included nausea, vomiting, altered sensorium, constipation, pancreatitis, AKI, acute on chronic kidney disease, and weight loss. Median (range age was 64 (45–89 years. Median (range serum 25(OHD level and median (range total serum calcium level were 99 (190–988 ng/mL and 139 (119–152 mg/dL, respectively. Overdose of Vitamin D caused by prescription of megadoses of Vitamin D was the cause of AKI in all cases. Median (range cumulative Vitamin D dose was 6,000,000 (3,600,000–9,000,000 IU. On three- and six-month follow-up, the creatinine and estimated glomerular filtration rate normalized and returned to baseline in all patients except three cases who had underlying chronic kidney disease. Three patients needed rehospitalization for another episode of AKI. Our data demonstrate an emergence of Vitamin D toxicity as a cause of AKI in this part of the world. Irrational use of Vitamin D in megadoses resulted in AKI in all cases. Persistence of Vitamin D in

  7. Lack of Screening Underlies Most Stage-5 Retinopathy of Prematurity among Cases Presenting to a Tertiary Eye Center in India.

    Science.gov (United States)

    Azad, Rajvardhan; Chandra, Parijat; Gangwe, Anil; Kumar, Vivek

    2016-11-07

    To study the barriers to effective screening, early detection and treatment of Retinopathy of Prematurity leading to advanced disease. Cross-sectional study. Tertiary eye care hospital in northern India. 115 babies with bilateral stage 5 ROP identified amongst 354 preterm infants examined over a one year period. Information regarding gestational age, birthweight, duration of stay in nursery, duration of supplemental oxygen therapy and treatment details were obtained from discharge summary when available, and by interviewing carers.28 stage 5 ROP eyes underwent pars plana lensectomy and vitrectomy. Among the 354 infants (708 eyes) examined, 115 had stage 5 ROP in both eyes. The mean post conceptional age (PCA) at first visit to an ophthalmologist was 54.6 (7.6) weeks (Median 52.9 ± 4.2). The mean overall delay in first examination for Retinopathy of Prematurity was 24.7 (3.9) weeks. Most common risk factor was oxygen therapy in 103 babies (89.6%). 109 (89.8%) babies had never been screened for ROP; four babies fell outside the NNF guidelines (i.e. they had a birth weight of 1750 gms or more and were born at 34 weeks gestational age or more). Another important finding is that only 4.3% of babies were given the correct diagnosis. While 99 babies (86.1%) were referred by ophthalmologists, only 10 babies (8.7%) were referred by pediatricians. A large number were from the capital city of Delhi (21 babies, 18.2%). 28 stage 5 ROP eyes (12.1%) underwent surgery, and at 6 months follow up, only 20 operated eyes had visible attached posterior pole. 210 (91.3%) stage 5 eyes were irreversibly blind. ROP is an increasingly important cause of leucocoria. There were notable gaps in timely ROP screening, referral and treatment and much needs to be done to improve awareness amongst ophthalmologists about ROP. Measures are needed to improve the coverage of initiatives for the detection and timely treatment of sight threatening ROP in India as well as improving neonatal care to

  8. Paroxysmal occipital discharges suppressed by eye opening: Spectrum of clinical and imaging features at a tertiary care center in India

    OpenAIRE

    Bhavna Kaul; Garima Shukla; Vinay Goyal; Achal Srivastava; Madhuri Behari

    2012-01-01

    Background: Paroxysmal occipital discharges (PODs) demonstrating the phenomena of fixation-off sensitivity have classically been described in childhood epilepsies with occipital paroxysms. Aim: We attempted to delineate the demographic, clinical and imaging characteristics of patients whose interictal electroencephalograms (EEGs) showed occipital discharges with fixation-off sensitivity at our center. Materials and Methods: During the period between 2003 and 2005, patients whose interictal EE...

  9. Resistive plate chamber online data quality monitoring for the Compact Muon Solenoid at the European Center for Nuclear Research

    CERN Document Server

    Whitaker, William David

    2008-01-01

    A comprehensive, online, data quality monitoring software package has been developed for the muon system at the European Center for Nuclear Research's (CERN's) Compact Muon Solenoid (CMS) experiment. The package was written in Java, C++, and HTML. It provides real-time, RPC performance feedback in an easy to use graphic user interface (GUI).

  10. Cytomegalovirus infection management in solid organ transplant recipients across European centers in the time of molecular diagnostics: An ESGICH survey.

    Science.gov (United States)

    Navarro, David; San-Juan, Rafael; Manuel, Oriol; Giménez, Estela; Fernández-Ruiz, Mario; Hirsch, Hans H; Grossi, Paolo Antonio; Aguado, José María

    2017-12-01

    Scant information is available about how transplant centers are managing their use of quantitative molecular testing (QNAT) assays for active cytomegalovirus (CMV) infection monitoring in solid organ transplant (SOT) recipients. The current study was aimed at gathering information on current practices in the management of CMV infection across European centers in the era of molecular testing assays. A questionnaire-based cross-sectional survey study was conducted by the European Study Group of Infections in Immunocompromised Hosts (ESGICH) of the Society of Clinical Microbiology and Infectious Diseases (ESCMID). The invitation and a weekly reminder with a personal link to an Internet service provider (https://es.surveymonkey.com/) was sent to transplant physicians, transplant infectious diseases specialists, and clinical virologists working at 340 European transplant centers. Of the 1181 specialists surveyed, a total of 173 responded (14.8%): 73 transplant physicians, 57 transplant infectious diseases specialists, and 43 virologists from 173 institutions located at 23 different countries. The majority of centers used QNAT assays for active CMV infection monitoring. Most centers preferred commercially available real-time polymerase chain reaction (RT-PCR) assays over laboratory-developed procedures for quantifying CMV DNA load in whole blood or plasma. Use of a wide variety of DNA extraction platforms and RT-PCR assays was reported. All programs used antiviral prophylaxis, preemptive therapy, or both, according to current guidelines. However, the centers used different criteria for starting preemptive antiviral treatment, for monitoring systemic CMV DNA load, and for requesting genotypic assays to detect emerging CMV-resistant variants. Significant variation in CMV infection management in SOT recipients still remains across European centers in the era of molecular testing. International multicenter studies are required to achieve commutability of CMV testing and

  11. Postoperative Central Nervous System Infection After Neurosurgery in a Modernized, Resource-Limited Tertiary Neurosurgical Center in South Asia.

    Science.gov (United States)

    Chidambaram, Swathi; Nair, M Nathan; Krishnan, Shyam Sundar; Cai, Ling; Gu, Weiling; Vasudevan, Madabushi Chakravarthy

    2015-12-01

    Postoperative central nervous system infections (PCNSIs) are rare but serious complications after neurosurgery. The purpose of this study was to examine the prevalence and causative pathogens of PCNSIs at a modernized, resource-limited neurosurgical center in South Asia. A retrospective analysis was conducted of the medical records of all 363 neurosurgical cases performed between June 1, 2012, and June 30, 2013, at a neurosurgical center in South Asia. Data from all operative neurosurgical cases during the 13-month period were included. Cerebrospinal fluid (CSF) analysis indicated that 71 of the 363 surgical cases had low CSF glucose or CSF leukocytosis. These 71 cases were categorized as PCNSIs. The PCNSIs with positive CSF cultures (9.86%) all had gram-negative bacteria with Pseudomonas aeruginosa (n = 5), Escherichia coli (n = 1), or Klebsiella pneumoniae (n = 1). The data suggest a higher rate of death (P = 0.031), a higher rate of CSF leak (P < 0.001), and a higher rate of cranial procedures (P < 0.001) among the infected patients and a higher rate of CSF leak among the patients with culture-positive infections (P = 0.038). This study summarizes the prevalence, causative organism of PCNSI, and antibiotic usage for all of the neurosurgical cases over a 13-month period in a modernized yet resource-limited neurosurgical center located in South Asia. The results from this study highlight the PCNSI landscape in an area of the world that is often underreported in the neurosurgical literature because of the paucity of clinical neurosurgical research undertaken there. This study shows an increasing prevalence of gram-negative organisms in CSF cultures from PCNSIs, which supports a trend in the recent literature of increasing gram-negative bacillary meningitis. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Trends in one-year mortality for stroke in a tertiary academic center in Saudi Arabia: a 5-year retrospective analysis.

    Science.gov (United States)

    Almekhlafi, Mohammed A

    2016-01-01

    Numerous studies have reported a decline in stroke-related mortality in developed countries. To assess trends in one-year mortality following a stroke diagnosis in Saudi Arabia. Retrospective longitudinal cohort study. Single tertiary care center from 2010 through 2014. All patients admitted with a primary admitting diagnosis of stroke. Demographic data (age, gender, nationality), risk factor profile, stroke subtypes, in-hospital complications and mortality data as well as cause of death were collected for all patients. A multivariable logistic regression model was used to assess factors associated with one-year mortality following a stroke admission. One-year mortality. In 548 patients with a mean age of 62.9 years (SD 16.9), the most frequent vascular risk factors were hypertension (90.6%), diabetes (65.5%), and hyperlipidemia (27.2%). Hemorrhagic stroke was diagnosed in 9.9%. The overall mortality risk was 26.9%. Non-Saudis had a significantly higher one-year mortality risk compared with Saudis (25% vs. 16.8%, respectively; P=.025). The most frequently reported causes of mortality were neurological and related to the underlying stroke (32%), sepsis (30%), and cardiac or other organ dysfunction-related (each 9%) in addition to other etiologies (collectively 9.5%) such as pulmonary embolism or an underlying malignancy. Significant predictors in the multivariate model were age (P stroke mortality in our center over the 5-year span. The establishment of stroke systems of care, use of thrombolytic agents, and opening of a stroke unit should play an important role in a decline in stroke mortality. Retrospective single center study. Mortality data were available only for patients who died in our hospital.

  13. Knowledge and Outcome Measure of HbA1c Testing in Asian Indian Patients with Type 2 Diabetes from a Tertiary Care Center

    Science.gov (United States)

    Kumpatla, Satyavani; Medempudi, Srikanth; Manoharan, Deepa; Viswanathan, Vijay

    2010-01-01

    Aim: HbA1c test is considered to be the reliable measure for evaluating long-term glycemic control in type 2 diabetes. The purpose of this study was to evaluate whether knowledge about HbA1c test is associated with a better glycemic control. Materials and Methods: We conducted a cross-sectional survey of 480 (M:F; 287:193) adults with type 2 diabetes attending a tertiary care center during a period of four months. Baseline demographic and clinical data of all the subjects was obtained. Subject’s knowledge about HbA1c test and their target goal was assessed using a questionnaire. Recent HbA1c results were obtained from medical records. Results: Seventy four per cent of the subjects had awareness about HbA1c test and about 43% of those who knew HbA1c test also knew their target goal. 33% remember their last HbA1c result. The mean A1C of Group A was significantly lower when compared with Group B (8.1 ± 1.7 vs 9.2 ± 1.9, P<0.0001). Group C had lower A1C levels compared to Group D (7.7 ± 1.4 vs 8.5 ± 1.9, p<0.0001). Patients who kept their HbA1c less than 7% were significantly higher in Group C than in Group D. (37.8 vs 12.7%, p<0.00001). Subjects had good glycemic control with increasing levels of awareness about HbA1c. Conclusion: Majority of the diabetic patients who attended the tertiary care center for diabetes care knew HbA1c test and half of them were aware about their target goal. Awareness about HbA1c had a positive impact on maintenance of better glycemic control. PMID:20922109

  14. Prevalence and risk factors of asymptomatic bronchiectasis in patients with rheumatoid arthritis at a tertiary care center in Saudi Arabia

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    Suzan Mansour Attar

    2015-01-01

    Full Text Available Introduction and Objectives: Bronchiectasis is a pulmonary manifestation that often occurs in individuals with rheumatoid arthritis (RA. Nevertheless, the prevalence of bronchiectasis in RA patients and predictors of its development/progression remain ill-defined. Our objective was to investigate the prevalence of bronchiectasis in a group of RA patients and examine possible clinical or biochemical risk factors that might contribute to its development. Methods: This was an observational study analyzing 100 RA patients with no pulmonary symptoms selected from King Abdulaziz University Hospital in the Western region of Saudi Arabia from October 2013 to 2014. Demographic, clinical and laboratory information were collected for all patients. Diagnosis was based on the 2010 American College of Rheumatology (ACR/European League Against Rheumatism (EULAR classification system, and disease activity was assessed using the 28-Joint Disease Activity Score Index with C-reactive protein; high-resolution computed tomography chest scans were performed. The prevalence of bronchiectasis was recorded and its association with different risk factors was examined using standard statistical methods. Results: All 100 patients fulfilled the ACR and EULAR classification criteria for RA diagnosis. Their mean age was 51.05 ± 13.5 years, disease duration was 6.19 ± 6.4 years and disease activity index was 4 ± 1.3 (moderate activity. A total of 35 (35% patients developed bronchiectasis. Notably, we observed significant positive associations of bronchiectasis with age, disease duration and male gender (P < 0.001, P = 0.006, P = 0.028, respectively. Conclusions: Asymptomatic bronchiectasis represents a common complication in moderately active RA patients within the Western Region of Saudi Arabia. Furthermore, several predictors of bronchiectasis development were identified, which can contribute to effective risk stratification in RA patients. Further prospective studies are

  15. Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil

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    Matheus Fachini Vane

    2016-03-01

    Full Text Available Background: Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. Objectives: The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. Contents: There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. Conclusions: There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care. Resumo: Justificativa: Nos últimos 25 anos ocorreram grandes mudanças na medicina em todo o mundo. Essas mudanças de tecnologias, riscos do paciente, perfil do paciente e leis que regulam medicamentos tiveram impacto na incid

  16. Prevalence and perinatal mortality associated with preterm births in a tertiary medical center in South East Nigeria

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    Iyoke CA

    2014-10-01

    perinatal mortality rate for preterm babies in the study center was 46.1% (236/512. The stillbirth rate for preterm babies was 22.0% (149/678 and the adjusted early neonatal death rate was 24.0% (87/363.Conclusion: The prevalence of preterm births and associated perinatal mortality were high which may be a reflection of suboptimal prenatal and newborn care. An urgent improvement in prenatal and newborn care is therefore needed in the study center in order to improve the capacity to prevent or abate preterm labor, and preterm premature rupture of membranes; and to reduce avoidable stillbirths. Further upgrading of personnel and facilities in the newborn special care unit is also required to minimize early neonatal deaths.Keywords: preterm birth, prevalence, mortality, pattern, Nigeria

  17. Frequency of dual tuberculosis/human immunodeficiency virus infection in patients presenting at tertiary care centers at karachi

    International Nuclear Information System (INIS)

    Mamon, A.R.; Zuberi, B.F.; Afsar, S.; Altaf, A.; Shah, A.

    2007-01-01

    To determine the frequency of dual infection of Tuberculosis and Human Immunodeficiency Virus (HIV) and document the sexual practices of infected patients. Patients were recruited in the study at both centers and tested for both HIV and TB if any one disease was identified. Diagnosis of TB was based on positive sputum AFB smear / caseous granulomatous lesion on histopathology. Diagnosis of HIV was based on positive anti-HIV serology by LISA technique. A questionnaire was also administered to all the study participants regarding demographics, sexual practices, blood transfusion and intravenous drug abuse. A total of 196 patients of HIV and TB were screened for the presence of dual infection (TB/HIV). Dual infection was present in 38 (19.39%) of patients. Out of 126 patients of HIV, evidence of TB was detected in 38 (30.16%). During the same duration, 70 patients of tuberculosis were screened for HIV and none was tested positive for HIV. History of illicit sexual relationship was found in 121 (96.03%) patients and 5 of these were homosexuals. Dual infection was present in patients of HIV with TB but vice versa was not documented in this study. (author)

  18. Therapeutic rigid bronchoscopy at a tertiary care center in North India: Initial experience and systematic review of Indian literature

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    Karan Madan

    2014-01-01

    Full Text Available Background and Aim: Rigid bronchoscopy is often an indispensable procedure in the therapeutic management of a wide variety of tracheobronchial disorders. However, it is performed at only a few centers in adult patients in India. Herein, we report our initial 1-year experience with this procedure. Materials and Methods: A prospective observational study on the indications, outcomes, and safety of various rigid bronchoscopy procedures performed between November 2009 and October 2010. Improvement in dyspnea, cough, and the overall quality of life was recorded on a visual analog scale from 0 to 100 mm. A systematic review of PubMed was performed to identify studies reporting the use of rigid bronchoscopy from India. Results: Thirty-eight rigid bronchoscopies (50 procedures were performed in 19 patients during the study period. The commonest indication was benign tracheal stenosis followed by central airway tumor, and the procedures performed were rigid bronchoplasty, tumor debulking, and stent placement. The median procedure duration was 45 (range, 30-65 min. There was significant improvement in quality of life associated with therapeutic rigid bronchoscopy. Minor procedural complications were encountered in 18 bronchoscopies, and there was no procedural mortality. The systematic review identified 15 studies, all on the role of rigid bronchoscopy in foreign body removal. Conclusions: Rigid bronchoscopy is a safe and effective modality for treatment of a variety of tracheobronchial disorders. There is a dire need of rigid bronchoscopy training at teaching hospitals in India.

  19. Fragile X Premutation Carrier Epidemiology and Symptomatology in Israel-Results from a Tertiary Child Developmental Center.

    Science.gov (United States)

    Gabis, Lidia V; Gruber, Noah; Berkenstadt, Michal; Shefer, Shahar; Attia, Odelia Leon; Mula, Dana; Cohen, Yoram; Elizur, Shai E

    2016-10-01

    Fragile X syndrome (FXS) is the most prevalent known genetically inherited cause for autism and intellectual disability. Premutation state can cause several clinical disorders as well. We aimed to perform a nesting approach to acquire data with regard to first degree relatives of index fragile X cases at the largest child development center in Israel in order to map characteristics of Israeli FXS permutation women carriers. Seventy-nine women were referred due to a related fragile X syndrome patient, mainly an offspring or sibling. General information regarding demographics, ethnicity, and associated medical conditions were collected using interviews and structured questionnaires. Thirteen (17 %) of the women who were referred as "carrier" were proven to be actually full mutation. The mean years of education were 14 (±1.51, range 12-17). Twenty-one women (27 %) originated from Tunisia (mainly from the island of Djerba). Ten women (13 %) reported delivery of their affected offspring beyond 41 gestational weeks. Twenty-two percent of women with premutation reported symptoms consistent with learning difficulties, mainly dyscalculia, and 14 % reported ADHD symptoms. Awareness about clinical disorders of the carriers was existent only in 25 % of the patients. Increased awareness and knowledge dissemination concerning premutation symptomatology and associated medical conditions are warranted. We suggest a national registry to be installed in different countries in order to identify fragile X premutation carriers at increased risk for various medical complications.

  20. Changes in patterns of uveitis at a tertiary referral center in Northern Italy: analysis of 990 consecutive cases.

    Science.gov (United States)

    Luca, Cimino; Raffaella, Aldigeri; Sylvia, Marchi; Valentina, Mastrofilippo; Fabiana, Viscogliosi; Marco, Coassin; Annamaria, Soldani; Luisa, Savoldi; Alessandro, De Fanti; Lucia, Belloni; Alessandro, Zerbini; Maria, Parmeggiani; Matthew, Chersich; Alessandra, Soriano; Carlo, Salvarani; Luigi, Fontana

    2018-02-01

    The role of uveitis, an uncommon ocular disease, is often neglected in research and treatment of autoimmune conditions. The study described the spectrum of uveitis at a referral center in North Italy, and compared that to a previously published series of patients. We reviewed all patients with uveitis diagnosed from 2013 to 2015 at the Immunology Eye Unit, Arcispedale S. M. Nuova-IRCCS, Reggio Emilia, Italy. We examined patient characteristics, disease spectrum, and etiologies. In total, 990 cases of uveitis were identified, who were mostly female (59%) with a median age at presentation of 44 years (interquartile range = 29-57). Anterior uveitis was most frequent (53.5%), followed by panuveitis (22.8%), posterior (16.2%), and intermediate uveitis (5.5%). Anterior herpetic uveitis (15.6%), Fuchs uveitis (9.7%), and HLA-B27 positive anterior uveitis (7.7%) were the most common specific diagnoses. Compared with the previous series, we observed an increased incidence of uveitis, and a different pattern of diagnoses. Rates of herpetic, HLA-B27 positive uveitis, and presumed ocular tuberculosis were higher, but Fuchs uveitis was less frequent. The pattern of uveitis appears to be changing, very likely due to population-level increases in infectious diseases, to the availability of new diagnostic tests and to the interdisciplinary approach used in patient diagnosis.

  1. Paroxysmal occipital discharges suppressed by eye opening: spectrum of clinical and imaging features at a tertiary care center in India.

    Science.gov (United States)

    Kaul, Bhavna; Shukla, Garima; Goyal, Vinay; Srivastava, Achal; Behari, Madhuri

    2012-01-01

    Paroxysmal occipital discharges (PODs) demonstrating the phenomena of fixation-off sensitivity have classically been described in childhood epilepsies with occipital paroxysms. We attempted to delineate the demographic, clinical and imaging characteristics of patients whose interictal electroencephalograms (EEGs) showed occipital discharges with fixation-off sensitivity at our center. During the period between 2003 and 2005, patients whose interictal EEGs showed PODs were included in the study. A detailed history, clinical examination and EEG findings along with imaging characteristics were analyzed. Of the 9,104 interictal EEGs screened during the study period, 11 patients (6 females and 5 males) aged between 5 and 17 years were identified to have PODs with fixation-off sensitivity. Five had history of generalized tonic-clonic seizures. Three patients could be classified under Panayiotopoulos syndrome; the remaining 8 (72.2%) patients had symptomatic epilepsy. This study suggests that the phenomenon of fixation-off sensitivity is found not only in patients of idiopathic focal epilepsies, but also in a substantial number of patients of symptomatic epilepsy. The high proportion of symptomatic epilepsy with phenomenon of fixation-off sensitivity may be related to the referral pattern.

  2. Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.

    Directory of Open Access Journals (Sweden)

    Maryse C Cnossen

    Full Text Available The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI is low. Comparative effectiveness research (CER has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI study.We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions.All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%, designated as a level I trauma center (n = 48, 68% and situated in an urban location (n = 70, 99%. The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57% had a dedicated neuro-intensive care unit (ICU, 36 (51% had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45 of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers.Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches.

  3. Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center.

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    Jacob, Christian P; Romanos, Jasmin; Dempfle, Astrid; Heine, Monika; Windemuth-Kieselbach, Christine; Kruse, Anja; Reif, Andreas; Walitza, Susanne; Romanos, Marcel; Strobel, Alexander; Brocke, Burkhard; Schäfer, Helmut; Schmidtke, Armin; Böning, Jobst; Lesch, Klaus-Peter

    2007-09-01

    The prevalence and consequences of co-morbid axis-I and axis-II disorders as well as personality traits were examined in a large cohort of adult attention-deficit/hyperactivity disorder (AADHD) at a tertiary referral center. In- and outpatients referred for diagnostic assessment of AADHD were screened. 372 affected probands were examined by means of the Structured Clinical Interview of DSM-IV axis-I/II disorders, the Revised NEO Personality Inventory (NEO-PI-R), and the Tridimensional Personality Questionnaire (TPQ). Lifetime co-morbidity with mood disorders was 57.3%, with anxiety disorders 27.2%, and with substance use disorders 45.0%. The histrionic personality disorder (35.2%) was the most frequent personality disorder. AADHD patients exhibited significantly altered scores on most of the NEO-PI-R and TPQ personality dimensions. The extent of substance abuse and dependence, as well as the presence of antisocial personality disorder alone or the cumulative number of other specific personality disorders was associated with lower psychosocial status (pdisorders was remarkably prevalent. In AADHD co-morbid mood, anxiety, and personality disorders as well as substance abuse/dependence is likely to be predictive of poor outcome.

  4. Risk factors for the acquisition of carbapenem-resistant Escherichia coli at a tertiary care center in South Korea: a matched case-control study.

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    Ahn, Jin Young; Song, Je Eun; Kim, Min Hyung; Choi, Heun; Kim, Jae Kyung; Ann, Hea Won; Kim, Jung Ho; Jeon, Yongduk; Jeong, Su Jin; Kim, Sun Bean; Ku, Nam Su; Han, Sang Hoon; Song, Young Goo; Yong, Dongeun; Lee, Kyungwon; Kim, June Myung; Choi, Jun Yong

    2014-06-01

    Carbapenem resistance among gram-negative bacilli is an emerging threat worldwide. The objective of this study was to identify risk factors for the acquisition of carbapenem-resistant Escherichia coli (CRE). We conducted a matched case-control study comprising 57 cases of acquisition of CRE and 114 controls (1:2 matched) selected from patients with a culture of carbapenem-susceptible E coli between January 2006 and December 2010 at a 2000-bed tertiary care center in South Korea. On univariate analysis, previous use of carbapenem (P carbapenem (odds ratio [OR], 4.56; 95% confidence interval [CI] 1.44-14.46; P = .01) and previous use of fluoroquinolone (OR, 2.81; 95% CI, 1.14-6.99; P = .03) were independent risk factors. At this institute, the antibiotic selective pressure of carbapenems and fluoroquinolones was shown to be an important risk factor for the acquisition of CRE. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  5. Mortality pattern in otorhinolaryngology ward: A 5 years retrospective study at an urban tertiary health care center in India.

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    Kumar, Vivek; Kumar, Satish; Chandra Sharma, Naresh; Kumar, Badal

    2017-10-01

    To recognize deaths in the otorhinolaryngology indoor wards, determine the reason behind the mortalities and recommend modifications for betterment of patient care and surgical outcomes. Data was collected from the mortality register, operation theatre registers, ward registers and case notes of patients declared dead at an urban tertiary health care center in India for a period of 5 years; from January 2012 to December 2016. The data included date of admission, age, sex, educational status, residence, and clinical diagnosis, course of hospital stay and medical cause of death. Data acquired was reviewed and statistically interpreted and presented in graphical and descriptive formats. 6157 admissions were made in otorhinolaryngology (ENT) ward in the 5 year period which included 3969 males and 2188 female patients. 58 deaths were recorded during this period which gives overall death per admission crude mortality rate of 9.42% at an average of about 12 (11.60) deaths per year. The major causes of death were malignancy and septicemia. The significance of health education, aggressive healthcare campaigns, enhancement of healthcare services and wide accessibility of healthcare services to remote areas has been emphasized. Role of structured study and protocols in the management of serious cases is highlighted along with the need for prompt referral and better interdepartmental cooperation. Copyright © 2017 Chang Gung University. Published by Elsevier B.V. All rights reserved.

  6. Association Between Weekend and Holiday Admission with Pneumonia and Mortality in a Tertiary Center in Portugal: A Cross-Sectional Study.

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    Cortes, Margarida Barreto; Fernandes, Samuel Raimundo; Aranha, Patricia; Avô, Luís Brito; Falcão, Luís Menezes

    2017-05-31

    Acute bacterial pneumonia is a common and potentially fatal disease where early recognition and treatment are crucial. Increasing medical literature suggests worse outcomes in patients admitted for medical and surgical conditions during the weekend. Little is known about this effect in patients with acute bacterial pneumonia. Obective: The aim of this study was to evaluate the impact of weekend and holiday hospital admission on the outcomes of acute bacterial pneumonia. Retrospective analysis of adult patients (> 18 years) with acute bacterial pneumonia collected from a tertiary referral center database. Length of stay, total cost, admission to intensive care unit, development of sepsis and organ failure, and mortality were compared between patients admitted on a weekday and patients admitted during a weekend or holiday. We analyzed 53 854 hospital admissions from 42 512 patients (median age 84.0 years, range 18 - 118 years), corresponding to 30 554 admissions during weekdays, 21 222 at weekends and 2078 during public holidays. Weekend and holiday admission was not associated with increased costs, length of stay, intensive care unit admission, development of sepsis, organ failure, and mortality. A weekend/holiday effect in acute bacterial pneumonia was not evident in our series.

  7. Factors associated with high stress levels in adults with diabetes mellitus attending a tertiary diabetes care center, Chennai, Tamil Nadu, India

    Science.gov (United States)

    Sendhilkumar, Muthappan; Tripathy, Jaya Prasad; Harries, Anthony D.; Dongre, Amol R.; Deepa, Mohan; Vidyulatha, Ashok; Poongothai, Subramanian; Venkatesan, Ulaganathan; Anjana, Ranjit Mohan; Mohan, Viswanathan

    2017-01-01

    Objective: We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM) in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. Methods: A mixed-methods (triangulation design) study with quantitative methodology (survey) and qualitative methodology (interviews) was carried out. Stress levels were assessed among type 2 DM patients attending a diabetes clinic using a 5-point perceived stress scale-10. One-on-one interviews were carried out with 376 participants with DM having high/very high stress levels to understand the reasons for perceived stress and explore their coping mechanisms. Results: The prevalence of high/very high stress was 35% among DM patients. Age 30–40 years, working in professional jobs, and lack of physical activity were factors significantly associated with stress. The perceived major stress inducers were related to family, work, financial issues, and the disease itself. Conclusions: This study showed high levels of stress in more than one-third of DM patients. Potential solutions include regular, formal assessment of stress levels in the clinic, providing integrated counseling and psychological care for DM patients, and promoting physical activity. PMID:28217499

  8. Factors associated with high stress levels in adults with diabetes mellitus attending a tertiary diabetes care center, Chennai, Tamil Nadu, India

    Directory of Open Access Journals (Sweden)

    Muthappan Sendhilkumar

    2017-01-01

    Full Text Available Objective: We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. Methods: A mixed-methods (triangulation design study with quantitative methodology (survey and qualitative methodology (interviews was carried out. Stress levels were assessed among type 2 DM patients attending a diabetes clinic using a 5-point perceived stress scale-10. One-on-one interviews were carried out with 376 participants with DM having high/very high stress levels to understand the reasons for perceived stress and explore their coping mechanisms. Results: The prevalence of high/very high stress was 35% among DM patients. Age 30–40 years, working in professional jobs, and lack of physical activity were factors significantly associated with stress. The perceived major stress inducers were related to family, work, financial issues, and the disease itself. Conclusions: This study showed high levels of stress in more than one-third of DM patients. Potential solutions include regular, formal assessment of stress levels in the clinic, providing integrated counseling and psychological care for DM patients, and promoting physical activity.

  9. Factors associated with high stress levels in adults with diabetes mellitus attending a tertiary diabetes care center, Chennai, Tamil Nadu, India.

    Science.gov (United States)

    Sendhilkumar, Muthappan; Tripathy, Jaya Prasad; Harries, Anthony D; Dongre, Amol R; Deepa, Mohan; Vidyulatha, Ashok; Poongothai, Subramanian; Venkatesan, Ulaganathan; Anjana, Ranjit Mohan; Mohan, Viswanathan

    2017-01-01

    We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM) in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. A mixed-methods (triangulation design) study with quantitative methodology (survey) and qualitative methodology (interviews) was carried out. Stress levels were assessed among type 2 DM patients attending a diabetes clinic using a 5-point perceived stress scale-10. One-on-one interviews were carried out with 376 participants with DM having high/very high stress levels to understand the reasons for perceived stress and explore their coping mechanisms. The prevalence of high/very high stress was 35% among DM patients. Age 30-40 years, working in professional jobs, and lack of physical activity were factors significantly associated with stress. The perceived major stress inducers were related to family, work, financial issues, and the disease itself. This study showed high levels of stress in more than one-third of DM patients. Potential solutions include regular, formal assessment of stress levels in the clinic, providing integrated counseling and psychological care for DM patients, and promoting physical activity.

  10. Characteristics of Travel-Related Severe Plasmodium vivax and Plasmodium falciparum Malaria in Individuals Hospitalized at a Tertiary Referral Center in Lima, Peru.

    Science.gov (United States)

    Llanos-Chea, Fiorella; Martínez, Dalila; Rosas, Angel; Samalvides, Frine; Vinetz, Joseph M; Llanos-Cuentas, Alejandro

    2015-12-01

    Severe Plasmodium falciparum malaria is uncommon in South America. Lima, Peru, while not endemic for malaria, is home to specialized centers for infectious diseases that admit and manage patients with severe malaria (SM), all of whom contracted infection during travel. This retrospective study describes severe travel-related malaria in individuals admitted to one tertiary care referral hospital in Lima, Peru; severity was classified based on criteria published by the World Health Organization in 2000. Data were abstracted from medical records of patients with SM admitted to Hospital Nacional Cayetano Heredia from 2006 to 2011. Of 33 SM cases with complete clinical data, the mean age was 39 years and the male/female ratio was 2.8. Most cases were contracted in known endemic regions within Peru: Amazonia (47%), the central jungle (18%), and the northern coast (12%); cases were also found in five (15%) travelers returning from Africa. Plasmodium vivax was most commonly identified (71%) among the severe infections, followed by P. falciparum (18%); mixed infections composed 11% of the group. Among the criteria of severity, jaundice was most common (58%), followed by severe thrombocytopenia (47%), hyperpyrexia (32%), and shock (15%). Plasmodium vivax mono-infection predominated as the etiology of SM in cases acquired in Peru. © The American Society of Tropical Medicine and Hygiene.

  11. Prevalence of Human Papilloma Virus Infection in Young Primiparous Women During Postpartum Period: Study from a Tertiary Care Center in Northern India.

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    Garg, Alpana; Suri, Vanita; Nijhawan, Raje; Aggarwal, Neelam; Aggarwal, Ritu; Guleria, Charu; Thakur, Mili

    2016-10-01

    Assessment of high-risk Human Papilloma Virus (HPV) prevalence is important for monitoring long-term decrease in cervical cancer after implementation of the prophylactic HPV vaccination. To determine the prevalence of high-risk HPV infection and cytological abnormalities in young primiparous women in the age group of 16-26years. In this cross-sectional study, 214 primiparous women aged 16-26years were recruited from a public tertiary health care center postpartum clinic between June 2013 and May 2014. Cytological analysis was performed by Pap smear test and patients underwent sampling with cervical brushes for HPV-DNA detection and typing by a PCR-based assay for HPV types 16, 18, 33 and 45. High-risk HPV was detected in 41 (19.2%) women. HPV 16 was found to be most prevalent with 17 (7.9%) samples testing positive, followed by HPV 18 in nine (4.2%), HPV 45 in six (2.8%) and HPV 31 in four (1.8%) women. Five women tested positive for more than one HPV types. There were no cases of intraepithelial lesions or cervical cancer. One patient who had Atypical Cells of Undetermined Significance (ASCUS) on cytology tested negative for all four HPV genotypes. This study provides a geographic baseline data of high-risk HPV prevalence in young Indian women before implementation of a vaccination program. The results are important for comparison with other global regions and monitoring the effect of HPV vaccination.

  12. Assessment of Physical Environment of Iran’s Neonatal Tertiary Care Centers from the Perspective of the Neonatal Individualized Developmental Care

    Directory of Open Access Journals (Sweden)

    Mostajab Razavi Nejad

    2017-12-01

    Full Text Available Background: Globally,it is estimated that approximately 13 million neonates are born prematurely each year. The development of the central nervous system in premature neonates continues outside of the uterus and in the environment of neonatal intensive care unit (NICU. This study aimed to evaluate the physical environment of hospital and nursery in Iran’s tertiary care centers. Methods: This cross-sectional study was conducted on a total of 23 NICUs of nine Universities of Medical Sciences, where students are trained in the neonatal fellowship course, from seven provinces of Iran, 20th July to 21th September 2015. Data analysis was performed using SPSS software, version 16, and descriptive statistics. Results: In this study, four dimensions of physical environment of hospitals and NICUs including the accessibility of NICU, the physical environment of NICU, infants’ bed space, and the sensory elements of bed spaces were evaluated. The obtained scores for each item was 41.17, 39.95, 38.83, and 39.28 out of 100, respectively. The highest mean score was 71.30 that was related to NICU temperature and ventilation considerations. The lowest mean score was 20, which was related to controlling over the movements around the infants’ beds. The total mean score of the physical environment of hospital and NICU was 39.77. Conclusion: According to the results, it is recommended to take appropriate action to develop physical space and infrastructures for neonatal care regarding developmental care along with other dimensions.

  13. Qualitative study of the communication expectations of clients accessing oncology care at a tertiary referral center for dogs with life-limiting cancer.

    Science.gov (United States)

    Stoewen, Debbie L; Coe, Jason B; MacMartin, Clare; Stone, Elizabeth A; E Dewey, Catherine

    2014-10-01

    To describe the process aspects (communication) of the information expectations of clients accessing oncology care services at a tertiary referral center for dogs with life-limiting cancer. Qualitative analysis of data acquired during in-person single and dyadic interviews. 43 dog owners participating in 30 interviews. Independent in-person interviews were conducted with standardized open- and closed-ended questions from April to October 2009. Thematic analysis was performed on transcripts of the interview discussions. The participants expected information to be communicated in a forthright manner; in multiple formats; with understandable language; in an unrushed environment wherein staff took the time to listen, answer all questions, and repeat information when necessary; on a continuous basis, with 24-hour access to address questions or concerns; in a timely manner; with positivity; with compassion and empathy; with a nonjudgmental attitude; and through staff with whom they had established relationships. Results indicated that the manner in which information is communicated is vitally important to clients of dogs with life-limiting cancer in that it not only facilitates comprehension but also creates a humanistic environment from which clients derive the psychosocial support needed to successfully cope with their pet's condition.

  14. Linear Accelerator Stereotactic Radiosurgery of Central Nervous System Arteriovenous Malformations: A 15-Year Analysis of Outcome-Related Factors in a Single Tertiary Center.

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    Thenier-Villa, José Luis; Galárraga-Campoverde, Raúl Alejandro; Martínez Rolán, Rosa María; De La Lama Zaragoza, Adolfo Ramón; Martínez Cueto, Pedro; Muñoz Garzón, Víctor; Salgado Fernández, Manuel; Conde Alonso, Cesáreo

    2017-07-01

    Linear accelerator stereotactic radiosurgery is one of the modalities available for the treatment of central nervous system arteriovenous malformations (AVMs). The aim of this study was to describe our 15-year experience with this technique in a single tertiary center and the analysis of outcome-related factors. From 1998 to 2013, 195 patients were treated with linear accelerator-based radiosurgery; we conducted a retrospective study collecting patient- and AVM-related variables. Treatment outcomes were obliteration, posttreatment hemorrhage, symptomatic radiation-induced changes, and 3-year neurologic status. We also analyzed prognostic factors of each outcome and predictability analysis of 5 scales: Spetzler-Martin grade, Lawton-Young supplementary and Lawton combined scores, radiosurgery-based AVM score, Virginia Radiosurgery AVM Scale, and Heidelberg score. Overall obliteration rate was 81%. Nidus diameter and venous drainage were predictive of obliteration (P linear accelerator-based radiosurgery is a useful, valid, effective, and safe modality for treatment of brain AVMs. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Failure of initial disease control in bullous pemphigoid: a retrospective study of hospitalized patients in a single tertiary center.

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    Kremer, Noa; Zeeli, Tal; Sprecher, Eli; Geller, Shamir

    2017-10-01

    Bullous pemphigoid (BP) is the most prevalent autoimmune blistering skin disease in Western countries and in Israel. Initial disease control is achieved in 60-90% of BP patients within 1-4 weeks of corticosteroid therapy. In the remainder of patients, recalcitrant disease is controlled with additional immunosuppressive treatment. We aimed to evaluate the rate of BP patients who needed adjuvant therapy to achieve initial disease control and to identify potential predictors for recalcitrant disease. We conducted a retrospective study of newly diagnosed BP patients who were hospitalized at the Tel Aviv Sourasky Medical Center between the years 2008-2014. We performed statistical analyses to assess the association between clinical factors and failure of initial disease control. Among 114 hospitalized patients with newly diagnosed BP, 1.8% presented with oral mucosa involvement. Seven patients (6.1%) required systemic agents in addition to corticosteroids to achieve disease control. Hypertension (P = 0.048), involvement of the head region (P = 0.042), and metformin treatment (P = 0.02) were significantly more prevalent among patients with recalcitrant disease. The low frequency of recalcitrant BP (6.1%) and the rarity of involvement of the oral mucosa (1.8%) in this study suggest that Israeli BP patients present a milder phenotype compared to similar patients from other geographic areas. Hypertension, head involvement, and metformin therapy were found to be significantly associated with the need for adjuvant therapy to achieve initial control, suggesting that these parameters may serve as predictors of treatment response in BP. © 2017 The International Society of Dermatology.

  16. Cynicism and other attitudes towards patients in an emergency department in a middle eastern tertiary care center.

    Science.gov (United States)

    Batley, Nicholas J; Nasreddine, Zeina; Chami, Ali; Zebian, Dina; Bachir, Rana; Abbas, Hussein A

    2016-01-29

    A caring, compassionate practitioner of the medical arts is the idealized version of what makes a good doctor. If asked to think of a painting of a doctor we most likely conjure an image of a physician sitting at a patient's bedside checking the pulse with a concerned look on his face. The reality is however that cynicism, among other negative attitudes, is becoming more prominent among physicians and medical staff. The causes and extent of cynicism likely vary among medical departments and different cultures. In this study, we aimed to assess attitudes of medical students and physicians in an Emergency Department (ED) in Lebanon that accommodates both local patients and is also known to attract patients from around the Middle East. A total of 30 students, residents and attending physicians at the American University of Beirut Medical Center were invited to participate. All participants underwent semi-structured interviews that were recorded, transcribed and then analyzed for common themes. More negative emotions were expressed among participants than positive ones. Negative emotions were more frequently expressed among medical students, interns and residents than attending physicians. Cynicism in the ED was commonly reported however, maintenance of professionalism and adequate patient care were underscored. While empathy was recurrently found among participants, a trend towards a decrease in empathy with career progression was noted among attending physicians. Further, negative feelings towards patient families were prominent. Participants tended to categorize patients based on willingness to cooperate, gender, age, case acuity, ethnic origins and social status. Cynicism emerged as a prominent theme among medical students and staff in our study. However, participants were also empathetic. These attitudes were generally attributed to the peculiar stressors associated with the Lebanese culture, low acuity cases and "VIP" patients. It is crucial to explore methods in

  17. Dissecting Costs of CT Study: Application of TDABC (Time-driven Activity-based Costing) in a Tertiary Academic Center.

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    Anzai, Yoshimi; Heilbrun, Marta E; Haas, Derek; Boi, Luca; Moshre, Kirk; Minoshima, Satoshi; Kaplan, Robert; Lee, Vivian S

    2017-02-01

    The lack of understanding of the real costs (not charge) of delivering healthcare services poses tremendous challenges in the containment of healthcare costs. In this study, we applied an established cost accounting method, the time-driven activity-based costing (TDABC), to assess the costs of performing an abdomen and pelvis computed tomography (AP CT) in an academic radiology department and identified opportunities for improved efficiency in the delivery of this service. The study was exempt from an institutional review board approval. TDABC utilizes process mapping tools from industrial engineering and activity-based costing. The process map outlines every step of discrete activity and duration of use of clinical resources, personnel, and equipment. By multiplying the cost per unit of capacity by the required task time for each step, and summing each component cost, the overall costs of AP CT is determined for patients in three settings, inpatient (IP), outpatient (OP), and emergency departments (ED). The component costs to deliver an AP CT study were as follows: radiologist interpretation: 40.1%; other personnel (scheduler, technologist, nurse, pharmacist, and transporter): 39.6%; materials: 13.9%; and space and equipment: 6.4%. The cost of performing CT was 13% higher for ED patients and 31% higher for inpatients (IP), as compared to that for OP. The difference in cost was mostly due to non-radiologist personnel costs. Approximately 80% of the direct costs of AP CT to the academic medical center are related to labor. Potential opportunities to reduce the costs include increasing the efficiency of utilization of CT, substituting lower cost resources when appropriate, and streamlining the ordering system to clarify medical necessity and clinical indications. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  18. Impact of generic antiretroviral therapy (ART) and free ART programs on time to initiation of ART at a tertiary HIV care center in Chennai, India.

    Science.gov (United States)

    Solomon, Sunil S; Lucas, Gregory M; Kumarasamy, Nagalingeswaran; Yepthomi, Tokugha; Balakrishnan, Pachamuthu; Ganesh, Aylur K; Anand, Santhanam; Moore, Richard D; Solomon, Suniti; Mehta, Shruti H

    2013-08-01

    Antiretroviral therapy (ART) access in the developing world has improved, but whether increased access has translated to more rapid treatment initiation among those who need it is unknown. We characterize time to ART initiation across three eras of ART availability in Chennai, India (1996-1999: pregeneric; 2000-2003: generic; 2004-2007: free rollout). Between 1996 and 2007, 11,171 patients registered for care at the YR Gaitonde Centre for AIDS Research and Education (YRGCARE), a tertiary HIV referral center in southern India. Of these, 5726 patients became eligible for ART during this period as per Indian guidelines for initiation of ART. Generalized gamma survival models were used to estimate relative times (RT) to ART initiation by calendar periods of eligibility. Time to initiation of ART among patients in Chennai, India was also compared to an HIV clinical cohort in Baltimore, USA. Median age of the YRGCARE patients was 34 years; 77% were male. The median CD4 at presentation was 140 cells/µl. After adjustment for demographics, CD4 and WHO stage, persons in the pregeneric era took 3.25 times longer (95% confidence interval [CI]: 2.53-4.17) to initiate ART versus the generic era and persons in the free rollout era initiated ART more rapidly than the generic era (RT: 0.73; 95% CI: 0.63-0.83). Adjusting for differences across centers, patients at YRGCARE took longer than patients in the Johns Hopkins Clinical Cohort (JHCC) to initiate ART in the pregeneric era (RT: 4.90; 95% CI: 3.37-7.13) but in the free rollout era, YRGCARE patients took only about a quarter of the time (RT: 0.31; 95% CI: 0.22-0.44). These data demonstrate the benefits of generic ART and government rollouts on time to initiation of ART in one developing country setting and suggests that access to ART may be comparable to developed country settings.

  19. Pathway of care among patients with Dhat syndrome attending a psychosexual clinic in tertiary care center in North India

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    Sandeep Grover

    2016-01-01

    Full Text Available Aim: The aim of this study was to understand the pathway to care among patients with Dhat syndrome and to study the factors leading to delay in seeking professional psychiatric help. Materials and Methods: Forty-seven patients diagnosed with Dhat syndrome as per the International Classification of Diseases-10 criteria were assessed for sociodemographic and clinical details and information regarding previous treatment taken to determine the pathways to care at their first contact with the outpatient psychosexual clinic. Results: Majority of the patients were single (70.2%, received formal education for at least more than 10 years (66.0%, were employed (59.6%, followers of Hinduism (68.1 and from middle socio-economic class (59.6%, nuclear family setup (53.2%, and rural locality (63.8%. Comorbidity in the form of any psychiatric illness or sexual dysfunction was present on 61.7% of the patients. The mean age at onset of symptoms of Dhat syndrome was 20.38 years (standard deviation [SD] - 6.91. The mean duration of symptoms of Dhat before the patients presented to our psychosexual clinic was 6.78 years (SD - 6.94 while the mean number of agencies/help contacted before was 2.85 (SD - 1.40; range: 1–5. The favorite choice for the first contact was indigenous practitioners, followed by asking for help from friends or relatives, allopathic doctors, and traditional faith healers or pharmacists. The preference to visit indigenous practitioners gradually declined at each stage. Ayurvedic doctors remained the most preferred among all indigenous practitioners. The absence of any comorbid sexual dysfunction in patients with Dhat syndrome predicted an earlier visit to our center as compared to the patients with any comorbid sexual dysfunction. Conclusions: Majority of the patients with Dhat syndrome present very late to specialized psychosexual clinics. There is a need for improving the sexual knowledge and attitude at the community level which will

  20. Identification of factors associated with sedation tolerance in 5000 patients undergoing outpatient colonoscopy: Canadian tertiary center experience.

    Science.gov (United States)

    Shingina, Alexandra; Ou, George; Takach, Oliver; Svarta, Sigrid; Kwok, Ricky; Tong, Jessica; Donaldson, Kieran; Lam, Eric; Enns, Robert

    2016-12-16

    adjusted analysis yielded similar results. These patients are more likely to need a longer recovery periods post-endoscopy, which could result in additional time and personnel requirements. The final predictive model has good predictive ability for Fentanyl ≥ 100 mcg and Midazolam ≥ 3 mg and fair predictive ability for Fentanyl ≥ 50 mcg and Midazolam ≥ 2 mg. The external validity of this model is planned to be tested in another center.

  1. Liquid nitrogen or phenolization for giant cell tumor of bone?: a comparative cohort study of various standard treatments at two tertiary referral centers.

    Science.gov (United States)

    van der Heijden, Lizz; van der Geest, Ingrid C M; Schreuder, H W Bart; van de Sande, Michiel A J; Dijkstra, P D Sander

    2014-03-05

    The rate of recurrence of giant cell tumor of bone is decreased by use of adjuvant treatments such as phenol, liquid nitrogen, or polymethylmethacrylate (PMMA) during curettage. We assessed recurrence and complication rates and functional outcome after curettage with use of phenol and PMMA, liquid nitrogen and PMMA, and liquid nitrogen and bone grafts. We retrospectively compared the relative effectiveness of treatment of giant cell tumors of bone at two tertiary centers with a regional function from 1990 to 2010. The 132 (of 201) patients who met the inclusion criteria had a mean age of thirty-three years (range, eleven to sixty-nine years). Treatment assignment depended purely on the center, with primary treatment consisting of curettage with use of phenol and PMMA (n = 82) at one center and with use of either liquid nitrogen and PMMA (n = 26) or liquid nitrogen and bone grafts (n = 24) at the other center. Recurrence and complication rates were determined, and functional outcome was assessed on the basis of the Musculoskeletal Tumor Society (MSTS) score. The mean duration of follow-up was eight years (range, two to twenty-two years). Recurrence rates were comparable among the groups (28% for phenol and PMMA, 31% for liquid nitrogen and PMMA, and 38% for liquid nitrogen and bone grafts; p = 0.52). Soft-tissue extension increased the recurrence risk (hazard ratio [HR] = 2.1, 95% confidence interval [CI] = 1.1 to 4.0, p = 0.024). The complication rate was 33% after use of liquid nitrogen and bone grafts, 27% after liquid nitrogen and PMMA, and 11% after phenol and PMMA (p = 0.019); complications included osteoarthritis, infection, postoperative fracture, nonunion, transient nerve palsy, and PMMA leakage. The complication risk was increased by the presence of a pathologic fracture (HR = 4.1, 95% CI = 1.7 to 9.5, p = 0.001) and use of liquid nitrogen (HR = 3.9, 95% CI = 1.5 to 10, p = 0.006 for liquid nitrogen and bone grafts; HR = 3.1, 95% CI = 1.1 to 8.6, p = 0

  2. Epidemiology, surgical management and early postoperative outcome in a cohort of gastric cancer patients of a tertiary referral center in relation to multi-center quality assurance studies.

    Science.gov (United States)

    Garlipp, Benjamin; Schwalenberg, Jens; Adolf, Daniela; Lippert, Hans; Meyer, Frank

    2011-03-01

    The aim of the study was to analyze epidemiologic parameters, treatment-related data and prognostic factors in the management of gastric cancer patients of a university surgical center under conditions of routine clinical care before the onset of the era of multimodal therapies. By analyzing our data in relation with multi-center quality assurance trials [German Gastric Cancer Study - GGCS (1992) and East German Gastric Cancer Study - EGGCS (2004)] we aimed at providing an instrument of internal quality control at our institution as well as a base for comparison with future analyses taking into account the implementation of evolving (multimodal) therapies and their influence on treatment results. Retrospective analysis of prospectively gathered data of gastric cancer patients treated at a single institution during a defined 10-year time period with multivariate analysis of risk factors for early postoperative outcome. From 04/01/1993 through 03/31/2003, a total of 328 gastric cancer patients were treated. In comparison with the EGGCS cohort there was a larger proportion of patients with locally advanced and proximally located tumors. 272 patients (82.9%) underwent surgery with curative intent; in 88.4% of these an R0 resection was achieved (EGGCS/GGCS: 82.5%/71.5%). 68.2% of patients underwent preoperative endoluminal ultrasound (EUS) (EGGCS: 27.4%); the proportion of patients undergoing EUS increased over the study period. Diagnostic accuracy of EUS for T stage was 50.6% (EGGCS: 42.6%). 77.2% of operated patients with curative intent underwent gastrectomy (EGGCS/GGCS: 79.8%/71.1%). Anastomotic leaks at the esophagojejunostomy occurred slightly more frequently (8.8%) than in the EGGCS (5.9%) and GGCS (7.2%); however, postoperative morbidity (36.1%) and early postoperative mortality (5.3%) were not increased compared to the multi-center quality assurance study results (EGGCS morbidity, 45%); EGGCS/GGCS mortality, 8%/8.9%). D2 lymphadenectomy was performed in 72

  3. Escherichia coli Sequence Type 131 H30 Is the Main Driver of Emerging Extended-Spectrum-β-Lactamase-Producing E. coli at a Tertiary Care Center.

    Science.gov (United States)

    Johnson, James R; Johnston, Brian; Thuras, Paul; Launer, Bryn; Sokurenko, Evgeni V; Miller, Loren G

    2016-01-01

    The H 30 strain of Escherichia coli sequence type 131 (ST131- H 30) is a recently emerged, globally disseminated lineage associated with fluoroquinolone resistance and, via its H 30Rx subclone, the CTX-M-15 extended-spectrum beta-lactamase (ESBL). Here, we studied the clonal background and resistance characteristics of 109 consecutive recent E. coli clinical isolates (2015) and 41 historical ESBL-producing E. coli blood isolates (2004 to 2011) from a public tertiary care center in California with a rising prevalence of ESBL-producing E. coli isolates. Among the 2015 isolates, ST131, which was represented mainly by ST131- H 30, was the most common clonal lineage (23% overall). ST131- H 30 accounted for 47% (8/17) of ESBL-producing, 47% (14/30) of fluoroquinolone-resistant, and 33% (11/33) of multidrug-resistant isolates. ST131- H 30 also accounted for 53% (8/14) of dually fluoroquinolone-resistant, ESBL-producing isolates, with the remaining 47% comprised of diverse clonal groups that contributed a single isolate each. ST131- H 30Rx, with CTX-M-15, was the major ESBL producer (6/8) among ST131- H 30 isolates. ST131- H 30 and H 30Rx also dominated (46% and 37%, respectively) among the historical ESBL-producing isolates (2004 to 2011), without significant temporal shifts in relative prevalence. Thus, this medical center's recently emerging ESBL-producing E. coli strains, although multiclonal, are dominated by ST131- H 30 and H 30Rx, which are the only clonally expanded fluoroquinolone-resistant, ESBL-producing lineages. Measures to rapidly and effectively detect, treat, and control these highly successful lineages are needed. IMPORTANCE The ever-rising prevalence of resistance to first-line antibiotics among clinical Escherichia coli isolates leads to worse clinical outcomes and higher health care costs, thereby creating a need to discover its basis so that effective interventions can be developed. We found that the H 30 subset within E. coli sequence type 131

  4. Student-Centered European Education System as a Factor of Professional Competence of a Future Teacher's Personality

    Directory of Open Access Journals (Sweden)

    Ivan Boychev

    2015-08-01

    Full Text Available Student-centered education system is seen as the most perspective didactic paradigm of future teachers’ training which directs institutes of higher education of our country towards the convergence with education system of Europe. Student-centered European education system shifts the focus at the educational process organization to the active didactic management and control, as well as the quality evaluation of future teachers’ independent work. It implies their active educational activities requiring substitution of monological presentation of teaching material in the form of informational lecture at its understanding at the form of pedagogics of creative cooperation and dialogue with teachers.

  5. Characteristics and outcomes of e-cigarette exposure incidents reported to 10 European Poison Centers: a retrospective data analysis

    OpenAIRE

    Vardavas, Constantine I.; Girvalaki, Charis; Filippidis, Filippos T; Oder, Mare; Kastanje, Ruth; de Vries, Irma; Scholtens, Lies; Annas, Anita; Plackova, Silvia; Turk, Rajka; Gruzdyte, Laima; Rato, F?tima; Genser, Dieter; Schiel, Helmut; Bal?zs, Andrea

    2017-01-01

    BACKGROUND: The use of e-cigarettes has increased during the past few years. Exposure to e-cigarette liquids, whether intentional or accidental, may lead to adverse events our aim was to assess factors associated with e-cigarette exposures across European Union Member States (EU MS). METHODS: A retrospective analysis of exposures associated with e-cigarettes reported to national poison centers was performed covering incidents from 2012 to March 2015 from 10 EU MS. De-identified and anonymous ...

  6. Risk factors associated with mortality in systemic lupus erythematosus. A case-control study in a tertiary care center in Mexico City.

    Science.gov (United States)

    Hernández-Cruz, B; Tapia, N; Villa-Romero, A R; Reyes, E; Cardiel, M H

    2001-01-01

    To identify the mortality risk factors in a group of Mexican patients with SLE. A case-control autopsy study in a tertiary care center in Mexico, City. Patients with SLE who died during 1958 to 1994 with an autopsy study were selected as cases, and alive patients matched by age (+/- 3 years), decade of SLE onset, and disease duration (+/- 5 years) were defined as controls. Clinical charts were reviewed looking at clinical variables. SLE disease activity was evaluated with the MexSledai index, and SLE disease severity with the Severity Index. Variables were classified as present at any moment during the follow-up and 3 months before death in cases or cut-off date in controls. matched univariate and multivariate analysis by multiple logistic regression were performed, and the results were presented as odds ratio and 95% confidence intervals (OR, 95%CI). 76 matched pairs of patients were studied. Age, gender, and years offormal education were similar in the cases and controls. Variables associated with mortality three months before death were: lung involvement OR= 15.6, 95%CI (4.8-50.3), p<0.001; severe thrombocytopenia 9.6 (2.9-31.7), p<0.001; heart involvement 5.8 (2.6-13.0), p<0.001; and the severity index (cases 8.8 mu, 2.4 sigma vs controls 3.5, 2.0, respectively) 2.2 (1.5-3.4), p<0.001. Variables associated with mortality detected at any moment before death were kidney involvement 2.16 (1.09-4.29), p<0.02; the steroid therapeutic index 2.3 (1.2-4.5), p<0.001; number of previous admissions 2.4 (1.4-4.3), p<0.001; the MEX-SLEDAI index (cases 21.6 mu 6.3 sigma vs controls 12.6, 5.8), 1.2 (1.1-1.3), p<0.001; and the number of severe infections 14.4 (4.4-46.2), p<0.001. Protective variables were skin involvement 0.1 (0.3-0.6), p<0.001; daily dose of chloroquine (cases 3.9 mu, 24.1 sigma vs controls 39.4, 60.0 mg), p <0.0001 and the time from thefirst SLE symptom to the patient's demise or the cut-off date 0.7(0.6-0.9), p<0.001. Multiple logistic regression showed

  7. Predicting long-term renal damage in children with vesicoureteral reflux under conservative initial management: 205 cases in a tertiary referral center.

    Science.gov (United States)

    Alvarez, Natalia; Alvira, Reyes Delgado; Ruiz, Yurema Gonzalez; Atuan, Rafael Fernandez; Hinojosa, Alexander Siles; Heras, Miguel Angel Rihuete; Roldan, Marisa Justa; Romero, Jesus Gracia

    2018-01-01

    Vesicoureteral reflux (VUR) is one of the most common ailments in children. Evidence-based guidelines recommend conservative treatment in children with VUR, followed by endoscopic surgery in those with breakthrough febrile urinary tract infections (UTIs). Despite this fact, the management of VUR is still controversial. Our objective is to evaluate the conservative strategy in children with primary VUR in terms of renal function and scarring, and identify factors associated with poor prognosis in those children. A retrospective study was carried out in a tertiary center in children with primary VUR under conservative strategy treatment from 1989 to 2015. Data extracted included age of presentation, family and prenatal backgrounds, radiographic evaluation including ultrasound (US), dimercaptosuccinic acid (DMSA) scans and voiding cystourethrogram (VCUG). The SPSS program was used for statistical analysis. Two-hundred and five patients were diagnosed and followed a conservative therapy scheme (49.8% males, 50.2% females) after febrile UTI (73.17%) or prenatal diagnosis (26.83%). VCUG showed 53.20% of low-moderate VUR grade, 46.80% high VUR grade. Renal damage was present at diagnosis in 40.89%. Mean follow-up reakthrough recurrent febrile UTIs and underwent surgery. Conservative therapy was followed in 189 patients. Renal scarring or decreased kidney function were shown in 15.12% respectively. Renal damage was identified as a risk factor for poor prognosis (p-value Conservative strategy is a feasible treatment for primary VUR in children. The majority of cases could be managed conservatively with good outcomes after long-term follow-up. Decreased renal function is more frequent in patients with high-grade VUR. Renal damage at diagnosis increases the risk for surgical treatment.

  8. Removal of the eye in a tertiary care center of China:a retrospective study on 573 cases in 20 years

    Directory of Open Access Journals (Sweden)

    Ying Zhang

    2015-10-01

    Full Text Available AIM:To investigate the original protopathy, direct indications, clinical characteristics, complications of orbit plants and visual conditions of eye enucleation/evisceration.METHODS: A retrospective study of 573 eyes removed (573 inpatients at Ophthalmology Department in a tertiary care center of China from January 1993 to December 2012 was completed.RESULTS:Cases underwent removal of the eye accounted for 2.15% of total ophthalmology inpatients, whose annual frequency declined from 3.80% to 0.52%. There were 167 eyes (29.14% being enucleated and 406 (70.86% eviscerated. Annual proportion of evisceration rose from 16.67% in 1993 to 90.48% in later years. Trauma was the top one (65.62% in original protopathies followed by neoplasm (13.44% and ocular infections (5.76%. Phthisis bulbi (45.20% was the most common direct indication, succeeded by malignant tumor (12.57%, loss/unreconstructed of intraocular tissues due to trauma (11.00%, untreatable inflammation (9.60%, intractable glaucoma (8.55% and sclerocorneal staphyloma (5.24%. Exenteration was underwent in 20 (25.97% cases (40% for recurrent carcinoma. Following evisceration, secondary prosthesis implantation was more and earlier, implant exposure occurred in less but earlier and infection and extraction/exchange of implants were more than those following enucleation. Male, phthisis bulbi, evisceration and secondary implantation meant lower risk of implant exposure; eyes removed within 24h following trauma was an independent risk factor. There were 14.37% of eyes with vision of light perception at least as been removed. In the residual contralateral eyes, low vision accounted 5.58% and blindness 3.14%.CONCLUSION:Ocular trauma, tumor and infections were great threats to eyeball preservation. Early and effective controlling of any original protopathies was vital. Generally evisceration presented more superior and safe outcomes than enucleation did. Visual conditions of the sufferers should be

  9. Severe Neutropenia at the Time of Implantable Subcutaneous Chest Port Insertion Is Not a Risk Factor for Port Removal at a Tertiary Pediatric Center.

    Science.gov (United States)

    Hoss, Daniel R; Bedros, Antranik A; Mesipam, Avinash; Criddle, Jared; Smith, Jason C

    2017-03-01

    To determine if severe neutropenia at the time of chest port insertion is a risk factor for port removal and central catheter-associated bloodstream infection (CCABSI) in pediatric patients. From May 2007 to June 2015, 183 consecutive patients (mean age, 9.9 y; range, 0.75-21 y) had a port inserted at a single tertiary pediatric center. Seventy-two had severe neutropenia at the time of port insertion (absolute neutrophil count [ANC] range, 0-500/mm 3 ; mean, 185/mm 3 ). Follow-up until port removal or death and CCABSI events were recorded. Within the first 30 days, similar incidences of CCABSI (12.5% of patients with severe neutropenia [n = 9] vs 4.5% of patients without [n = 5]), port removal for infection (2.8% [n = 2] vs 2.7% [n = 3]), and local port infection (2.8% [n = 2] vs 0.9% [n = 1]) were observed in both groups (P > .05), but the rate of CCABSI per 1,000 catheter-days was higher for patients with severe neutropenia (P = .045). Overall, similar incidences of CCABSI (18.1% [n = 13] vs 16.2% [n = 18]), port removal for infection (2.8% [n = 2] vs 7.2% [n = 8]), local port infection (2.8% [n = 2] vs 2.7% [n = 3]), and CCABSIs per 1,000 catheter-days (0.332 vs 0.400) were observed in both groups (P > .05). Port placement in patients with severe neutropenia can be performed without an increased incidence of port removal for infection. The majority of CCABSIs were successfully treated without port removal. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  10. Clinicopathologic features of adult T-cell leukemias/lymphomas at a North American tertiary care medical center: infrequent involvement of the central nervous system.

    Science.gov (United States)

    Hsi, Andy C; Kreisel, Friederike H; Frater, John L; Nguyen, TuDung T

    2014-02-01

    Human T-cell lymphotropic virus type 1 is associated with adult T-cell leukemia/lymphoma (ATLL). Published series of ATLLs seen at a United States medical institution are rare. We present the features of 4 ATLLs diagnosed at our North American tertiary care medical center from 1990 to 2012. Despite the absence of a history of origin from an endemic region, all our ATLLs demonstrated evidence of human T-cell lymphotropic virus type 1 infection. Central nervous system (CNS) involvement by ATLL was uncommon in our series, and represented only 1.6% (1/64) of all CNS B-cell or T-cell lymphomas diagnosed over a 20+ year period at our institution. Review of the medical literature reveals that the majority of CNS-involved ATLLs present with the lymphoma or acute subtype, and complete remission is difficult to achieve in these cases. CNS involvement frequently occurs with a systemic disease, which carries an aggressive clinical course with poor prognosis. In addition, CNS involvement by ATLL can be the initial presentation or seen with relapsed disease, can be the only site or be associated with other tissue sites of involvement, and may manifest with variable clinical signs/symptoms. Our retrospective study reveals that ATLLs are rare mature T-cell lymphomas in a native North American population, but the clinical and histopathologic features of ATLLs from this nonendemic region are similar to those seen from other endemic regions. Early recognition of these rare ATLLs involving uncommon sites, such as the CNS, will help optimize treatment for these infrequent mature T-cell lymphomas.

  11. A personalized mobile patient guide system for a patient-centered smart hospital: Lessons learned from a usability test and satisfaction survey in a tertiary university hospital.

    Science.gov (United States)

    Yoo, Sooyoung; Jung, Se Young; Kim, Seok; Kim, Eunhye; Lee, Kee-Hyuck; Chung, Eunja; Hwang, Hee

    2016-07-01

    The present study focused on the design, implementation, and evaluation of a personalized mobile patient guide system that utilizes smart phones, indoor navigation technology and a hospital information system (HIS) to address the difficulties that outpatients face in finding hospital facilities, recognizing their daily treatment schedule, and accessing personalized medical and administrative information. The present study was conducted in a fully digitized tertiary university hospital in South Korea. We developed a real-time location-based outpatient guide system that consists of Bluetooth access points (APs) for indoor navigation, an Android-based guide application, a guide server, and interfaces with the HIS. A total of 33 subjects and 43 outpatients participated in the usability test (UT) and the satisfaction survey, respectively. We confirmed that the indoor navigation feature can be applied to outpatient departments with precision using a position error test. The participants in the UT completed each scenario with an average success rate of 67.4%. According to the results, we addressed the problems and made improvements to the user interface by providing users with context-based guidance information. The satisfaction rating of the system was high, with an average score of 4.0 out of 5.0, showing its utility as a patient-centered hospital service. The innovative mobile patient guide system for outpatients is feasible and can be successfully implemented to provide personalized information with high satisfaction. Additionally, the issues identified and lessons learned from our experiences regarding task scheduling, indoor navigation, and usability should be considered when developing the system. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.

    Science.gov (United States)

    Agwu, Allison L; Lee, Carlton K K; Jain, Sanjay K; Murray, Kara L; Topolski, Jason; Miller, Robert E; Townsend, Timothy; Lehmann, Christoph U

    2008-09-15

    Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program. A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated. After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy. The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World

  13. EMERALD: Emergency visit audit of patients treated under medical oncology in a tertiary cancer center: Logical steps to decrease the burden.

    Science.gov (United States)

    Joshi, Amit; Patil, Vijay M; Noronha, Vanita; Ramaswamy, Anant; Gupta, Sudeep; Bhattacharjee, Atanu; Bonda, Avinash; Chandrakanth, M V; Ostwal, Vikas; Khattry, Navin; Banavali, Shripad; Prabhash, Kumar

    2017-01-01

    We are a tertiary care cancer center and have approximately 1000-1500 emergency visits by cancer patients undergoing treatment under the adult medical oncology unit each month. However, due to the lack of a systematic audit, we are unable to plan steps toward the improvement in quality of emergency services, and hence the audit was planned. All emergency visits under the adult medical oncology department in the month of July 2015 were audited. The cause of visit, the demographic details, cancer details, and chemotherapy status were obtained from the electronic medical records. The emergency visits were classified as avoidable or unavoidable. Descriptive statistics were performed. Reasons for avoidable emergency visits were sought. Out of 1199 visits, 1168 visits were classifiable. Six hundred and ninety-six visits were classified as unavoidable (59.6%, 95% CI: 56.7-62.4), 386 visits were classified as probably avoidable visit (33.0%, 95% CI: 30.4-35.8) whereas the remaining 86 (7.4%, 95% CI: 6.0-9.01) were classified as absolutely avoidable. Two hundred and ninety-seven visits happened on weekends (25.6%) and 138 visits converted into an inpatient admission (11.9%). The factors associated with avoidable visits were curative intention of treatment (odds ratio - 2.49), discontinued chemotherapy status (risk ratio [RR] - 8.28), and private category file status (RR - 1.89). A proportion of visits to emergency services can be curtailed. Approximately one-fourth of patients are seen on weekends, and only about one-tenth of patients get admitted.

  14. Coexistence of lichen sclerosus and morphea: a retrospective analysis of 472 patients with localized scleroderma from a German tertiary referral center.

    Science.gov (United States)

    Kreuter, Alexander; Wischnewski, Jana; Terras, Sarah; Altmeyer, Peter; Stücker, Markus; Gambichler, Thilo

    2012-12-01

    The coexistence of lichen sclerosus (LiS) and localized scleroderma (LoS) has sporadically been reported in the literature. Recently, a prospective multicenter study demonstrated a surprisingly high percentage of genital LiS in patients with morphea. The aim of this study was to determine the prevalence of LiS in a cohort of patients with LoS who presented at a tertiary referral medical center for connective tissue diseases in Germany. We retrospectively evaluated the prevalence of genital and extragenital LiS in adult and pediatric patients with different subtypes of LoS. Secondary outcome measures included demographic characteristics and prevalence of other concomitant autoimmune diseases. Of the 472 patients (381 adults, 91 children; mean age: 46 years; range, 4-88 years; female to male ratio: 3.5:1 in adults and 8:1 in children) with LoS, 27 (5.7%) also presented with LiS (19 extragenital and 8 genital lesions). LiS exclusively occurred in patients with plaque-type (morphea) and generalized LoS. Twenty-six of the 27 (96.2%) patients with concomitant LoS and LiS were adults. Compared with LiS in the general population, LiS was significantly more frequent in LoS as indicated by an odds ratio of 18.1 (95% confidence interval 2.6-134.2; P morphea, should be carefully screened for concomitant LiS, including inspection of the anogenital region. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  15. Association Between Sedentary Lifestyle and Diastolic Dysfunction Among Outpatients With Normal Left Ventricular Systolic Function Presenting to a Tertiary Referral Center in the Middle East.

    Science.gov (United States)

    Matta, Stephanie; Chammas, Elie; Alraies, Chadi; Abchee, Antoine; AlJaroudi, Wael

    2016-05-01

    Sedentary lifestyle has become prevalent in our community. Recent data showed controversy on the effect of regular exercise on left ventricular compliance and myocardial relaxation. We sought to assess whether physical inactivity is an independent predictor of diastolic dysfunction in or community, after adjustment for several covariates. Consecutive outpatients presenting to the echocardiography laboratory between July 2013 and June 2014 were prospectively enrolled. Clinical variables were collected prospectively at enrollment. Patients were considered physically active if they exercised regularly ≥3× a week, ≥30 minutes each time. The primary endpoint was presence of diastolic dysfunction. The final cohort included 1356 patients (mean age [SD] 52.9 [17.4] years, 51.3% female). Compared with physically active patients, the 1009 (74.4%) physically inactive patients were older, more often female, and had more comorbidities and worse diastolic function (51.3% vs 38.3%; P < 0.001). On univariate analysis, physical inactivity was associated with 70% increased odds of having diastolic dysfunction (odds ratio: 1.70, 95% confidence interval: 1.32-2.18, P < 0.001). There was significant interaction between physical activity and left ventricular mass index (LVMI; P = 0.026). On multivariate analysis, patients who were physically inactive and had LVMI ≥ median had significantly higher odds of having diastolic dysfunction (odds ratio: 2.82, 95% confidence interval: 1.58-5.05, P < 0.001). In a large, prospectively enrolled cohort from a single tertiary center in the Middle East, physically inactive patients with increased LVMI had 2- to 3-fold increased odds of having diastolic dysfunction after multivariate adjustment. © 2016 Wiley Periodicals, Inc.

  16. Knowledge, attitude and practice of cervical cancer screening among women attending gynecology clinics in a tertiary level medical care center in southeastern Nigeria.

    Science.gov (United States)

    Mbamara, Sunday U; Ikpeze, Okechukwu C; Okonkwo, John E N; Onyiaorah, Igwebuike V; Ukah, Cornelius O

    2011-01-01

    To describe the knowledge, attitudes and practices of gynecology clinic attendees in a tertiary level healthcare center in Nigeria. This is a descriptive, cross-sectional, questionnaire-based study conducted at Nnamdi Azikwe University Teaching Hospital in Nigeria in December 2007. A total of 200 questionnaires were distributed, and 198 were properly completed. The 198 completely and properly filled questionnaires formed the basis of the analysis. Twenty-five (12.6%) of the women were aware of the cervical cancer screening test, while 173 (87.4%) had never heard of the test before. Only 8% of the respondents had knowledge of the prevention of cervical cancer, but none of them were aware of the introduction of the human papillomavirus vaccine. Twenty-one (84.0%) of those women who were aware of the cervical cancer screening test got their information from healthcare providers, 3 (12.0%) from television and 2 (8.0%) from radio. Of the 25 respondents who were aware of the cervical cancer screening test, 15 (60.0%) had received at least a Pap smear test. All of the screening was done as an opportunistic screening exercise. A total of 119 (85.0%) of the women were not able to be screened because they were not aware of the cervical cancer smear screening, while 4 (3.2%) felt that it was unnecessary. There is a significant association between the educational status and the knowledge of the cervical smear Pap test (chi2 = 10.14, p value = 0.001). Eighty (57.1%) of the women agreed that they would like to undertake cervical cancer screening, while 60 (42.9%) would decline the cervical cancer screening test. The knowledge about cervical cancer in this study was very low. This poor knowledge may limit the utilization of cervical cancer prevention programs. This study underscores the need to establish an intensive and sustainable awareness campaign on the prevention of cancer of the cervix.

  17. Postpartum intrauterine contraceptive device: Knowledge and factors affecting acceptance among pregnant/parturient women attending a large tertiary health center in Puducherry, India

    Directory of Open Access Journals (Sweden)

    Abinaya Valliappan

    2017-01-01

    Full Text Available Context: Intrauterine contraceptive device (IUCD has been recommended for insertion within 10 min of placental delivery or within 48 h of delivery (postpartum IUCD [PPIUCD] by the WHO. However, the acceptance across our country has been low. Aims: To determine the level of knowledge and the factors affecting it and the likely adoption of PPIUCD. Settings and Design: This cross-sectional study was carried out in the antenatal clinic and postnatal ward of a large tertiary care center in South India. Subjects and Methods: A total of 339 women were studied with the help of a validated structured pro forma. Proportions were expressed in percentage. Chi-square test was applied to compare proportions and univariate analysis for the factors affecting knowledge and likely acceptance. Results: Among the 339 women, 152 (44.8% were aware of the method. Of the 152 women, 56 had a negative attitude about the method. Multiparity of the women was a significant factor affecting knowledge (χ2 = 8.068, P = 0.045. Women who were not exposed to formal health counseling were significantly associated with a lack of knowledge (χ2 = 23.332, P = 0.0001. Primiparity (χ2 = 14.683, P = 0.0001, husbands with skilled jobs (χ2 = 8.272, P = 0.0407, having shared information with their husband regarding the method (χ2 = 38.1, P < 0.001, and family support (χ2 = 58.25, P < 0.001 were the major factors associated with willingness to adopt the method. Conclusion: The level of knowledge about PPIUCD of our study population is 44.8%. Exposure to formal health counseling classes and prior discussion with husbands and family members could improve the knowledge and likelihood of acceptance of PPIUCD.

  18. High burden of hepatocellular carcinoma and viral hepatitis in Southern and Central Vietnam: Experience of a large tertiary referral center, 2010 to 2016.

    Science.gov (United States)

    Nguyen-Dinh, Song-Huy; Do, Albert; Pham, Trang Ngoc Doan; Dao, Doan Y; Nguy, Trinh Nhu; Chen, Moon S

    2018-01-27

    To examine the largest tertiary referral center in southern and central Vietnam from 2010 to 2016, evaluating epidemiological trends of hepatocellular carcinoma (HCC) and viral hepatitis B-C in this resource-limited setting. We extracted data of patients receiving care from Cho Ray Hospital (Ho Chi Minh City), the largest oncology referral center in southern and central Vietnam, from 2010 to 2016. We collected information on patient age, gender, geographic distribution, and disease characteristics including disease stage, tumor biomarker levels [serum alpha-fetoprotein (AFP), AFP-L3 isoform percentage, and prothrombin induced by induced by vitamin K absence-II], and serological testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Data from 24091 HCC patients were extracted, with sample demographics comprising mostly male (81.8%) and older age (however with 8.5% younger than 40 years old). This patient sample included a geographic catchment population of 56 million people (60% of the country's total population of 92.7 million), derived from 38 provinces and municipalities in Vietnam. Chronic HBV infection was found in 62.3% of cases, and chronic HCV infection in 26.0%. HBV and HCV co-infection was seen in 2.7%. Cirrhosis was found in an estimated 30% to 40% of cases. Nine percent of patients were not found to have chronic viral hepatitis. Twenty three point two percent of the patients had a normal AFP level. A total of 2199 patients were tested with AFP-L3 and PIVKA II over two years, with 57.7% having elevated AFP-L3%, and 88.5% with elevated PIVKA II levels. Over this 7-year period, the incidence of HCC increased, with a large proportion of cases (overall 40.8%) presenting initially an advanced stage, not amendable to surgical or locoregional therapy. HCC contributes significant health care burden in southern and central Vietnam, with increasing case volume over this seven-year period. Viral hepatitis likely explains this high HCC prevalence.

  19. Inpatient satisfaction and usage patterns of personalized smart bedside station system for patient-centered service at a tertiary university hospital.

    Science.gov (United States)

    Ryu, Borim; Kim, Seok; Lee, Kee-Hyuck; Hwang, Hee; Yoo, Sooyoung

    2016-11-01

    Bedside stations, also known as bedside terminals, are in place to enhance the quality and experience of a hospital's healthcare service delivery. The purpose of this study was to identify information needs and overall satisfaction with the personalized patient bedside system, called Smart Bedside Station (SBS) system, embedded in a tertiary general university hospital. End-user responses on the satisfaction survey and system usage logs of the SBS system were collected and analyzed. For the user opinion survey, 156 nurses and 1914 patients, their family members, or caregivers participated during the evaluation period of 2013 to 2014 in this study. All working nurses in the SBS-installed ward were answered the paper-based evaluation, for complete enumeration survey. Inpatients were voluntary participated to deliver the online questionnaire on the SBS menu. We also explored system log data including page calls and usage time from December 2013 to 2015. Regarding the relationship of overall satisfaction of the SBS with patient's characteristics, patient's education status and degree of familiarity with the smart device were statistically significant. From the analysis of system logs, Personalized My Menu(28.0%) was the most frequently used menu item (except for TV and Internet entertainment service use of 62.7%),it provides individual health information, such as laboratory test results, hospital fee check, message logs, daily medication information, and meal information. Next frequently used menus were information support(4.9%) which deliver hospital guide and health information and convenience service ordering(4.4%) such as meal order, bed sheet change. Satisfaction survey results and log data results show that the personalized service enhances the user satisfaction during hospital admission. Our post-implementation experience and subsequent assessment of SBS system is capable of providing insights into improving the hospital information system and service contents

  20. Profile of European proton and carbon ion therapy centers assessed by the EORTC facility questionnaire.

    Science.gov (United States)

    Weber, Damien C; Abrunhosa-Branquinho, André; Bolsi, Alessandra; Kacperek, Andrzej; Dendale, Rémi; Geismar, Dirk; Bachtiary, Barbara; Hall, Annika; Heufelder, Jens; Herfarth, Klaus; Debus, Jürgen; Amichetti, Maurizio; Krause, Mechthild; Orecchia, Roberto; Vondracek, Vladimir; Thariat, Juliette; Kajdrowicz, Tomasz; Nilsson, Kristina; Grau, Cai

    2017-08-01

    We performed a survey using the modified EORTC Facility questionnaire (pFQ) to evaluate the human, technical and organizational resources of particle centers in Europe. The modified pFQ consisted of 235 questions distributed in 11 sections accessible on line on an EORTC server. Fifteen centers from 8 countries completed the pFQ between May 2015 and December 2015. The average number of patients treated per year and per particle center was 221 (range, 40-557). The majority (66.7%) of centers had pencil beam or raster scanning capability. Four (27%) centers were dedicated to eye treatment only. An increase in the patients-health professional FTE ratio was observed for eye tumor only centers when compared to other centers. All centers treated routinely chordomas/chondrosarcomas, brain tumors and sarcomas but rarely breast cancer. The majority of centers treated pediatric cases with particles. Only a minority of the queried institutions treated non-static targets. As the number of particle centers coming online will increase, the experience with this treatment modality will rise in Europe. Children can currently be treated in these facilities in a majority of cases. The majority of these centers provide state of the art particle beam therapy. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI)

    DEFF Research Database (Denmark)

    Maas, Andrew I R; Menon, David K; Steyerberg, Ewout W

    2015-01-01

    in process and clinical care. Results will be integrated with living systematic reviews in a process of knowledge transfer. The study initiation was from October to December 2014, and the recruitment period was for 18 to 24 months. EXPECTED OUTCOMES: Collaborative European NeuroTrauma Effectiveness Research...

  2. Trauma pattern in a level I east-European trauma center

    Directory of Open Access Journals (Sweden)

    Bogdan Stoica

    2015-10-01

    Conclusions: Our trauma pattern profile is similar to the one found in west-European countries, with a predominance of traffic-related injuries and falls. The severity and anatomical puzzle for trauma lesions were more complex secondary to motorcycle or bicycle-to-auto vehicles collisions. A trauma registry, with prospective enrollment of patients, is a very effective tool for constant improvements in trauma care.

  3. Secular trends of blood isolates in patients from a rural area population hospitalized in a tertiary center in a small city in Greece

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    Holevas Pierros V

    2006-05-01

    Full Text Available Abstract Background Most of the studies evaluating the secular trends of blood isolates come from tertiary hospitals in urban areas. We sought to study the trends of the antimicrobial resistance of blood isolates in patients from a rural population hospitalized in a tertiary hospital in a small city in Greece. Methods We retrospectively collected and analysed data for the first positive blood culture obtained for each admission for each patient hospitalized in General Hospital of Tripolis, Tripolis, Peloponnesus, Greece during a 5 year period (16/05/2000 – 15/05/2005. Results Sixty-seven thousand and seventy patients were hospitalized during the study period from whom 3,206 blood cultures were obtained. A higher increase of the number of obtained blood cultures than the number of admissions was noted during the study period (p Escherichia coli (29%, and Staphylococcus aureus (18.2% were the most commonly isolated pathogens. Among the Staphylococcus aureus isolates, the proportion of methicillin-resistant Staphylococcus aureus (MRSA was 17.2% (5/29. The proportion of Escherichia coli resistant to trimethoprim and sulfamethoxazole, ampicillin and cefuroxime was 29.6% (32/108, 25.0% (27/108, and 8.3% (9/108 respectively. Imipenem-resistance was noted in 3.4% (1/29 of Pseudomonas aeruginosa isolates. There were only 6 (1.6% Acinetobacter baummanii blood isolates during the study period. Conclusion The antimicrobial resistance of isolates from patients receiving care at the studied tertiary hospital in a small city in Greece is considerably less compared to that noted in tertiary hospitals in larger cities of the country.

  4. European Facility for Antiproton and Ion Research (FAIR): the new international center for fundamental physics and its research program

    International Nuclear Information System (INIS)

    Fortov, Vladimir E; Sharkov, Boris Yu; Stöker, H

    2012-01-01

    The Facility for Antiproton and Ion Research (FAIR) accelerator center at Darmstadt, Germany, will provide the international scientific community with unique experimental opportunities of a scope and scale out of reach for any other large-scale facility in the world. With its staff of over 2500, it is expected to fundamentally expand our knowledge of hadron, nuclear, and atomic physics and their application to cosmology, astrophysics, and technology. In this review, the design details of the accelerator complex are discussed and the experimental research program for FAIR is presented. Particular attention is paid to experiments on the extreme state of matter arising from the isochoric heating of a material by heavy-ion beams. One of the largest facilities of its kind in Europe, FAIR is a part of the strategic development roadmap for the European Strategic Forum on Research Infrastructures (ESFRI). (physics of our days)

  5. Looking for a Person-Centered Medicine: Non Conventional Medicine in the Conventional European and Italian Setting

    Directory of Open Access Journals (Sweden)

    Paolo Roberti di Sarsina

    2011-01-01

    Full Text Available In Italy, the use of non conventional medicines (NCMs is spreading among people as in the rest of Europe. Sales of alternative remedies are growing, and likewise the number of medical doctors (MDs who practise NCM/complementary and alternative medicine (CAM. However, in Italy as in other countries of the European Union, at the present time the juridical/legal status of NCM/CAM is not well established, mainly due to the lack of any national law regulating NCM/CAM professional training, practice and public supply and the absence of government-promoted scientific research in this field. This is an obstacle to safeguarding the patient's interests and freedom of choice, especially now that dissatisfaction with biomedicine is inclining more and more people to look for a holistic and patient-centered form of medicine.

  6. Detection of Arctic and European cluster of canine distemper virus in north and center of Iran.

    Science.gov (United States)

    Namroodi, Somayeh; Rostami, Amir; Majidzadeh-Ardebili, Keyvan; Ghalyanchi Langroudi, Arash; Morovvati, Abbas

    2015-01-01

    Canine distemper virus (CDV) creates a very contagious viral multi-systemic canine distemper (CD) disease that affects most species of Carnivora order. The virus is genetically heterogeneous, particularly in section of the hemagglutinin (H) gene. Sequence analysis of the H gene can be useful to investigate distinction of various lineages related to geographical distribution and CDV molecular epidemiology. Since vaccination program is conducted only in large cities of Iran, CD still remains as one of the major causes of death in dogs in this country. In order to monitor H gene, CDV has been detected in 14 out of 19 sampled dogs through the amplification of nucleoprotein (NP) gene in nested-PCR assay. In the next step 665 bp of H gene was amplified in 9 out of 14 NP-gene positive dogs. Phylogenetic analysis distinguished two distinct CDV genotypes in Iran. JN941238 has been embedded in European cluster and JN941239 has been embedded in Arctic cluster. Nucleic analysis has been shown high difference among both Iranian CDV lineages with CDV vaccine strains.

  7. A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: a multifaceted intervention in a Japanese tertiary care center.

    Science.gov (United States)

    Honda, Hitoshi; Sato, Yumiko; Yamazaki, Akinori; Padival, Simi; Kumagai, Akira; Babcock, Hilary

    2013-11-01

    Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult. Before-and-after trial. Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan. We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution. With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study. Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.

  8. Outcomes of robot-assisted simple enucleation of renal masses: A single European center experience.

    Science.gov (United States)

    Matei, Deliu Victor; Vartolomei, Mihai Dorin; Musi, Gennaro; Renne, Giuseppe; Tringali, Valeria Maria Lucia; Mistretta, Francesco Alessandro; Delor, Maurizio; Russo, Andrea; Cioffi, Antonio; Bianchi, Roberto; Cozzi, Gabriele; Di Trapani, Ettore; Bottero, Danilo; Cordima, Giovanni; Lucarelli, Giuseppe; Ferro, Matteo; de Cobelli, Ottavio

    2017-05-01

    The aim of this study was to assess the ability of pre-and intraoperative parameters, to predict the risk of perioperative complications after robot-assisted laparoscopic simple enucleation (RASE) of renal masses, and to evaluate the rate of trifecta achievement of this approach stratifying the cohort according to the use of ischemia during the enucleation.From April 2009 to June 2016, 129 patients underwent RASE at our Institution. We stratified the procedures in 2 groups: clamping and clamp-less RASE. After RASE, all specimens were retrospectively reviewed to assess the surface-intermediate-base (SIB) scoring system. Patients were followed-up according to the European Association of Urology guidelines recommendations. All pre-, intra-, and postoperative outcomes were prospectively collected in a customized database and retrospectively analyzed.A total of 112 (86.8%) patients underwent a pure RASE and 17 (13.2%) had a hybrid according to SIB classification system. The mean age was 61.17 years. In 21 patients (16.3%), complications occurred, 13 (61.9%) were Clavien 1 and 2, while 8 were Clavien 3a and b complications. Statistical significant association with complications was found in patients with American Society of Anestesiology (ASA) score 3 (44.5%, P = .04), longer mean operative time (OT) 195 versus 161.36 minutes (P =.03), mean postoperative hemoglobin (Hb) 10.1 versus 11.8 (P 3, longer OT, and ΔHb. RASE is suitable for the clamp-less approach, which allows to perform easier the pure enucleation (SIB 0) and to obtain higher rates of trifecta outcomes.

  9. Delay in presentation to the hospital and factors affecting it in breast cancer patients attending tertiary care center in Central India.

    Science.gov (United States)

    Thakur, N A; Humne, A Y; Godale, L B

    2015-01-01

    Despite lower incidence of breast cancer in India, the total number of cases and the net mortality is high. To reduce this increasing load of mortality due to breast cancer we need to lay emphasis on early detection and increased use of systemic therapy. Early detection itself depends on early presentation to a health facility; thus, it is important to identify factors affecting delay in a presentation to hospital. To study the clinico-social profile of breast carcinoma patients attending a tertiary care hospital and to study the time lag since detection of lump by women and presentation to the hospital and factors affecting them. A total of 120 primary breast cancer patients visiting a tertiary care hospital over a period of 7 months (August 2010 to February 2011) were taken up for study. A detailed retrospective analysis of patients was done according to planned proforma. Maximum study subjects were in the age group of 41-50 years. Right and left breasts were equally affected. The most common histo-pathological type of breast carcinoma observed was invasive ductal carcinoma (NOS) in 105 (87.50%) cases. Majority of the cases were in stage III or stage II. The median time lag self-detection of lump in the breast by women and presentation to the hospital was 6 months. Women living in a rural area, those with lower socio-economic status and those with older age tend to assess health-care late. Carcinoma of the breast is a common cancer affecting young to middle age group with invasive ductal carcinoma being the most common histological type. Delay in presentation and late stage presentation is a major concern. Hence, proper awareness and screening programmers are needed to identify, inform and educate these categories of women.

  10. Multi-center study on the characteristics and treatment strategies of patients with Graves' orbitopathy: the first European Group on Graves' Orbitopathy experience

    NARCIS (Netherlands)

    Prummel, Mark F.; Bakker, Annemieke; Wiersinga, Wilmar M.; Baldeschi, Lelio; Mourits, Maarten P.; Kendall-Taylor, Pat; Perros, Petros; Neoh, Chris; Dickinson, A. Jane; Lazarus, John H.; Lane, Carol M.; Heufelder, Armin E.; Kahaly, George J.; Pitz, Suzanne; Orgiazzi, Jacques; Hullo, Alain; Pinchera, Aldo; Marcocci, Claudio; Sartini, Maria S.; Rocchi, Roberto; Nardi, Marco; Krassas, Gerry E.; Halkias, A.

    2003-01-01

    To improve management of patients with Graves' orbitopathy, a multi-center collaborative approach is necessary in order to have large enough sample sizes for meaningful randomized clinical trials. This is hampered by a lack of consensus on how to investigate the eye condition. The European Group on

  11. Demographic details, clinical features, and nutritional characteristics of young adults with Type 1 diabetes mellitus - A South Indian tertiary center experience.

    Science.gov (United States)

    Joseph, Mini; Shyamasunder, Asha H; Gupta, Riddhi D; Anand, Vijayalakshmi; Thomas, Nihal

    2016-01-01

    Type 1 diabetes mellitus (T1DM) accounts for 5-10% of all diagnosed diabetes and the highest incidence is found in India. The main objectives were to study the demographic, clinical, and nutritional characteristics of young adults with T1DM and its effect glycosylated hemoglobin levels. This cross-sectional study was conducted among young adults with T1DM (18-45 years of age) in a tertiary hospital in South India. Data were obtained from updated medical records. The dietary data were assessed from food diaries and 24 h recall method. Anthropometry was determined. The analysis revealed that socio-economic variables did not affect the glycosylated hemoglobin levels. The mean glycosylated hemoglobin value was 8.81 ± 2.38%. Nearly, half the patients were malnourished. The overall dietary intake was inadequate. The multivariate regression model, adjusted for confounding factors such as gender, age, and body mass index, revealed that only duration of diabetes and protein intake were significant predictors of glycosylated hemoglobin status ( P diabetes management. However, there is an urgent need to educate our patients on nutrition therapy. T1DM patients need specialized advice to ensure appropriately balanced nutrition that has a significant impact on their long-term glycemic control.

  12. Sun protection behavior and knowledge of patients attending laser clinic to prevent adverse events of laser: A Cross-sectional, Single Center, Tertiary Care Study.

    Science.gov (United States)

    Tempark, Therdpong; Lueangarun, Suparuj; Chatproedprai, Susheera; Panchaprateep, Ratchathorn; Pongprutthipan, Marisa; Wananukul, Siriwan

    2018-06-08

    Limited data of sun protection knowledge in laser treatment patients exists therefore, preventative information should be provided by dermatologists to minimize harmful effects. To assess sun protection knowledge-behavior and knowledge to prevent adverse events from laser therapy among patients who visited a laser clinic at a tertiary university hospital in Bangkok, Thailand. This is a self-reported questionnaire, cross-sectional survey. All participants from the Laser Clinic in KCMH were recruited into the study. A Total of 385 patients were enrolled into the study; 80.5% female participants. Patients who never received laser treatment significantly lacked proper sun protection knowledge to prevent adverse events of lasers when compared to those who previous received laser treatments regarding the application of sunscreen after laser treatment (56.6% vs 17.4%, p protection in the post laser area (41.9% vs 20.4%, p knowledge of sun protection to prevent adverse events were significantly different among the group of educational levels and previous history of laser treatment. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. Group B streptococcus serotype prevalence in reproductive-age women at a tertiary care military medical center relative to global serotype distribution

    Directory of Open Access Journals (Sweden)

    Williams Julie

    2010-11-01

    Full Text Available Abstract Background Group B Streptococcus (GBS serotype (Ia, Ib, II-IX correlates with pathogen virulence and clinical prognosis. Epidemiological studies of seroprevalence are an important metric for determining the proportion of serotypes in a given population. The purpose of this study was to evaluate the prevalence of individual GBS serotypes at Madigan Healthcare System (Madigan, the largest military tertiary healthcare facility in the Pacific Northwestern United States, and to compare seroprevalences with international locations. Methods To determine serotype distribution at Madigan, we obtained GBS isolates from standard-of-care anogenital swabs from 207 women of indeterminate gravidity between ages 18-40 during a five month interval. Serotype was determined using a recently described molecular method of polymerase chain reaction by capsular polysaccharide synthesis (cps genes associated with pathogen virulence. Results Serotypes Ia, III, and V were the most prevalent (28%, 27%, and 17%, respectively. A systematic review of global GBS seroprevalence, meta-analysis, and statistical comparison revealed strikingly similar serodistibution at Madigan relative to civilian-sector populations in Canada and the United States. Serotype Ia was the only serotype consistently higher in North American populations relative to other geographic regions (p Conclusion This study establishes PCR-based serotyping as a viable strategy for GBS epidemiological surveillance. Our results suggest that GBS seroprevalence remains stable in North America over the past two decades.

  14. Emergence of non-albicans Candida among candidal vulvovaginitis cases and study of their potential virulence factors, from a tertiary care center, North India.

    Science.gov (United States)

    Kumari, Varsha; Banerjee, Tuhina; Kumar, Pankaj; Pandey, Sulekha; Tilak, Ragini

    2013-01-01

    The purpose of this study was to determine the prevalence of various Candida species and study some of their virulence factors among thevulvovaginal candidiasis(VVC)patients. The study was conducted in a Tertiary Care University Hospital in North India. This study was carried out prospectively for a period of 1 year. High vaginal swabs (HVSs) were collected from women in childbearing age group attending the gynecology and obstetrics out-patient departments with the complaints suggestive of vulvovaginitis. Samples were plated on Sabouraud's dextrose agar slope. Candida spp. isolated was further speciated based on microscopy, biochemical tests and culture characteristics on special media. Virulence factors of these strains were determined by biofilm formation and phospholipase activity. A total of 464 HVS from 232 patients with the complaints of vulvovaginitis were included in this study. Following laboratory workup, 71 specimens were positive for genus Candida (30.6%). Further speciation showed 32.4% as Candida albicans, 45.07% Candida parapsilosis and 22.53% of Candida glabrata. Biofilm production was shown by 50 candidal strains (70.4%) and phospholipase activity was given by 41 candidal strains (57.74%). Our study suggests increasing prevalence of non-albicans Candida among the VVC cases along with their virulence factors. Therefore, we recommend that microbiological investigation upto species level should be mandatory to determine the emergence of non-albicans Candida as a major cause of VVC.

  15. Emergence of non-albicans Candida among candidal vulvovaginitis cases and study of their potential virulence factors, from a tertiary care center, North India

    Directory of Open Access Journals (Sweden)

    Varsha Kumari

    2013-01-01

    Full Text Available Purpose: The purpose of this study was to determine the prevalence of various Candida species and study some of their virulence factors among thevulvovaginal candidiasis(VVCpatients. Study Design and Settings: The study was conducted in a Tertiary Care University Hospital in North India. Materials and Methods: This study was carried out prospectively for a period of 1 year. High vaginal swabs (HVSs were collected from women in childbearing age group attending the gynecology and obstetrics out-patient departments with the complaints suggestive of vulvovaginitis. Samples were plated on Sabouraud′s dextrose agar slope. Candida spp. isolated was further speciated based on microscopy, biochemical tests and culture characteristics on special media. Virulence factors of these strains were determined by biofilm formation and phospholipase activity. Result: A total of 464 HVS from 232 patients with the complaints of vulvovaginitis were included in this study. Following laboratory workup, 71 specimens were positive for genus Candida (30.6%. Further speciation showed 32.4% as Candida albicans, 45.07% Candida parapsilosis and 22.53% of Candida glabrata. Biofilm production was shown by 50 candidal strains (70.4% and phospholipase activity was given by 41 candidal strains (57.74%. Conclusion: Our study suggests increasing prevalence of non-albicans Candida among the VVC cases along with their virulence factors. Therefore, we recommend that microbiological investigation upto species level should be mandatory to determine the emergence of non-albicans Candida as a major cause of VVC.

  16. Clinical profile, evaluation, management and visual outcome of idiopathic intracranial hypertension in a neuro-ophthalmology clinic of a tertiary referral ophthalmic center in India

    Directory of Open Access Journals (Sweden)

    Ambika S

    2010-01-01

    Full Text Available Aim: To discuss the clinical features and management of patients who presented with optic disc edema and had features of presumed idiopathic intracranial hypertension (IIH. Materials and Methods: Case series of all patients diagnosed to have IIH from January 2000 to December 2003 in the neuro-ophthalmology clinic of a tertiary referral ophthalmic institution, were retrospectively analyzed. Analysis was done for 50/106 patients who fulfilled modified Dandy′s criteria and had optic disc edema and a minimal follow-up period of two years. Results: Most (40/50, 80% of the patients were females and the mean age of presentation for all the 50 patients was 32.89 years. Chief complaints were headache in 38 (76% patients, 24 (48% patients had transient visual obscuration, 24 (48% patients had reduced vision, 15 (30% patients had nausea, vomiting, 4 (8% patients had diplopia. Bilateral disc edema was seen in 46 (92% patients and unilateral disc edema in 4 (8% patients. 60 eyes had enlarged blind spot as the common visual field defect. Neuroimaging revealed prominent perioptic CSF spaces in 14 patients and empty sella in three patients. CSF opening pressure was 250-350 mm H2O (water in 39 patients and was > 350 mm H2O in 11 patients. Medical treatment was started for all patients; whereas 35 [70%] patients responded, 15 [30%] patients had to undergo LP shunt.

  17. Fluorescence In Situ Hybridization for MDM2 Amplification as a Routine Ancillary Diagnostic Tool for Suspected Well-Differentiated and Dedifferentiated Liposarcomas: Experience at a Tertiary Center

    Directory of Open Access Journals (Sweden)

    Khin Thway

    2015-01-01

    Full Text Available Background. The assessment of MDM2 gene amplification by fluorescence in situ hybridization (FISH has become a routine ancillary tool for diagnosing atypical lipomatous tumor (ALT/well-differentiated liposarcoma and dedifferentiated liposarcoma (WDL/DDL in specialist sarcoma units. We describe our experience of its utility at our tertiary institute. Methods. All routine histology samples in which MDM2 amplification was assessed with FISH over a 2-year period were included, and FISH results were correlated with clinical and histologic findings. Results. 365 samples from 347 patients had FISH for MDM2 gene amplification. 170 were positive (i.e., showed MDM2 gene amplification, 192 were negative, and 3 were technically unsatisfactory. There were 122 histologically benign cases showing a histology:FISH concordance rate of 92.6%, 142 WDL/DDL (concordance 96.5%, and 34 cases histologically equivocal for WDL (concordance 50%. Of 64 spindle cell/pleomorphic neoplasms (in which DDL was a differential diagnosis, 21.9% showed MDM2 amplification. Of the cases with discrepant histology and FISH, all but 3 had diagnoses amended following FISH results. For discrepancies of benign histology but positive FISH, lesions were on average larger, more frequently in “classical” (intra-abdominal or inguinal sites for WDL/DDL and more frequently core biopsies. Discrepancies of malignant histology but negative FISH were smaller, less frequently in “classical” sites but again more frequently core biopsies. Conclusions. FISH has a high correlation rate with histology for cases with firm histologic diagnoses of lipoma or WDL/DDL. It is a useful ancillary diagnostic tool in histologically equivocal cases, particularly in WDL lacking significant histologic atypia or DDL without corresponding WDL component, especially in larger tumors, those from intra-abdominal or inguinal sites or core biopsies. There is a significant group of well-differentiated adipocytic neoplasms

  18. Prevalence of Antimicrobial Resistance Among Gram-Negative Isolates in and Adult Intensive care unit at a Tertiary care Center in Saudi Arabia

    International Nuclear Information System (INIS)

    Al Johani, Sameera

    2010-01-01

    Patients in the ICU have encountered an increasing emergence and spread of antibiotic-resistant pathogens. We examined patterns of antimicrobial susceptibility in gram-negative isolates to commonly used drugs in an adult ICU at a tertiary care hospital in Riyadh, Saudi Arabia.A retrospective study was carried out of gram-negative isolates from the adult ICU of King Fahad National Guard Hospital (KFNGH) between 2004 and 2009. Organisms were identified and tested by an automated identification and susceptibility system, and the antibiotic susceptibility testing was confirmed by the disk diffusion. The most frequently isolated organism was Acinetobacter baumannii, followed by Pseudomonas aeruginosa, Escherichia coli, Klebsiella pnemoniae, Stenotrophomonas maltophilia, and Enterobacter. Antibiotic susceptibility patterns significantly declined in many organisms, especially A baumannii, E coli, S marcescens, and Enterobacter. A baumannii susceptibility was significantly decreased to imipenem (55% to 10%), meropenem (33% to 10%), ciprofloxacin (22% to 10%), and amikacin (12% to 6%). E coli susceptibility was markedly decreased (from 75% to 50% or less) to cefuroxime, ceftazidime, cefotaxime, and cefepime. S marcescens susceptibility was markedly decreased to cefotaxime (100% to 32%), ceftazidime (100% to 35%), and cefepime (100% to 66%). Enterobacter susceptibility was markedly decreased to ceftazidime (34% to 5%), cefotaxime (34% to 6%), and pipracillin-tazobactam (51% to 35%). Respiratory samples were the most frequently indicative of multidrug-resistant pathogens (63%), followed by urinary samples (57%).Antimicrobial resistance is an emerging problem in the KFNGH ICU, justifying new more stringent antibiotic prescription guidelines. Continuous monitoring of antimicrobial susceptibility and strict adherence to infection prevention guidelines are essential to eliminate major outbreaks in the future (Author).

  19. The prevalence of genital Candida species among pregnant women attending antenatal clinic in a tertiary health center in North-west Nigeria

    Directory of Open Access Journals (Sweden)

    Daniel Chukwunyere Nnadi

    2017-01-01

    Full Text Available Background: Vulvovaginal candidiasis (VVC is a common genital tract infection that affects the quality of life in many women. It is more prevalent in pregnancy and may lead to complications. Aims and Objectives: The study aimed to determine the prevalence of VVC among pregnant women attending the antenatal clinic of a tertiary health institution in North-West Nigeria and to emphasize the need for accurate diagnosis and adequate treatment. Subjects and Methods: This is a 2-month cross-sectional study performed at the Department of Obstetrics and Gynaecology in association with the Department of Medical Microbiology of the Usmanu Danfodiyo University Teaching Hospital, Sokoto in North-Western Nigeria. It involved pregnant women at various periods of gestation presenting with vaginitis and selected by simple random sampling. A pair of high vaginal swabs was collected aseptically from the study subjects which was used for Gram's staining and inoculation into Sabouraud's dextrose agar (SDA. The samples were then cultured according to standard procedures on sterile SDA. Infection with Candida species was diagnosed by microscopy of a saline wet mount, Gram-stained smear and colony growth on SDA. Results: Of the 288 pregnant women sampled, 175 were positive for candidiasis giving a prevalence rate of 60.8%. The ages of the women ranged from 16 to 45 years with a mean of 26.8 (standard deviation ± 4.93. Pregnant women aged 26–30 years recorded the highest prevalence of 37.1% (65/175. The multigravidae were more affected 41.7% (120/288 than the primigravidae 19.1% (55/288. VVC showed a progressive increase with trimester of pregnancy. Candida albicans was the most prevalent species isolated in 73.7% of the women. Conclusion: There is a high prevalence of VVC among pregnant women in our institution. There is need to educate the women on genital hygiene and practice of regular screening for candidiasis in our antenatal program.

  20. [Epidemiology and associated factors with depression among people suffering from epilepsy: A transversal French study in a tertiary center].

    Science.gov (United States)

    Vallée, C; Biraben, A; Nica, A; Loiseau, M

    2018-03-07

    The occurrence of depression in people with epilepsy is almost twice as common as in the general population. Furthermore, depression is the first cause of lower quality of life among those patients. Which is why the main goal of this study was to assess the epidemiology of depression and its associated factors among the patients from the tertiary department of epileptology in Rennes. The subjects were included prospectively and consecutively at the moment of their consultation or hospitalisation in the department. Personal data about the socio-economic status and the type of epilepsy was collected. The subjects filled validated self-assessment of depression (NDDIE), anxiety (GAD-7) and quality of life (QOLIE-10). Thanks to the NDDIE, the patients were divided into: "depressed" and "not depressed"; and the two groups were compared with univariate and multivariate models. Of the 322 patients followed-up in the department between the 17th of June and the 9th of September 2016 223 of them were included in the study. According to the NDDIE, 22.6% suffered from depression; according to the GAD-7, 46.4% suffered from anxiety. In the "depressed" group, 82% were not under anti-depressant medication. In the univariate model, depression was associated with: anxiety, suicidal ideations, lower quality of life, vague nervus stimulation treatment, anticonvulsant benzodiazepine medication or psychiatric medication, and last of all bitherapy or polytherapy antiepileptic medication compared to monotherapy. In the multivariate model, depression was significantly related to anxiety (OR: 8.86 [3.00; 26.19] p=0.0001), suicidal ideas (OR: 7.43 [2.93; 18.81] pstudy highlights the importance of interdisciplinary cooperation between neurologists and psychiatrists in order to aim at better management of epileptic patients as a whole. Copyright © 2018 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  1. Idiopathic inflammatory myopathies in adults: A comparative study of Bohan and Peter and European Neuromuscular Center 2004 criteria.

    Science.gov (United States)

    Challa, Sundaram; Jakati, Saumya; Uppin, Megha S; Kannan, Meena A; Liza, Rajasekhar; Murthy Jagarlapudi, M K

    2018-01-01

    Bohan and Peter criteria are widely used for the diagnosis of idiopathic inflammatory myopathies (IIMs). Recently, European Neuromuscular Center (ENMC) formulated criteria to identify subgroups of IIMs. To compare the two diagnostic criteria in adult IIMs. This was a retrospective review of case records of histologically confirmed IIMs in adults between January 2014 and May 2015. Both the Bohan and Peter, and ENMC 2004 criteria were applied in the same group of patients to subgroup the IIMs. Muscle biopsy was evaluated in all the four domains: muscle fiber, inflammatory, connective tissue, and vascular, with the basic panel of histological stains. Sporadic inclusion body myositis (s-IBM) was diagnosed using ENMC IBM diagnostic research criteria 2011. During the study period, 69 patients fulfilled the ENMC criteria for IIMs including 16 patients with s-IBM. The subgrouping as per the ENMC criteria (53) was: dermatomyositis (DM) in 30; polymyositis (PM) in 2; immune-mediated necrotizing myopathy (IMNM) in 9; and nonspecific myositis (NM) in 12 patients, whereas subgrouping by the Bohan and Peter criteria was DM in 9 and PM with and without connective tissue disease (CTD) in 26 patients only. There was underdiagnosis of DM, as perifascicular atrophy is not recognized as a diagnostic histological feature, and overdiagnosis of PM with and without CTD due to poor characterization of histological features in PM by the Bohan and Peter criteria. Systematic evaluation of muscle biopsy according to the ENMC criteria with basic panel of histochemical stains improved the diagnostic yield of IIM significantly when compared to the Bohan and Peter criteria.

  2. Pregnancy and Delivery in Patients with Mastocytosis Treated at the Polish Center of the European Competence Network on Mastocytosis (ECNM.

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    Katarzyna Ciach

    Full Text Available To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients.Case control national study.Polish Center of the European Competence Network on Mastocytosis (ECNM.23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999-2014, before becoming pregnant.Prospective analysis outcomes of pregnancies and deliveries.Survey developed in cooperation with the Spanish Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast, Hospital Virgen del Valle, Toledo, Red Espańola de Mastocitosis (REMA, Spain.All 23 pregnancies resulted from natural conception. Obstetrical complications recorded in the first trimester included spontaneous miscarriage (5 pregnancies. Four patients delivered preterm, including one delivery due to preeclampsia at 26 weeks which resulted with neonate death due to extreme prematurity. Five women delivered via cesarean: four due to obstetrical indications and one due to mastocytosis, during which no anesthesia related complications were recorded. Of patients delivering vaginally, two received extradural anesthesia, three required oxytocin infusion due to uterine hypotonia. No labor complications were recorded. In one woman with pregnancy-induced hypertension, early puerperium was complicated by the presence of persistent arterial hypertension. One neonate was born with the signs of cutaneous mastocytosis. Another neonate was diagnosed with Patau syndrome. Four women were treated for mastocytosis prior to conception and continued therapy after becoming pregnant. One patient was put on medications in the first trimester due to worsening of her symptoms. Pregnancy exerted only a slight effect on the intensity and frequency of mastocytosis-related symptoms observed. Worsening of the disease-related symptoms was documented in only four patients (23%. None of the patients showed the signs of anaphylaxis, either before becoming pregnant, or during

  3. Pregnancy and Delivery in Patients with Mastocytosis Treated at the Polish Center of the European Competence Network on Mastocytosis (ECNM).

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    Ciach, Katarzyna; Niedoszytko, Marek; Abacjew-Chmylko, Anna; Pabin, Izabela; Adamski, Przemyslaw; Leszczynska, Katarzyna; Preis, Krzysztof; Olszewska, Hanna; Wydra, Dariusz G; Hansdorfer-Korzon, Rita

    2016-01-01

    To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients. Case control national study. Polish Center of the European Competence Network on Mastocytosis (ECNM). 23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999-2014, before becoming pregnant. Prospective analysis outcomes of pregnancies and deliveries. Survey developed in cooperation with the Spanish Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Red Espańola de Mastocitosis (REMA), Spain. All 23 pregnancies resulted from natural conception. Obstetrical complications recorded in the first trimester included spontaneous miscarriage (5 pregnancies). Four patients delivered preterm, including one delivery due to preeclampsia at 26 weeks which resulted with neonate death due to extreme prematurity. Five women delivered via cesarean: four due to obstetrical indications and one due to mastocytosis, during which no anesthesia related complications were recorded. Of patients delivering vaginally, two received extradural anesthesia, three required oxytocin infusion due to uterine hypotonia. No labor complications were recorded. In one woman with pregnancy-induced hypertension, early puerperium was complicated by the presence of persistent arterial hypertension. One neonate was born with the signs of cutaneous mastocytosis. Another neonate was diagnosed with Patau syndrome. Four women were treated for mastocytosis prior to conception and continued therapy after becoming pregnant. One patient was put on medications in the first trimester due to worsening of her symptoms. Pregnancy exerted only a slight effect on the intensity and frequency of mastocytosis-related symptoms observed. Worsening of the disease-related symptoms was documented in only four patients (23%). None of the patients showed the signs of anaphylaxis, either before becoming pregnant, or during pregnancy

  4. Can pre-operative axial CT imaging predict syndesmosis instability in patients sustaining ankle fractures? Seven years' experience in a tertiary trauma center

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    Yeung, Tsz Wai; Chan, Chung Yan Grace; Chan, Wun Cheung Samuel; Yuen, Ming Keung [Tuen Mun Hospital, Department of Radiology, Tuen Mun (China); Yeung, Yuk Nam [Tune Mun Hospital, Department of Orthopaedics and Traumatology, Tuen Mun (China)

    2015-06-01

    The purpose of this study is to explore the diagnostic accuracy of CT measurements in predicting syndesmosis instability of injured ankle, with correlation to operative findings. From July 2006 to June 2013, 123 patients presented to a single tertiary hospital who received pre-operative CT for ankle fractures were retrospectively reviewed. All patients underwent open reduction and internal fixation for fractures and intra-operative syndesmosis integrity tests. The morphology of incisura fibularis was categorized as deep or shallow. The tibiofibular distance (TFD) between the medial border of the fibula and the nearest point of the lateral border of tibia were measured at anterior (aTFD), middle (mTFD), posterior (pTFD), and maximal (maxTFD) portions across the syndesmosis on axial CT images at 10 mm proximal to the tibial plafond. Statistical analysis was performed with independent samples t test and ROC curve analysis. Intraobserver reproducibility and inter-observers agreement were also evaluated. Of the 123 patients, 39 (31.7 %) were operatively diagnosed with syndesmosis instability. No significant difference of incisura fibularis morphology (deep or shallow) and TFDs was demonstrated respective to genders. The axial CT measurements were significantly higher in ankles diagnosed with syndesmosis instability than the group without (maxTFD means 7.2 ± 2.96 mm vs. 4.6 ± 1.4 mm, aTFD mean 4.9 ± 3.7 mm vs. 1.8 ± 1.4 mm, mTFD mean 5.3 ± 2.4 mm vs. 3.2 ± 1.6 mm, pTFD mean 5.3 ± 1.8 mm vs. 4.1 ± 1.3 mm, p < 0.05). Their respective cutoff values with best sensitivity and specificity were calculated; the aTFD (AUC 0.798) and maxTFD (AUC 0.794) achieved the highest diagnostic accuracy. The optimal cutoff levels were aTFD = 4 mm (sensitivity, 56.4 %; specificity, 91.7 %) and maxTFD = 5.65 mm (sensitivity, 74.4 %; specificity, 79.8 %). The inter-observer agreement was good for all aTFD, mTFD, pTFD, and maxTFD measurements (ICC 0.959, 0.799, 0.783, and 0.865). The ICC

  5. Increasing use of less-invasive hemodynamic monitoring in 3 specialty surgical intensive care units: a 5-year experience at a tertiary medical center.

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    Kirton, Orlando C; Calabrese, Rebecca C; Staff, Ilene

    2015-01-01

    Less-invasive hemodynamic monitoring (eg, esophageal doppler monitoring [EDM] and arterial pressure contour analysis, FloTrac) is increasingly used as an alternative to pulmonary artery catheters (PACs) in critically ill intensive care unit (ICU). The decrease in use of PACs is not associated with increased mortality. Five-year retrospective review of 1894 hemodynamically monitored patients admitted to 3 surgical ICUs in a university-affiliate, tertiary care urban hospital. Data included the number of admissions, diagnosis-related group discharge case mix, length of stay, insertion of monitoring devices (PAC, EDM, and FloTrac probes), administered intravenous vasoactive agents (β-predominant agonists--dobutamine, epinephrine, and dopamine; vasopressors--norepinephrine and phenylephrine), and mortality. Data from hospital administrative databases were compiled to create patient characteristic and monitoring variables across a 5-year time period, 2005 to 2009 inclusive. Chi-square for independent proportions, 1-way analysis of variance, and Kruskal-Wallis tests were used; tests for trend were conducted. An α level of .05 was considered significant. Statistical Package for the Social Sciences v14 was used for all statistical testing. There was a significant change in the type of hemodynamic monitors inserted in 2 of the 3 surgical ICUs (in the general surgery and neurointensive care but not in the cardiac ICU) from PACs to less-invasive devices (FloTrac or EDM) during the 5-year study period (P < .001). There was no change in mortality rate over the time period (P = .492). There was an overall increase in the proportion of monitored patients who received intravenous vasoactive agents (P < .001) with a progressive shift from β-agonists to vasopressors (P < .002). Multivariate analyses indicated that age, case mix, and use of vasoactive agents were all independent predictors of inhospital mortality (P = .001) but that type of monitoring was not (P = .638). In a 5

  6. Can pre-operative axial CT imaging predict syndesmosis instability in patients sustaining ankle fractures? Seven years' experience in a tertiary trauma center

    International Nuclear Information System (INIS)

    Yeung, Tsz Wai; Chan, Chung Yan Grace; Chan, Wun Cheung Samuel; Yuen, Ming Keung; Yeung, Yuk Nam

    2015-01-01

    The purpose of this study is to explore the diagnostic accuracy of CT measurements in predicting syndesmosis instability of injured ankle, with correlation to operative findings. From July 2006 to June 2013, 123 patients presented to a single tertiary hospital who received pre-operative CT for ankle fractures were retrospectively reviewed. All patients underwent open reduction and internal fixation for fractures and intra-operative syndesmosis integrity tests. The morphology of incisura fibularis was categorized as deep or shallow. The tibiofibular distance (TFD) between the medial border of the fibula and the nearest point of the lateral border of tibia were measured at anterior (aTFD), middle (mTFD), posterior (pTFD), and maximal (maxTFD) portions across the syndesmosis on axial CT images at 10 mm proximal to the tibial plafond. Statistical analysis was performed with independent samples t test and ROC curve analysis. Intraobserver reproducibility and inter-observers agreement were also evaluated. Of the 123 patients, 39 (31.7 %) were operatively diagnosed with syndesmosis instability. No significant difference of incisura fibularis morphology (deep or shallow) and TFDs was demonstrated respective to genders. The axial CT measurements were significantly higher in ankles diagnosed with syndesmosis instability than the group without (maxTFD means 7.2 ± 2.96 mm vs. 4.6 ± 1.4 mm, aTFD mean 4.9 ± 3.7 mm vs. 1.8 ± 1.4 mm, mTFD mean 5.3 ± 2.4 mm vs. 3.2 ± 1.6 mm, pTFD mean 5.3 ± 1.8 mm vs. 4.1 ± 1.3 mm, p < 0.05). Their respective cutoff values with best sensitivity and specificity were calculated; the aTFD (AUC 0.798) and maxTFD (AUC 0.794) achieved the highest diagnostic accuracy. The optimal cutoff levels were aTFD = 4 mm (sensitivity, 56.4 %; specificity, 91.7 %) and maxTFD = 5.65 mm (sensitivity, 74.4 %; specificity, 79.8 %). The inter-observer agreement was good for all aTFD, mTFD, pTFD, and maxTFD measurements (ICC 0.959, 0.799, 0.783, and 0.865). The ICC

  7. Early mortality after radical radiotherapy for non-small-cell lung cancer: comparison of PET-staged and conventionally staged cohorts treated at a large tertiary referral center

    International Nuclear Information System (INIS)

    Mac Manus, Michael P.; Wong, Kevin; Hicks, Rodney J.; Matthews, Jane P.; Wirth, Andrew; Ball, David L.

    2002-01-01

    Purpose: At our center, approximately 30% of radical radiotherapy (RRT) candidates become ineligible for RRT for non-small-cell lung cancer (NSCLC) after positron emission tomography (PET). We hypothesized that early cancer death rates would be lower in patients receiving RRT after PET staging compared with conventionally staged patients. Methods and Materials: Two prospective cohorts were compared. Cohort 1 consisted of all participants in an Australian randomized trial from our center given 60 Gy conventionally fractionated RRT with or without concurrent carboplatin from 1989 to 1995. Eligible patients had Stage I-III, Eastern Cooperative Oncology Group status 0 or 1, <10% weight loss, and had not undergone PET. Cohort 2 included all RRT candidates between November 1996 and April 1999 who received RRT after PET staging and fulfilled the above criteria for stage, Eastern Cooperative Oncology Group status, and weight loss. Results: Eighty and 77 eligible patients comprised the PET and non-PET groups, respectively. The PET-selected patients had significantly less weight loss; 73% and 49% of the PET and non-PET patients, respectively, received chemotherapy. The median survival was 31 months for PET patients and 16 months for non-PET patients. Mortality from NSCLC and other causes in the first year was 17% and 8% for PET patients and 32% and 4% for non-PET patients, respectively. The hazard ratio for NSCLC mortality for PET vs. non-PET patients was 0.49 (p=0.0016) on unifactorial analysis and was 0.55 (p = 0.0075) after adjusting for chemotherapy, which significantly improved survival. Conclusion: Patients selected for RRT after PET have lower early cancer mortality than those selected using conventional imaging

  8. Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia.

    Science.gov (United States)

    Rajagopal, Revathi; Abd-Ghafar, Sayyidatul; Ganesan, Dharmendra; Bustam Mainudin, Anita Zarina; Wong, Kum Thong; Ramli, Norlisah; Jawin, Vida; Lum, Su Han; Yap, Tsiao Yi; Bouffet, Eric; Qaddoumi, Ibrahim; Krishnan, Shekhar; Ariffin, Hany; Abdullah, Wan Ariffin

    2017-04-01

    Pediatric medulloblastoma (MB) treatment has evolved over the past few decades; however, treating children in countries with limited resources remains challenging. Until now, the literature regarding childhood MB in Malaysia has been nonexistent. Our objectives were to review the demographics and outcome of pediatric MB treated at the University Malaya Medical Center between January 1994 and December 2013 and describe the challenges encountered. Fifty-one patients with childhood MB were seen at University Malaya Medical Center. Data from 43 patients were analyzed; eight patients were excluded because their families refused treatment after surgery. Headache and vomiting were the most common presenting symptoms, and the mean interval between symptom onset and diagnosis was 4 weeks. Fourteen patients presented with metastatic disease. Five-year progression-free survival (± SE) for patients ≥ 3 years old was 41.7% ± 14.2% (95% CI, 21.3% to 81.4%) in the high-risk group and 68.6% ± 18.6% (95% CI, 40.3% to 100%) in the average-risk group, and 5-year overall survival (± SE) in these two groups was 41.7% ± 14.2% (95% CI, 21.3% to 81.4%) and 58.3% ± 18.6% (95% CI, 31.3% to 100%), respectively. Children younger than 3 years old had 5-year progression-free and overall survival rates (± SE) of 47.6% ± 12.1% (95% CI, 28.9% to 78.4%) and 45.6% ± 11.7% (95% CI, 27.6% to 75.5%), respectively. Time to relapse ranged from 4 to 132 months. Most patients who experienced relapse died within 1 year. Febrile neutropenia, hearing loss, and endocrinopathy were the most common treatment-related complications. The survival rate of childhood MB in Malaysia is inferior to that usually reported in the literature. We postulate that the following factors contribute to this difference: lack of a multidisciplinary neuro-oncology team, limited health care facilities, inconsistent risk assessment, insufficient data in the National Cancer Registry and pathology reports, inadequate long

  9. Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia

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    Revathi Rajagopal

    2017-04-01

    Full Text Available Purpose: Pediatric medulloblastoma (MB treatment has evolved over the past few decades; however, treating children in countries with limited resources remains challenging. Until now, the literature regarding childhood MB in Malaysia has been nonexistent. Our objectives were to review the demographics and outcome of pediatric MB treated at the University Malaya Medical Center between January 1994 and December 2013 and describe the challenges encountered. Methods: Fifty-one patients with childhood MB were seen at University Malaya Medical Center. Data from 43 patients were analyzed; eight patients were excluded because their families refused treatment after surgery. Results: Headache and vomiting were the most common presenting symptoms, and the mean interval between symptom onset and diagnosis was 4 weeks. Fourteen patients presented with metastatic disease. Five-year progression-free survival (± SE for patients ≥ 3 years old was 41.7% ± 14.2% (95% CI, 21.3% to 81.4% in the high-risk group and 68.6% ± 18.6% (95% CI, 40.3% to 100% in the average-risk group, and 5-year overall survival (± SE in these two groups was 41.7% ± 14.2% (95% CI, 21.3% to 81.4% and 58.3% ± 18.6% (95% CI, 31.3% to 100%, respectively. Children younger than 3 years old had 5-year progression-free and overall survival rates (± SE of 47.6% ± 12.1% (95% CI, 28.9% to 78.4% and 45.6% ± 11.7% (95% CI, 27.6% to 75.5%, respectively. Time to relapse ranged from 4 to 132 months. Most patients who experienced relapse died within 1 year. Febrile neutropenia, hearing loss, and endocrinopathy were the most common treatment-related complications. Conclusion: The survival rate of childhood MB in Malaysia is inferior to that usually reported in the literature. We postulate that the following factors contribute to this difference: lack of a multidisciplinary neuro-oncology team, limited health care facilities, inconsistent risk assessment, insufficient data in the National Cancer

  10. When Partial Nephrectomy is Unsuccessful: Understanding the Reasons for Conversion from Robotic Partial to Radical Nephrectomy at a Tertiary Referral Center.

    Science.gov (United States)

    Kara, Önder; Maurice, Matthew J; Mouracade, Pascal; Malkoç, Ercan; Dagenais, Julien; Nelson, Ryan J; Chavali, Jaya Sai S; Stein, Robert J; Fergany, Amr; Kaouk, Jihad H

    2017-07-01

    We sought to identify the preoperative factors associated with conversion from robotic partial nephrectomy to radical nephrectomy. We report the incidence of this event. Using our institutional review board approved database, we abstracted data on 1,023 robotic partial nephrectomies performed at our center between 2010 and 2015. Standard and converted cases were compared in terms of patients and tumor characteristics, and perioperative, functional and oncologic outcomes. Logistic regression analysis was done to identify predictors of radical conversion. The overall conversion rate was 3.1% (32 of 1,023 cases). The most common reasons for conversion were tumor involvement of hilar structures (8 cases or 25%), failure to achieve negative margins on frozen section (7 or 21.8%), suspicion of advanced disease (5 or 15.6%) and failure to progress (5 or 15.6%). Patients requiring conversion were older and had a higher Charlson score (both p partial nephrectomy cases had similar short-term oncologic outcomes but better renal functional preservation (p partial nephrectomy conversion to radical nephrectomy was 3.1%, including 2.2% of preoperatively anticipated nephrectomy cases. Increasing tumor size and complexity, and poor preoperative renal function are the main predictors of conversion. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. Factors that influence the outcome of open urethroplasty for pelvis fracture urethral defect (PFUD): an observational study from a single high-volume tertiary care center.

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    Fu, Qiang; Zhang, Yu-meng; Barbagli, Guido; Zhang, Jiong; Xie, Hong; Sa, Ying-long; Jin, San-bao; Xu, Yue-min

    2015-12-01

    To report the clinical features of pelvic fracture urethral injury (PFUI) and assess the real effect of factors that are believed to have adverse effects on delayed urethroplasty. An observational descriptive study in a single urological center examined 376 male patients diagnosed with PFUI who underwent open urethroplasty from 2009 to 2013. Analyzed factors included patient age at the time of injury, etiology of PFUI, type of emergency treatment, concomitant injuries, length and position of stricture, type of urethroplasty and the outcome of surgery. Univariate and multivariate logistic regression analyses were applied, together with analytical statistic methods such as t test and Chi-square test. The overall success rate of delayed urethroplasty was 80.6 %. Early realignment was associated with reduced stricture length and had beneficial effect on delayed surgery. Concomitant rectum rupture, strictures longer than 1.6 cm and strictures closer than 3 cm to the bladder neck were indicators of poor outcome. Age, type of injury, urethral fistula and bladder rupture were not significant predicators of surgery outcome. Failed direct vision internal urethrotomy and urethroplasty had no significant influence on salvage operation. The outcome of posterior urethroplasty is affected by multiple factors. Early realignment has beneficial effect; while the length and position of stricture and its distance to bladder neck plays the key role, rectum rupture at the time of injury is also an indicator of poor outcome. The effect of other factors seems insignificant.

  12. Is Level of Injury a Determinant of Quality of Life Among Individuals with Spinal Cord Injury? A Tertiary Rehabilitation Center Report

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    Seyed Amir Hossein Tavakoli

    2016-03-01

    Full Text Available Objectives: The role of injury-related variables in determining health-related quality of life (HRQOL among Iranian persons with spinal cord injury (SCI has not yet been fully described. In this study, we compared HRQOL between individuals with injury at cervical level and those with injury at thoracolumbar sections and evaluated the discriminating value of injury level as a determinant of HRQOL among Iranian people with SCI. Methods: Individuals with SCI, who were referred to Brain and Spinal Cord Injury Research Center, were invited to participate in this investigation. HRQOL was assessed using the Short Form (SF-36 questionnaire to determine the quality of life (QOL in eight domains: physical functioning (PF, role limitation due to physical problems (RP, bodily pain (BP, general health (GH, vitality (VT, social functioning (SF, role limitation due to emotional problems (RE, and mental health (MH. Results: Ninety patients with paraplegia and 94 quadriplegic patients participated in this investigation. The mean score of PF domain was significantly lower in patients with injury at cervical level (p < 0.0001. There was no significant difference in other domains of SF-36 between subjects with paraplegia and quadriplegia (p = 0.670, 0.700, 0.910, 0.710, 0.730, 0.290 and 0.850 for RP, RE, VT, MH, SF, BP and GH, respectively. Similarly, the mean physical component summary (PCS score was significantly higher among individuals with injury at thoracolumbar sections (p < 0.0001. The mean mental component summary (MCS score did not differ between the two groups (p = 0.720. Conclusions: Patients with SCI at the cervical level have similar mental health compared to those with injury at thoracolumbar sections, which shows proper mental adaptability in quadriplegic individuals. Injury level can be used as a major determinant of the physical component of QOL among people with SCI.

  13. Impact of a change in surveillance definition on performance assessment of a catheter-associated urinary tract infection prevention program at a tertiary care medical center.

    Science.gov (United States)

    Sopirala, Madhuri M; Syed, Asma; Jandarov, Roman; Lewis, Margaret

    2018-03-16

    In January 2015, the Centers for Disease Control and Prevention (CDC)/National Health Safety Network (NHSN) changed the definition of catheter-associated urinary tract infection (CAUTI). We evaluated the outcomes of a robust CAUTI prevention program when we performed surveillance using the old definition (before 2015) versus the new definition (after 2015). This is the first study to evaluate how the change in CDC/NHSN definitions affected the outcomes of a CAUTI reduction program. Baseline was from January 2012 to September 2014; the intervention period was from October 2014 to February 2016. Staff nurses were trained to be liaisons of infection prevention (Link Nurses) with clearly defined CAUTI prevention goals and with ongoing monthly activities. CAUTI incidence per 1000 catheter days was compared between the baseline and intervention periods, using the 2 definitions. With the new definition, CAUTIs decreased by 33%, from 2.69 to 1.81 cases per 1000 catheter days (incidence rate ratio [IRR] = 0.67; 95% confidence interval [CI]: 0.48-0.93; P definition, CAUTIs increased by 12%, from 3.38 to 3.80 cases per 1000 catheter days (IRR = 1.12; 95% CI: 0.88-1.43; P = .348). We aggressively targeted CAUTI prevention, but a reduction was observed only with the new definition. Our findings stress the importance of having a reasonably accurate surveillance definition to monitor infection prevention initiatives. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  14. Pattern of Adverse Drug Reactions in Children Attending the Department of Pediatrics in a Tertiary Care Center: A Prospective Observational Study

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    Kishour Kumar Digra

    2015-01-01

    Full Text Available AIM To study the pattern of various adverse drug reactions (ADRs occurring in children attending the Department of Pediatrics, SMGS Hospital, Jammu over 1 year. Subjects and Methods This was a prospective study, with study population of patients attending Department of Pediatrics over a period of 1 year. A structured format was used to enroll the participants. A pilot study was conducted to test the suitability of the format and feasibility of the study. The study was carried out to review various pattern of ADRs by using the Naranjo probability scale, and severity was assessed by using the Hartwig severity scale. ADRs were classified according to the classification used by the Adverse Drug Reaction Monitoring Center, Central Drugs Standard Control Organization, New Delhi, India. Results In the present study, 104 patients were found to have developed acute drug reactions. Among these, 83.6% were type B, 14.42% type A, and 1.92% were type U. Furthermore, 25.96% ADRs were due to anticonvulsants, followed by antibiotics (22.11%, antipyretics (11.53%, vaccination (8.65%, steroids (6.73%, decongestants (5.67%, snake antivenom and antiemetics (3.84%, and fluids, insulin, and antacids (1.92%. The patients’ dermatological system was involved in 67.30%, followed by the central nervous system (CNS in 11.53% patients. Renal system was involved in 6.73% patients. Cardiac, musculoskeletal, metabolic, and other systems were involved in 4.80%, 3.84%, 2.88%, and 0.96%, respectively. According to the Hartwig severity scale of ADRs, 64.4% patients had moderate ADRs, 29.8% patients had severe ADRs, and 5.76% had mild ADRs. In the present study, 64.4% patients expressed moderate severity, whereas 29.8% expressed high severity and 5.76% expressed mild ADRs. Conclusion ADRs were seen in 71% of the patients between 1 and 5 years of age, 26% in the age group of 5–10 years, and 3% were more than 10 years old. Anticonvulsants (25.96% and antibiotics (22.11% were

  15. Non-tuberculous mycobacteria I: one year clinical isolates identification in Tertiary Hospital Aids Reference Center, Rio de Janeiro, Brazil, in pre highly active antiretroviral therapy era

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    Ferreira Rosa Maria Carvalho

    2002-01-01

    Full Text Available The aim of this study was to determine the prevalence of non-tuberculous mycobacteria (NTM isolates at University Hospital, Reference Center for Aids in Rio de Janeiro, Brazil, during one year. We used standard biochemical tests for species identification and IS1245 PCR amplification was applied as a Mycobacterium avium specific identification marker. Four hundred and four specimens from 233 patients yielded acid-fast bacilli growth. M. tuberculosis was identified in 85% of the patients and NTM in 15%. NTM disseminated infection was a common event correlated with human immunodeficiency virus (HIV infected patients and only in HIV negative patients the source of NTM was non sterile site. M. avium complex (MAC was biochemically identified in 57.8% (49/83 of NTM isolates, most of them from sterile sites (75.5%, and in 94% (46/49 the IS 1245 marker specific for M. avium was present. Twenty NTM strains showed a MAC biochemical pattern with the exception of a urease-positive (99% of MAC are urease-negative, however IS1245 was detected in 96% of the strains leading to their identification as M. avium. In this group differences in NTM source was not significant. The second most frequently isolated NTM was identified as M. scrofulaceum (7.2%, followed by M. terrae (3.6%, M. gordonae (2.4%, M. chelonae (1.2%, M. fortuitum (1.2% and one strain which could not be identified. All were IS1245 negative except for one strain identified as M. scrofulaceum. It is interesting to note that non-sterile sites were the major source of these isolates (92.8%. Our finding indicated that M. avium is still the major atypical species among in the MAC isolates recovered from Brazilian Aids patients without highty active antiretroviral therapy schema. Some discrepancies were seen between the identification methods and further investigations must be done to better characterize NTM isolates using other phenotypic and genotypic methods.

  16. Current socioclinical trend of sexually transmitted diseases and relevance of STD clinic: A comparative study from referral tertiary care center of Gwalior, India

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    Sandeep Singh

    2014-01-01

    back. A shift from adolescent towards adult age group have been reported, which could be the result of awareness generated from counseling patients during their visit to the STD clinic. The problem of low and infrequent condom use and improper binding to the treatment with multiple non-regular sex partners was seen in a fairly good proportion. Study also delineates the change in health-seeking behavior of the attendees. Deterrence towards public health facilities and an upsurge in self-medication as treatment-seeking behavior and approach towards the private health facilities have been reported. Conclusion: Study shows the very significant and much needed role of counseling center like STD clinic, in changing the due course and trend of STDs epidemiology.

  17. Characteristics and outcomes of e-cigarette exposure incidents reported to 10 European Poison Centers : a retrospective data analysis

    NARCIS (Netherlands)

    Vardavas, Constantine I; Girvalaki, Charis; Filippidis, Filippos T.; Oder, Mare; Kastanje, Ruth; de Vries, Irma; Scholtens, Lies; Annas, Anita; Plackova, Silvia; Turk, Rajka; Gruzdyte, Laima; Rato, Fátima; Genser, Dieter; Schiel, Helmut; Balázs, Andrea; Donohoe, Elaine; Vardavas, Alexander I; Tzatzarakis, Manolis N; Tsatsakis, Aristidis M; Behrakis, Panagiotis K

    BACKGROUND: The use of e-cigarettes has increased during the past few years. Exposure to e-cigarette liquids, whether intentional or accidental, may lead to adverse events our aim was to assess factors associated with e-cigarette exposures across European Union Member States (EU MS). METHODS: A

  18. Regional Media Education Centers (For Non-Professionals in the Media Fields) in the European Part of Russia

    Science.gov (United States)

    Levitskaya, Anastasia

    2014-01-01

    In the European parts of Russia (Archangelsk, Belgorod, Vladimir, Voronezh, Kazan, Krasnodar, Penza, Rostov-on-Don, St. Petersburg, Saratov, Smolensk, Taganrog, Tambov, Tver, Tolyatti and so on.) there is a lot of pedagogues, who strive to develop media competence among different age groups with different social status. More and more media…

  19. Secondary and tertiary hyperparathyroidism.

    Science.gov (United States)

    Jamal, Sophie A; Miller, Paul D

    2013-01-01

    We reviewed the etiology and management of secondary and tertiary hyperparathyroidism. Secondary hyperparathyroidism is characterized by an increase in parathyroid hormone (PTH) that is appropriate and in response to a stimulus, most commonly low serum calcium. In secondary hyperparathyroidism, the serum calcium is normal and the PTH level is elevated. Tertiary hyperparathyroidism is characterized by excessive secretion of PTH after longstanding secondary hyperparathyroidism, in which hypercalcemia has ensued. Tertiary hyperparathyroidism typically occurs in men and women with chronic kidney disease usually after kidney transplant. The etiology and treatment of secondary hyperparathyroidism is relatively straightforward whereas data on the management of tertiary hyperparathyroidism is limited to a few small trials with short follow-up. Copyright © 2013 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  20. Oral glucose tolerance test significantly impacts the prevalence of abnormal glucose tolerance among Indian women with polycystic ovary syndrome: lessons from a large database of two tertiary care centers on the Indian subcontinent.

    Science.gov (United States)

    Ganie, Mohd Ashraf; Dhingra, Atul; Nisar, Sobia; Sreenivas, Vishnubhatla; Shah, Zaffar Amin; Rashid, Aafia; Masoodi, Shariq; Gupta, Nandita

    2016-01-01

    To estimate the prevalence of abnormal glucose tolerance (AGT) among Indian women with polycystic ovary syndrome (PCOS) and analyze the role of oral glucose tolerance (OGTT) test on its estimation. Cross-sectional clinical study. Tertiary care center. A total of 2,014 women with PCOS diagnosed on the basis of the Rotterdam 2003 criteria were enrolled, and the data of 1,746 subjects were analyzed. In addition to recording clinical, biochemical, and hormone parameters, a 75 g OGTT was administered. Prevalence of AGT and impact of age, body mass index (BMI), family history, and OGTT on its prevalence. The mean age of subjects was 23.8 ± 5.3 years, with a mean BMI of 24.9 ± 4.4 kg/m(2). The overall prevalence of AGT was 36.3% (6.3% diabetes and 30% impaired fasting plasma glucose/impaired glucose tolerance) using American Diabetes Association criteria. The glucose intolerance showed a rising trend with advancing age (30.3%, 35.4%, 51%, and 58.8% in the second, third, fourth, and fifth decades, respectively) and increasing BMI. Family history of diabetes mellitus was present in 54.6% (953/1,746) subjects, and it did not correlate with any of the studied parameters except waist circumference and BMI. Sensitivity was better with 2-hour post-OGTT glucose values as compared with fasting plasma glucose, since using fasting plasma glucose alone would have missed the diagnosis in 107 (6.1%) subjects. We conclude that AGT is high among young Indian women with PCOS and that it is not predicted by family history of type 2 DM. OGTT significantly improves the detection rate of AGT among Indian women with PCOS. Copyright © 2016. Published by Elsevier Inc.

  1. Prevalence of osteoporosis in patients with chronic kidney disease (stages 3-5) in comparison with age- and sex-matched controls: A study from Kashmir Valley Tertiary Care Center.

    Science.gov (United States)

    Najar, M Saleem; Mir, Mohamad Muzzafer; Muzamil, Mudasir

    2017-01-01

    Chronic kidney disease (CKD) is associated with a range of metabolic bone diseases. Fracture rates are higher in CKD patients than age-matched controls throughout all the five stages of CKD. Dialysis patients have 4 times as many hip fractures as expected for their age. CKD forms an independent risk factor for osteoporosis, even in the absence of traditional risk factors. This study was carried out at the nephrology unit in a tertiary care center of Kashmir to know the prevalence of osteoporosis in CKD patients having glomerular filtration rate (GFR) stages 3-5). Among the 151 cases studied, the average estimated GFR was 16.78 ± 10.714 mL/min. There were 98 males (64.9%) and 53 females (35.1%). Their mean age was 51.01 ± 14.138 years. Osteoporosis based on femoral neck T-Score was seen in 31 patients (31.6%) while 43 patients (28.5%) had osteoporosis at L1, L2 lumbar vertebrae. The prevalence of osteoporosis based on femoral neck T-Score as well as osteopenia was highest in stage-5 CKD. In our study, the body mass index (BMI) had a positive correlation with osteoporosis; low BMI patients were at higher risk for osteoporosis (P = 0.014). In the Kashmir valley, the prevalence of osteoporosis was 31.8% in CKD patients against 22% in controls. Thus, CKD forms an important risk factor for osteoporosis even in the absence of traditional risk factors. We recommend early screening, detection, and management of osteoporosis to reduce the burden of morbidity and mortality in this subset of patients.

  2. INTRAUTERINE FETAL DEATH CASES AT TERTIARY CENTER

    Directory of Open Access Journals (Sweden)

    Babu Lal Bishnoi

    2018-01-01

    Full Text Available BACKGROUND Intrauterine fetal death is a tragic event for the parents and a great cause of stress for the caregiver. It is an important indicator of maternal and perinatal health of a given population. This study was undertaken to study the maternal and fetal factors associated with intrauterine fetal death. Aim and Objective- This was an Analytical study aimed to evaluate and understand the prevalence, socio-epidemiological and etiological factors of IUFD methodology should not be mixed with aims and objectives MATERIALS AND METHODS The study was carried out at March 2017 to June 2017 (4 months study which was conducted at Dr. S. N. Medical College, Jodhpur, Rajasthan. The details were entered in a preformed proforma. IUD is defined as fetal death beyond 20 weeks of gestation and/or birth weight >500g. The details of complaints at admission, obstetrics history, menstrual history, examination findings, per vaginal examination findings, mode and method of delivery and fetal outcomes and investigation reports were recorded. RESULTS A total of 227 intrauterine fetal deaths were reported amongst 6264 deliveries conducted during the study period. The incidence rate of intrauterine fetal death was 36/1000 live births. 192 (84.56% deliveries were unbooked and unsupervised and 133 (58.59% belonged to rural population and 126 (55.5% were preterm and 221 (97.55% were singleton pregnancy. Among the identifiable causes hypertensive disorders (24.22% and severe anemia (13.10% were most common followed by placental causes (9.97%. Congenital malformations were responsible for 12.39% and unidentifiable causes were 11.01%. Induction was done in 103 patients, 94 patients had spontaneous onset of labour and caesarean section was done in 30 patients. Incidence of intrauterine foetal demise gradually decreased as parity advanced. CONCLUSION Institutional deliveries should be promoted to prevent intrapartum fetal deaths. Decrease in the incidence of IUD would significantly reduce the perinatal mortality. Majority of fetal wastage can be prevented with universal and improved antenatal care.

  3. MONITORING OF THE CEPHALOSPORINS CONSUMPTION IN THE TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Radmila Veličković-Radovanović

    2015-06-01

    Full Text Available Irrational antibiotic consumption, especially in the case when there is no appropriate indication for its usage, may be one of the most crucial global issues for public health care, leading to bacterial resistance and the increase of indirect medical expenses. According to the report of the European program for the monitoring of the antibiotic consumption, Serbia is on the fifth place among the countries which are not members of EU. The goal of this work is the evaluation of antibiotic consumption in the Clinical Centre Niš, from 2007 to 2013, with the focus on the monitoring of the cephalosporins utilization, as they are one of the most prescribed groups of antibiotics in the tertiary health care. The utilization of antibiotics in the Clinical Center Niš in the observed period was obtained from the computerized database of the Department of Pharmacotherapy and expressed as defined daily dose (DDD per 100 bed/days (DBD. Our results showed that there was an increase in antibiotic use of the whole group of cephalosporins and penicillin as well as a reduction of quinolones consumption within the observed period. Our analysis showed that ceftriaxone was the most frequently prescribed cephalosporin, followed by cefuroxime. Although antibiotic therapy and prophylaxis in our hospital are in keeping with the recommended guidelines, the obtained results may suggest that cephalosporin consumption, and especially ceftriaxone consumption is higher than in other European countries.

  4. Contributions of the German Research Center for Geosciences (GFZ) to the EPOS (European Plate Observing System) Implementation Phase 2015-18

    Science.gov (United States)

    Hoffmann, T. L.; Lauterjung, J.

    2017-12-01

    The European Plate Observing System project is currently approaching the end of year two of its four-year Implementation Phase 2015-18 (EPOS-IP). Under the Horizon 2020 Programme INFRADEV-3, the EPOS cyberinfrastructure is being established as an ERIC (European Research Infrastructure Consortium) and encompasses the implementation of both the EPOS Integrated Core Services (ICS) for solid Earth Science and a multitude of EPOS Thematic Core Services (TCS). During year two, a basic set of ICS and TCS services was developed and implemented, so that in October 2017 the validation phase (year 3) of EPOS is ready to be launched. Up to now, various TCS-Elements have integrated different Service Providers (SD) that are delivering Data, Data Products, Services and Software (DDSS) to their specific scientific community. As one of the 29 awardees of the EC grant, the German Research Center for Geosciences (GFZ) plays an important role in the implementation of EPOS and its Thematic and Integrated Core Services. The presented poster will give an overview of GFZ's participation in the work of nine technical EPOS Work Packages (WP7 ICS Development, WP8 Seismology, WP11 Volcano Observations, WP12 Satellite Data, WP13 Geomagnetic Observations, WP14 Anthropogenic Hazards, WP15 Geological Information and Modelling, WP16 Multi-Scale Laboratories and WP17 Geo Energy Test Beds) as well as in four administrative EPOS Work Packages (WP2 Communication, WP3 Harmonization, WP4 Legal & Governance, and WP5 Financial).

  5. 2. Tertiary Foraminifera

    NARCIS (Netherlands)

    Umbgrove, J.H.F.

    1931-01-01

    In his review of the palaeozoology of Java, K. Martin could in 1919, record 49 foraminifera from tertiary strata of Java, on the strength of a critical study of the existant literature, and especially on the strength of his own studies and knowledge of the above mentioned fossils (Bibl. 49). In

  6. Food Waste Generation at Household Level: Results of a Survey among Employees of Two European Research Centers in Italy and Germany

    Directory of Open Access Journals (Sweden)

    Juliane Jörissen

    2015-03-01

    Full Text Available There is a broad consensus in literature that private households are significant contributors to the total amount of food waste in the EU. Thus, any strategy to meaningfully combat food wastage must put the end consumer in the center of prevention activities. This requires deeper insights into people’s motivations to discard still edible food and knowledge about potential barriers to reduce wasting. This paper reports on results of an online survey among two European research centers in Italy (JRC/Ispra and Germany (KIT/Karlsruhe. The focus of the survey was on households’ behaviors (shopping, eating, and food preparation habits and its influence on the generation of food waste. Furthermore, reasons for the disposal of food as well as measures and technologies most needed to prevent wastage were discussed. The results of the survey are analyzed, especially with regard to two questions: (1 Are there considerable differences between Ispra and Karlsruhe? (2 Are there considerable similarities or inconsistencies with the results of previous studies?

  7. Pediatric otorhinolaryngology anno 2008: towards European standards for training?

    LENUS (Irish Health Repository)

    Verwoerd, Carel

    2009-06-01

    The Union Européen des Médecins Spécialistes (UEMS) has been promoting harmonization of specialist training programs in Europe. Anticipating a future contribution to a European standard for training specialists for tertiary care of children with otorhinolaryngology (ORL)-related problems this Round Table was organized by ESPO. The presentations refer to six European countries. The number of ORL specialists (including pediatric ORL specialists) appeared to vary from +\\/-8 to +\\/-1 per 100,000 inhabitants, suggesting significant differences as far as their contribution to health care is concerned. Numbers for pediatricians vary from 12 to 3 and for family doctors from 50 to 100 per 100,000. In two countries pediatric ORL has the status of an official sub-specialty for tertiary care, requiring at least 2 years of additional training for qualified ORL specialists. In three other countries specific centers for pediatric ORL are present, although the sub-specialty has no official status. In the last a center for pediatric otorhinolaryngology has not yet been established and facilities for training in pediatric ORL are not available. For each country various aspects of current practice of tertiary ORL care for children are presented. It is concluded that a European standard for pediatric ORL could be most useful, if it would not only refer to current diagnostic and therapeutic skills but also to relevant scientific knowledge and skills. However, it should be recognized that the relevance of today\\'s standards is restricted, as medicine and medical technology are rapidly developing.

  8. Avaliação dos pacientes portadores de lesão por pressão internados em hospital geral Assessment of patients with pressure sores admitted in a tertiary care center

    Directory of Open Access Journals (Sweden)

    Adriana Moro

    2007-08-01

    Full Text Available OBJETIVOS: Determinar a prevalência e analisar o perfil dos portadores de lesão por pressão, enfocando fatores de risco, características clínicas e demográficas dos pacientes internados em hospital geral e estádio e localização das lesões no corpo. MÉTODOS: Estudo transversal observacional não controlado. Foram observados diariamente os pacientes internados em hospital geral no período de abril a junho de 2005, a fim de identificar todos os casos de lesão por pressão. Os pacientes acometidos foram avaliados através de um questionário padronizado e a Escala de Braden foi aplicada para definir o risco de desenvolvimento das lesões. RESULTADOS: Do total de 690 pacientes internados durante o período referido, observou-se uma prevalência de 5,9% de portadores de lesão por pressão, equivalente a 41 pacientes. Desses, 63,9% eram idosos. A média do tempo de internação foi de 18 dias. Observou-se que o setor de clínica médica e a Unidade de Terapia Intensiva (UTI apresentaram prevalência de 41,5%. Quanto à localização das lesões, 73,1% apresentavam-na em região sacral, e o grau mais evidenciado foi o estádio II, perfazendo um total de 58,5%. De acordo com a Escala de Braden, a maioria (80,4% apresentava alto risco para o desenvolvimento das lesões, comparado com 9,7% dos pacientes com risco moderado e 7,4% com baixo risco. CONCLUSÃO: Os pacientes acometidos apresentaram alto risco de desenvolver lesões por pressão. A prevalência dessas e o perfil clínico e demográfico dos pacientes acometidos estão de acordo com os dados encontrados na literatura.BACKGROUND: To determine the prevalence and analyze the profile of patients with pressure sores, focusing on risk factors, the patients' clinical characteristics at a tertiary care center, as well as stage and location of the lesions on the body. METHODS: This was a cross sectional not controlled observational study, all patients admitted from April to June of 2005 were

  9. CH4 emissions from European Major Population Centers: Results from aircraft-borne CH4 in-situ observations during EMeRGe-Europe campaign 2017

    Science.gov (United States)

    Roiger, A.; Klausner, T.; Schlager, H.; Ziereis, H.; Huntrieser, H.; Baumann, R.; Eirenschmalz, L.; Joeckel, P.; Mertens, M.; Fisher, R.; Bauguitte, S.; Young, S.; Andrés Hernández, M. D.

    2017-12-01

    Urban environments represent large and diffuse area sources of CH4 including emissions from pipeline leaks, industrial/sewage treatment plants, and landfills. However, there is little knowledge about the exact magnitude of these emissions and their contribution to total anthropogenic CH4. Especially in the context of an urbanizing world, a better understanding of the methane footprint of urban areas is crucial, both with respect to mitigation and projection of climate impacts. Aircraft-borne in-situ measurements are particularly useful to both quantify emissions from such area sources, as well as to study their impact on the regional distribution. However, airborne CH4 observations downstream of European cities are especially sparse.Here we report from aircraft-borne CH4 in-situ measurements as conducted during the HALO aircraft campaign EMeRGe (Effect of Megacities on the Transport and Transformation of Pollutants on the Regional to Global Scales) in July 2017, which was led by the University of Bremen, Germany. During seven research flights, emissions from a variety of European (Mega)-cities were probed at different altitudes from 3km down to 500m, including measurements in the outflows of London, Rome, Po Valley, Ruhr and Benelux. We will present and compare the CH4 distribution measured downstream of the various studied urban hot-spots. With the help of other trace gas measurements (including e.g. CO2, CO, O3, SO2), observed methane enhancements will be attributed to the different potential source types. Finally, by the combination of in-situ measurements and regional model simulations using the EMAC-MECO(n) model, the contribution of emissions from urban centers to the regional methane budget over Europe will be discussed.

  10. Trends in cigarette smoking in the German centers of the European Prospective Investigation into Cancer and Nutrition (EPIC): the influence of the educational level.

    Science.gov (United States)

    Rohrmann, Sabine; Becker, Nikolaus; Kroke, Anja; Boeing, Heiner

    2003-04-01

    Several studies in Germany and other European countries have already shown smoking prevalence to be related to education. This study was aimed to investigate time trends in smoking habits in the German cohorts Heidelberg and Potsdam of the European Prospective Investigation into Cancer and Nutrition (EPIC) according to sex, birth cohort, and level of education. Within EPIC, 25,546 and 27,548 participants were recruited in Heidelberg and Potsdam, respectively. Data on smoking were collected by means of a computer-guided interview during the baseline examination between 1994 and 1998. For each birth cohort smoking prevalence and mean number of cigarettes smoked per day at different ages were calculated. Odds ratios and 95% confidence interval for associations between smoking prevalence and educational level were computed by using logistic regression. Smoking prevalence was higher among men than among women, with a smaller difference in younger birth cohorts. Between 1950 and 1960, smoking prevalence among women in the Heidelberg cohort rose sharply (from 12.8% to 51.8% in the least educated group). This strong increase was delayed by 10 years in the Potsdam cohort. Men and women in Heidelberg smoked more cigarettes per day than their counterparts in Potsdam, but in both study centers less educated subjects smoked more than subjects with a higher education. Smoking patterns in the Potsdam and Heidelberg cohorts are quite similar with respect to prevalence and years of lifetime smoking. Since an increasing difference between smoking prevalence of less and high educated individuals is observable, programs on smoking cessation should especially concentrate on persons of lower educational level.

  11. Precipitable water and surface humidity over global oceans from special sensor microwave imager and European Center for Medium Range Weather Forecasts

    Science.gov (United States)

    Liu, W. T.; Tang, Wenqing; Wentz, Frank J.

    1992-01-01

    Global fields of precipitable water W from the special sensor microwave imager were compared with those from the European Center for Medium Range Weather Forecasts (ECMWF) model. They agree over most ocean areas; both data sets capture the two annual cycles examined and the interannual anomalies during an ENSO episode. They show significant differences in the dry air masses over the eastern tropical-subtropical oceans, particularly in the Southern Hemisphere. In these regions, comparisons with radiosonde data indicate that overestimation by the ECMWF model accounts for a large part of the differences. As a check on the W differences, surface-level specific humidity Q derived from W, using a statistical relation, was compared with Q from the ECMWF model. The differences in Q were found to be consistent with the differences in W, indirectly validating the Q-W relation. In both W and Q, SSMI was able to discern clearly the equatorial extension of the tongues of dry air in the eastern tropical ocean, while both ECMWF and climatological fields have reduced spatial gradients and weaker intensity.

  12. Paucity of intrahepatic bile ducts in infancy: experience of a tertiary center Hipoplasia de vias biliares intra-hepáticas na infância: experiência de um serviço terciário

    Directory of Open Access Journals (Sweden)

    Adriana Maria Alves De Tommaso

    2004-09-01

    Full Text Available BACKGROUND: Intrahepatic cholestasis secondary to paucity of bile duct is an alteration of the anatomic integrity of the biliary tract. Can be defined only histologically and, clinically, two categories are recognized: syndromic and non-syndromic, where the prognosis is generally more severe. AIM: To evaluate the history, clinical and biochemical characteristics, etiology and improvement of children who have paucity of intrahepatic bile duct followed at tertiary center. PATIENTS AND METHODS: Eleven children with paucity of intrahepatic bile duct, followed at the Pediatric Hepatology Service of the University Hospital, Campinas, SP, Brazil, were evaluated in the period from 1986 to 2001. RESULTS: Among the patients, three presented the syndromic and eight the non-syndromic form (two with alpha-1-antitrypsin deficiency, one with lues, one secondary to sepsis, three with probable etiology by cytomegalovirus and one without a definite etiology. Referral ranged from 31 to 1185 days. Birth weights ranged from 1920 g to 3590 g. Most of the patients presented pale stools. The median bile duct/portal tract ratio was 0.14. The majority of the children presented a favorable follow-up, regardless of the form of presentation. CONCLUSION: Paucity of intrahepatic bile ducts should be considered in children with cholestasis and its differentiation from extrahepatic causes of neonatal cholestasis is important in order to avoid surgery. Diagnosis of non-syndromic form should not be regarded as unfavorable prognosis, as the evolution is probably related to the etiology in this form of presentation.RACIONAL: A hipoplasia das vias biliares intra-hepáticas é causa de colestase secundária a uma alteração na integridade anatômica do trato biliar. A definição é dada pelo exame histopatológico e, do ponto de vista clínico, pode ser classificada em sindrômica e não-sindrômica onde o prognóstico é, geralmente, mais grave. OBJETIVO: Avaliar a hist

  13. Visualization of atherosclerosis as detected by coronary artery calcium and carotid intima-media thickness reveals significant atherosclerosis in a cross-sectional study of psoriasis patients in a tertiary care center.

    Science.gov (United States)

    Santilli, S; Kast, D R; Grozdev, I; Cao, L; Feig, R L; Golden, J B; Debanne, S M; Gilkeson, R C; Orringer, C E; McCormick, T S; Ward, N L; Cooper, K D; Korman, N J

    2016-07-22

    Psoriasis is a chronic inflammatory disease of the skin and joints that may also have systemic inflammatory effects, including the development of cardiovascular disease (CVD). Multiple epidemiologic studies have demonstrated increased rates of CVD in psoriasis patients, although a causal link has not been established. A growing body of evidence suggests that sub-clinical systemic inflammation may develop in psoriasis patients, even from a young age. We aimed to evaluate the prevalence of atherosclerosis and identify specific clinical risk factors associated with early vascular inflammation. We conducted a cross-sectional study of a tertiary care cohort of psoriasis patients using coronary artery calcium (CAC) score and carotid intima-media thickness (CIMT) to detect atherosclerosis, along with high sensitivity C-reactive protein (hsCRP) to measure inflammation. Psoriasis patients and controls were recruited from our tertiary care dermatology clinic. Presence of atherosclerosis was defined using validated numeric values within CAC and CIMT imaging. Descriptive data comparing groups was analyzed using Welch's t test and Pearson Chi square tests. Logistic regression was used to analyze clinical factors associated with atherosclerosis, and linear regression to evaluate the relationship between psoriasis and hsCRP. 296 patients were enrolled, with 283 (207 psoriatic and 76 controls) having all data for the hsCRP and atherosclerosis analysis. Atherosclerosis was found in 67.6 % of psoriasis subjects versus 52.6 % of controls; Psoriasis patients were found to have a 2.67-fold higher odds of having atherosclerosis compared to controls [95 % CI (1.2, 5.92); p = 0.016], after adjusting for age, gender, race, BMI, smoking, HDL and hsCRP. In addition, a non-significant trend was found between HsCRP and psoriasis severity, as measured by PASI, PGA, or BSA, again after adjusting for confounders. A tertiary care cohort of psoriasis patients have a high prevalence of early

  14. A retrospective review of snake bite victims admitted in a tertiary ...

    African Journals Online (AJOL)

    Objective: Snake bite remains major public health problem worldwide. We present our experience with cases of snake bites managed in our tertiary care teaching center of South India. Materials and Methods: The details of all patients with snake bite admitted to a tertiary teaching care hospital from 2010 to 2012 were ...

  15. Omalizumab use during pregnancy for CIU: a tertiary care experience.

    Science.gov (United States)

    Cuervo-Pardo, L; Barcena-Blanch, M; Radojicic, C

    2016-07-01

    The treatment of antihistamine and steroid resistant Chronic Idiopathic Urticaria (CIU) during pregnancy poses a challenge due to teratogenicity of immunosuppressants. Omalizumab is a recently FDA approved therapy for CIU and is classified as pregnancy category B. We present an initial series of subjects treated at a tertiary care center for antihistamine and steroid resistant CIU with omalizumab who became pregnant during therapy.

  16. Perfil dos profissionais da voz com queixas vocais atendidos em um centro terciário de saúde Profile of voice professionals seen in a tertiary health center

    Directory of Open Access Journals (Sweden)

    Felipe Sartor Guimarães Fortes

    2007-02-01

    Full Text Available As laringopatias relacionadas ao trabalho acarretam conseqüências para os profissionais da voz. OBJETIVO: Analisar o perfil destes profissionais atendidos em um hospital terciário. FORMA DE ESTUDO: Estudo de coorte histórica longitudinal. MATERIAL E MÉTODOS: Análise retrospectiva de prontuários. Os diagnósticos foram fornecidos através de videoestrobolaringoscopia. RESULTADOS: Foram atendidos 163 pacientes (119 do sexo feminino, 44 do sexo masculino, idade média de 36,5 anos. Em relação aos grupos profissionais, encontramos profissionais da voz falada (vendedores, professores, telemarketing, recepcionistas, atores e profissionais de saúde e da voz cantada. Os diagnósticos foram: alteração estrutural mínima (33%, nódulos (22%, edema de Reinke (10% e pólipos (6%. Foi observada correlação com tabagismo (p=0,002, sexo (p=0,004 e idade (pWork-related laryngopathy may have negative consequences for voice professionals. AIM: To analyze the profile of voice professionals seen in a tertiary level hospital. STUDY DESIGN: a longitudinal historical cohort. METHODS: A retrospective analysis of patient files. Diagnosis was reached using videostroboscopy. RESULTS: 163 patients (119 females and 44 males were seen. The mean age was 36.5 years. Professionals included spoken voice users (salesman, teachers, telemarketers, receptionists, health professionals and singers. The most frequent diagnoses were: minor structural changes (33%, nodules (22%, Reinke’s edema (10%, and polyps (6%. A correlation was observed between smoking, age and gender; there was an association between smoking and Reinke’s edema, leucoplasia and tabagism, females and Reinke’s edema, nodules and minor structural changes, and also between patients aged over 40 years and Reinke’s edema, and patients under 40 with nodules, laryngitis, and minor structural changes. Symptoms lasted more than 6 months in 74% of patients. CONCLUSION: The profile of voice professionals

  17. Effect of Intensive Education and Training of Nurses on Ventilator-associated Pneumonia and Central Line-associated Bloodstream Infection Incidence in Intensive Care Unit at a Tertiary Care Center in North India.

    Science.gov (United States)

    Sahni, Neeru; Biswal, Manisha; Gandhi, Komal; Kaur, Kulbeer; Saini, Vikas; Yaddanapudi, Lakshminarayana N

    2017-11-01

    The aim was to analyze the impact of education and training of nurses on the incidence of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI). A prospective observational study at a tertiary care hospital included adult patients with Intensive Care Unit stay >48 h. The study was done in three phases: in Phase 1, baseline VAP and CLABSI incidence was calculated; in Phase 2, education and training of nurses; and in Phase 3, data were recollected for the incidence of VAP and CLABSI. The baseline incidence of VAP in Phase 1 was 28.86/1000 ventilator days and that of CLABSI was 7.89/1000 central-line days. In Phase 3, the incidence of VAP increased to 35.06 and that of CLABSI decreased significantly, 1.73. Intensive education and training sessions with feedback from nurses over a period of 6 months led to significant reduction in the incidence of CLABSI; however, the incidence of VAP increased.

  18. What puts them at risk? A cross-sectional case-control survey of demographic profile and sexual behavior of patients with sexually transmitted infections at a tertiary care center in North India.

    Science.gov (United States)

    Raj, Rama; Gupta, Vishal; Pathak, Mona; Sreenivas, Vishnubhatla; Sood, Seema; Singh, Sarman; Verma, Kaushal K; Khanna, Neena; Das, Bimal K; Gupta, Somesh

    2017-01-01

    Sexually transmitted infections (STIs) are a major public health problem in developing nations. Identification of risk factors can help in formulating effective strategies against them. The present study was conducted in a tertiary care hospital in North India over 1 year to identify the risk factors associated with STIs. A questionnaire-based cross-sectional case-control survey was conducted where participants answered questions on demographic details, sexual behavior, and awareness of STIs. Cases were patients with STIs whereas controls were randomly selected from healthy individuals accompanying patients with nonvenereal complaints attending our hospital. There were 106 cases and 64 controls. STI patients had sexual debut 2 years before controls. A higher proportion of STI cases had lower education, multiple sexual partners, lived separately from their partner, had nonregular partners, had protected sex in the last month, had sex under influence of alcohol/illicit drugs, sex in unstructured settings, and engaged in transactional sex, in comparison to controls ( P sexual partners, sex under influence of alcohol/illicit drugs with nonregular partner, protected sex in the last month, and knowledge of preventive measures were found to be statistically associated with STIs ( P diseases. Increasing the knowledge about STIs in these patients can translate into more common condom usage that lends support for strengthening sexual health programs at grass-root levels. The small size of the study population could have led to decreased power of the study to detect differences between cases and controls. The external validity of our results needs to be tested in different population groups involving larger sample sizes.

  19. Biomarker-based evaluation of two 24-h recalls for comparing usual fish, fruit and vegetable intakes across European centers in the EFCOVAL Study

    NARCIS (Netherlands)

    Vries, de J.H.M.; Crispim, S.P.; Souverein, O.W.; Hulshof, P.J.M.; Ruprich, J.; Dofkova, M.; Huybrechts, I.; Keyzer, de W.; Lillegaard, I.T.L.; Lafay, L.; Rousseau, A.S.; Ocke, M.C.; Slimani, N.; Veer, van 't P.

    2011-01-01

    Background/Objectives: A standardized methodology is important to enable consistent monitoring of dietary intake across European countries. For this reason, we evaluated the comparability of the assessment of usual food intake collected with two non-consecutive computerized 24-h dietary recalls

  20. Time to positivity and detection of growth in anaerobic blood culture vials predict the presence of Candida glabrata in candidemia: a two-center European cohort study.

    Science.gov (United States)

    Cobos-Trigueros, Nazaret; Kaasch, Achim J; Soriano, Alex; Torres, Jorge-Luis; Vergara, Andrea; Morata, Laura; Zboromyrska, Yuliya; De La Calle, Cristina; Alejo, Izaskun; Hernández, Cristina; Cardozo, Celia; Marco, Franscesc; Del Río, Ana; Almela, Manel; Mensa, Josep; Martínez, José Antonio

    2014-08-01

    This study shows the accuracy of exclusive or earlier growth in anaerobic vials to predict Candida glabrata in a large series of candidemic patients from two European hospitals using the Bactec 9240 system. Alternatively, C. glabrata can be predicted by a time to positivity cutoff value, which should be determined for each setting. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  1. Tertiary climatic fluctuations and methods of analysis of tertiary floras

    Science.gov (United States)

    Wolfe, J.A.

    1971-01-01

    On theoretical grounds, an analysis of the physiognomy of a Tertiary leaf assemblage is more direct and reliable than a circuitous floristic analysis in assigning thermal regimes to fossil assemblages. Using primarily foliar physiognomy and secondarily floristic composition, it can be shown that: (1) some middle latitude Tertiary assemblages probably lived under meteoroligically tropical climates; (2) a major and rapid climatic deterioration occurred in the Oligocene; and (3) a major climatic fluctuation probably occurred in the Late Eocene. These analyses thus substantiate the conclusions of several other paleobotanists regarding climatic fluctuations. Recent criticisms of these analyses are shown to be invalid and to be based largely on misinterpretations. ?? 1971.

  2. The organization of indoor plants which are used in the aim of recreational at shopping centers and assessment of application parameters in Istanbul (European side example

    Directory of Open Access Journals (Sweden)

    Selvinaz Gülçin Bozkurt

    2014-07-01

    Full Text Available In our modernizing era progressing and transforming urban formation also renewed public and social composition. As a result of that transformation new economic systems have been emerged and in association shopping places have changed. Individuals in urban rush, due to narrow time period to satisfy their plenty of needs expected huge shopping centers in which they will be able to access all issues. With this object in mind, designed shopping centers; are designed as centers eliminating natural landscape affection in metropolitan life, applied decorative intended plants and responding individual’s recreation expectations. Whereas in the present study; as one of the recreational issues and used in contemporary shopping centers types of indoor plants, their use and design methods are investigated.

  3. Tertiary lymphoid structures in cancer and beyond.

    Science.gov (United States)

    Dieu-Nosjean, Marie-Caroline; Goc, Jérémy; Giraldo, Nicolas A; Sautès-Fridman, Catherine; Fridman, Wolf Herman

    2014-11-01

    Tertiary lymphoid structures (TLS) are ectopic lymphoid formations found in inflamed, infected, or tumoral tissues. They exhibit all the characteristics of structures in the lymph nodes (LN) associated with the generation of an adaptive immune response, including a T cell zone with mature dendritic cells (DC), a germinal center with follicular dendritic cells (FDC) and proliferating B cells, and high endothelial venules (HEV). In this review, we discuss evidence for the roles of TLS in chronic infection, autoimmunity, and cancer, and address the question of whether TLS present beneficial or deleterious effects in these contexts. We examine the relationship between TLS in tumors and patient prognosis, and discuss the potential role of TLS in building and/or maintaining local immune responses and how this understanding may guide therapeutic interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Rethinking the Tertiary Mathematics Curriculum

    Science.gov (United States)

    Petocz, Peter; Reid, Anna

    2005-01-01

    Mathematics curriculum at the tertiary level is located within a range of social and cultural theories, and is often constructed by academics seeking to promulgate a particular view of mathematics. We argue that such a curriculum should incorporate a real acknowledgement of the different ways in which students understand the nature of mathematics…

  5. Seasonal variation in month of diagnosis in children with type 1 diabetes registered in 23 European centers during 1989-2008

    DEFF Research Database (Denmark)

    Patterson, C C; Gyürüs, E; Rosenbauer, J

    2015-01-01

    BACKGROUND: The month of diagnosis in childhood type 1 diabetes shows seasonal variation. OBJECTIVE: We describe the pattern and investigate if year-to-year irregularities are associated with meteorological factors using data from 50 000 children diagnosed under the age of 15 yr in 23 population......-based European registries during 1989-2008. METHODS: Tests for seasonal variation in monthly counts aggregated over the 20 yr period were performed. Time series regression was used to investigate if sunshine hour and average temperature data were predictive of the 240 monthly diagnosis counts after taking...

  6. European Union

    International Nuclear Information System (INIS)

    Schaller, K.

    1995-01-01

    Different instruments used by European Commission of the European Union for financial support radioactive waste management activities in the Russian Federation are outlined. Three particular programmes in the area are described

  7. How Do Tertiary Dropouts Fare in the Labour Market? A Comparison between EU Countries

    Science.gov (United States)

    Schnepf, Sylke V.

    2017-01-01

    Dropping out of university is regularly discussed as a negative indicator. However, research on actual career trajectories of dropouts is virtually non-existent. This study estimates the association between tertiary dropouts and career chances in 15 European countries. Using data from the 2011 Programme for the International Assessment of Adult…

  8. IMRT credentialing for prospective trials using institutional virtual phantoms: results of a joint European Organization for the Research and Treatment of Cancer and Radiological Physics Center project

    International Nuclear Information System (INIS)

    Weber, Damien C; Vallet, Veronique; Molineu, Andrea; Melidis, Christos; Teglas, Vanda; Naudy, Suzanne; Moeckli, Raphael; Followill, David S; Hurkmans, Coen W

    2014-01-01

    Intensity-modulated radiotherapy (IMRT) credentialing for a EORTC study was performed using an anthropomorphic head phantom from the Radiological Physics Center (RPC; RPC PH ). Institutions were retrospectively requested to irradiate their institutional phantom (INST PH ) using the same treatment plan in the framework of a Virtual Phantom Project (VPP) for IMRT credentialing. CT data set of the institutional phantom and measured 2D dose matrices were requested from centers and sent to a dedicated secure EORTC uploader. Data from the RPC PH and INST PH were thereafter centrally analyzed and inter-compared by the QA team using commercially available software (RIT; ver.5.2; Colorado Springs, USA). Eighteen institutions participated to the VPP. The measurements of 6 (33%) institutions could not be analyzed centrally. All other centers passed both the VPP and the RPC ±7%/4 mm credentialing criteria. At the 5%/5 mm gamma criteria (90% of pixels passing), 11(92%) as compared to 12 (100%) centers pass the credentialing process with RPC PH and INST PH (p = 0.29), respectively. The corresponding pass rate for the 3%/3 mm gamma criteria (90% of pixels passing) was 2 (17%) and 9 (75%; p = 0.01), respectively. IMRT dosimetry gamma evaluations in a single plane for a H&N prospective trial using the INST PH measurements showed agreement at the gamma index criteria of ±5%/5 mm (90% of pixels passing) for a small number of VPP measurements. Using more stringent, criteria, the RPC PH and INST PH comparison showed disagreement. More data is warranted and urgently required within the framework of prospective studies

  9. Parathyroid carcinoma in tertiary hyperparathyroidism.

    Science.gov (United States)

    Kim, Byung Seup; Ryu, Han Suk; Kang, Kyung Ho; Park, Sung Jun

    2016-10-01

    Parathyroid carcinoma is a rare disease of unknown etiology. This study presents a case of parathyroid carcinoma in a patient with tertiary hyperparathyroidism. Despite a successful kidney transplantation, the intact parathyroid hormone (iPTH) level of the patient was elevated consistently and could not be controlled by medical therapy. Due to the development of tertiary hyperparathyroidism with bone pain and osteoporosis, subtotal parathyroidectomy was performed 4 months after the kidney transplantation. Histological evaluation revealed that one of four parathyroid lesions was a parathyroid carcinoma, while the others were diffuse hyperplasia. Postoperative laboratory studies indicated a decreased level of iPTH. A positron emission tomography-computed tomography performed 6 months after the operation revealed no evidence of local recurrence or distant metastasis. Copyright © 2013. Published by Elsevier Taiwan.

  10. Validation of the 2014 European Society of Cardiology Sudden Cardiac Death Risk Prediction Model in Hypertrophic Cardiomyopathy in a Reference Center in South America.

    Science.gov (United States)

    Fernández, Adrián; Quiroga, Alejandro; Ochoa, Juan Pablo; Mysuta, Mauricio; Casabé, José Horacio; Biagetti, Marcelo; Guevara, Eduardo; Favaloro, Liliana E; Fava, Agostina M; Galizio, Néstor

    2016-07-01

    Sudden cardiac death (SCD) is a common cause of death in hypertrophic cardiomyopathy (HC). Our aim was to conduct an external and independent validation in South America of the 2014 European Society of Cardiology (ESC) SCD risk prediction model to identify patients requiring an implantable cardioverter defibrillator. This study included 502 consecutive patients with HC followed from March, 1993 to December, 2014. A combined end point of SCD or appropriate implantable cardioverter defibrillator therapy was assessed. For the quantitative estimation of individual 5-year SCD risk, we used the formula: 1 - 0.998(exp(Prognostic index)). Our database also included the abnormal blood pressure response to exercise as a risk marker. We analyzed the 3 categories of 5-year risk proposed by the ESC: low risk (LR) validated in our population and represents an improvement compared with previous approaches. A larger multicenter, independent and external validation of the model with long-term follow-up would be advisable. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Case studies on recent Stark broadening calculations and STARK-B database development in the framework of the European project VAMDC (Virtual Atomic and Molecular Data Center)

    International Nuclear Information System (INIS)

    Sahal-Brechot, S

    2010-01-01

    Stark broadening theories and calculations have been extensively developed for about 50 years. The theory can now be considered as mature for many applications, especially for accurate spectroscopic diagnostics and modelling. In astrophysics, with the increasing sensitivity of observations and spectral resolution, in all domains of wavelengths from far UV to infrared, it has become possible to develop realistic models of interiors and atmospheres of stars and interpret their evolution and the creation of elements through nuclear reactions. For hot stars, especially white dwarfs, Stark broadening is the dominant collisional line broadening process. This requires the knowledge of numerous profiles, especially for trace elements, which are used as useful probes for modern spectroscopic diagnostics. Hence, calculations based on a simple but enough accurate and fast method, are necessary for obtaining numerous results. Ab initio calculations are a growing domain of development. Nowadays, the access to such data via an on line database becomes crucial. This is the object of STARK-B, which is a collaborative project between the Paris Observatory and the Astronomical Observatory of Belgrade. It is a database of calculated widths and shifts of isolated lines of atoms and ions due to electron and ion collisions. It is devoted to modelling and spectroscopic diagnostics of stellar atmospheres and envelopes. In addition, it is relevant to laboratory plasmas, laser equipments and technological plasmas. It is a part of VAMDC (Virtual Atomic and Molecular Data Centre), which is an European Union funded collaboration between groups involved in the generation and use of atomic and molecular data.

  12. European communion

    DEFF Research Database (Denmark)

    Manners, Ian James

    2013-01-01

    Political theory of European union, through an engagement between political concepts and theoretical understandings, provides a means of identifying the EU as a political object. It is argued that understanding the projects, processes and products of European union, based on ‘sharing’ or ‘communion......’, provides a better means of perceiving the EU as a political object rather than terms such as ‘integration’ or ‘co-operation’. The concept of ‘European communion’ is defined as the ‘subjective sharing of relationships’, understood as the extent to which individuals or groups believe themselves to be sharing...... relations (or not), and the consequences of these beliefs for European political projects, processes and products. By exploring European communion through an engagement with contemporary political theory, using very brief illustrations from the Treaty of Lisbon, the article also suggests that European...

  13. Study of refractory status epilepticus from a tertiary care center

    Directory of Open Access Journals (Sweden)

    Sahil Kohli

    2017-01-01

    Full Text Available Objectives: To determine the proportion of refractory status epilepticus (RSE and super-RSE (SRSE among patients with status epilepticus (SE and to analyze RSE and non-RSE (NRSE in terms of etiology and predictors for RSE. Materials and Methods: Patients were identified from discharge summaries database with keywords of SE and records of the portable electroencephalogram (EEG machine from January 2011 to March 2016. Results: Two hundred and eighteen events were included in the study with 114 (52.3% males, bimodal age preponderance age <5 years 30%, and second peak in age 15–65 years 52.8%, preexisting seizures were present in 34.4% (n = 75. Nearly 77.1% had NRSE (n = 168 and 22.9% had RSE (n = 50. This included 17 patients with SRSE (n = 17, 7.8% of all SE. Central nervous system (CNS infection was a single largest etiological group in SE (69/218, 31.7%. In RSE, autoimmune encephalitis (17/50 and CNS infection (13/50 were the largest groups. De novo seizures (P = 0.007, low sensorium at admission (P = 0.001, low albumin at admission (P = 0.002, and first EEG being abnormal (P = 0.001 were risk factors on bivariate analysis. An unfavorable status epilepticus severity score (STESS was predictive for RSE (P = 0.001. On multivariate analysis, de novo seizures (P = 0.009 and abnormal EEG at admission (P = 0.03 were predictive for RSE. Conclusions: Fifty patients had RSE (22.9%, of which 17 went on to become SRSE (7.8%. Unfavorable STESS score was predictive for RSE on bivariate analysis. On multivariate analysis, de novo seizures and abnormal initial EEG were predictors of RSE.

  14. Health Disparities in Pediatric Asthma: Comprehensive Tertiary Care Center Experience.

    Science.gov (United States)

    Holmes, Laurens; Kalle, Fanta; Grinstead, Laura; Jimenez, Maritza; Murphy, Meghan; Oceanic, Pat; Fitzgerald, Diane; Dabney, Kirk

    2015-03-01

    Study conducted at Nemours /Alfred I. duPont Hospital for Children, Wilmington, DE 19803 BACKGROUND: Although the treatment and management of asthma hasimproved over time, incidence and prevalence among children continues to rise in the United States. Asthma prevalence, health services utilization, and mortality rate demonstrate remarkable disparities. The underlying causes of these disparities are not fully understood. We aimed to examine racial/ethnic variances in pediatric asthma prevalence/admission. We retrospectively reviewed data on 1070 patients and applied a cross-sectional design to assess asthma admission between 2010 and 2011. Information was available on race/ethnicity, sex, insurance status, severity of illness (SOI), and length of stay/hospitalization (LOS).Chi-square statistic was used for the association between race and other variables in an attempt to explain the racial/ethnic variance. The proportionate morbidity of asthma was highest amongCaucasians (40.92%) and African Americans (40.54%), intermediate among others (16.57%), and lowest among Asian (0.56%), American Indian/Alaska Native (0.28%), and Hawaiian Native/Pacific Islander (0.28%). Overall there were disparities by sex, with more boys (61.80%) diagnosed with asthma than girls (38.20%), χ2(7)=20.1, p=0.005. Insurance status, and SOI varied by race/ethnicity, but not LOS. Caucasian children were more likely to have private insurance, while African Americans and Hispanics were more likely to have public insurance (p<0.005). Asthma was more severe among non-Hispanic children, χ2(14)=154.6, p<0.001. While the overall readmission proportion was 2.8%, readmission significantly varied by race/ethnicity. Racial/ethnic disparities in asthma admission exist among children in the Delaware Valley. There were racial/ethnic disparities in insurance status, asthma severity, and sex differed by race/ethnicity, but not in length of hospitalization. © 2015 National Medical Association. Published by Elsevier Inc. All rights reserved.

  15. Maternal obesity and obstetric outcomes in a tertiary referral center

    Directory of Open Access Journals (Sweden)

    Gitana Ramonienė

    2017-01-01

    Conclusions: Maternal obesity is significantly associated with an increased risk of gestational hypertension, preeclampsia, gestational diabetes, dystocia, labor induction, failed induction of labor, large-for-gestational-age newborns and cesarean delivery.

  16. Bleeding Peptic Ulcer - Tertiary Center Experience: Epidemiology, Treatment and Prognosis.

    Science.gov (United States)

    Budimir, Ivan; Stojsavljević, Sanja; Hrabar, Davor; Kralj, Dominik; Bišćanin, Alen; Kirigin, Lora Stanka; Zovak, Mario; Babić, Žarko; Bohnec, Sven; Budimir, Ivan

    2017-12-01

    The aim of this study was to demonstrate epidemiological, clinical and endoscopic characteristics of acute upper gastrointestinal bleeding (UGIB) with special reference to peptic ulcer bleeding (PUB). The study included 2198 consecutive patients referred to our emergency department due to acute UGIB from January 2008 to December 2012. All patients underwent urgent upper GI endoscopy within 24 hours of admission, and 842 patients diagnosed with PUB were enrolled and prospectively followed-up. The cumulative incidence of UGIB was 126/100,000 in the 5-year period. Two out of five patients had a bleeding peptic ulcer; in total, 440 (52.3%) had bleeding gastric ulcer, 356 (42.3%) had bleeding duodenal ulcer, 17 (2%) had both bleeding gastric and duodenal ulcers, and 29 (3.5%) patients had bleeding ulcers on gastroenteric anastomoses. PUB was more common in men. The mean patient age was 65.9 years. The majority of patients (57%) with PUB were taking agents that attenuate the cytoprotective function of gastric and duodenal mucosa. Rebleeding occurred in 77 (9.7%) patients and 47 (5.9%) patients required surgical intervention. The 30-day morality was 5.2% and 10% of patients died from uncontrolled bleeding and concomitant diseases. In conclusion, PUB is the main cause of UGIB, characterized by a significant rebleeding rate and mortality.

  17. Colostomy for anorectal malformation in a tertiary center in Nigeria ...

    African Journals Online (AJOL)

    Background: Anorectal malformations constitute a wide spectrum of congenital anorectal abnormalities ranging from absent anus to anal membranes and fistulae. It is one major indication for the creation of colostomy in early neonatal life. This study was aimed at o describe and highlight the place of colostomy in the ...

  18. Hazardous alcohol use among doctors in a Tertiary Health Center

    Directory of Open Access Journals (Sweden)

    Adetunji Obadeji

    2015-01-01

    Full Text Available Background: Doctors have been identified as one of the key agents in the prevention of alcohol-related harm, however, their level of use and attitudes toward alcohol will affect such role. Aim: This study is aimed at describing the pattern of alcohol use and the predictors of hazardous drinking among hospital doctors. Setting: Study was conducted at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. Design: A cross-sectional survey involving all the doctors in the teaching hospital. Materials and Methods: All the consenting clinicians completed a sociodemographic questionnaire and alcohol use was measured using the 10-item alcohol use disorder identification test (AUDIT and psychological well-being was measured by the 12-item General Health Questionnaire (GHQ-12. Statistical Analysis Used: Statistical analyses were done using the Statistical Package for Social Sciences version 16. Chi-square tests with Yates correction were used to describe the relationship between respondent′s characteristics and AUDIT scores as appropriate. Results: There were a total of 122 participants. Eighty-five (69.7% of them were abstainers, 28 (23% were moderate drinkers, and 9 (7.3% hazardous drinkers. With the exception of age, there was no significant relationship between sociodemographic status, years of practice, specialty of practice, and hazardous alcohol use. Experiencing stress or GHQ score above average is significantly associated with hazardous drinking. Conclusion: Hazardous drinking among hospital doctors appears to be essentially a problem of the male gender, especially among those older than 40 years. Stress and other form of psychological distress seem to play a significant role in predicting hazardous drinking among doctors.

  19. Study of Refractory Status Epilepticus from a Tertiary Care Center.

    Science.gov (United States)

    Kohli, Sahil; Pasangulapati, Suresh Babu; Yoganathan, Sangeetha; Rynjah, Gideon Lyngsyun; Prabhakar, A T; Aaron, Sanjith; Alexander, Mathew; Mathew, Vivek

    2017-01-01

    To determine the proportion of refractory status epilepticus (RSE) and super-RSE (SRSE) among patients with status epilepticus (SE) and to analyze RSE and non-RSE (NRSE) in terms of etiology and predictors for RSE. Patients were identified from discharge summaries database with keywords of SE and records of the portable electroencephalogram (EEG) machine from January 2011 to March 2016. Two hundred and eighteen events were included in the study with 114 (52.3%) males, bimodal age preponderance age status epilepticus severity score (STESS) was predictive for RSE ( P = 0.001). On multivariate analysis, de novo seizures ( P = 0.009) and abnormal EEG at admission ( P = 0.03) were predictive for RSE. Fifty patients had RSE (22.9%), of which 17 went on to become SRSE (7.8%). Unfavorable STESS score was predictive for RSE on bivariate analysis. On multivariate analysis, de novo seizures and abnormal initial EEG were predictors of RSE.

  20. Prevalence of Pancreatic Steatosis at a Pediatric Tertiary Care Center.

    Science.gov (United States)

    Pham, Yen H; Bingham, Brigid A; Bell, Cynthia S; Greenfield, Susan A; John, Susan D; Robinson, Lawrence H; Eissa, Mona A

    2016-03-01

    Pancreatic steatosis in adults has been proposed to be associated with obesity; however, data on pancreatic steatosis in children are lacking. Our study aimed to measure the prevalence of pancreatic steatosis in children and to examine its association with obesity and nonalcoholic fatty liver disease. This is a retrospective chart review study of 232 patients 2 to 18 years old who underwent abdominal computed tomographic imaging in the emergency department or inpatient ward within a 1-year time span and from whom demographics, anthropometrics, and medical history were obtained. Our radiologist determined mean Hounsfield unit (HU) measurements for the pancreas, liver, and spleen. A difference of -20 between the pancreas and spleen (psHU) and between the liver and spleen was used to determine fatty infiltration. Of the 232 patients, 11.5% had a psHU less than -20. The prevalence of pancreatic steatosis was more than double among obese children (19%) than that in nonobese groups (8%). There is a significant correlation between the psHU and liver-spleen HU (r = 0.50, P < 0.001). Pancreatic steatosis was identified in 10% of the study population and is associated with obesity. Also, pancreatic steatosis is significantly associated with nonalcoholic fatty liver disease. This is the first study assessing the prevalence of pancreatic steatosis in children.

  1. European Institutions?

    NARCIS (Netherlands)

    Meacham, Darian

    2016-01-01

    The aim of this article is to sketch a phenomenological theory of political institutions and to apply it to some objections and questions raised by Pierre Manent about the project of the European Union and more specifically the question of “European Construction”, i.e. what is the aim of the

  2. European Whiteness?

    DEFF Research Database (Denmark)

    Blaagaard, Bolette

    2008-01-01

    Born out of the United States’ (U.S.) history of slavery and segregation and intertwined with gender studies and feminism, the field of critical whiteness studies does not fit easily into a European setting and the particular historical context that entails. In order for a field of European...

  3. Phylogenetic and paleobotanical evidence for late Miocene diversification of the Tertiary subtropical lineage of ivies (Hedera L., Araliaceae).

    Science.gov (United States)

    Valcárcel, V; Guzmán, B; Medina, N G; Vargas, P; Wen, J

    2017-06-22

    post-Miocene lineages, with a similar role as consecutive centers of centrifugal dispersal (including islands) and speciation. The Miocene Asian extinction and European survival of Hedera question the general pattern of Tertiary regional extinction of temperate angiosperms in Europe while they survived in Asia. The Tortonian/Messinian diversification increase of ivies in the Mediterranean challenges the idea that this aridity period was responsible for the extinction of the Mediterranean subtropical Tertiary flora. Differential responses of Hedera to geographic barriers throughout its evolutionary history, linked to spatial isolation related to historical geologic and climatic constraints may have shaped diversification of ivies in concert with recurrent polyploidy.

  4. Eastern Dimension of the European Neighbourhood Policy: Europeanization Mutual Trap

    Directory of Open Access Journals (Sweden)

    V. A. Latkina

    2014-01-01

    Full Text Available The article analyses the Europeanization policy of the European Union towards the Eastern Partnership participant countries. Suffering from the lack of clear strategy and ultimate goal in the European Neighbourhood Policy the European Union enhances external democratization and its governance in post soviet states without immediate Union's membership perspective. Underestimation of common neighbourhood geopolitical duality in the context of growing rivalry between European (EU and Eurasian (Custom Union/Eurasian Economic Union integration gravitation centers presents the Eastern partners of the EU with a fierce dilemma of externally forced immediate geopolitical and civilizational choice while not all of them are well prepared to such a choice. The mutual Europeanization trap here to be studied both for the EU and its Eastern partners (involving Russia is a deficiency of regulating cooperation mechanism in the situation of European and Eurasian free trades zones overlapping. Vilnius Summit 2013 results test the "European aspirations" of the New Independent States and upset the ongoing process of the European Neighbourhood Policy in the context of growing economic interdependence in Wider Europe. Besides, the Ukrainian crisis escalation during 2014 as a new seat of tension provokes unbalance of the whole European security system and creates new dividing lines in Europe from Vancouver to Vladivostok.

  5. Selective Europeanization

    DEFF Research Database (Denmark)

    Hoch Jovanovic, Tamara; Lynggaard, Kennet

    2014-01-01

    and rules. The article examines the reasons for both resistance and selectiveness to Europeanization of the Danish minority policy through a “path dependency” perspective accentuating decision makers’ reluctance to deviate from existing institutional commitments, even in subsequently significantly altered...... political contexts at the European level. We further show how the “translation” of international norms to a domestic context has worked to reinforce the original institutional setup, dating back to the mid-1950s. The translation of European-level minority policy developed in the 1990s and 2000s works most...

  6. Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017); Venice (Italy); October 31-November 4, 2017; Session "Quality Improvement, Parents Centered Care"

    OpenAIRE

    --- Various Authors

    2017-01-01

    Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017); Venice (Italy); October 31-November 4, 201758th ESPR Annual Meeting, 7th International Congress of UENPS, 3rd International Congress of EFCNIORGANIZING INSTITUTIONSEuropean Society for Paediatric Research (ESPR), European Society for Neonatology (ESN), Union of European Neonatal & Perinatal Societies (UENPS), European Foundation for the Care of Newborn Infants (EFCNI)ORGANIZING COMMITTEELuc Zi...

  7. European Security

    DEFF Research Database (Denmark)

    Møller, Bjørn

    Theoretical chapters on "Security", "Organisations" and "Regions," Historical Chapters on "Europe and Its Distinguishing Features" and on "The United Nations," "NATO," "The CSCE/OSCE and the Council of Europe" and "The European Union"......Theoretical chapters on "Security", "Organisations" and "Regions," Historical Chapters on "Europe and Its Distinguishing Features" and on "The United Nations," "NATO," "The CSCE/OSCE and the Council of Europe" and "The European Union"...

  8. European Community.

    Science.gov (United States)

    1987-05-01

    The European Community was established in 1951 to reconcile France and Germany after World War II and to make possible the eventual federation of Europe. By 1986, there were 12 member countries: France, Italy, Belgium, the Federal Republic of Germany, Luxembourg, the Netherlands, Denmark, Ireland, the United Kingdom, Greece, Spain, and Portugal. Principal areas of concern are internal and external trade, agriculture, monetary coordination, fisheries, common industrial and commercial policies, assistance, science and research, and common social and regional policies. The European Community has a budget of US$34.035 billion/year, funded by customs duties and 1.4% of each member's value-added tax. The treaties establishing the European Community call for members to form a common market, a common customs tariff, and common agricultural, transport, economic, and nuclear policies. Major European Community institutions include the Commission, Council of Ministers, European Parliament, Court of Justice, and Economic and Social Committee. The Community is the world's largest trading unit, accounting for 15% of world trade. The 2 main goals of the Community's industrial policy are to create an open internal market and to promote technological innovation in order to improve international competitiveness. The European Community aims to contribute to the economic and social development of Third World countries as well.

  9. Occupational hand dermatitis in a tertiary referral dermatology clinic in Taipei.

    Science.gov (United States)

    Sun, C C; Guo, Y L; Lin, R S

    1995-12-01

    Occupational skin disease is one of the most common occupational diseases. The hand is the most frequent site of involvement in occupational skin disease. We interviewed and examined patients seen in the Contact Dermatitis Clinic of the National Taiwan University Medical Center, a tertiary referral center in Taipei City. For patients suspected of having allergic skin diseases, patch testing was carried out using the European standard series and suspected allergens. Occupational hand dermatitis (OHD) was diagnosed according to medical history, work exposure, physical examination, and patch test findings. 36% of patients seen were diagnosed as having OHD. Electronics, hairdressing, medical, chemical, and construction were the most important industries causing OHD. In the 164 patients with OHD, 58.5% had irritant contact dermatitis (ICD) and 41.5% allergic contact dermatitis (ACD). Dorsal fingers, nail folds, and dorsal hands were most frequently involved in patients with ACD; dorsal fingers, volar fingers and fingertips were most frequently involved in those with ICD. Using logistic regression analysis, we were able to identify the most important clinical presentations that predicted the types of OHD, ACD versus ICD. Patients with atopic history and palm involvement were more likely to have ICD, and those with nail fold involvement more likely to have ACD. In patients with ACD, the most important allergens were dichromate, nickel, cobalt, fragrance mix, epoxy resin, thiuram mix, and p-phenylenediamine. In this study, we identified the important industries and causal agents for OHD. Future preventive measures focused on these industries and agents to reduce OHD will be warranted.

  10. Point prevalence survey of antimicrobial utilization in a Canadian tertiary-care teaching hospital

    Directory of Open Access Journals (Sweden)

    Colin Lee

    2015-06-01

    Conclusion: This prospective point prevalence survey provided important baseline information on antimicrobial use within a large tertiary care teaching hospital and identified potential targets for future antimicrobial stewardship initiatives. A multi-center point prevalence survey should be considered to identify patterns of antimicrobial use in Canada and to establish the first steps toward international antimicrobial surveillance.

  11. Profile of Microvascular Disease in Type 2 Diabetes in a Tertiary ...

    African Journals Online (AJOL)

    Background: Diabetes mellitus (DM) is a metabolic disorder complicated by microvascular and macrovascular diseases. The clinical profile of these complications has not been adequately studied in many tertiary health care centers in India. Aim: The authors studied the clinical profile of microvascular diabetes ...

  12. European visit

    CERN Multimedia

    2006-01-01

    The European Commissioner for Science and Research, Janez Potočnik, (on the right) visited the CMS assembly hall accompanied by Jim Virdee, Deputy Spokesman of CMS (on the left), and Robert Aymar, Director-General of CERN. The European Commissioner for Science and Research, Janez Potočnik, visited CERN on Tuesday 31 January. He was welcomed by the Director-General, Robert Aymar, who described the missions and current activities of CERN to him, in particular the realisation of the LHC with its three components: accelerator, detectors, storage and processing of data. The European Commissioner then visited the CMS assembly hall, then the hall for testing the LHC magnets and the ATLAS cavern. During this first visit since his appointment at the end of 2004, Janez Potočnik appeared very interested by the operation of CERN, an example of successful scientific co-operation on a European scale. The many projects (30 on average) that CERN and the European Commission carry out jointly for the benefit of res...

  13. Regionalised tertiary psychiatric residential facilities.

    Science.gov (United States)

    Lesage, Alain; Groden, David; Goldner, Elliot M; Gelinas, Daniel; Arnold, Leslie M

    2008-01-01

    Psychiatric hospitals remain the main venue for long-term mental health care and, despite widespread closures and downsizing, no country that built asylums in the last century has done away with them entirely--with the recent exception of Italy. Differentiated community-based residential alternatives have been developed over the past decades, with staffing levels that range from full-time professional, to daytime only, to part-time/on-call. This paper reviews the characteristics of community-based psychiatric residential care facilities as an alternative to long-term care in psychiatric hospitals. It describes five factors decision makers should consider: 1. number of residential places needed; 2. staffing levels; 3. physical setting; 4. programming; and 5. governance and financing. In Italy, facilities with full-time professional staff have been developed since the mid-1990s to accommodate the last cohorts of patients discharged from psychiatric hospitals. In the United Kingdom, experiments with hostel wards since the 1980s have shown that home-like, small-scale facilities with intensive treatment and rehabilitation programming can be effective for the most difficult-to-place patients. More recently in Australia, Community Care Units (CCUs) have been applying this concept. In the Canadian province of British Columbia (BC), Tertiary Psychiatric Residential Facilities (TPRFs) have been developed as part of an effort to regionalise health and social services and downsize and ultimately close its only psychiatric hospital. This type of service must be further developed in addition to the need for forensic, acute-care and intermediate-level beds, as well as for community-based care such as assertive community treatment and intensive case management. All these types of services, together with long-term community-based residential care, constitute the elements of a balanced mental health care system. As part of a region's balanced mental health care plan, these Tertiary

  14. European hadrons

    International Nuclear Information System (INIS)

    Anon.

    1986-01-01

    The European Hadron Facility (EHF) is a project for particle and nuclear physics in the 1990s which would consist of a fast cycling high intensity proton synchrotron of about 30 GeV primary energy and providing a varied spectrum of intense high quality secondary beams (polarized protons, pions, muons, kaons, antiprotons, neutrinos). The physics case of this project has been studied over the last two years by a European group of particle and nuclear physicists (EHF Study Group), whilst the conceptual design for the accelerator complex was worked out (and is still being worked on) by an international group of machine experts (EHF Design Study Group). Both aspects have been discussed in recent years in a series of working parties, topical seminars, and workshops held in Freiburg, Trieste, Heidelberg, Karlsruhe, Les Rasses and Villigen. This long series of meetings culminated in the International Conference on a European Hadron Facility held in Mainz from 10-14 March

  15. Recruitment Of International Students Into Cameroon Tertiary ...

    African Journals Online (AJOL)

    Recruitment Of International Students Into Cameroon Tertiary Institutions In The Absence Of International Offices. ... The present system of recruiting international students is haphazardly been handled by ... AJOL African Journals Online.

  16. Learning Enhancement in Tertiary Institutions Using Mobile ...

    African Journals Online (AJOL)

    2012-12-01

    Dec 1, 2012 ... model that is still by far the dominant mode of education and learning in tertiary institutions. In addition to identifying ... education has there been a technology that ..... Determinant of Mobile Learning Acceptance: An Empirical.

  17. Tertiary Lymphoid Organs in Takayasu Arteritis.

    Science.gov (United States)

    Clement, Marc; Galy, Adrien; Bruneval, Patrick; Morvan, Marion; Hyafil, Fabien; Benali, Khadija; Pasi, Nicoletta; Deschamps, Lydia; Pellenc, Quentin; Papo, Thomas; Nicoletti, Antonino; Sacre, Karim

    2016-01-01

    The role of B cells in the pathogenesis of Takayasu arteritis (TA) is controversial. We aimed to study the presence of tertiary lymphoid organs (TLOs) in the aortic wall of TA patients. Hematoxylin and eosin-stained sections from aorta specimens from patients with TA were screened for TLOs. The presence of B cell aggregates (CD20), follicular dendritic cells (FDCs, CD21), and high endothelial venules (HEVs, PNAd) was investigated by immunohistochemistry. Immune cells from the adventitial layer of one patient were characterized by flow cytometry. Demographic, medical history, laboratory, imaging, treatment, and follow-up data were extracted from medical records. Aorta specimens from Bentall procedures were available from seven patients (5 females, aged 22-57 years) with TA. Surgical treatment was performed at TA diagnosis (n = 4) or at a median of 108 months (84-156) after TA diagnosis. Disease was active at surgery in four patients according to NIH score. B cell aggregates-TLOs containing HEVs were observed in the adventitia of all but one patient. Of note, ectopic follicles containing CD21(+) FDCs were found in all patients (4/4) with increased aortic (18)F-fluoro-deoxyglucose (FDG) uptake before surgery but were absent in all but one patients (2/3) with no FDG uptake. In addition, flow cytometry analysis confirmed the accumulation of memory/germinal center-like B cells in the adventitial layer and showed the presence of antigen-experienced T follicular helper cells. Ectopic lymphoid neogenesis displaying functional features can be found in the aortic wall of a subset of patients with active TA. The function of these local B cell clusters on the pathogenesis of TA remains to be elucidated.

  18. European Cinema

    NARCIS (Netherlands)

    Elsaesser, Thomas

    2005-01-01

    In the face of renewed competition from Hollywood since the early 1980s and the challenges posed to Europe's national cinemas by the fall of the Wall in 1989, independent filmmaking in Europe has begun to re-invent itself. European Cinema: Face to Face with Hollywood re-assesses the different

  19. Resistance patterns and outcomes in intensive care unit (ICU)-acquired pneumonia. Validation of European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification of multidrug resistant organisms.

    Science.gov (United States)

    Martin-Loeches, Ignacio; Torres, Antonio; Rinaudo, Mariano; Terraneo, Silvia; de Rosa, Francesca; Ramirez, Paula; Diaz, Emili; Fernández-Barat, Laia; Li Bassi, Gian Luigi; Ferrer, Miquel

    2015-03-01

    Bacterial resistance has become a major public health problem. To validate the definition of multidrug-resistant organisms (MDRO) based on the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification. Prospective, observational study in six medical and surgical Intensive-Care-Units (ICU) of a University hospital. Three-hundred-and-forty-three patients with ICU-acquired pneumonia (ICUAP) were prospectively enrolled, 140 patients had no microbiological confirmation (41%), 82 patients (24%) developed ICUAP for non-MDRO, whereas 121 (35%) were MDROs. Non-MDRO, MDRO and no microbiological confirmation patients did not present either a significant different previous antibiotic use (p 0.18) or previous hospital admission (p 0.17). Appropriate antibiotic therapy was associated with better ICU survival (105 [92.9%] vs. 74 [82.2%]; p = 0.03). An adjusted multivariate regression logistic analysis identified that only MDRO had a higher ICU-mortality than non-MDRO and no microbiological confirmation patients (OR 2.89; p < 0.05; 95% CI for Exp [β]. 1.02-8.21); Patients with MDRO ICUAP remained in ICU for a longer period than MDRO and no microbiological confirmation respectively (p < 0.01) however no microbiological confirmation patients had more often antibiotic consumption than culture positive ones. Patients who developed ICUAP due to MDRO showed a higher ICU-mortality than non-MDRO ones and use of ICU resources. No microbiological confirmation patients had more often antibiotic consumption than culture positive patients. Risk factors for MDRO may be important for the selection of initial antimicrobial therapy, in addition to local epidemiology. Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  20. Radioguided parathyroidectomy for tertiary hyperparathyroidism.

    Science.gov (United States)

    Somnay, Yash R; Weinlander, Eric; Alfhefdi, Amal; Schneider, David; Sippel, Rebecca S; Chen, Herbert

    2015-05-15

    Tertiary hyperparathyroidism (3HPT) is defined as the persistent hyperproduction of parathyroid hormone and resulting hypercalcemia after renal transplantation. Here, we examine the utility of radioguided parathyroidectomy (RGP) in patients with 3HPT. We reviewed a prospective surgery database containing 80 3HPT patients who underwent RGP from January 2001-July 2014 at our institution. We evaluated patient demographics, operative management, radioguided neoprobe utilization, and operative outcomes. Data are reported as mean ± standard error of the mean. The mean age of the patients was 52 ± 1 y, and 46% were male. A total of 69 patients had hyperplasia and received subtotal parathyroidectomy, whereas 5 patients had double adenomas and 6 patients had single adenomas. The average calcium level among 3HPT patients was 10.8 ± 0.1 mg/dL preoperatively and 8.7 ± 0.1 mg/dL postoperatively. In vivo radioguided counts normalized to background counts averaged 145 ± 4%, whereas ex vivo counts normalized to background counts averaged 69 ± 5%. All but one ex vivo count was >20%. Ectopically located glands were successfully localized in 38 patients using the gamma probe. Ex vivo percentage did not correlate with parathyroid gland weight, preoperative parathyroid hormone, or preoperative calcium. Our radioguided approach achieved normocalcemia in 96% of 3HPT patients undergoing RGP; two patients developed recurrent disease. In this series, all enlarged parathyroid glands were localized and resected using the gamma probe. Thus, RGP reliably localizes adenomatous, hyperplastic, and ectopically located glands in patients with 3HPT, resulting in high cure rate after resection. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. [Experience in molecular diagnostic in hereditary neuropathies in a pediatric tertiary hospital].

    Science.gov (United States)

    Fernández-Ramos, Joaquín A; López-Laso, Eduardo; Camino-León, Rafael; Gascón-Jiménez, Francisco J; Jiménez-González, M Dolores

    2015-12-01

    Charcot-Marie-Tooth (CMT) is the most common hereditary sensory motor neuropathy. Advances in molecular diagnosis have increased the diagnostic possibilities of these patients. Retrospective study of 36 pediatric patients diagnosed with CMT in a tertiary center in 2003-2015. We found 16 patients were diagnosed by a duplication in PMP22; two cases were diagnosed of hereditary neuropathy with liability to pressure palsies, one with a point mutation in PMP22; a male with a mild demyelinating phenotype, without family history, was diagnosed with GJB1 mutation; in a patient with a peripheral hypotonia at birth and axonal pattern in EMG by mutation in MFN2; a gypsy patient, with consanguineous family, CMT4D, was identified by a mutation in the gene NDRG1; a patient with multiplex congenital arthrogryposis and vocal cord paralysis, whose mother had a scapular-peroneal syndrome, had a congenital spinal muscular atrophy with mild distal axonal neuropathy by mutation in gene TRPV4; three girls, from a gypsy consanguineous family, with axonal CMT with neuromyotonic discharges were diagnosed by a mutation in the gene HINT1; twelve patients haven't molecular diagnosis currently. CMT1A predominated in our series (44%), as previous studies. We emphasize the description of a patient with a mutation in TRPV4 recently described as a cause of CMT2C and three cases, of gypsy consanguineous family, with the same mutation in HINT1 gene, recently described as a cause of axonal neuropathy with neuromyotonia, autosomal recessive (AR-CMT2). The proportion of patients without molecular diagnosis is similar to main European series.

  2. Utility and Actual Use of European and Spanish Guidelines on the Management of Endometrial Cancer Among Gynecologic Oncologists in Spain.

    Science.gov (United States)

    Zapardiel, Ignacio; Blancafort, Claudia; Cibula, David; Jaunarena, Ibon; Gorostidi, Mikel; Gil-Moreno, Antonio; De Santiago, Javier

    2017-07-01

    The aim of the study was to analyze the current management of endometrial cancer across Spain and to evaluate the use and applicability of the national and international guidelines. An electronic 30-question survey was distributed among all Spanish Society of Obstetrics and Gynecology-registered specialists dedicated to gynecologic oncology in Spain by e-mail. Data were collected anonymously and analyzed using SPSS program. One hundred forty-five (17.8%) surveys were collected. Significant differences were observed between tertiary hospitals and secondary or private hospitals in terms of appropriate (according to European Society of Gynaecologic Oncology guidelines) nodal staging in low-risk cases (96 [95%] vs 27 [61.4%], respectively; P comparing centers with less than 20 cases per year to centers with more than 40 cases annually, with significant differences in the management of low-risk and intermediate-risk endometrial cancers. This cross-sectional study demonstrates a broad heterogeneity of care giving between the clinical national and international guidelines and the actual practice in Spain. Although most of the responders refer to base their endometrial cancer management on Spanish and European Society of Gynaecologic Oncology guidelines (64.1%), many discrepancies have been observed, mainly in the management of intermediate-risk cases and follow-up. It may be caused by the lack of consensus on certain points, lack of facilities in lower case load centers, and also due to disagreement or unawareness on the current knowledge.

  3. European astronaut training in Houston.

    Science.gov (United States)

    Chiarenza, O

    1993-11-01

    Three European astronauts are currently training as Space Shuttle Mission Specialists at NASA's Johnson Space Center in Houston. Two of the astronauts, Maurizio Cheli and Jean-Francois Clervoy, recently became members of NASA's 'astronaut pool' and have entered the Advanced Training phase. The third one, Claude Nicollier, is now preparing for the mission to service the Hubble Space Telescope in December.

  4. Mineral metabolism in European children living with a renal transplant: a European society for paediatric nephrology/european renal association-European dialysis and transplant association registry study

    NARCIS (Netherlands)

    Bonthuis, Marjolein; Busutti, Marco; van Stralen, Karlijn J.; Jager, Kitty J.; Baiko, Sergey; Bakkaloğlu, Sevcan; Battelino, Nina; Gaydarova, Maria; Gianoglio, Bruno; Parvex, Paloma; Gomes, Clara; Heaf, James G.; Podracka, Ludmila; Kuzmanovska, Dafina; Molchanova, Maria S.; Pankratenko, Tatiana E.; Papachristou, Fotios; Reusz, György; Sanahuja, Maria José; Shroff, Rukshana; Groothoff, Jaap W.; Schaefer, Franz; Verrina, Enrico

    2015-01-01

    Data on mineral metabolism in pediatric renal transplant recipients largely arise from small single-center studies. In adult patients, abnormal mineral levels are related to a higher risk of graft failure. This study used data from the European Society for Paediatric Nephrology/European Renal

  5. A tertiary care-primary care partnership model for medically complex and fragile children and youth with special health care needs.

    Science.gov (United States)

    Gordon, John B; Colby, Holly H; Bartelt, Tera; Jablonski, Debra; Krauthoefer, Mary L; Havens, Peter

    2007-10-01

    To evaluate the impact of a tertiary care center special needs program that partners with families and primary care physicians to ensure seamless inpatient and outpatient care and assist in providing medical homes. Up to 3 years of preenrollment and postenrollment data were compared for patients in the special needs program from July 1, 2002, through June 30, 2005. A tertiary care center pediatric hospital and medical school serving urban and rural patients. A total of 227 of 230 medically complex and fragile children and youth with special needs who had a wide range of chronic disorders and were enrolled in the special needs program. Care coordination provided by a special needs program pediatric nurse case manager with or without a special needs program physician. Preenrollment and postenrollment tertiary care center resource utilization, charges, and payments. A statistically significant decrease was found in the number of hospitalizations, number of hospital days, and tertiary care center charges and payments, and an increase was found in the use of outpatient services. Aggregate data revealed a decrease in hospital days from 7926 to 3831, an increase in clinic visits from 3150 to 5420, and a decrease in tertiary care center payments of $10.7 million. The special needs program budget for fiscal year 2005 had a deficit of $400,000. This tertiary care-primary care partnership model improved health care and reduced costs with relatively modest institutional support.

  6. Severe accident research in the core degradation area: An example of effective international cooperation between the European Union (EU) and the Commonwealth of Independent States (CIS) by the International Science and Technology Center

    Energy Technology Data Exchange (ETDEWEB)

    Bottomley, D., E-mail: paul.bottomley@ec.europa.eu [ITU Institut fuer Transurane, PO box 2340, 76125 Karlsruhe (Germany); Stuckert, J.; Hofmann, P. [KIT Campus Nord, Hermann-von-Helmholtz Pl. 1, 76344 Eggenstein-Leopoldshafen (Germany); Tocheny, L. [ISTC Krasnoproletarskaya 32-34, PO Box 20, 127473 Moscow (Russian Federation); Hugon, M. [European Commission DG - Research and Tech. Development, Sq. de Meeus, B-1049 Brussels (Belgium); Journeau, C. [CEA, DEN, Cadarache, F13108 St Paul lez Durance (France); Clement, B. [IRSN PSN-RES/SAG Cadarache, BP3 F13115, St Paul lez Durance (France); Weber, S. [GRS Muenchen, Thermal Hydraulics Div., Garching 85748,Germany (Germany); Guentay, S. [PSI NES/LTH OHSA C11, 5232 Villigen (Switzerland); Hozer, Z. [AEKI Fuel Department, P.O. Box 49, Budapest H-1525 (Hungary); Herranz, L. [CIEMAT, Energy -Nuclear Fission Division, Complutense 40, 28040 Madrid (Spain); Schumm, A. [EDF - R and D, SINETICS, Avenue du General de Gaulle 1, Clamart 92140 (France); Oriolo, F. [Pisa University, Ing. Mecc. Nucl. Prod., Largo Lazarino 2, Pisa 56126 (Italy); Altstadt, E. [HZDR Structural Matls, Rossendorf, Postfach 51 01 19, 01314 Dresden (Germany); Krause, M. [AECL - Reactor Safety, Chalk River, Ontario, Canada K0J 1J0 (Canada); Fischer, M. [AREVA NP GMBH, Dept. PEPA-G, 91058 Erlangen (Germany); Khabensky, V.B. [Alexandrov Institute of Technologies (NITI), Sosnovy Bor (Russian Federation); Bechta, S.V. [Kungliga Tekniska Hoegskolan (KTH), AlbaNova University Centre, Roslagstullsbacken 21, SE-106 91 Stockholm (Sweden); Veshchunov, M.S. [Nuclear Safety Institute (IBRAE), Russian Academy of Sciences, 52 B. Tulskaya, Moscow 115191 (Russian Federation); Palagin, A.V. [KIT Campus Nord, Hermann-von-Helmholtz Pl. 1, 76344 Eggenstein-Leopoldshafen (Germany); and others

    2012-11-15

    Highlights: Black-Right-Pointing-Pointer ISTC supported successful nuclear safety projects between EU and Russian institutes. Black-Right-Pointing-Pointer Two-tier project monitoring has proved to be very successful and flexible. Black-Right-Pointing-Pointer Examples are reactor degradation, corium steel corrosion, and corium thermodynamics. - Abstract: The International Science and Technology Center (ISTC) was set up in Moscow to support non-proliferation of sensitive knowledge and technologies in biological, chemical and nuclear domains by engaging scientists in peaceful research programmes with a broad international cooperation. The paper has two following objectives: Bullet to describe the organization of complex, international, experimental and analytical research of material processes under extreme conditions similar to those of severe accidents in nuclear reactors and, Bullet to inform briefly about some results of these studies. The main forms of ISTC activity are Research Projects and Supporting Programs. In the Research Projects informal contact expert groups (CEGs) were set up by ISTC to improve coordination between adjacent projects and to encourage international collaboration. The European Commission was the first to use this. The CEG members - experts from the national institutes and industry - evaluated and managed the projects' scientific results from initial stage of proposal formulation until the final reporting. They were often involved directly in the project's details by joining the Steering Committees of the project. The Contact Expert Group for Severe Accidents and Management (CEG-SAM) is one of these groups, five project groups from this area from the total of 30 funded projects during 10 years of activity are detailed to demonstrate this: (1) QUENCH-VVER from RIAR, Dimitrovgrad and IBRAE, Moscow, and PARAMETER projects (SF1-SF4) from LUCH, Podolsk and IBRAE, Moscow; these concerned a detailed study of bundle quenching from high

  7. Tertiary recovery and tritide injection equipment

    International Nuclear Information System (INIS)

    Li Lin

    1989-01-01

    The exploitation of an oil field is a continously developing process, undergoing seveal stages, such as the low production, the high production, the stable production and the decline. The tertiary recovery is an important means of the enhanced oil recovery. Since the object of the tertiary recovery is to treat the oil in micropores which is difficult to be produced, it is more necessary to know further the reservoir. Tritide can be used as a tracer and is an ideal marker of knowing the reservoir and the state of the fluid movement. The paper presents the tritide injection equipment

  8. European Utility Requirements: European nuclear energy

    International Nuclear Information System (INIS)

    Komsi, M.; Patrakka, E.

    1997-01-01

    The work procedure and the content of the European Utility Requirements (EUR) concerning the future LWRs is described in the article. European Utility Requirements, produced by utilities in a number of European countries, is a document specifying the details relating to engineered safety, operating performance, reliability and economics of the reactors to be built by manufacturers for the European market

  9. Constructivism in Teaching English for Special Purposes at Tertiary School

    Directory of Open Access Journals (Sweden)

    Anna Y. Polenova

    2017-09-01

    Full Text Available The article looks at some principles of constructivism philosophy and the ways they are realized in ESP teaching at tertiary school. The purpose of this article is to describe constructivist teaching approach in enhancing students’ use of appropriate ESP learning strategies. Constructivism is a theory that emphasizes the active role of students in building understanding and making sense of the information. The constructivist teaching is learner-centered where students are actively involved in knowledge construction rather than passive listeners. Students construct knowledge by transforming, organizing, reorganizing previous knowledge through social interaction in construction of knowledge and understanding. The paper is an attempt to examine the principles of constructivist teaching and learning by providing analysis of features of constructivist theory and the organization of a constructivist classroom.

  10. Defensive medicine among obstetricians and gynecologists in tertiary hospitals.

    Directory of Open Access Journals (Sweden)

    Elad Asher

    Full Text Available OBJECTIVE: To describe the daily work practice under the threat of defensive medicine among obstetricians and gynecologists. STUDY DESIGN: A prospective cross-sectional survey of obstetricians and gynecologists working at tertiary medical centers in Israel. RESULTS: Among the 117 obstetricians and gynecologists who participated in the survey, representing 10% of the obstetricians and gynecologists registered by the Israel Medical Association, 113 (97% felt that their daily work practice is influenced by concern about being sued for medical negligence and not only by genuine medical considerations. As a result, 102 (87% physicians are more likely to offer the cesarean section option, even in the absence of a clear medical indication, 70 (60% follow court rulings concerning medical practices, and 85 (73% physicians mentioned that discussions about medical negligence court rulings are included in their departments' meetings. CONCLUSIONS: Defensive medicine is a well-embedded phenomenon affecting the medical decision process of obstetricians and gynecologists.

  11. Solvent effects on the magnetic shielding of tertiary butyl alcohol

    African Journals Online (AJOL)

    )4 and tetramethyl ammonium cation N(CH3)4(+) have also been presented. KEY WORDS: Solvent effects, Magnetic shielding, Tertiary butyl alcohol, Tertiary butyl amine, Continuum solvation calculations, Chemical shift estimation methods

  12. Modelling the harmonized tertiary Institutions Salary Structure ...

    African Journals Online (AJOL)

    This paper analyses the Harmonized Tertiary Institution Salary Structure (HATISS IV) used in Nigeria. The irregularities in the structure are highlighted. A model that assumes a polynomial trend for the zero step salary, and exponential trend for the incremental rates, is suggested for the regularization of the structure.

  13. American Tertiary mollusks of the genus Clementia

    Science.gov (United States)

    Woodring, W.P.

    1927-01-01

    Aside from its value as an aid in determining the age of Tertiary beds, the chief interest of the genus Clementia lies in the anomalous features of its present and former distribution. An attempt is made in this paper to trace its geologic history, to point out its paleobiologic significance, and to describe all the known American Tertiary species. The fossils from Colombia used in preparing this report were collected during explorations made under the direction of Dr. 0. B. Hopkins, chief geologist of the Imperial Oil Co. (Ltd.), who kindly donated them to the United States National Museum. Dr. T. Wayland Vaughan, of the Scripps Institution of Oceanography, furnished information relating to specimens collected by him in Mexico. Dr. Bruce L. Clark, of the University of California; Dr. G. Dallas Hanna, of the California Academy of Sciences; Dr. H. A. Pilsbry, of the Philadelphia Academy of Natural Sciences; and Dr. W. D. Matthew, of the American Museum of Natural History, generously loaned type specimens and other material. Doctor Clark and Doctor Hanna also gave information concerning the Tertiary species from California. Mr. Ralph B. Stewart, of the University of California, read the manuscript, and I have taken advantage of his suggestions. I am also indebted to Mr. L. R. Cox, of the British Museum, for information relating to the fossil species from Persia, Zanzibar, and Burma, and to Dr. Axel A. Olsson, of the International Petroleum Co., for data concerning undescribed Tertiary species from Peru.

  14. Misconception of emergency contraception among tertiary school ...

    African Journals Online (AJOL)

    Objective: To assess the degree of awareness and use of emergency contraception among tertiary school students in Akwa Ibom State, Nigeria. Design: A self-administered questionnaire survey. Setting: The Akwa Ibom State Polytechnic, Ikot Osurua, located on the outskirts of Ikot Ekpene local government area between ...

  15. Understanding Australian Aboriginal Tertiary Student Needs

    Science.gov (United States)

    Oliver, Rhonda; Rochecouste, Judith; Bennell, Debra; Anderson, Roz; Cooper, Inala; Forrest, Simon; Exell, Mike

    2013-01-01

    Drawing from a study of the experiences of Australian Aboriginal and Torres Strait Islander university students, this paper presents an overview of the specific needs of these students as they enter and progress through their tertiary education. Extracts from a set of case studies developed from both staff and student interviews and an online…

  16. Indigenous Students in the Tertiary Education Sector

    Science.gov (United States)

    Bandias, Susan; Fuller, Don; Larkin, Steven

    2014-01-01

    Important recent objectives of indigenous education policy in Australia have been aimed at redressing indigenous economic and social disadvantage through increasing student retention, progression and completion rates in both compulsory and post-compulsory education. The two sectors of the tertiary education system, vocational education and…

  17. SECTORAL ANALYSIS: GROWTH ACCOUNTING OF TERTIARY INDUSTRIES

    Directory of Open Access Journals (Sweden)

    Yahya Z. ALSHEHHI

    2017-08-01

    Full Text Available The tertiary sector is one of the modern styles of economic systems in view of the share it occupies in the field of production as well as employment occupied share. Hence, just like other lands, the UAE, witnessed an economic structural change similar to developed and developing nations, where the tertiary industries contributed 55.4% in 2015 to total country’s income. The empirical study aimed to analyze the contribution portion of growth in the tertiary industries through using the growth accounting framework in time-series from 1990 to 2015. The empirical study found that most of the industries contributed significantly to the growth of the tertiary sector. The contribution shares of growth due to labor and capital varied among industries. The main observed results show that there was a vice versa relationship between TFP performance and the size of labor, where the TFP positively corresponded with the decline in the size of labor specifically from 2010-2015.

  18. Risk of malignancy index used as a diagnostic tool in a tertiary centre for patients with a pelvic mass

    DEFF Research Database (Denmark)

    Håkansson, Fanny; Høgdall, Estrid V S; Nedergaard, Lotte

    2012-01-01

    Abstract Objective. Risk of malignancy index (RMI), based on a serum cancer antigen 125 level, ultrasound findings and menopausal status, is used to discriminate ovarian cancer from benign pelvic mass. In Denmark, patients with pelvic mass and RMI =200 are referred to tertiary gynecologic oncology...... the use of RMI =200 as a tool for preoperative identification of ovarian cancer at a tertiary center. Design. Prospective observational study. Setting. A tertiary center in Copenhagen, Denmark. Population. One thousand one hundred and fifty-nine women with pelvic mass. Methods. The RMI was calculated...... pelvic mass. Results. There were 778 women diagnosed with benign pelvic mass, while 251 had ovarian cancer and 74 had borderline ovarian tumor. Fifty-six women were diagnosed with other forms of cancer. Sensitivity and specificity for ovarian cancer vs. benign pelvic mass for RMI =200 were 92 and 82...

  19. Economics of Tertiary Education - Challenges and dynamics of the public tertiary education in Albania

    Directory of Open Access Journals (Sweden)

    Gledian Llatja

    2016-07-01

    Full Text Available The tertiary education is a critic mechanism for the socio-economic progress, for individuals who aspire a brighter future and it is also considered an important catalyzer of the economic mobility (Department of Treasury and Department of Education, 2012, 2. Based on the positive role and impact that the tertiary education has on the sustainable development, President Obama once stated that it is of damage to treat education as a luxurious public service. In line with the general considerations about the tertiary education in the U.S. the parallel comparison with Albania comes as a direct interpretation of utopia in the education policy-making. As policies are usually drafted based on data and findings, in the case of Albania there is a lack of data on expenses on tertiary education as share of GDP. This stands also for the main limitation of the paper.

  20. Diversification Management at Tertiary Education Level: A Review

    Science.gov (United States)

    Takwate, Kwaji Tizhe

    2016-01-01

    This paper examines the concept of management of diversification at tertiary education level in view of the growth of national secondary education system which vested high scramble for tertiary education was made in relation to question of access and expansion. This paper examines management of diversification at tertiary education level as a…

  1. Tertiary Education in the Czech Republic: The Pathway to Change

    Science.gov (United States)

    Pesik, Richard; Gounko, Tatiana

    2011-01-01

    This article analyzes recent policy proposals to reform Czech tertiary education. A brief overview of the evolution of Czech tertiary education presents the background against which emerging policy trends in education are examined. We relate the changes in tertiary education to the policy framework and recommendations of the OECD, underpinned by…

  2. Bahrain’s tertiary education reform : a step towards sustainable economic development

    OpenAIRE

    Karolak, Magdalena

    2012-01-01

    Bahrain has been experiencing along with other Gulf Council Cooperation countries a rapid development of its tertiary sector of education. The 2000's were marked by a boom in education with the opening of twelve private universities in this country of roughly 1 million inhabitants. Some institutions were locally based, while others worked in affiliation with foreign based universities. It is in sharp contrast with the 1990's, when only three public universities served as centers of higher edu...

  3. Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017; Venice (Italy; October 31-November 4, 2017; Session "Quality Improvement, Parents Centered Care"

    Directory of Open Access Journals (Sweden)

    --- Various Authors

    2017-10-01

    Full Text Available Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017; Venice (Italy; October 31-November 4, 201758th ESPR Annual Meeting, 7th International Congress of UENPS, 3rd International Congress of EFCNIORGANIZING INSTITUTIONSEuropean Society for Paediatric Research (ESPR, European Society for Neonatology (ESN, Union of European Neonatal & Perinatal Societies (UENPS, European Foundation for the Care of Newborn Infants (EFCNIORGANIZING COMMITTEELuc Zimmermann (President of ESPR, Morten Breindahl (President of ESN, Manuel Sánchez Luna (President of UENPS, Silke Mader (Chairwoman of the Executive Board and Co-Founder of EFCNISCIENTIFIC COMMITTEEVirgilio P. Carnielli (Congress President Chair, Pierre Gressens (Past Scientific President, Umberto Simeoni, Manon Benders, Neil Marlow, Ola D. Saugstad, Petra Hüppi, Agnes van den HoogenSession "Quality Improvement, Parents Centered Care"ABS 1. REDUCING MEDICATION ERRORS IN NICU – A QUALITY IMPROVEMENT PROJECT • D.A. Al Masri, B. Ofoegbu, L. Yahya, K. Catroon, A. Saliba, H. IbrahimABS 2. PRETERM INFANTS WITH MEDICAL COM­PLEXITY: IMPACT ON HEALTH CARE RESOURCE USE, FAMILY EMPLOYMENT AND NEURODEVELOPMENTAL OUTCOMES • D. Nassel, C. Chartrand, M.-J. Doré-Bergeron, M. Ballantyne, F. Lefebvre, T.M. LuuABS 3. BREAST MILK DONATION IN THE MUSLIM POPULATION • S. Jebali, E. Ayachi, R. Terki Hassaine, A. Giuseppi, D. Vaiman, S. Brunet, V. RigourdABS 4. CORE OUTCOMES IN NEONATOLOGY: PRELIMINARY RESULTS • J. Webbe, N. Modi, C. Gale, on behalf of the COIN Steering GroupABS 5. A PILOT STUDY ASSESSING THE EFFECTIVENESS OF A FAMILY-CENTERED CARE INTERVENTION IN PRETERM INFANTS IN CHINA • R. Zhang, R. Huang, X. Gao, X. Peng, L. Zhu, R. Ramanathan, J. LatourABS 6. TO DETERMINE HOW MANY MOTHERS OF PRETERM BABIES, WHO WERE DELIVERED BETWEEN 24 AND 34 WEEKS GESTATION AND WERE ADMITTED TO NEONATAL UNIT AT ST. MARY’ S HOSPITAL, DID NOT RECEIVE ANTENATAL STEROIDS • A. Arunoday, A. Manou

  4. European nuclear education initiatives

    International Nuclear Information System (INIS)

    Glatz, Jean-Paul

    2011-01-01

    Whatever option regarding their future nuclear energy development is chosen by European Union Member States, the availability of a sufficient number of well trained and experienced staff is key for the responsible use of nuclear energy. This is true in all areas including design, construction, operation, decommissioning, fuel cycle and waste management as well as radiation protection. Given the high average age of existing experts leading to a significant retirement induce a real risk of the loss of nuclear competencies in the coming years. Therefore the demand of hiring skilled employees is rising. The challenge of ensuring a sufficient number of qualified staff in the nuclear sector has been acknowledged widely among the different stakeholders, in particular the nuclear industry, national regulatory authorities and Technical Support Organisations (TSOs). Already the EURATOM Treaty refers explicitly to the obligation for the Commission to carry out training actions. Recently initiatives have been launched at EU level to facilitate and strengthen the efforts of national stakeholders. The European Nuclear Education Network (ENEN) Association aims at preservation and further development of expertise in the nuclear field by higher education and training. The goal of the European Nuclear Energy Leadership Academy (ENELA) is to educate future leaders in the nuclear field to ensure the further development of sustainable European nuclear energy solutions The European Nuclear Energy Forum (ENEF) is a platform operated by the European Commission for a broad discussion on the opportunities and risks of nuclear energy. The nuclear programs under investigation in the Joint Research Center (JRC) are increasingly contributing to Education and Training (E and T) initiatives, promoting a better cooperation between key players and universities as well as operators and regulatory bodies in order to mutually optimise their training programmes. Another objective is to increase

  5. Tertiary Treatment Process of Preserved Wastewater

    Directory of Open Access Journals (Sweden)

    Wang Qingyu

    2016-01-01

    Full Text Available The effects of the composite coagulants on coagulation sedimentation for the preserved wastewater was investigated by changing the composite coagulant dosages, and the coagulant was composed of polymeric ferric sulfate (PFS, polyaluminium chloride (PAC, and polyaluminum ferric silicate (PAFSC, while the effect of the tertiary treatment process on the preserved wastewater was tested, which was exceeded the standard seriously. The results showed that 400 mg/L was the optimum composite coagulant dosage. The removal rates of salt and sugar were as high as 99.1% and 99.5% respectively, and the removal rates of CODCr and SS were 99.3% and 96.0%, respectively after the preserved wastewater was treated by the tertiary treatment technology, which both reached the primary standard of “The Integrated Wastewater Discharge Standard” (GB8978-1996.

  6. Optimising Tertiary Student Accommodation within University Neighbourhoods

    OpenAIRE

    Ike, Nnenna; Baldwin, Claudia; Lathouras, Athena

    2017-01-01

    Tertiary students’ activities within neighbourhoods adjacent to universities engender positive and negative impacts that have consequences for neighbourhood sustainability. This might lead to studentification, a process that triggers physical, economic and socio-cultural transformation of university towns. Where non-student residents perceive negative impacts, it can lead to conflict and resentment towards the student population, mistrust between student and local resident groups and a decrea...

  7. Tertiary lymphoid organs in Takayasu Arteritis

    OpenAIRE

    Marc eClement; Marc eClement; Adrien eGaly; Patrick eBruneval; Marion eMorvan; Fabien eHyafil; Fabien eHyafil; Khadija eBenali; Nicoletta ePasi; Lydia eDeschamps; Quentin ePellenc; Quentin ePellenc; Thomas ePapo; Antonino eNicoletti; Antonino eNicoletti

    2016-01-01

    Objective: The role of B cells in the pathogenesis of Takayasu arteritis (TA) is controversial. We aimed to study the presence of tertiary lymphoid organs (TLOs) in the aortic wall of TA patients.Methods: Hematoxylin and eosin–stained sections from aorta specimens from patients with TA were screened for TLOs. The presence of B cell aggregates (CD20), follicular dendritic cells (FDCs, CD21), and high endothelial venules (HEVs, PNAd) was investigated by immunohistochemistry. Immune cells from t...

  8. Tertiary Lymphoid Organs in Takayasu Arteritis

    OpenAIRE

    Clement, Marc; Galy, Adrien; Bruneval, Patrick; Morvan, Marion; Hyafil, Fabien; Benali, Khadija; Pasi, Nicoletta; Deschamps, Lydia; Pellenc, Quentin; Papo, Thomas; Nicoletti, Antonino; Sacre, Karim

    2016-01-01

    Objective The role of B cells in the pathogenesis of Takayasu arteritis (TA) is controversial. We aimed to study the presence of tertiary lymphoid organs (TLOs) in the aortic wall of TA patients. Methods Hematoxylin and eosin-stained sections from aorta specimens from patients with TA were screened for TLOs. The presence of B cell aggregates (CD20), follicular dendritic cells (FDCs, CD21), and high endothelial venules (HEVs, PNAd) was investigated by immunohistochemistry. Immune ce...

  9. European Studies

    Directory of Open Access Journals (Sweden)

    V. O. Pechatnov

    2014-01-01

    Full Text Available The study of Western countries and teaching courses on the related subjects have longstanding and established tradition at MGIMO-University. The basis of this brilliant research and teaching tradition was laid down by such academicians as E.V. Tarle and V.G. Trukhanovsky, Professor L.I. Clove, Y. Borisov, F.I. Notovitch, G.L. Rozanov. Their work in 1940-1960's at the Department of World History at MGIMO-University progressed in following directions: France studies, German studies, American studies. The work resulted in a number of monographs and textbooks on modern history and foreign policy of the studied countries and regions. The aim of the publications was dictated by the goal of the Institute - to prepare the specialists in international affairs primarily for practical work. A close relationship with the Foreign Ministry was "binding advantage" sometimes limiting researchers in choosing periods and subjects for the study. At the same time the undisputed advantage and quality of regional studies at MGIMO were strengthened by the practical relevance of research, making it a vital and interesting not only for specialists but also for students and researchers from other research centers. Another characteristic of the tradition is the analysis of foreign policy and diplomacy in a close relationship with the socio-economic and political processes. Such an integrated approach to regional geography also formed largely under the influence of institutional profile designed to train highly skilled and versatile specialists in specific countries and regions with a good knowledge of their languages, history, economics, politics, law and culture. Therefore, scientific and educational-methodical work at MGIMO-University has always relied on a wealth of empirical data and has been focused on the analysis of real-world phenomena and processes, acute problems of foreign countries. Scientific research at MGIMO-University traditionally intertwined with

  10. The European Central Bank and the Eurosystem

    OpenAIRE

    Carol C. Bertaut

    2002-01-01

    The Eurosystem comprises the European Central Bank at its center as well as the national central banks of the twelve countries currently participating in monetary union. The European Central Bank was established in July 1998, six months before the beginning of Stage Three of economic and monetary union. Although decisions regarding monetary policy are made centrally by the Governing Council of the Eurosystem, the operational aspects of monetary policy-including open market operations, adminis...

  11. European Unity – Between Philosophy and Ideology

    Directory of Open Access Journals (Sweden)

    Lorena Stuparu

    2011-09-01

    Full Text Available Parallel or tacit agreement with the European cultural model, union political projects have evolved over time from imperial ambitions in the global democratic principles. The current project of European integration, initiated by Pan Europe manifesto as an philosophical-political alternative centered on the individual, personality and freedom ideas has a striking table normative component, for both theoretical and ideological initiatives are under the sign of moral imperative, i.e. the soteriological peaceful shade.

  12. Launch Vehicle Control Center Architectures

    Science.gov (United States)

    Watson, Michael D.; Epps, Amy; Woodruff, Van; Vachon, Michael Jacob; Monreal, Julio; Williams, Randall; McLaughlin, Tom

    2014-01-01

    This analysis is a survey of control center architectures of the NASA Space Launch System (SLS), United Launch Alliance (ULA) Atlas V and Delta IV, and the European Space Agency (ESA) Ariane 5. Each of these control center architectures have similarities in basic structure, and differences in functional distribution of responsibilities for the phases of operations: (a) Launch vehicles in the international community vary greatly in configuration and process; (b) Each launch site has a unique processing flow based on the specific configurations; (c) Launch and flight operations are managed through a set of control centers associated with each launch site, however the flight operations may be a different control center than the launch center; and (d) The engineering support centers are primarily located at the design center with a small engineering support team at the launch site.

  13. Detachment of Tertiary Dendrite Arms during Controlled Directional Solidification in Aluminum - 7 wt Percent Silicon Alloys: Observations from Ground-based and Microgravity Processed Samples

    Science.gov (United States)

    Grugel, Richard N.; Erdman, Robert; Van Hoose, James R.; Tewari, Surendra; Poirier, David

    2012-01-01

    Electron Back Scattered Diffraction results from cross-sections of directionally solidified aluminum 7wt% silicon alloys unexpectedly revealed tertiary dendrite arms that were detached and mis-oriented from their parent arm. More surprisingly, the same phenomenon was observed in a sample similarly processed in the quiescent microgravity environment aboard the International Space Station (ISS) in support of the joint US-European MICAST investigation. The work presented here includes a brief introduction to MICAST and the directional solidification facilities, and their capabilities, available aboard the ISS. Results from the ground-based and microgravity processed samples are compared and possible mechanisms for the observed tertiary arm detachment are suggested.

  14. Stereoinversion of tertiary alcohols to tertiary-alkyl isonitriles and amines.

    Science.gov (United States)

    Pronin, Sergey V; Reiher, Christopher A; Shenvi, Ryan A

    2013-09-12

    The SN2 reaction (bimolecular nucleophilic substitution) is a well-known chemical transformation that can be used to join two smaller molecules together into a larger molecule or to exchange one functional group for another. The SN2 reaction proceeds in a very predictable manner: substitution occurs with inversion of stereochemistry, resulting from the 'backside attack' of the electrophilic carbon by the nucleophile. A significant limitation of the SN2 reaction is its intolerance for tertiary carbon atoms: whereas primary and secondary alcohols are viable precursor substrates, tertiary alcohols and their derivatives usually either fail to react or produce stereochemical mixtures of products. Here we report the stereochemical inversion of chiral tertiary alcohols with a nitrogenous nucleophile facilitated by a Lewis-acid-catalysed solvolysis. The method is chemoselective against secondary and primary alcohols, thereby complementing the selectivity of the SN2 reaction. Furthermore, this method for carbon-nitrogen bond formation mimics a putative biosynthetic step in the synthesis of marine terpenoids and enables their preparation from the corresponding terrestrial terpenes. We expect that the general attributes of the methodology will allow chiral tertiary alcohols to be considered viable substrates for stereoinversion reactions.

  15. managing tertiary institutions for the promotion of lifelong learning

    African Journals Online (AJOL)

    Global Journal

    KEYWORDS: Managing, tertiary institutions, promotion, lifelong learning. INTRODUCTION ... science, medicine and technology towards the ... different environments, whether formal, informal ... schools considering that each day gives birth to.

  16. Health status in 1040 adults with disorders of sex development (DSD: a European multicenter study

    Directory of Open Access Journals (Sweden)

    Henrik Falhammar

    2018-03-01

    Full Text Available Objective: The knowledge about health status in adults with disorder of sex development (DSD is scarce. Design and methods: A cross-sectional observational study in 14 European tertiary centers recruited 1040 participants (717 females, 311 males, 12 others with DSD. Mean age was 32.4 ± 13.6 year (range 16–75. The cohort was divided into: Turner (n = 301, Klinefelter (n = 224, XY-DSD (n = 222, XX-DSD (excluding congenital adrenal hyperplasia (CAH and 46,XX males (n = 21, 46,XX-CAH (n = 226 and 45,X/46,XY (n = 45. Perceived and objective health statuses were measured and compared to European control data. Results: In DSD, fair to very good general health was reported by 91.4% and only 8.6% reported (very bad general health (controls 94.0% and 6.0%, P < 0.0001. Longstanding health issues other than DSD and feeling limited in daily life were reported in 51.0% and 38.6%, respectively (controls 24.5% and 13.8%, P < 0.0001 both. Any disorder except DSD was present in 84.3% (controls 24.6%, P < 0.0001. Males reported worse health than females. In the subgroup analysis, Klinefelter and 46, XX-DSD patients reported bad general health in 15.7% and 16.7%, respectively (Turner 3.2% and CAH 7.4%. Comorbidities were prevalent in all DSD subgroups but Klinefelter and Turner were most affected. Early diagnosis of DSD and a healthy lifestyle were associated with less comorbidities. Conclusions: Overall, general health appeared to be good but a number of medical problems were reported, especially in Klinefelter and Turner. Early diagnosis of DSD and a healthy lifestyle seemed to be important. Lifelong follow-up at specialized centers is necessary.

  17. Open-Access Single Balloon Enteroscopy: A Tertiary Care Experience.

    Science.gov (United States)

    Holman, Nathan; Wallace, Kristin; Moore, J Matthew; Brock, Andrew S

    2015-12-01

    To compare single balloon enteroscopy (SBE) between patients seen in consultation by a member of our gastroenterology team with those performed as open-access cases. Retrospective study of all patients who underwent SBE at a single tertiary care center from April 2008 to January 2012. Open- and closed-access procedures were compared in terms of diagnostic and therapeutic yield, adverse events, and procedural success. A total of 125 SBEs were performed on 125 patients. The mean age was 63.1 (53% men) years. In all, 43 procedures were performed open access and 82 after face-to-face consultation. Indications included anemia/gastrointestinal bleeding (110), abdominal pain (8), and other (7). Diagnostic yield for open- and closed-access procedures was 53% and 60%, respectively (P = 0.501) and therapeutic yield was 37% and 52%, respectively (P = 0.11). Overall technical success was 91% with no difference between the groups (P = 0.27). There were no major adverse events in either group. SBE can be performed as an open-access procedure without compromise to safety or diagnostic yield.

  18. Determinants of propensity of tertiary agricultural students in Ghana ...

    African Journals Online (AJOL)

    The study aimed to identify factors that affect the decision of tertiary agricultural students in Ghana to enter agribusiness as a self-employment venture after graduation. The results showed that tertiary agricultural students in Ghana were predominantly males with little or no farming background. They had a rather moderate ...

  19. Crime and Crime Management in Nigeria Tertiary Institutions

    Science.gov (United States)

    Adebanjo, Margaret Adewunmi

    2014-01-01

    This paper examines crime and its management in Nigerian tertiary institutions. Tertiary institutions today have become arenas for crime activities such as rape, cultism, murder, theft, internet fraud, drug abuse, and examination malpractices. This paper delves into what crime is, and its causes; and the positions of the law on crime management.…

  20. Massification and Quality Assurance in Tertiary Education: The ...

    African Journals Online (AJOL)

    The study sets out to examine massification and its impact on quality assurance in tertiary education and the extent to which lecturer–student ratio, adequacy of infrastructure and pedagogical resources affect quality in tertiary institutions. Two research questions and one hypothesis were posed to guide the investigation.

  1. Pushing the frontiers of atomic models for protein tertiary structure ...

    Indian Academy of Sciences (India)

    as an NP complete or NP hard problem.4,5 This notwith- standing, the dire need for tertiary structures of proteins in drug discovery and other areas6–8 has propelled the development of a multitude of computational recipes. In this article, we focus on ab initio/de novo strategies,. Bhageerath in particular, for protein tertiary ...

  2. Academic mentoring and the future of tertiary education in Nigeria ...

    African Journals Online (AJOL)

    Tertiary education is a major outlet for the provision of high manpower for national development. This paper therefore highlighted the challenges of tertiary education in Nigeria, early perspectives of mentoring undergraduates, the rationale for academic mentoring, the role of a mentor, and the role of library as catalyst in the ...

  3. Ensuring Effective Mentoring in Tertiary Institutions in Anambra State ...

    African Journals Online (AJOL)

    This paper concerns itself only with ascertaining the strategies that could ensure effective mentoring in tertiary institutions. The survey method was employed. The study population comprised 78 teacher educators in tertiary institutions in Anambra State. One research question guided the study while one null hypothesis was ...

  4. 10 CFR 212.78 - Tertiary incentive crude oil.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Tertiary incentive crude oil. 212.78 Section 212.78 Energy DEPARTMENT OF ENERGY OIL MANDATORY PETROLEUM PRICE REGULATIONS Producers of Crude Oil § 212.78 Tertiary incentive crude oil. Annual prepaid expenses report. By January 31 of each year after 1980, the project...

  5. Literacy Skills Development for Tertiary Institutions: A Case Study of ...

    African Journals Online (AJOL)

    Literacy Skills Development for Tertiary Institutions: A Case Study of the University of Calabar. ... These were drawn from five faculties, namely Education, Social Sciences, Law, Arts and Agriculture. The study observed that there is a ... more literacy skills. Key Words: Literacy skills, university, Nigeria, tertiary institution ...

  6. European Vegetation Archive (EVA)

    NARCIS (Netherlands)

    Chytrý, Milan; Hennekens, S.M.; Jiménez-Alfaro, Borja; Schaminée, J.H.J.; Haveman, Rense; Janssen, J.A.M.

    2016-01-01

    The European Vegetation Archive (EVA) is a centralized database of European vegetation plots developed by the IAVS Working Group European Vegetation Survey. It has been in development since 2012 and first made available for use in research projects in 2014. It stores copies of national and

  7. Seepage characteristics of the second tertiary combined model

    Directory of Open Access Journals (Sweden)

    Huan ZHAO

    2015-08-01

    Full Text Available The second tertiary combined model experiment zone has been developed in Block B, Field L. The percolation feature of the second tertiary combined develop model shows great importance to rational and efficient development of the reservoir. In order to clearly illuminate its percolation feature, the typical reservoir numerical model is built by Eclipse, which is a reservoir numerical simulation software. The percolation features of original and added perforation interval under the second tertiary combined model are studied, and the variation features of general water-cut, recovery percentage, wellbore pressure, reservoir pressure and water saturation on condition of higher injection rate under the second tertiary combined model are analyzed. The research indicates that the second tertiary combined enhances the recovery of remaining oil on top of thick reservoir by developing and enhancing original perforation interval under water drive, then improves development results by polymer flooding, and gains higher recovery rate by synthetic action of water driver and polymer flooding.

  8. Integrated complex care coordination for children with medical complexity: A mixed-methods evaluation of tertiary care-community collaboration

    Directory of Open Access Journals (Sweden)

    Cohen Eyal

    2012-10-01

    Full Text Available Abstract Background Primary care medical homes may improve health outcomes for children with special healthcare needs (CSHCN, by improving care coordination. However, community-based primary care practices may be challenged to deliver comprehensive care coordination to complex subsets of CSHCN such as children with medical complexity (CMC. Linking a tertiary care center with the community may achieve cost effective and high quality care for CMC. The objective of this study was to evaluate the outcomes of community-based complex care clinics integrated with a tertiary care center. Methods A before- and after-intervention study design with mixed (quantitative/qualitative methods was utilized. Clinics at two community hospitals distant from tertiary care were staffed by local community pediatricians with the tertiary care center nurse practitioner and linked with primary care providers. Eighty-one children with underlying chronic conditions, fragility, requirement for high intensity care and/or technology assistance, and involvement of multiple providers participated. Main outcome measures included health care utilization and expenditures, parent reports of parent- and child-quality of life [QOL (SF-36®, CPCHILD©, PedsQL™], and family-centered care (MPOC-20®. Comparisons were made in equal (up to 1 year pre- and post-periods supplemented by qualitative perspectives of families and pediatricians. Results Total health care system costs decreased from median (IQR $244 (981 per patient per month (PPPM pre-enrolment to $131 (355 PPPM post-enrolment (p=.007, driven primarily by fewer inpatient days in the tertiary care center (p=.006. Parents reported decreased out of pocket expenses (p© domains [Health Standardization Section (p=.04; Comfort and Emotions (p=.03], while total CPCHILD© score decreased between baseline and 1 year (p=.003. Parents and providers reported the ability to receive care close to home as a key benefit. Conclusions Complex

  9. Navigating the global space of tertiary education:

    DEFF Research Database (Denmark)

    Wilken, Lisanne

    , and to the development of transnational elites. This is especially true for mobile students who attend “elite universities” in the USA, UK and France. As pointed out by sociologist Michael Börjesson (2005), an investment in an education at one of the American Ivy League universities or France’s Grand Ecoles, is not only......Over the past ten years the number of students who go abroad to pursue tertiary education has more than doubled, from 1, 9 million in 2000 to 4.1 million in 2010 (OECD 2012). This growing number of students studying abroad contributes to the overall flow of individuals and ideas across borders...... an investment in a significant educational capital with global applicability, but also an investment in an institutionalized transnational social capital that stretches across most of the world. It is less clear to what extent this also applies to students who go abroad to attend international programs...

  10. Patient satisfaction with care in an urban tertiary referral academic glaucoma clinic in the US

    Directory of Open Access Journals (Sweden)

    Peterson KM

    2018-05-01

    Full Text Available Kristen M Peterson, Carrie E Huisingh, Christopher Girkin, Cynthia Owsley, Lindsay A Rhodes Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA Background: The purpose of this study was to determine the factors associated with glaucoma patients’ satisfaction with their medical care by fellowship-trained glaucoma specialists in an urban tertiary referral clinic in the US.Methods: A total of 110 established patients aged ≥60 years with a diagnosis of either primary open angle glaucoma, glaucoma suspect, or ocular hypertension monitored by an ophthalmologist with fellowship training in glaucoma were enrolled at an academic, urban, tertiary referral eye clinic. Enrolled patients were administered a general demographics questionnaire along with a Patient Satisfaction Questionnaire-18 (PSQ-18, a Likert scale validated tool. The seven dimensions of patient satisfaction from the PSQ-18 were summarized for the sample overall and by the patients’ age, race, employment status, education level, distance travelled from home address to clinic, and glaucoma therapy type. Two-sample t-tests were used to compare group means. Spearman correlation coefficients were used to correlate satisfaction scores with peripheral vision and visual acuity function.Results: Overall, the general satisfaction scores were high (mean 4.62. Patients ≥70 years of age had lower general satisfaction with their care (mean 4.5 vs 4.8, p=0.03, the interpersonal manner of their appointment (mean 4.7 vs 4.9, p=0.009, and with their time spent with their doctor (mean 4.4 vs 4.7, p=0.03 than patients aged 60–69 years. Non-European descent patients (47% African descent and 1% other of sample were more satisfied with the time they spent with the doctor (mean 4.7 vs 4.4, p=0.04 and with the communication during the appointment (mean 4.8 vs 4.6, p=0.04 than European descent patients (52% of sample. Patients with a higher level of

  11. A European Research Area

    International Nuclear Information System (INIS)

    Caro, R.

    2001-01-01

    This article is a summary of the presentation of the European Commissioner, Philippe Busquen, to the European Parliament (beginning of year 2000) with the proposal and method for a revival of the Research and Development in this wider sense in the European Union. The starting point of his thesis is that Europe performs less, and more disorderly, activities in this field that her main competitors. USA and Japan. His basic proposal is a larger coordination among the european research projects, with a previous phase of informatics intoxicator among the european research centres and the cross-linked participation, real of virtual in the experiments and projects. (Author)

  12. European Competence Network on Mastocytosis (ECNM)

    DEFF Research Database (Denmark)

    Valent, Peter; Arock, Michel; Bonadonna, Patrizia

    2012-01-01

    The European Competence Network on Mastocytosis (ECNM) was initiated in 2002 as a multidisciplinary and multinational cooperative approach to increase awareness and to improve diagnosis and therapy of mastocytosis. The network is composed of local centers, physicians, and scientists who have dedi...

  13. Usage Center

    DEFF Research Database (Denmark)

    Kleinaltenkamp, Michael; Plewa, Carolin; Gudergan, Siegfried

    2017-01-01

    Purpose: The purpose of this paper is to advance extant theorizing around resourceintegration by conceptualizing and delineating the notion of a usage center. Ausage center consists of a combination of interdependent actors that draw onresources across their individual usage processes to create v...

  14. Sustained Reduction in Bloodstream Infections in Infants at a Large Tertiary Care Neonatal Intensive Care Unit

    Science.gov (United States)

    Neill, Sara; Haithcock, Sarah; Smith, P. Brian; Goldberg, Ronald; Bidegain, Margarita; Tanaka, David; Carriker, Charlene; Ericson, Jessica E.

    2015-01-01

    Purpose Reduction of bloodstream infections (BSI) has emerged as an important patient safety goal. Implementation of central line insertion bundles, standardized line care protocols, and health care provider education programs have reduced BSI in neonatal intensive care units (NICUs) around the country. The ability of large tertiary care centers to decrease nosocomial infections, including BSI, has been demonstrated. However, long-term BSI reductions in infants are not well documented. We sought to demonstrate that a low incidence of BSI can be maintained over time in a tertiary care NICU. Subjects 6,790 infants admitted to a large, tertiary care NICU between 2005 and 2013. Design Retrospective intervention study. Methods A staged, multifaceted infection prevention plan was implemented beginning in October 2007 under nursing leadership. The incidence of BSI was determined annually for 2005-2013. Results Baseline BSI incidence for infants admitted to the NICU was 5.15 and 6.08 episodes per 1,000 infant-days in 2005 and 2006, respectively. After protocol implementation, the incidence of BSI decreased to 2.14/1,000 infant-days and 2.44/1,000 infant-days in 2008 and 2009, respectively. Yearly incidence remained low over the next 4 years and decreased even further to 0.20-0.45 infections/1,000 infant days. This represents a 92% decrease in BSI over a period of >5 years. Conclusions Implementation of a nursing-led comprehensive infection control initiative can effectively produce and maintain a reduction in the incidence of BSI in infants at a large tertiary care NICU. What this study adds Long term reductions in neonatal BSI are possible with implementation of a multidisciplinary team approach and strong nursing leadership. PMID:25915573

  15. Neuromodulation of chronic headaches: position statement from the European Headache Federation

    Science.gov (United States)

    2013-01-01

    The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases. Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches. In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile. PMID:24144382

  16. Mixed La-Li heterobimetallic complexes for tertiary nitroaldol resolution.

    Science.gov (United States)

    Tosaki, Shin-ya; Hara, Keiichi; Gnanadesikan, Vijay; Morimoto, Hiroyuki; Harada, Shinji; Sugita, Mari; Yamagiwa, Noriyuki; Matsunaga, Shigeki; Shibasaki, Masakatsu

    2006-09-13

    A kinetic resolution of tertiary nitroaldols derived from simple ketones is described. Mixed BINOL/biphenol La-Li heterobimetallic complexes gave the best selectivity in retro-nitroaldol reactions of racemic tertiary nitroaldols. By using a mixture of La-Li3-(1a)3 complex (LLB 2a) and La-Li3-(1b)3 (LLB* 2b) complex in a ratio of 2/1, chiral tertiary nitroaldols were obtained in 80-97% ee and 30-47% recovery yield.

  17. Westinghouse European trainee program

    International Nuclear Information System (INIS)

    Jimenez, G.

    2010-01-01

    with managers. The third session occurred in September 2008 in Madrid, Spain. During four days, the Trainees attended presentations about the business of Westinghouse in Spain, as well as various technical and management courses. Highlights of the week included the visit of 'El Cabril', the Spanish low-level waste disposal and Cordoba, one of Spain's most beautiful cities. The next session took place in Nivelles, Belgium, in December 2008. During five days the Trainees took some useful management courses and got a good overview of the activities of Westinghouse Belgium. The Trainees also visited one of the most important research centers in Europe: the SKC-CEN as well as the controlled area of Field Services. The last session took place in Mannheim, Germany, in February 2009. During four days the Trainees took some further management-related courses and got to know Westinghouse Germany a little more. They also had the opportunity to visit a nuclear power plant in operation, which was both really interesting and very useful. For the last six months of the program, the Trainees were able to choose a location for their international assignment: two Trainees went to the US, two went to Belgium, two went to Spain and one each went to Sweden, Germany, UK and France. In October 2009 a new wave of the European Trainee Program started, with trainees from Sweden, Spain, Germany, Belgium and France as well. The program has the same basic outline as before. The Trainees have the opportunity to become acquainted with Westinghouse during 18 months with the most part of the program spent in the country of hire, and the last six months on abroad assignment. The European Trainee Program gave the trainees the chance to work in an international environment for one year and a half. During the time based in their country of hire, they all tried different departments and projects to get to know more about the work being performed. It gave them also the chance to work with different managers

  18. What is the role of general internists in the tertiary or academic setting?

    Science.gov (United States)

    Tanriover, Mine Durusu; Rigby, Shirley; van Hulsteijn, L Harry; Ferreira, Faustino; Oliveira, Narcisso; Schumm-Draeger, Petra-Maria; Weidanz, Frauke; Kramer, Mark H H

    2015-01-01

    The changing demography of European populations mandates a vital role for internists in caring for patients in each level of healthcare. Internists in the tertiary or academic setting are highly ranked in terms of their responsibilities: they are clinicians, educators, researchers, role models, mentors and administrators. Contrary to the highly focused approach of sub-specialties, general internists working in academic settings can ensure that coordinated care is delivered in the most cost-conscious and efficient way. Moreover, internal medicine is one of the most appropriate specialties in which to teach clinical reasoning skills, decision-making and analytical thinking, as well as evidence based, patient oriented medicine. Internists deal with challenging patients of the new millennium with a high burden of chronic diseases and polypharmacy; practice personalised medicine with a wide scientific background and so they are the perfect fit to establish and implement new tools for scientific research. In conclusion, internal medicine is developing a new identity as a specialty in its own right. The European Federation of Internal Medicine supports the concept of academic internists and calls upon the member countries to construct academic (general) internal medicine departments in their respective countries. As 'internal medicine is the cornerstone of every national healthcare system', academic (general) internal medicine should strive to be the cornerstone of every integrated, patient-centred, modern medical care and training system. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  19. Differences in Patient Characteristics and Midterm Outcome Between Asian and European Patients Treated with Radiofrequency Ablation for Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Burgmans, Mark Christiaan, E-mail: m.c.burgmans@lumc.nl [Leiden University Medical Centre, Department of Radiology (Netherlands); Too, Chow Wei, E-mail: too.chow.wei@singhealth.com.sg [Singapore General Hospital, Department of Diagnostic Radiology (Singapore); Fiocco, Marta, E-mail: m.fiocco@lumc.nl [Leiden University Medical Centre, Department of Medical Statistics and Bioinformatics (Netherlands); Kerbert, Annarein J. C., E-mail: a.kerbert@lumc.nl [Leiden University Medical Centre, Department of Hepatology and Gastroenterology (Netherlands); Lo, Richard Hoau Gong, E-mail: richard.lo.h.g@sgh.com.sg [Singapore General Hospital, Department of Diagnostic Radiology (Singapore); Schaapman, Jelte J., E-mail: j.j.schaapman@lumc.nl [Leiden University Medical Centre, Department of Radiology (Netherlands); Erkel, Arian R. van, E-mail: a.r.van-erkel@lumc.nl [Leiden University Medical Centre, Department of Hepatology and Gastroenterology (Netherlands); Coenraad, Minneke J., E-mail: m.j.coenraad@lumc.nl [Leiden University Medical Centre, Department of Radiology (Netherlands); Tan, Bien Soo, E-mail: tan.bien.soo@singhealth.com.sg [Singapore General Hospital, Department of Diagnostic Radiology (Singapore)

    2016-12-15

    PurposeThe aim of this study was to compare patient characteristics and midterm outcomes after RFA for unresectable Hepatocellular carcinoma (HCC) in Asian and European cohorts.Materials and MethodsThe study was based on retrospective analysis of 279 patients (mean 64.8 ± 12.1 years; 208 males) treated with RFA for de novo HCC in tertiary referral centers in Singapore and the Netherlands, with median follow-up of 28.2 months (quartiles: 13.1–40.5 months). Cumulative incidence of recurrence and death were analyzed using a competing risk model.ResultsAge was higher in the Asian group: 66.5 versus 60.1 years (p < 0.0001). The most common etiology was hepatitis B in the Asian group (48.0 %) and alcohol-induced cirrhosis in Europeans (54.4 %); p < 0.001. Asian patients had less advanced disease: 35.5, 55.0, and 3.0 %, respectively, had BCLC 0, A, and B versus 21.5, 58.2, and 15.2 % in the European group (p = 0.01). The cumulative incidences of recurrence in the Asian group at 1, 2, 3, and 5 years were 37.0, 56.4, 62.3, and 67.7 %, respectively, compared to 32.6, 47.2, 49.7, and 53.4 % in the European group (p = 0.474). At 1, 2, 3, and 5 years, the cumulative incidence rates of death in the Asian group were 2.0, 3.9, 4.9, and 4.9 %, respectively, corresponding to 7.7, 9.2, 14.1, and 21.0 % in the European group (p = 0.155).ConclusionSimilar short-term treatment outcomes are achieved with RFA in HCC patients in the South-East Asian and Northern-European populations. Midterm recurrence and death rates differ between the groups as a result of differences in baseline patient characteristics and patient selection. Our study provides insight relevant to the design of future international studies.

  20. Differences in Patient Characteristics and Midterm Outcome Between Asian and European Patients Treated with Radiofrequency Ablation for Hepatocellular Carcinoma

    International Nuclear Information System (INIS)

    Burgmans, Mark Christiaan; Too, Chow Wei; Fiocco, Marta; Kerbert, Annarein J. C.; Lo, Richard Hoau Gong; Schaapman, Jelte J.; Erkel, Arian R. van; Coenraad, Minneke J.; Tan, Bien Soo

    2016-01-01

    PurposeThe aim of this study was to compare patient characteristics and midterm outcomes after RFA for unresectable Hepatocellular carcinoma (HCC) in Asian and European cohorts.Materials and MethodsThe study was based on retrospective analysis of 279 patients (mean 64.8 ± 12.1 years; 208 males) treated with RFA for de novo HCC in tertiary referral centers in Singapore and the Netherlands, with median follow-up of 28.2 months (quartiles: 13.1–40.5 months). Cumulative incidence of recurrence and death were analyzed using a competing risk model.ResultsAge was higher in the Asian group: 66.5 versus 60.1 years (p < 0.0001). The most common etiology was hepatitis B in the Asian group (48.0 %) and alcohol-induced cirrhosis in Europeans (54.4 %); p < 0.001. Asian patients had less advanced disease: 35.5, 55.0, and 3.0 %, respectively, had BCLC 0, A, and B versus 21.5, 58.2, and 15.2 % in the European group (p = 0.01). The cumulative incidences of recurrence in the Asian group at 1, 2, 3, and 5 years were 37.0, 56.4, 62.3, and 67.7 %, respectively, compared to 32.6, 47.2, 49.7, and 53.4 % in the European group (p = 0.474). At 1, 2, 3, and 5 years, the cumulative incidence rates of death in the Asian group were 2.0, 3.9, 4.9, and 4.9 %, respectively, corresponding to 7.7, 9.2, 14.1, and 21.0 % in the European group (p = 0.155).ConclusionSimilar short-term treatment outcomes are achieved with RFA in HCC patients in the South-East Asian and Northern-European populations. Midterm recurrence and death rates differ between the groups as a result of differences in baseline patient characteristics and patient selection. Our study provides insight relevant to the design of future international studies.

  1. The impact of tertiary wastewater treatment on copper and zinc complexation.

    Science.gov (United States)

    Constantino, C; Gardner, M; Comber, S D W; Scrimshaw, M D; Ellor, B

    2015-01-01

    Tightening quality standards for European waters has seen a move towards enhanced wastewater treatment technologies such as granulated organic carbon treatment and ozonation. Although these technologies are likely to be successful in degrading certain micro-organic contaminants, these may also destroy compounds which would otherwise complex and render metals significantly less toxic. This study examined the impact of enhanced tertiary treatment on the capacity of organic compounds within sewage effluents to complex copper and zinc. The data show that granulated organic carbon treatment removes a dissolved organic carbon (DOC) fraction that is unimportant to complexation such that no detrimental impact on complexation or metal bioavailability is likely to occur from this treatment type. High concentrations of ozone (>1 mg O3/mg DOC) are, however, likely to impact the complexation capacity for copper although this is unlikely to be important at the concentrations of copper typically found in effluent discharges or in rivers. Ozone treatment did not affect zinc complexation capacity. The complexation profiles of the sewage effluents show these to contain a category of non-humic ligand that appears unaffected by tertiary treatment and which displays a high affinity for zinc, suggesting these may substantially reduce the bioavailability of zinc in effluent discharges. The implication is that traditional metal bioavailability assessment approaches such as the biotic ligand model may overestimate zinc bioavailability in sewage effluents and effluent-impacted waters.

  2. Challenges and opportunities for primary, secondary, and tertiary prevention of Chagas' disease.

    Science.gov (United States)

    Rassi, A; Dias, J C P; Marin-Neto, J A; Rassi, A

    2009-04-01

    A century after its discovery, Chagas' disease still represents a major public health challenge in Latin America. Moreover, because of growing population movements, an increasing number of cases of imported Chagas' disease have now been detected in non-endemic areas, such as North America and some European countries. This parasitic zoonosis, caused by Trypanosoma cruzi, is transmitted to humans by infected Triatominae insects, or occasionally by non-vectorial mechanisms, such as blood transfusion, mother to fetus, or oral ingestion of materials contaminated with parasites. Following the acute phase of the infection, untreated individuals enter a chronic phase that is initially asymptomatic or clinically unapparent. Usually, a few decades later, 40-50% of patients develop progressive cardiomyopathy and/or motility disturbances of the oesophagus and colon. In the last decades several interventions targeting primary, secondary and tertiary prevention of Chagas' disease have been attempted. While control of both vectorial and blood transfusion transmission of T cruzi (primary prevention) has been successful in many regions of Latin America, early detection and aetiological treatment of asymptomatic subjects with Chagas' disease (secondary prevention) have been largely underutilised. At the same time, in patients with established chronic disease, several pharmacological and non-pharmacological interventions are currently available and have been increasingly used with the intention of preventing or delaying complications of the disease (tertiary prevention). In this review we discuss in detail each of these issues.

  3. European nuclear education network

    International Nuclear Information System (INIS)

    Blomgren, J.; Moons, F.; Safieh, J.

    2005-01-01

    In most countries within the European Union that rely to a significant extent on nuclear power, neither undergraduate nor PhD education is producing a sufficient number of engineers and doctors to fill the needs of the industry. As a result of an EU-supported project, a new education organisation, European Nuclear Education Network (ENEN), has recently been established, with the aim to establish a European master's degree of nuclear engineering. Recently, a new EU project, Nuclear European Platform of Training and University Organisations (NEPTUNO), has been launched, aiming at the practical implementation of ENEN and harmonisation of training activities. (author)

  4. European mobility cultures

    DEFF Research Database (Denmark)

    Haustein, Sonja; Nielsen, Thomas A. Sick

    2016-01-01

    More targeted European policies promoting green travel patterns require better knowledge on differing mobility cultures across European regions. As a basis for this, we clustered the EU population into eight mobility styles based on Eurobarometer data. The mobility styles - including, for example...... positions on the path towards sustainable mobility and therefore different requirements towards European platforms and support measures, e.g. for 'Sustainable Urban Mobility Plans'. The country clusters can provide a starting point for future communication and targeting of European efforts in sustainable...

  5. Social Activities and Manifest Anxiety among Freshmen in Tertiary ...

    African Journals Online (AJOL)

    ) in tertiary institutions in Lagos state of Nigeria were analysed to determine the relationship between social activities and manifest anxiety. Social activities in the study were measured in terms of freshmen adjustment to religious activities and ...

  6. Factors affecting utilization of University health services in a tertiary ...

    African Journals Online (AJOL)

    2013-01-16

    Jan 16, 2013 ... Objective: To determine students' perception of health care services provided in a tertiary institution and ... evaluation of health services utilization among students in the .... African culture and health. ... Asian Am Pac Isl J.

  7. Assessment of job satisfaction among health workers in a tertiary ...

    African Journals Online (AJOL)

    Assessment of job satisfaction among health workers in a tertiary hospital in Zaria ... factors affecting job satisfaction and retention of health professionals working in ... help the hospital management to increase their employee's job satisfaction.

  8. Employees' Assessment Of Customer Focus In A Tertiary Hospital In ...

    African Journals Online (AJOL)

    Employees' Assessment Of Customer Focus In A Tertiary Hospital In ... tool 'Are we making progress?' were used by respondents to rate customer focus. ... that they were allowed to take decisions to solve problems for customers (p < 0.001).

  9. Helpless patients' perception of bed-bath in tertiary health ...

    African Journals Online (AJOL)

    Helpless patients' perception of bed-bath in tertiary health institutions in Enugu, Southeast Nigeria. ... Journal Home > Vol 10, No 2 (2005) > ... patients to bed bathing by nurses is a very important aspect of quality assurance in nursing care.

  10. Enhancing learning in tertiary institutions through multimedia based ...

    African Journals Online (AJOL)

    Enhancing learning in tertiary institutions through multimedia based ... convenient and cost-effective courseware reengineering methodology of our age. ... Also discussed are the reasons for converting classroom courses to e-learning format.

  11. Effect of health education on knowledge and attitude of tertiary ...

    African Journals Online (AJOL)

    Background: In order to make good decisions about their sexual and ... of health education on the knowledge and attitude of tertiary school students towards sexually ... Methods: The study employed a quasi-experimental study design in which ...

  12. Integrated Identity and Access Management System for Tertiary ...

    African Journals Online (AJOL)

    Nigerian Journal of Technology ... identity management and access control and the unavailability of actionable information on pattern of ... This Tertiary Identity and Access Management System (T-IAMS) is a fingerprint biometric database that ...

  13. Sexism and Sexual Harassment in Tertiary Institutions | Akpotor ...

    African Journals Online (AJOL)

    Gender and Behaviour ... Sexual harassment is a recurring decimal in tertiary institutions. The paper therefore investigates the effects of sexual harassment on the academic performance of female students, using Delta State University, Abraka, ...

  14. Mothers’ experiences of labour in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    M S Maputle

    2008-11-01

    Full Text Available The purpose of the study was to explore and describe experiences of mothers during childbirth in a tertiary hospital in the Limpopo Province. This was achieved through a qualitative research study which was exploratory, descriptive, contextual and inductive in nature. A sample of 24 mothers participated in this study. Data obtained from unstructured in-depth interviews were analysed according to the protocol by Tesch (1990, cited in Cresswell, 1994:155. Five themes were identified, namely mutual participation and responsibility sharing, dependency and decision-making; information sharing and empowering autonomy and informed choices; open communication and listening; accommodative/non-accommodative midwifery actions; and maximising human and material infrastructure. The themes indicated experiences that foster or promote dependency on midwifery care. Guidelines on how to transform this dependency into a mother-centered care approach during childbirth are provided. Opsomming Die doel van die studie was om moeders se belewenis van kindergeboorte in ’n tersiêre hospitaal in die Limpopo Provinsie te verken en te beskryf. Dit is gedoen deur middel van kwalitatiewe navorsing wat verkennend, beskrywend, en kontekstueel was. ‘n Steekproef van 24 moeders het aan die studie deelgeneem. Inligting is verkry deur middel van ongestruktureerde in-diepte onderhoude. Hierdie inligting is geanaliseer aan die hand van Tesch (1990: aangehaal in Creswell, 1994:155 se protokol. Die volgende kategorieë is geïdentifiseer, wedersydse deelname en gedeelde verantwoordelik- hede, afhanklikheid en besluitneming, deel van inligting, bemagtiging tot outonomie en ingeligte keuse, oop kommunikasie en luister, akkommoderende/nie-akkommoderende vroedvrou-aksies en bevordering van menslike en materiële infrastrukture. Die resultate van die onderhoude het belewenisse blootgelê wat dui op die bevordering van afhanklikheid in vroedvrouversorging. Riglyne om hierdie

  15. Malaysian Instructors’ Assessment Beliefs in Tertiary ESL Classrooms

    Directory of Open Access Journals (Sweden)

    Niveen R. M. Elshawa

    2017-04-01

    Full Text Available Language assessment can be a valuable tool for providing information regarding language teaching. Given the importance of assessment that has undergone much change, there are important issues that warrant investigation, particularly those related to language instructors. Understanding the assessment beliefs of ESL instructors, especially at the tertiary level, is important since it can help improve the quality of assessment practices as well. Therefore, this study investigated English language instructors’ assessment beliefs in the Malaysian context. This study adopted a cross-sectional research design. The survey method was utilized to collect data from six Malaysian universities using a purposive sampling strategy. English language instructors (n=83 were selected via purposive sampling for the study. Findings of the study revealed that English language instructors believed that the purpose of assessment was to improve teaching and learning. Regarding the assessment beliefs that are related to the assessment purposes, analyses of data showed that the items that received the highest percentage of agreement were diagnosing strength and weaknesses in students, providing information about students’ progress and providing feedback to students as they learn, respectively. Although they reported using both formal and informal assessment of their students’ work, English language instructors relied heavily on paper and pencil assessment while giving more weightage on formative assessment. The majority of English language instructors reported employing marking schemes for the courses they taught, carrying out sample marking and providing feedback. Finally, English language instructors reported using different types of assessments for every language skill taught in their language unit/center. The findings highlight the fact that English instructors should be more empowered in their role as the assessors of students. Their knowledge about what, how

  16. Challenges with Tertiary-Level Mechatronic Fluid Power

    DEFF Research Database (Denmark)

    Dransfield, Peter; Conrad, Finn

    1996-01-01

    As authors we take the view that mechatronics, as it relates to fluid power, has three levels which we designate as primary, secondary and tertiary. A brief review of the current status of fluid power, hydraulic and pneumatic, and of electronic control of it is presented and discussed. The focus...... is then on tertiary-level mechatronic fluid power and the challenges to it being applied successfully....

  17. Interactive Intranet Portal for effective Management in Tertiary Institution

    OpenAIRE

    Idogho O. Philipa; Akpado Kenneth; James Agajo

    2011-01-01

    Interactive Intranet Portal for effective management in Tertiary Institution is an enhanced and interactive method of managing and processing key issues in Tertiary Institution, Problems of result processing, tuition fee payment, library resources management are analyzed in this work. An interface was generated to handle this problem; the software is an interactive one. Several modules are involved in the paper, like: LIBRARY CONSOLE, ADMIN, STAFF, COURSE REGISTRATION, CHECKING OF RESULTS and...

  18. Tertiary colleges: a study of perspectives on organizational innovation

    OpenAIRE

    Preedy, Margaret

    1998-01-01

    The purpose of this research study was to explore organisational innovation in education with reference to one particular type of organisation - the tertiary college. The research sought to examine the extent to which the intended objectives for new educational organisations are realised in practice, and how far the goals and ethos which organisational leaders seek to promote are shared by organisational members. The study focused on eleven tertiary colleges, comparing the 'official' view of ...

  19. Assessment Quality in Tertiary Education: An Integrative Literature Review

    OpenAIRE

    Gerritsen-van Leeuwenkamp, Karin; Joosten-ten Brinke, Desirée; Kester, Liesbeth

    2018-01-01

    In tertiary education, inferior assessment quality is a problem that has serious consequences for students, teachers, government, and society. A lack of a clear and overarching conceptualization of assessment quality can cause difficulties in guaranteeing assessment quality in practice. Thus, the aim of this study is to conceptualize assessment quality in tertiary education by providing an overview of the assessment quality criteria, their influences, the evaluation of the assessment quality ...

  20. Gender Role Attitudes among Higher Education Students in a Borderland Central-Eastern European Region Called "Partium"

    Science.gov (United States)

    Fényes, Hajnalka

    2014-01-01

    In this paper, we examine the attitudes towards gender roles among higher education students in a borderland Central-Eastern European region. We used the database of "The Impact of Tertiary Education on Regional Development" project (N = 602, 2010). We intend to determine what kind of attitudes towards gender roles the students identify…

  1. Syn-kinematic palaeogeographic evolution of the West European Platform: correlation with Alpine plate collision and foreland deformation

    NARCIS (Netherlands)

    Sissingh, W.

    Sequence stratigraphic correlations indicate that intermittent changes of the kinematic far-field stress-field regimes, and the associated geodynamic re-organisations at the plate-tectonic contacts of the African, Apulian, Iberian and European plates, affected the Tertiary palaeogeographic evolution

  2. CLINICAL SPECTRUM OF HYPONATRAEMIA IN TERTIARY CENTRE

    Directory of Open Access Journals (Sweden)

    Suresh Chincholi

    2017-02-01

    Full Text Available BACKGROUND Hyponatraemia is defined as a serum sodium level less than 135 mEq/L. High mortality among the patients of hyponatraemia is secondary to the underlying medical condition. Frequency is high in elderly patients. MATERIALS AND METHODS The study was conducted at a tertiary care centre (Basaveshwar Teaching and General Hospital, Gulbarga, from the period September 2014 to August 2016. These patients were evaluated for the underlying cause of hyponatraemia, which included detailed history and physical examination followed by appropriate laboratory investigations. Patients were followed up till the hyponatraemia was treated or patients were discharged from the hospital. RESULTS 100 patients of hyponatraemia were included in the study. 46% of the patients were asymptomatic. 33% patients had lethargy, 28% patients had postural dizziness and 19% had abnormal behaviour. Overall incidence of hyponatraemia was 4.58% in the hospitalised population, whereas its incidence in ICU patients was 22.4%. Twelve patients of symptomatic severe hyponatraemia were treated with hypertonic saline infusion, 25% patients were given loop diuretics with oral supplementation of sodium chloride for free water excretion in SIADH cases and in patients with hypervolaemia, hyponatraemia, fluid restriction was advised to 44 patients, oral supplementation of sodium chloride was given in 36 patients and 64 patients received normal saline. 9 patients included in the study died, 5 of which had advanced cirrhosis of liver as underlying cause. One patient developed Osmotic Demyelination Syndrome (ODS. CONCLUSION The possible cause of hyponatraemia should always be sought as outcome in severe hyponatraemia is governed by aetiology, and not by the serum sodium level. Treatment of severe symptomatic hyponatraemia with hypertonic saline is safe if recommendation for the rate of correction of hyponatraemia is strictly followed.

  3. Tertiary lymphoid organs in Takayasu Arteritis

    Directory of Open Access Journals (Sweden)

    Marc eClement

    2016-04-01

    Full Text Available Objective: The role of B cells in the pathogenesis of Takayasu arteritis (TA is controversial. We aimed to study the presence of tertiary lymphoid organs (TLOs in the aortic wall of TA patients.Methods: Hematoxylin and eosin–stained sections from aorta specimens from patients with TA were screened for TLOs. The presence of B cell aggregates (CD20, follicular dendritic cells (FDCs, CD21, and high endothelial venules (HEVs, PNAd was investigated by immunohistochemistry. Immune cells from the adventitial layer of one patient were characterized by flow cytometry. Demographic, medical history, laboratory, imaging, treatment and follow up data were extracted from medical records.Results: Aorta specimens from Bentall procedures were available from 7 patients (five female, aged 22 to 57 years with TA. Surgical treatment was performed at TA diagnosis (n=4 or at a median of 108 months [84-156] after TA diagnosis. Disease was active at surgery in four patients according to NIH score. B cell aggregates-TLOs containing HEVs were observed in the adventitia of all but one patient.. Of note, ectopic follicles containing CD21+ FDCs were found in all patients (4/4 with increased aortic FDG uptake before surgery but were absent in all but one patients (2/3 with no FDG uptake. In addition, flow cytometry analysis confirmed the accumulation of memory/germinal center–like B cells in the adventitial layer and showed the presence of antigen-experienced T follicular helper cells.Conclusion: Ectopic lymphoid neogenesis displaying functional features can be found in the aortic wall of a subset of patients with active TA. The function of these local B cell clusters on the pathogenesis of TA remains to be elucidated.

  4. ATLAS OF EUROPEAN VALUES

    NARCIS (Netherlands)

    M Ed Uwe Krause

    2008-01-01

    Uwe Krause: Atlas of Eurpean Values De Atlas of European Values is een samenwerkingsproject met bijbehorende website van de Universiteit van Tilburg en Fontys Lerarenopleiding in Tilburg, waarbij de wetenschappelijke data van de European Values Study (EVS) voor het onderwijs toegankelijk worden

  5. European media law

    NARCIS (Netherlands)

    Castendyk, O.; Dommering, E.; Scheuer, A.

    2008-01-01

    European Union legislation concerning electronic communications media is firmly established as an essential part of the law in the field in Europe. From relevant provisions of the European Convention of Human Rights and the EC Treaty to numerous directives, the most recent being the Audiovisual

  6. European Industry, 1700 - 1870

    NARCIS (Netherlands)

    Broadberry, Stephen; Fremdling, Rainer; Solar, Peter M.

    2008-01-01

    This paper offers an overview of the development of European industry between 1700 and 1870, drawing in particular on the recent literature that has emerged following the formation of the European Historical Economics Society in 1991. The approach thus makes use of economic analysis and quantitative

  7. European Stars and Stripes

    National Research Council Canada - National Science Library

    Hendricks, Nancy

    1994-01-01

    The European Stars and Stripes (ES&S) organization publishes a daily newspaper, The Stars and Stripes, for DoD personnel stationed in Germany, Italy, the United Kingdom, and other DoD activities in the U.S. European Command...

  8. Introduction: European climate leadership

    NARCIS (Netherlands)

    Wurzel, R.K.W.; Liefferink, J.D.; Connelly, J.; Wurzel, R.K.W.; Connelly, J.; Liefferink, D.

    2017-01-01

    There is no shortage of would-be leaders in EU climate change politics. The EU institutions (e.g. European Council, Council of the EU, Commission and the European Parliament (EP)), member states and societal actors have all, though to varying degrees and at different time periods, tried to offer

  9. European works councils

    DEFF Research Database (Denmark)

    Knudsen, Herman Lyhne

    2004-01-01

    The theme addressed by this artcle is the opportunities for European Works Councils of gaining influence on corporate decisions in multinational companies.......The theme addressed by this artcle is the opportunities for European Works Councils of gaining influence on corporate decisions in multinational companies....

  10. European Home Energy

    DEFF Research Database (Denmark)

    Tommerup, Henrik M.

    2009-01-01

    An important aim of the european energy performance of buildings directive is to improve the overall energy efficiency of new homes......An important aim of the european energy performance of buildings directive is to improve the overall energy efficiency of new homes...

  11. The European Programme Manager

    DEFF Research Database (Denmark)

    Larson, Anne; Bergman, E.; Ehlers, S.

    The publication is a result of a cooperation between organisations in six European countries with the aim to develop a common European education for programme managers. It contains of a description of the different elements of the education together with a number of case-studies from the counties...

  12. European Analytical Column

    DEFF Research Database (Denmark)

    Karlberg, B.; Grasserbauer, M.; Andersen, Jens Enevold Thaulov

    2009-01-01

    for European analytical chemistry. During the period 2002–07, Professor Grasserbauer was Director of the Institute for Environment and Sustainability, Joint Research Centre of the European Commission (EC), Ispra, Italy. There is no doubt that many challenges exist at the present time for all of us representing...

  13. European Union and oil

    International Nuclear Information System (INIS)

    Paillard, Christophe Alexandre

    2004-01-01

    In a context of oil price increase, problems about a Russian oil company (Loukos), and uncertainties in the Middle-East, the possibility of a new oil shock is a threat for Europe, and raises the issue of a true European energy policy which would encompass, not only grid development, environmental issues or market regulation issues, but also strategic issues related to energy supply security. This article proposes an overview of the European policy: first steps for a future European energy and oil policy in the green paper of the European Commission published in November 2000, issues of pollution and safety for hydrocarbon maritime transport. The article then examines the possibility of a third oil shock due to a crisis in the Middle East, and discusses whether European must have strategic stocks to face an outage of oil supplies

  14. Contact allergy to rubber accelerators remains prevalent: retrospective results from a tertiary clinic suggesting an association with facial dermatitis.

    Science.gov (United States)

    Schwensen, J F; Menné, T; Johansen, J D; Thyssen, J P

    2016-10-01

    Chemicals used for the manufacturing of rubber are known causes of allergic contact dermatitis on the hands. Recent European studies have suggested a decrease in thiuram contact allergy. Moreover, while an association with hand dermatitis is well established, we have recently observed several clinical cases with allergic facial dermatitis to rubber. To evaluate temporal trends of contact allergy to rubber accelerators from the European baseline series in a tertiary patch test clinic in Denmark, and examine associations with anatomical locations of dermatitis. Patch test and clinical data collected in a Danish tertiary dermatology clinic in Gentofte, Herlev, Copenhagen between 1 January 2005 and 31 December 2014 were analysed. The following rubber accelerators or mixtures in petrolatum from the European baseline patch test series were included: thiuram mix 1.0%, mercaptobenzothiazole 2.0% and mercapto mix 1.0%. The overall prevalence of contact allergy to rubber accelerators was 3.1% with no significant change during the study period (P trend = 0.667). Contact allergy to thiuram mix was the most prevalent and was significantly associated with occupational contact dermatitis, hand dermatitis, age >40 years and facial dermatitis in adjusted binary logistic regression analysis. Current clinical relevance of contact allergy to thiuram mix was 59.3%. Patients with contact allergy to mercapto mix and mercaptobenzothiazole had a concomitant reaction to thiuram mix in 35.2% (19/54) and 35.4% (17/48) of the cases respectively. Contact allergy to rubber accelerators remains prevalent. Clinicians should be aware of the hitherto unexplored clinical association with facial dermatitis. © 2016 European Academy of Dermatology and Venereology.

  15. Determination of consumption biogenic solid fuels in the commercial sector, trade, services (tertiary sector). Final report

    International Nuclear Information System (INIS)

    Viehmann, Cornelia; Westerkamp, Tanja; Schwenker, Andre; Schenker, Marian; Thraen, Daniela; Lenz, Volker; Ebert, Marcel

    2012-01-01

    The policy has both national and European level ambitious program aimed at expansion of renewable energy and related to the reduction of greenhouse gas emissions. In the national action plan for renewable energy of the Federal Republic of Germany these goals are defined by 2020. The share of renewable energy in the provision of heat and cold should therefore rise from 6.6% to 15.5% of gross final energy consumption. According to the increasing importance of solar-thermal, near-surface and geothermal heat, the relative share of biomass is decreasing. However biomass makes with those listed in the national action plan with 79% an essential amount in regenerative heat market [BMU 2010]. For the pursuit of goals and reviews, the support measures and packages of measures which are initiated in this context, a regular and timely reporting on the development of the above objectives is mandatory. The diverse and growing reporting requirements such as in the EU directive on the promotion of renewable energy, require, however well-founded knowledge of the sector-specific energy consumption from renewable sources. While the data available for use of biogenic solid fuels in the sectors household and industry has improved significantly in recent years, for the sector commercial sector, trade, services (tertiary sector) reliable figures are still lacking. Against this background, the objective is to present study, in close cooperation with the Federal Environment Agency (UBA), the determination of the final energy consumption biogenic solid fuels in the tertiary sector in Germany for the year 2008. The basis is, in addition to the development of the current knowledge of the energy and heat consumption, the delimitation and characterization of the sector and the development of an extrapolation tools. The demand for this tool is its expandability and update possibility. From the industry-nonspecific and industry-specific input data can be derived, collecting for the extrapolation

  16. Center for Adaptive Optics | Center

    Science.gov (United States)

    Astronomy, UCSC's CfAO and ISEE, and Maui Community College, runs education and internship programs in / Jacobs Retina Center Department of Psychology University of California, San Francisco Department of University School of Optometry Maui Community College Maui Community College Space Grant Program Montana

  17. Update of European bioethics

    DEFF Research Database (Denmark)

    Rendtorff, Jacob Dahl

    2015-01-01

    This paper presents an update of the research on European bioethics undertaken by the author together with Professor Peter Kemp since the 1990s, on Basic ethical principles in European bioethics and biolaw. In this European approach to basic ethical principles in bioethics and biolaw......, the principles of autonomy, dignity, integrity and vulnerability are proposed as the most important ethical principles for respect for the human person in biomedical and biotechnological development. This approach to bioethics and biolaw is presented here in a short updated version that integrates the earlier...... research in a presentation of the present understanding of the basic ethical principles in bioethics and biolaw....

  18. Transnational European Television Drama

    DEFF Research Database (Denmark)

    Bondebjerg, Ib; Redvall, Eva Novrup; Helles, Rasmus

    This book deals with the role of television drama in Europe as enabler of transnational, cultural encounters for audiences and the creative community. It demonstrates that the diversity of national cultures is a challenge for European TV drama but also a potential richness and source of creative...... variation. Based on data on the production, distribution and reception of recent TV drama from several European countries, the book presents a new picture of the transnational European television culture. The authors analyse main tendencies in television policy and challenges for national broadcasters...

  19. European [Security] Union

    DEFF Research Database (Denmark)

    Manners, Ian James

    2013-01-01

    The past 20 years, since the 1992 Treaty on European Union, have seen the gradual creation of both an “Area of Freedom, Security and Justice” and a “Common Foreign and Security Policy”. More recent is the development of a “European Neighbourhood Policy” over the past 10 years. All three...... of these policies involved the navigation and negotiation of security, borders and governance in and by the European Union (EU). This article analyses these practices of bordering and governance through a five-fold security framework. The article argues that a richer understanding of EU security discourses can...

  20. Democratic Citizenship: European referents

    Directory of Open Access Journals (Sweden)

    María PUIG GUTIÉRREZ

    2011-09-01

    Full Text Available Let’s sense beforehand in this article a tour concerning the educational European policies that favors the development of a democratic citizenship. The aim that we chase is to understand the way in which nowadays it is being interpreted and stimulated the Citizenship education from European Union. for it we offer a conceptual delimiting of «Citizenship education» and later, we show an analysis of the principal documents and materials elaborated principally by the Council of Europe that mark the way followed by European Union as for education for Democratic Citizenship (EDC.

  1. Symbolism in European Integration

    DEFF Research Database (Denmark)

    Manners, Ian

    2011-01-01

    Ernst Haas observed over fifty years ago that ‘United Europe' is a resilient, adaptable, unifying, and yet unspecified symbol'. It is precisely this adaptability and ambiguity that has ensures the continuing importance of European studies as a means of understanding ‘the remarkable social...... of social transformation involved' (Calhoun 2003: 18). This article will consider the role of symbolism in European integration as part of answering Craig Calhoun's call for a means of transcending specific regimes of analysis in order to advance European studies....

  2. Neutron bomb and European defense

    Energy Technology Data Exchange (ETDEWEB)

    Sweet, W.

    1980-08-15

    France's development of the controversial neutron bomb is in line with the US goal of flexible response to a Soviet threat in Europe. US neutron bomb production is on a standby basis pending agreement among the North Atlantic Treaty Organization (NATO) members for deployment. Controversy over the bomb centers on its anti-personnel nature, which many see as immoral in comparison with weapons that primarily damage property. Opponents also see it as lowering the nuclear threshold and increasing the chance of nuclear war. Supporters view the bomb as a tactical weapon to be used on a limited scale as a last resort. If Germany's Chancellor Schmidt fails to negotiate a limit to European nuclear arms deployment with the Soviet Union, neutron-bomb production in the US and France will most likely proceed. The prospects for including European nuclear weapons in the Strategic Arms Limitation Talks (SALT) III are jeopardized by the Soviet invasion of Afghanistan and the failure of an early SALT II ratification. 17 references. (DCK)

  3. Neutron bomb and European defense

    International Nuclear Information System (INIS)

    Sweet, W.

    1980-01-01

    France's development of the controversial neutron bomb is in line with the US goal of flexible response to a Soviet threat in Europe. US neutron bomb production is on a standby basis pending agreement among the North Atlantic Treaty Organization (NATO) members for deployment. Controversy over the bomb centers on its anti-personnel nature, which many see as immoral in comparison with weapons that primarily damage property. Opponents also see it as lowering the nuclear threshold and increasing the chance of nuclear war. Supporters view the bomb as a tactical weapon to be used on a limited scale as a last resort. If Germany's Chancellor Schmidt fails to negotiate a limit to European nuclear arms deployment with the Soviet Union, neutron-bomb production in the US and France will most likely proceed. The prospects for including European nuclear weapons in the Strategic Arms Limitation Talks (SALT) III are jeopardized by the Soviet invasion of Afghanistan and the failure of an early SALT II ratification. 17 references

  4. European Southern Observatory

    CERN Multimedia

    CERN PhotoLab

    1970-01-01

    Professor A. Blaauw, Director general of the European Southern Observatory, with George Hampton on his right, signs the Agreement covering collaboration with CERN in the construction of the large telescope to be installed at the ESO Observatory in Chile.

  5. Causality in Europeanization Research

    DEFF Research Database (Denmark)

    Lynggaard, Kennet

    2012-01-01

    to develop discursive institutional analytical frameworks and something that comes close to the formulation of hypothesis on the effects of European Union (EU) policies and institutions on domestic change. Even if these efforts so far do not necessarily amount to substantive theories or claims of causality......Discourse analysis as a methodology is perhaps not readily associated with substantive causality claims. At the same time the study of discourses is very much the study of conceptions of causal relations among a set, or sets, of agents. Within Europeanization research we have seen endeavours......, it suggests that discourse analysis and the study of causality are by no means opposites. The study of Europeanization discourses may even be seen as an essential step in the move towards claims of causality in Europeanization research. This chapter deals with the question of how we may move from the study...

  6. European Molecular Biology Laboratory

    CERN Multimedia

    1973-01-01

    On 10 May an Agreement was signed at CERN setting up a new European Laboratory. It will be concerned with research in molecularbiology and will be located at Heidelberg in the Federal Republic of Germany.

  7. European 'Stabilisation through Association'

    DEFF Research Database (Denmark)

    Rodt, Annemarie Peen

    In 2012 the Nobel Committee awarded the European Union (EU) its Peace Prize. It commemorated the building and sustaining of peace between Europeans, a process in which the Nobel Committee proposed that the EU and its predecessors had played an important part. It explicitly commen-ded the Union......’s success in repeatedly reconciling a divided continent and complemented its efforts to build peace beyond its borders. But does the EU (continue to) deserve such praise? This contribution examines European peacebuilding from the early inte-gration of post-World War Two economies, through the uniting...... of Europe after the Cold War to contemporary conflict management efforts in the Western Balkans and the Eastern neighbourhood. The purpose of this endeavour is to examine whether lessons from the European experience can be observed that may facilitate future regional stabilisation processes – within...

  8. CERN welcomes European science

    CERN Multimedia

    2002-01-01

    On 3 and 4 October CERN will host a special workshop for Marie Curie fellows. This programme is a key plank in the EU's strategy for creating a European research area.     With thousands of scientists from all over the continent working together, CERN is already an exemplary European science showcase. On 3 and 4 October, the Laboratory will contribute further to unifying all European science by hosting a special workshop for EU-funded Marie Curie fellows. This scheme gives young researchers from around the continent the mobility to go to wherever Europe's best facilities in their chosen field happen to be. The event that will take place at CERN, entitled 'Special workshop of Marie Curie Fellows on research and training in physics and technology', organised together with the European Commission, is a continuation of a series of workshops with the aim, among others, of promoting young researchers, supporting their training and mobility, and facilitating the interdisciplinary dissemination of knowledge. Dur...

  9. European Economic Integration

    Science.gov (United States)

    Huston, James A.

    1971-01-01

    Recounts the history and problems of European Economic Integration from the first post World War II organization, the OEEC, to the EEC (Common Market) and the EFTA. Suggestions for further reading are included. (JB)

  10. Ethics and European security

    Energy Technology Data Exchange (ETDEWEB)

    Paskins, B.

    1986-01-01

    The alliance between the United States and her NATO partners has been strained severely in the last few years. American perceptions of European disloyalty and European impressions of American assertiveness and lack of judgment have played a large part in generating tensions between the allies and emphasising the new peace movements. This book is an attempt to develop a broader understanding of the problem of European security based on Christian ethics. There are disagreements and differences of emphasis among the contributors but they have in common the view that an exclusive preoccupation with the military dimension is damagingly one-sided. Instead the contributors argue that moral and theological concerns are a vital part of the politics and mechanics of European security and must be incorporated in any effort to devise new policies for security in Europe and the West.

  11. The European XFEL project

    International Nuclear Information System (INIS)

    Floettmann, K.

    2005-01-01

    The European XFEL project is a 4th generation synchrotron radiation facility based on the SASE FEL concept and the superconducting TESLA technology for a linear accelerator. In February 2003 the German government decided that the XFEL should be realized as a European project and be located at DESY in Hamburg. The paper will give an overview of the overall layout and parameters of the facility, with emphasis on the accelerator design, technology and physics. (author)

  12. European Union Energy Research

    International Nuclear Information System (INIS)

    Valdalbero, D.R.; Schmitz, B.; Raldow, W.; Poireau, M.

    2007-01-01

    This article presents an extensive state of the art of the energy research conducted at European Union level between 1984 and 2006, i.e. from the first to the sixth European Community Framework Programmes (FP1-FP6) for Research, Technological Development and Demonstration (RTD and D). The FP is the main legal tool and financial instrument of EU RTD and D policy. It sets the objectives, priorities and budgets for a period of several years. It has been complemented over time with a number of policy oriented initiatives and notably with the launch of the European Research Area. FP7 will cover the period 2007-2013 and will have a total budget of more than euros 50 billion. Energy has been a main research area in Europe since the founding Treaties (European Coal and Steel Community, European Atomic Energy Community-Euratom and European Economic Community), and energy RTD and D has always been a substantial part of common EU research. Nevertheless, when inflation and successive European enlargements are taken into account, over time the RTD and D effort in the field of energy has decreased significantly in relative terms. In nominal terms it has remained relatively stable at about euros 500 million per year. For the next years (FP7), it is expected that energy will still represent about 10 % of total EU research effort but with an annual budget of more than euros 800 million per year. This article presents a detailed review of the thematic areas and budget in both European nuclear energy research (fusion and fission) and non-nuclear energy research (energy efficiency/rational use of energy, fossil fuels, CO 2 capture and storage, fuel cells and hydrogen, renewable energy sources, strategic energy research/socio-economy). (authors)

  13. Education in European countries

    Directory of Open Access Journals (Sweden)

    Petcu, N.

    2010-12-01

    Full Text Available Education, vocational training and lifelong learning play a vital role in both an economic and social context. The paper herein aims to identify Romania’s place within the UE-countries, considering a series of general indices: total public expenditure on education as a percentage of GDP, private expenditure on education as % of GDP, annual expenditure on public and private educational institutions per pupil/student - by level of education, school expectancy, pupils and students, students - tertiary education, mobility of students in Europe, science and technology graduates, doctorate students in science and technology fields. Analysis methods: main components analysis, cluster analysis.

  14. ELSY. European LFR activities

    International Nuclear Information System (INIS)

    Alemberti, Alessandro; Carlsson, Johan; Malambu, Edouard; Orden, Alfredo; Cinotti, Luciano; Struwe, Dankward; Agostini, Pietro; Monti, Stefano

    2011-01-01

    The European Lead Fast Reactor has been developed in the frame of the European lead system (ELSY) project funded by the Sixth Framework Programme of EURATOM. The project, coordinated by Ansaldo Nucleare, involved a wide consortium of European organizations. The ELSY reference design is a 600 MWe pool-type reactor cooled by pure lead. The project demonstrates the possibility of designing a competitive and safe fast critical reactor using simple engineered technical features, whilst fully complying with the Generation IV goals. The paper focuses on the main aspects of the proposed design for the European lead fast reactor highlighting the innovation of this reactor concept and overall objectives. Special attention has been dedicated to safety starting from the first step of the design development taking into account other important aspects, such as the investment protection, the compactness of the primary system as well as sustainability. The main safety features of the proposed innovative decay heat removal (DHR) systems are presented. From the beginning of 2010, and for a duration of three years, the European Commission (EC) is financing the new project Lead European Advanced Demonstration Reactor (LEADER) as part of the 7th Framework Program. This paper highlights the main objectives of the LEADER project. (author)

  15. Large Scale Cooling in Tertiary Central Europe as inferred by the MBT/CBT Paleothermometer

    Science.gov (United States)

    Bauersachs, T.; Schouten, S.; Schwark, L.

    2011-12-01

    Earth's climate experienced dramatic changes throughout the last 65 Ma. Starting at the Paleocene/Eocene thermal maximum, the global climate underwent a gradual cooling that eventually resulted in the glaciations in the Neogene. Most reconstructions of climate variability are derived from the marine realm using global deep sea oxygen isotope curves or molecular paleotemperature proxies. In contrast, only little information on the changes of the continental climate is available, which is mainly due to a lack of continuous high resolution records and suitable quantitative temperature proxies. The MBT/CBT paleothermometer is a novel temperature proxy based on temperature-driven changes in the branched glycerol dialkyl glycerol tetraether (GDGT) content of soil-living bacteria. These changes have been demonstrated to correlate well with ambient air temperature and the MBT/CBT proxy has thus been used to reconstruct paleotemperature records of terrestrial as well as coastal marine sediments (1). In this study, we employed the MBT/CBT paleothermometer on a number of maar lake deposits that - due to their exceptional well preserved organic matter content and finely-laminated sediments - comprise excellent archives of a continental climate. The analysed lacustrine deposits were all situated in the middle European Tertiary volcanic belt and ranged in age from the Early Eocene to the Late Oligocene, allowing for the detailed reconstruction of climate evolution of the Central European continent. Calculated mean annual air temperatures (MAAT) of the Messel oil shale, deposited during the Eocene climate optimum, averaged at 25 °C. This agrees well with previous temperature estimates based on paleontological observations, suggesting a paratropical climate in Eocene Central Europe with an average air temperature of ca. 25-30 °C (2). In contrast, to the green house period of the Early Eocene, the climate of the Oligocene was significantly cooler reflected by low MAAT of 8-15

  16. Satellite medical centers project

    Science.gov (United States)

    Aggarwal, Arvind

    2002-08-01

    World class health care for common man at low affordable cost: anywhere, anytime The project envisages to set up a national network of satellite Medical centers. Each SMC would be manned by doctors, nurses and technicians, six doctors, six nurses, six technicians would be required to provide 24 hour cover, each SMC would operate 24 hours x 7 days. It would be equipped with the Digital telemedicine devices for capturing clinical patient information and investigations in the form of voice, images and data and create an audiovisual text file - a virtual Digital patient. Through the broad band connectivity the virtual patient can be sent to the central hub, manned by specialists, specialists from several specialists sitting together can view the virtual patient and provide a specialized opinion, they can see the virtual patient, see the examination on line through video conference or even PCs, talk to the patient and the doctor at the SMC and controlle capturing of information during examination and investigations of the patient at the SMC - thus creating a virtual Digital consultant at the SMC. Central hub shall be connected to the doctors and consultants in remote locations or tertiary care hospitals any where in the world, thus creating a virtual hub the hierarchical system shall provide upgradation of knowledge to thedoctors in central hub and smc and thus continued medical education and benefit the patient thru the world class treatment in the smc located at his door step. SMC shall be set up by franchisee who shall get safe business opportunity with high returns, patients shall get Low cost user friendly worldclass health care anywhere anytime, Doctors can get better meaningful selfemplyment with better earnings, flexibility of working time and place. SMC shall provide a wide variety of services from primary care to world class Global consultation for difficult patients.

  17. The equity imperative in tertiary education: Promoting fairness and efficiency

    Science.gov (United States)

    Salmi, Jamil; Bassett, Roberta Malee

    2014-06-01

    While the share of the tertiary education age cohort (19-25) which is being given the opportunity to study has increased worldwide over the past two decades, this does not in fact translate into reduced inequality. For many young people, especially in the developing world, major obstacles such as disparities in terms of gender, minority population membership or disabilities as well as academic and financial barriers are still standing in their way. The authors of this article propose a conceptual framework to analyse equity issues in tertiary education and document the scope, significance and consequences of disparities in tertiary education opportunities. They throw some light on the main determinants of these inequalities and offer suggestions about effective equity promotion policies directed towards widening participation and improving the chances of success of underprivileged youths in order to create societies which uphold humanistic values.

  18. Public Healthcare Services - Component of Tertiary Economy

    Directory of Open Access Journals (Sweden)

    Mircea Bunaciu

    2016-05-01

    Full Text Available The field of public health care is a major social objective in all countries of the world. The public health care assistance reflects an effort organised to protect and promote the health of population, being achievable through political-legislative measures, programs and strategies addressed to the forums in the field of public health, as well as by establishing an organisational framework that would favour the provision of medical services requested by the population. The implementation of the objectives of health policy and strategy is done by the Ministry of Public Health as central authority in the field of public health, and local actions of public health are developed and implemented by the county authorities of public health. Public health authorities in the ascribed territory operate under the subordination of the public health authorities. Also, the county public health authorities coordinate locally the implementation of the activities arising from obligations assumed under the Treaty of Accession of Romania to the European Union and the plans for implementing the Community instruments relating to health.

  19. Spatio-temporal observations of the tertiary ozone maximum

    Directory of Open Access Journals (Sweden)

    V. F. Sofieva

    2009-07-01

    Full Text Available We present spatio-temporal distributions of the tertiary ozone maximum (TOM, based on GOMOS (Global Ozone Monitoring by Occultation of Stars ozone measurements in 2002–2006. The tertiary ozone maximum is typically observed in the high-latitude winter mesosphere at an altitude of ~72 km. Although the explanation for this phenomenon has been found recently – low concentrations of odd-hydrogen cause the subsequent decrease in odd-oxygen losses – models have had significant deviations from existing observations until recently. Good coverage of polar night regions by GOMOS data has allowed for the first time to obtain spatial and temporal observational distributions of night-time ozone mixing ratio in the mesosphere.

    The distributions obtained from GOMOS data have specific features, which are variable from year to year. In particular, due to a long lifetime of ozone in polar night conditions, the downward transport of polar air by the meridional circulation is clearly observed in the tertiary ozone maximum time series. Although the maximum tertiary ozone mixing ratio is achieved close to the polar night terminator (as predicted by the theory, TOM can be observed also at very high latitudes, not only in the beginning and at the end, but also in the middle of winter. We have compared the observational spatio-temporal distributions of the tertiary ozone maximum with that obtained using WACCM (Whole Atmosphere Community Climate Model and found that the specific features are reproduced satisfactorily by the model.

    Since ozone in the mesosphere is very sensitive to HOx concentrations, energetic particle precipitation can significantly modify the shape of the ozone profiles. In particular, GOMOS observations have shown that the tertiary ozone maximum was temporarily destroyed during the January 2005 and December 2006 solar proton events as a result of the HOx enhancement from the increased ionization.

  20. Improvement in subclinical cognitive dysfunction with thyroxine therapy in hypothyroidism: A study from tertiary care center

    Directory of Open Access Journals (Sweden)

    Sridevi Paladugu

    2015-01-01

    Full Text Available Aim: To evaluate the effect of hypothyroidism (both overt and subclinical on cognitive function using latencies of P300 auditory evoked potentials (AEPs. P300 latency suggests that shorter latency times are related to better cognitive performance. P300 latencies were also done after thyroxine replacement to see the effect of treatment on cognitive function. Materials and Methods: Biochemically proven new onset cases with hypothyroidism (overt and subclinical were enrolled into the study, AEPs of these two groups when compared with matched controls. After detailed history and physical examination, P300 potentials were recorded at two points Cz and Pz (Cz: On the midline of the head at the vertex, Pz: On the midline of the head between the vertex and occipital protuberance using a Nicolet Viking Select neuro diagnostic system version 10.0. The study was done in electrophysiology lab in Osmania Medical College. Results: A patient characteristics of both cases and controls were comparable. The cases consisted of two groups, overt hypothyroid cases 24, mean thyroid stimulating hormone (TSH values in them was 94, subclinical cases 21 in whom mean TSH value was 12.3. Mean P300 latencies of all cases at Cz was 342.42 ± 29.5 ms, and at Pz was 345.4 ± 30 ms. Mean P300 latencies of controls at Cz was 296.4 ± 34 ms and at Pz was 297.9 ± 33 ms (difference in P < 0.001. Mean P300 values in overt cases were 362.6 ± 32.9 ms at Cz, and at Pz it was 362.5 ± 33.9 ms. Mean P300 values in subclinical cases were 319.3 ± 30.9 ms at Cz, and at Pz it was 316.4 ± 27.9 ms. P300 values in overt cases were highly significant as compared to controls, and P300 values in the subclinical cases versus controls were also significant (P < 0.001. Conclusion: P300 latency prolongation in both clinical and subclinical hypothyroid cases shows that cognitive function is affected adversely in hypothyroidism including the subclinical hypothyroid cases. Larger studies evaluating the effect of subclinical hypothyroidism on cognitive function are needed with objective means such as the AEPs P300.

  1. Retrospective Analysis of Outcome of Patients with Metastatic Leiomyosarcoma in a Tertiary Referral Center.

    Science.gov (United States)

    van Cann, Tom; Cornillie, Jasmien; Wozniak, Agnieszka; Debiec-Rychter, Maria; Sciot, Raf; Hompes, Daphne; Vergote, Ignace; Schöffski, Patrick

    2018-01-01

    Leiomyosarcoma is a common subtype of soft tissue sarcoma originating from smooth muscle. We evaluated the clinical course and treatment outcome of patients with metastatic leiomyosarcoma. We retrospectively reviewed the records of patients at the University Hospitals Leuven. We identified 122 patients with metastatic leiomyosarcoma, 77 female, median age 59.5 years. Most patients developed leiomyosarcoma in the extremities (35%), the uterus (20%) or the abdomen (19%); 69% developed metachronous metastasis, 31% had synchronous metastatic disease. Most patients (74%) received palliative systemic therapy. The most common first-line treatments were doxorubicin (n = 47) and an anthracycline combined with an alkylator (n = 28). The objective response rate to first-line palliative systemic therapy was 20% and the median progression-free survival was 4.9 months (range 0.1-17.1). The median survival from diagnosis of metastasis was 20.5 months (range 0.4-126.9). On multivariate analysis, metachronous disease, no progressive disease as best response to first-line treatment, the possibility of metastasectomy with curative intent and use of palliative radiotherapy were indicators for better survival. The prognosis of patients with metastatic leiomyosarcoma is limited and objective responses to first-line systemic therapy are rare. The treatment of metastatic leiomyosarcoma remains an unmet medical need. © 2018 S. Karger GmbH, Freiburg.

  2. Blood transfusion practices in a tertiary care center in Northern India

    OpenAIRE

    Kumari, Sonam

    2017-01-01

    Background: Blood transfusion plays vital roles in the medical and surgical practice. To achieve optimum use of blood, transfusion has to be appropriate and judicious consuming minimal resources and manpower. Objective: To evaluate the pattern of blood transfusion requests and utilization with the aim of determining transfusion practice. Materials and Methods: Blood request forms and cross-match worksheets at the blood bank were analyzed over a 6-month period. Numbers of requisitions, b...

  3. Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review

    Directory of Open Access Journals (Sweden)

    Jaber Alshammari

    2017-03-01

    Conclusion: Our study showed that primary endoscopic management was successful in 82.3% of cases of acquired subglottic stenosis including those with high grade stenosis and long segment of more than 12 mm in terms of the craniocaudal length. CO2 laser was an important tool to convert mature hard stenotic segment into a soft one. The latter yielded to the lateral pressure created by balloon dilatation better.

  4. Diagnosis and Management Pattern of Lateral Epicondylitis in a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Sita Dhakal

    2016-10-01

    application of heat, 63% use of tennis elbow band, 29% exercise and 28% physiotherapy. Surgical intervention (3% was also done when the conservative management failed.  Conclusion: There is professional risk of tennis elbow for housewives, farmers and shopkeepers in context of Nepal. Only one treatment approach is not effective in management of tennis elbow for long term effect. Keywords: lateral epicondylitis; NSAIDs; physiotherapy; steroid; tennis elbow.

  5. Patterns of glomerulonephritis with crescents: Experience at a tertiary medical center in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Turki Al-Hussain

    2017-01-01

    Full Text Available A series of 78 cases of glomerulonephritis (GN, in which renal biopsy revealed changes of GN associated with crescent formation, were reviewed. Renal pathology findings were correlated with clinical features including patient’s age, renal function, and serologic findings. In most of the cases (71.8%, the crescents were due to immune complex-mediated GN. This was followed by pauci-immune GN (20.5% and anti-glomerular basement membrane antibody (GBM GN (7.7%. The percentage of glomeruli with crescents was the highest in cases of anti-GBM disease (mean of 93.3%, followed by pauci-immune GBM (mean of 48.2% and immune complex GN (30.9%. In cases with the pauci- immune GN, there were additional features of glomerular injury including fibrinoid necrosis, disruption of the GBM, and rupture of Bowman’s capsule. These changes were generally more pronounced in a subset of pauci-immune GN associated with serum elevation of antineutrophil cytoplasmic antibody (c-ANCA. In biopsies from patient with immune complex disease, systemic lupus erythematosus was the most common cause of crescentic GN.

  6. Outcome of therapeutic penetrating keratoplasty in a tertiary eye care center in Nepal

    Directory of Open Access Journals (Sweden)

    Bajracharya L

    2015-12-01

    Full Text Available Leena Bajracharya, Reeta Gurung Department of Cornea, Tilganga Institute of Ophthalmology, Kathmandu, Nepal Background: Corneal ulcer is an important cause of blindness in developing countries. Therapeutic keratoplasty for infective keratitis is a frequently performed surgery in these countries.Objective: To find out the outcome of therapeutic keratoplasty for infective keratitis.Methods: Records of 5 years were reviewed of patients who underwent therapeutic keratoplasty from 2006 to 2010. Data collected included demographic parameters, indications for surgery, microbiology of the ulcers, type of surgery performed, and donor tissue details. In the follow-up period, ocular status was evaluated in terms of eradication of disease, anatomic success, graft clarity, visual acuity, and development of glaucoma and cataract.Results: In all, 180 eyes of 180 patients were enrolled in the study; 59.4% of the patients were male. Average age was 44.4±16.7 years. Overall, 71% of infective keratitis was perforated. A total of 101 (56% eyes were positive for organisms of which 49 showed pure fungus and 49 showed pure bacteria. The commonest fungus and bacteria isolated were Aspergillus and Streptococcus, respectively. Average follow-up period was 29±23 months. Overall cure rate of infection was 88.8%, anatomical success rate was 89.5%, and graft clarity was 37.2%. Overall, 43.4% had secondary glaucoma. In the postoperative course, 65.8% of phakic eyes had developed cataract. In all, 38.6% of graft had endothelial failure and 24% of the graft failed due to late infective keratitis. Overall functional success with a visual acuity above 6/60 was 25.4%. Bacterial keratitis had a significantly higher cure rate, anatomical success, and graft clarity compared to fungal keratitis.Conclusion: Therapeutic keratoplasty is an important procedure to save the eye and preserve vision in severe infective keratitis. There is a high incidence of postoperative glaucoma, cataract, and graft failure in such a surgery. Bacterial keratitis has a better outcome than fungal keratitis. Keywords: therapeutic penetrating keratoplasty, infective keratitis, Nepal, corneal ulcer 

  7. Palliative sedation for terminally ill cancer patients in a tertiary cancer center in Shanghai, China.

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    Gu, Xiaoli; Cheng, Wenwu; Chen, Menglei; Liu, Minghui; Zhang, Zhe

    2015-01-01

    There are a number of studies dedicated to characteristics of sedation, but these studies are mostly bound to western country practices. The aim of this study is to describe the characteristics of patients who suffered from cancer and who had been sedated until their death in Shanghai, China. Retrospective medical data of 244 terminally ill cancer patients including 82 sedated patients were collected. Data collected included demographic characteristics, disease-related characteristics and details of the sedation. In sedated cases, patients and/or caregivers gave the consent to start palliative sedation due to unmanageable symptoms. On average, sedation was performed 24.65(±1.78)hours before death. Agitated delirium and dyspnea were the most frequent indications for palliative sedation. There was no significant difference in survival time from admission till death between sedated and non-sedated patients (p > 0.05). Palliative sedation is effective for reducing terminally ill cancer patients' suffering without hastening death. Prospective research is needed to determine the optimal conditions for Chinese patients including indications, decision making process, informed consent, cultural and ethical issues, type of sedation and drugs.

  8. Rhegmatogenous retinal detachments associated to Stickler syndrome in a tertiary eye care center in Saudi Arabia

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    Alshahrani ST

    2015-12-01

    Full Text Available Saeed T Alshahrani,1 Nicola G Ghazi,2 Saba Al-Rashaed2 1Ophthalmology Department, King Fahad Specialist Hospital, Dammam, 2Vitreoretinal Department, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia Purpose: To investigate the clinical findings and outcomes of rhegmatogenous retinal detachment (RRD in Stickler syndrome on affected and fellow eyes that underwent prophylactic retinopexy.Patients and methods: Chart review of 70 eyes (62 patients. Incidence of RRD, postoperative visual acuity, and risk factors were evaluated.Results: Twenty-two patients (35% had RRD in the fellow eye, 37% of the eyes had cataract, 93% had macular detachment, 50% had proliferative vitreoretinopathy, and 41% had posterior vitreous detachment. Success rates were: 60% of patients after scleral buckling; 57.1% after pars plana vitrectomy; and 75% after combined scleral buckling and pars plana vitrectomy. Sixty-one (93.8% of patients had successful surgery (including second surgery. Silicone oil tamponade was significantly associated with final anatomic outcome, with a protective odds ratio of 0.11 (P=0.027. Visual acuity improved in 54% of eyes and decreased in 5%. Statistically significant associations were present for eyes with final visual acuity ≥20/200, and total retinal detachment (P<0.001; preoperative cataract (P=0.023; and proliferative vitreoretinopathy (P<0.001. RRD developed in 16/44 eyes despite laser prophylaxis.Conclusion: Prophylactic retinopexy was not beneficial for Stickler syndrome patients. Success of primary surgery for RRD remains low. The primary surgery should be vitrectomy combined with scleral buckling and silicone oil tamponade. Keywords: Stickler syndrome, retinopexy, Gulf States, Saudi Arabia, ocular genetics, arthro-ophthalmopathy, collagen disorder

  9. Prevalence of metabolic syndrome in hypothyroidism: Experience in a tertiary center in South India

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    Jaideep Khare

    2017-01-01

    Full Text Available Introduction: Thyroid disorders are among the most common endocrine disorders, with an overall prevalence of hypothyroidism about 10.95% in the general population. Prevalence of the metabolic syndrome (MetS in the Indian population is about 31.6%, with the prevalence of 22.9% in men and 39.9% in women. Aim: The aim of this study is to determine the prevalence of MetS and its components in people with hypothyroidism. Materials and Methods: A total of 154 hypothyroid patients attending our outpatient department were consecutively enrolled for the study. MetS identified by National Cholesterol Education Program′s Adult Treatment Panel III report (ATP III. Clinical data were obtained by interviewing the patients and referring to their case folders and prescriptions. The anthropometric indices were recorded. The laboratory parameters that were analyzed included fasting lipid profile, thyroid function tests, and fasting blood sugars. Results: The patients were aged between 18 and 75 years, with a mean age of 43.6 years, and the female-to-male ratio was 123:31. The overall prevalence of the MetS was 53.24% by ATP III criteria, which is significantly higher than that in the general population, as reported earlier in various studies. The most common occurring MetS-defining criterion was increased waist circumference, and hypertension was the least documented criterion. Conclusion: MetS occurs in approximately every second patient of hypothyroidism, and so, routine screening for components of MetS may be of benefit in this group.

  10. Incidence, Etiology, and Outcomes of Rhabdomyolysis in a Single Tertiary Referral Center

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    Park, Jae-Seok; Seo, Min-Sook; Gil, Hyo-Wook; Yang, Jong-Oh; Lee, Eun-Young

    2013-01-01

    We have encountered numerous cases of rhabdomyolysis associated with acute pesticide intoxication; however, the cause, incidence, and treatment outcomes of rhabdomyolysis have not been studied. The current study involved 2,125 patients hospitalized with acute chemical poisoning. Based on clinical and laboratory parameters and treatment outcomes, we found that overall incidence of rhabdomyolysis in our hospital was 0.06% (93 of 143,830 patients admitted), but the incidence associated with acute pesticide intoxication was 1.8% (33 of 1,793 cases). The incidence of rhabdomyolysis after pesticide intoxication was significantly higher in men than in women (P = 0.010). The amount of pesticide ingested was significantly higher in rhabdomyolysis patients than that in those who did not develop rhabdomyolysis (mean ± SD, 114.1 ± 79.5 mL vs 74.1 ± 94.2 mL, P = 0.010). Our results show that pesticide intoxication is a frequent cause of rhabdomyolysis and is more common among men than women. The volume of pesticide ingested, and not the degree of human toxicity, is the main factor influencing the incidence of rhabdomyolysis. PMID:23960447

  11. Antibiotic sensitivity of Enterobacteriaceae at a tertiary care center in India

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    Summaiya Mulla

    2011-01-01

    Full Text Available Aims and Objectives: It has been observed that various microorganisms are acquiring resistance to most of the available potent antibiotics; hence, there is a need for every hospital to follow the use of antibiotics according to antibiotic sensitivity pattern in that particular hospital or geographical area. It has been reported that Enterobacteriaceae group of microorganisms are increasingly acquiring resistance to many antibiotics and this resistance varies geographically. As there is a short of recent data with respect to Indian hospital, this particular study was designed with the aim of establishing sensitivity pattern of Enterobacteriaceae group of microorganisms to various antibiotics. Materials and Methods: Data of antibiotic sensitivity from December 2010 to April 2011 of different Enterobacteriaceae was taken from the Department of Microbiology, Govt. Medical College, Surat. Sensitivity of different Enterobacteriaceae was shown as using descriptive statistics. Results: E. coli (55.6% and Klebsiella (31.2% were the most frequent bacteria isolated. Enterobacteriaceae were very less sensitive to amoxicillin + clavulanic acid (13.7%, chloramphenicol (7.6%, cefoperazone (14.4%, cefixime (15.7%, and cefuroxime (17.6. Sensitivity to aztreonam was 32.7%. Sensitivity to carbapenem group of drugs included in this study, i.e., meropenem was 69.8%. Highest sensitivity was shown for ceftazidime (74.1%. E. coli is more sensitive to meropenem as compared with Klebsiella. Conclusion: Sensitivity of Enterobacteriaceae group of microorganisms to known antibiotics is decreasing. Decreased sensitivity to carbapenem group of antibiotics is a matter of concern.

  12. Etiology of mental retardation in children referred to a tertiary care center: a prospective study

    NARCIS (Netherlands)

    van Karnebeek, Clara D. M.; Scheper, Frederike Y.; Abeling, Nico G.; Alders, Marielle; Barth, Peter G.; Hoovers, Jan M. N.; Koevoets, Cindy; Wanders, Ronald J. A.; Hennekam, Raoul C. M.

    2005-01-01

    A prospective assessment following a step-wise protocol in 281 patients with unexplained cognitive delay was used to assess diagnostic possibilities. Diagnostic procedures were complex and required a multidisciplinary approach. One third of diagnoses was established based on clinical history and

  13. EVALUATION OF PROPTOSIS BY USING COMPUTED TOMOGRAPHY IN A TERTIARY CARE CENTER, BURLA, SAMBALPUR, ODISHA

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    Vikas Agrawal

    2017-07-01

    Full Text Available BACKGROUND Proptosis is defined as the abnormal anterior protrusion of the globe beyond the orbital margins.1 It is an important clinical manifestation of various orbital as well as systemic disorders. Aetiology ranging from infection to malignant tumours, among which space occupying lesions within the orbits are the most important. Proptosis is defined as an abnormal protrusion of the eyeball. MATERIALS AND METHODS A total of 32 patients referred from various departments mainly from ophthalmology and medicine with history and clinical features suggestive of proptosis were evaluated in our department and after proper history taking and clinical examination, Computed Tomography (CT scan was done. RESULTS The age of the patients ranged from 1-55 years. Associated chief complaints in case of proptosis were in decreasing order from pain / headache, restricted eye movement, diminished vision and diplopia. Mass lesions (46.87% were the most common cause of proptosis followed by inflammatory lesions (37.5%. Trauma vascular lesions and congenital conditions were infrequent causes of proptosis. In children, common causes of proptosis were retinoblastoma (35.71% and orbital cellulitis (28.57% and in adults the common causes were thyroid ophthalmopathy (22.22%, trauma (16.66% and pseudo-tumour (16.66%. CONCLUSION Mass lesions (46.87% were the most common cause of proptosis followed by inflammatory lesions (37.5%. CT scanning should be the chief investigation in evaluation of lesions causing proptosis. It is the most useful in detecting characterising and determining the extent of disease process. The overall accuracy of CT scan in diagnosis of proptosis is 96.87%.

  14. Penile manipulation: The most common etiology of penile fracture at our tertiary care center

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    Md. Jawaid Rahman

    2016-01-01

    Full Text Available Penile fracture is the disruption of the tunica albuginea with rupture of the corpus cavernosum secondary to blunt trauma to the erect penis. It is an unusual condition, usually underreported. According to the published literature, vigorous vaginal intercourse with women on top position is the most common etiology across the globe including India with Middle Eastern countries being the exception. A total of seven patients of penile fracture presented in emergency in the last 6 months. The etiology was penile manipulation at the time of sexual excitement in six out of seven patients of penile fracture, which was contrary to the literature published except in Middle Eastern countries. All the patients were managed by emergency exploration and repair. Thus, the incidence and etiologies of penile fracture vary according to geographic region, sexual behavior, marital status, and culture.

  15. Endoscopic excavation for gastric heterotopic pancreas: an analysis of 42 cases from a tertiary center.

    Science.gov (United States)

    Zhang, Yu; Huang, Qin; Zhu, Lin-hong; Zhou, Xian-bin; Ye, Li-ping; Mao, Xin-li

    2014-09-01

    Because of the difficulty associated with making an accurate diagnosis of gastric heterotopic pancreas (HP) before surgery, surgical resection is usually performed in suspected cases. However, this is an invasive procedure and prone to certain surgical complications. This study was designed to evaluate the feasibility of endoscopic excavation for gastric HP, as well as the value of endoscopic ultrasonography (EUS) in diagnosing gastric HP. Between January 2007 and January 2013, 42 consecutive patients with gastric HP were enrolled in this retrospective study. Key steps: (1) Injection of a solution (100 ml saline + 2 ml indigo carmine + 1 ml epinephrine) into the submucosal layer after making several dots around the lesion; (2) Incision of the mucosa outside the marker dots with a needle-knife, and then circumferential excavation until complete resection of the lesion; (3) Closure of the artificial ulcer with several clips after tumor removal. In this study, 18 cases (42.9%) were suspected as gastric HP (assessed by two experienced endoscopists before endoscopic excavation), 8 (19.0%) were suspected as gastrointestinal stromal tumors, 7 (16.7%) as gastric polyp, and the remaining 9 cases (21.4%) were still unknown. The mean procedure duration was 28.6 min. En bloc resection by endoscopic excavation was achieved in 40 cases (95.2%), and no massive bleeding, delayed bleeding, perforation, or other severe complication occurred in these patients. Among the 42 lesions, a tube echo could be detected in 11 cases by EUS. Those 11 cases were diagnosed as gastric HP by histopathology. Endoscopic excavation appears to be a safe and feasible procedure for accurate histopathologic evaluation and curative treatment in gastric HP. Use of EUS has some value in the diagnosis of gastric HP before the procedure

  16. IVC filter retrieval in adolescents: experience in a tertiary pediatric center.

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    Guzman, Anthony K; Zahra, Mahmoud; Trerotola, Scott O; Raffini, Leslie J; Itkin, Maxim; Keller, Marc S; Cahill, Anne Marie

    2016-04-01

    Inferior vena cava (IVC) filters are commonly implanted with the intent to prevent life-threatening pulmonary embolism in at-risk patients with contraindications to anticoagulation. Various studies have reported increases in the rate of venous thromboembolism within the pediatric population. The utility and safety of IVC filters in children has not yet been fully defined. To describe the technique and adjunctive maneuvers of IVC filter removal in children, demonstrate its technical success and identify complications. A retrospective 10-year review was performed of 20 children (13 male, 7 female), mean age: 15.1 years (range: 12-19 years), who underwent IVC filter retrieval. Eleven of 20 (55%) were placed in our institution. Electronic medical records were reviewed for filter characteristics, retrieval technique, technical success and complications. The technical success rate was 100%. Placement indications included: deep venous thrombosis with a contraindication to anticoagulation (10/20, 50%), free-floating thrombus (4/20, 20%), post-trauma pulmonary embolism prophylaxis (3/20, 15%) and pre-thrombolysis pulmonary patient (1/20, 5%). The mean implantation period was 63 days (range: 20-270 days). Standard retrieval was performed in 17/20 patients (85%). Adjunctive techniques were performed in 3/20 patients (15%) and included the double-snare technique, balloon assistance and endobronchial forceps retrieval. Median procedure time was 60 min (range: 45-240 min). Pre-retrieval cavogram demonstrated filter tilt in 5/20 patients (25%) with a mean angle of 17° (range: 8-40). Pre-retrieval CT demonstrated strut wall penetration and tip embedment in one patient each. There were two procedure-related complications: IVC mural dissection noted on venography in one patient and snare catheter fracture requiring retrieval in one patient. There were no early or late complications. In children, IVC filter retrieval can be performed safely but may be challenging, especially in cases of filter tilt or embedding. Adjunctive techniques may increase filter retrieval rates.

  17. Cost analysis of intraoperative frozen section examinations in thyroid surgery in a Canadian tertiary center.

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    Lai, Philip; Segall, Lorne; de Korompay, Nevin; Witterick, Ian; Freeman, Jeremy

    2009-10-01

    To perform a cost analysis of the routine intraoperative frozen section (FS) examinations in the management of patients undergoing thyroid surgery for unilateral thyroid nodules with benign or indeterminate cytology on preoperative fine-needle aspiration biopsies (FNABs). A retrospective chart review of 190 consecutive patients with unilateral thyroid nodules undergoing thyroid surgery was undertaken between March 2006 and March 2008. The results of FNAB, FS, and final histology were obtained from the pathology report. A cost analysis was performed to compare the cost of routine FS examinations to determine malignancy with the cost of performing a second surgical procedure. Of the 169 patients evaluated, there were 53 cases of malignant nodules. Malignancy was diagnosed by FS in 16 of these 53 cases, resulting in a total thyroidectomy and thereby avoiding the need for a completion thyroidectomy. The sensitivity and specificity of FS examination were 30.2% and 100.0%, respectively. The routine use of intraoperative FS examination in cases of benign or indeterminate nodules afforded a total cost savings of $3719.27, or a cost savings of $22.01 per patient. FS examination was useful in guiding our intraoperative management for patients with unilateral thyroid nodules with benign or indeterminate preoperative FNAB. The routine use of FS was cost-effective in our Canadian health care system, even without considering the intangible costs, such as patients' anxiety, emotional stress, and the loss of productivity owing to a second surgical procedure.

  18. Outcomes in Lung Cancer: 9-Year Experience From a Tertiary Cancer Center in India

    OpenAIRE

    Aditya Navile Murali; Venkatraman Radhakrishnan; Trivadi S. Ganesan; Rejiv Rajendranath; Prasanth Ganesan; Ganesarajah Selvaluxmy; Rajaraman Swaminathan; Shirley Sundersingh; Arvind Krishnamurthy; Tenali Gnana Sagar

    2017-01-01

    Purpose: Lung cancer is the most common cause of cancer mortality in the world. There are limited studies on survival outcomes of lung cancer in developing countries such as India. This study analyzed the outcomes of patients with lung cancer who underwent treatment at Cancer Institute (WIA), Chennai, India, between 2006 and 2015 to determine survival outcomes and identify prognostic factors. Patients and Methods: In all, 678 patients with lung cancer underwent treatment. Median age was 58 ye...

  19. Outcomes in Lung Cancer: 9-Year Experience From a Tertiary Cancer Center in India

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    Aditya Navile Murali

    2017-10-01

    Full Text Available Purpose: Lung cancer is the most common cause of cancer mortality in the world. There are limited studies on survival outcomes of lung cancer in developing countries such as India. This study analyzed the outcomes of patients with lung cancer who underwent treatment at Cancer Institute (WIA, Chennai, India, between 2006 and 2015 to determine survival outcomes and identify prognostic factors. Patients and Methods: In all, 678 patients with lung cancer underwent treatment. Median age was 58 years, and 91% of patients had non–small-cell lung cancer (NSCLC. Testing for epidermal growth factor receptor mutation was performed in 132 of 347 patients and 61 (46% were positive. Results: Median progression-free survival was 6.9 months and overall survival (OS was 7.6 months for patients with NSCLC. Median progression-free survival was 6 months and OS was 7.2 months for patients with small-cell lung cancer. On multivariable analysis, the factors found to be significantly associated with inferior OS in NSCLC included nonadenocarcinoma histology, performance status more than 2, and stage. In small-cell lung cancer, younger age and earlier stage at presentation showed significantly better survival. Conclusion: Our study highlights the challenges faced in treating lung cancer in India. Although median survival in advanced-stage lung cancer is still poor, strategies such as personalized medicine and use of second-line and maintenance chemotherapy may significantly improve the survival in patients with advanced-stage lung cancer in developing countries.

  20. Outcomes in Lung Cancer: 9-Year Experience From a Tertiary Cancer Center in India

    Science.gov (United States)

    Murali, Aditya Navile; Ganesan, Trivadi S.; Rajendranath, Rejiv; Ganesan, Prasanth; Selvaluxmy, Ganesarajah; Swaminathan, Rajaraman; Sundersingh, Shirley; Krishnamurthy, Arvind; Sagar, Tenali Gnana

    2017-01-01

    Purpose Lung cancer is the most common cause of cancer mortality in the world. There are limited studies on survival outcomes of lung cancer in developing countries such as India. This study analyzed the outcomes of patients with lung cancer who underwent treatment at Cancer Institute (WIA), Chennai, India, between 2006 and 2015 to determine survival outcomes and identify prognostic factors. Patients and Methods In all, 678 patients with lung cancer underwent treatment. Median age was 58 years, and 91% of patients had non–small-cell lung cancer (NSCLC). Testing for epidermal growth factor receptor mutation was performed in 132 of 347 patients and 61 (46%) were positive. Results Median progression-free survival was 6.9 months and overall survival (OS) was 7.6 months for patients with NSCLC. Median progression-free survival was 6 months and OS was 7.2 months for patients with small-cell lung cancer. On multivariable analysis, the factors found to be significantly associated with inferior OS in NSCLC included nonadenocarcinoma histology, performance status more than 2, and stage. In small-cell lung cancer, younger age and earlier stage at presentation showed significantly better survival. Conclusion Our study highlights the challenges faced in treating lung cancer in India. Although median survival in advanced-stage lung cancer is still poor, strategies such as personalized medicine and use of second-line and maintenance chemotherapy may significantly improve the survival in patients with advanced-stage lung cancer in developing countries. PMID:29094084

  1. Donor deferral due to anemia: A tertiary care center-based study

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    Bahadur Shalini

    2011-01-01

    Full Text Available Background: The minimum hemoglobin cutoff for blood donation in India is 12.5 gm% for both male and female donors and the minimum donation interval is 3 months. Donation of one unit of blood results in decrease in hemoglobin by 1 gm% and loss of 200-250 mg of iron. Donor deferral due to anemia is one of the major reasons of temporary rejection of blood donors. In the absence of further workup or advise, it results in loss of valuable donor base. Aim and Objective: To provide baseline information regarding the prevalence and spectrum of anemia in prospective blood donors to help plan a future strategy for donor management. Materials and Methods: Hemoglobin testing of donors was performed using Hemocue and Copper sulfate specific gravity method.