WorldWideScience

Sample records for european tertiary center

  1. Assessing uncertainty in outsourcing clinical services at tertiary health centers.

    Science.gov (United States)

    Billi, John E; Pai, Chih-Wen; Spahlinger, David A

    2007-01-01

    When tertiary health centers face capacity constraint, one feasible strategy to meet service demand is outsourcing clinical services to qualified community providers. Clinical outsourcing enables tertiary health centers to meet the expectations of service timeliness and provides good opportunities to collaborate with other health care providers. However, outsourcing may result in dependence and loss of control for the tertiary health centers. Other parties involved in clinical outsourcing such as local partners, patients, and payers may also encounter potential risks as well as enjoy benefits in an outsourcing arrangement. Recommendations on selecting potential outsourcing partners are given to minimize the risks associated with an outsourcing contract. Copyright (c) 2006 John Wiley & Sons, Ltd.

  2. Who Has to Pay for Their Education? Evidence from European Tertiary Education

    Science.gov (United States)

    Lim, Gieyoung; Kim, Chong-Uk

    2013-01-01

    In this article, we investigate a positive tertiary education externality in 18 European countries. Using a simple Cobb-Douglas-type production function with constant returns to scale, we find that there are positive spillover effects from tertiary education in European countries. According to our model prediction, on average, 72,000 new employed…

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

    OpenAIRE

    Carmelle Tsai; Camila B. Walters; John Sampson; Francis Kateh; Chang, Mary P.

    2017-01-01

    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 ...

  4. Hospital mortality in cirrhotic patients at a tertiary care center.

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    Zubieta-Rodríguez, R; Gómez-Correa, J; Rodríguez-Amaya, R; Ariza-Mejia, K A; Toloza-Cuta, N A

    Cirrhosis of the liver is known for its high risk of mortality associated with episodes of acute decompensation. There is an even greater risk in patients that present with acute-on-chronic liver failure. The identification of patients at higher risk for adverse outcomes can aid in making the clinical decisions that will improve the prognosis for these patients. To determine in-hospital mortality and evaluate the epidemiologic and clinical characteristics of patients with cirrhosis of the liver seen at a tertiary referral hospital. A descriptive, observational, cohort study was conducted on adult patients with cirrhosis of the liver, admitted to a tertiary care center in Bucaramanga, Colombia, within the time frame of March 1, 2015 and February 29, 2016. Eighty-one patients with a mean age of 62 years were included in the study. The main etiology of the cirrhosis was alcoholic (59.3%). In-hospital mortality was 23.5% and the most frequent cause of death was septic shock (68.4%), followed by hypovolemic shock (10.5%). A MELD score≥18, a leukocyte count>12,000/ul, and albumin levels below<2.5g/dl were independent factors related to hospital mortality. In-hospital mortality in cirrhotic patients is high. Sepsis and bleeding are the 2 events leading to acute-on-chronic liver failure and death. A high MELD score, elevated leukocyte count, and low level of albumin are related to poor outcome during hospitalization. Adjusted prevention-centered public health measures and early and opportune diagnosis of this disease are needed to prevent the development of complications and to improve outcome in cirrhotic patients. Copyright © 2017 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  5. PROSE for irregular corneas at a tertiary eye care center.

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    Arumugam, Amudha Oli; Rajan, Rajni; Subramanian, Madhumathi; Mahadevan, Rajeswari

    2014-03-01

    The aim of this study was to report and discuss the clinical experience with PROSE (Prosthetic Replacement of Ocular Surface Ecosystem) practice at a tertiary eye care hospital. Retrospective data of patients who were prescribed PROSE during April 2011 to March 2012 in a tertiary eye care center in south India were analyzed. Data collected include patient demographics, indications of scleral lens fitting, previous correction modality, PROSE parameters, best-corrected visual acuity (BCVA) with spectacles, and BCVA with PROSE at initial assessment and few hours of wear. The BCVA before (with glasses) and after PROSE fitting was recorded in logMAR units. The age of the patients ranged between 13 and 68 years (male:female 60:25) with a mean age of 32.44±13.45 years. Mean BCVA improved by 0.3 logMAR units (3 lines) after fitting with PROSE. There was a statistically significant difference between pre- and post-PROSE BCVA (P=0.0001). Failure of rigid gas-permeable lens fitting or intolerance was the common indication for PROSE in corneas with irregular astigmatism (refractive conditions). The other reasons for which PROSE was prescribed were pain, photophobia, comfort, ghosting of images, and frequent loss of smaller lenses. Toric scleral haptic was indicated in 62 eyes. The diameter, vault, and haptic measurements of PROSE in ocular surface disorders were much less and flatter than that of refractive conditions. PROSE device is a very useful alternative for irregular corneas to improve visual acuity, to improve comfort, and for symptomatic relief.

  6. [Minimally Invasive Surgery in Pediatric Oncology. Tertiary center experience].

    Science.gov (United States)

    Gómez-Chacón Villalba, J; Rodríguez Caraballo, L; Marco Macián, A; Segarra Llido, V; Vila Carbó, J J

    2015-07-20

    To describe our experience using Minimally Invasive Surgery (MIS) techniques in tertiary center with specific oncological pediatric surgery unit. Retrospective review of patients undergoing MIS techniques in pediatric oncology surgery unit between January 2011 and December 2014. MIS procedures were considered made by both techniques such as laparoscopy and thoracoscopy with both diagnostic and therapeutic intent. 4 procedures were diagnostic and the rest were therapeutic: During the study, 56 procedures were performed by MIS. By type of technique, 13 were thoracoscopic (7 metastasectomies, 6 thoracic masses) and 43 laparoscopic (3 hepatic masses, 3 pancreatic masses 7 abdominal masses, 2 ovarian masses, 2 typhlitis 1 splenic mass and 25 oophorectomy for ovarian cryopreservation). In 5 cases (2 thoracic masses 1 pancreatic mass abdominal masses) conversion to open surgery to complete the procedure (2 for caution in the absence of vascular control bleeding 1 and 2 for lack of space) was necessary. In all cases safety principles of oncological surgery were respected. Providing an adecuate selection of patiens, MIS techniques are safe, reproducible and fulfill the objectives of quality of cancer surgery.

  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. Nocardiosis: a 15-year experience in a tertiary medical center in Israel.

    Science.gov (United States)

    Rosman, Yossi; Grossman, Ehud; Keller, Nathan; Thaler, Michael; Eviatar, Tali; Hoffman, Chen; Apter, Sarah

    2013-09-01

    The objective of this study is to characterize the common risk factors, clinical presentation, imaging findings, treatment and outcome of nocardial infection. A retrospective cohort study. We reviewed the charts of all patients with nocardiosis in the Chaim Sheba Medical Center, a tertiary medical center in Israel, between the years 1996 and 2011. A total of 39 patients who had positive culture of Nocardia were analyzed. The majority of our patients were immunocompromised (74.5%), mostly due to corticosteroid therapy. None had HIV/AIDS. The clinical presentation was either acute or a chronic smoldering illness. The three major clinical syndromes were pleuropulmonary, neurological and skin/soft tissue infection about 20.5% each. Pathology in the lungs was seen in most of the patients by CT scan; discrete nodules and wedge shaped pleural based consolidations were the most frequent findings. Brain lesions consistent with abscesses were detected in 10 patients by brain imaging. Some cases had relapsing disease in spite of antimicrobial treatment. 25% of examined isolates were resistant to trimethoprim/sulfamethoxazole. The duration of intravenous antimicrobial treatment ranged from one month to over a year in the severe cases. One year mortality rate was 32%. Nocardiosis requires a high clinical index of suspicion in order to diagnose and treat promptly. Disease extent and bacterial susceptibility have important implications for prognosis and treatment. Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  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. Septic arthritis in adults in a tertiary care center.

    Science.gov (United States)

    Ornelas-Aguirre, José Manuel

    2016-01-01

    To describe the history, clinical features and microorganisms involved in a group of adult subjects with and without septic arthritis (SA) at a tertiary care in Mexico. A cross-sectional descriptive study was conducted on 96 adults with clinical suspicion of AS in one or more joints. In all cases synovial fluid arthrocentesis and culture was performed. The comparison group subjects were culture negative. A descriptive statistical analysis and binary logistic regression model was performed between the variables associated with the development of AS. A value of P≤.05 was significant. A total of 49 out of 96 subjects had a positive culture, mostly of the monoarticular type (96%; P=.02). The knee was the most common site (61%; P=.06) and pain was the main clinical manifestation (59%; P=.001). Staphylococcus was the most common etiological agent (65%; P<.001). The risk factors revealed in the final regression model were SA the history of joint disease (OR=25; P=.03) and volume increase (OR=13.16; P=.06). Functional limitation (OR=8.54; P=.04) showed a significant risk among borderline for SA. Our results are consistent with previous studies, and can be generalized to geographical areas with similar clinical features to those observed in this study. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  11. Meconium aspiration syndrome - the experience of a tertiary center.

    Science.gov (United States)

    Espinheira, M C; Grilo, M; Rocha, G; Guedes, B; Guimarães, H

    2011-01-01

    Approximately 5 % of infants born with a meconium-stained amniotic fluid (MSAF) develop meconium aspiration syndrome (MAS). The aims of this study were to analyse demographic data, morbidity and mortality associated with MAS and to identify possible risk factors. Retrospective chart review of newborns with MAS delivered at a tertiary centre from January 1st, 1997 to December 31st, 2008. MAS was responsible for 1.4 % of all Neonatal Intensive Care Unit (NICU) admissions, with a trend towards a decreasing incidence during the study duration, especially in the cases of thin meconium. Seventy two newborns were analysed during the study period: 55.6 % (n = 40) were of the female gender, 62.5 % were delivered by caesarean section, 93 % had > 36 weeks of gestational age and 91.2 % had a birth weight over 2500g. Sixty-nine percent had an Apgar score bradicardia was present in 26.4 % of the newborns and tachycardia in 1.4 %. The presence of meconium was associated with severe asphyxia and carried a bad prognosis with an increased risk of developing hypoxia (58.3 %), need of mechanical ventilatory support (43.1 %), respiratory and/or metabolic acidosis (30.6 %), pulmonary hypertension (11.1 %) and hypoxic ischemic encephalopathy (29.2 %). The mortality rate was 2.8 %. Thick meconium was associated with higher morbidity and mortality rates. The number of admissions for MAS has been decreasing mostly because of a lower admission rate due to thin meconium; the number of cases with thick meconium has remained constant throughout the years. An Apgar score < 7 at 1 minute and signs of foetal distress during labour were associated with MAS. The MAS related morbidity remains significant.

  12. [Eosinophilic esophagitis--the experience in a tertiary pediatric center].

    Science.gov (United States)

    Guz-Mark, Anat; Zevit, Noam; Rosenbach, Yoram; Morgenstern, Sara; Reznik, Dana; Davidson, Keren; Shamir, Raanan; Livni, Gilat

    2011-05-01

    Eosinophilic esophagitis (EoE) is an inflammatory disorder with increasing prevalence. It typically presents with swallowing difficulties, heartburn or dyspepsia, and in toddlers, failure to thrive. EoE is characterized by eosinophilic infiltrates of the esophageal mucosa, and endoscopies with tissue diagnosis are mandatory. Hypersensitivity has been implicated in the pathogenesis, therefore, most treatment options include steroids and allergen avoidance. To summarize a tertiary pediatric clinic's experience with EoE in children and adolescents, describe the spectrum of clinical presentations and treatment options, and raise awareness of this disorder among medical personnel. A retrospective, descriptive study of patients diagnosed with EoE at our institute over the past 5 years. Demographic details, presenting symptoms, laboratory studies, endoscopic and pathologic findings were analyzed. Information regarding medical and nutritional therapies and response to treatment were summarized. Fifteen cases of EoE in children and adolescents are described. Average age at diagnosis was 9 years (range 0.7-161. The most common complaint was dysphagia (60%e. The majority demonstrated food allergies 19/121. Most of the patients were treated with topical ingested steroids, while others had either elemental formula or allergen elimination. Favorable responses were seen in most patients treated with steroids (8/11). Long-term results of nutritional therapy are insufficient to draw conclusions on its efficacy. EoE causes major eating difficulties and affects quality of life in children, sometimes accompanied by failure to thrive. There is a clear association with food allergies, and positive responses to steroids are common. A high index of suspicion and referral to a gastroenterologist for definite diagnosis are required. Combining medical with nutritional treatment seems promising but further studies regarding the long-term outcome are needed.

  13. Clinical patterns and characteristics of uveitis in a tertiary center for uveitis in China

    NARCIS (Netherlands)

    Yang, P.; Zhang, Z.; Zhou, H.; Li, B.; Huang, X.; Gao, Y.; Zhu, L.; Ren, Y.; Klooster, J.; Kijlstra, A.

    2005-01-01

    Purpose: To address the clinical pattern and characteristics of uveitis in a tertiary center for uveitis in China and compare the similarity and difference in the distribution of uveitis entities between China and other countries. Methods: A retrospective study was performed on the patients with

  14. Pediatric Toxic Epidermal Necrolysis: Experience of a Tertiary Burn Center.

    Science.gov (United States)

    Rizzo, Julie A; Johnson, Rebekah; Cartie, Richard J

    2015-01-01

    Pediatric toxic epidermal necrolysis (TEN) is a rare and potentially fatal skin disease with a multitude of causative factors and no consensus on treatment guidelines and, as a result, it has a variety of short- and long-term outcomes. We present the experience of a large specialty burn center to share our diagnostic and treatment principles. A retrospective review from 1989 to 2010 at the Joseph M. Still Burn Center was performed to find patients with a diagnosis of Steven-Johnson syndrome (SJS) or TEN. Information was obtained on demographic and physiologic parameters such as age, race, total body surface area involved, treatments, hospital stay, and need for ventilator support. We identified SJS or TEN in 21 patients. Prescription drugs were the most common etiology (in 15 patients), with antibiotics as the most common causative agent. Histology confirmed the clinical diagnosis of TEN in 14 patients. Our treatment plan included a multidisciplinary team, early initiation of intravenous immunoglobulin, bronchoscopy, strict management of electrolyte and fluid balances, and meticulous surgical wound care. Mortality was 9.5%. Our experience in treating this rare but devastating disease affords us the opportunity to share the diagnostic dilemmas we faced and the treatment principles we used to treat this unique patient population successfully. © 2015 Wiley Periodicals, Inc.

  15. Lesions Simulating Retinoblastoma at a Tertiary Care Center.

    Science.gov (United States)

    Ghassemi, Fariba; Bazvand, Fatemeh; Makateb, Ali

    2015-01-01

    To determine the types and frequency of ocular conditions simulating retinoblastoma (pseudo-retinoblastoma) at Farabi Eye Hospital, Tehran, Iran. We reviewed data of patients who were referred with a diagnosis of retinoblastoma to Farabi Eye Hospital oncology clinic, from January 2009 to July 2013. Examination under general anesthesia was performed for all patients. Other investigations, such as ultrasonography, were performed as required. Of a total of 331 patients (aged 1-60 months), 138 (42%) were found to be suffering from a benign disorder. Among these pseudo-retinoblastoma cases, Coats' disease was the most prevalent codition (n = 36, 26%); persistent hyperplastic primary vitreous (PHPV) and familial exudative vitreo-retinopathy (FEVR) were the next two common pseudo-retinoblastoma cases in our series. The rate of misdiagnosis upon referral to our center was close to 40%. The most common pseudo-retinoblastomas entities include Coats' disease, PHPV and FEVR. An accurate diagnosis is essential for management of pseudo-retinoblastoma cases.

  16. Celiac disease: 10-year experience in a Romanian tertiary center.

    Science.gov (United States)

    Maxim, Roxana; Pleşa, Alina; Ciortescu, Irina; Gîrleanu, Irina; Stoica, Oana; Trifan, Anca-Victoriţa

    2014-01-01

    To evaluate the experience of a single coeliac center over a 10-year-observational period. Between January 2003 and December 2013 a total of 195 consecutive patients admitted with celiac disease were tested by multiple duodenal biopsies, anti-tissue transglutaminase and anti-gliadin antibodies, and baseline demographic, clinical, biological and immunological parameters. Patients were divided into two major groups according to the clinical features and number of signs and symptoms present upon admission: gastrointestinal (131, 67.17%) and non-gastrointestinal (64, 32.8%). Anti-tissue transglutaminase and anti-gliadin antibodies showed seropositivity in 109/158. Histological samples were available in 152 cases, according to Marsh-Oberhuber classification 11.18% being type 0, 17.76%, type I-II, and 71.05% type III. Correlations between anti-tissue transglutaminase antibody titers and Marsh-Oberhuber classification were found to be statistically significant. Body mass index was available in 96 cases. We found that severe atrophy was predominant in patients with a BMICeliac disease has an increasing prevalence and can be diagnosed at any age. Histology samples were indicative of different stages of villous atrophy. The disease prevalence is significantly higher among women. There was no statistically significant correlation between Marsh classification and BMI values.

  17. 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

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

    OpenAIRE

    Freitas-Lima, Priscila de; Baldoni, Andre de Oliveira; Alexandre, Veriano; Pereira, Leonardo Regis Leira; Sakamoto, Americo Ceiki

    2013-01-01

    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% ...

  19. 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...

  20. 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

  1. Association between contact precautions and delirium at a tertiary care center.

    Science.gov (United States)

    Day, Hannah R; Perencevich, Eli N; Harris, Anthony D; Gruber-Baldini, Ann L; Himelhoch, Seth S; Brown, Clayton H; Dotter, Emily; Morgan, Daniel J

    2012-01-01

    To investigate the relationship between contact precautions and delirium among inpatients, adjusting for other factors. Retrospective cohort study. A 662-bed tertiary care center. All nonpyschiatric adult patients admitted to a tertiary care center from 2007 through 2009. Generalized estimating equations were used to estimate the association between contact precautions and delirium in a retrospective cohort of 2 years of admissions to a tertiary care center. During the 2-year period, 60,151 admissions occurred in 45,266 unique nonpsychiatric patients. After adjusting for comorbid conditions, age, sex, intensive care unit status, and length of hospitalization, contact precautions were significantly associated with delirium (as defined by International Classification of Diseases, Ninth Revision), medication, or restraint exposure (adjusted odds ratio [OR], 1.40 [95% confidence interval {CI}, 1.24-1.51]). The association between contact precautions and delirium was seen only in patients who were newly placed under contact precautions during the course of their stay (adjusted OR, 1.75 [95% CI, 1.60-1.92]; P contact precautions at admission (adjusted OR, 0.97 [95% CI, 0.86-1.09]; P = .06). Although delirium was more common in patients who were newly placed under contact precautions during the course of their hospital admission, delirium was not associated with contact precautions started at hospital admission. Patients newly placed under contact precautions after admission but during hospitalization appear to be at a higher risk and may benefit from proven delirium-prevention strategies.

  2. 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; Pprevalence 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; Pprevalence of family history of CVD, smoking, and alcoholism was 52.24%, 4.87%, and 45.33%, respectively. There was a high prevalence of cardiovascular risk factors in apparently healthy workers at the private tertiary center in Angola.

  3. 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.

  4. Pediatric Vascular Surgery Review with a 30-Year-Experience in a Tertiary Referral Center

    Science.gov (United States)

    Min, Seung-Kee; Cho, Sungsin; Kim, Hyun-Young; Kim, Sang Joon

    2017-01-01

    Pediatric vascular disease is rare, and remains a big challenge to vascular surgeons. In contrast to adults, surgery for pediatric vascular disease is complicated by issues related to small size, future growth, and availability of suitable vascular conduit. During the last 30 years, 131 major vascular operations were performed in a tertiary referral center, Seoul National University Hospital, including aortoiliac aneurysm, acute or chronic arterial occlusion, renovascular hypertension, portal venous hypertension, trauma, tumor invasion to major abdominal vessels, and others. Herein we review on the important pediatric vascular diseases and share our clinical experiences on these rare diseases. PMID:28690995

  5. 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

  6. Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East.

    Science.gov (United States)

    Chaudhry, Imtiaz A; Shamsi, Farrukh A; Elzaridi, Elsanusi; Al-Rashed, Waleed; Al-Amri, Abdulrahman; Al-Anezi, Fahad; Arat, Yonca O; Holck, David E

    2007-02-01

    To describe risk factors predisposing patients to orbital cellulitis and potential complications in patients treated at a tertiary eye care referral center in the Middle East. Noncomparative, interventional, retrospective case series. Patients diagnosed with orbital cellulitis. A 15-year clinical review of patients with a diagnosis of orbital cellulitis referred to King Khaled Eye Specialist Hospital, an accredited (Joint Council on Accreditation of Healthcare Organizations, Washington, DC) tertiary care center in Riyadh, Saudi Arabia, was performed. Only those patients who had clinical signs and symptoms or radiologic evidence suggestive of orbital cellulitis were included in the study. Patient demographics, factors predisposing to orbital cellulitis, and resulting complications. A total of 218 patients (136 male, 82 female) fulfilling the diagnostic criteria for orbital cellulitis were identified. The average age of these patients was 25.7 years (range, 1 month-85 years). On imaging studies, there was evidence of inflammatory or infective changes to orbital structures; orbital abscesses were identified in 116 patients (53%). Sinus disease was the most common predisposing cause in 86 patients (39.4%), followed by trauma in 43 patients (19.7%). All patients received systemic antibiotic treatment before the identification of any responsible organisms. Of the 116 patients with orbital abscess, 101 patients (87%) required drainage. The results of cultures in patients in whom an orbital abscess was drained were positive for 91 patients (90%). The most common microorganisms isolated from the drained abscesses were Staphylococci and Streptococci species. Blood cultures were positive in only 4 patients from whom blood was drawn for cultures. Visual acuity improved in 34 eyes (16.1%) and worsened in 13 eyes (6.2%), including 9 (4.3%) eyes that sustained complete loss of vision, which was attributed to the delay in correct diagnosis and timely intervention (average 28 days

  7. 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.

  8. Prevalence of nontuberculous mycobacteria among extrapulmonary tuberculosis cases in tertiary care centers in Northern India.

    Science.gov (United States)

    Maurya, A K; Nag, V L; Kant, S; Kushwaha, R A S; Kumar, M; Singh, A K; Dhole, T N

    2015-01-01

    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.

  9. 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...... (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...

  10. 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

  11. 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

  12. American vs. European Trauma Centers: A Comparison of Preventable Deaths.

    Science.gov (United States)

    Montmany, Sandra; Pascual, Jose L; Kim, Patrick K; McMaster, Janet; Pallisera, Anna; Rebasa, Pere; Luna, Alexis; Navarro, Salvador

    2017-10-01

    The aim is comparing the quality of care at a typical American trauma center (USC) vs. an equivalent European referral center in Spain (SRC), through the analysis of preventable and potentially preventable deaths. Comparative study that evaluated trauma patients older than 16 years old who died during their hospitalization. We cross-referenced these deaths and extracted all deaths that were classified as potentially preventable or preventable. All errors identified were then classified using the JC taxonomy. The rate of preventable and potentially preventable mortality was 7.7% and 13.8% in the USC and SRC respectively. According to the JC taxonomy, the main error type was clinical in both centers, due to errors in intervention (treatment). Errors occurred mostly in the emergency department and were caused by physicians. In the USC, 73% of errors were therapeutic as compared to 59% in the SRC (P=.06). The SRC had a 41% of diagnosis errors vs just 18% in the USC (P = .001). In both centers, the main cause of error was human. At the USC, the most frequent human cause was 'knowledge-based' (44%). In contrast, at the SRC center the most common errors were 'rule-based' (58%) (P<.001). The use of a common language of errors among centers is key in establishing benchmarking standards. Comparing the quality of care of an American trauma center and a Spanish referral center, we have detected remarkably similar avoidable errors. More diagnostic and 'ruled-based' errors have been found in the Spanish center. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  13. 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.

  14. 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?

  15. Improved Operating Room Efficiency via Constraint Management: Experience of a Tertiary-Care Academic Medical Center.

    Science.gov (United States)

    Kimbrough, Charles W; McMasters, Kelly M; Canary, Jeff; Jackson, Lisa; Farah, Ian; Boswell, Mark V; Kim, Daniel; Scoggins, Charles R

    2015-07-01

    Suboptimal operating room (OR) efficiency is a universal complaint among surgeons. Nonetheless, maximizing efficiency is critical to institutional success. Here, we report improvement achieved from low-cost, low-technology measures instituted within a tertiary-care academic medical center/Level I trauma center. Improvements in preadmission testing and OR scheduling, including appointing a senior nurse anesthetist to help direct OR use, were instituted in March 2012. A retrospective review of prospectively maintained OR case data was performed to evaluate time periods before and after program implementation, as well as to assess trends over time. Operating room performance metrics were compared using Mann-Whitney and chi-squared tests. Changes over time were analyzed using linear regression. Data including all surgical cases were available for a 36-month period; 10 months (6,581 cases) before program implementation and 26 months afterward (17,574 cases). Dramatic improvement was seen in first-case on-time starts, which increased from 39.3% to 83.8% (p efficiency and case volume. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Endosonogragphic features of lesions suggesting gastricectopic pancreas: experience of a single tertiary center.

    Science.gov (United States)

    Yüksel, Mahmut; Kacar, Sabite; Akpinar, Muhammet Yener; Saygili, Fatih; Akdoğan Kayhan, Meral; Dişibeyaz, Selçuk; Özin, Yasemin; Kaplan, Mustafa; Ateş, İhsan; Kayaçetin, Ertuğrul

    2017-02-27

    We aimed to present the endoscopic ultrasound (EUS) features of gastric lesions suggesting gastric ectopic pancreas during upper gastrointestinal endoscopy that were diagnosed in our gastroenterology unit, which is a tertiary center for endoscopic procedures in Turkey. The data of patients who underwent upper gastrointestinal EUS in our center between April 2012 and July 2014 were retrospectively analyzed. All of the lesions suggesting gastric ectopic pancreas were localized in the gastric antrum. Thirty-six of 44 lesions (81.1%) showed central dimpling. Lesion borders were shown to be definite in 10 (22.7%) lesions, whereas the borders of 34 lesions (77.3%) were indefinite. Thirty-nine lesions (88.6%) had heterogeneous and 5 lesions (11.4%) had homogeneous echo patterns; whereas 29 lesions (65.9%) were hypoechoic, 9 lesions (20.5%) were hyperechoic and 6 lesions (13.6%) had mixed echogenicity. Forty-two lesions (95.5%) were shown to affect only a single sonographic layer of the gastric wall. EUS features of lesions that strongly suggest gastric ectopic pancreas endoscopically, without any histopathological evidence and without either endoscopic or surgical resection, are as follows: indefinite border appearance, minimal heterogeneous hypoisoechoic echo pattern, existence of anechoic duct-like structures inside the lesion, common localization in the submucosal layer, and existence of umbilication.

  17. Financial Analysis of Treating Periprosthetic Joint Infections at a Tertiary Referral Center.

    Science.gov (United States)

    Waddell, Bradford S; Briski, David C; Meyer, Mark S; Ochsner, John L; Chimento, George F

    2016-05-01

    Periprosthetic joint infection (PJI) is a significant challenge to the orthopedic surgeon, patient, hospital, and insurance provider. Our study compares the financial information of self-originating and referral 2-stage revision hip and knee surgeries at our tertiary referral center for hip or knee PJI over the last 4 years. We performed an in-house retrospective financial review of all patients who underwent 2-stage revision hip or knee arthroplasty for infection between January 2008 and August 2013, comparing self-originating and referral cases. We found an increasing number of referrals over the study period. There was an increased cost of treating hips over knees. All scenarios generated a positive net income; however, referral hip PJIs offered lower reimbursement and net income per case (although not statistically significant), whereas knee PJIs offered higher reimbursement and net income per case (although not statistically significant). With referral centers treating increased numbers of infected joints performed elsewhere, we show continued financial incentive in accepting referrals, although with less financial gain than when treating one's own hip PJI and an increased financial gain when treating referral knee PJIs. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Two years retrospective study of maxillofacial trauma at a tertiary center in North West Ethiopia.

    Science.gov (United States)

    Teshome, Amare; Andualem, Getaneh; Tsegie, Rediet; Seifu, Samuel

    2017-08-08

    Maxillofacial injury poses a challenge to oral and maxillofacial surgeons working in developing countries with limited resource and human power. The present study aimed to determine the etiology, pattern, and management of maxillofacial trauma in Gondar university of Gondar hospital. A retrospective descriptive study design was used. Medical registration retrieving of patients with maxillofacial trauma visited dental center of University of Gondar Hospital from September 2013 to August 2015 was done. During data collection, etiology of trauma, pattern of fracture, treatment modality and complications were recorded using predesigned data collection template and analyzed using SPSS computer software version 20. Statistical analysis was done to show the sex distribution of maxillofacial trauma and the effect of alcohol intake on the incidence of trauma. During 2-year period, September 2013-August 2015, 326 patients of maxillofacial trauma were treated in the dental center of university of Gondar hospital. The mean age was 29.12 (± 8.62) with age range of 11-75 years. Majority of the study participants (47.2%) were within the age group of 21-30 years. Eighty percent of the participants were male with a male to female ratio of 4.02:1. Interpersonal violence (75.8%) and Road traffic accident (21.5%) were the leading causes. Males are at high risk of maxillofacial trauma relative to females (P maxillofacial trauma, while mandible and soft tissue were the most affected maxillofacial areas. The federal ministry of health, Ethiopia should have well-organized maxillofacial center in tertiary hospitals for emergency management to avoid morbidity and mortality.

  19. Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India.

    Science.gov (United States)

    Koshy, Jacob; John, M Joseph; Thomas, Satish; Kaur, Gurvinder; Batra, Nitin; Xavier, Wilson J

    2015-08-01

    Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse. This study evaluates the spectrum of ocular manifestations in acute and chronic leukemias presenting to a tertiary care center in India. Subjects of leukemia presenting to a tertiary care center in India. A prospective, cross-sectional study looking at the spectrum of ocular manifestations in all inpatients of acute or chronic leukemia. The collected data were analyzed using the Statistical Package for Social Sciences for Windows software, version 16 (SPSS Inc., Chicago, Illinois, USA). The study subjects (n = 96) comprised 61 males and 35 females whose age ranged from 18 months to 91 years (mean = 39.73, ±22.1). There were 79 adults and 17 children, 53 new and 43 existing patients, 68 acute and 28 chronic, 61 myeloid and 35 lymphoid patients. Ocular lesions were found in 42 patients (43.8%). The ocular manifestations of leukemia were significantly (P = 0.01467) more frequent in acute 35/68 (51.9%) than chronic 7/28 (25%) leukemias. Primary or direct leukemic infiltration was seen in 8 (8.3%) subjects while secondary or indirect involvement due to anemia, thrombocytopenia, hyperviscosity, total body irradiation, and immunosuppression were seen in 42 (43.8%) subjects. Ocular changes were present in 37/79 (46.8%) adults and 5/17 (29.4%) children (P = 0.09460). Twenty-eight males (28/61) 45.9% and 14/35 (40%) females had ocular manifestations (P = 0.2874). The ocular manifestations were significantly (P = 0.01158) more frequent in myeloid leukemias 32/61 (52.9%) than lymphoid leukemias 10/35 (28.6%). Leukemic ophthalmic lesions were found in 42/96 (43.8%) patients. Ocular involvement is more often seen in adults, acute and myeloid leukemias. All the primary leukemic manifestations were seen in males. A periodic ophthalmic examination should be mandatory for all leukemic patients, as ocular

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

    Science.gov (United States)

    Verma, Rajesh; Sharma, Pawan; Garg, Ravindra Kumar; Atam, Veerendra; Singh, Maneesh Kumar; Mehrotra, Hardeep Singh

    2011-10-01

    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. 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. 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. Dengue fever was associated with widespread neurological complications. Brachial neuritis and opsoclonus-myoclonus syndrome were observed for the first time in this study.

  1. Long-term evaluation of the efficacy of digital dermatoscopy monitoring at a tertiary referral center.

    Science.gov (United States)

    Rinner, Christoph; Tschandl, Philipp; Sinz, Christoph; Kittler, Harald

    2017-05-01

    We examined the value of monitoring patients with multiple nevi using sequential digital dermatoscopy imaging at a tertiary referral center. This is a retrospective cohort study including 2,824 patients and 23,241 monitored lesions. We calculated trends in key parameters such as the number of melanomas and nevi monitored and excised. During follow-up, we excised 1,266 lesions in 709 patients, including 146 (11.5 %) melanomas. The percentage of in situ melanomas detected at follow-up was significantly higher than at baseline (46.6 % versus 23.4 %, p ≤ 0.001). The risk of detecting a melanoma during follow-up was higher for patients with a melanoma at baseline, compared to those without (relative risk: 3.59, 95 % CI: 2.15 to 6.00). The number of documented lesions showed a positive correlation with the benign/malignant ratio, and excisions at baseline decreased significantly over the course of the study period. Digital dermatoscopy monitoring improves the detection of thin melanomas in patients with multiple nevi. Patients with a melanoma at baseline are at an increased risk of developing a melanoma during follow-up and should therefore be a target group for sequential dermatoscopy imaging. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  2. 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.

  3. A descriptive analysis of patients presenting to psychosexual clinic at a tertiary care center.

    Science.gov (United States)

    Verma, Rohit; Mina, Shaily; Ul-Hassan, Shiraz; Balhara, Yatan Pal Singh

    2013-07-01

    Psychosexual problems are very common presentation, be it with psychiatric or physical illness but there are very few studies available on psychosexual disorders especially in the Indian context. Indian society is deeply ingrained in customs and several misconceptions, myths, prejudices, and social taboos are attached to sex which makes it further very difficult to tackle. The aim of this current study was to descriptively analyze the nature of sexual disorders in a tertiary care center. The current retrospective chart review included 698 consecutive subjects seeking treatment for their psychosexual problems at the Sexual Clinic, Department of Psychiatry, Dr. Ram Manohar Hospital, New Delhi (between 2006 and 2010). This study observed erectile dysfunction (ED) (29.5%), Premature ejaculation (PME) (24.6%), Dhat syndrome (DS) (18.1%), and ED with PME (17.5%) as the common sexual dysfunctions leading to treatment seeking. DS was the major complaint among younger and unmarried individuals. We observed more married individuals seeking treatment for sexual disorders. These findings provide important information on a relatively under-researched area.

  4. The course and outcomes of complicated gallstone disease in pregnancy: Experience of a tertiary center.

    Science.gov (United States)

    İlhan, Mehmet; İlhan, Gülşah; Gök, Ali Fuat Kaan; Günay, Kayıhan; Ertekin, Cemalettin

    2016-12-01

    To evaluate the course and outcomes of pregnant patients with complicated gallstone disease and to reveal the experience of a tertiary center. The records of 92.567 patients were evaluated using searches for diagnoses with the terms of pregnant, pregnancy, gallstone, cholecystitis, cholangitis, choledocholithiasis, pancreatitis, and endoscopic retrograde cholangiopancreatography in pregnancy in the hospital database. Patients' age, week of gestation, parity, body mass index, definitive diagnosis, attack episodes, treatment modalities, and obstetric and neonatal complications were evaluated. Overall, 59 women were diagnosed as having complicated gallstone disease in pregnancy. Acute cholecystitis was the most commonly diagnosed complicated gallbladder disease (62.7%). Cholecystectomy was performed in 15 women during gestation. Perinatal outcomes were as follows: one (1.7%) maternal death, 4 (6.8%) preterm deliveries, 5 (8.5%) low-birth-weight fetuses, and 1 (1.7%) missed abortion were encountered. No fetal abnormalities were encountered. A significant proportion of women experience biliary disease during pregnancy. Herein, we presented our clinical experience because the diagnosis, course, and management of complicated gallstone disease in pregnancy is complicated.

  5. Pediatric tracheotomy: 3-year experience at a tertiary care center with 54 children.

    Science.gov (United States)

    Atmaca, Sinan; Bayraktar, Cem; Aşilioğlu, Nazik; Kalkan, Gökhan; Ozsoy, Zeki

    2011-01-01

    The aim of this study was to evaluate the indications, complications and outcomes of pediatric tracheotomies at a tertiary care center. Data were obtained retrospectively from 54 patients who underwent tracheotomy from July 2007 to May 2010. Over the three-year period, 54 tracheotomies were performed. Thirty-two patients (59.3%) were male and 22 (40.7%) were female. The mean and median ages of the patients were 54 and 14 months (6 days-17 years), respectively. Twenty-six patients (48.1%) were under 1 year of age. The most common indication for tracheotomy was prolonged intubation (87%), followed by upper airway obstruction (13%). Five patients (9.2%) underwent tracheotomy under semiurgent settings. The overall complication rate was 29.6% (16/54). Early complications occurred in 7 patients (13%), including accidental decannulation in 2 patients, subcutaneous emphysema in 4 patients and hemorrhage in 1 patient. Late complications occurred in 9 patients (16.7%) (stomal granulation in 7 patients and stomal infection in 2 patients). Eight patients (14.8%) were decannulated successfully. No tracheotomy-related deaths occurred, with an overall mortality rate of 27.7% (15/54). Pediatric tracheotomy is a relatively safe procedure with a low incidence of procedure-related morbidities. The indication for the majority of the procedures was prolonged intubation (87%). The lower decannulation rate is related to the higher percentage of patients needing assisted ventilation and the relatively short follow-up period.

  6. Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi

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    Aysha Almas

    2014-01-01

    Full Text Available Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387 had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218. Per oral calcium channel blocker; 35.4% (137 and intravenous nitrate; 22.7% (88 were the most commonly administered medication in the ER. The mean (SD drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29 mm Hg and on per oral treatment was 43 (27 mm Hg. The maximum mean (SD drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51 mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24. Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.

  7. Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi.

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    Almas, Aysha; Ghouse, Ayaz; Iftikhar, Ahmed Raza; Khursheed, Munawwar

    2014-01-01

    Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.

  8. Pediatric Admissions After Dental Care Under General Anesthesia: A Retrospective Study at a Tertiary Care Center.

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    Lucy, Anna L; Gandhi, Roopa P; Gross, Lilyana; McNair, Bryan

    2017-05-15

    The purpose of this study was to identify factors associated with planned and unplanned pediatric hospital admissions following dental treatment under general anesthesia (DGA) in a tertiary care center. Dental and medical records of 100 subjects one to 20 years of age, with a known history of admission after DGA, were reviewed retrospectively for patient-, procedure-, and anesthesia-related factors as well as adverse events following DGA. During the review period (December 3, 2011 to June 30, 2015), 10,371 subjects underwent DGA, of which 100 subjects (less than one percent) required admission. A significant association was found between postoperative (PO) recovery time and unplanned admissions following DGA (P<0.001). Adverse post-operative events significantly associated with unplanned admissions included emesis (P=0.01) and hypoxia (P<0.001). Patients who were classified as having American Anesthesiology Association (ASA) III status were more frequently admitted following DGA. Adverse events such as emesis and hypoxia were significantly associated with patients with an unplanned admission.

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

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    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. [A consecutive study of patients with irritable bowel disease in two tertiary referral centers].

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    Porsch, U; Wanitschke, R; Linhart, P; Börner, N; Bassler, M; Galle, P; Hoffmann, S O

    2001-07-01

    We investigated the nature of illness behavior and the meaning of emotional deficiencies during childhood in patients with irritable bowel diseases (IBS). A consecutive study in two tertiary referral centers was conducted with 48 patients suffering from irritable bowel diseases (IBS) and 91 patients with inflammatory bowel disease (IBD). The diagnosis of IBS was made by following the Manning criteria, a positive diagnosis of IBD was established through physical, endoscopic and radiologic examinations and was confirmed histologically. Psychological data were obtained by structured psychiatric interviews and psychological self-report measures (GBB). We found that the rate of physician visits given in the course of the disease, is increased for those having irritable bowel disease (IBS). These patients are dissatisfied with the physicians and prone to psychophysiological complaint. In the daily routine and in occupation they are more impaired than those with inflammatory disease. This finding emphasizes in particular that patients with irritable bowel diseases (IBS) have experienced emotional deficiencies in childhood as an after effect of loss, divorce of the parents etc. Implications for doctor-patient relationship and the necessity for epidemiological studies in Germany are discussed.

  11. Keratoglobus: An experience at a tertiary eye care center in India

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    Varsha M Rathi

    2015-01-01

    Full Text Available Context: This study was carried out as a part of an internal audit and is the largest series of patients having keratoglobus, published in the literature. Poor visual acuity of the patients indicates the blinding nature of the disease. Aims: We report our experience with patients having keratoglobus at a tertiary eye care center in India. Settings and Design : Retrospective study. Materials and Methods: We analyzed adults and pediatric patients (20/40 in 6/42 (14.3% pediatric eyes and 15/53 (28.30% adults. Visual acuity ranging from counting of fingers to no light perception was noted in 20/53 (37.74% adults and 21/42 (50% pediatric patients; 13/20 (65% with blue sclera and 8/22 eyes (36.37% without blue sclera. Vernal keratoconjunctivitis was present in one pediatric patient. Choroidal osteoma, retinitis pigmentosa, and retinal detachment were present in adults. Surgeries performed were corneal tear repair (5 eyes, tissue adhesive application (2 eyes, descematopexy (4 eyes and penetrating keratoplasty (PK - 8 eyes: Three had post-PK glaucoma, graft failure-one eye, 4 patients wore scleral lens - prosthetic replacement of the ocular surface ecosystem. Conclusions: About 50% of pediatric eyes (65% having blue sclera had no functional vision. Trivial trauma was responsible for corneal rupture indicating need for protective glasses. About 50% patients had post-PK glaucoma though grafts were clear.

  12. Keratoglobus: An experience at a tertiary eye care center in India.

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    Rathi, Varsha M; Murthy, Somasheila I; Bagga, Bhupesh; Taneja, Mukesh; Chaurasia, Sunita; Sangwan, Virender S

    2015-03-01

    This study was carried out as a part of an internal audit and is the largest series of patients having keratoglobus, published in the literature. Poor visual acuity of the patients indicates the blinding nature of the disease. We report our experience with patients having keratoglobus at a tertiary eye care center in India. Retrospective study. We analyzed adults and pediatric patients (20/40 in 6/42 (14.3%) pediatric eyes and 15/53 (28.30%) adults. Visual acuity ranging from counting of fingers to no light perception was noted in 20/53 (37.74%) adults and 21/42 (50%) pediatric patients; 13/20 (65%) with blue sclera and 8/22 eyes (36.37%) without blue sclera. Vernal keratoconjunctivitis was present in one pediatric patient. Choroidal osteoma, retinitis pigmentosa, and retinal detachment were present in adults. Surgeries performed were corneal tear repair (5 eyes), tissue adhesive application (2 eyes), descematopexy (4 eyes) and penetrating keratoplasty (PK - 8 eyes: Three had post-PK glaucoma, graft failure-one eye, 4 patients wore scleral lens - prosthetic replacement of the ocular surface ecosystem). About 50% of pediatric eyes (65% having blue sclera) had no functional vision. Trivial trauma was responsible for corneal rupture indicating need for protective glasses. About 50% patients had post-PK glaucoma though grafts were clear.

  13. Nosocomial infections in patients admitted in intensive care unit of a tertiary health center, India.

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    Mythri, H; Kashinath, Kr

    2014-09-01

    Patients in Intensive Care Units (ICUs) are a significant subgroup of all hospitalized patients, accounting for about a quarter of all hospital infections. The aim was to study, the current status of nosocomial infection, rate of infection and distribution of infection among patients admitted in Medical Intensive Care Unit (MICU) of a District Hospital. Data were collected retrospectively from 130 patient's records presented with symptoms of nosocomial infection in MICU of a Tertiary Health Center, Tumkur from August 2012 to May 2013. Descriptive statistics using percentage was calculated. Incidence of nosocomial infections in MICU patients was 17.7% (23/130). Of which 34.8% (8/130) was urinary tract infection (UTI) being the most frequent; followed by pneumonia 21.7% (5/130), 17.4% (4/130) surgical site infection, 13.0% (3/130) gastroenteritis, 13.0% (3/130) blood stream infection and meningitis. The nosocomial infection was seen more in the 40-60 year of age. The male were more prone to nosocomial infections than the female. The most frequent nosocomial infections (urinary, respiratory, and surgical site) were common in geriatric patients in the MICU setting and are associated with the use of invasive device. Large-scale studies are needed to be carried out in Indian population to plan long-term strategies for prevention and management of nosocomial infections.

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

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

    2016-08-24

    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. One hundred and twenty-three 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). 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. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  15. Suboptimal Clinical Documentation in Young Children with Severe Obesity at Tertiary Care Centers

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    Cassandra C. Brady

    2016-01-01

    Full Text Available Background and Objectives. The prevalence of severe obesity in children has doubled in the past decade. The objective of this study is to identify the clinical documentation of obesity in young children with a BMI ≥ 99th percentile at two large tertiary care pediatric hospitals. Methods. We used a standardized algorithm utilizing data from electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile at age <6 years. We extracted descriptive terms and ICD-9 codes to evaluate documentation of obesity at Boston Children’s Hospital and Cincinnati Children’s Hospital and Medical Center between 2007 and 2014. Results. A total of 9887 visit records of 2588 children with severe early onset obesity were identified. Based on predefined criteria for documentation of obesity, 21.5% of children (13.5% of visits had positive documentation, which varied by institution. Documentation in children first seen under 2 years of age was lower than in older children (15% versus 26%. Documentation was significantly higher in girls (29% versus 17%, p<0.001, African American children (27% versus 19% in whites, p<0.001, and the obesity focused specialty clinics (70% versus 15% in primary care and 9% in other subspecialty clinics, p<0.001. Conclusions. There is significant opportunity for improvement in documentation of obesity in young children, even years after the 2007 AAP guidelines for management of obesity.

  16. Demographic and clinical profile of vernal keratoconjunctivitis at a tertiary eye care center in India.

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    Saboo, Ujwala S; Jain, Manish; Reddy, Jagadesh C; Sangwan, Virender S

    2013-09-01

    To study the demographic and clinical profile of patients with vernal keratoconjunctivitis (VKC) at a tertiary eye care center in India. Retrospective chart analysis of 468 patients of VKC seen from January 2006 to December 2006. Mean age at presentation was 12 years. Majority of the patients had mixed pattern disease (72%). Chronic perennial disease was seen in 36% patients. Personal or family history of allergies was noted in 5% patients. Severe disease based on clinical grading was present in 37% patients. Moderate to severe vision loss was seen in 12% of total population. Persistent disease beyond 20 years of age was found in 12% patients. VKC-related complications such as corneal scarring (11%), shield ulcer (3%), keratoconus (6%), and limbal stem cell deficiency (1.2%) were seen. Treatment-related complications like corticosteroid-induced cataract and glaucoma were seen in 6% and 4% of patients, respectively. Clinical pattern of VKC seen in the tropical climate of India is essentially similar to that seen in other tropical countries. Few distinct features that we noted represent chronic perennial disease, low association with atopy, and higher propensity for disease and treatment-related complications.

  17. 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.

  18. Cytopathology of neoplastic meningitis: A series of 66 cases from a tertiary care center

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    Gurdeep Singh

    2013-01-01

    Full Text Available Background: Neoplastic meningitis (NM is a condition characterized by leptomeningeal involvement by metastatic carcinoma. Detection of exfoliated malignant cells in cerebrospinal fluid (CSF due to meningeal metastasis is frequently associated with diverse neurologic presentations. Materials and Methods: In this retrospective study of all cases of NM diagnosed in CSF samples over a 20-year period at a tertiary care referral center, the cytomorphologic features were reviewed. Results: Sixty six cases of NM were identified of which 36 already had an established diagnosis of malignancy while in 30 patients, there was no previously known tumor. The most common known primary in the former group was breast followed by ovary. Single cell pattern, cellular cannibalism, moderate cytoplasm and rounded nuclei were seen in breast and lung tumors. Papillary architecture and cytoplasmic vacuolation were seen in the ovarian primaries. Melanin pigment was seen in malignant melanoma. Conclusion: CSF cytology is an important tool for diagnosis of NM. Cytomorphologic features helped in diagnosis and for prediction of the primary site. Correct identification of this condition is important as it has therapeutic and prognostic implications.

  19. 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.

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

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    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.

  1. Benzodiazepine and "Z-Drug" Dependence: Data From a Tertiary Care Center.

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    Shukla, Lekhansh; Bokka, Spandana; Shukla, Tulika; Kandasamy, Arun; Chand, Prabhat; Benegal, Vivek; Murthy, Pratima

    2017-02-16

    To examine the clinical characteristics and course of benzodiazepine and �Z-drug� dependence in patients presenting to a tertiary deaddiction center in southern India. Case files of 950 inpatients admitted between January 2007 and January 2014 who reported benzodiazepine or Z-drug use were reviewed. Patients (n = 170) with an ICD-10 diagnosis of mental and behavioral disorders due to the use of sedatives or hypnotics-dependence syndrome currently using substance (F13.24) were included in this study. Alprazolam (n = 86, 50.6%), nitrazepam (n = 40, 23.5%), and zolpidem (n = 19, 11.2%) were the most commonly reported drugs of abuse. Alcohol dependence was present in 37 subjects (21.8%) and opioid dependence in 41 subjects (24.1%). Comorbid psychiatric illness was diagnosed in 67 patients (39.0%). Only 28 patients (16.5%) had sedative dependence with no other substance use disorder. High comorbidity occurs in this group of patients. Outcome varies significantly (P dependent only and multiple-substance�dependent patients. High attrition should be addressed through follow-up and tracking mechanisms.

  2. Ocular manifestations of xeroderma pigmentosum at a tertiary eye care center in Saudi Arabia.

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    Alfawaz, Abdullah M; Al-Hussain, Hailah M

    2011-01-01

    To study the clinical profile of Saudi cases of xeroderma pigmentosum (XP). This is a single-center, retrospective, consecutive case series of all cases of XP seen at King Khaled Eye Specialist Hospital from January 1, 1986, to December 31, 2006. The main outcome measures were clinical features, visual outcome, and histopathologic findings. Of 33 patients initially included in this study, 6 were excluded from the final analysis because of either unconfirmed diagnosis of XP or insufficient follow up. The final analysis included 27 patients (14 female patients, 13 male patients). A history of consanguinity was present in the parents of one third of our patients. The age at onset of ocular complications ranged from 5 to 67 years (median age, 19 years). The number of patients with no light perception (NLP) increased from 1 patient (3.7%) at the initial visit to 5 patients (18.5%) at the last visit. In 13 of 27 patients (48.1%), conjunctival tumors were observed; 10 tumors were confirmed histopathologically to be squamous cell carcinomas. Basal cell carcinoma (BCC) was the most common histopathologic diagnosis of eyelid tumors and was noted in 4 patients (14.8%). Furthermore, 10 patients (37.0%) had a history of skin malignancy, and 5 patients (18.1%) had neurologic abnormalities. Patients with XP who presented to a tertiary eye care center in Saudi Arabia had a high percentage of consanguinity in parents and late onset of ocular complications. Additionally, XP behaved aggressively in both malignancy profile and visual outcome.

  3. 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

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

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    Al-Hemairi, Mohammad H.; Albokhari, Shatha M.; Muzaffer, Mohammed A.

    2016-01-01

    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 PMID:26966610

  5. 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.

  6. 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.

  7. 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

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

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    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.

  9. Yield and complications of kidney biopsy over two decades in a tertiary pediatric center.

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    Hod Feins, Roei; Tobar, Anna; Davidovits, Miriam

    2017-04-01

    Kidney biopsy serves as an adjunct for the diagnosis of renal disease, but it is not always productive. This study evaluated the yield and risks of kidney biopsies performed in 1995-2014 at a tertiary pediatric medical center. The medical files of all patients who underwent closed percutaneous biopsy for various indications in native or transplanted kidneys were retrospectively reviewed for patient characteristics, technical and histopathologic findings, biopsy yield, and biopsy complications. Biopsy yield was considered positive if findings confirmed a probable diagnosis or led to a change in clinical diagnosis, disease severity/activity grade, treatment strategy, or prognosis; and negative, if findings were non-informative and in cases of technical failure. During the study period, 216 biopsies were performed on native kidneys and 84 on transplanted kidneys. In the transplanted kidney group, the most common indications for biopsy were decreased glomerular filtration rate and suspected rejection. Rates of positive biopsy yield were 86.6% in the native kidney group and 82.1% in the transplanted kidney group; the difference was not statistically significant. Significant between-group differences were found in various technical and histopathological parameters, patient age at biopsy, and sex distribution. In the native kidney group, positive biopsy yield was associated with the presence of nephrotic-range proteinuria. Post-procedural complications occurred in three patients (1.3%) with native kidneys, and in one patient (1.1%) with a transplanted kidney. Kidney biopsy is an efficient and safe procedure in both native and transplanted kidneys and provides helpful diagnostic information in most cases in which it is deemed necessary. © 2016 Japan Pediatric Society.

  10. Profile of retinal vasculitis in a tertiary eye care center in Eastern India

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    Kumar Saurabh

    2011-01-01

    Full Text Available Aims: To provide a fact file on the etiology, clinical presentations and management of retinal vasculitis in Eastern India. Materials and Methods: Retrospective, record based analysis of retinal vasculitis cases in a tertiary care center in Eastern India from January 2007 to December 2009 . Results: One hundred and thirteen eyes of 70 patients of retinal vasculitis were included in this study. Sixty (85.7% patients were male (mean age 33± 11.1 years and 10 (14.3% were female (mean age 32.4 ± 13.6 years. Vasculitis was bilateral in 43 (61.4% and unilateral in 27 (38.6% patients. Commonest symptoms were dimness of vision (73; 64.6% and floaters (36; 31.9%. Vascular sheathing (82; 72.6% and vitritis (51; 45.1% were commonest signs. Mantoux test was positive in 21 (30% patients but tuberculosis was confirmed in only four (5.71% patients. Raised serum angiotensin-converting enzyme level and positive antinuclear antibody level were reported in four (5.71% patients each. Human leukocyte antigen B5 (HLA B5 marker was present in one (1.4% patient. However, none of the total 70 patients were found to have a conclusively proven systemic disease attributable as the cause of retinal vasculitis. Oral corticosteroid (60; 85.7% was the mainstay of treatment. Forty-eight (42.5% eyes maintained their initial visual acuity and 43 (38% gained one or more line at mean follow-up of 16.6± 6.3 months. Conclusion: Retinal vasculitis cases had similar clinical presentations and common treatment plan. There was no systemic disease association with vasculitis warranting a careful approach in prescribing investigations.

  11. DICER1 syndrome: Approach to testing and management at a large pediatric tertiary care center.

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    van Engelen, Kalene; Villani, Anita; Wasserman, Jonathan D; Aronoff, Laura; Greer, Mary-Louise C; Tijerin Bueno, Marta; Gallinger, Bailey; Kim, Raymond H; Grant, Ronald; Meyn, M Stephen; Malkin, David; Druker, Harriet

    2018-01-01

    To expand the current knowledge of DICER1 syndrome and to propose criteria for genetic testing based on experience at a pediatric tertiary care center. This study involved a retrospective chart review of the 78 patients (47 probands and 31 family members) seen in the Cancer Genetics Program at The Hospital for Sick Children (SickKids) who were offered genetic testing for DICER1. Of 47 probands offered genetic testing for DICER1, 46 pursued testing: 11 (23.9%) carried a pathogenic variant and one proband (2.1%) carried a missense variant of uncertain significance with evidence for pathogenicity. Thirty-one family members of variant-positive probands were offered testing: eight of the 25 who agreed to testing carried their familial variant (32.0%). Overall, 20 patients were identified to have a variant in DICER1 (eight males, 12 females). Of these, 13 (65.0%) presented with clinical manifestations associated with the syndrome. The most common lesions were pleuropulmonary blastoma (PPB) (five of 20 patients, 25.0%) and pineoblastoma (three of 20 patients, 15.0%). The average age at which individuals were diagnosed with a primary neoplasm was 5.2 years (range 0.8-20 years, median 3.0). Surveillance at our institution, with a median follow-up time of 23 months, has identified PPB in two asymptomatic individuals. These lesions were identified at early stages, thus potentially reducing treatment-related morbidity and mortality. This study further delineates the DICER1 syndrome phenotype and demonstrates the feasibility of a DICER1 syndrome surveillance protocol for the early detection of tumors. © 2017 Wiley Periodicals, Inc.

  12. Hospice eligibility in patients who died in a tertiary care center.

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    Freund, Katherine; Weckmann, Michelle T; Casarett, David J; Swanson, Kristi; Brooks, Mary Kay; Broderick, Ann

    2012-03-01

    Hospice is a service that patients, families, and physicians find beneficial, yet a majority of patients die without receiving hospice care. Little is known about how many hospitalized patients are hospice eligible at the time of hospitalization. Retrospective chart review was used to examine all adult deaths (n = 688) at a tertiary care center during 2009. Charts were selected for full review if the death was nontraumatic and the patient had a hospital admission within 12 months of the terminal admission. The charts were examined for hospice eligibility based on medical criteria, evidence of a hospice discussion, and hospice enrollment. Two hundred nine patients had an admission in the year preceding the terminal admission and a nontraumatic death. Sixty percent were hospice eligible during the penultimate admission. Hospice discussions were documented in 14% of the hospice-eligible patients. Patients who were hospice eligible had more subspecialty consults on the penultimate admission compared to those not hospice eligible (P = 0.016), as well as more overall hospitalizations in the 12 months preceding their terminal admission (P = 0.0003), and fewer days between their penultimate admission and death (P = 0.001). The majority of terminally ill inpatients did not have a documented discussion of hospice with their care provider. Educating physicians to recognize the stepwise decline of most illnesses and hospice admission criteria will facilitate a more informed decision-making process for patients and their families. A consistent commitment to offer hospice earlier than the terminal admission would increase access to community or home-based care, potentially increasing quality of life. Copyright © 2011 Society of Hospital Medicine.

  13. Scald burn, a preventable injury: Analysis of 4306 patients from a major tertiary care center.

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    Sahu, Shamendra Anand; Agrawal, Karoon; Patel, Pankaj Kumar

    2016-12-01

    Scalds have distinct epidemiological and predisposing risk factors amongst all types of burns. Though scald affects all age groups, the brunt falls on the minor age groups. It may result in major physical disabilities and significant loss of school years. Apart from the economic burden on family, major scald burn may compromise overall development of the affected children. Most of the scald injuries occur in domestic settings and are preventable. Despite improvement in living conditions, the incidence of scald burn has failed to decline. Our aim was to study the detailed epidemiology and severity of scald burn amongst all age groups. A retrospective study was carried out from the records of all burn patients who attended a tertiary burn care center from January 2013 and December 2014. Data of the patients with scald injury was segregated and analyzed using Microsoft excel spreadsheet. 10,175 burn patients attended the burn casualty during the study period, of which 42.3% had sustained scald. 56.85% of patients were under 15 years of age with preschool children (36.4%) being the prime victims of scald. The % TBSA involved is also relatively larger in children. Scald follows definite seasonal variation peaking in winters. 36.8% patients arrived to the hospital without any first aid. 74.2% of patients reported to casualty with in 24hours after sustaining scald injury. The median time interval between injury and reporting to casualty was 3hours 30minutes. This study concludes that the scald is injury of all age groups, though majority of them are children. The first aid is not given to large number of patients and late reporting is quite common. These are the factors which may affect the course of scald burn. Spreading public awareness regarding safe household practises and educating them for proper first aid management after scald may have significant impact on the burden of care and outcome. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  14. 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

  15. 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.

  16. MammaPrint Feasibility in a Large Tertiary Urban Medical Center: An Initial Experience

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    C. Francisco Espinel

    2012-01-01

    Full Text Available Background. The MammaPrint (MP diagnostic assay stratifies breast cancer patients into high- and low-risk groups using mRNA analysis of a 70-gene profile. The assay is validated for assessment of patients with estrogen receptor positive or negative tumors less than 5 cm with 3 or fewer malignant lymph nodes. TargetPrint (TP is an assay for assessing estrogen, progesterone, and HER2-neu receptor status based on mRNA expression. A potential limitation of these assays is that they require an evaluation of fresh tissue samples. There is limited published experience describing MP or TP implementation. Methods. Over 10 months, 4 breast surgeons obtained samples from 54 patients for MP/TP analysis. The samples were analyzed by Agendia Labs. The tumors were independently evaluated for receptor status using immunohistochemistry (IHC. Retrospectively, we identified patients who were assessed by MP/TP during this period. Patients who underwent OncotypeDx evaluation were also identified. Results. Of the 54 patients receiving MP, 4 were found ineligible for MP risk assessment because >3 lymph nodes were found to be malignant. Out of all eligible patients, 14/50 (28% had samples whose quantity of tumor was not sufficient for analysis (QNS. Out of eligible patients with tumors <1 cm, 7/8 (88% had QNS samples. 7/42 with tumors ≥1 cm (17% had QNS samples. Nine patients had discordant receptor results when evaluated by IHC versus. TP. Of patients who also underwent OncotypeDx testing, 6/14 (43% had discordant results with MP. Conclusions. This study indicates that using MP/TP assay is feasible in a tertiary care center but there may be utility in limiting MP testing to patients with tumors between 1 and 5 cm due to high likelihood of uninformative results in subcentimeter tumors. Further study is needed to explore the discordance between oncotype and MP results.

  17. 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

  18. Therapeutic flexible airway endoscopy of small children in a tertiary referral center-11 years' experience.

    Science.gov (United States)

    Soong, Wen-Jue; Tsao, Pei-Chen; Lee, Yu-Sheng; Yang, Chia-Feng

    2017-01-01

    Use of therapeutic flexible airway endoscopy (TFAE) is very limited in pediatrics. We report our clinical experiences and long term outcomes of TFAE in small children from a single tertiary referral center. This is a retrospective cohort study. Small children with their body weight no more than 5.0 kg who had received TFAE between 2005 and 2015 were enrolled. Demographic information and outcomes were reviewed and analyzed from medical charts and TFAE videos. A total of 313 TFAE were performed in 225 children. The mean age was 3.50 ± 0.24 (0.01-19.2) months old; the mean body weight was 3.52 ± 0.65 (0.57-5.0) kg. A noninvasive ventilation technique, without mask or artificial airway, was applied to support all the procedures. TFAE included laser therapy (39.6%), balloon dilatation plasty (25.6%), tracheal intubation (24.3%) and metallic stent placement (6.4%). Short-length endoscopes of 30-35 cm were used in 96%. All TFAE were successfully completed without serious adverse events or mortality. Mean procedural time was 27.6 ± 16.1 minutes. TFAE resulted in successful extubation immediately in 67.2% (45/67) and 62.8% (118/188) were able to wean off their positive pressure ventilation support in 7 days after procedures. By the end of this study, these TFAE averted the originally suggested airway surgeries in 93.8% (61/65), as benefited from laser therapy, stent implantation, and balloon dilatation plasty. The TFAE modality of using short-length endoscopes as supported with this noninvasive ventilation and ICU support is a viable, instant and effective management in small children. It has resulted in rapid weaning of respiratory supports and averted more invasive rigid endoscopy or airway surgeries.

  19. Factors Influencing Rate of Testicular Salvage in Acute Testicular Torsion at a Tertiary Pediatric Center

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    Ramachandra, Puneeta

    2015-01-01

    Full Text Available Introduction: Studies have demonstrated that variables other than duration of symptoms can affect outcomes in children with acute testicular torsion. We examined demographic and logistical factors, including inter-hospital transfer, which may affect outcomes at a tertiary pediatric referral center. Methods: We reviewed charts of all pediatric patients with acute testicular torsion during a five-year period. Data were collected regarding age, insurance type, socioeconomic status, duration of symptoms prior to presentation, transfer status, time of day, time to surgical exploration, and testicular salvage. Results: Our study included 114 patients. Testicular salvage was possible in 55.3% of patients. Thirty-one percent of patients included in the study were transferred from another facility. Inter-hospital transfer did not affect testicular salvage rate. Time to surgery and duration of pain were higher among patients who underwent orchiectomy versus orchidopexy. Patients older than eight years of age were more likely to undergo orchidopexy than those younger than eight (61.5% vs. 30.4%, p=0.01. Ethnicity, insurance type, or time of day did not affect the testicular salvage rates. On multivariate analysis, only duration of symptoms less than six hours predicted testicular salvage (OR 22.5, p<0.001. Conclusion: Even though inter-hospital transfer delays definitive surgical management, it may not affect testicular salvage rates. Time to presentation is the most important factor in predicting outcomes in children with acute testicular torsion. [West J Emerg Med. 2015;16(1:190–194.

  20. 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.

  1. 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

  2. Prevalence and predictive factors of birth traumas in neonates presenting to the children emergency center of a tertiary center in Southwest, Nigeria

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    Babayemi O Osinaike; Labake O.O Akinseye; Olubusola R Akiyode; Chinwe Anyaebunam; Olusola Kushimo

    2017-01-01

    Background: Although the majority of birth injuries are minor and often unreported, occasionally birth injuries may be so severe as to be fatal or leave the child with a permanent disability or even death.Objective: This study aimed to document the patterns and predictive factors of birth injuries in neonates presenting at the emergency center of a tertiary hospital in South west, Nigeria. Patients And Methods: This was a cross-sectional study of neonates who presented at the Olikoye Ransome-...

  3. Comparison of Ramadan-specific education level in patients with diabetes seen at a Primary and a Tertiary care center of Karachi-Pakistan.

    Science.gov (United States)

    Masood, Shabeen Naz; Alvi, Syed Faraz Danish; Ahmedani, Muhammad Yakoob; Kiran, Shazia; Zeeshan, Nimra Fatima; Basit, Abdul; Shera, A Samad

    2014-01-01

    To compare Ramadan-specific education level in fasting patients with diabetes at a Primary and a Tertiary care center. An observational study was conducted in the Outpatient departments of a Primary care center and a Tertiary care center in Karachi-Pakistan. Recruitment of patients started at the end of Ramadan 2011 and continued till three months after Ramadan 2011. All patients with diabetes who observed fast during the month of Ramadan 2011 were included in the study. In Primary care center, patients were attended by physicians only, while at Tertiary care center patients were seen by physicians, diabetes educator and dietician. For data collection, standardized questionnaire based interview was conducted on one to one basis by trained healthcare professionals. Same questionnaire was used at both the centers. A total of 392 and 199 patients with diabetes recruited at Primary and Tertiary care centers, respectively. Ramadan-specific diabetes education received by 213 (55%) and 123 (61.80%) patients with diabetes at Primary and Tertiary care centers, respectively. Compared to Primary care center, patients at Tertiary care centers were more aware about components of Ramadan-specific diabetes education such as signs and symptoms of hypoglycemia and hyperglycemia, dose of medicines/insulin during Ramadan fasting, dose of medicines/insulin when not fasting, self-monitoring of blood glucose, dietary modifications, physical activity, adequate nutrition and adequate hydration during Ramadan (pRamadan-specific education level of patients at Tertiary care center was significantly better compared to patients at Primary care center. Copyright © 2014 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  4. 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

    BACKGROUND: Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest....... METHODS AND RESULTS: Consecutive out-of-hospital cardiac arrest patients (n=1078) without ST-segment-elevation myocardial infarction admitted to tertiary centers (54%) and nontertiary hospitals (46%) were included (2002-2011). Patient charts were reviewed focusing on level-of-care and comorbidity....... The adjusted odds of predefined markers of level-of-care were higher in tertiary centers: admission to intensive care unit (odds ratio [OR], 1.8 [95% confidence interval, 1.2-2.5]), temporary pacemaker (OR, 6.4 [2.2-19]), vasoactive agents (OR, 1.5 [1.1-2.1]), acute (

  5. Fatigue and depression and sleep problems among hemodialysis patients in a tertiary care center

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    Bincy Joshwa

    2012-01-01

    Full Text Available High prevalence of sleep problems, fatigue and depression are reported in maintenance hemodialysis (MHD patients. To assess fatigue, depression, sleep problems and their co-relates among MHD patients in a tertiary care center in India, we studied 47 patients on MHD for >3 months. Patients demographic, medical and co-morbidity profile were recorded. Pittsburgh Sleep Quality Index (poor sleeper if score >5 and Epworth Sleepiness Scale (EPSS, abnormal daytime sleepiness if score >13 were used to assess sleep abnormalities and quality. Beck Depression Inventory (BDI was used to screen for depression. Depression was classified on BDI scores as mild-moderate (score 11-30 and severe (score >30. Fatigue Severity Scale was used to assess fatigue (score ≥36 indicates fatigue. The correlations of these parameters among themselves and with social and demographic parameters were also analyzed. The mean age of the study population was 37.1 ± 13.1 (range 19-65 years years, with 89.3% being males. The majority (68.1% of the MHD patients was poor sleepers, but only five (10.6% patients had borderline or abnormal daytime sleepiness. Of the patients, 44.7% reported fatigue and (72.3% had depression (mild to moderate in 59.7% and severe in 12.6%. Fatigue scores were found to be significantly associated with lesser frequency of dialysis (P < 0.05. There was higher daytime sleepiness in patients who were working (mean EPSS score 6.2 ± 3.7 than who were unemployed (mean EPSS score 3.9 ± 2.7. Depression was found to be higher in those who were paying for the treatment themselves (mean BDI score 20 ± 11.8 as compared with those who were getting medical expenditure reimbursed (mean BDI score 12.9 ± 8.8. Fatigue positively correlated with that of daytime sleepiness (P = 0.02, poor nighttime sleep (P = 0.02 and depression (P=0.006. In the present study, there was no correlation (P <0.05 found between daytime and night time sleep and depression. We found a high

  6. 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

  7. 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

    .8), moderate (OR = 8.68), and late (OR = 2.15). PTB and risks for PTB remain high in Nigeria. We recommend that any high risk pregnancy should be referred to a tertiary center for prenatal care in order to significantly reduce adverse birth outcomes such as PTBs.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  10. Neovascular Glaucoma: A Retrospective Review from a Tertiary Eye Care Center in Mexico.

    Science.gov (United States)

    Lazcano-Gomez, Gabriel; R Soohoo, Jeffrey; Lynch, Anne; N Bonell, Levi; Martinez, Karina; Turati, Mauricio; Gonzalez-Salinas, Roberto; Jimenez-Roman, Jesus; Y Kahook, Malik

    2017-01-01

    To describe the demographic characteristics, ocular comorbidities, and clinical outcomes of patients with neovascular glaucoma (NVG) and to determine the number of patients who returned for a follow-up eye examination. We examined the clinical data of patients with NVG, who attended a glaucoma clinic between July 2010 and November 2014. We collected information on the demographic characteristics of the patients to include the level of education, ocular comorbidities, NVG stage, visual acuity, glaucoma medications, intraocular pressure (IOP), and the number of patients who had a follow-up ocular examination at month 1, 3, 6, and 12. Data from 350 patients (473 eyes) with NVG were collected. We found 91% of the cohort had proliferative diabetic retinopathy (PDR). We found blindness in both or one eye in 14% and 31% of the cohort respectively. Low vision was found in both or one eye in 14% and 32% of the eyes respectively. By 6 months follow-up, only 32% of the patients were seen at our clinic and by 12 months follow-up, this number decreased to 15%. Around 60% of the patients were on no IOP lowering drugs at the first visit. We found 53% of the cohort had an incomplete elementary school education. The results suggest that advanced NVG is a significant ocular problem for patients referred to our clinic with just over half of the patients presenting as blind. We also found that several socioeconomic factors that had an important role in the development of PDR and NVG, specifically, educational status. We described the characteristics of a large cohort of patients with very advanced NVG, reflecting the fact that the strict control of the underlying disease must be the main goal of the Mexican national health system. Lazcano-Gomez G, Soohoo JR, Lynch A, Bonell LN, Martinez K, Turati M, González-Salinas R, Jimenez-Roman J, Kahook MY. Neovascular Glaucoma: A Retrospective Review from a Tertiary Eye Care Center in Mexico. J Curr Glaucoma Pract 2017;11(2):48-51.

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

    African Journals Online (AJOL)

    ebutamanya

    2016-05-01

    May 1, 2016 ... present study, we describe in detail maternal, fetal/neonatal and obstetric characteristics associated with PTB at the Lagos University. Teaching Hospital, a tertiary hospital in Lagos, Nigeria. Methods. Data for this study was obtained from the labor ward records of the. Lagos University Teaching Hospital ...

  13. Spectrum of eyelid disorders at a Nigerian tertiary eye care center ...

    African Journals Online (AJOL)

    Objective: To describe the spectrum of eyelid disorders presenting at a Nigerian tertiary eye care centre with a view to determine the most common type of eyelid disorders as well as available treatment options. Study Design: Retrospective chart review. Methods: A retrospective chart review of all patients who were ...

  14. 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

    Directory of Open Access Journals (Sweden)

    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.

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Impact of a Movement Disorders Clinic on the trends of Parkinson's Disease Consultations at a Tertiary Referral Center.

    Science.gov (United States)

    Corona, Teresa; Cervantes-Arriaga, Amin; Velásquez-Pérez, Leora; Rodríguez-Violante, Mayela

    2016-01-01

    Outpatient clinics for movement disorders provide specialized diagnosis and treatment services for the specific needs of this patient population. Describe the impact of implementing a Movement Disorder Clinic on the trends of consultations per year and hospitalizations of subjects with Parkinson's disease at a tertiary referral center. A retrospective study was carried out. We collected data from the Clinical File Archive and the Epidemiology Department at the National Institute of Neurology and Neurosurgery in Mexico. Data from January 1, 1999 through December 31, 2015 were included for analysis. The number of total consultations had an increase of 632.1% between 1999 and 2015. Follow-up visits represented up to 95% of the consultations. Peaks found correlated with the inclusion of new specialists in the clinic. Regarding hospitalization, the number of patients discharged with a diagnosis of Parkinson's disease increased from a median of 17 (range 9-35) to 46 patients (range 31-53) per year. The implementation of a multidisciplinary Movement Disorders Outpatient Clinic in a tertiary referral center had a direct impact on the total number of consultations per year, mainly follow-up visits. The latter may reflect in an improvement in the quality of care.

  18. 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…

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

    Directory of Open Access Journals (Sweden)

    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

  20. Triage Patterns of Traumatic Subarachnoid Hemorrhage: Is Referral to a Tertiary Care Center Necessary?

    Science.gov (United States)

    Gates, Marcus; Mallory, Grant; Planchard, Ryan; Nothdurft, Georgia; Graffeo, Christopher; Atkinson, John

    2017-04-01

    Isolated traumatic subarachnoid hemorrhage (iTSAH) in mild head injuries has more evidence that triage to a tertiary care facility, intensive care unit admission, and repeat imaging is not warranted. Certain factors were identified that predict radiographic and clinical progression in hopes of preventing avoidable cost, which occur with transfer and subsequent management. A retrospective analysis identified 67 patients transferred between January 2010 and December 2014 who met inclusion criteria. Primary outcomes assessing neurosurgical intervention, radiographic, and clinical progression were documented. Secondary outcomes included any operative intervention, length of stay, standardized hospital costs, disposition at discharge, and 30-day mortality. The mean age of the cohort was 67.7 ± 16.4 years, with most patients (82.1%) having a Glasgow coma score of 15. Warfarin was used in 10 patients (14.9%), although 55.2% were on an antiplatelet or anticoagulation agent. No patient required neurosurgical intervention. One patient, on clopidogrel (Plavix) and warfarin, neurologically declined with radiographic progression. Older age seem to correlate with radiographic progression (P = 0.05). Dementia (P = 0.05) as well as warfarin use (P = 0.06) correlated with clinical progression. Cost in patients without other injuries was associated with warfarin use (P = 0.0002), injury severity scores (P = 0.01), and initial Glasgow coma score (P = 0.0003) on multivariate analysis. In this series of patients with mild traumatic brain injury, the rate of neurological deterioration due to expansion of iTSAH in patients is low, regardless of the use of antiplatelets/anticoagulants. Triage to a tertiary care facility generally is not warranted and can prove costly to patients with iTSAH without other injures. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Management of neck metastases of unknown primary origin united in two European centers.

    Science.gov (United States)

    Straetmans, Jos; Vent, Julia; Lacko, Martin; Speel, Ernst-Jan; Huebbers, Christian; Semrau, Robert; Hoebers, Frank; Mujagic, Zlatan; Klussmann, Jens-Peter; Preuss, Simon F; Kremer, Bernd

    2015-01-01

    Combined analysis of diagnostic and therapeutic management of neck metastases of carcinoma of unknown primary origin ('true CUP') in two European tertiary referral centers (University Medical Centers of Maastricht, NL and Cologne, D) to contribute to the ongoing discussion on management in CUP. Retrospective analysis of 29 (Maastricht) and 22 (Cologne) true cervical CUP syndrome patients (squamous cell carcinoma). The diagnostic and therapeutic approaches were correlated with clinical follow-up data and HPV status. In total, 48 out of 51 true CUP patients received postsurgical adjuvant radiotherapy. In eight patients from Cologne, this was combined with concomitant platin-based chemotherapy. Neither in Cologne nor in Maastricht, radiotherapy of the pharyngeal mucosa was commonly performed (n = 6, 12.5 %) The percentage of patients who were irradiated ipsilaterally or bilaterally did not differ between both institutes (N = 21/27 in Maastricht vs. 11/21 in Cologne), nor did the 5-year overall survival differ significantly. Oncogenic HPV was only found in 4 out of 51 CUPs (7, 8 %). Therefore, no relation with overall and recurrence-free survival could be detected. No occult primary tumors were revealed during follow-up despite de-escalation of therapy by abandoning irradiation of the pharyngeal mucosa in both institutes. There were no significant differences between ipsilateral and bilaterally irradiated patients regarding overall and recurrence-free survival. The occurrence of distant metastases was more often noticed in ipsilaterally treated patients as compared to bilaterally radiated patients (8 vs. 2, p = 0.099). Those patients all had been classified N2b or higher. International guidelines still are not unified and there is an urgent need for a consented therapeutic regimen. Comparison of two international strategies on the management of CUP patients is presented and further research is recommended regarding the role of radiotherapy of the pharyngeal axis, the

  2. Referral Bias in Primary Total Knee Arthroplasty: Retrospective Analysis of 22,614 Surgeries in a Tertiary Referral Center.

    Science.gov (United States)

    Maradit Kremers, Hilal; Salduz, Ahmet; Schleck, Cathy D; Larson, Dirk R; Berry, Daniel J; Lewallen, David G

    2017-02-01

    Patients who travel a significant distance to obtain surgical treatment typically experience better outcomes. This is called the referral bias and can limit the generalizability of studies performed at large tertiary care centers. We explored the influence of referral bias by comparing the clinical characteristics and outcomes of total knee arthroplasty (TKA) at a large tertiary care hospital in the United States. The study cohort included 22,614 primary TKA procedures performed between 1985 and 2010. Patients were stratified into 5 groups using home address zip codes and according to travel distance from the hospital. Clinical characteristics and the risk of TKA complications and surgical outcomes (instability, surgical-site infections, and thrombovascular complications within the first year, reoperations, revisions, and mortality) were compared across the 5 groups. Compared with local patients, patients who traveled from other parts of the United States were significantly younger (mean age 67.8 vs 68.5 years; P history of prior surgeries on the same knee (20% vs 14%; P < .001). Referral patients also had significantly higher American Society of Anesthesiologists scores and longer operative times (mean 173 vs 156 minutes P < .001). Despite these differences, the risk of instability, surgical-site infections, thrombovascular complications, reoperations, and revision surgeries were similar across the 5 groups. Although referral patients differ from local patients, the groups seem to experience largely similar complication and revision rates after TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Pathways to Care of Alcohol -Dependent Patients: An Exploratory Study From a Tertiary Care Substance Use Disorder Treatment Center.

    Science.gov (United States)

    Pal Singh Balhara, Yatan; Prakash, Sathya; Gupta, Rishab

    2016-09-01

    No study from India has examined pathways to care in alcohol using population systematically. The present study aimed to understand the pathways to care among alcohol-dependent individuals seeking help at a tertiary care center. It was a cross-sectional, observational study. A total of 58 subjects diagnosed with alcohol- dependence syndrome as per DSM-IV-TR were included in the study. Pathways to care were assessed using the world health organization encounter form. For 56.9% of the subjects, first point of contact was with a tertiary care addiction psychiatrist. Traditional healers were consulted by about 5.2% of the patients seeking help for the first time. The mean duration of main problems due to alcohol use was 5.82 ± 4.95 years. The first contact tended to be at place nearer to the patient's residence while further contacts tended to be farther away. Family, friends and neighbours together constituted the single largest group suggesting patients to seek care. There is a long time lag between the onset of alcohol use related problems and the first help seeking attempt. Of those who do decide to seek help, the proportion of those obtaining specialist help is higher than commonly believed.

  4. 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,

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

    Directory of Open Access Journals (Sweden)

    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.

  6. [Characterization of the pain, sleep and alexithymia patterns of patients with fibromyalgia treated in a Brazilian tertiary center].

    Science.gov (United States)

    Avila, Lazslo A; de Araujo Filho, Gerardo M; Guimarães, Estefano F U; Gonçalves, Lauro C S; Paschoalin, Paola N; Aleixo, Fabia B

    2014-01-01

    Fibromyalgia (FM) is a complex syndrome that is characterized by lasting and diffuse chronic musculoskeletal pain, derived from non-inflammatory causes and classically associated with the presence of specific tender points. However, studies have highlighted other important symptoms associated with a lower quality of life (QOL) in FM, such as sleep disturbances and alexithymia. This study aimed to investigate the pain, sleep and alexithymia patterns of FM patients treated in a Brazilian tertiary center. 20 patients with FM who were followed-up in the Rheumatology outpatient clinic of a Brazilian tertiary center (Faculdade de Medicina de São José do Rio Preto - FAMERP, São Paulo, Brazil) and 20 patients without FM from other outpatient services of the FAMERP completed a clinical and socio-demographic questionnaire, the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), the Toronto Alexithymia Scale (TAS-20) and the SF-36 (WHOQOL). The patients with FM presented worse performances in all QOL dimensions of the SF-36 and higher scores on the PSQI (p=0.01), and the TAS-20 (p=0.02). Patients with FM also scored significantly higher in all specific domains of PSQI and TAS-20. The present data were in accordance with literature, disclosing a worse performance of patients with FM on pain impact, sleep complains and more presence of alexithymia. Studies have disclosed the presence of important and frequently underdiagnosed symptoms beyond pain complaints in FM, such as sleep complaints and alexithymia, and a better knowledge of such disturbances might improve FM patients' approach and treatment. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

  7. Quality assessments for cancer centers in the European Union

    NARCIS (Netherlands)

    Wind, Anke; Rajan, A.; van Harten, Willem H.

    2016-01-01

    Background 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

  8. Breast Cancer Association with Cytomegalo Virus-A Tertiary Center Case-Control Study.

    Science.gov (United States)

    Surendran, Anilkumar; Chisthi, Meer M

    2017-12-18

    Cytomegalo virus is a ubiquitous virus often associated with congenital infections. Some studied have claimed an association between infection with this virus and development of breast cancer. The aim of this prospective research was to study the difference in Cytomegalo virus sero-positivity among patients with breast cancer and benign breast diseases, and thereby to prove any association. This was a hospital based Case-Control study conducted at the General Surgery wards of our hospital, a tertiary level public sector health care institution. This study was done on 130 patients with breast swellings who underwent surgical excision of their lumps over a 1-year period. Patients with histologically proven malignancies were selected as cases while proven benign cases were deemed to be the controls. IgG and IgM antibodies to Cytomegalo virus were checked in the patients from both groups. All of the studied patients turned out to be positive for Immunoglobulin G against Cytomegalo virus while all the patients were found to be negative for Immunoglobulin M. There was no difference in the antibody titers among the benign and malignant cases in the study. Logistic regression calculation was also carried out including the study parameters and other known risk factors. We conclude that there is no association between Cytomegalo virus sero-positivity and breast cancer. Another conclusion is that the studied adult population has been exposed to Cytomegalo virus in some point of their lives. Further studies of a larger magnitude are essential to confirm our results.

  9. 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.

  10. Evaluation of severe maternal outcomes to assess quality of maternal health care at a tertiary center.

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    Sangeeta, Gupta; Leena, Wadhwa; Taru, Gupta; Sushma, Kumari; Nupur, Gupta; Amrita, Pritam

    2015-02-01

    Maternal mortality and near-miss index reflect the quality of care provided by a health facility. The World Health Organization recently published near-miss approach where strict near- miss criteria based on markers of organ dysfunction are defined. The aim of the study was to determine the frequency of severe maternal complications, maternal near-miss cases and maternal deaths, to analyze causes of near-miss and maternal mortality and to determine the values of maternal near-miss indicators. This was a prospective observational study conducted at a tertiary care centre in North India from January 2012 - March 2013. WHO's near-miss approach was implemented for evaluation of severe maternal outcomes and to assess the quality of maternal health care. The number of women attending our facility with severe maternal complications was low (205 in 6,767 live births); as a result maternal near-miss ratio (MNMR) was low; 3.98/1,000 live births; Overall Maternal near-miss mortality ratio (MNM:1MD) was also low, 3.37:1, because of strict criterion of labeling near-miss and delay in referral to the hospital. Hypertensive disorder (37.5 %) was the commonest underlying cause for maternal mortality. Basic implementation of WHO near-miss approach helped in the systematic identification and evidence-based management of severe maternal complications thereby improving the quality of maternal health in a developing country.

  11. 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.

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

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    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.

  13. Pediatric Keratoconus in a Tertiary Referral Center: Incidence, Presentation, Risk Factors, and Treatment.

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    El-Khoury, Sylvain; Abdelmassih, Youssef; Hamade, Adib; Slim, Elise; Cherfan, Carole G; Chelala, Elias; Bleik, Jamal; Jarade, Elias F

    2016-08-01

    To report the incidence, clinical presentation, risk factors, and treatment outcome of pediatric keratoconus in a tertiary referral eye hospital in Beirut, Lebanon. In this retrospective study, the authors evaluated all patients with keratoconus 14 years or younger newly diagnosed at the Beirut Eye Specialist Hospital, Beirut, Lebanon, between January 2010 and December 2014. The incidence of pediatric keratoconus among all pediatric patients and among patients with keratoconus of all ages was assessed. Patients with pediatric keratoconus were evaluated for keratoconus stage, initial presentation, uncorrected distance visual acuity, corrected distance visual acuity (CDVA), corneal topography, and pachymetry. Patients were classified according to different treatment regimen groups and different follow-up visits were evaluated. During 5 years, 16,808 patients were examined, of whom 2,972 were 14 years or younger. A total of 541 patients were diagnosed as having keratoconus; of those, 16 were 14 years or younger at the time of diagnosis. Hence, the incidence of keratoconus was 0.53% among pediatric patients and 3.78% among adult patients (> 14 years). Initial presentation was during routine checkup (1 of 16) for allergic conjunctivitis (3 of 16), reduced vision (10 of 16), and corneal hydrops (mimicking keratitis) (2 of 16). Except for 2 patients lost to follow-up, all eyes received corneal cross-linking treatment and 16 eyes received additional intracorneal ring segment implantation. The incidence of pediatric keratoconus indicates that increased awareness for keratoconus among children is needed, mainly in cases of family history of keratoconus, ocular allergy/pruritus, poor CDVA, corneal hydrops, and/or high astigmatism. [J Refract Surg. 2016;32(8):534-541.]. Copyright 2016, SLACK Incorporated.

  14. Recurrent multifocal osteomyelitis in children: Experience in a tertiary care center.

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    Ariza Jiménez, Ana Belén; Núñez Cuadros, Esmeralda; Galindo Zavala, Rocío; Núñez Caro, Leticia; Díaz-Cordobés Rego, Gisela; Urda Cardona, Antonio

    2017-05-19

    Chronic recurrent multifocal osteomyelitis is a rare aseptic bone inflammation that affects pediatric patients. Its management and treatment have not yet been standardized. Retrospective, descriptive study of patients under 14 years of age diagnosed with chronic nonbacterial osteomyelitis (CNBO) in a tertiary hospital. We included patients diagnosed over the last 6 years (2010-2015) who met the Jansson criteria. The clinical and radiological characteristics of CNBO were analyzed, as was the outcome after different therapeutic options. We report 12 patients, with a mean age of 11 years (±1.6 standard deviation [SD]) and female predominance (10:2). The mean number of foci was 3.5 (±2.2 SD). The most common locations were ankle (58%), clavicle (50%), sternum (33%) and hip (25%). The mean disease duration was 10.5 months (±10.3 SD), and the median time to diagnosis was 2.38 months (range 0.17-16). Bone scintigraphy detected asymptomatic foci in 33% and we detected lytic lesions in 50% through magnetic resonance imaging. Biopsy was performed in 60%; 2/12 (16%) were associated with inflammatory disease and 1/12 (8.3%) later developed lymphoma. In all, 58% received antibiotic therapy with little response, 100% anti-inflammatory agents, 50% systemic corticosteroids, 41.6% methotrexate/pamidronate and 16% anti-tumor necrosis factor (TNF) α. The mean duration of treatment was 14.8 months (±12.4 SD) and 66% had recurrences. Currently, 83% are in clinical remission without treatment. When CNBO is refractory to treatment with anti-inflammatory drugs, intravenous pamidronate can be an alternative. Anti-TNF drugs can be considered in patients who fail with pamidronate, as can agents associated with other autoimmune conditions. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  15. The Effect on Academic Health Centers of Tertiary Care in Community Hospitals.

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    Gee, David A.; Rosenfeld, Lisa A.

    1984-01-01

    The growing cost of medical education and the provision of care to the indigent can be endangered by the dilution of revenue sources traditionally available to the academic health centers but which are being taken over by suburban hospitals. (Author/MLW)

  16. Prevalence and predictive factors of birth traumas in neonates presenting to the children emergency center of a tertiary center in Southwest, Nigeria

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    Babayemi O Osinaike

    2017-01-01

    Full Text Available Background: Although the majority of birth injuries are minor and often unreported, occasionally birth injuries may be so severe as to be fatal or leave the child with a permanent disability or even death.Objective: This study aimed to document the patterns and predictive factors of birth injuries in neonates presenting at the emergency center of a tertiary hospital in South west, Nigeria. Patients And Methods: This was a cross-sectional study of neonates who presented at the Olikoye Ransome-Kuti Children Emergency Center of the Lagos University Teaching Hospital between October and December 2016. All neonates admitted for treatment at the center for any clinical condition were included in the study after initial review or resuscitation/treatment for their primary complaint, and consent was obtained from their caregivers. The babies were examined by at least a senior resident and any abnormality documented. Any underlining medical conditions such as asphyxia and neonatal sepsis were properly investigated and treated. Statistical analyses were performed by chi-square, student's t-test, using SPSS version 20.0. P ≤ 0.05 was considered statistically significant. Results: A total of 134 neonates were reviewed during the study period with majority, 84 (62.7%, being males. The mean age at presentation was 65.2 ± 89.2 h (median 24 h. Caput succedaneum (22.2% and subconjunctival hemorrhage (22.2% were the most frequent injuries observed, while cranial nerve injury the least. One patient had multiple injuries (cranial nerve injury with fractures humerus. Conclusions: Overall prevalence and pattern of birth injuries in neonates presenting at our emergency center was consistent with various studies from other centers. Parity of the mother, significant maternal medical history, duration of labor, mode of delivery, and skill of attending personnel at delivery were significant factors associated with birth injuries

  17. Age-related risk factors, culture outcomes, and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers

    NARCIS (Netherlands)

    van der Meulen, Ivanka J.; van Rooij, Jeroen; Nieuwendaal, Carla P.; van Cleijnenbreugel, Hugo; Geerards, Annette J.; Remeijer, Lies

    2008-01-01

    PURPOSE: To assess age-related risk factors (RFs), microbiologic profile, and prognosis of infectious keratitis and create guidelines for prevention and treatment. METHODS: Retrospective review of patients with infectious keratitis admitted to 2 Dutch tertiary referral centers from January 2002 to

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

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    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.

  19. Clinical profile of geriatric acute kidney injury in a tertiary care center from south India

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    Eshwarappa Mahesh

    2017-01-01

    Full Text Available The incidence of acute kidney injury (AKI is high in the elderly, who comprise an ever-growing segment of the population. Elderly patients pose a different set of diagnostic and therapeutic challenge owing to their associated comorbidities. AKI in the elderly is associated with an increased risk of mortality, morbidity, prolonged length of stay, and progression to chronic kidney disease. Data regarding the clinical profile of AKI in the elderly from the South Indian population are limited. Hence, we present this analysis of the etiological and prognostic factors associated with AKI in elderly population from South India. This is a cross-sectional, prospective, observational study conducted in a tertiary care teaching hospital from Bengaluru, during the period from May 2011 to October 2012. Institutional Ethical Committee clearance was obtained. Informed consents were obtained from patients who fulfilled the inclusion criteria. Elderly patients >60 years of age with features of AKI (Risk, Injury, Failure, Loss, and End-stage criteria 1 at admission and those who developed AKI following hospital admission were included in the study. Demographic details, detailed medical history, comorbid conditions, etiological factors, prognostic factors, and outcomes were collected. Statistical analysis was done using Statistical Package for the Social Sciences software. Two hundred patients fulfilled the inclusion criteria and were enrolled into the study. The mean age was 70.5 years. Fifty-nine percent were males and 41% were females. Peak incidence of AKI was in the age group 60–69 years. Diabetes was seen in 44%, hypertension in 35%, ischemic heart disease in 19%, and chronic obstructive pulmonary disease in 12% of cases. Ninety-one percent had AKI at admission, and the rest developed it during hospitalization. The average duration of hospital stay was seven days. Etiological factors for AKI were medical in 87% of the cases, surgical in 11%, and

  20. Hospital survival upon discharge of ill-neonates transported by ground or air ambulance to a tertiary center

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    Jorge Luis Alvarado-Socarras

    2016-06-01

    Full Text Available Abstract Objective: To evaluate the differences in hospital survival between modes of transport to a tertiary center in Colombia for critically ill neonates. Methods: Observational study of seriously ill neonates transported via air or ground, who required medical care at a center providing highly complex services. Data on sociodemographic, clinical, the Transport Risk Index of Physiologic Stability (TRIPS, and mode of transport were collected. Patients were described, followed by a bivariate analysis with condition (live or dead at time of discharge as the dependent variable. A multiple Poisson regression with robust variance model was used to adjust associations. Results: A total of 176 neonates were transported by ambulance (10.22% by air over six months. The transport distances were longer by air (median: 237.5 km than by ground (median: 11.3 km. Mortality was higher among neonates transported by air (33.33% than by ground (7.79%. No differences in survival were found between the two groups when adjusted by the multiple model. An interaction between mode of transport and distance was observed. Live hospital discharge was found to be associated with clinical severity upon admittance, birth weight, hemorrhaging during the third trimester, and serum potassium levels when admitted. Conclusions: Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation to obtain good clinical outcomes according type of ambulance.

  1. Pulmonary alveolar proteinosis: Experience from a tertiary care center and systematic review of Indian literature

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    Vijay Hadda

    2016-01-01

    Full Text Available Background: Pulmonary alveolar proteinosis (PAP is a rare disorder characterized by deposition of lipoproteinaceous material within alveoli, with a variable clinical course. Here, we report an experience of management of PAP at our center. A systematic review of previously reported cases from India is also included in the article. Materials and Methods: This study included patients with primary PAP managed at our center from 2009 to 2015. Diagnosis of primary PAP was based on histopathologic diagnosis on bronchoalveolar lavage or transbronchial lung biopsy and absence of causes of secondary PAP. For systematic review of Indian publications, the literature search was performed using PubMed and EMBASE databases using the terms “pulmonary alveolar proteinosis'” or “alveolar proteinosis” and “India” or “Indian.” Results: During the above-specified period, five patients with diagnosis of PAP were admitted at our center. Median age of patients was 32 years (interquartile range [IQR] 30.5–59; 80% were female. Mean duration (± standard deviation of symptoms was 6.2 (±1.79 months. Anti-granulocyte-macrophage colony stimulating factor (GM-CSF antibodies were elevated in 4 out of 5 patients (80%. For management, whole lung lavage (WLL was done for four patients with median volume of 32.5 (IQR 18–74 L per patient. All the patients showed significant symptomatic as well as improvement in physiological parameters. Subcutaneous GM-CSF and ambroxol were given to 3 patients and 1 patient, respectively. The median follow-up of all patients was 18 (IQR 5–44 months. A systematic review of all Indian studies of PAP revealed thirty publications. Conclusions: WLL is the most common, effective, and safe therapy in patients with PAP. GM-CSF administration is an efficacious treatment for patients with incomplete response after WLL.

  2. Patterns, severity, and management of maxillofacial injuries in a suburban South Western Nigeria tertiary center.

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    Ogunmuyiwa, Stella Aimiede; Gbolahan, Olalere Omoyosola; Ayantunde, Abiodun Abraham; Odewabi, Adenike Abidemi

    2015-01-01

    Trauma remains a leading cause of maxillofacial injury globally. Changing etiological factors and patterns of maxillofacial injury continue to be reported and are largely modulated by socio-geographic and environmental factors. It is important to have an in-depth understanding of the pattern and etiology in a particular region before effective preventive measures can be developed. The aim was to evaluate the patterns, etiological factors, and management of maxillofacial injuries in Ogun state, Nigeria. A prospective descriptive cohort study of all consecutive patients that presented with maxillofacial injuries at our center between January and December 2013. Information about demographic data, types of maxillofacial and associated injury, etiology of injury, treatment received and complications were collected and analyzed. Seventy patients presented with maxillofacial injury during the study period with a male to female ratio of 4:1. The age range was 9 months to 60 years with a mean of 30.11 ± standard deviation 14.97 years. Majority of the facial fractures were due to motorcycle related crashes. There were 57.1% mandibular fractures and 55.7% middle third fractures. Closed reduction with maxillo-mandibular fixation was the major method of treatment of facial fractures. Postoperative complications were observed in 11.4% of patients. Road traffic crashes (RTCs) remain the leading etiological factor of maxillofacial injuries in our center. Enforcement of stricter traffic regulations and possibly replacement of motorcycles with tricycles for commercial transportation may help to reduce the incidence of RTCs.

  3. 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.

  4. Survey of delivery room resuscitation practices at tertiary perinatal centers in Japan.

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    Hosono, Shigeharu; Tamura, Masanori; Kunikata, Tetsuya; Wada, Masaki; Kusakawa, Isao; Ibara, Satoshi

    2015-04-01

    The aim of this study was to determine the current neonatal resuscitation practices for term infants in Japan, immediately before the 2010 publication of the international neonatal resuscitation consensus. In January 2010, a 26-question survey was mailed to neonatal department directors. A total of 287 neonatal departments were identified. Four surveys were returned as undeliverable. A total of 191 surveys were returned completed, but four departments had no labor and delivery rooms (66.6% response rate, 65.2% survey available response rate). Flow-inflating bags were most commonly used (63.2%), followed by self-inflating bags (35.8%), and T-piece resuscitators (1.0%). Among the participants, 42.1% used oxygen blenders, 56.2% used pure oxygen for initial resuscitation, and 79.5% used a pulse oximeter to change the fraction of inspired oxygen. Among the participants, 45.3% used carbon dioxide detectors to confirm intubation, 42.5% routinely used the detectors, and 55.2% used them when confirming a difficult intubation. In addition, 42.5% of the participants used continuous positive airway pressure to treat breathing problems, most commonly with flow-inflating bags (93.2%). The equipment and techniques used in Japanese perinatal center delivery room resuscitation practices are highly varied. Further research is required to determine which devices and techniques are appropriate for this important and common intervention. © 2014 Japan Pediatric Society.

  5. Decrease in the Prevalence of Pancreatitis Associated with Primary Hyperparathyroidism: Experience at a Tertiary Referral Center.

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    Janka-Zires, Marcela; Hernández-Calleros, Jorge; Gómez-Pérez, Francisco Javier; Uscanga-Domínguez, Luis Federico; Pelaez-Luna, Mario César; Almeda-Valdés, Paloma

    2015-01-01

    Hypercalcemia is a rare but well recognized cause of acute and chronic pancreatitis. Hypercalcemia-related pancreatitis is mainly caused by primary hyperparathyroidism. The prevalence of pancreatitis in hyperparathyroidism varies worldwide and additional disease-modifying factors may play a role in its development. In 1988 the prevalence of pancreatitis secondary to primary hyperparathyroidism at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), a referral center in Mexico City, was 12.1% (95% CI: 6.7-21). To describe the current prevalence of pancreatitis secondary to primary hyperparathyroidism at the INCMNSZ. We reviewed 385 cases of primary hyperparathyroidism seen at the hospital between 1987 and 2012. 26 cases with acute or chronic pancreatitis associated with primary hyperparathyroidism were documented, with a prevalence of 6.7% (95% CI: 4.6-9.7), which was lower than the 12.1% previously reported. In the present study, 20% had a history of alcohol consumption, 10% of gallstones, and 20% of ureteral calculi, compared with the previously reported 32.0, 34.6, and 40.0%, respectively. The average calcium levels were 13.1 and 13.8 mg/dl in the previous and current series, respectively. We found a decrease in the prevalence of pancreatitis associated with primary hyperparathyroidism from 12.1% (95% CI: 6.7-21) to 6.7% (95% CI: 4.6-9.7).

  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. Perinatal Diagnostic Approach to Fetal Skeletal Dysplasias: Six Years Experience of a Tertiary Center.

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    Toru, Havva Serap; Nur, Banu Guzel; Sanhal, Cem Yasar; Mihci, Ercan; Mendilcioğlu, İnanç; Yilmaz, Elanur; Yilmaz, Gulden Tasova; Ozbudak, Irem Hicran; Karaali, Kamil; Alper, Ozgul M; Karaveli, Fatma Şeyda

    2015-01-01

    Skeletal dysplasias (SDs) constitute a group of heterogeneous disorders affecting growth morphology of the chondro-osseous tissues. Prenatal diagnosis of SD is a considerable clinical challenge due to phenotypic variability. We performed a retrospective analysis of the fetal autopsies series conducted between January 2006 and December 2012 at our center. SD was detected in 54 (10%) out of 542 fetal autopsy cases which included; 11.1% thanatophoric dysplasia (n = 6), 7.4% achondroplasia (n = 4), 3.7% osteogenesis imperfect (n = 2), 1.9% Jarcho-Levin Syndrome (n = 1), 1.9% arthrogryposis (n = 1), 1.9% Dyggve-Melchior-Clausen syndrome (n = 1), 72.1% of dysostosis cases (n = 39). All SD cases were diagnosed by ultrasonography. In 20 of the cases, amniocentesis was performed, 4 cases underwent molecular genetic analyses. Antenatal identification of dysplasia is important in the management of pregnancy and in genetic counseling. Our data analysis showed that SD is usually detected clinically after the 20th gestational week. Genetic analyses for SD may provide early diagnosis and management.

  8. Prevalence of renal insufficiency in elderly cancer patients in a tertiary cancer center.

    Science.gov (United States)

    Pontes, Lucíola de Barros; Antunes, Yuri Philippe Pimentel Vieira; Bugano, Diogo Diniz Gomes; Karnakis, Theodora; Giglio, Auro Del; Kaliks, Rafael Aliosha

    2014-09-01

    To estimate the prevalence of abnormal glomerular filtration rate in elderly patients with solid tumors. A retrospective study with patients aged >65 years diagnosed with solid tumors between January 2007 and December 2011 in a cancer center. The following data were collected: sex, age, serum creatinine at the time of diagnosis and type of tumor. Renal function was calculated using abbreviated Modification of Diet in Renal Disease (MDRD) formulae and then staged in accordance with the clinical practice guidelines published by the Working Group of the National Kidney Foundation. A total of 666 patients were included and 60% were male. The median age was 74.2 years (range: 65 to 99 years). The most prevalent diagnosis in the study population were colorectal (24%), prostate (20%), breast (16%) and lung cancer (16%). The prevalence of elevated serum creatinine (>1.0mg/dL) was 30%. However, when patients were assessed using abbreviated MDRD formulae, 66% had abnormal renal function, stratified as follows: 45% with stage 2, 18% with stage 3, 3% with stage 4 and 0.3% with stage 5. To the best of our knowledge, this was the first study to estimate the frequency of renal insufficiency in elderly cancer patients in Brazil. The prevalence of abnormal renal function among our cohort was high. As suspected, the absolute creatinine level does underestimate renal function impairment and should not be used as predictor of chemotherapy metabolism, excretion and consequent toxicity.

  9. 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

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

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    Amankwa Richcane

    2017-07-01

    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 KirbyBauer 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.

  11. Psycho-Oncology Structure and Profiles of European Centers Treating Patients With Gynecological Cancer

    NARCIS (Netherlands)

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

    2011-01-01

    Objective: 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 psychooncology services within European Society of Gynecological Oncology (ESGO) centers. Methods: In 2010, a survey, which consisted of

  12. 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.

  13. A prolonged outbreak of methicillin-resistant Staphylococcus aureus in the burn unit of a tertiary medical center.

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    Meier, P A; Carter, C D; Wallace, S E; Hollis, R J; Pfaller, M A; Herwaldt, L A

    1996-12-01

    To report an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in our burn unit and the steps we used to eradicate the organism. Outbreak investigation in the burn unit of a 900-bed tertiary-care medical center. Between March and June 1993, MRSA was isolated from 10 patients in our burn unit. All isolates had identical antibiograms and chromosomal DNA patterns. Infection control personnel encouraged healthcare workers to wash their hands after each patients contact. The unit cohorted all infected or colonized patients, placed each affected patient in isolation, and, if possible, transferred the patient to another unit. Despite these measures, new cases occurred. Infection control personnel obtained nares cultures from 56 healthcare workers, 3 of whom carried the epidemic MRSA strain. One healthcare worker cared for six affected patients, and one cared for five patients. We treated the three healthcare workers with mupirocin. Subsequently, no additional patients became colonized or infected with the epidemic MRSA strain. The outbreak ended after we treated healthcare workers who carried the epidemic strain with mupirocin. This approach is not appropriate in all settings. However, we felt it was justified in this case because of a persistent problem after less intrusive measures.

  14. An outbreak of Candida spp. bloodstream infection in a tertiary care center in Bogotá, Colombia

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    Carlos A. DiazGranados

    Full Text Available Several cases of Candida bloodstream infections were documented from June to October 2004 at a tertiary care center in Bogotá, Colombia. Since no cases of candidemia had occurred during the preceding four months, an outbreak was declared. As a result, a microbiological study, a revision of infection control practices and a case-control study were performed. In all, 18 cases of candidemia were ascertained. Parenteral nutrition (p=0.04, presence of a central line (p=0.03, and severity of illness (p=0.03 were associated with candidemia in bivariate analysis. Diverse Candida species were observed. Candida parapsilosis contamination was found in plastic containers used for transient intravenous (IV medication storage at the bedside, plastic bags reused for the transportation of IV medicines and cotton used for disinfection of IV ports. Poor infection control practices were widely observed. The outbreak was controlled after elimination of plastic bags used for transportation, instauration of daily disinfection of IV medication containers, acquisition of sterile alcohol swabs for port disinfection and staff education. It was concluded that candidemia was associated with previously-described risk factors and that poor infection-control practices were likely responsible for the outbreak.

  15. Definition of performance metrics and methods for screening for sudden cardiac arrest risk at a tertiary care medical center.

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    Rea, Robert F; Beinborn, Douglas; Webster, Tracy; Acker, Nancy; Kester, Tammy; Hayes, David L; McConnell, Mark

    2011-09-01

    The purpose of this study is to describe the results of manual and automatic electronic medical record-based screening of patients at risk of sudden cardiac arrest (SCA) based on measurements of left ventricular ejection fraction (LVEF). Counseling regarding SCA risk and implantable cardioverter defibrillator (ICD) therapy is underutilized in patients with reduced LVEF. We developed and implemented an electronic medical record (EMR)-based system for screening of such patients to improve care. In phase one, manual screening of electronic records and LVEF databases was initially performed by trained cardiac device nurses. In phase two, records were screened automatically by a customized program, and candidate patient records were sent to cardiac device nurses for final review and disposition. In phase one, 2,531 patients with LVEF ≤35% were identified over 398 days. Manual EMR review showed that 1,918 patients (76%) received appropriate counseling regarding SCA risk, received ICDs, or had disqualifying comorbidities. In phase two, 1,081 patients with LVEF ≤35% were identified after automatic screening of 44,672 echocardiograms and EMR over 251 days. Of these, 513 patients (58%) received appropriate counseling regarding SCA risk, received ICDs, or had disqualifying comorbidities. These data detail the utilization of consultation regarding SCA risk and ICDs in patients with reduced LVEF at a tertiary care center with ready access to arrhythmia specialists. Notification of primary providers of reduced LVEF with recommendation for consultation was not effective in improving patient care.

  16. Sweet syndrome in patients with and without malignancy: A retrospective analysis of 83 patients from a tertiary academic referral center.

    Science.gov (United States)

    Nelson, Caroline A; Noe, Megan H; McMahon, Christine M; Gowda, Asha; Wu, Benedict; Ashchyan, Hovik J; Perl, Alexander E; James, William D; Micheletti, Robert G; Rosenbach, Misha

    2018-02-01

    Sweet syndrome is a neutrophilic dermatosis that may be categorized into classic, malignancy-associated, and drug-induced subtypes. Few studies have systematically analyzed this rare disorder. To describe the clinicopathologic characteristics and treatment of Sweet syndrome and identify characteristics associated with concurrent malignancy. We retrospectively reviewed patients with Sweet syndrome at the University of Pennsylvania from 2005 to 2015. We identified 83 patients (mean age, 57 years; 51% male) with Sweet syndrome: 30% with the classic form, 44% with the malignancy-associated form, 24% with the drug-induced form in the setting of malignancy, and 2% with the drug-induced form. Acute myeloid leukemia was the most common malignancy (in 24 of 83 patients [29%]). Filgrastim was the most common medication (used in 8 of 83 patients [10%]). Leukopenia (P < .001), anemia (P = .002), thrombocytopenia (P < .001), absence of arthralgia (P < .001), and histiocytoid or subcutaneous histopathology (P = .024) were associated with malignancy (χ 2 test). This was a retrospective study that represents patients from a single tertiary academic referral center, which may limit its generalizability to other settings. When caring for patients with Sweet syndrome, dermatologists should be aware of the potential association of leukopenia, anemia, thrombocytopenia, absence of arthralgia, and histiocytoid or subcutaneous histopathology with malignancy. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  17. Assessment of visual morbidity amongst diabetic retinopathy at tertiary eye care center, Nepal: a cross-sectional descriptive study.

    Science.gov (United States)

    Pandey, Araniko; Lamichhane, Gyanendra; Khanal, Roshija; Rai, Salma K C; Bhari, Arjun Malla; Borroni, Davide; Gautam, Narayan

    2017-12-28

    Diabetic retinopathy (DR) is one of the leading causes of preventable blindness in low and middle income countries. In Nepal, there are less studies regarding DR and they too are limited around Kathmandu valley. This study was done to assess visual morbidity in patients with DR at a peripheral tertiary eye care center of Nepal. This was a prospective, hospital based, cross-sectional study in which all consecutive cases of DR were evaluated. DR was classified according to Early Treatment Diabetic Retinopathy Study Research Group - report no. 10 Table A5-1 (Modified Airlie House Classification). Data entry and analysis was done in an SPSS unit version 20. Wherever applicable, variables were set as 100 eyes. Total number of patients included in this study was 50. Commonest age group was 50-69 yrs. (43/77 yrs.; min/max) comprising 80% of the total population (n = 50) and the predominant population was male (76%). Non proliferative diabetic retinopathy (NPDR) was found in 69%, proliferative diabetic retinopathy (PDR) in 31% and advanced diabetic eye disease (ADED) in 3% (n = 100). All the stages of DR were present at significant proportions in this study, noteworthy was the percentage of PDR. This study shows an urgency to gather a national data on DR, raise awareness among diabetics and train effective man power at a local level to diagnose DR at an early stage.

  18. Late effects of treatment in survivors of childhood cancer from a tertiary cancer center in South India

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    Rejiv Rajendranath

    2014-01-01

    Full Text Available Background: Improved survival after childhood cancer is attributed to intensive, aggressive therapy, adverse sequelae of which can manifest months to years after completion of treatment. There is little information about the late adverse effects of both childhood cancer and its therapy in survivors in India. Aim: To determine the long-term sequelae associated with therapy in childhood cancer survivors attending a tertiary cancer center in India. Materials and Methods: We studied 155 consecutive survivors of childhood cancer who were ≤14 years at the time of diagnosis and had completed 3 years of follow-up. The study included a complete history and clinical examination, with specific investigations to detect organ toxicity. Quality of life (QOL was assessed from responses to a standardized questionnaire. Neurocognitive assessment was carried out in 20 survivors with an adaptation of the revised Wechsler adult intelligence scale for adults and the Malins intelligence scale for children. Results: The late effects included impaired fertility in 38 patients (24.5%, impaired growth pattern in 7 (4.5%, endocrine dysfunction in 7 (4.5% and second malignancy in 2 (1.2%. Three of the 20 patients assessed had severe neurocognitive impairment. A high QOL was reported by 60% of survivors and an "average" QOL by 38%. Conclusion: Our study showed that most survivors had a good QOL and our results will help clinicians to better monitor childhood cancer survivors in countries with limited resources.

  19. Colorectal cancer burden and trends in a South Asian cohort: experience from a regional tertiary care center in Sri Lanka.

    Science.gov (United States)

    Chandrasinghe, P C; Ediriweera, D S; Hewavisenthi, J; Kumarage, S K; Fernando, F R; Deen, K I

    2017-10-30

    Colorectal cancer (CRC) burden is increasing in the south Asian region due to the changing socio-economic landscape and population demographics. There is a lack of robust high quality data from this region in order to evaluate the disease pattern and comparison. Using generalized linear models assuming Poisson distribution and model fitting, authors describe the variation in the landscape of CRC burden along time since 1997 at a regional tertiary care center in Sri Lanka. Analyzing 679 patients, it is observed that both colon and rectal cancers have significantly increased over time (pre 2000-61, 2000 to 2004-178, 2005 to 2009-190, 2010 to 2014-250; P < 0.05). Majority of the cancers were left sided (82%) while 77% were rectosigmoid. Over 25% of all CRC were diagnosed in patients less than 50 years and the median age at diagnosis is < 62 years. Increasing trend is seen in the stage at presentation while 33% of the rectal cancers received neoadjuvant chemoradiation. Left sided preponderance, younger age at presentation and advanced stage at presentation was observed. CRC disease pattern in the South Asian population may vary from that observed in the western population which has implications on disease surveillance and treatment.

  20. The new generation of graduating anesthesia residents: what is the impact on a major tertiary referral private practice medical center?

    Science.gov (United States)

    Ramsay, Michael

    2007-12-01

    The new graduate entering the private practice arena faces many challenges. Expectations regarding both the professional environment and personal lifestyle have changed from previous generations, and these are reviewed and discussed. The challenges for both professional and personal development and the responsibilities of the new graduate to continue to learn and stay on top of the specialty are enormous. The best graduates add to the reputation and performance of a department. Marginal graduates have a much tougher experience; their career in a tertiary care, level 1 trauma center environment is unlikely to be sustainable. The motivation and expectations of the new graduates, as they relate to lifestyle, schedules, and reimbursement, have changed. The expectations of the practice, the institution, the payers, and the public have also changed and are increasingly focused on performance, efficiency, and safety. Anesthesiology continues to attract some of our best physicians, and this is vital for the survival of anesthesiology as a medical specialty. The new generation challenges us to make the necessary changes in practice pattern and lifestyle to sustain this goal. The new generation is also challenged by an environment of performance-based expectations.

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

    Science.gov (United States)

    Tsai, Carmelle; Walters, Camila B; Sampson, John; Kateh, Francis; Chang, Mary P

    2017-01-30

    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.

  2. 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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  5. Socio-demographic and clinical characteristics of benzodiazepine long-term users: Results from a tertiary care center.

    Science.gov (United States)

    Cosci, F; Mansueto, G; Faccini, M; Casari, R; Lugoboni, F

    2016-08-01

    The use of benzodiazepines (BDZs) represents a critical issue since a long-term treatment may lead to dependence. This study aimed at evaluating socio-demographic and clinical characteristics of BZD long-term users who followed a detoxification program at a tertiary care center. Two hundred-five inpatients were evaluated. Socio-demographic (e.g., gender, age, education) and clinical information (e.g., BZD used, dose, reason of prescription) was collected. BZDs dose was standardized as diazepam dose equivalents and was compared via the Defined Daily Dose (DDD). Chi-square, Fisher test, ANOVA and Bonferroni analyses were performed. Females were more frequently BDZ long-term users than males. Hypnotic BZDs were frequently prescribed for problems different from sleep disturbances. Lorazepam, alprazolam, and lormetazepam were the most prescribed drugs. Lorazepam was more frequently used by males, consumed for a long period, in pills, and prescribed for anxiety. Lormetazepam was more frequently consumed by females with a high school education, having a psychiatric disorder, taken in drops and prescribed for insomnia. Lormetazepam had the highest DDD. A specific profile of BZD long-term user seems to exist and presents different socio-demographic and clinical characteristics according to the benzodiazepine taken into account. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Hypofractionated radiotherapy for breast cancers--preliminary results from a tertiary care center in eastern India.

    Science.gov (United States)

    Nandi, Moujhuri; Mahata, Anurupa; Mallick, Indranil; Achari, Rimpa; Chatterjee, Sanjoy

    2014-01-01

    The standard radiotherapy (RT) fractionation practiced in India and worldwide is 50 Gy in 25 fractions over 5 weeks to the chest wall or whole breast followed by tumour bed boost in case of breast conservation (BCS). A body of validated data exists regarding hypofractionation in breast cancer. We here report initial results for 135 patients treated at our center with the START-B type of fractionation. From May 2011 till July 2012, women with all stages of breast cancer (excluding metastatic), who had undergone BCS or mastectomy were planned for 40 Gy in 15 fractions over 3 weeks to chest wall/whole breast and supraclavicular fossa (where indicated) followed by tumour bed boost in BCS patients. Planning was done using Casebow's technique. The primary end point was to assess the acute toxicity and the cosmetic outcomes. Using cosmetic scales; patients were assessed during radiotherapy and at subsequent follow up visits with the radiation oncologist. Of the 135 patients, 62 had undergone BCS and 73 mastectomy. Median age of the population was 52 years. Some 80% were T1 and T2 tumours in BCS whereas most patients in mastectomy group were T3 and T4 tumours (60%). 45% were node negative in BCS group whilst it was 23% in the mastectomy group. Average NPI scores were 3.9 and 4.9, respectively. Most frequently reported histopathology report was infiltrating ductal carcinoma (87%), grade III being most common (58%), and 69% were ER positive tumours, and 30% were Her 2 Neu positive. Triple negative tumours accounted for 13% and their mean age was young (43 yrs.) The maximum acute skin toxicity at the end of treatment was Grade 1 in 94% of the mastectomy group patients and 71% in BCS patients. Grade 2 toxicity was 6% in mast group and 23% in BCS group. Grade 3 was 6% in BCS group, no grade 3 toxicity in mastectomy patients and there was no grade 4 skin toxicity in any case. Post RT at 1 month; 39% of BCS patients had persisting Grade I skin reaction which was only 2% in

  7. Endoscopic correction of vesicoureteric reflux: 10-year experience of a tertiary care center

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    Khalid Fouda Neel

    2012-01-01

    Full Text Available Endoscopic treatment (ET of vesicoureteric reflux (VUR is becoming the new gold standard for surgical correction. ET for VUR using newly available bulking agents is a reliable and safe alternative procedure to open ureteral reimplantation for the treatment of VUR in children. We retrospectively reviewed our experience over 10 years of patients with primary VUR who underwent ET and had at least one year of follow-up at our center from 1998 to 2008. We looked at laterality, success rate, need for a second procedure and complication rate. We observed 321 patients with ET for VUR during this period; 115 (35.8% of them were males and the total intervened ureters were 480. Correction of VUR was defined as either the resolution of reflux or a downgrading to grade 1 revealed with a follow-up voiding cystourethrogram and no ipsilateral renal or ureteric dilatation detected on renal ultrasound. At two to three months of follow-up, VUR was corrected in 393/480 (81.8% refluxing ureters after a single endoscopic injection. With a second, repeated injection in the failed cases, VUR was corrected in a total of 418 (87.1% refluxing ureters. Only three patients had post-operative complications (<1%. We conclude that our study suggests that the majority of patients will be cured after undergoing, as out-patients, this endoscopic procedure. We believe that the widely reported safety of bulking agents and the short learning curve will make ET the standard treatment for VUR once surgical correction is warranted.

  8. Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center.

    Science.gov (United States)

    Chiappini, Elena; Camposampiero, Caterina; Lazzeri, Simone; Indolfi, Giuseppe; De Martino, Maurizio; Galli, Luisa

    2017-05-04

    Background: Paediatric acute hematogenous osteomyelitis (AHOM) is a serious disease requiring early diagnosis and treatment. To review the clinical presentation, management and organisms responsible for AHOM, and to explore risk factors for complicated AHOM, a large cohort referring to a single center over a 6-year period was evaluated. Methods: Data from children with AHOM, hospitalized between 2010 and 2015, and aged > 1 month, were retrospectively collected and analyzed. Results: 121 children (median age 4.8 years; 55.4% males) were included. Fever at onset was present in 55/121 children (45.5%); the lower limb was most frequently affected (n = 68/121; 56.2%). Microbiological diagnosis (by culture and/or polymerase chain reaction (PCR)) was reached in 33.3% cases. Blood and pus/biopsy culture sensitivities were 32.4% and 46.4%, respectively. PCR sensitivity was 3.6% (2/55) on blood, and 66.6% (16/24) on pus/biopsy sample. Staphylococcus aureus was the most commonly identified pathogen (n = 20); no methicillin-resistant Staphylococcus aureus (MRSA) was isolated, 10.0% (n = 2) strains were Panton-Valentine-Leukocidin (PVL) producer; 48.8% (59/121) cases were complicated. At univariate analysis, factors associated with complicated AHOM were: recent fever episode, fever at onset, upper limb involvement, white blood count (WBC) ≥ 12,000/µL, C reactive protein (CRP) ≥ 10 mg/L, S. aureus infection. At multivariate analyses S. aureus infection remained the only risk factor for complicated AHOM (aOR = 3.388 (95%CI: 1.061-10.824); p-value = 0.039). Conclusions: In this study microbiological diagnosis was obtained in over one third of cases. Empiric treatment targeting methicillin-sensitive Staphylococcus aureus seems to be justified by available microbiological data.

  9. Total and attributable costs of surgical-wound infections at a Canadian tertiary-care center.

    Science.gov (United States)

    Zoutman, D; McDonald, S; Vethanayagan, D

    1998-04-01

    To determine the total and attributable costs of surgical-wound infections in a Canadian teaching hospital. Retrospective incidence series study with chart review and examination of resource utilization attributable to wound infection. The charts of inpatients with wound infections were examined using the Appropriateness Evaluation Protocol (AEP), a validated chart review instrument designed to determine appropriateness of care, modified for wound infections. A university referral center in Canada. Medical records were abstracted from patients with wound infections who underwent an inpatient clean or clean-contaminated procedure during 1991. During the wound-infection treatment period, the hospital costs associated with providing care were tabulated for all inpatient days and for outpatient and emergency visits. Costs taken into account included nursing salary and benefits, nonphysician professional services, operating room time, laboratory, pharmacy, supplies, ancillary tests, and hotel costs. We identified 108 wound infections. Twenty-two patients required 28 surgical procedures related to a wound infection. Inpatient days totalled 1,116, costing $394,337. Fifty-five emergency and 42 clinic visits occurred, costing $27,193. By applying the AEP to the inpatient days, 833 days, or 10.2 days per case, were directly attributable to the wound infection. The hospital costs for inpatient care attributable to wound infections were $321,533 in total, or $3,937 per infection. Costs were distributed as follows: nursing, 51%; hotel, 14%; pharmacy, 10%; laboratory, 9%; emergency and outpatient clinic, 6%; professional services, 5%; operating room, 3%; and ancillary tests, 2%. Wound infections contribute markedly to extra days of hospitalization and related costs. The AEP method is applied easily to determine attributable days of care and costs of wound infections, which are necessary to calculate the cost-benefit of infection control programs.

  10. Persistent left superior vena cava: experience of a tertiary health-care center.

    Science.gov (United States)

    Kula, Serdar; Cevik, Ayhan; Sanli, Cihat; Pektas, Ayhan; Tunaoglu, Fatma Sedef; Oguz, Ayse Deniz; Olgunturk, Rana

    2011-12-01

    The aim of this study was to assess the prevalence of persistent left superior vena cava (PLSVC) in patients with all types of congenital heart defects and to determine the congenital heart anomalies accompanying PLSVC. The present study is based on a retrospective review of 1205 children who consecutively underwent cardiac catheterization from 2000 to 2007. In order to determine the existence of PLSVC, all the subjects routinely underwent superior vena cava (SVC) injection during angiography at the catheter laboratory of the study center. The prevalence of PLSVC was computed to be 6.1% for the present study population. Transthoracic echocardiography was able to detect PLSVC in 32 children (2.6%) whereas angiography diagnosed PLSVC in 74 children (6.1%). The mean age of the patients with PLSVC was 40.09 ± 50.21 months. A communication between the right and left SVC was determined in 27% of the children who were diagnosed with PLSVC after angiography was performed (20 out of 74). A statistically significant association was present between PLSVC and other congenital cardiac anomalies, including ventricular septal defect (n= 42, 56.8%), atrial septal defect (n= 31, 41.9%), pulmonary stenosis (n= 19, 25.7%), atrioventricular septal defect (n= 10, 13.5%), patent ductus arteriosus (n= 6, 8.1%) and cor triatriatum (n= 3, 4.1%). Transthoracic echocardiography usually visualizes dilated coronary sinus in association with PLSVC. However, SVC injection should be performed in patients undergoing angiography so that morbidity and mortality related with persistent left superior vena cava can be avoided during cardiovascular surgery. © 2011 The Authors. Pediatrics International © 2011 Japan Pediatric Society.

  11. A RETROSPECTIVE ANALYSIS OF ETIOLOGY AND OUTCOMES OF REFRACTORY CAPD PERITONITIS IN A TERTIARY CARE CENTER FROM NORTH INDIA.

    Science.gov (United States)

    Thammishetti, Venkatesh; Kaul, Anupama; Bhadauria, Dharmendra S; Balasubramanian, Karthikeyan; Prasad, Narayan; Gupta, Amit; Sharma, Raj K

    2018-01-31

    Refractory peritonitis is defined as failure of clearance of peritoneal fluid despite 5 days of appropriate antibiotic therapy. Catheter removal decreases morbidity and mortality. Data on the outcomes of refractory peritonitis and of reinitiation of peritoneal dialysis (PD) in this group of patients are sparse. The present study analyzed etiology, outcomes, and prognostic factors of refractory peritonitis as well as survival of the reinitiation of the technique. This was a single-center retrospective study that included 90 patients of refractory continuous ambulatory PD (CAPD) peritonitis at a tertiary care center in North India. We collected information regarding symptomatology, causes, prognostic factors, and outcomes of refractory peritonitis. Ninety patients suffered 93 episodes of refractory peritonitis. Fungal peritonitis was the most common cause of refractory peritonitis. Twenty nine (31%) episodes were culture- negative. We observed no difference between culture-positive and culture-negative peritonitis. Out of 90 patients, 54 (60%) recovered while 36 (40%) died. Septic shock at presentation alone was significantly associated with mortality in our study. The immediate mortality of refractory peritonitis is high. Even in patients who were shifted to permanent hemodialysis, 33% died in the first 3 months. Mean duration of technique survival after reinitiation was 23 months (1 - 85 months). Among the 12 patients who were reinitiated on CAPD, 5 patients had technique failure due to refractory peritonitis or ultrafiltration (UF) failure. Refractory peritonitis is associated with significant morbidity and mortality despite catheter removal. Reinitiation is confounded by residual infection, which is a concern for poor technique survival, and high immediate mortality.

  12. Using an Electronic Perioperative Documentation Tool to Identify Returns to Operating Room (ROR) in a Tertiary Care Academic Medical Center.

    Science.gov (United States)

    Cima, Robert R; Dhanorker, Sarah R; Ostendorf, Christopher L; Ntekpe, Mfonabasi; Mudundi, Raghu V; Habermann, Elizabeth B; Deschamps, Claude

    2017-03-01

    The metric "Unplanned returns to operating room (ROR)" is being tracked in surgical quality dashboards; 70% of unplanned RORs may be related to surgical complications. With increasing regionalization of trauma and complex surgical care at tertiary care academic centers, it is unclear if a simple ROR metric is a valid assessment of surgical quality at such centers. A real-time electronic tool was used to identify all RORs-planned and unplanned-in a high-volume, high-complexity academic surgical practice at Mayo Clinic-Rochester within 45 days of the index operation. Analysis by ROR type and indication was performed. During the analysis period (June 2014-February 2015) 44,031 operations were performed, with 5,552 subsequent RORs (13%). Of all RORs, 51% (n = 2,818) were planned staged returns, 29% (n = 1,589) were unrelated, 15% (n = 830) were unplanned and 6% (n = 315) were planned because of previous complications. Overall, unplanned reoperations were uncommon (n = 830, 2% of all operations). The most common indications for unplanned RORs included "other" (32%, n = 266), bleeding related (24%, n = 198) and wound complications (20%, n = 166). In a high-volume, high-complexity academic surgical practice, RORs occurred after 13% of cases. Unplanned returns were infrequent and usually were associated with complications; most RORs were planned staged or unrelated returns. A simple ROR metric that does not consider planned/unrelated returns is likely not a valid surgical quality measure. Electronic tools designed specifically to identify in real-time RORs, associated indication, and clinical validation should provide more reliable data for public reporting and quality improvement efforts. Copyright © 2016 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  13. Hospital survival upon discharge of ill-neonates transported by ground or air ambulance to a tertiary center.

    Science.gov (United States)

    Alvarado-Socarras, Jorge Luis; Idrovo, Alvaro Javier; Bermon, Anderson

    2016-01-01

    To evaluate the differences in hospital survival between modes of transport to a tertiary center in Colombia for critically ill neonates. Observational study of seriously ill neonates transported via air or ground, who required medical care at a center providing highly complex services. Data on sociodemographic, clinical, the Transport Risk Index of Physiologic Stability (TRIPS), and mode of transport were collected. Patients were described, followed by a bivariate analysis with condition (live or dead) at time of discharge as the dependent variable. A multiple Poisson regression with robust variance model was used to adjust associations. A total of 176 neonates were transported by ambulance (10.22% by air) over six months. The transport distances were longer by air (median: 237.5km) than by ground (median: 11.3km). Mortality was higher among neonates transported by air (33.33%) than by ground (7.79%). No differences in survival were found between the two groups when adjusted by the multiple model. An interaction between mode of transport and distance was observed. Live hospital discharge was found to be associated with clinical severity upon admittance, birth weight, hemorrhaging during the third trimester, and serum potassium levels when admitted. Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation) to obtain good clinical outcomes according type of ambulance. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  14. Impact of introduction of endoscopic ultrasound on volume, success, and complexity of endoscopic retrograde cholangiopancreatography in a tertiary referral center.

    Science.gov (United States)

    Yandrapu, Harathi; Elhanafi, Sherif; Chowdhury, Farhanaz; Liu, Jiayang; Onate, Eduardo J; Dwivedi, Alok; Othman, Mohamed O

    2017-01-01

    Endoscopic ultrasound (EUS) is commonly used to examine pancreaticobiliary disorders. We hypothesize that the introduction of EUS service may change the pattern and the complexity of endoscopic retrograde cholangiopancreatographies (ERCPs) performed. The aim of this study is to assess the impact of introducing EUS on the volume, success, and complexity of ERCP. This is a single-center retrospective data review of ERCP procedures done "before" and "after" the introduction of EUS (before EUS and after EUS). Patients' demographics, ERCP indications, types of sedation, therapeutic interventions, outcomes, complications, and complexity of ERCP were collected. The categorical and continuous variables were compared using Fisher's exact test and the unpaired t-test, respectively. Multivariable logistic regression analysis was used to compare ERCP outcomes. A total of 945 ERCPs performed over a 3-year period between January 2010 and January 2013 (411 and 534 in the "before EUS" and "after EUS" time periods, respectively) were included in this study. There was a 30% relative increase in the volume of ERCPs after the introduction of EUS. ERCP success rate was higher after the introduction of EUS, even after adjusting the complexity grade [odds ratio (OR) = 4.54, P = 0.001]. Significant increase in the complexity of ERCP was observed after the introduction of EUS service. The OR of performing grade 4 ERCP was 4.44 (P = 0.0005) after the introduction of EUS. The introduction of a new EUS service in our tertiary referral university medical center is associated with an increase in the volume, success, and complexity of ERCP procedures. EUS expertise may be valuable for better ERCP outcomes.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  17. 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

    2017-05-24

    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.

  18. Genotypic analysis of multidrug-resistant tuberculosis isolates from extra pulmonary tuberculosis cases in tertiary care centers in Northern India.

    Science.gov (United States)

    Maurya, Anand K; Nag, Vijaya L; Kant, Surya; Kushwaha, Ramawadh S; Dhole, Tapan N

    2016-12-01

    Multidrug-resistant tuberculosis (MDR-TB) is a major public health problem. The diagnosis of MDR-TB is of paramount importance in establishing appropriate clinical management and infection control measures. Rapid detection of MDR-TB allows the establishment of an effective treatment regimen, minimizes the risk of further resistance, and limits the spread of drug-resistant strains. The aim of this study is to determine the genotypic characterization of MDR-TB isolates from extra pulmonary tuberculosis (EPTB) cases in tertiary care centers in Northern India. This study was a prospective study. In total, 756 extra pulmonary specimens were collected from patients with suspected tuberculosis in two tertiary care hospitals in Northern India. Specimens were processed for Ziehl-Neelsen staining, culture, and first-line drug susceptibility test using BacT/ALERT 3D system and GenoType MTBDRplus assay for genotypic analysis of MDR-TB. MDR-TB strains were further processed by novel multiplex polymerase chain reaction for rapid identification of Beijing and non-Beijing strains associated with MDR-TB. Of these 164 Mycobacterium tuberculosis complex isolates, 100 (60.9%) strains were fully susceptible and 64 (39.1%) strains were resistant. We noted that the prevalence of MDR-TB among EPTB was 22 (13.4%). The prevalence of MDR-TB was 11.4% in new cases and 19.1% in previously treated cases (p<0.05). Ser531Leu mutation was the predominant mutation noted, and Ser315Thr mutation was more prevalent among the MDR-TB isolates (p<0.05). The proportion of Beijing strains was significantly higher among MDR-TB strains (72.7%, p<0.05). The prevalence (13.4%) of MDR-TB among EPTB was high, and the most prominent mutations in rpoB, katG, and inhA genes were S531L (67.3%), S315T1 (94.5%), and C15T (20%), respectively. Beijing stains are significantly associated with MDR-TB among EPTB in this region. We found that the transmission of prominent mutations contributes to an unexpected increase in

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

    OpenAIRE

    Mostajab Razavi Nejad; Mohammad Heidarzadeh; Parisa Mohagheghi; Forouzan Akrami; Amir Almasi-Hashiani; Zahra Eskandary

    2017-01-01

    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, ...

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

  2. Knowledge and practices of infection control among healthcare workers in a Tertiary Referral Center in North-Western Nigeria.

    Science.gov (United States)

    Iliyasu, Garba; Dayyab, Farouq Muhammad; Habib, Zaiyad Garba; Tiamiyu, Abdulwasiu Bolaji; Abubakar, Salisu; Mijinyawa, Mohammad Sani; Habib, Abdulrazaq Garba

    2016-01-01

    Healthcare acquired infections (HCAIs) otherwise call nosocomial infection is associated with increased morbidity and mortality among hospitalized patients and predisposes healthcare workers (HCWs) to an increased risk of infections. The study explores the knowledge and practices of infection control among HCW in a tertiary referral center in North-Western Nigeria. This is a cross-sectional study. A self-administered structured questionnaire was distributed to the study group (of doctors and nurses). Data on knowledge and practice of infection control were obtained and analyzed. Study population were selected by convenience sampling. A total of 200 responses were analyzed, 152 were nurses while 48 were doctors. The median age and years of working experience of the respondents were 35 years (interquartile range [IQR] 31-39) and 7 years (IQR 4-12), respectively. Most of the respondents 174/198 (87.9%) correctly identified hand washing as the most effective method to prevent HCAI, with nurses having better knowledge 139/152 (91%) (P = 0.001). Majority agreed that avoiding injury with sharps 172/200 (86%), use of barrier precaution 180/200 (90%) and hand hygiene 184/200 (92%) effectively prevent HCAI. Only 88/198 (44.4%), 122/198 (61.6%), and 84/198 (42.4%) of the respondents were aware of the risks of infection following exposure to human immunodeficiency virus, hepatitis B virus and hepatitis C virus-infected blood, respectively. About 52% of doctors and 76% of nurses (P = 0.002) always practice hand hygiene in between patient care. Gaps have been identified in knowledge and practice of infection control among doctors' and nurses' in the study; hence, it will be beneficial for all HCW to receive formal and periodic refresher trainings.

  3. Surveillance of musculoskeletal injuries and disorders in a diverse cohort of workers at a tertiary care medical center.

    Science.gov (United States)

    Pompeii, Lisa A; Lipscomb, Hester J; Dement, John M

    2008-05-01

    The purpose of this study was to investigate the incidence of work-related musculoskeletal (MSK) injuries and disorders among a dynamic cohort of health care workers, including direct care providers and support services, employed at a tertiary care medical center. Human resources data were used to define the cohort and time at risk. Workers' compensation (WC) records (1997-2003) were utilized to identify work-related MSK claims. Poisson regression was used to generate gender specific rate ratios and 95% confidence intervals (CI) of MSK injuries among workgroups. MSK injuries resulted equally ( approximately 30% each) from lift/push/pull of equipment, patient handling, and slip/trip/falls. Injury rates and their mechanisms varied substantially by occupational group, gender, and race. Even with declining injury rates over time, black workers had rates 2.5 times higher than other workers and women had rates 1.8 times higher than men. Male and female nurses' aides, housekeepers, and radiology technicians had among the highest rates of injury, while lost workdays rates were highest for male and female nurses' aides, female housekeepers, and male patient transporters. Differential risk associated with work tasks in highly segregated work populations can contribute to disparities in health, and the patterns we observed partly reflect the high concentration of female and black workers in occupations with increased physical demands. While the greatest public health impact will be achieved by implementing prevention strategies among large workgroups with high injury rates, public health efforts must not ignore smaller, often segregated, workgroups identified in this study as high risk. (c) 2008 Wiley-Liss, Inc.

  4. 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.

  5. 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.

  6. A Clinico-Etiological Study of Dermatoses in Pediatric Age Group in Tertiary Health Care Center in South Gujarat Region.

    Science.gov (United States)

    Jawade, Sugat A; Chugh, Vishal S; Gohil, Sneha K; Mistry, Amit S; Umrigar, Dipak D

    2015-01-01

    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. To study the pattern of various dermatoses in infants and children in tertiary health care center in South Gujarat region. 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. 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%). There is a need to emphasize on training the management of common pediatric dermatoses to dermatologists, general practitioners and pediatricians for early treatment.

  7. 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.)

  8. [Evaluation of multidisciplinary team meeting; the example of gynecological mammary cancers in a tertiary referral center in Morocco].

    Science.gov (United States)

    Chaouki, Wahid; Mimouni, Mohsine; Boutayeb, Saber; Hachi, Hafid; Errihani, Hassan; Benjaafar, Noureddine

    The multidisciplinary team meeting has become a standard medical practice in oncology. However, no evaluation of this activity was carried out in Morocco. The aim of this study was to evaluate the multidisciplinary team meeting of gynecological mammary cancers in a National Tertiary Referral Center. The study was carried out by retrospective analysis of 207 cases of patients randomly selected among the 1190 cases recruited during the year 2015. Completeness and quality criteria were evaluated. The global completeness rate of passage in multidisciplinary team meeting is 38%. According to the therapeutic specialities, the completeness of passage in multidisciplinary team meeting is 68% of surgery, 35% of medical oncology and 19% of radiotherapy. As far as localizations are concerned, the completeness of passage in multidisciplinary team meeting is 43% for the breast and only 19% for the cervix. A quorum was met 100% of the cases. In 96% of cases the treatment performed is in accordance with the decision of the multidisciplinary team meeting. Eighty-four percent of cases performed multidisciplinary team meeting within less than one month. This analysis shows that the completeness of the transition to multidisciplinary team meeting has not reached the 100% planned by our institution. However, the requirements for conducting the multidisciplinary team meeting were generally met. This study shows an organizational evolution of our structure based on collective and multidisciplinary medical decision. The national obligation measure of multidisciplinary team meeting is necessary. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  9. Initial CT-guided needle biopsy of extremity skeletal lesions: Diagnostic performance and experience of a tertiary musculoskeletal center

    Energy Technology Data Exchange (ETDEWEB)

    Nouh, Mohamed Ragab, E-mail: mragab73@yahoo.com [Department of Radiology, Faculty of Medicine, Alexandria University (Egypt); Department of Radiology, Al-Razi Hospital, Sulibikhate 13001 (Kuwait); Abu Shady, Hamdy Mohamed, E-mail: hamdi_abushadi@yahoo.com [Department of Radiology, Al-Razi Hospital, Sulibikhate 13001 (Kuwait)

    2014-02-15

    Introduction: Appendicular long bones are the target for a wide spectrum of bony lesions with variable clinical presentations. Biopsy procedures are needed for subsequent proper patient's management. Most of the available literature globally assessed musculoskeletal biopsies with inclusion of repeat biopsy results. We thought to retrospectively assess the diagnostic performance of initial CT-guided percutaneous core needle biopsy (PCNB) of extremity long bone lesions in a tertiary musculoskeletal referral center. Patients and methods: We retrospectively analyzed the outcome of initial CT-guided PCNB of 49 patients who presented with extremity long bone lesions which were biopsied in our hospital during a 36 months’ time period. The diagnostic performance was assessed in terms of diagnostic yield and accuracy. Results: There were 34 males and 15 females with a mean age of 33.69 years (range from 4 to 77 years). The overall diagnostic yield of initial biopsies was 87.75% with a diagnostic accuracy of 82.85% derived from the surgically proven cases. The higher diagnostic yield was recorded with malignancy, presence of extra-osseous soft-tissue component as well as mixed and sclerotic lesions. The pathologies of the non-diagnostic biopsies included large-cell lymphoma, giant-cell tumor, langerhans cell histiocytosis, osteoid osteoma and a non-ossifying fibroma. Conclusion: Initial CT-guided PCNB in extremities’ long bones lesions showed high diagnostic performance in malignant, mixed and/or sclerotic lesions as well as lesions with extra-osseous exophytic tissue growth. Lack of extra-osseous components, benign and lytic lesions all had worse diagnostic performance.

  10. Prevalence and factors predictive of intraocular fungal infection in patients with fungemia at an academic urban tertiary care center

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    Geraymovych E

    2015-09-01

    Full Text Available Elena Geraymovych,1 Joseph H Conduff,2 Puneet S Braich,3 Christopher T Leffler,3 Vikram S Brar3 1Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, TX, 2Virginia Commonwealth University School of Medicine, 3Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA, USA Objective: To report the prevalence and to identify factors predictive of intraocular infection in patients with fungemia receiving prophylactic antifungal therapy. Methods: A retrospective review of patients who received prophylactic antifungal therapy and a dilated fundus examination at an academic urban tertiary care center from 2000 to 2007. Basic demographic information, fungal species grown, antifungal agent(s used, number of positive blood culture specimens, visual acuity, visual symptoms, and known risks of disseminated candidiasis were noted. Logistic regression analysis was used to determine the factors significantly associated with intraocular fungal infection. Results: A total of 132 patients with positive fungemia culture were requested to have ophthalmology consults. The prevalence of ocular infection was 6.9% (N=9. All nine patients were infected with Candida species. Undergoing gastrointestinal (GI surgery within the prior 6 months was significantly related to developing intraocular infection, with an odds ratio of 18.5 (95% confidence interval, 15.1–24.3; P=0.002. Having ≥3 positive fungal blood cultures was also a significant risk factor, with an odds ratio of 2.6 (95% confidence interval, 1.8–3.7; P=0.03. Among 40 patients having GI surgery, eight (20.0% had intraocular fungal disease, compared with one of 92 patients (1.1% not having GI surgery. Among 125 patients with a negative baseline examination result, two of 32 patients (6.3%, who had recent GI surgery, subsequently developed fungal ocular disease, compared with 0 of 93 patients (0%, who did not have recent GI surgery. Conclusion

  11. Multi-institutional neurosurgical training initiative at a tertiary referral center in Mwanza, Tanzania: where we are after 2 years.

    Science.gov (United States)

    Coburger, Jan; Leng, Lewis Z; Rubin, David G; Mayaya, Gerald; Medel, Ricky; Ngayomela, Isidor; Ellegala, Dilantha; Durieux, Marcel E; Nicholas, Joyce; Härtl, Roger

    2014-01-01

    The paucity of neurosurgical care in East Africa remains largely unaddressed. A sustained investment in local health infrastructures and staff training is needed to create an independent surgical capacity. The Madaktari organization has addressed this issue by starting initiatives to train local general surgeons and assistant medical officers in basic neurosurgical procedures. We report illustrative cases since beginning of the program in Mwanza in 2009 and focus on the most recent training period. A multi-institutional neurosurgical training program and a surgical database was created at a tertiary referral center in Mwanza, Tanzania. We collected clinical data on consecutive patients who underwent a neurosurgical procedure between September 9th and December 1st, 2011. All procedures were performed by a local surgeon under the supervision of a visiting neurosurgeon. Since the inception of the training initiative, comprehensive multidisciplinary training courses in Tanzania and an annual visiting fellowship for East African surgeons to travel to a major U.S. medical center have been established. At initial visits infrastructure and feasibility of complex case scenarios was assessed. Surgeries for brain tumors and complex spinal cases were performed. During the 3-month training period, 62 patients underwent surgery. Pediatric hydrocephalus comprised 52% of patients, 11% suffered from meningomyelocelia, and 6% presented with an encephalocele. A total of 24% of patients were treated for trauma-related conditions, representing 75% of the adult patients. A total of 10% of patients had surgery because of traumatic spine injury, and 15% of operations were on patients with severe head injury. A total of 6% of patients presented with degenerative spine disease. One patient sustained a fatal perioperative complication. At the end of the training period, the local general surgeon was able to perform all basic neurosurgical cases independently. Neurosurgical care in Tanzania

  12. Pioneering Quality Assessment in European Cancer Centers: A Data Analysis of the Organization for European Cancer Institutes Accreditation and Designation Program

    NARCIS (Netherlands)

    Saghatchian, Mahasti; Thonon, Frederique; Boomsma, Femke; Hummel, Henk; Koot, Bert; Harrison, Chris; Rajan, Abinaya; de Valeriola, Dominique; Otter, Renee; Pontes, Jose Laranja; Lombardo, Claudio; McGrath, Eoin; Ringborg, Ulrik; Tursz, Thomas; van Harten, Willem H.

    2014-01-01

    Purpose: In order to improve the quality of care in Cancer Centers (CC) and designate Comprehensive Cancer Centers (CCCs), the Organization for European Cancer Institutes (OECI) launched an Accreditation and Designation (A&D) program. The program facilitates the collection of defined data and the

  13. 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; J Mayson, Sarah; Grinberg, Amy S; Grosberg, Brian M; Pavlovic, Jelena M; Robbins, Matthew S; Vollbracht, Sarah E; Lipton, Richard B

    2017-04-01

    To evaluate the relationships among modifiable psychological factors and chronic migraine and severe migraine-related disability in a clinic-based sample of persons with migraine. 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. 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. 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. 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 the relationships among

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

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    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

  15. Pattern and Outcome of Acute Disseminated Encephalomyelitis (ADEM) in Children: Experience in a Tertiary Center, Upper Egypt.

    Science.gov (United States)

    Sadek, Abdelrahim Abdrabou; Mohamed, Mostafa Ashry; Abou-Taleb, Ashraf; Mohammed, Marwa Ibrahim

    2016-07-01

    Acute disseminated encephalomyelitis (ADEM) is an immune mediated disease of the brain. Although it occurs in all ages, most reported cases are in children and adolescents. The aims of this study were to study the clinical pattern and outcome of ADEM in children in a tertiary center in Upper Egypt and to determine the effect of combined use of steroids and IVIg on outcome. This observational study was carried out from January 2014 through December 2014 in the Pediatric Department of Sohag University Hospital (Egypt). All children diagnosed as ADEM during a one year period were included in this study. The treatments used were IV methylprednisolone followed by oral prednisone taper and intravenous immunoglobulin for severe cases. All studied cases were followed up and reevaluated at three months and six months. We used SPSS version 10 and Chi Square, Spearman's test and t-test for data analysis. Eighteen children were included in this study (10 males and 8 females), the average age was 5.5 ± 0.9 years. Prodroma was found in 72.22% of the cases while the main complaint was encephalopathy (83.33%) followed by seizures (11.11%). The neurological findings were convulsions in 83.33%, quadriparesis (33.33%), hemiparesis (33.33), bladder involvement (both retention and incontinence) in 61.11%, and cranial nerve affection (11.11%). Demyelination patches were multifocal in 50%, mainly subcortical in 27.78%. Intelligence quotient (IQ) assessment after 6 months follow up showed that 50% were below average, 25% had mild MR while neurological evaluation showed that 75% of our patients were completely cured. The predictors of better outcome were; children related to the age group (1-4 years) (p = 0.01), children with higher GCS (6-14) (p = 0.01), and children who received steroids on the first day of symptoms and intravenous immunoglobulin in the first week (p = 0.03). The clinical pattern of acute disseminated encephalomyelitis is variable, and a disturbed level of consciousness

  16. Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center.

    Science.gov (United States)

    Valsangkar, Nakul P; Eppstein, Andrew C; Lawson, Rick A; Taylor, Amber N

    2017-01-01

    There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Databases in the Veterans Integrated Service Network 11 Data Warehouse, Veterans Health Administration Support Service Center, and Veterans Information Systems and Technology Architecture/Dynamic Host Configuration Protocol were queried to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center. All patients evaluated by the general surgery department through outpatient clinics, clinical video teleconferencing, and e-consultations from October 2011 through September 2014 were included. Patients evaluated through the emergency department or as inpatient consults were excluded. The surgery service and systems redesign service held a value stream analysis in FY 2013, culminating in multiple rapid process improvement workshops. Multidisciplinary teams identified systemic inefficiencies and strategies to improve interdepartmental and patient communication to reduce canceled consultations and cases, diagnostic rework, and no-shows. High-priority triage with enhanced operating room flexibility was instituted to reduce scheduling wait times. General surgery department pilot projects were then implemented mid-FY 2013. Planned outcome measures included wait time, clinic and telehealth volume, number of no-shows, and operative volume. Paired t tests were used to identify differences in outcome measures after the institution of reforms. Following rapid process improvement workshop project rollouts, mean

  17. Quality of anticoagulation control among patients with atrial fibrillation: An experience of a tertiary care center in Saudi Arabia

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    Sarah M. Alyousif

    2016-10-01

    Conclusion: Quality of anticoagulation in patients with AF receiving medical care in a tertiary care hospital was suboptimal, with nearly 40% of the time spent outside the therapeutic range. Methods to improve anticoagulation control among patients with AF should be implemented.

  18. Predicting sickness impact profile at six months after stroke: further results from the European multi-center CERISE study

    NARCIS (Netherlands)

    Stummer, C.A.; Verheyden, G.; Putman, K.; Jenni, W.; Schupp, W.; Wit, L. De

    2015-01-01

    PURPOSE: To develop prognostic models and equations for predicting participation at six months after stroke. METHODS: This European prospective cohort study recruited 532 consecutive patients from four rehabilitation centers. Participation was assessed at six months after stroke with the Sickness

  19. 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.

  20. Assessment of utilization pattern of fixed dose drug combinations in primary, secondary and tertiary healthcare centers in Nepal: a cross-sectional study.

    Science.gov (United States)

    Poudel, Arjun; Mohamed Ibrahim, Mohamed Izham; Mishra, Pranaya; Palaian, Subish

    2017-11-02

    Prescription practices, especially in South Asian countries, have come under investigation for quality. Although there have been no studies in Nepal that have analyzed the prescription pattern of FDCs for different levels of health care centers, several studies from Nepal and other countries in the region have revealed poor medicine use practices, including irrational use of fixed-dose drug combinations (FDCs). This research aimed at assessing the utilization pattern of FDCs among primary (PHC), secondary (SHC) and tertiary health care (THC) centers in Western region of Nepal. A cross-sectional descriptive study was conducted at primary, secondary and tertiary health care centers in Western Nepal. One hundred prescriptions from each health care center were chosen through systematic random sampling. The International Network for Rational Use of Drug (INRUD) indicators were used to assess the rationality of prescribing. Both descriptive and inferential statistics were applied. The alpha level used was 0.05. At the PHC center, 206 medicines were prescribed, of which 20.0% were FDCs. Antimicrobials were the most prescribed FDCs (57.1%). The unit prices of all FDCs were below 100 Nepalese Price Rupees (NPRs). At the SHC center, 309 medicines were prescribed, and 30% were FDCs. Vitamins, minerals and dietary supplements were the most prescribed FDCs (25.8%). The costs of 63.5% of FDCs were below 100 NPRs. At the THC center, 33.5% of 270 medicines were FDCs. As at the SHC center, vitamins, minerals and dietary supplements were the most prescribed FDCs (40.6%). The costs of 50.5% of FDCs were below 100 NPRs. FDCs were used extensively at different health care centers. The number of prescription in private centers, following established guidelines and the essential drug list (EDL), was much lower. The cost associated with the utilization of FDCs was higher in private sectors compared to public health care centers. In certain cases, the use of FDCs was questionable, and this

  1. 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.

  2. Testing a maintenance model for eating disorders in a sample seeking treatment at a tertiary care center: a structural equation modeling approach.

    Science.gov (United States)

    Tasca, Giorgio A; Presniak, Michelle D; Demidenko, Natasha; Balfour, Louise; Krysanski, Valerie; Trinneer, Anne; Bissada, Hany

    2011-01-01

    Fairburn et al (Fairburn, CG, Cooper, Z, Shafran, R. Behav Res Ther 2003;41:509-528) proposed additional maintenance mechanisms (ie, interpersonal difficulties, mood intolerance, low self-esteem, and perfectionism) for some individuals with eating disorders in addition to core eating disorder psychopathology (ie, overevaluation of eating, weight, and shape and their control). This is the first study to both elaborate and test this maintenance model as a structural model. Adults seeking treatment of an eating disorder (N = 1451) at a specialized tertiary care center were included in this cross-sectional study. In the first part of the study, diagnostically heterogeneous participants (n = 406) were randomly selected to test a structural model based on the maintenance model. In the second part of the study, remaining participants (n = 1045) were grouped according to eating disorder diagnosis to test for invariance of the structural paths of the final model across diagnoses. Overall, the structural model with core and additional mechanisms fit the data well and, with 1 exception, represented maintenance processes for each of the diagnostic groups. Treatment models based on both core and additional maintenance factors for those seeking therapy at a specialized tertiary care center may result in improved treatment outcomes for these patients with eating disorders. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Detection and Enumeration of the Commonest Stool Parasites Seen in a Tertiary Care Center in South India

    OpenAIRE

    Chandrashekar, Vani

    2013-01-01

    The aim of this study was to identify common stool parasites in patients attending a tertiary care centre in South India. We evaluated 2355 stool samples and parasites were detected in 7.9% of samples. 41.1% of our patients were in the 45–58-year age group. Protozoal infections were the commonest seen in 7.8% of samples. Entamoeba histolytica was the commonest protozoa (4.6%) followed by Entamoeba coli (1.2%) and Giardia (0.8%). Entamoeba histolytica and Entamoeba coli were together seen in 0...

  4. EPIDEMIOLOGICAL AND CLINICOPATHOLOGICAL MORPHOLOGY OF PATIENTS WITH HAEMOLYTIC ANAEMIA IN A TERTIARY CARE CENTER OF NORTH KERALA

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    Sheela Thomas

    2017-06-01

    Full Text Available BACKGROUND Haemolytic anaemia’s are characterised by increased RBC destruction and evidence of accelerated erythropoiesis. Haemolysis due to intrinsic RBC disorders, i.e. the inherited haemolytic anaemias are more common. Most of these anaemias are easily recognisable under the light microscope. MATERIALS AND METHODS To study the clinical and morphological profile of different types of haemolytic anaemia due to RBC defects in patients admitted in a tertiary care hospital of North Kerala, India. RESULTS A cross-sectional study was carried out among 217 patients of haemolytic anaemia admitted in a tertiary care hospital over a period of five years from January 2012 to December 2016. The data on sociodemographic profile, relevant clinical history and clinical examination were collected in predesigned and pretested standard proforma and morphological parameters were assessed by using standard guidelines. CONCLUSION Sickle cell anaemia was found to be the most common of haemolytic anaemias reported in the hospital. HbE and HbD are extremely rare entities with only a single case report each. A single case of Paroxysmal Nocturnal Haemoglobinuria (PNH was reported, this was included as it is an intrinsic RBC disorder.

  5. 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.

  6. Clinical Marine Toxicology: A European Perspective for Clinical Toxicologists and Poison Centers

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    Luc De Haro

    2013-08-01

    Full Text Available Clinical marine toxicology is a rapidly changing area. Many of the new discoveries reported every year in Europe involve ecological disturbances—including global warming—that have induced modifications in the chorology, behavior, and toxicity of many species of venomous or poisonous aquatic life including algae, ascidians, fish and shellfish. These changes have raised a number of public issues associated, e.g., poisoning after ingestion of contaminated seafood, envenomation by fish stings, and exposure to harmful microorganism blooms. The purpose of this review of medical and scientific literature in marine toxicology is to highlight the growing challenges induced by ecological disturbances that confront clinical toxicologists during the everyday job in the European Poison Centers.

  7. Five-Year Retrospective Review of Cases with Benign Essential Blepharospasm and Hemifacial Spasm Presenting in a Tertiary Eye Care Center in North India.

    Science.gov (United States)

    Raj, Amit; Arya, Sudesh Kumar; Deswal, Jyoti; Bamotra, Ravi Kant

    2017-01-01

    Retrospective analysis of epidemiological and clinical characteristics of patients diagnosed with benign essential blepharospasm and hemifacial spasm who reported to the oculoplasty clinic of a tertiary eye care center in north India between January 2010 and April 2015 was carried out. Dry eye, as well as all the local factors that can cause blepharospasm or hemifacial spasm, was ruled out. Systemic evaluation was done to rule out any neurological disorder. A detailed history was taken to rule out any associated psychiatric disorders as well as use of any medication which could be responsible for dystonic movements. In every patient of hemifacial spasm, magnetic resonance imaging (MRI) of the brain was done for any facial nerve compression or tumor involving posterior fossa. Botulinum type A injections were given after assessing their requirements on the basis of guidelines given by Jankovic et al.

  8. Vitamin D Levels in Malnourished Children under 5 Years in a Tertiary Care Center at Muhimbili National Hospital, Dar es Salaam, Tanzania-A Cross-sectional Study.

    Science.gov (United States)

    Walli, Nahida Z; Munubhi, Emmanuel K; Aboud, Said; Manji, Karim P

    2017-06-01

    : To evaluate vitamin D levels/deficiency among malnourished children <5 years admitted at a tertiary care center, the Muhimbili National Hospital, Dar es Salaam, Tanzania. Children with malnutrition may have co-existing vitamin D deficiency (VDD), which may be severe. : Serum vitamin D and alkaline phosphatase were evaluated, and X-ray of the wrist was carried out on 134 children. : VDD was found in 41 of 134 children (30.6%). The mean vitamin D level was 74.8 nmol/l. The mean alkaline phosphatase level was 176.6 U/l. Sixty-four (48%) children were found to have severe stunting, of whom 20 (31.2%) were vitamin D deficient. Marasmic children had higher odds of VDD compared with other forms of malnutrition. : The high prevalence of VDD in malnourished children underlines the need for active surveillance and aggressive management.

  9. Epidemiological, Clinico-Pathological Profile and Management of Colorectal Carcinoma in a Tertiary Referral Center of Eastern India

    Directory of Open Access Journals (Sweden)

    Shyamal Kumar Halder

    2013-01-01

    Full Text Available Background: The colorectal carcinoma is a common cancer in males and in females and second most common cause of death in Europe and third commonest cause in the United States. Recent Indian study shows that there is a significant increase in incidence of colonic carcinoma but the incidence of rectal carcinoma remains steady. Aims and Objectives: This prospective study was undertaken to assess the clinico-pathological profile and management of colorectal malignancy in a tertiary referral institute of eastern India and to compare the above data with the data from the western world. Material and Methods: The patients admitted with the diagnosis of colorectal carcinoma in IPGME and R (SSKM, a tertiary hospital in eastern India, between January 2006 and December 2010, were included in this study. These patients were prospectively analyzed for age, sex, site of the lesion, clinical presentations, nature of the growth and types of surgery performed. Results: 192 patients were included in this study of which 78 patients were of younger age group (35 years. The mean age of this series was 44.1 years. The male to female ratio of younger and older group was 1.68:1 and 1.85:1 respectively. Reetal bleeding was the commenest symptom irrespective of age and sex. Pain in abdomen (39.7% and intestinal obstruction (21.8% were the predominant presenting features in the patients of younger group whereas weight loss was commonest presenting feature in the patients of older age group. Most common histological type, irrespective of age, was adenocarcinoma (93.8%. Overall, right sided colonic growth was more common in females while rectum was the commonest site of affection in males. The patients of younger age group presented in advanced stage like Duke’s C and Duke’s D. Conclusions: The younger patients are diagnosed with colorectal carcinoma. Cancer of right colon is more common than that of left. The younger patients present more often with abdominal pain and

  10. Thrombotic thrombocytopenic purpura - analysis of clinical features, laboratory characteristics and therapeutic outcome of 24 patients treated at a Tertiary Care Center in Saudi Arabia

    Science.gov (United States)

    Iqbal, Shahid; Zaidi, Syed Z. A.; Motabi, Ibraheem H; Alshehry, Nawal Faiez; AlGhamdi, Mubarak S.; Tailor, Imran Khan

    2016-01-01

    Objective: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease. The primary aim was overall response rate (ORR) assessment in the treated patients Methods: This retrospective study included 24 patients treated during 2006-2015. TTP patients with microangiopathic hemolysis (MAHA) and thrombocytopenia were included. We analyzed clinical features, laboratory characteristics and treatment outcomes of 24 TTP patients treated at our tertiary care center (KFMC). Results: Twenty-four TTP patients (18 females; 6 males) had a mean age of 33.5±13.9 years; 22(91%) had neurologic features, 7(29%) fever, 10(42%) renal impairment; 4(20.83%) cardiac manifestations; 22(91.7%) had triad with additional neurologic abnormalities; only 2(8.2%) had pentad of TTP. Majority (54.16%) had idiopathic TTP. All patients received therapeutic plasma exchange (TPE); 23(95.8%) received adjunctive corticosteroids and 13(54.2%) received rituximab either due to refractoriness to TPE on ~day7, or earlier. Twenty-one out of 24 (87.5%) achieved complete remission (CR) without any subsequent relapse. At 22 months (median, range 1-113), 20 patients (83.3%) are alive at the time of report. Three patients died during acute episode because of sever disease or delayed treatment and one died in CR. Conclusion: TPE, steroids and or rituximab was very effective in preventing high risk of mortality and achieving durable CR in 87.5% of patients. More awareness is needed for early diagnosis and early referral to centers with appropriate tertiary care facilities.. PMID:28083052

  11. [The advantages of a large tertiary academic medical center in managing disease and promoting health: a glimpse into Sheba Medical Center].

    Science.gov (United States)

    Segal, Gad; Zimlichman, Eyal

    2015-02-01

    Academic medical centers have traditionally been at the forefront of medical training for the next generation of clinicians, providing the highest quality of care and conducting translational and clinical research. The Sheba Medical Center is the largest academic medical center in Israel and, as such, has been shaping the medical scene in Israel since the birth of the State. The cornerstones of the Sheba Medical Center have always brought together the best clinicians, fostering a multidisciplinary approach environment, encouraging research and innovation from lab to bedside and compassionate, patient-centered care. Clinicians at Sheba enjoy the wide variety of clinical conditions that are present at the hospital, the existence of multiple professions and specialties from neonates to geriatric rehabilitation and the advanced technologies available to patients. In this special issue we describe some of the important work that takes place at Sheba, while emphasizing the above-mentioned advantages.

  12. Paediatric traumatic brain injury: Presentation, prognostic indicators and Outcome analysis from a tertiary care center in a developing country.

    Science.gov (United States)

    Ujjan, Badar; Waqas, Muhammad; Khan, Muhammad Babar; Bakhshi, Saqib Kamran; Bari, Muhammad Ehsan

    2016-10-01

    Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children worldwide. This study was conducted to report the presentation, management, outcomes and prognostic indicators in a large series of patients from a tertiary care centre in a developing country. It is a review of prospectively collected data of paediatric patients with TBI admitted at our centre between July 2010 and December 2013. A total of 291 patients with a mean age of 7.2±5.0 years were dichotomised into survivors and non-survivors, and variables were compared between the two groups. The mean post-resuscitation Glasgow coma scale (GCS) score was 11.6±3.9, mean Marshall Score was 2.26±0.95 and the mean revised trauma score at presentation was 10.58±1.7. Younger age, lower GCS score after resuscitation, lower revised trauma score, absent cisterns on imaging, associated subarachnoid haemorrhage (SAH) and intraventricular haemorrhage (IVH) and a lower Marshall score were associated with higher mortality.

  13. A point prevalence study of cancer nursing practices for managing intravascular devices in an Australian tertiary cancer center.

    Science.gov (United States)

    Russell, Emily; Chan, Raymond Javan; Marsh, Nicole; New, Karen

    2014-06-01

    The use of intravascular devices is associated with a number of potential complications. Despite a number of evidence-based clinical guidelines in this area, there continues to be nursing practice discrepancies. This study aims to examine nursing practice in a cancer care setting to identify nursing practice and areas for improvement respective to best available evidence. A point prevalence survey was undertaken in a tertiary cancer care centre in Queensland, Australia. On a randomly selected day, four nurses assessed intravascular device related nursing practices and collected data using a standardized survey tool. 58 inpatients (100%) were assessed. Forty-eight (83%) had a device in situ, comprising 14 Peripheral Intravenous Catheters (29.2%), 14 Peripherally Inserted Central Catheters (29.2%), 14 Hickman catheters (29.2%) and six Port-a-Caths (12.4%). Suboptimal outcomes such as incidences of local site complications, incorrect/inadequate documentation, lack of flushing orders, and unclean/non intact dressings were observed. This study has highlighted a number of intravascular device related nursing practice discrepancies compared with current hospital policy. Education and other implementation strategies can be applied to improve nursing practice. Following education strategies, it will be valuable to repeat this survey on a regular basis to provide feedback to nursing staff and implement strategies to improve practice. More research is required to provide evidence to clinical practice with regards to intravascular device related consumables, flushing technique and protocols. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  14. Pattern of congenital heart disease in a developing country tertiary care center: Factors associated with delayed diagnosis.

    Science.gov (United States)

    Rashid, Usman; Qureshi, Ahmad U; Hyder, Syed N; Sadiq, Masood

    2016-01-01

    To determine the delay in diagnosis of various types of congenital heart defects in children and factors associated with such delay. For this observational study, 354 patients having congenital heart disease (CHD) presenting for the first time to the Department of Cardiology, Children's Hospital, Lahore, Pakistan, between January 1, 2015 and June 30, 2015, were enrolled after obtaining informed verbal consent from the guardian of each child. Demographical profile and various factors under observation were recorded. Among the 354 enrolled children (M: F 1.7:1) with age ranging from 1 to 176 months (median 24 months), 301 (85.1%) had delayed diagnosis of CHD (mainly acyanotic 65.3%), with median delay (8 months). Main factors for delay were delayed first consultation to a doctor (37.2%) and delayed diagnosis by a health professional (22.5%). Other factors included delayed referral to a tertiary care hospital (13.3%), social taboos (13.0%), and financial constraints (12.3%). Most children were delivered outside hospital settings (88.7%). Children with siblings less than two (40%) were less delayed than those having two or more siblings (60%, P congenital heart defect was delayed in majority of patients. Multiple factors such as lack of adequately trained health system and socioeconomic constraints were responsible for the delay. There is a need to develop an efficient referral system and improve public awareness in developing countries for early diagnosis and management of such children.

  15. Risk Factors for Urinary Tract Infections in Renal Allograft Recipients: Experience of a Tertiary Care Center in Hyderabad, South India.

    Science.gov (United States)

    Mohan, M V N L R; Neeraja, M; Sudhaharan, S; Raju, S B; Gangadhar, T; Lakshmi, V

    2017-01-01

    Renal transplantation is an effective and commonly performed procedure for end-stage renal disease. Urinary tract infections are a major cause of morbidity and mortality in renal transplant patients. As data on postrenal transplant urinary tract infections from the Indian subcontinent are limited, the present study was conducted to estimate the burden of urinary tract infections in this vulnerable group of patients. This was a prospective study on patients undergoing renal transplantation in 2014 at our tertiary hospital in South India with a follow-up of 2 years to evaluate the risk factors for urinary tract infections. The prevalence of urinary tract infections was 41.9% with a male preponderance of 76.9%. Mean age of the 31 patients was 32.4 ± 10.2 years (range: 16-55 years). Gram-negative bacilli were the most common isolates with Escherichia coli being the predominant pathogen (53.3%). All the infections occurred within 1 year of transplantation with delayed graft function (P urinary tract infections. Carbapenemase production was noted in 33.3% of isolates and all the Gram-negative organisms isolated in the 1st month of transplantation were carbapenem-resistant (CR) E. coli. The high rate of carbapenem-resistant organisms in the early posttransplant period is a point of concern, especially with cadaver transplants. Infection control practices and catheter care need to be strictly monitored to minimize the risk for UTI in the immediate posttransplant period.

  16. Profile of skin biopsies and patterns of skin cancer in a tertiary care center of Western Nepal.

    Science.gov (United States)

    Kumar, Ajay; Shrestha, Prashanna Raj; Pun, Jenny; Thapa, Pratichya; Manandhar, Merina; Sathian, Brijesh

    2015-01-01

    Skin biopsy is the method to assist clinicians to make definite dermatological diagnosis which further helps in holistic management. Skin cancers are relatively rare clinical diagnosis in developing countries like Nepal, but the prevalence is on rise. To investigate the profile of skin biopsies and frequencies and pattern of skin cancers in a tertiary care centre of Western Nepal. The materials consisted of 434 biopsies (1.37%) out of 31,450 OPD visits performed in the Department of Dermatology, Manipal Teaching Hospital, Pokhara, Nepal, during the period of Dec 2011-Nov 2014. Data were collected and analyzed using SPSS-16 with reference to incidence, age, sex, race and clinical and histopathological features. The commonest disorders observed in biopsies were papulosquamous lesions, skin tuberculosis of different types, benign skin tumors, leprosy, collagen and fungal diseases. Viral diseases were rarely seen, probably due to straight forward clinical diagnosis. Dermatological malignancies accounted for 55/434 (12.67%) of biopsies. Skin disorders in general were commoner in females 280/434 (64%), including malignancies 32/55(58.2%). Mean age of patients with skin cancer was 54.5 years. Facilities for proper laboratory investigation of dermatological disorders will improve the quality of life. The most prevalent lesion in skin biopsies was papulosquamous disorders followed by skin tuberculosis of different types. Dermatological malignancy constituted 55/434 (12.67%) cases. The prevalence of skin malignancy is on rise in Nepalese society probably due to increase in life expectancy and better diagnostic services.

  17. Infarct size in primary angioplasty without on-site cardiac surgical backup versus transferal to a tertiary center: a single photon emission computed tomography study

    Energy Technology Data Exchange (ETDEWEB)

    Knaapen, Paul; Rossum, Albert C. van [VU University Medical Center, Department of Cardiology, Amsterdam (Netherlands); Mulder, Maarten de; Peels, Hans O.; Cornel, Jan H.; Umans, Victor A.W.M. [Medical Center Alkmaar, Department of Cardiology, Alkmaar (Netherlands); Zant, Friso M. van der [Medical Center Alkmaar, Department of Nuclear Medicine, Alkmaar (Netherlands); Twisk, Jos W.R. [VU University Medical Center, Department of Clinical Epidemiology and Biostatistics, Amsterdam (Netherlands)

    2009-02-15

    Primary percutaneous coronary intervention (PCI) performed in large community hospitals without cardiac surgery back-up facilities (off-site) reduces door-to-balloon time compared with emergency transferal to tertiary interventional centers (on-site). The present study was performed to explore whether off-site PCI for acute myocardial infarction results in reduced infarct size. One hundred twenty-eight patients with acute ST-segment elevation myocardial infarction were randomly assigned to undergo primary PCI at the off-site center (n = 68) or to transferal to an on-site center (n = 60). Three days after PCI, {sup 99m}Tc-sestamibi SPECT was performed to estimate infarct size. Off-site PCI significantly reduced door-to-balloon time compared with on-site PCI (94 {+-} 54 versus 125 {+-} 59 min, respectively, p < 0.01), although symptoms-to-treatment time was only insignificantly reduced (257 {+-} 211 versus 286 {+-} 146 min, respectively, p = 0.39). Infarct size was comparable between treatment centers (16 {+-} 15 versus 14 {+-} 12%, respectively p = 0.35). Multivariate analysis revealed that TIMI 0/1 flow grade at initial coronary angiography (OR 3.125, 95% CI 1.17-8.33, p = 0.023), anterior wall localization of the myocardial infarction (OR 3.44, 95% CI 1.38-8.55, p < 0.01), and development of pathological Q-waves (OR 5.07, 95% CI 2.10-12.25, p < 0.01) were independent predictors of an infarct size > 12%. Off-site PCI reduces door-to-balloon time compared with transferal to a remote on-site interventional center but does not reduce infarct size. Instead, pre-PCI TIMI 0/1 flow, anterior wall infarct localization, and development of Q-waves are more important predictors of infarct size. (orig.)

  18. 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).

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

    Science.gov (United States)

    Vane, Matheus Fachini; do Prado Nuzzi, Rafael Ximenes; Aranha, Gustavo Fabio; da Luz, Vinicius Fernando; Sá Malbouisson, Luiz Marcelo; Gonzalez, Maria Margarita Castro; Auler, José Otávio Costa; Carmona, Maria José Carvalho

    2016-01-01

    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. 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. 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. 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. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  20. Clinical experience with Liraglutide in 196 patients with type 2 diabetes from a tertiary care center in India

    Directory of Open Access Journals (Sweden)

    Parjeet Kaur

    2014-01-01

    Full Text Available Context: GLP-1 receptor agonists (GLP-1 RA are unique antidiabetic agents that have the ability to lower blood glucose without causing hypoglycemia, while at the same time promoting weight loss. Information on the efficacy and safety of GLP-1 RA in the Indian diabetic population is limited. Aims: (1 To evaluate the effect of GLP-1 RA, Liraglutide on glycemic control, and weight in obese Indian patients with type 2 diabetes. (2 To study the adverse event profile of Liraglutide in these patients in real-world clinical setting. Settings and Design: Observational study conducted in a tertiary care hospital. Materials and Methods: Liraglutide was prescribed to 196 obese patients with type 2 diabetes who had poor glycemic control on oral medications ± insulin. The initial dose of Liraglutide was 0.6 mg, which was up-titrated to 1.2 mg after 1 week; further up-titration to 1.8 mg was done based on tolerance. Dipeptidyl peptidase-IV (DPP-IV inhibitors were discontinued and dose of other medications adjusted according to clinical judgment during the study period. Results: Mean age of patients was 49.9 ± 9.6 years. Three month data were available for 175 patients out of a total of 196. At 3 months, glycosylated hemoglobin (HbA1c was 7.6 ± 0.9% vs. 9.2 ± 1.9% at baseline (P = 0.007 and mean body weight was 96.0 ± 16.5 kg vs. 100.1 ± 17.5 kg at baseline (P < 0.001. Most common adverse events were nausea, burping, and eructation (10%. Conclusion: Liraglutide significantly improves glycemic control with low risk of hypoglycemia and is associated with significant weight loss in obese Indian patients with type 2 diabetes mellitus.

  1. Solitary Fibrous Tumors of the Pleura of the Thorax: CT and FDG PET Characteristics in a Tertiary Referral Center.

    Science.gov (United States)

    Yeom, Yoo Kyung; Kim, Mi Young; Lee, Hyun Joo; Kim, Sung-Soo

    2015-09-01

    This study was conducted to describe the characteristics of a solitary fibrous tumor of the pleura (SFTP) on chest CT, and FDG PET. Furthermore, we analyze the prognosis of SFTP using large data confirmed in a tertiary referral hospital. From January 1997 to March 2012, 41 patients (21 males and 20 females; median age: 59 yr; age range: 27-85 yr) who were pathologically diagnosed with SFTP were consecutively examined. The CT findings, including the size, shape, homogeneity, and anatomic location (chest wall, intrapulmonary/fissure space, diaphragm, and mediastinum) of the SFTP, the F-fluorodeoxyglucose positron emission tomography (FDG PET) findings, and the histopathology findings were evaluated. Most of the patients had a mass-type (70.7%), oval/elliptical (80.5%), and homogeneous (70.7%) SFTP with a median diameter of 6.0 cm (range: 1-17). The most common anatomic location was the chest wall (43.9%), followed by the intrapulmonary/fissure space (22.0%), diaphragm (22.0%), and mediastinum (12.3%). For all the 9 patients, the mean maxSUV was 2.9 (SD = 1.16; range: 1.2-4.9) on FDG PET. The malignant SFTP (median: 3.6, range: 2.5-4.9) showed more hypermetabolic than benign SFTP (median: 2.0, range: 1.2-3.1) (P = 0.049). Through familiarity with the various features of the SFTP with regard to its size and location on the preoperative CT and FDG PET, we can add this rare pleural neoplasm to the differential diagnosis of other more common conditions. Moreover, an appropriate treatment choice can be made.

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

    Directory of Open Access Journals (Sweden)

    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. Status of Thyroid Peroxidase Antibodies in Pregnant Women and Association with Obstetric and Perinatal Outcomes in Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Karuna

    2017-10-01

    Full Text Available Introduction: Thyroid dysfunction is reported in 8.25% of pregnant women in Indian subcontinent. About two thirds of these women have subclinical hypothyroidism and the rest have overt hypothyroidism. Aim: To study the prevalence and impact of Thyroid Peroxidase (TPO antibodies on obstetric and perinatal outcome in a tertiary health centre. Materials and Methods: This was a prospective cohort study conducted in antenatal clinic of Department of Obstetrics and Gynaecology in collaboration with Department of Biochemistry at King George Medical University, Lucknow, India. Total 230 antenatal women upto 20 weeks of gestational age were recruited, venous blood sample was assessed for serum TSH and TPO Ab and women were classified as subclinical or overt hypothyroid. Subsequently, serum TSH was repeated at interval of 4-6 weeks after initiation of treatment. All the enrolled women were followed for obstetric and perinatal outcome. Results: The prevalence of TPO Ab in pregnant women was 49 (21.3%. The proportion of hypothyroid women was higher in TPO positive group as compared to TPO negative group (48.98% V/s 27.22%, p=0.01. There were 10 abortions, 4 of them had TPO Ab V/s 6 who were TPO Ab negative. Among TPO Ab positive hypothyroid women 37.5% had preterm labour Vs 5.26% in TPO Ab positive euthyroid women (p-value=0.04. GDM was observed more in TPO Ab positive group (14.2% vs 7.56% p=0.157. There was no difference in terms of caesarean section or neonatal outcome in the study. Conclusion: The study shows the high prevalence (21.3% of TPO antibody in antenatal women. Hypothyroidism was more prevalent in TPO Ab positive group. Preterm labour was seen more often in hypothyroid women with TPO Ab.

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

    Science.gov (United States)

    Vane, Matheus Fachini; do Prado Nuzzi, Rafael Ximenes; Aranha, Gustavo Fabio; da Luz, Vinicius Fernando; Sá Malbouisson, Luiz Marcelo; Gonzalez, Maria Margarita Castro; Auler, José Otávio Costa; Carmona, Maria José Carvalho

    2016-01-01

    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. 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. 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. 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. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  5. Virtual microscopy in medical research: Open European Nephrology Science Center (OpEN.SC)

    Science.gov (United States)

    Schrader, Thomas; Beil, Michael; Schmidt, Danilo; Dietel, Manfred; Lindemann, Gabriela

    2007-03-01

    The amount and heterogeneity of data in biomedical research, notably in transnational research, requires new methods for the collection, presentation and analysis of information. Important data from laboratory experiments as well as patient trials are available as images. Thus, the integration and processing of image data represent a crucial component of information systems in biomedical research. The Charité Medical School in Berlin has established a new information service center for kidney diseases and transplantation (Open European Nephrology Science Centre - OpEN.SC) together with the German Research Agency (DFG). The aims of this project are (i) to improve the availability of raw data, (ii) to establish an infrastructure for clinical trials, (iii) to monitor the occurrence of rare disease patterns and (iv) to establish a quality assurance system. Major diagnostic procedures in medicine are based on the processing and analysis of image data. In diagnostic pathology, the availability of automated slide scanners provide the opportunity to digitize entire microscopic slides. The processing, presentation and analysis of these image data are called virtual microscopy. The integration of this new technology into the OpEN.SC system and the link to other heterogeneous data of individual patients represent a major technological challenge. Thus, new ways in communication between clinical and scientific partners have to be established and will be promoted by the project. The technological basis of the repository are web services for a scalable and adaptable system. HL7 and DICOM are considered the main medical standards of communication.

  6. Control of the T follicular helper-germinal center B-cell axis by CD8⁺ regulatory T cells limits atherosclerosis and tertiary lymphoid organ development.

    Science.gov (United States)

    Clement, Marc; Guedj, Kevin; Andreata, Francesco; Morvan, Marion; Bey, Laetitia; Khallou-Laschet, Jamila; Gaston, Anh-Thu; Delbosc, Sandrine; Alsac, Jean-Marc; Bruneval, Patrick; Deschildre, Catherine; Le Borgne, Marie; Castier, Yves; Kim, Hye-Jung; Cantor, Harvey; Michel, Jean-Baptiste; Caligiuri, Giuseppina; Nicoletti, Antonino

    2015-02-10

    The atheromodulating activity of B cells during the development of atherosclerosis is well documented, but the mechanisms by which these cells are regulated have not been investigated. Here, we analyzed the contribution of Qa-1-restricted CD8(+) regulatory T cells to the control of the T follicular helper-germinal center B-cell axis during atherogenesis. Genetic disruption of CD8(+) regulatory T cell function in atherosclerosis-prone apolipoprotein E knockout mice resulted in overactivation of this axis in secondary lymphoid organs, led to the increased development of tertiary lymphoid organs in the aorta, and enhanced disease development. In contrast, restoring control of the T follicular helper-germinal center B-cell axis by blocking the ICOS-ICOSL pathway reduced the development of atherosclerosis and the formation of tertiary lymphoid organs. Moreover, analyses of human atherosclerotic aneurysmal arteries by flow cytometry, gene expression analysis, and immunofluorescence confirmed the presence of T follicular helper cells within tertiary lymphoid organs. This study is the first to demonstrate that the T follicular helper-germinal center B-cell axis is proatherogenic and that CD8(+) regulatory T cells control the germinal center reaction in both secondary and tertiary lymphoid organs. Therefore, disrupting this axis represents an innovative therapeutic approach. © 2014 American Heart Association, Inc.

  7. Epidemiology of Joint Dislocations and Ligamentous/Tendinous Injuries among 2,700 Patients: Five-year Trend of a Tertiary Center in Iran.

    Science.gov (United States)

    Nabian, Mohammad H; Zadegan, Shayan Abdollah; Zanjani, Leila Oryadi; Mehrpour, Saeed R

    2017-11-01

    The epidemiology of traumatic dislocations and ligamentous/tendinous injuries is poorly understood. In this study, we aimed to evaluate the prevalence and distribution of various dislocations and ligamentous/tendinous injuries in a tertiary orthopedic hospital in Iran. Musculoskeletal injuries in an academic tertiary health care center in Tehran February 2005 to October 2010 were recorded. The demographic details of patients with pure dislocations and ligamentous/tendinous injuries were extracted and the type and site of injuries were classified according to their specific age/gender groups. Among 18,890 admitted patients, 628 (3.3%) were diagnosed with dislocations and 2.081 (11%) with ligamentous/tendinous injuries. The total male/female ratio was 4.2:1 in patients with dislocations and 1.7:1 in patients with ligamentous/tendinous injuries. Shoulder was the most prevalent site of dislocation (50.6%), followed by fingers (10.1%), toes (7.6%), hip (7.3%), and elbow (6.5%). Ankle was the most common site of ligamentous/tendinous injury (53.5%), followed by midfoot (12.3%), knee (8.3%), hand (7%), and shoulder (5%). The mean ages of the patients in dislocations and ligamentous/tendinous injuries were 35.0±18.2 and 31.3± 15.1, respectively. There was no seasonal variation. Shoulder dislocation and ankle ligamentous injury are the most frequent injuries especially in younger population and have different distribution patterns in specific age and sex groups. Epidemiologic studies can help develop and evaluate the injury prevention strategies, resource allocation, and training priorities.

  8. Experience of intravenous sedation for pediatric gastrointestinal endoscopy in a large tertiary referral center in a developing country.

    Science.gov (United States)

    Amornyotin, Somchai; Aanpreung, Prapun; Prakarnrattana, Ungkab; Chalayonnavin, Wiyada; Chatchawankitkul, Sukanda; Srikureja, Wichit

    2009-08-01

    The aim of this study was to evaluate the clinical efficacy of intravenous sedation for pediatric gastrointestinal endoscopy (GIE) at a tertiary care teaching hospital in a developing country. We undertook a retrospective review of the sedation service records of pediatric patients who underwent GIE. All endoscopies were performed by a pediatric gastroenterologist. All of the sedation was administered by staff anesthesiologist or anesthetic personnel in the gastroenterology procedure room. Sedation was provided for 222 procedures in 214 patients ranged in age from younger than 1 to 17 years and in weight from 2.7 to 80.0 kg. Intravenous sedation was provided in 176 patients (82.2%). Of these patients, 185 procedures were performed and reviewed, with 152 (82.2%) procedures were esophagogastroduodenoscopy (EGD) alone, 14 (7.6%) procedures were colonoscopy alone, 18 (9.7%) procedures were EGD and colonoscopy, and one procedure was endoscopic ultrasonography (EUS). Most common indications of the procedure were screening for esophageal varices (25.2%), abdominal pain (15.9%), history of upper gastrointestinal hemorrhage (13.6%), and unexplained anemia (10.3%). The majority of preanesthetic problems were hematologic disease, anemia (38.2%); liver disease, cirrhosis (13.5%); and electrolyte imbalance (13.5%). Propofol (94.0%), fentanyl (87.0%), and midazolam (67.8%) were frequently used. The mean dose of propofol was 7.8 +/- 4.1 mg.kg(-1).h(-1), fentanyl 2.3 +/- 1.1 mcg.kg(-1).h(-1), and midazolam 0.1 +/- 0.1 mg.kg(-1).h(-1). Most of them were used in combination. The combination of propofol, fentanyl, and midazolam was commonly employed (46.4%). The mean sedation time of all procedures was 28.2 min and was different according to procedure type. Complications occurred infrequently (13.5%) and were medication or airway related. All complications were easily treated, with no adverse sequelae. Intravenous sedation was successful except for one patient who required general

  9. EVALUATION OF OCULAR PROFILE OF PATIENTS WITH PSEUDOEXFOLIATION SYNDROME IN A TERTIARY EYE CARE CENTER IN WEST BENGAL

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    Nirmal Kumar Sasmal

    2017-07-01

    Full Text Available BACKGROUND Pseudoexfoliation Syndrome (PEX is characterized by the deposition of a distinctive fibrillar material on the lens capsule, pupillary margin, iris, ciliary body and subconjunctival tissue and has also been identified in other parts of the body. PEX occurs worldwide and prevalence rates vary from 10 to 20% of the general population over the age of 60 years. Heightened awareness of this condition and its associated clinical signs are important in the detection and management of glaucoma, and preoperative determination of those patients at increased risk for surgical complications. The aim of the study was to evaluate the ocular profile of patients with Pseudoexfoliation Syndrome in a tertiary eye care centre in West Bengal and to assess surgical complications which may arise from Pseudoexfoliation Syndrome. MATERIALS AND METHODS This is institution based cross sectional study, conducted at the Regional Institute of Ophthalmology (RIO OPD over a period of 1.5 years starting from February 2014 to July 2015. Fifty patients with the age between 20-80 years, attending RIO, OPD and diagnosed as having Pseudoexfoliation Syndrome were included in our study. Patients with other causes of secondary glaucoma and Fuchs Heterochromic Uveitis were excluded from our study RESULTS In our study we found results similar to other studies with respect to age distribution of pseudo exfoliation patients. Higher incidence was found in age group of patients more than 55 years. The PEX patients in our study had10.0%, 4.0%, 3.0% and 2.0% of pseudoexfoliation glaucoma (PXG, primary open angle glaucoma (POAG, primary angle closure glaucoma(PACG and normal tension glaucoma (NTG respectively. 81% eyes were non-glaucomatous. The mean IOP (mean ± s.d. of the patients was 17.48 ± 2.58 mmHg with range 14 - 23 mmHg and the median was 17 mmHg. Surgical complication was observed in 22.22% of the cases, but this was not further analysed since very few patients (9 patients

  10. [ACADEMIC SURGICAL SERVICES IN A TERTIARY MEDICAL CENTER IN THE NEGEV-DESERT, PERIPHERY OF ISRAEL: IS IT A HYBRID?].

    Science.gov (United States)

    Mizrahi, Solly

    2016-02-01

    Soroka Medical Center, a major affiliated hospital of the Faculty of Health Sciences in Ben Gurion University of the Negev, serving 1,000,000 citizens in the south part of Israel and is designated as a "peripheral hospital". Herein, we address the factors that influence our high level academic surgical training program with its broad base surgical experience, which focused on the "spirit of Beer Sheba". Should we call our program a hybrid?

  11. The epidemiological analysis of maxillofacial fractures in Italy: The experience of a single tertiary center with 1720 patients.

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    Bonavolontà, Paola; Dell'aversana Orabona, Giovanni; Abbate, Vincenzo; Vaira, Luigi Angelo; Lo Faro, Carmelo; Petrocelli, Marzia; Attanasi, Federica; De Riu, Giacomo; Iaconetta, Giorgio; Califano, Luigi

    2017-08-01

    Maxillofacial fractures represent a serious public health problem. Their epidemiology is extremely variable, and its analysis is crucial to establish effective treatment and prevention of these injuries. However only two works have been published about maxillofacial fracture epidemiology in Italy. The records of 1720 patients diagnosed with maxillofacial fractures in a 15-years period (2001-2015) in our department were retrospectively reviewed. A total of 1108 male and 612 female patients were included in the study. The most frequent aetiology of fracture was road traffic injuries (57.1%), followed by assault (21.7%), falls (14.2%), work accidents (3.5%), sport accidents (3.3%) and other causes (0.2%). Significant variations of aetiology were detected between males and females and between Italians and individuals from other countries. The most frequently observed fracture involved the mandible (861 cases, 36%), followed by zygoma (489 cases, 20.4%), orbital walls (386 cases, 16.1%) and maxilla (282 cases, 11.8%). Road traffic legislation enforcement and continuous public education regarding the use of security devices remain an ongoing problem in our region and should be encouraged. In the same way, as migration flows influence and change the epidemiology of facial traumas, it is crucial to establish social support programs that avoid these disadvantaged categories of victims of violence and crime. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  12. A case study on the safety impact of implementing smart patient-controlled analgesic pumps at a tertiary care academic medical center.

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    Tran, Mai; Ciarkowski, Scott; Wagner, Deborah; Stevenson, James G

    2012-03-01

    As with the use of any therapy involving opioids, patient-controlled analgesia (PCA)-related errors can lead to overdose and even death. "Smart" (computerized) pumps have medication safety enhancements, particularly those related to operator errors during administration, to improve overall safety and efficacy. After the occurrence of PCA-related errors that occurred at a tertiary care academic medical center, an analysis of PCA errors was conducted. The introduction of smart pumps was identified as a possible solution, and the medical center adopted the technology in 2006. A study was conducted to investigate the impact of implementation. The study had three primary objectives: (1) to evaluate history logs stored in the smart PCA pumps to characterize the nature of hard and soft stop alerts and identify potential errors that may have been averted, (2) to examine the impact of smart PCA pumps on voluntarily reported PCA therapy-related errors, and (3) to assess nursing perceptions regarding the improvement in safety due to the introduction of smart PCA pumps. The smart pumps potentially prevented 159 errors for the January-June 2007 period; upper hard limits had the most number of alerts, representing avoidance of errors with the greatest potential to be detrimental to the patient. In addition, pump-programming errors due to wrong concentration were eliminated after implementation. Finally, nursing staff perceived smart pumps to be valuable in improving patient safety. Smart PCA pumps had an important positive impact on PCA-related patient safety at the medical center. Other facilities should adopt PCA devices with additional safety features such as bar-code verification of the drug and concentration, as well as dosage limits, to prevent pump-programming errors.

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

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    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.

  14. Association of interatrial septal abnormalities with cardiac impulse conduction disorders in adult patients: experience from a tertiary center in Kosovo.

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    Zaim Gashi

    2011-06-01

    Full Text Available Interatrial septal disorders, which include: atrial septal defect, patent foramen ovale and atrial septal aneurysm, are frequent congenital anomalies found in adult patients. Early detection of these anomalies is important to prevent their hemodynamic and/or thromboembolic consequences. The aims of this study were: to assess the association between impulse conduction disorders and anomalies of interatrial septum; to determine the prevalence of different types of interatrial septum abnormalities; to assess anatomic, hemodynamic, and clinical consequences of interatrial septal pathologies. Fifty-three adult patients with impulse conduction disorders and patients without ECG changes but with signs of interatrial septal abnormalities, who were referred to our center for echocardiography, were included in a prospective transesophageal echocardiography study. Intera trial septal anomalies were detected in around 85% of the examined patients.

  15. Progress in implantable gastric stimulation: summary of results of the European multi-center study.

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    De Luca, Maurizio; Segato, Gianni; Busetto, Luca; Favretti, Franco; Aigner, Franz; Weiss, Helmut; de Gheldere, Charles; Gaggiotti, Giorgio; Himpens, Jacques; Limao, Jorge; Scheyer, Matthias; Toppino, Mauro; Zurmeyer, Ernst L; Bottani, Giorgio; Penthaler, Heinrich

    2004-09-01

    The Implantable Gastric Stimulator (IGS(R)), a pacemaker-like device, has been found to be safe and effective to induce and maintain weight loss. The LOSS (Laparoscopic Obesity Stimulation Survey) is a prospective non-randomized trial which enrolled 69 patients involving 11 investigator centers in 5 European Countries. In 19 patients, ghrelin was analyzed. Between January 2002 and December 2003, 69 patients (F/M 49/20), mean age 41 years (18-65) underwent IGS implantation. Mean BMI was 41 (35-57), mean weight 115.0 kg (65-160) and mean excess weight (EW) 52 kg (13-89). The IGS was actived 30 days after implantation. In a subset of 19 patients studied further, 0, 6, and 12 months appetite and satiety score were evaluated and 0 and 6 months ghrelin profile was analyzed. The mean +/- standard error %EWL was: 8.6+/-1.8 at 1 month, 15.8+/-2.3 at 3 months, 17.8+/-2.6 at 6 months, 21.0+/-3.5 at 10 months, and 21.0+/-5.0 at 15 months. There were no intraoperative surgical or long-term complications. 7 intra-operative gastric penetrations occurred, observed by gastroscopy, without sequelae. 1 patient required a reoperation to remove a retained lead needle. In the subset of 19 patients, appetite was reduced and post-prandial and inter-prandial satiety was increased after IGS implantation. In the 19 patients, despite weight reduction, ghrelin did not increase. IGS can be implanted laparoscopically with minimal perioperative complications. Appetite is reduced and satiety is increased after the implantation. Ghrelin levels could be one of the mechanisms explaining weight loss and weight maintenance in IGS patients. If weight loss is maintained, IGS could be considered a good option for selected patients.

  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. Prevalence of non-motor dysfunction among Parkinson's disease patients from a tertiary referral center in Mexico City.

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    Rodríguez-Violante, Mayela; Cervantes-Arriaga, Amin; Villar-Velarde, Alejandra; Corona, Teresa

    2010-12-01

    Data on the frequency of non-motor symptoms among patients with Parkinson's disease (PD) in Mexico has not been reported. To study the prevalence of these symptoms in a sample of Mexican PD patients attending a referral neurologic center using the Non Motor Symptoms Questionnaire (NMSQuest) and the Non Motor Symtpoms Scale (NMSS). One-hundred consecutive PD patients, of all ages and disease severity were included in a cross-sectional design study. The NMSQuest and NMSS were applied during the "on" state. Sample had a mean age of 64.5±10.9 years and disease duration of 6.6±4.8 years. Total NMSQuest median score was 10 and the mean NMSS score was 69.3±56.7. Positive answers classified by domain were as follows: gastrointestinal symptoms 30%, urinary symptoms 60%, memory/attention/apathy 39%, hallucinations/delusions 16%, depression/anxiety 55%, sexual dysfunction 30%, cardiovascular symptoms 35%, sleep disorders 40% and miscellany 27%. The prevalence of non-motor symptoms among mexican patients with PD is similar to other countries. Mood, cognitive and perceptual symptoms seems to be more severe in our population. Copyright © 2010 Elsevier B.V. All rights reserved.

  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. Status migrainosus and migraine aura status in a French tertiary-care center: An 11-year retrospective analysis.

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    Beltramone, Marion; Donnet, Anne

    2014-07-01

    Status migrainosus (SM) and migraine aura status (MAS) are two migraine complications. Few data exist in literature. This 11-year retrospective study in one French center describes patients' characteristics, modifications of the migraine before complication, evolution after the episode and management in patients who had SM or MAS according to International Classification of Headache Disorders, second edition (ICHD-II) criteria. Among 8821 patients, 24 had SM, three had MAS and one had both forms. Mean duration of SM was 4.8 weeks and four weeks for MAS. Stress and menstruation were the main precipitating factors for SM (68.8% and 31.3%, respectively). No precipitating factor was found for MAS. For a majority of patients, the frequency of migraine attack was the same before and after SM or MAS. SM and MAS occurred more frequently in patients with initial low-frequency migraine attacks. Eight patients had a relapse of SM and three of MAS. Fifteen were hospitalized for amitriptyline intravenous treatment. SM and MAS are rare. Our results highlight a high rate of relapse and a similar frequency of migraine attacks before and after SM. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  20. 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 radiosurgery is a useful, valid, effective, and safe modality for treatment of brain AVMs. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. A 5-Year Audit of Accidental Dural Punctures, Postdural Puncture Headaches, and Failed Regional Anesthetics at a Tertiary-Care Medical Center

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    Sukhdip Singh

    2009-01-01

    Full Text Available Obstetric anesthesia-related complications occur as a result of labor epidural or spinal placement. The purpose of this continuous quality-improvement audit was to review the occurrence of accidental dural punctures (ADPs, postdural puncture headaches (PDPHs, and failed regional anesthetics at an academic tertiary-care medical center over a 5-year period. Obstetric anesthesia complications contained in three databases consisting of ADPs, PDPHs, and failed regional anesthetics were matched to a perinatal database, with no complications serving as controls. Of the 40,894 consecutive parturients, there were 765 documented complications. Complication rates were 0.73% (95% CI: 0.65–0.82 for ADP, 0.49% (95% CI: 0.43–0.56 for PDPH, and 0.65% (95% CI: 0.57–0.73 for failed regional anesthetic. When compared to the no complication group, factors associated with obstetric anesthesia complications included increased weight and BMI (p < 0.01, epidural block (p < 0.01, and vaginal delivery (p< 0.01.

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

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    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.

  3. Malnutrition Matters in Canadian Hospitalized Patients: Malnutrition Risk in Hospitalized Patients in a Tertiary Care Center Using the Malnutrition Universal Screening Tool.

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    Rahman, Adam; Wu, Thomas; Bricknell, Ryan; Muqtadir, Zack; Armstrong, David

    2015-10-01

    Malnutrition is common in Canadian hospitalized patients, yet system-wide malnutrition screening is not mandatory in Canada. Our goal was to define the point prevalence of malnutrition risk at a major tertiary care center in Hamilton, Ontario, using the Malnutrition Universal Screening Tool (MUST) to determine feasibility of hospital-wide screening in the Canadian context. After research ethics approval was obtained, we arranged for a clinical nutrition support team to conduct the MUST screening on all inpatients at Hamilton Health Sciences, Juravinski site, a large academic acute care hospital. A total of 315 patients were included (female, n = 160 [51%]; male, n = 155 [49%]; average age, 71 years). We identified 31% at high risk for malnutrition and 14% at medium risk, keeping with reported rates of malnutrition in the literature. Survey of dietitians and interns indicated that the MUST was easy to use and perform and that they had support of their unit supervisors. All respondents thought that the screen was useful and they wanted to repeat it. The MUST is an easy and efficient way to define point prevalence of malnutrition risk in Canadian hospitalized patients. Moving to system-wide nutritional screening will bring about the best practices in nutrition care with the involvement of key stakeholders and decision makers. Nutritional screening will allow us to utilize nutrition resources more efficiently, engage administrators in addressing shortfalls in nutrition care, and form a baseline for which to measure the efficacy of future nutritional interventions. © 2015 American Society for Parenteral and Enteral Nutrition.

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

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    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.

  5. Adherence to the 2010 American College of Cardiology Foundation Appropriate Use Criteria for Cardiac Computed Tomography: Quality Analysis at a Tertiary Referral Center.

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    Sidhu, Manavjot S; Lumish, Heidi; Uthamalingam, Shanmugam; Engel, Leif-Christopher; Abbara, Suhny; Brady, Thomas J; Hoffmann, Udo; Ghoshhajra, Brian B

    2016-03-01

    In November 2010, the American College of Cardiology Foundation published revised appropriateness criteria (AC) for cardiac computed tomography (CT). We evaluated adherence to these criteria by providers of different subspecialties at a tertiary referral center. Reports of 383 consecutive patients who underwent clinically indicated cardiac CT from December 1, 2010, to July 31, 2011, were reviewed by physicians with appropriate training in cardiac CT. Scans were classified as appropriate, inappropriate, or uncertain based on the revised 2010 AC. Studies that did not fall under any of the specified indications were labeled as unclassified. Adherence to the AC was also analyzed as a function of provider type. Research scans were excluded from this analysis. Three hundred eight exams (80%) were classified as appropriate; 26 (7%), as inappropriate; 30 (8%), as uncertain; and 19 (5%), as unclassified. Of the 19 (5%) unclassified cardiac CT exams, the most common indication was for evaluation of suspected aortic dissection. Three hundred five exams (80%) were referred by cardiologists; 73 (19%), by internists; and 5 (1%), by neurologists. Of the 305 cardiology-referred studies, 221 (73%) were ordered by general cardiologists; 28 (9%), by interventional cardiologists; and 56 (19%), by electrophysiologists. There was no significant difference in adherence to the criteria between provider specialties or between cardiology subspecialties (P > 0.05). high across provider specialties.

  6. Prospective Evaluation of Infection Episodes in Cancer Patients in a Tertiary Care Academic Center: Microbiological Features and Risk Factors for Mortality

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    Nursel Çalık Başaran

    2016-12-01

    Full Text Available Objective: We aimed to determine the frequency, type, and etiology of infections and the risk factors for infections and mortality in hospitalized cancer patients. Materials and Methods: We prospectively enrolled adult cancer patients hospitalized in the internal medicine wards of a tertiary care academic center between January and August 2004. Patients were followed during their hospitalization periods for neutropenia, infections, culture results, and mortality. Results: We followed 473 cancer patients with 818 hospitalization episodes and 384 infection episodes in total. Seventy-nine percent of the infections were nosocomial, and febrile neutropenia (FN was observed in 196 (51% of the infection episodes. Bacteremia was found in 29% of FN episodes and in 8% of nonneutropenic patients. Gram-positive bacteria were the leading cause of bacteremia in both neutropenic and nonneutropenic cases (70% and 58%, respectively. Presence of an indwelling central catheter increased bacteremia risk by 3-fold. The overall mortality rate was 17%, whereas 34% of the patients with bloodstream infections died. Presence of bacteremia and advanced disease stage increased overall mortality by 6.1-fold and 3.7-fold, respectively. Conclusion: Nearly half of the cancer patients developed an infection during their hospital stays, with gram-positive bacteria being the predominant etiologic microorganisms. This demonstrates the changing trends in infections considering that, until 2004, gramnegative bacteria were the most predominant microorganisms among cancer patients in our institute.

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

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    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.

  8. 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.

  9. Differences in MRSA prevalence and resistance patterns in a tertiary center before and after joining an international program for surveillance of antimicrobial resistance.

    Science.gov (United States)

    Djuric, Olivera; Jovanovic, Snezana; Stosovic, Branka; Tosic, Tanja; Jovanovic, Milica; Nartey, Naomi; Todorovic, Jovana; Markovic-Denic, Ljiljana

    2017-06-01

    Methicillin-resistant Staphylococcus aureus (MRSA) emerged as one of the most important causes of hospital-acquired bloodstream infections (BSIs), especially the multidrug resistant clones. The aim of the present study was to compare prevalence and resistance patterns of MRSA bacteremia in the major tertiary-care academic and referral center in Serbia before and after implementing an active antimicrobial resistance (AMR) surveillance. Laboratory-based before-after study was conducted during a two-year period (January 2012 to December 2013) in Clinical Centre of Serbia. Isolation and identification of bacterial strains were done following standard microbiological procedures. During the AMR surveillance, nearly twice more bloodstream samples were collected compared to the year without surveillance (1,528 vs. 855). In total, 43 isolates of MRSA were identified. MRSA was significantly more prevalent during the AMR surveillance compared to the previous year [14 (66.7%) to 29 (76.3%); P = 0.046]. During the AMR surveillance, MRSA more frequently originated from medical departments compared to intensive care unit, surgical department, and internal medicine (P = 0.027) indicating increasing MRSA infections in patients with less severe clinical condition and no apparent risk factors. Higher prevalence of MRSA and its lower susceptibility to erythromycin were revealed by implementation of active AMR surveillance, which may reflect more thoughtful collection of bloodstream samples from patients with suspected BSI.

  10. Bacterial spectrum and resistance patterns in corneal infections at a Tertiary Eye Care Center in South China

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    Nan Wang

    2016-03-01

    Full Text Available AIM: To investigate the spectrum and antibiotic susceptibility of bacteria isolated from patients with suspected corneal infections in Zhongshan Ophthalmic Center in South China over the past four years retrospectively. METHODS: Totally 1943 corneal scrapes from patients with corneal infections from 2010 to 2013 were cultured and processed using standard microbiological procedures to identify bacterial isolates. Simultaneously, the bacterial isolates were tested for antibiotic susceptibility to 8 antibiotics (ceftazidime, cefuroxim, cefazolin, levofloxacin, ofloxacin, neomycin, tobramycin, chloramphenicol using the Kirby-Bauer disc diffusion technique. RESULTS: Of the total 1943 scrapes, 397 (20.43% were culture-positive, of which 294 (74.06% were gram-positive (GP and 103 (25.94% were gram-negative (GN bacteria. Of the GP organisms, the most prevalent genera were Staphylococcus spp. (56.17%, n=223, Kocuria spp. (5.29%, n=21 and Micrococcus spp. (1.26%, n=5. On the other hand, the most prevalent genera were Pseudomonas spp. (12.85%, n=51, Burkholderia spp. (2.02%, n=8 and Acinetobacter spp. (1.51%, n=6 for the GN organisms. Among five antibiotics that have eye drop products, the resistant to neomycin of GP (7.82%, 95% CI: 4.72%-10.92% and GN isolates (9.71%, 95% CI: 4.01%-15.41% was lowest, while the resistant to chloramphenicol was highest (GP: 34.35%, 95% CI: 28.92%-39.78%; GN: 60.19%, 95% CI: 50.74%-69.64%. CONCLUSION: Staphylococcus spp. was the most common bacterial pathogens isolated from patients with corneal infections in this setting. High percentages of GP and GN bacteria were mostly susceptible to neomycin and highly resistant to chloramphenicol.

  11. Changing Indications and Surgical Techniques for Corneal Transplantation Between 2004 and 2009 at a Tertiary Referral Center

    Science.gov (United States)

    Zare, Mohammad; Javadi, Mohammad A.; Einollahi, Bahram; Karimian, Farid; Rafie, Ali R. B.; Feizi, Sepehr; Azimzadeh, Ahmad

    2012-01-01

    Purpose: The aim of this study is to report the indications, techniques, and clinical outcomes of corneal transplantation and investigate any changing trends in surgical techniques over a 6 year period. Materials and Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran, from January 2004 to December 2009 were reviewed to determine the indications and types of corneal transplantation. Postoperative best-corrected visual acuity, refractive error, graft clarity, and complications were reported. Results: During this period, 1859 eyes of 1624 patients with a mean age of 41.3 ± 21.3 years underwent corneal transplantation. The most common indication was keratoconus (38.4%) followed by aphakic/pseudophakic bullous keratopathy (11.7%), previous failed grafts (10.6%), infectious corneal ulcers (10.1%), non-herpetic corneal scars (7.6%), trachoma keratopathy (4.7%), stromal corneal dystrophies (4.6%), post-herpetic corneal scar (3.7%), Fuchs’ endothelial dystrophy (0.8%), and congenital hereditary endothelial dystrophy (0.4%). Techniques of corneal transplantation included penetrating keratoplasty (PKP; 70.9%), deep anterior lamellar keratoplasty (DALK; 20.1%), conventional lamellar keratoplasty (LKP; 4.4%), and Descemet's stripping automated endothelial keratoplasty (DSAEK; 2.3%). Over the study period, there was a significant increase in the relative frequency of infectious corneal ulcers, failed grafts, and trachoma keratopathy. Additionally, a significant reduction was observed in PKP and LKP procedures, and volume of DALK and DSAEK increased significantly. At final follow-up, 69.0% of grafts were clear in the PKP group. This figure was 82.6%, 82.7%, and 97.6% in the DALK, LKP, and DSAEK groups, respectively. Conclusion: Keratoconus was the most common indication and PKP was the most prevalent technique used for corneal transplantation. However, significant changes in the indications and

  12. Association of interatrial septal abnormalities with cardiac impulse conduction disorders in adult patients: experience from a tertiary center in Kosovo

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    Bakalli, Aurora; Pllana, Ejup; Koçinaj, Dardan; Bekteshi, Tefik; Dragusha, Gani; Gashi, Masar; Musliu, Nebih; Gashi, Zaim

    2011-01-01

    Interatrial septal disorders, which include: atrial septal defect, patent foramen ovale and atrial septal aneurysm, are frequent congenital anomalies found in adult patients. Early detection of these anomalies is important to prevent their hemodynamic and/or thromboembolic consequences. The aims of this study were: to assess the association between impulse conduction disorders and anomalies of interatrial septum; to determine the prevalence of different types of interatrial septum abnormalities; to assess anatomic, hemodynamic, and clinical consequences of interatrial septal pathologies. Fifty-three adult patients with impulse conduction disorders and patients without ECG changes but with signs of interatrial septal abnormalities, who were referred to our center for echocardiography, were included in a prospective transesophageal echocardiography study. Interatrial septal anomalies were detected in around 85% of the examined patients. Patent foramen ovale was encountered in 32% of the patients, and in combination with atrial septal aneurysm in an additional 11.3% of cases. Atrial septal aneurysm and atrial septal defect were diagnosed with equal frequency in 20.7% of our study population. Impulse conduction disorders were significantly more suggestive of interatrial septal anomalies than clinical signs and symptoms observed in our patients (84.91% vs 30.19%, P=0.002). Right bundle branch block was the most frequent impulse conduction disorder, found in 41 (77.36%) cases. We conclude that interatrial septal anomalies are highly associated with impulse conduction disorders, particularly with right bundle branch block. Impulse conduction disorders are more indicative of interatrial septal abnormalities in earlier stages than can be understood from the patient’s clinical condition. PMID:21977304

  13. Delivering heart failure disease management in 3 tertiary care centers: key clinical components and venues of care.

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    Shah, Monica R; Whellan, David J; Peterson, Eric D; Nohria, Anju; Hasselblad, Vic; Xue, Zhenyi; Bowers, Margaret T; O'Connor, Christopher M; Califf, Robert M; Stevenson, Lynne W

    2008-04-01

    Little data exist to assist to help those organizing and managing heart failure (HF) disease management (DM) programs. We aimed to describe the intensity of outpatient HF care (clinic visits and telephone calls) and medical and nonpharmacological interventions in the outpatient setting. This was a prospective substudy of 130 patients enrolled in STARBRITE in HFDM programs at 3 centers. Follow-up occurred 10, 30, 60, 90, and 120 days after discharge. The number of clinic visits and calls made by HF cardiologists, nurse practitioners, and nurses were prospectively tracked. The results were reported as medians and interquartile ranges. There were a total of 581 calls with 4 (2, 6) per patient and 467 clinic visits with 3 (2, 5) per patient. Time spent per patient was 8.9 (6, 10.6) minutes per call and 23.8 (20, 28.3) minutes per clinic visit. Nurses and nurse practitioners spent 113 hours delivering care on the phone, and physicians and nurse practitioners spent 187.6 hours in clinic. Issues addressed during calls included HF education (341 times [52.6%]) and fluid overload (87 times [41.8%]). Medical interventions included adjustments to loop diuretics (calls 101 times, clinic 156 times); beta-blockers (calls 18 times, clinic 126 times); vasodilators (calls 8 times, clinic 55 times). More than a third of clinician time was spent on calls, during which >50% of patient contacts and HF education and >39% of diuretic adjustments occurred. Administrators and public and private insurers need to recognize the amount of medical care delivered over the telephone and should consider reimbursement for these activities.

  14. Hashimoto encephalopathy: A study of the clinical profile, radiological and electrophysiological correlation in a Tertiary Care Center in South India

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    Pattanagere Manjunatha Suryanarayana Sharma

    2015-01-01

    Full Text Available Background: Hashimoto encephalopathy (HE is a poorly understood and often misdiagnosed entity with variable clinical spectrum. There are many uncertainties that still remain about this condition and the pathological significance of thyroid peroxidase (TPO antibody. Objective: To characterize the clinical, laboratory and radiologic findings in patients with HE. Design: Retrospective analysis of clinical features and diagnostic test data. Main Outcome Measures: Clinical features, laboratory, radiologic, electroencephalography (EEG findings associated with HE and therapeutic outcome. Results: Thirteen consecutive patients were identified as having HE. The median age at onset was 48.5 years (range, 19-62 years. There was a female preponderance (76.9%. Clinical manifestations were cognitive impairment and behavioral changes in 10 (76.9%, sleep disturbance in 9 (69.2%, seizures in 6 (46.1%, headache in 4 (30.8%, psychosis or paranoia in 5 (38.5%, transient symptoms in 6 (46.1%, myoclonus in 4 (30.8%, ataxia or gait disorder in 4 (30.8%. The most frequent laboratory abnormalities were increased TPO (n = 13 in all cases, increased thyroid stimulating hormone levels (n = 6, and increased erythrocyte sedimentation rate (n = 5. The cerebrospinal fluid protein level was elevated in 8 of 9 patients (88.8%. Magnetic resonance imaging abnormalities were present in 2 patients (15.4%. EEG changes were seen in 7 patients (53.8%. All but two patients showed significant therapeutic benefit with steroids. Conclusions: HE has a wide range of clinical, laboratory, and radiologic findings. All patients with an unexplained encephalopathy should be screened for this condition as treatment response is excellent. To the best of our knowledge, this is the largest single center clinical series of HE from the Indian subcontinent.

  15. Association of interatrial septal abnormalities with cardiac impulse conduction disorders in adult patients: experience from a tertiary center in Kosovo.

    Science.gov (United States)

    Bakalli, Aurora; Pllana, Ejup; Koçinaj, Dardan; Bekteshi, Tefik; Dragusha, Gani; Gashi, Masar; Musliu, Nebih; Gashi, Zaim

    2011-01-01

    INTERATRIAL SEPTAL DISORDERS, WHICH INCLUDE: atrial septal defect, patent foramen ovale and atrial septal aneurysm, are frequent congenital anomalies found in adult patients. Early detection of these anomalies is important to prevent their hemodynamic and/or thromboembolic consequences. The aims of this study were: to assess the association between impulse conduction disorders and anomalies of interatrial septum; to determine the prevalence of different types of interatrial septum abnormalities; to assess anatomic, hemodynamic, and clinical consequences of interatrial septal pathologies. Fifty-three adult patients with impulse conduction disorders and patients without ECG changes but with signs of interatrial septal abnormalities, who were referred to our center for echocardiography, were included in a prospective transesophageal echocardiography study. Interatrial septal anomalies were detected in around 85% of the examined patients. Patent foramen ovale was encountered in 32% of the patients, and in combination with atrial septal aneurysm in an additional 11.3% of cases. Atrial septal aneurysm and atrial septal defect were diagnosed with equal frequency in 20.7% of our study population. Impulse conduction disorders were significantly more suggestive of interatrial septal anomalies than clinical signs and symptoms observed in our patients (84.91% vs 30.19%, P=0.002). Right bundle branch block was the most frequent impulse conduction disorder, found in 41 (77.36%) cases. We conclude that interatrial septal anomalies are highly associated with impulse conduction disorders, particularly with right bundle branch block. Impulse conduction disorders are more indicative of interatrial septal abnormalities in earlier stages than can be understood from the patient's clinical condition.

  16. A clinicopathological analysis of primary cutaneous lymphomas: A 6-year observational study at a tertiary care center of south India

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    Anza Khader

    2016-01-01

    Full Text Available Background: Little data are available concerning clinical and pathological patterns of cutaneous lymphomas in India. Aim: To analyze the clinical and histopathological characteristics of cutaneous lymphomas in Indian patients Materials and Methods: This is a single-center, prospective, observational study carried out from January 1, 2010, to December 31, 2015. The patients underwent clinical examination, human T-cell lymphotropic virus-1 (HTLV-1 screening, skin biopsy with hematoxylin and eosin and immunohistochemistry staining. Results: Among 35 cases, 33 (94.3% were T-cell, and 2 (5.7% were B-cell lymphomas. The mean age was 52.66, and the male to female ratio was 2.5:1. The most common types of T-cell lymphomas included mycosis fungoides (MF (57.1% followed by adult T-cell lymphoma/leukemia (ATL (17.1%. Primary cutaneous peripheral T-cell lymphoma not otherwise specified was diagnosed in 17.1% and anaplastic large cell lymphoma in 2.9%. The morphological types of MF included polymorphic, poikilodermatous, folliculotropic, hypopigmented, hyperpigmented, mixed, and purpuric. Skin manifestations of ATL included ulcerated plaques and erythroderma. Epidermotropism was very marked in ATL (83.3% than in MF (70%. Larger Pautrier′s microabscess was noted in ATL compared to smaller ones in MF. Markedly dense, diffuse infiltrate of atypical cells was noted in ATL in contrast to mild to moderate nodular or perivascular infiltrate in MF. ATL had an extremely poor prognosis. Limitations: Identification of DNA integration of HTLV-1 by Southern blot could not be analyzed, and the number of cases studied is limited. Conclusions: The study showed unique patterns of subtypes of cutaneous lymphomas in our country. Variations in the clinical pattern and histopathological analysis will help to differentiate T-cell lymphoma types which have prognostic implications.

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

    Science.gov (United States)

    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. 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

    Objective To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients. Design Case control national study. Setting Polish Center of the European Competence Network on Mastocytosis (ECNM). Population or Sample 23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999?2014, before becoming pregnant. Methods Prospective analysis outcomes of pregnancies and deliveries. Main Outcome Measures Survey developed in...

  19. 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.

  20. Philadelphia chromosome-positive acute lymphoblastic leukemia: 8 years′ experience from a tertiary care center in India

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    Madhav Danthala

    2016-01-01

    Full Text Available Introduction: The Philadelphia chromosome (Ph is the most common cytogenetic abnormality associated with adult acute lymphoblastic leukemia (ALL occurring in 20% to 40% of patients. It is also detected in 2% to 5% of children with ALL. Historically, patients with Ph-positive ALL carried a dismal prognosis, with poor response to most chemotherapy combinations, short remission durations, and long-term disease-free survival rates of 10% to 20%. The advent of tyrosine kinase inhibitors (TKIs has revolutionized therapy of Ph-positive ALL. Materials and Methods: This retrospective and descriptive single center study was carried out based on data retrieved of 508 patients treated for ALL from 2007 to 2014. Of these thirty patients were Ph-positive ALL and were available for analysis, and these patients were included in the study. Ph-positive ALL was defined as ALL carrying the t(9;22 translocation on standard karyotype and/or fluorescent in situ hybridization analysis and/or positivity for BCR-ABL fusion transcript detection by real-time quantitative polymerase chain reaction (RQ-PCR analysis. Patients were treated with combination chemotherapy and oral TKIs and responses were classified as either CR defined by the absence of circulating blasts and <5% marrow blasts on a bone marrow examination done at the end of induction chemotherapy or failure, including persistent disease and early death. Results: There were 30 (5.9% cases of Ph-positive ALL out of a total of 508 cases of ALL with a median age of 27.5 years (range: 7-55. The choice of first line TKI was Imatinib in 25 (83.3 % patients and Dasatinib in 1 (3.3 % patient. Fourteen patients (46.6 % had a CR, 3 (10 % had a partial response (PR, 8 (26.6 % had persistence of disease at the end of induction chemotherapy. The overall survival in those who received sequential chemotherapy followed by TKI (n = 4 was 28.5 months (95% CI 10.78 to 46.21 months compared with 13.98 months (95% CI 6.04 to 21

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

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    Grover, Sandeep; Gupta, Sunil; Mahajan, Sudhir; Avasthi, Ajit

    2016-01-01

    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. 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. 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. 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 facilitate the early help seeking in patients with Dhat syndrome.

  2. 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

  3. Early tracheostomy in closed head injuries: experience at a tertiary center in a developing country – a prospective study

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    Priyambada Binita

    2005-10-01

    mortality. Those patients who continued to have a GCS score of 50 for more than 24 hours (to rule out concussion or recovery underwent tracheostomy. All these patients were finally assessed for mortality rate and hospital stay, the statistical analysis was carried out using SPSS10 version. The final outcome (in terms of mortality was analyzed utilizing chi-square test and p value Results At admission both tracheostomy and non-tracheostomy groups were matched with respect to GCS score and SAPS score. The average day of tracheostomy was 2.18 ± 1.0038 days. The GCS scores on days 1, 2, 3, 4, 5, 10 between tracheostomy and non-tracheostomized group were comparable. However the difference in the GCS scores was statistically significant on day 15 being higher in the tracheostomy group.Thus early tracheostomy was observed to improve the mortality rate significantly in patients with isolated closed head injury Conclusion It may be concluded that early tracheostomy is beneficial in patients with isolated closed head injury which is severe enough to affect systemic physiological parameters, in terms of decreased mortality and intubation associated complications in centers where ICU care is not readily available. Also, in a selected group of patients, early tracheostomy may do away with the need for prolonged mechanical ventilation.

  4. 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

    : 1.74-4.77; P = 0.001) having the highest predictive value of high sedation requirements. Our prediction model using the following pre-procedural variables including age, gender, indication for the procedure, medication/substance use, previous surgeries, previous high sedation requirements for colonoscopy yielded an area under the curve of 0.76 for Fentanyl ≥ 100 mcg and Midazolam ≥ 3 mg. Pre-procedural planning is the key in conducting successful, efficient colonoscopy. Logistic regression analysis of 5000 patients who underwent out-patient colonoscopy revealed the following factors associated with increased sedation requirement: Younger age, female gender, difficult endoscopy, specific indications as well as cardiopulmonary complications and current use of opioids/benzodiazepines. Age and gender 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.

  5. 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 H30 strain of Escherichia coli sequence type 131 (ST131-H30) is a recently emerged, globally disseminated lineage associated with fluoroquinolone resistance and, via its H30Rx 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-H30, was the most common clonal lineage (23% overall). ST131-H30 accounted for 47% (8/17) of ESBL-producing, 47% (14/30) of fluoroquinolone-resistant, and 33% (11/33) of multidrug-resistant isolates. ST131-H30 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-H30Rx, with CTX-M-15, was the major ESBL producer (6/8) among ST131-H30 isolates. ST131-H30 and H30Rx 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-H30 and H30Rx, 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 H30 subset within E. coli sequence type 131 (ST131-H30) is

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

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    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.

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

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    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

  8. Indications and graft survival analysis in optical penetrating keratoplasty in a tertiary care center in North India: a 5-year study.

    Science.gov (United States)

    Arya, Sudesh Kumar; Raj, Amit; Bamotra, Ravi Kant; Bhatti, Anubha; Deswal, Jyoti; Sindhu, Meenakshi

    2017-07-07

    To study the indications and variables correlating with graft survival in optical penetrating keratoplasty in a tertiary care hospital in north India. All patients who underwent optical keratoplasty, except those undergoing lamellar grafts, tectonic grafts transplants and penetrating keratoplasty done for therapeutic purposes were included in the study. Patients with follow-up less than 2 years were excluded from the study. Data were obtained by reviewing the records of 101 patients who underwent optical penetrating keratoplasty from 2008 to 2013 for various indications. Out of 101 patients who underwent optical penetrating keratoplasty, 71 were males and 30 were females. The mean age of the recipient was 48.53 years with range 1-82 years. The main indications were previous failed graft (29.7%), healed keratitis except HSV (15.8%), pseudophakic or aphakic bullous keratopathy (14.8%), corneal dystrophies/degenerations (12.9%), adherent leucoma (9.9%), post-HSV scars (8.9%), and others like anterior staphyloma, congenital corneal opacities, buphthalmos and keratoconus (7.9%). The graft survival rate was 67.33% at 1-year follow-up and 59.4% at 2-year follow-up. The mean survival time of the grafts was 22.42 months. The mean time for graft failure was 7.12 (±0.9) months. One- and 2-year survival of grafts at our center is lower as compared to western studies, probably due to higher percentage of poor prognosis indications for surgery and a relative scarcity of excellent-quality donor corneas.

  9. Perioperative cardiac arrests in children between 1988 and 2005 at a tertiary referral center: a study of 92,881 patients.

    Science.gov (United States)

    Flick, Randall P; Sprung, Juraj; Harrison, Tracy E; Gleich, Stephen J; Schroeder, Darrell R; Hanson, Andrew C; Buenvenida, Shonie L; Warner, David O

    2007-02-01

    The objective of this study was to determine the incidence and outcome of perioperative cardiac arrest (CA) in children younger than 18 yr undergoing anesthesia for noncardiac and cardiac procedures at a tertiary care center. After institutional review board approval (Mayo Clinic, Rochester, Minnesota), all patients younger than 18 yr who had perioperative CA between November 1, 1988, and June 30, 2005, were identified. Perioperative CA was defined as a need for cardiopulmonary resuscitation or death during anesthesia care. A cardiac procedure was defined as a surgical procedure involving the heart or great vessels requiring an incision. A total of 92,881 anesthetics were administered during the study period, of which 4,242 (5%) were for the repair of congenital heart malformations. The incidence of perioperative CA during noncardiac procedures was 2.9 per 10,000, and the incidence during cardiac procedures was 127 per 10,000. The incidence of perioperative CA attributable to anesthesia was 0.65 per 10,000 anesthetics, representing 7.5% of the 80 perioperative CAs. Both CA incidence and mortality were highest among neonates (0-30 days of life) undergoing cardiac procedures (incidence: 435 per 10,000; mortality: 389 per 10,000). Regardless of procedure type, most patients who experienced perioperative CA (88%) had congenital heart disease. The majority of perioperative CAs were caused by factors not attributed to anesthesia, in distinction to some recent reports. The incidence of perioperative CA is many-fold higher in children undergoing cardiac procedures, suggesting that definition of case mix is necessary to accurately interpret epidemiologic studies of perioperative CA in children.

  10. Molecular analysis and distribution of multidrug-resistant Enterococcus faecium isolates belonging to clonal complex 17 in a tertiary care center in Mexico City

    Science.gov (United States)

    2013-01-01

    Background Enterococcus faecium has recently emerged as a multidrug-resistant nosocomial pathogen involved in outbreaks worldwide. A high rate of resistance to different antibiotics has been associated with virulent clonal complex 17 isolates carrying the esp and hyl genes and the purK1 allele. Results Twelve clinical vancomycin-resistant Enterococcus faecium (VREF) isolates were obtained from pediatric patients at the Hospital Infantil de México Federico Gómez (HIMFG). Among these VREF isolates, 58.3% (7/12) were recovered from urine, while 41.7% (5/12) were recovered from the bloodstream. The VREF isolates showed a 100% rate of resistance to ampicillin, amoxicillin-clavulanate, ciprofloxacin, clindamycin, chloramphenicol, streptomycin, gentamicin, rifampicin, erythromycin and teicoplanin. In addition, 16.7% (2/12) of the isolates were resistant to linezolid, and 66.7% (8/12) were resistant to tetracycline and doxycycline. PCR analysis revealed the presence of the vanA gene in all 12 VREF isolates, esp in 83.3% (10/12) of the isolates and hyl in 50% (6/12) of the isolates. Phylogenetic analysis via molecular typing was performed using pulsed-field gel electrophoresis (PFGE) and demonstrated 44% similarity among the VREF isolates. MLST analysis identified four different sequence types (ST412, ST757, ST203 and ST612). Conclusion This study provides the first report of multidrug-resistant VREF isolates belonging to clonal complex 17 from a tertiary care center in Mexico City. Multidrug resistance and genetic determinants of virulence confer advantages among VREF in the colonization of their host. Therefore, the prevention and control of the spread of nosocomial infections caused by VREF is crucial for identifying new emergent subclones that could be challenging to treat in subsequent years. PMID:24330424

  11. Investigation of a nosocomial outbreak of fungemia caused by Candida pelliculosa (Pichia anomala) in a Korean tertiary care center.

    Science.gov (United States)

    Jung, Jiwon; Moon, Young Sook; Yoo, Jung A; Lim, Ji-Hun; Jeong, Joseph; Jun, Jae-Bum

    2017-06-28

    Candida pelliculosa is a rare pathogen of fungemia. There have been a few nosocomial outbreaks of C. pelliculosa fungemia in nurseries and pediatric intensive care units (ICU), hematologic units, and surgical ICU. We describe an epidemiologic outbreak investigation, including case findings of C. pelliculosa fungemia in South Korea. This outbreak investigation conducted in a 940-bed, tertiary referral center, Ulsan, South Korea and included active microbial surveillance and a case-control study. A patient in the trauma intensive care unit (ICU) with multiple trauma developed C. pelliculosa fungemia, and 10 patients in the trauma ICU, medical ICU, and 2 general wards subsequently contracted C. pelliculosa fungemia during the next 24 days (November 16 and December 9, 2015). The 16s rRNA sequencing of 4 isolates showed that C. pelliculosa was verified with 99-100% similarity (GenBank accession number: KF317892.1), and these isolates were identical in the randomly amplified polymorphic DNA (RAPD) assay. A case-control study showed that medical staff and staying in the interventional radiology procedure room were risk factor for development of C. pelliculosa fungemia. After intervention including strict hand washing, disinfecting medical equipment, and contact precautions, there have been no new C. pelliculosa infections since December 10, 2015. This is the first report of a nosocomial outbreak involving 11 patients in 2 ICUs and 2 general wards caused by C. pelliculosa in South Korea. Infection control measures are important for decreasing transmission of C. pelliculosa in the hospital. Copyright © 2017. Published by Elsevier B.V.

  12. Rescue therapy in adult and pediatric patients with pH1N1 influenza infection: a tertiary center intensive care unit experience from April to October 2009.

    Science.gov (United States)

    Norfolk, Stephanie G; Hollingsworth, Caroline L; Wolfe, Cameron R; Govert, Joseph A; Que, Loretta G; Cheifetz, Ira M; Hollingsworth, John W

    2010-11-01

    Severe respiratory failure is a well-recognized complication of pH1N1 influenza infection. Limited data regarding the efficacy of rescue therapies, including high-frequency oscillatory ventilation and extracorporeal membrane oxygenation, have been previously reported in the setting of pH1N1 influenza infection in the United States. Retrospective, single-center cohort study. Pediatric, cardiac, surgical, and medical intensive care units in a single tertiary care center in the United States. One hundred twenty-seven consecutive patients with confirmed influenza A infection requiring hospitalization between April 1, 2009, and October 31, 2009. Electronic medical records were reviewed for demographic and clinical data. The number of intensive care unit admissions appears inversely related to age with 39% of these admissions intensive care unit care was 10.0 days (4.0-24.0), and median duration of mechanical ventilation was 8.0 days (0.0-23.5). Rescue therapy (high-frequency oscillatory ventilation or extracorporeal membrane oxygenation) was used in 36% (12 of 33) of intensive care unit patients. The severity of respiratory impairment was determined by Pao²/Fio² ratio and oxygenation index. High-frequency oscillatory ventilation at 24 hrs resulted in improvements in median Pao²/Fio² ratio (71 [58-93] vs. 145 [126-185]; p parameters of oxygenation at both 2 hrs and 24 hrs after initiation of therapy. Despite the severity of oxygenation impairment, overall survival for both rescue therapies was 75% (nine of 12), 80% (four of five) for high-frequency oscillatory ventilation alone, and 71% (five of seven) for high-frequency oscillatory ventilation + extracorporeal membrane oxygenation. In critically ill adult and pediatric patients with pH1N1 infection and severe lung injury, the use of high-frequency oscillatory ventilation and extracorporeal membrane oxygenation can result in significant improvements in Pao²/Fio² ratio, oxygenation index, and Fio². However, the

  13. 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.

  14. Clinical profile and juvenile arthritis damage index in children with juvenile idiopathic arthritis: A study from a tertiary care center in south India.

    Science.gov (United States)

    Menon, Nisha Vengassery Balakrishnan; Peethambaran, Geetha; Puthiyapurayil, Ashraf Thottoli; Nambudakath, Cherian; Arakkal, Riazudeen

    2016-06-16

    This study was designed to determine the clinical profile of juvenile idiopathic arthritis (JIA) and its morbidity using the juvenile arthritis damage index (JADI) score at a tertiary care center in northern Kerala and to compare with data from India and abroad. A hospital-based cross-sectional study was carried out over a period of one and half years from January 2011 to July 2012. Clinical and laboratory profiles and morbidity were assessed. There were 62 children (mean age 8.9 ± 3.8 years) with JIA during this period with a median duration of disease of 24 months (2-151 months). The most common subgroup was polyarticular JIA (n = 26; 41.9%) followed by systemic JIA (sJIA) (n = 20; 32.3%), oligoarticular JIA (n = 15; 24.2%) and enthesitis-related arthritis (n = 1; 1.6%). The most common joints involved at presentation were the knee (38.7%) followed by the ankle (25.8%). Weights and heights were less than the fifth centile in 25.8% and 11.3%, respectively, being most affected in sJIA. The frequencies of articular and extra-articular morbidities were highest in sJIA and showed negative correlation with age at onset and positive correlation with the duration of illness. Macrophage activation syndrome was diagnosed in 50% of sJIA with a mortality of 33.3%. We experienced lower frequency of articular (30.6% vs. 60.7%) and extra-articular damage (24.2% vs. 39.3%), growth failure (19.3% vs. 68.5%) and pubertal delay (4.8% vs. 20.2%) compared to another study from north India. Our study shows lower frequency of morbidity in JIA; probably related to a better healthcare system facilitating early diagnosis and treatment in this part of the country. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  15. Predictive factors for obtaining a correct therapeutic range using antivitamin K anticoagulants: a tertiary center experience of patient adherence to anticoagulant therapy

    Directory of Open Access Journals (Sweden)

    Jurcuţ R

    2015-09-01

    and the patient’s living conditions, INR monitoring frequency, and bleeding history. Conclusion: In a tertiary cardiology center, more than half of patients receiving VKAs are admitted with an INR falling outside the therapeutic range, irrespective of the bleeding or embolic risk. Patients with a mechanical prosthesis and complex antithrombotic regimens appear to be the most careful with INR monitoring, especially if they have a higher level of education. Identifying patient groups with the lowest time interval spent in the therapeutic range could help attending physicians educate patients focusing on specific awareness issues. Keywords: anticoagulant therapy, antivitamin K agents, patient adherence, questionnaire

  16. Low Infection-Related Re-Admission Rates in a Retrospective of 4725 Children with Appendicitis Using a Clinical Pathway in a Tertiary Care Pediatric Center.

    Science.gov (United States)

    Marino, Nikolas E; Davenport, Kate; Hilfiker, Mary; Langness, Simone; Fairbanks, Timothy; Stucky Fisher, Erin; Newbury, Robert; Andrews, Allyson; Wells, Alan; Chaparro, Juan D; Bradley, John S

    2017-10-24

    Standardization of antibiotic management of appendicitis in tertiary care pediatric centers has been associated with improved outcomes. Rady Children's Hospital-San Diego implemented an appendicitis clinical pathway in 2005. We evaluated infection-related re-admission risk factors since 2010, when an electronic medical record was established, with the aim to optimize the clinical pathway. Between January 2010 and August 2015, 4725 children with a diagnosis of appendicitis were evaluated for demographic data, pathology diagnoses, culture results, and inpatient and oral step-down antibiotic therapy regimens. From children originally admitted for appendicitis, those who were re-admitted with infection were compared with those who were not re-admitted for infection. The populations were controlled by severity of infection using a pathology-defined appendicitis severity scale: Grade 0, no appendicitis; grade 1, simple acute appendicitis with gross and microscopic evidence of inflammation, but no perforation; grade 2, gangrenous/necrotizing/micro-perforated appendicitis with subserosal or serosal exudate, but no frank or visually appreciated perforation; and grade 3, frank perforation. Of 4725 children (total population, TP) admitted with a diagnosis of appendicitis, only 199 (4.2%) were re-admitted, with 125 of these admissions for infection (2.65% of the TP). Age, race/ethnicity, language preference, and body mass index were not found to correlate with re-admission for infection. Length of stay significantly differed between the no infection-related re-admission population and infection-related re-admission population (3.02 vs. 4.03 d, p admission rates as the pathology grade increased (odds ratio grade 1 vs. grade 3 = 2.28, 95% confidence interval 1.03, 5.03). Infection-related re-admission rates for children on the clinical pathway in our institution were infrequent. The greater association of all-cause and infection-related re-admission rates with pathology

  17. Evaluation of the Xpert MTB/RIF Performance on Tissues: Potential Impact on Airborne Infection Isolation at a Tertiary Cancer Care Center.

    Science.gov (United States)

    McMillen, Tracy; Usiak, Shauna C; Chen, Liang Hua; Gomez, Luz; Ntiamoah, Peter; Hameed, Meera R; Budvytiene, Indre; Banaei, Niaz; Kamboj, Mini; Babady, N Esther

    2018-02-15

    OBJECTIVES In this study, we sought to evaluate the performance of the Xpert MTB/RIF (Cepheid) assay for the detection of Mycobacterium tuberculosis (MTB) complex DNA on fresh and formalin-fixed, paraffin-embedded (FFPE) tissue specimens from oncology patients in an area with a low prevalence of tuberculosis. We also aimed to retrospectively assess the potential impact of Xpert MTB/RIF on the duration of airborne infection isolation (AII). SETTING A 473-bed, tertiary-care cancer center in New York City. DESIGN A total of 203 tissue samples (101 FFPE and 102 fresh) were tested using Xpert MTB/RIF, including 133 pulmonary tissue samples (65.5%) and 70 extrapulmonary tissue samples (34.5%). Acid-fast bacilli (AFB) culture was used as the diagnostic gold standard. The limit of detection (LOD) and reproducibility were also evaluated for both samples types using contrived specimens. The potential impact of the Xpert MTB PCR assay on tissue samples from AII patients on AII duration was retrospectively assessed. RESULTS Using the Xpert MTB/RIF for fresh tissue specimens, the sensitivity was 50% (95% CI, 1.3%-98.7%) and the specificity was 99% (95% CI, 94.5%-99.9%). For FFPE tissue specimens, the sensitivity was 100% (95% CI, 63.1%-100%) and the specificity was 98.3% (95% CI, 95.5%-100%. The LOD was 103 colony-forming units (CFU)/mL for both fresh and FFPE tissue specimens, and the Xpert MTB/RIF was 100% reproducible at concentrations 10 times that of the LOD. With an expected turnaround time of 24 hours, the Xpert MTB PCR could decrease the duration of AII from a median of 8 days to a median of 1 day. CONCLUSIONS The Xpert MTB/RIF assay offers a valid option for ruling out Mycobacterium tuberculosis complex (MTBC) on tissue samples from oncology patients and for minimizing AII resource utilization. Infect Control Hosp Epidemiol 2018;1-5.

  18. Association of hypertension and obesity with HIV and antiretroviral therapy in a rural tertiary health center in Nigeria: a cross-sectional cohort study.

    Science.gov (United States)

    Ogunmola, Olarinde Jeffrey; Oladosu, Olatunji Yusuf; Olamoyegun, Adeyemi Michael

    2014-01-01

    There are few studies from Nigeria and Africa regarding the contribution of obesity and hypertension to cardiovascular risk in HIV-infected patients. This study investigates the prevalence of hypertension and obesity and their association with HIV infection and antiretroviral treatment (ART). We conducted a cross-sectional cohort study in a rural tertiary health center in Nigeria. The data collected included demographic variables, blood pressure, body mass index (BMI), monthly income, educational attainment, HIV status and ART treatment, duration of treatment, and CD4 T-lymphocyte count. A total of 403 participants met the inclusion criteria. There were 153 (38.0%) HIV-negative subjects (42.5% male, 57.5% female; mean age: 35.5 ± 7.6 years), 120 (29.8%) HIV-positive drug-naïve subjects (42.5% male, 57.5% female; mean age: 36.5 ± 9.1 years), and 130 (32.2%) HIV-positive subjects taking antiretroviral drugs (33.1% male, 66.9% female; mean age: 38.6 ± 8.0 years). The prevalence of hypertension was 13.7% in HIV-negative subjects, 19.0% in HIV-positive drug-naïve subjects, and 12.3% in HIV-positive ART subjects. The prevalence of obesity was 15.9% in the HIV-negative group, 3% in the HIV-positive drug-naïve group, and 8% in the HIV-positive ART group. Multivariate regression analysis showed no relationship between hypertension and HIV status (P=0.293) or ART status (P=0.587). In contrast, BMI showed a strong relationship with HIV status (odds ratio: 0.281; 95% confidence interval: 0.089-0.884; P=0.030) but not with ART status (P=0.593). BMI was a significant predictor of hypertension. HIV or ART status was not associated with hypertension. HIV infection was associated with a lower BMI, and a lower prevalence of obesity compared with HIV-negative subjects.

  19. The representativeness of a European multi-center network for influenza-like-illness participatory surveillance.

    Science.gov (United States)

    Cantarelli, Pietro; Debin, Marion; Turbelin, Clément; Poletto, Chiara; Blanchon, Thierry; Falchi, Alessandra; Hanslik, Thomas; Bonmarin, Isabelle; Levy-Bruhl, Daniel; Micheletti, Alessandra; Paolotti, Daniela; Vespignani, Alessandro; Edmunds, John; Eames, Ken; Smallenburg, Ronald; Koppeschaar, Carl; Franco, Ana O; Faustino, Vitor; Carnahan, AnnaSara; Rehn, Moa; Colizza, Vittoria

    2014-09-20

    The Internet is becoming more commonly used as a tool for disease surveillance. Similarly to other surveillance systems and to studies using online data collection, Internet-based surveillance will have biases in participation, affecting the generalizability of the results. Here we quantify the participation biases of Influenzanet, an ongoing European-wide network of Internet-based participatory surveillance systems for influenza-like-illness. In 2011/2012 Influenzanet launched a standardized common framework for data collection applied to seven European countries. Influenzanet participants were compared to the general population of the participating countries to assess the representativeness of the sample in terms of a set of demographic, geographic, socio-economic and health indicators. More than 30,000 European residents registered to the system in the 2011/2012 season, and a subset of 25,481 participants were selected for this study. All age classes (10 years brackets) were represented in the cohort, including under 10 and over 70 years old. The Influenzanet population was not representative of the general population in terms of age distribution, underrepresenting the youngest and oldest age classes. The gender imbalance differed between countries. A counterbalance between gender-specific information-seeking behavior (more prominent in women) and Internet usage (with higher rates in male populations) may be at the origin of this difference. Once adjusted by demographic indicators, a similar propensity to commute was observed for each country, and the same top three transportation modes were used for six countries out of seven. Smokers were underrepresented in the majority of countries, as were individuals with diabetes; the representativeness of asthma prevalence and vaccination coverage for 65+ individuals in two successive seasons (2010/2011 and 2011/2012) varied between countries. Existing demographic and national datasets allowed the quantification of the

  20. 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

    BACKGROUND: Current classification of traumatic brain injury (TBI) is suboptimal, and management is based on weak evidence, with little attempt to personalize treatment. A need exists for new precision medicine and stratified management approaches that incorporate emerging technologies. OBJECTIVE......: To improve characterization and classification of TBI and to identify best clinical care, using comparative effectiveness research approaches. METHODS: This multicenter, longitudinal, prospective, observational study in 22 countries across Europe and Israel will collect detailed data from 5400 consenting...... 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...

  1. Daptomycin antimicrobial activity tested against methicillin-resistant staphylococci and vancomycin-resistant enterococci isolated in European medical centers (2005

    Directory of Open Access Journals (Sweden)

    Watters Amy A

    2007-04-01

    Full Text Available Abstract Background Daptomycin is a cyclic lipopeptide with potent activity and broad spectrum against Gram-positive bacteria currently used for the treatment of complicated skin and skin structure infections and bacteremia, including right sided endocarditis. We evaluated the in vitro activity of this compound and selected comparator agents tested against clinical strains of staphylococci and enterococci collected in European medical centers in 2005. Methods A total of 4,640 strains from 23 medical centers located in 10 European countries, Turkey and Israel (SENTRY Program platform were tested for susceptibility by reference broth microdilution methods according to Clinical and Laboratory Standards Institute guidelines and interpretative criteria. Mueller-Hinton broth was supplemented to 50 mg/L Ca++ for testing daptomycin. Results for oxacillin (methicillin-resistant staphylococci and vancomycin-resistant enterococci were analyzed separately. Results Oxacillin resistance rates among Staphylococcus aureus varied from 2.1% in Sweden to 42.5% in the United Kingdom (UK and 54.7% in Ireland (29.1% overall, while vancomycin resistance rates varied from 0.0% in France, Sweden and Switzerland to 66.7% in the UK and 71.4% in Ireland among Enterococcus faecium (17.9% overall. All S. aureus strains were inhibited at daptomycin MIC of 1 mg/L (MIC50/90, 0.25/0.5 mg/L; 100.0% susceptible and only one coagulase-negative staphylococci strain (0.1% showed an elevated (>1 mg/L daptomycin MIC value (4 mg/L. Among E. faecalis (MIC50/90, 0.5/1 mg/L; 100% susceptible the highest daptomycin MIC value was 2 mg/L; while among E. faecium (MIC50/90, 2/4 mg/L; 100% susceptible the highest MIC result was 4 mg/L. Conclusion Daptomycin showed excellent in vitro activity against staphylococci and enterococci collected in European medical centers in 2005 and resistance to oxacillin, vancomycin or quinupristin/dalfopristin did not compromise its activity overall against these

  2. 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.

  3. The Tripler Army Medical Center's LE3AN program: a six-month retrospective analysis of program effectiveness for African-American and European-American females.

    Science.gov (United States)

    Simpson, Mark; Earles, Jay; Folen, Raymond; Trammel, Rick; James, Larry

    2004-10-01

    This is a retrospective study that examines the effectiveness of the Tripler Army Medical Center (TAMC) LE3AN Program for weight management among African-American and European American women. African-American and European-American active-duty females who enrolled in the TAMC LE3AN Program between July 1998 and December 2001, and completed six months of follow-up were included in the analysis. The results indicate that the program is associated with significant weight loss for participants, and that it is equally effective for African-American and European-American women. Weekly follow-up visits were correlated with greater weight loss.

  4. European cardiovascular magnetic resonance (EuroCMR registry – multi national results from 57 centers in 15 countries

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    Bruder Oliver

    2013-01-01

    Full Text Available Abstract Background The EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting. Furthermore, interim analysis of the specific protocols should underscore the prognostic potential of CMR. Methods Multi-center registry with consecutive enrolment of patients in 57 centers in 15 countries. More than 27000 consecutive patients were enrolled. Results The most important indications were risk stratification in suspected CAD/Ischemia (34.2%, workup of myocarditis/cardiomyopathies (32.2%, as well as assessment of viability (14.6%. Image quality was diagnostic in more than 98% of cases. Severe complications occurred in 0.026%, always associated with stress testing. No patient died during or due to CMR. In 61.8% CMR findings impacted on patient management. Importantly, in nearly 8.7% the final diagnosis based on CMR was different to the diagnosis before CMR, leading to a complete change in management. Interim analysis of suspected CAD and risk stratification in HCM specific protocols revealed a low rate of adverse events for suspected CAD patients with normal stress CMR (1.0% per year, and for HCM patients without LGE (2.7% per year. Conclusion The most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM. Condensed abstract The EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting in a large number of cases (n > 27000. Based on our data CMR is frequently performed in

  5. Profile of adult and pediatric neurocysticercosis cases observed in five Southern European centers.

    Science.gov (United States)

    Zammarchi, Lorenzo; Angheben, Andrea; Gobbi, Federico; Zavarise, Giorgio; Requena-Mendez, Ana; Marchese, Valentina; Montagnani, Carlotta; Galli, Luisa; Bisoffi, Zeno; Bartoloni, Alessandro; Muñoz, Jose

    2016-08-01

    In Europe the management of neurocysticercosis (NCC) is challenging because health care providers are unaware of this condition, thus leading to diagnostic delay and mismanagement. The aim of this study is to retrospectively review the cases of NCC observed in five centers located in Florence, Negrar (Italy) and Barcelona (Spain). A total of 81 subjects with NCC were evaluated in the period 1980-2013. By applying the Del Brutto's criteria 39 cases (48.1 %) were classified as definitive cases, 31 (38.8 %) as probable cases and 11 (13.6 %) did not satisfy the diagnostic criteria. Continent of origin was known for 80 subjects. Latin America and Asia were the most frequent continents of origin (n = 37; 46.3 % and n = 22; 27.5 %) followed by Europe (n = 14; 17.5 %) and Africa (n = 7; 8.8 %). Compared with adults, paediatric patients were more likely to have eosinophilia, to have other parasitic infections, to be asymptomatic, to not be treated with antiepileptic drugs or analgesic and to heal. The study shows that there are some hurdles in the management of NCC in Europe. A not negligible portion of patients diagnosed at reference centers do not fully satisfy Del Brutto's diagnostic criteria. The higher portion of asymptomatic subjects found among the paediatric group is probably related to an ongoing serological screening among adopted children coming from endemic regions. The value of such a serological screening should be better assessed by a further cost-effective analysis.

  6. 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

  7. European Cardiovascular Magnetic Resonance (EuroCMR) registry--multi national results from 57 centers in 15 countries.

    Science.gov (United States)

    Bruder, Oliver; Wagner, Anja; Lombardi, Massimo; Schwitter, Jürg; van Rossum, Albert; Pilz, Günter; Nothnagel, Detlev; Steen, Henning; Petersen, Steffen; Nagel, Eike; Prasad, Sanjay; Schumm, Julia; Greulich, Simon; Cagnolo, Alessandro; Monney, Pierre; Deluigi, Christina C; Dill, Thorsten; Frank, Herbert; Sabin, Georg; Schneider, Steffen; Mahrholdt, Heiko

    2013-01-18

    The EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting. Furthermore, interim analysis of the specific protocols should underscore the prognostic potential of CMR. Multi-center registry with consecutive enrolment of patients in 57 centers in 15 countries. More than 27000 consecutive patients were enrolled. The most important indications were risk stratification in suspected CAD/Ischemia (34.2%), workup of myocarditis/cardiomyopathies (32.2%), as well as assessment of viability (14.6%). Image quality was diagnostic in more than 98% of cases. Severe complications occurred in 0.026%, always associated with stress testing. No patient died during or due to CMR. In 61.8% CMR findings impacted on patient management. Importantly, in nearly 8.7% the final diagnosis based on CMR was different to the diagnosis before CMR, leading to a complete change in management. Interim analysis of suspected CAD and risk stratification in HCM specific protocols revealed a low rate of adverse events for suspected CAD patients with normal stress CMR (1.0% per year), and for HCM patients without LGE (2.7% per year). The most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM.

  8. The importance of entrepreneurial learning on the example of the South East European Center for entrepreneurial learning in Croatia

    Directory of Open Access Journals (Sweden)

    Sanja Maleković

    2016-05-01

    Full Text Available The paper focuses on the experience in development of entrepreneurial learning (EL policy in South and East Europe (SEE, as a result of activities implemented by the South East European Center for Entrepreneurial Learning (SEECEL in Croatia. It aims to explore whether the EL concept, as promoted and developed by SEECEL, can also contribute to development of an entrepreneurial mindset and behaviour, creative thinking, as well as enhancing the development of individual’s entrepreneurial characteristics regardless of their ambition to start/conduct some business. The authors also seek to explore the relevance of the exchange of experience, effective partnership and cooperation of all involved education and other institutions and actors engaged in policy support for further development of the EL approach in SEE. The authors address different perspectives and understandings of the EL concept, point out to the existence of different schools of thought on EL, and consider the interaction between learning and entrepreneurship, which asks for novel and rigorous theorizing.

  9. Questionnaire survey about use of an online appointment booking system in one large tertiary public hospital outpatient service center in China.

    Science.gov (United States)

    Zhang, MinMin; Zhang, CongXin; Sun, QinWen; Cai, QuanCai; Yang, Hua; Zhang, YinJuan

    2014-06-09

    As a part of nationwide healthcare reforms, the Chinese government launched web-based appointment systems (WAS) to provide a solution to problems around outpatient appointments and services. These have been in place in all Chinese public tertiary hospitals since 2009. Questionnaires were collected from both patients and doctors in one large tertiary public hospital in Shanghai, China.Data were analyzed to measure their satisfaction and views about the WAS. The 1000 outpatients randomly selected for the survey were least satisfied about the waiting time to see a doctor. Even though the WAS provided a much more convenient booking method, only 17% of patients used it. Of the 197 doctors surveyed, over 90% thought it was necessary to provide alternative forms of appointment booking systems for outpatients. However, about 80% of those doctors who were not associated professors would like to provide an 'on-the-spot' appointment option, which would lead to longer waits for patients. Patients were least satisfied about the waiting times. To effectively reduce appointment-waiting times is therefore an urgent issue. Despite the benefits of using the WAS, most patients still registered via the usual method of queuing, suggesting that hospitals and health service providers should promote and encourage the use of the WAS. Furthermore, Chinese health providers need to help doctors to take others' opinions or feedback into consideration when treating patients to minimize the gap between patients' and doctors' opinions. These findings may provide useful information for both practitioners and regulators, and improve recognition of this efficient and useful booking system, which may have far-reaching and positive implications for China's ongoing reforms.

  10. A comparison of induction of labor success rates over three time periods in 20 years at a single academic tertiary care center: are we improving vaginal delivery rates?

    Science.gov (United States)

    Fischer, Richard; Machac, Nicole; Hunter, Krystal; Adriance, Lori

    2018-04-01

    To compare the rates of successful induction of labor during three one-year periods over 20 years at a single institution. All women at 37 weeks or beyond with a living, singleton, cephalic fetus admitted for induction of labor in 1992, 2002, and 2012 were included. The use of induction agents and rates of successful vaginal delivery were compared. A total of 627 women were evaluated, 219 in 1992, 220 in 2002, and 188 in 2012. Various induction agents were employed over the 20 year period. However, the rates of successful vaginal deliveries did not significantly vary over the three time periods, 79.5% in 1992, 72.3% in 2002, 76.1% in 2012, p = .21. In subgroup analysis, no significant differences were found among women with one or more prior vaginal delivery, no prior vaginal delivery, or after excluding those with a prior cesarean section. In multiple variable logistic regression analysis, no induction agent besides amniotomy improved successful vaginal delivery rates. Despite the multiple induction agents available at our tertiary care institution over the past 20 years, we were unable to demonstrate any significant improvement in successful vaginal delivery rates after induction of labor.

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

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    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.

  12. 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.

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

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    Mini Joseph

    2016-01-01

    Full Text Available Context: Type 1 diabetes mellitus (T1DM accounts for 5–10% of all diagnosed diabetes and the highest incidence is found in India. Aims: The main objectives were to study the demographic, clinical, and nutritional characteristics of young adults with T1DM and its effect glycosylated hemoglobin levels. Subjects and Methods: 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. Results: 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 < 0.005. Conclusion: Integrated care provided at subsidized cost has been pivotal in effective 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.

  14. Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass. Data from IFSO-European Chapter Center of Excellence Program.

    Science.gov (United States)

    Melissas, John; Stavroulakis, Konstantinos; Tzikoulis, Vassilis; Peristeri, Angeliki; Papadakis, John A; Pazouki, Abdolreza; Khalaj, Alireza; Kabir, Ali

    2017-04-01

    The purpose of this study is to compare sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP) performed in Institutions participating in IFSO-European Chapter, Center of Excellence (COE) program. Since the initiation of the program in January 2010, 6413 SGs and 10,622 RYGBPs performed as primary procedures by December 31, 2014, with at least 12-month follow-up, were retrospectively compared. There were steadily increasing numbers of patients underwent SG from 2010 to 2015. Early (<30 days) postoperative complication rate of 3.02 % for RYGBP was significantly higher than 2.12 % seen after SG (p = 0.0006). Only two patients, one in each group, died in the first 30 postoperative days (0.016 % mortality for SG vs 0.009 % for RYGBP-NS). From SG group, 103 patients, 1.61 %, and 206 patients, 1.94 %, from RYGBP group required readmission following hospital discharge in the first 30 days following bariatric surgery-NS. From the readmitted patients in the SG group, 75.72 % were reoperated vs 50.50 % in the RYGBP group (p < 0.0001). SG patients were heavier (BMI 44.93 vs 43.96 kg/m 2 , p < 0.0001). However, significantly better % excess weight loss were seen following RYGBP in all postoperative years (60.36 vs 67.72 %, p = 0.002 at fifth year). Better remission rates were seen for diabetes, arterial hypertension, dyslipidemia, and sleep apnea syndrome after RYGBP in the first postoperative year. Both procedures were performed with very low complications, mortality, readmissions, and reoperations rate. Better weight loss was observed following RYGBP, the first five postoperative years.

  15. 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

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

    Science.gov (United States)

    Pabin, Izabela; Adamski, Przemyslaw; Leszczynska, Katarzyna; Preis, Krzysztof; Olszewska, Hanna; Wydra, Dariusz G.; Hansdorfer-Korzon, Rita

    2016-01-01

    Objective To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients. Design Case control national study. Setting Polish Center of the European Competence Network on Mastocytosis (ECNM). Population or Sample 23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999–2014, before becoming pregnant. Methods Prospective analysis outcomes of pregnancies and deliveries. Main Outcome Measures 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. Results 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

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

    Science.gov (United States)

    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

  18. Tertiary lymphoid tissue

    Science.gov (United States)

    Di Caro, Giuseppe; Marchesi, Federica

    2014-01-01

    Tumor-infiltrating lymphocytes influence colorectal cancer progression. We have recently documented that tertiary lymphoid tissue in the colorectal cancer microenvironment orchestrates lymphocyte infiltration and that tertiary lymphoid tissue and lymphocytes cooperate in a coordinated antitumor immune response to improve patient outcome. Thus, tertiary lymphoid tissue represents a potential target in the design of tailored immune-based therapeutic approaches. PMID:25083321

  19. Occurrence of TEM, SHV and CTX-M β lactamases in clinical isolates of Proteus species in a tertiary care center.

    Science.gov (United States)

    Chaubey, Mohit; Shenoy, Suchitra

    2017-04-25

    Extended spectrum beta lactamases (ESBL) are responsible for increased resistance to third generation cephalosporins. Proteus species is an important cause of both community acquired and nosocomial infections. The Proteus spp is usually susceptible to beta lactam drugs but there is progressive increase in beta lactam resistance and recently ESBLs are also fast spreading to this species. This study was conducted to study ESBL production and occurrence of TEM, SHV and CTX M beta lactamases in clinical isolates of Proteus spp in a tertiary care centre. This prospective hospital based study was carried out in Microbiology, Kasturba Medical College, Mangalore over 9 months. All non-duplicate consecutive proteus isolates were identified and antibiotic susceptibility testing done. ESBL detection was done by double disk synergy method and TEM, SHV, CTX M genes were detected by PCR. 84 proteus isolates from urine (29), blood (1), respiratory secretions (2), tissue (20) and exudates (47) were included in the study. 20.2% (17) were ESBL positive by disk synergy method. CTX M was present in 6, TEM in 2 and both in 9 isolates. SHV was not present in any isolate. Our findings showed that 20% of clinical isolates of proteus spp were ESBL producers. 52% of ESBL positive isolates carried both TEM and CTX M genes followed by CTX M alone (35%) and only 11% had TEM alone. This stresses on the fact that ESBL detection should be done routinely in proteus isolates and the genotype surveyed periodically for better management. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  20. Utility of conventional transbronchial needle aspiration with rapid on-site evaluation (c-TBNA-ROSE at a tertiary care center with endobronchial ultrasound (EBUS facility

    Directory of Open Access Journals (Sweden)

    Neha Kawatra Madan

    2016-01-01

    Conclusion: c-TBNA with ROSE is a safe, efficacious, and cost-effective bronchoscopic modality. When it was performed by operators routinely performing EBUS-TBNA, diagnostic yields similar to that of EBUS-TBNA can be obtained. Even at the centers where EBUS facilities are available, c-TBNA should be routinely performed.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  2. Epstein-Barr Virus-Positive Diffuse Large B cell Lymphoma in the Experience of a Tertiary Medical Center in Poland.

    Science.gov (United States)

    Ziarkiewicz, Mateusz; Wołosz, Dominika; Dzieciątkowski, Tomasz; Wilczek, Ewa; Dwilewicz-Trojaczek, Jadwiga; Jędrzejczak, Wiesław Wiktor; Gierej, Beata; Ziarkiewicz-Wróblewska, Bogna

    2016-04-01

    The role of Epstein-Barr virus (EBV) in the biology and clinical characteristics of diffuse large B cell lymphoma (DLBCL) is still poorly defined. A new provisional entity EBV-positive DLBCL of the elderly has been described in Asian population. Its incidence and prognosis remains unknown in middle European patients. Clinical data and tissue samples were collected from 74 Caucasian patients with DLBCL, aged between 23 and 86 years, treated at a single institution. Lymphoma morphology was reassessed, laboratory procedures included in situ hybridization specific for EBV-encoded small RNAs (EBER), immunohistochemical staining for latent membrane protein and serological testing for EBV-specific antibodies. EBER staining revealed 12.2 % of EBV-positive cases, whereas 9.5 % were diagnosed as EBV-positive DLBCL of the elderly. Serologic EBV markers did not correlate with the presence of EBV in tissue samples (P > 0.10). Elderly EBV-positive cases had lower BCL-6 (P = 0.038) and higher CD30 (P = 0.049) expression and were characterized by higher progression risk (median time-to-progression 12.5 months vs not reached; P = 0.029) and a trend towards worse overall survival (median overall survival 24.5 months vs not reached; P = 0.059). EBV-positive DLBCL of the elderly occurs relatively frequently in Polish population and may be associated with inferior prognosis in comparison with DLBCL, not otherwise specified.

  3. Significant male preponderance in childhood acute lymphoblastic leukemia in India and regional variation: tertiary care center experience, systematic review, and evaluation of population-based data.

    Science.gov (United States)

    Kulkarni, Ketan Prasad; Marwaha, Ram Kumar

    2013-09-01

    Although, a slight male preponderance has been reported in childhood acute lymphoblastic leukemia (ALL) from several developed nations, several Indian studies suggest a skewed gender ratio in ALL. To assess the gender ratio at presentation in ALL in India, we used a three-prong approach: (i) center audit, (ii) systematic review of published studies on ALL in India, and (iii) assessment of population based registry data. Data on gender at presentation in ALL were extracted from these multiple sources. In our center audit, we observed a significantly higher of male:female (M:F) ratio of 3.16:1 (P = .046) in ALL as compared to world literature. In the systematic review of all ALL studies from India, 367 articles were identified and reviewed. A total of 4230 and 1843 boys and girls in these studies were assessed and the M:F ratio was 2.503:1; much higher than the world ratio but not significantly different (P = .10). Population-based data obtained from the National Cancer Registry Program also depicted a male preponderance, especially from large cities in India in a consistent manner since 1984. There is also significant (P = .025) interregional variation in the gender ratio in India. Our study clearly demonstrates a consistent male preponderance in childhood ALL in India along with significant interregional variations over the last three decades. There is a clear need of prospective nationwide multicenter assessment of high-resolution data to confirm this important observation and assess its implications, especially on the health care system.

  4. 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

  5. Array-Based Comparative Genomic Hybridization in 190 Korean Patients with Developmental Delay and/or Intellectual Disability: A Single Tertiary Care University Center Study

    Science.gov (United States)

    Lee, Cha Gon; Park, Sang-Jin; Yun, Jun-No; Ko, Jung Min; Kim, Hyon-Ju; Yim, Shin-Young

    2013-01-01

    Purpose This study analyzed and evaluated the demographic, clinical, and cytogenetic data [G-banded karyotyping and array-based comparative genomic hybridization (array CGH)] of patients with unexplained developmental delay or intellectual disability at a single Korean institution. Materials and Methods We collected clinical and cytogenetic data based on retrospective charts at Ajou University Medical Center, Suwon, Korea from April 2008 to March 2012. Results A total of 190 patients were identified. Mean age was 5.1±1.87 years. Array CGH yielded abnormal results in 26 of 190 patients (13.7%). Copy number losses were about two-fold more frequent than gains. A total of 61.5% of all patients had copy number losses. The most common deletion disorders included 22q11.2 deletion syndrome, 15q11.2q12 deletion and 18q deletion syndrome. Copy number gains were identified in 34.6% of patients, and common diseases among these included Potocki-Lupski syndrome, 15q11-13 duplication syndrome and duplication 22q. Abnormal karyotype with normal array CGH results was exhibited in 2.6% of patients; theses included balanced translocation (n=2), inversion (n=2) and low-level mosaicism (n=1). Facial abnormalities (pabnormal CGH findings. Conclusion Array CGH is a useful diagnostic tool in clinical settings in patients with developmental delay or intellectual disability combined with facial abnormalities or failure to thrive. PMID:24142652

  6. Audit of postoperative pain management after open thoracotomy and the incidence of chronic postthoracotomy pain in more than 500 patients at a tertiary center.

    Science.gov (United States)

    Niraj, G; Kelkar, A; Kaushik, Vipul; Tang, Yee; Fleet, Danny; Tait, Frances; Mcmillan, Theresa; Rathinam, Sridhar

    2017-02-01

    To evaluate the quality of postoperative pain relief during the first 3 days after surgery and to evaluate with the incidence of persistent pain at 6 months after surgery. Retrospective single-center audit. University hospital. Five hundred four patients who underwent thoracotomy. Review of patient records, questionnaire, and telephone review. Of the 364 survivors, 306 were contacted. Five or more episodes of severe pain (numerical rating scale >6/10 at rest or movement) during the first 72 hours after surgery occurred in 133 patients. Persistent postsurgical pain at 6 months was present in 82% (109/133) of these patients. Patient satisfaction with acute postoperative pain management was excellent (36%), good (43%), and fair or poor (21%).The incidence of postthoracotomy pain was 56% (mild 32%, moderate 18%, and severe 6%). Poorly controlled acute postoperative pain correlated with persistent postsurgical pain at 6 months. In view of such a high incidence in thoracotomy patients, preventative strategies assume great significance. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. 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.

    Science.gov (United States)

    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.

  8. 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…

  9. 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) 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Effect of race/ethnicity on clinical presentation and risk of gestational trophoblastic neoplasia in patients with complete and partial molar pregnancy at a tertiary care referral center.

    Science.gov (United States)

    Gockley, Allison A; Joseph, Naima T; Melamed, Alexander; Sun, Sue Yazaki; Goodwin, Benjamin; Bernstein, Marilyn; Goldstein, Donald P; Berkowitz, Ross S; Horowitz, Neil S

    2016-09-01

    The reported incidence of molar pregnancy varies widely among different geographic locations. This variation has been attributed, at least in part, to racial/ethnic differences. While the incidence of molar pregnancies is decreasing, certain ethnic groups such as Hispanics, Asians, and American Indians continue to have an increased risk of developing gestational trophoblastic disease across the globe. We sought to describe the potential effect of ethnicity/race on the presentation and clinical course of complete mole and partial mole. All patients followed up for complete mole and partial mole at a single institution referral center from 1994 through 2013 were identified. Variables including age, race, gravidity, parity, gestational age, presenting signs/symptoms, serum human chorionic gonadotropin values, and development of gestational trophoblastic neoplasia were extracted from medical records and patient surveys. Patients with complete mole and partial mole were categorized into race/ethnicity groups defined as white, black, Asian, or Hispanic. Due to low numbers of non-white patients with partial mole in each non-white category, patients with partial mole were grouped as white or non-white. Continuous variables were compared using the Kruskal-Wallis test and binary variables were compared using the Fisher exact test. A total of 167 complete mole patients with known race/ethnicity status were included (57.48% white, 14.97% Asian, 14.37% black, 13.17% Hispanic). Hispanics presented at younger age (median 24.5 years) compared to whites (median 32.0 years, P = .04) and Asians (median 31.0 years, P = .03). Blacks had higher gravidity than whites (P gestational age at diagnosis, and preevacuation serum human chorionic gonadotropin level by race/ethnicity. Hispanics were significantly less likely than whites to develop gestational trophoblastic neoplasia (absolute risk difference, 28.6%; 95% confidence interval, 8.1-39.2%; P = .02). A total of 144 patients with

  12. 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

  13. 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.

  14. 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.

  15. Waterworks, a full-scale chemical exposure exercise: interrogating pediatric critical care surge capacity in an inner-city tertiary care medical center.

    Science.gov (United States)

    Shah, Vikas S; Pierce, Lauren C; Roblin, Patricia; Walker, Sarah; Sergio, Marte N; Arquilla, Bonnie

    2014-02-01

    Pediatric Intensive Care Unit (PICU) resources are overwhelmed in disaster as the need to accommodate influx of critically-ill children is increased. A full-scale chlorine overexposure exercise was conducted by the New York Institute for All Hazard Preparedness (NYIAHP) to assess the appropriateness of response of Kings County Hospital Center's (KCHC's) PICU surge plan to an influx of critically-ill children. The primary endpoint that was assessed was the ability of the institution to follow the PICU surge plan, while secondary endpoints include the ability to provide appropriate medical management. Thirty-six actors/patients (medical students or emergency medicine residents) were educated on presentations and appropriate medical management of patients after a chlorine overexposure, as well as lectures on drill design and expected PICU surge response. Victims presented to the hospital after simulated accidental chlorine overexposure at a public pool. Twenty-two patients with 14 family members needed evaluation; nine of these patients would require PICU admission. Three of nine PICU patients were low-fidelity mannequins. In addition to the 36 actor/patient evaluators, each area had two to four expert evaluators (disaster preparedness experts) to assess appropriateness of global response. Patients were expected to receive standard of care. Appropriateness of medical decisions and treatment was assessed retrospectively with review of electronic medical record. The initial PICU census was three of seven; two of these patients were transferred to the general ward. Of the nine patients that required Intensive Care Unit (ICU) admission, six actor/patients were admitted to the PICU, one was admitted to the Surgical Intensive Care Unit (SICU), one went to the Operating Room (OR), and one was admitted to a monitored-surge general pediatric bed. The remaining 13 actor/patients were treated and released. Medical, nursing, and respiratory staffing in the PICU and the general

  16. INTERNATIONAL COOPERATION OF DRUG TREATMENT CENTER IN MURSKA SOBOTA FOR DEVELOPMENT OF EUROPEAN TREATMENT INDEX EXIT TREATMENT (ETI

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    Dušan Nolimal

    2003-05-01

    Full Text Available Background. Our goal is to introduce the international cooperation of the Drug Treatment Centre in Murska Sobota in European project of the development of the final processing index under patronage of the Pompidou-group. The principal goal of the research was to collect the basic informations for the development of the final processing index and the introduction of unified epidemiological attendance of drug users in different European cities.Methods. The quality research method was used in this research.Difficulties in development of unified attendance of the phenomenon are discribed and informations which should be included in such a system are exposed.15 European cities from 6 different countries cooperated in this project.The project has bin going on for 12 months and includet minimum 20 questionaris.Results. There are introduced basic habbits which were recognized in centre in Murska Sobota. Comparative informationes which we could comprehend with other cities and issuficiences which we recognized at the treatment.Conclusions. It is about the first experiment of collecting such unified information in this area. It is important to compare the information that indicate the initial treatment with the concluded treatment.The continuation of work on developing and indicative and preparation of adequate protocol which will settle the unified convoyment of treatment at the beginning, and on the end is one of the priorities of epidemic work on the area of drugs in Europe and in Slovenia.

  17. A European multi-center trial investigating the anti-restenotic effect of intravascular sonotherapy after stenting of de novo lesions (EUROSPAH: EUROpean Sonotherapy Prevention of Arterial Hyperplasia).

    Science.gov (United States)

    Serruys, P W; Hoye, A; Grollier, G; Colombo, A; Symons, J; Mudra, H

    2004-01-01

    Intravascular sonotherapy (IST) reduces neointimal hyperplasia post-stenting in animal studies. Euro-SPAH is a multi-center, double blind, randomized trial investigating the efficacy of IST to reduce in-stent late loss. Patients with angina or silent ischaemia with stented de novo lesions were randomised to sham or IST. The sample size had a 90% power to detect a late loss difference of 0.21 mm at 6 months. The secondary endpoints were MACE at 1, 6, 12 months and neo-intimal hyperplasia on IVUS at 6 months. At 23 sites in Europe, 403 patients were randomized, with successful treatment with sham or IST in 95.6%. There were no significant differences between the groups in terms of baseline demographics or lesion characteristics. Angiographic follow-up was obtained in 89%. In-stent late loss was not significantly different. The restenosis rate at 6 months was 23% in the IST group versus 25% in the sham group. The IVUS measurements confirm the absence of effect of IST on neointimal hyperplasia. At one year, the event-free survival did not significantly differ between the two groups. The use of sonotherapy following stent implantation in de novo lesions does not reduce intra-stent neointimal hyperplasia, or effect the angiographic restenosis rate compared to sham treatment.

  18. Positive and negative impact of increased tertiary attainment

    OpenAIRE

    Alena Bušíková

    2013-01-01

    The theory of human capital clearly states that the investments into the education bring many benefits and are worth the cost. The OECD Education at a Glance analysis provides support for both public and private investing in tertiary education as the net present value is positive for all observed countries. Considering the benefits of education, a growth in tertiary education should be viewed very positively. In this context, the European Strategy Europe 2020 set up one of its main goals for ...

  19. 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

    Directory of Open Access Journals (Sweden)

    M Saleem Najar

    2017-01-01

    Full Text Available 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 <60 mL/min (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.

  20. 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.

  1. From the Sidelines to Center Stage: Sidekick No More? The European Commission in Justice and Home Affairs

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    Emek M. Ucarer

    2001-05-01

    Full Text Available Cooperation in Justice and Home Affairs (JHA an issue area that includes matters of asylum, immigration, police and judicial cooperation is a relatively new policy arena for the European Union. The level and quality of the collective thinking on these issues have improved since the mid-1980s. JHA cooperation was formally endorsed in Maastricht and revisited during the 1996 IGC, resulting in new institutional frameworks within which discussions now occur. Throughout this period, the European Commission has seen its involvement in the decision-making enhanced. Its efforts as an actor began with a humble Task Force with which the Commission attempted to steer EU's policies on asylum and immigration, as well as police and judicial cooperation. After Amsterdam, and particularly as a result of the Commission's restructuring following the resignation of the Santer Commission, the Commission's institutional capacities as well as its charge vis-à-vis the treaties has changed quite remarkably. This paper reviews the Commission's role in JHA as an institutional actor and will evaluate its agency and emerging autonomy in these fields. It argues that the Commission has a stronger constitutional and institutional basis from which to work, bolstered by the increased propensity by member states to delegate to the Commission and enhanced by the creation of the Directorate General for Justice and Home Affairs. While improvements in the Commission's position vis-à-vis the immediate aftermath of Maastricht are visible, challenges remain nonetheless which constrain the Commissions ability to act as a competence-maximizing institution with formal agenda-setting powers.

  2. From the Sidelines to Center Stage: Sidekick No More? The European Commission in Justice and Home Affairs

    Directory of Open Access Journals (Sweden)

    Emek M. Ucarer

    2001-05-01

    Full Text Available Cooperation in Justice and Home Affairs (JHA an issue area that includes matters of asylum, immigration, police and judicial cooperation is a relatively new policy arena for the European Union. The level and quality of the collective thinking on these issues have improved since the mid-1980s. JHA cooperation was formally endorsed in Maastricht and revisited during the 1996 IGC, resulting in new institutional frameworks within which discussions now occur. Throughout this period, the European Commission has seen its involvement in the decision-making enhanced. Its efforts as an actor began with a humble Task Force with which the Commission attempted to steer EU's policies on asylum and immigration, as well as police and judicial cooperation. After Amsterdam, and particularly as a result of the Commission's restructuring following the resignation of the Santer Commission, the Commission's institutional capacities as well as its charge vis-à-vis the treaties has changed quite remarkably. This paper reviews the Commission's role in JHA as an institutional actor and will evaluate its agency and emerging autonomy in these fields. It argues that the Commission has a stronger constitutional and institutional basis from which to work, bolstered by the increased propensity by member states to delegate to the Commission and enhanced by the creation of the Directorate General for Justice and Home Affairs. While improvements in the Commission's position vis-à-vis the immediate aftermath of Maastricht are visible, challenges remain nonetheless which constrain the Commissions ability to act as a competence-maximizing institution with formal agenda-setting powers.

  3. From the Sidelines to Center Stage: Sidekick No More? The European Commission in Justice and Home Affairs

    Directory of Open Access Journals (Sweden)

    Emek M. Uçarer

    2001-05-01

    Full Text Available Cooperation in Justice and Home Affairs (JHA – an issue area that includes matters of asylum, immigration, police and judicial cooperation – is a relatively new policy arena for the European Union. The level and quality of the collective thinking on these issues have improved since the mid-1980s. JHA cooperation was formally endorsed in Maastricht and revisited during the 1996 IGC, resulting in new institutional frameworks within which discussions now occur. Throughout this period, the European Commission has seen its involvement in the decision-making enhanced. Its efforts as an actor began with a humble Task Force with which the Commission attempted to steer EU's policies on asylum and immigration, as well as police and judicial cooperation. After Amsterdam, and particularly as a result of the Commission's restructuring following the resignation of the Santer Commission, the Commission's institutional capacities as well as its charge vis-à-vis the treaties has changed quite remarkably. This paper reviews the Commission's role in JHA as an institutional actor and will evaluate its agency and emerging autonomy in these fields. It argues that the Commission has a stronger constitutional and institutional basis from which to work, bolstered by the increased propensity by member states to delegate to the Commission and enhanced by the creation of the Directorate General for Justice and Home Affairs. While improvements in the Commission's position vis-à-vis the immediate aftermath of Maastricht are visible, challenges remain nonetheless which constrain the Commission’s ability to act as a “competence-maximizing” institution with formal agenda-setting powers.

  4. Integrated Land Data Assimilation System for Numerical Weather Prediction at the European Center for Medium-Range Weather Forecasts

    Science.gov (United States)

    de Rosnay, Patricia; Hólm, Elias; Bonavita, Massimo; English, Steve

    2017-04-01

    The European Centre for Medium-Range Weather Forecasts (ECMWF) system relies on an Earth System approach focusing on atmosphere, ocean, waves, land, and sea ice. Different data assimilation methods are used for the each component of the Earth System. A hybrid 4D-Var is used for the atmosphere, a simplified sea-surface temperature (SST) and sea ice analysis is used for medium-range forecasts and for the reanalyses (ERA-Interim and ERA5). The ECMWF land and atmosphere data assimilation systems are weakly coupled, using a coupled land-atmosphere background forecast and separate analyses for the atmosphere and for the surface (soil moisture and snow). Conventional and satellite observations that inform on the state of both subsystems are assimilated. They are located at the land-atmosphere interface and include two-metre temperature and relative humidity, snow depth, and soil moisture. In this presentation we present the land-atmosphere weakly coupled assimilation currently used at ECMWF for Numerical Weather Prediction (NWP) purpose. Perspectives of coupling enhancement using Ensemble Data Assimilaton (EDA) and EDA-based cross correlation estimates with coupling at the outer loop level of the atmospheric 4D-Var are discussed.

  5. Exploring the Interaction Between Nursing Decision Making and Patient Outcomes in 2 European Cancer Centers: A Qualitative Study.

    Science.gov (United States)

    Valcarenghi, Dario; Bagnasco, Annamaria; Aleo, Giuseppe; Catania, Gianluca; Zanini, Milko; Cavaliere, Bruno; Carnevale, Franco; Sasso, Loredana

    2017-04-20

    In some clinical settings, nurses have difficulty describing the outcomes of their caring activities. Understanding the reasons for this could help nurse leaders to improve the effectiveness and visibility of nursing practice and safeguard nurses' working conditions. The aims of this study were to understand how nurses working in 2 different adult cancer centers make healthcare decisions and assess the respective outcomes on their patients. Through a constructivist grounded theory approach, we involved 15 clinical cancer nurses with different experiences and educational backgrounds and 6 nurse managers, working in 2 comprehensive cancer centers, 1 in Italy and 1 in Switzerland. Data were collected in 2 phases using 20 semistructured interviews and 9 field observations. Six macrocategories emerged: interacting with situational factors, deciding relevant interventions, using multiple decision-making approaches, evaluating interventions and reporting them, pursuing healthcare outcomes, and clarifying professional identity and roles. Nurses' decision-making processes varied and were influenced by various factors, which mutually influenced one another. This process was interpreted using an explicative theory called "dynamic decision-making adaptation." The present study showed how the aims, contents, and degree of autonomy in the nurses' decision-making process are strongly influenced by the dialectic interaction between professional and contextual factors, such as competency and professional identity. Cancer nurses could influence their clinical practice by developing nursing competencies that effectively resolve patients' problems. This is a key factor that nurses govern autonomously and therefore a responsibility that involves the entire nursing educational, organizational, and scientific leadership.

  6. Assessment of risk and prophylaxis for deep vein thrombosis and pulmonary embolism in medically ill patients during their early days of hospital stay at a tertiary care center in a developing country

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    Ambarish Pandey

    2009-08-01

    Full Text Available Ambarish Pandey, Nivedita Patni, Mansher Singh, Randeep GuleriaDepartment of Medicine, All India Institute of Medical Sciences, New Delhi, IndiaAim: Deep vein thrombosis (DVT and pulmonary thromboembolism (PE are important causes of morbidity and mortality in medically ill patients. This study was done to assess risk factors and prophylaxis given for DVT and PE in newly admitted medically ill patients during the first two weeks of their hospital stay at a tertiary care center hospital in India.Methods: All patients within one week of their admission in intensive care unit (ICU and wards were enrolled in the study after an informed written consent. Patients who had DVT prophylaxis within the past month or any contraindications for DVT prophylaxis were excluded. A structured proforma was designed and effective risk stratification for DVT was done. Patients were followed for up to two weeks to record any changes in the risk categories and document any signs of PE or DVT if present. Any prophylaxis given for DVT or PE was noted.Results: Seventy-five percent of patients had the highest risk for DVT and PE. Only 12.5% had DVT prophylaxis within the first two days of admission. Within two weeks of admission, 30.8% of patients were discharged, and 16.2% died. 72.6% of the patients still in the wards belonged to the highest risk category. Clinical signs and symptoms of DVT and PE were present in 25.8% and 9.8% of patients, respectively after the second week of admission. 86% of symptomatic patients belonged to the highest risk category initially and none of them received any prophylaxis. 21.6% of the highest risk category patients died within two weeks of their admission. A statistically significant correlation was found between mortality and risk score of the patients for DVT and between lack of prophylaxis and mortality (p < 0.05.Conclusion: A significant risk for DVT and PE exists in medically ill patients, but only a small proportion of the patients

  7. Positive predictive value of non-invasive prenatal screening for fetal chromosome disorders using cell-free DNA in maternal serum: independent clinical experience of a tertiary referral center.

    Science.gov (United States)

    Neufeld-Kaiser, Whitney A; Cheng, Edith Y; Liu, Yajuan J

    2015-06-02

    Non-invasive prenatal screening (NIPS) for fetal chromosome abnormalities using cell-free deoxyribonucleic acid (cfDNA) in maternal serum has significantly influenced prenatal diagnosis of fetal aneuploidies since becoming clinically available in the fall of 2011. High sensitivity and specificity have been reported in multiple publications, nearly all of which have been sponsored by the commercial performing laboratories. Once results are returned, positive and negative predictive values (PPVs, NPVs) are the performance metrics most relevant to clinical management. The purpose of this report is to present independent data on the PPVs of NIPS in actual clinical practice. Charts were retrospectively reviewed for patients who had NIPS and were seen March 2012 to December 2013 in a tertiary academic referral center. NIPS results were compared to diagnostic genetic test results, fetal ultrasound results, and clinical phenotype/outcomes. The PPV was calculated using standard epidemiological methods. Correlation between screen results and both maternal age at delivery and gestational age at time of screening was assessed using Wilcoxon's rank sum test. Of 632 patients undergoing NIPS, 92 % of tests were performed in one of the four major commercial laboratories offering testing. However, all four laboratories are represented in both the normal and abnormal results groups. There were 55 abnormal NIPS results. Forty-one of 55 abnormal NIPS results were concordant with abnormal fetal outcomes, 12 were discordant, and 2 were undetermined. The PPV for all conditions included in the screen was 77.4 % (95 % CI, 63.4 - 87.3). Of 578 patients with normal NIPS results, normal pregnancy outcome was confirmed for 156 (27 %) patients. This incomplete follow-up of normal NIPS results does not affect PPV calculations, but it did preclude calculations of sensitivity, specificity, and NPV. Maternal age at delivery was significantly lower for patients with abnormal discordant results

  8. 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?

  9. 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.

  10. 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

  11. Positive and negative impact of increased tertiary attainment

    Directory of Open Access Journals (Sweden)

    Alena Bušíková

    2013-04-01

    Full Text Available The theory of human capital clearly states that the investments into the education bring many benefits and are worth the cost. The OECD Education at a Glance analysis provides support for both public and private investing in tertiary education as the net present value is positive for all observed countries. Considering the benefits of education, a growth in tertiary education should be viewed very positively. In this context, the European Strategy Europe 2020 set up one of its main goals for EU27 countries as follows: to increase the educated population so that it reaches 40% (tertiary educated people aged 30-34. This article, on an example of Slovakia, provides an analysis of both positive and negative impact of increased tertiary attainment.

  12. Visibility of natural tertiary rainbows.

    Science.gov (United States)

    Lee, Raymond L; Laven, Philip

    2011-10-01

    Naturally occurring tertiary rainbows are extraordinarily rare and only a handful of reliable sightings and photographs have been published. Indeed, tertiaries are sometimes assumed to be inherently invisible because of sun glare and strong forward scattering by raindrops. To analyze the natural tertiary's visibility, we use Lorenz-Mie theory, the Debye series, and a modified geometrical optics model (including both interference and nonspherical drops) to calculate the tertiary's (1) chromaticity gamuts, (2) luminance contrasts, and (3) color contrasts as seen against dark cloud backgrounds. Results from each model show that natural tertiaries are just visible for some unusual combinations of lighting conditions and raindrop size distributions.

  13. 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.

  14. Impact of (18)f-fluorodeoxyglucose positron emission tomography/computed tomography scan on initial evaluation of head and neck squamous cell carcinoma: our experience at a tertiary care center in India.

    Science.gov (United States)

    Nair, Satish; Mohan, Sharad; Nilakantan, Ajith; Gupta, Atul; Malik, Akshat; Gupta, Abhishek

    2015-01-01

    The efficacy of the whole body (WB) (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) as a part of conventional initial staging in all cases of head and neck squamous cell carcinoma (HNSCC) is still controversial with various studies in literature giving contradictory reports. We conducted this study at a government tertiary care oncology center in India to identify the impact of WB (18)F-FDG PET-CT scan on HNSCC staging and treatment. A prospective clinical study of patients of HNSCC who were evaluated and treated at our center was performed. The patients included in the study were HNSCC of the oral cavity, oropharynx, hypopharynx, larynx, nasopharynx, and carcinoma of unknown primary site (CUPS) with cervical metastasis. The study design was to evaluate the cases of HNSCC initially by staging with conventional investigations followed by staging with the information derived from WB (18)F-FDG PET-CT scan. At the end of the conventional investigations, a tumor, node, metastasis (TNM) staging as per AJCC 7(th) edition, and a detailed treatment plan as per NCCN 2012 guidelines was decided in consultation with the multidisciplinary oncology team of the hospital. WB (18)F-FDG PET-CT scan was carried out in all these patients. The findings of WB (18)F-FDG PET-CT were then interpreted with the staging with conventional investigations to identify the cases with change in staging and also those in whom the treatment protocol would be affected. Descriptive analysis of demographic data and analytical analysis of the sensitivity and specificity of WB (18)F-FDG PET-CT scan and also the change in staging and treatment plan after WB (18)F-FDG PET-CT scan was analyzed using SPSS version 18. A total of 131 patients met the inclusion criteria, which included 123 males and 8 females. The various sites involved among the study group are oral cavity 11 (8.3%), oropharyn × 39 (29.7%), hypopharyn × 31 (23.6%), laryn × 34 (25.9%), nasopharyn

  15. Avaliação de atopia em crianças respiradoras bucais atendidas em centro de referência Evaluation of atopy among mouth-breathing pediatric patients referred for treatment to a tertiary care center

    Directory of Open Access Journals (Sweden)

    Juliana R. C. Barros

    2006-12-01

    key role due to its high prevalence. The aim of this study was to assess the presence of atopy among mouth-breathing patients referred to a tertiary care center in the metropolitan region of Belo Horizonte, Brazil. METHODS: Cross-sectional, descriptive study carried out at Hospital das Clínicas of Universidade Federal de Minas Gerais. Patients aged 2 to 12 years, admitted between November 2002 and April 2004, were included. Parents or surrogates completed a comprehensive questionnaire, and patients were submitted to a skin test for inhalant allergens. A total of 140 patients participated in the study. Those with a positive result for at least one allergen were regarded as atopic. The statistical analyses were made using SPSS, with univariate analyses followed by logistic regression. RESULTS: Of 140 patients, 44.3% (62/140 obtained positive results on the allergic test. Mites were the most predominant allergens, with a positive rate of 100% among atopic patients. In the multivariate analysis, atopy was significantly associated with the male sex (p = 0.05, presence of asthma (p = 0.014, lower number of people sleeping in the same room with the patient (p = 0.005, absence of passive smoking (p = 0.005 and absence of sleep apnea (p = 0.003. CONCLUSION:The high prevalence of positive results on the allergic test highlights the importance of allergologic investigation in mouth-breathers, since allergy has specific treatments that may reduce morbidity in these patients when properly used.

  16. 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

  17. Sustainable development of low income countries through investment in tertiary education

    OpenAIRE

    Kundu, Nobinkhor; Banu, Asma

    2014-01-01

    To counterbalance the challenges of globalization, raising the superiority of our tertiary education to global standard is very significant. Tertiary education is the essential enabler of the human capital of the twenty-first century that demands a set of new competencies. It draws lessons for developing countries where policy makers have set out procedure to build a tertiary education in which higher priorities and future strategies would form the center of the sustainable development strate...

  18. 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 ...

  19. 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 ...

  20. 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

  1. Characteristics of Inflammatory Bowel Disease in Three Tertiary ...

    African Journals Online (AJOL)

    BACKGROUND: Inflammatory bowel disease (IBD) refers to two chronic inflammatory disorders of the gastrointestinal tract which is generally believed to be rare in most African countries. The objectives of the current study were to present the experience of three tertiary gastroenterology centers in southern part of Nigeria on ...

  2. Changes in private returns to education caused by the tertiary education expansion in Slovakia

    OpenAIRE

    Miroslav Stefanik

    2011-01-01

    This article brings evidence on tertiary education expansion in Slovakia and explores possible effects of this expansion on private returns to education. It focuses particularly on intergenerational differences in private returns to education. The question is whether tertiary education expansion has decreased private returns to education and whether there are differences in the value of education acquired by different generations. European Union Community Statistics on Income and Living Condi...

  3. Navigating the global space of tertiary education:

    DEFF Research Database (Denmark)

    Wilken, Lisanne

    to the Bologna model in order to ease mobility (at least within Europe). This paper which is based on some very preliminary findings from an ongoing research project exploring internationalization of university education in Denmark, discusses educational strategies of students attending internationalized English......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...... at lesser known universities in smaller European countries such as Sweden, Norway, Denmark and the Netherlands where the national language is not one of the major world languages but where courses and educations are increasingly offered in English and where the educational structures are adapted...

  4. Retrospective analysis of 55,769 HbA1c EQA results obtained from professional laboratories and medical offices participating in surveys organized by two European EQA centers over a nine-year period.

    Science.gov (United States)

    Morandi, Pierre-Alain; Deom, André; Kesseler, Dagmar; Cohen, Richard

    2011-01-01

    External Quality Assessment (EQA) is an essential tool for laboratories to monitor the performances of their analyses. It also allows a comparison of methods and types of laboratories (professional laboratories vs. medical offices). We, therefore, compared 55,769 HbA1c EQA results obtained between 1999 and 2008 by laboratories participating in EQA schemes organized by two European centers, Switzerland (center 1) and France (center 2). We used simple, nonparametrical statistics suited to EQA results to calculate the yearly and global precision performances. All the results, including the outliers, were included in the calculations. The best global precision performances were obtained by professional laboratories and medical offices using DCA POCT devices, followed by professional laboratories with the Integra, Hitachi, Cobas Mira, and HPLC groups of devices, and finally by both types of laboratories with the NycoCard POCT devices. When considering yearly precision performances, an overall improvement over time was observed for almost all diagnostic devices of center 1, whereas the trend was less clear for center 2. The HbA1c EQA results collected and analyzed over a 9-year period showed that the DCA POCT devices used either by professional laboratories or medical offices had better reproducibility than laboratory devices (other than POCT) and that a general improvement of yearly precision performances was observed, especially when frequent EQA schemes were organized. © 2011 Wiley-Liss, Inc.

  5. A Single-Center, Adult Chronic Intestinal Failure Cohort Analyzed According to the ESPEN-Endorsed Recommendations, Definitions, and Classifications

    DEFF Research Database (Denmark)

    Brandt, Christopher Filtenborg; Tribler, Siri; Hvistendahl, Mark

    2017-01-01

    BACKGROUND/AIMS: The objective of this study was to describe a clinically well-defined, single-center, intestinal failure (IF) cohort based on a template of definitions and classifications endorsed by the European Society for Clinical Nutrition and Metabolism (ESPEN). METHODS: A cross-sectional, ......BACKGROUND/AIMS: The objective of this study was to describe a clinically well-defined, single-center, intestinal failure (IF) cohort based on a template of definitions and classifications endorsed by the European Society for Clinical Nutrition and Metabolism (ESPEN). METHODS: A cross......-sectional, retrospective, adult IF cohort, receiving parenteral support (PS), was extracted from the Copenhagen IF database at the tertiary IF center, Copenhagen University Hospital, Rigshospitalet, Denmark. RESULTS: Rigshospitalet provided PS to 188 adult patients with IF on December 31, 2011. Six patients received only...

  6. Multidisciplinary approach and long-term follow-up in a series of 640 consecutive patients with sarcoidosis: Cohort study of a 40-year clinical experience at a tertiary referral center in Barcelona, Spain.

    Science.gov (United States)

    Mañá, Juan; Rubio-Rivas, Manuel; Villalba, Nadia; Marcoval, Joaquim; Iriarte, Adriana; Molina-Molina, María; Llatjos, Roger; García, Olga; Martínez-Yélamos, Sergio; Vicens-Zygmunt, Vanessa; Gámez, Cristina; Pujol, Ramón; Corbella, Xavier

    2017-07-01

    Cohort studies of large series of patients with sarcoidosis over a long period of time are scarce. The aim of this study is to report a 40-year clinical experience of a large series of patients at Bellvitge University Hospital, a tertiary university hospital in Barcelona, Spain. Diagnosis of sarcoidosis required histological confirmation except in certain specific situations. All patients underwent a prospective study protocol. Clinical assessment and follow-up of patients were performed by a multidisciplinary team.From 1976 to 2015, 640 patients were diagnosed with sarcoidosis, 438 of them (68.4%) were female (sex ratio F/M 2:1). The mean age at diagnosis was 43.3 ± 13.8 years (range, 14-86 years), and 613 patients (95.8%) were Caucasian. At diagnosis, 584 patients (91.2%) showed intrathoracic involvement at chest radiograph, and most of the patients had normal pulmonary function. Erythema nodosum (39.8%) and specific cutaneous lesions (20.8%) were the most frequent extrapulmonary manifestations, but there was a wide range of organ involvement. A total of 492 patients (76.8%) had positive histology. Follow-up was carried out in 587 patients (91.7%), over a mean of 112.4 ± 98.3 months (range, 6.4-475 months). Corticosteroid treatment was administered in 255 patients (43.4%), and steroid-sparing agents in 49 patients (7.7%). Outcomes were as follows: 111 patients (18.9%) showed active disease at the time of closing this study, 250 (42.6%) presented spontaneous remission, 61 (10.4%) had remission under treatment, and 165 (28.1%) evolved to chronic sarcoidosis; among them, 115 (19.6%) with mild disease and 50 (8.5%) with moderate to severe organ damage. A multivariate analysis showed that at diagnosis, age more than 40 years, the presence of pulmonary involvement on chest radiograph, splenic involvement, and the need of treatment, was associated with chronic sarcoidosis, whereas Löfgren syndrome and mediastinal lymphadenopathy on chest radiograph were

  7. 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.

  8. Adherence of the indication to European Association of Urology guideline recommended pelvic lymph node dissection at a high-volume center: Differences between open and robot-assisted radical prostatectomy.

    Science.gov (United States)

    Schiffmann, J; Haese, A; Leyh-Bannurah, Sami-Ramzi; Salomon, G; Steuber, T; Schlomm, T; Boehm, K; Beyer, B; Larcher, A; Michl, U; Heinzer, H; Huland, H; Graefen, M; Karakiewicz, P I

    2015-11-01

    Contemporary adherence of the indication to European Association of Urology (EAU) guideline recommendation for pelvic lymph node dissection (PLND) at either open (ORP) or robot-assisted radical prostatectomy (RARP) at a high-volume center is unknown. To assess guideline recommended and observed PLND rates in a high-volume center cohort. We relied on the Martini-Clinic database and focused on patients treated with either ORP or RARP, between 2010 and 2013. Actual performed PLND was compared to European Association of Urology (EAU) guideline recommendation defined by nomogram predicted risk of lymph node invasion >5%. Categorical and multivariable logistic regression analyses targeted two endpoints: 1) probability of guideline recommended PLND and 2) probability of no PLND, when not recommended by EAU guideline. Within 7868 PCa patients, adherence to EAU PLND guideline recommendation was 97.1% at ORP and 96.8% at RARP (p = 0.7). When PLND was not recommended, it was more frequently performed at RARP (71.6%) than at ORP (66.2%) (p = 0.002). Gleason score, PSA and number of positive biopsy cores were independent predictors for both either PLND when recommended, or no PLND when not recommended (all p < 0.05). Clinical tumor stage, age and surgical approach were also independent predictors for no PLND when not recommended (all p < 0.05). Adherence of the indication to EAU guideline recommended PLND is high at this high-volume center. Neither ORP nor RARP represent a barrier for PLND, when recommended. However, a high number of patients underwent PLND despite absence of guideline recommendation. Possible staging advantages and PLND related complications needs to be individually considered, especially, when LNI risk is low. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Bipolar transurethral enucleation and resection of the prostate versus bipolar resection of the prostate for prostates larger than 60gr: A retrospective study at a single academic tertiary care center.

    Science.gov (United States)

    Wei, Yong; Xu, Ning; Chen, Shao-Hao; Li, Xiao-Dong; Zheng, Qing-Shui; Lin, Yun-Zhi; Xue, Xue-Yi

    2016-01-01

    To evaluate the efficacy and safety of bipolar transurethral enucleation and resection of the prostate (B-TUERP) versus bipolar transurethral resection of the prostate (B-TURP) in the treatment of prostates larger than 60g. Clinical data for 270 BPH patients who underwent B-TUERP and 204 patients who underwent B-TURP for BPH from May 2007 to May 2013 at our center were retrospectively analyzed. Outcome measures included operative time, decreased hemoglobin level, total prostate specific antigen (TPSA), International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), quality of life (QoL) score, post void residual urine volume (RUV), bladder irrigation duration, hospital stay, and the weight of resected prostatic tissue. Other measures included perioperative complications including transurethral resection syndrome (TURS), hyponatremia, blood transfusion, bleeding requiring surgery, postoperative acute urinary retention, urine incontinence and urinary sepsis. Patients in both groups were followed for two years. Compared with the B-TURP group, the B-TUERP group had shorter operative time, postoperative bladder irrigation duration and hospital stay, a greater amount of resected prostatic tissue, less postoperative hemoglobin decrease, better postoperative IPSS and Qmax, as well as lower incidences of hyponatremia, urinary sepsis, blood transfusion requirement, urine incontinence and reoperation (P<0.05 for all). B-TUERP is superior to B-TURP in the management of large volume BPH in terms of efficacy and safety, but this finding needs to be validated in further prospective, randomized, controlled studies. Copyright© by the International Brazilian Journal of Urology.

  10. Bipolar transurethral enucleation and resection of the prostate versus bipolar resection of the prostate for prostates larger than 60gr: A retrospective study at a single academic tertiary care center

    Directory of Open Access Journals (Sweden)

    Yong Wei

    Full Text Available ABSTRACT Objective: To evaluate the efficacy and safety of bipolar transurethral enucleation and resection of the prostate (B-TUERP versus bipolar transurethral resection of the prostate (B-TURP in the treatment of prostates larger than 60g. Material and Methods: Clinical data for 270 BPH patients who underwent B-TUERP and 204 patients who underwent B-TURP for BPH from May 2007 to May 2013 at our center were retrospectively analyzed. Outcome measures included operative time, decreased hemoglobin level, total prostate specific antigen (TPSA, International Prostate Symptom Score (IPSS, maximal urinary flow rate (Qmax, quality of life (QoL score, post void residual urine volume (RUV, bladder irrigation duration, hospital stay, and the weight of resected prostatic tissue. Other measures included perioperative complications including transurethral resection syndrome (TURS, hyponatremia, blood transfusion, bleeding requiring surgery, postoperative acute urinary retention, urine incontinence and urinary sepsis. Patients in both groups were followed for two years. Results: Compared with the B-TURP group, the B-TUERP group had shorter operative time, postoperative bladder irrigation duration and hospital stay, a greater amount of resected prostatic tissue, less postoperative hemoglobin decrease, better postoperative IPSS and Qmax, as well as lower incidences of hyponatremia, urinary sepsis, blood transfusion requirement, urine incontinence and reoperation (P<0.05 for all. Conclusions: B-TUERP is superior to B-TURP in the management of large volume BPH in terms of efficacy and safety, but this finding needs to be validated in further prospective, randomized, controlled studies.

  11. The Expanding Context of European and Mediterranean Security: A Joint Project Between the Center for Naval Analyses (CNA) and Centro Militare di Studi Strategici (CeMiSS)

    Science.gov (United States)

    2007-07-01

    November 2006 in Rome , the Center for Naval Analyses (CNA) of Alexandria, Virginia, USA, and the Centro Militare di Studi Strategici (CeMiSS) of the...a military man or junta these days (even though monarchs may wear military uniforms, and Presidents Bouteflika and Mubarak wear mufti). 25 The...being left in anomie in a betwixt and between world when they get to Europe, with its ancient class distinctions. Beyond the problems of the Middle East

  12. Infliximabe na doença de crohn: experiência clínica de um centro terciário paulista Infliximab in crohn's disease: clinical experience from a single tertiary center of Sao Paulo State

    Directory of Open Access Journals (Sweden)

    Ulysses dos Santos Torres

    2009-03-01

    Full Text Available INTRODUÇÃO: Na Doença de Crohn (DC ocorre uma reatividade anormal dos linfócitos T da mucosa intestinal e produção excessiva de citocinas pró-inflamatórias, entre as quais o fator de necrose tumoral alfa (TNF-á. O infliximabe é um anticorpo monoclonal anti-TNF-á indicado no tratamento de pacientes com DC fistulizante ou não responsiva ao tratamento convencional. OBJETIVOS: Caracterizar as indicações clínicas do infliximabe na DC em um serviço referencial paulista, avaliando padrões de resposta e a efetividade do tratamento através do Índice de Atividade da DC (CDAI. PACIENTES E MÉTODOS: O estudo foi observacional retrospectivo e analisou dados de 21 pacientes com DC em uso de infliximabe atendidos no Hospital de Base de Rio Preto entre janeiro de 2004 e julho de 2008. RESULTADOS: Houve predomínio de pacientes do sexo feminino (67%, com média de idade de 33 anos. As indicações mais freqüentes foram fístulas perianais (48%. Resposta clínica total à droga ocorreu em 43% dos pacientes, e resposta parcial em 47%; a diferença da média do CDAI entre os grupos antes e após o tratamento foi de 244,61 pontos (pINTRODUCTION: In Crohn's Disease (CD occurs an abnormal reactivity of T lymphocytes of intestinal mucosa and an exceeding production of proinflammatory cytokines, such as the tumor necrosis factor- alpha (TNF-á. Infliximab is a monoclonal antibody against TNF-á, indicated for treatment of patients with fistulizing or refractory CD. OBJECTIVES: To characterize the clinical indications of infliximab in CD at a referral center of Sao Paulo State, assessing patterns of response and treatment effectiveness by Crohn's Disease Activity Index (CDAI. PATIENTS AND METHODS: This was an observational, retrospective study; data of 21 patients with CD receiving infliximab therapy at Hospital de Base de Rio Preto between January 2004 and July 2008 were analyzed. RESULTS: Female patients were predominant (67% and mean age was 33

  13. Fundamentals of tertiary oil recovery. Pt. 1. Why tertiary recovery

    Energy Technology Data Exchange (ETDEWEB)

    Herbeck, E.F.; Heintz, R.C.; Hastings, J.R.

    1976-01-01

    Secondary recovery projects initiated annually by Atlantic Richfield Co. in the U.S. show a general trend somewhat characteristic of all U.S. producers. Why did the number of project starts decline. Simply because there was a lack of prospects for Atlantic Richfield to apply waterflooding economically. This raises the question of what is the next step to maintain U.S. oil producing rates. One answer is to recover a third crop of oil from those fields which have already undergone secondary recovery. It is becoming evident that tertiary recovery must be undertaken while the existing wells and surface equipment are still intact and usable. Very few prospects are expected to be so profitable that economics will permit redrilling of wells and replacement of surface equipment, but tertiary recovery will be applicable to many of the existing oil fields. Engineers and production personnel at all organizational levels must make an effort to recognize those fields under their supervision which are candidates for tertiary recovery applications.

  14. 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...

  15. 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.

  16. Aspiration Therapy As a Tool to Treat Obesity: 1- to 4-Year Results in a 201-Patient Multi-Center Post-Market European Registry Study.

    Science.gov (United States)

    Nyström, Max; Machytka, Evzen; Norén, Erik; Testoni, Pier Alberto; Janssen, Ignace; Turró Homedes, Jesus; Espinos Perez, Jorge Carlos; Turro Arau, Roman

    2018-02-01

    The objective of this post-market study was to evaluate long-term safety and efficacy of aspiration therapy (AT) in a clinical setting in five European clinics. The AspireAssist® System (Aspire Bariatrics, Inc. King of Prussia, PA) is an endoscopic weight loss therapy utilizing a customized percutaneous endoscopic gastrostomy tube and an external device to aspirate approximately 30% of ingested calories after a meal, in conjunction with lifestyle counseling. A total of 201 participants, with body mass index (BMI) of 35.0-70.0 kg/m2, were enrolled in this study from June 2012 to December 2016. Mean baseline BMI was 43.6 ± 7.2 kg/m2. Mean percent total weight loss at 1, 2, 3, and 4 years, respectively, was 18.2% ± 9.4% (n/N = 155/173), 19.8% ± 11.3% (n/N = 82/114), 21.3% ± 9.6% (n/N = 24/43), and 19.2% ± 13.1% (n/N = 12/30), where n is the number of measured participants and N is the number of participants in the absence of withdrawals or lost to follow-up. Clinically significant reductions in glycated hemoglobin (HbA1C), triglycerides, and blood pressure were observed. For participants with diabetes, HbA1C decreased by 1% (P < 0.0001) from 7.8% at baseline to 6.8% at 1 year. The only serious complications were buried bumpers, experienced by seven participants and resolved by removal/replacement of the A-Tube, and a single case of peritonitis, resolved with a 2-day course of intravenous antibiotics. This study establishes that aspiration therapy is a safe, effective, and durable weight loss therapy in people with classes II and III obesity in a clinical setting. ISRCTN 49958132.

  17. 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

  18. Selective Europeanization

    DEFF Research Database (Denmark)

    Hoch Jovanovic, Tamara; Lynggaard, Kennet

    2014-01-01

    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...

  19. Update on the in vitro activity of daptomycin tested against 17,193 Gram-positive bacteria isolated from European medical centers (2005-2007).

    Science.gov (United States)

    Sader, H S; Moet, G; Jones, R N

    2009-11-01

    The antimicrobial susceptibility patterns of 17,193 Gram-positive isolates consecutively collected from 28 medical centers in 12 countries in europe and israel in 2005-2007 were evaluated by Clinical and laboratory Standards institute (CLSI) broth microdilution methods supplemented with calcium to 50 mg/l for testing daptomycin. Overall, the rate of methicillin-resistant Staphylococcus aureus (MRSA) was 28.3%, varying from 32.3% in 2005 to 27.1% in 2006 and 28.5% in 2007. Vancomycin resistance rates were 0.8% and 21.5% among Enterococcus faecalis and E. faecium, respectively. Among E. faecium, vancomycin resistance increased from 17.9% in 2005 to 26.3% in 2007, and varied from 0.0% in Spain, Sweden and Switzerland to as high as 54.6% in ireland for 2007. All isolates tested, except for seven CoNS (0.2%; 3,234 tested) were considered susceptible to daptomycin using breakpoints established by the United States food and Drug Administration, the CLSI and the EUCAST. Daptomycin was very active against all Gram-positive species with the highest minimum inhibitory concentration (MIC) results being 1, 4, 2 and 4 mg/l for S. aureus, coagulase-negative staphylococci, E. faecalis and E. faecium, respectively. Daptomycin activity was not adversely influenced by resistance to oxacillin among staphylococci or to vancomycin among enterococci.

  20. 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.

  1. Neck masses in children: Etiopathology in a tertiary center

    African Journals Online (AJOL)

    2011-02-15

    Feb 15, 2011 ... The masses were located in the anterior triangle in 14 (40%) cases, right side of the neck in ... with 15 (42.9%) mainly congenital tumors which were benign. Four malignant tumors (11.4%) were rare in anterior triangle. Hodgkin's lymphoma, 9 .... of the children who were at the early stages of the disease.

  2. Chlamydia trachomatis causing neonatal conjunctivitis in a tertiary care center

    Directory of Open Access Journals (Sweden)

    Kakar S

    2010-01-01

    Full Text Available Chlamydia trachomatis is considered a major aetiological agent of conjunctivitis in newborns. The objective of the present study was to determine the aetiology of neonatal conjunctivitis and clinico-epidemiological correlates of chlamydial ophthalmia neonatorum. Fifty-eight newborns with signs and symptoms of conjunctivitis were studied. Conjunctival specimens were subjected to Gram staining, routine bacteriological culture, culture for Neisseria gonorrhoeae and direct fluorescent antibody (DFA staining for diagnosis of C. trachomatis infection. C. trachomatis was detected in 18 (31% neonates. Findings suggest that since C. trachomatis is the most common cause of neonatal conjunctivitis, routine screening and treatment of genital C. trachomatis infection in pregnant women and early diagnosis and treatment of neonatal Chlamydial conjunctivitis may be considered for its prevention and control.

  3. 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 ...

  4. Intravesical Foreign Body: Tertiary care center experience from Pakistan.

    Science.gov (United States)

    Soomro, Hussam Uddin; Jalbani, Imran; Faruqui, Nuzhat

    2016-10-01

    Foreign body in bladder is relatively uncommon condition with variable presentations. Literature is limited to case reports and small series from region. Therefore, we planned this study to review our experience regarding intravesical foreign body. This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised 14 patients having intravesical foreign bodies from March 1989 to March 2013. Demographics, presentation, mode of insertion, type of foreign body and management were noted. Of the 11(78.6%) patients included in the study, 10(90.9%) patients were male and 1(9.1%) was female. The mean age was 51± 20 years. In 5(45.5%) patients, foreign bodies reached bladder by iatrogenic route followed by self-insertion in 4(36.4%) patients. Retrieved foreign bodes included piece of Foley\\'s catheter, electric wire, ureteric stent, plastic material, double-J stent pusher, Endo gastrointestinal (GI) staples, sticks of broom and bomb shrapnel. All patients were managed successfully with endoscopic removal. However, 5(45.5%) patients required additional urological procedures. This could represent a urologic challenge. Careful history and symptoms could lead to further investigations.

  5. Musculoskeletal manifestations in diabetic patients at a tertiary center

    African Journals Online (AJOL)

    2012-10-29

    Oct 29, 2012 ... in association with limited joint mobility in the absence of Raynaud phenomenon, calcinosis, and telangiectasia. 3) CTS was defined as weakness or pain of the hand, evidence of thenar atrophy, or nocturnal paresthesia of the thumb, index, and long fingers, with or without a positive Tinel's or Phalen's sign.

  6. Musculoskeletal manifestations in diabetic patients at a tertiary center

    African Journals Online (AJOL)

    2012-10-29

    Oct 29, 2012 ... of this study was to determine the frequency of MSK in diabetic patients and to examine the possible predictors for its development. Methods: We performed a cross-sectional study from June 1, 2010, to June 30, 2011, to evaluate MSK manifestations in adult diabetic patients at an outpatient clinic of King ...

  7. [Open acess to endoscopy in a tertiary referal center].

    Science.gov (United States)

    Morelos, Erick Joel Reyes; Cruz, Enrique Paredes; Hernández, Margarita Guerrero

    2006-01-01

    The purpose of this study was to determine the yield of open access endoscopy in a third level Mexican hospital. Open access endoscopy is common in United States of America and Europe (endoscopy is performed without prior specialist consultation). In Mexico this system hasn't become popular yet. The usefulness of open access endoscopy has been questioned. Some indications for upper gastrointestinal endoscopy (UGE) aren't included in the guidelines for appropriate use of endoscopy. All patients referred to diagnostic UGE in our hospital were admitted during a period of 30 days. The indications of UGE were analyzed by means the American Society of Gastrointestinal Endoscopy (ASGE) guidelines for the appropriate use of upper gastrointestinal endoscopy. Relevant findings were analyzed to all UGE performed in the study. The mean age of the 208 patients studied was 52.5 years; 169 UGE (81.2%) were appropriated according to the ASGE guidelines. Seventy-five percent of appropriate UGE had relevant findings compared with 59% of inappropriate UGE (p open acces endoscopy.

  8. 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.

  9. 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...... critical whiteness studies to emerge, its relation to the U.S. theoretical framework, as well as the particularities of the European context need to be taken into account.. The article makes a call for a multi-layered approach to take over from the identity politics so often employed in the fields of U...

  10. 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"...

  11. Tertiary hypothyroidism in a dog

    Directory of Open Access Journals (Sweden)

    Shiel Robert E

    2007-02-01

    Full Text Available A nine-year-old male entire Labrador was diagnosed with pituitary dependent hyperadrenocorticism. Following seven months of successful mitotane therapy, the dog presented with marked weight gain, seborrhoea and alopecia. Routine clinicopathological analyses revealed marked hypercholesterolaemia. Serum total and free thyroxine (T4 concentrations were below their respective reference ranges. Serum thyroid stimulating hormone (cTSH concentration was within reference range. TSH and thyrotropin releasing hormone (TRH response tests revealed adequate stimulation of total T4 in both, and cTSH in the latter test. Magnetic resonance imaging revealed a mass arising from the pituitary fossa, with suprasellar extension. A diagnosis of tertiary hypothyroidism was made. Following four weeks of levothyroxine therapy, circulating cholesterol concentration had declined, weight loss had ensued and dermatological abnormalities had improved. Euthanasia was performed four months later due to the development of neurological signs. A highly infiltrative pituitary adenoma, with effacement of the overlying hypothalamus was identified on post mortem examination. Tertiary hypothyroidism has not been previously reported in dogs.

  12. 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...

  13. Retrospective analysis of 88,429 serum and urine glucose EQA results obtained from professional laboratories and medical offices participating in surveys organized by three European EQA centers between 1996 and 2007.

    Science.gov (United States)

    Morandi, Pierre-Alain; Deom, André; Kesseler, Dagmar; Cohen, Richard

    2010-09-01

    The aim of this study was to provide inter-laboratory imprecision comparisons of different groups of diagnostic systems as well as a comparison of professional laboratories with medical offices performance on the basis of 88,429 glucose results obtained in external quality assessment (EQA) schemes organized by three European EQA centers between 1996 and 2007. A simple, non-parametrical statistical model suited to all EQA results, including outliers, was used to calculate yearly and global performance. The best performance was obtained from professional laboratories with a group of three diagnostic systems--Hitachi, Integra, and Vitros, followed by Cobas Mira, and finally by Reflotron. For medical offices, the best performance was achieved with the Cobas Mira diagnostic systems, followed by the Reflotron, SpotChem, and Vitros DT60 diagnostic systems. A slight but overall improvement in performance over time was observed for most diagnostic devices. The analysis of glucose EQA results collected over a 12-year period showed that professional laboratories obtained better performances than medical offices, and that a general improvement in yearly performance was observed for both types of laboratories.

  14. Training and mobility: a priority for the Organisation of the European Cancer Institutes. How a national mobility initiative could enhance EU cooperation in cancer research contributing to the development of an European Research Area: the example of The Italian Comprehensive Cancer Centers' Network "Alleanza Contro il Cancro".

    Science.gov (United States)

    Lombardo, Claudio; Albanese, Daniela; Belardelli, Filippo; d'Alessandro, Francesca; Giacomini, Mauro; Rondanina, Tania; Spagnoli, Luigi G

    2008-01-01

    It is widely recognized that productivity gains, sustained economic growth and employment are largely determined by technological progress, innovation and human capital. The 2000 Lisbon strategy to make Europe a competitive knowledge-based economy by 2010 and, more specifically, the Barcelona objectives agreed upon in 2002 to increase R&D investment in the EU to approach 3% of GDP, ensuring that there are sufficient human resources for research, are a preliminary step in this direction. If we want to reach this goal we have to succeed in retaining the best researchers, creating the right environment where they can perform their activities and develop their careers. To this aim the Organization of European Cancer Institutes (OECI) has set up a working group on Education and Training with the mandate to encourage continuing education in cancer research and applications and to verify the feasibility to promote mobility programs inside the network and in association with industries. Until now only few OECI training programs have been launched and a full mobility program has not been developed yet due to limited budget resources. The Italian Network of Comprehensive Cancer Centers, Alleanza Contro il Cancro, has planned the launch of a mobility program awarding 70 annual fellowships over a period of 36 months. This program, which will be open to the world research community, could represent a first interaction through mobility among the members of the OECI network also involving industries. The program is a tangible approach to sustain the translational process needed for the development of an European Research Area in the field of cancer and its related biomedical disciplines, thus providing a practical answer to the 2005 renewed Lisbon Strategy.

  15. 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...

  16. Supporting Low Ability Learners in a Tertiary Level Compulsory English Programme Using CEFR Based Online Language Software

    Science.gov (United States)

    Lynch, Gavin; McKeurtan, Maureen

    2012-01-01

    This report describes the processes, methods and results of using language software based on the Common European Framework of Reference for Languages (CEFR) in a tertiary level institute in Japan in order to facilitate the learning of low ability learners of English. None of the learners were English majors, all were between the ages of 18 and 20,…

  17. Detailed analysis of electricity consumption in tertiary buildings as a basis for energy efficiency policies

    Energy Technology Data Exchange (ETDEWEB)

    Gruber, Edelgard [Fraunhofer Inst. for Systems and Innovation Research (Fraunhofer ISI) (Germany); Sofronis, Ilias [Centre for Renewable Energy Sources (CRES) (Greece); Dusee, Rinto [Weerdenburg Huisvesting Consultants (WHC) (Netherlands); Plesser, Stefan [Inst. for Building and Solar Technology (IGS), Technical Univ. Braunschweig (Germany)

    2007-07-01

    Electricity consumption in the tertiary sector is still increasing - by 3 % per year between 1995 and 2005 in the EU-25 countries - and a further increase is expected of more than 2 % per year over the next 15 years. The tertiary sector includes companies and institutions of public and private services with very heterogeneous economic and energy-related characteristics. A study of the current state of data in the tertiary sector in European countries revealed that the availability of disaggregated data on electricity consumption and its use by purpose (lighting, office equipment, ventilation, air conditioning, etc.) is poor. Building managers and decision-makers are not well enough informed about the electricity consumption structure and electricity-saving potentials. EL-TERTIARY develops a harmonised methodology for monitoring electricity consumption and applies it in more than 100 cases in 12 EU countries. Implications for dissemination and energy efficiency policies will be derived. It is regarded as important to have an exchange of experiences on these issues within the scientific community and with actors and decision-makers in order to develop efficient instruments for practical use. EL-TERTIARY is an EU Intelligent Energy project under Key Action 4 'Energy efficient equipment and products'.

  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. What can existing overeducation tell us about the situation in supply and demand of tertiary educate

    OpenAIRE

    Miroslav Štefanik

    2011-01-01

    The submitted article deals with the problem of overeducation. It offers a brief overview of existing explanations and introduces a method of overeducation measurement based on internationally used classifications ISCO and ISCED. It also brings some evidence on overeducation measured by this method, using data mostly from the National level census and European Community Household Panel. The analysis is focused on the overeducation of workers with tertiary degrees, which becomes especially int...

  20. Pattern and prevalence of ameloblastoma in a tertiary hospital – a ...

    African Journals Online (AJOL)

    Background: Ameloblastoma is the commonest odontogenic tumour afflicting our populace. Furthermore, its management has been engulfed in controversy.As a tertiary institution serving as a referral center to neighboring states, no evaluation of demographics, clinical, radiological and pathological picture of ...

  1. 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 ...

  2. 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.

  3. Retrospective study on cost distribution of antiretroviral therapy in a tertiary care hospital

    OpenAIRE

    Shreenivas P. Revankar; H. Vedavathi

    2015-01-01

    Background: Acquired immunodeficiency syndrome (AIDS) is caused by human immunodeficiency virus (HIV), which is an RNA virus. The first case of AIDS in human beings was reported in 1981, and now spread of HIV infection is alarmingly high with around 20 million deaths. The objective of the study was to determine the cost distribution of antiretroviral therapy among autoimmune deficiency syndrome (AIDS) patient attending the anti-retroviral therapy (ART) center of the tertiary care center. M...

  4. misconception of emergency contraception among tertiary school ...

    African Journals Online (AJOL)

    formation of reproductive health clubs in our tertiary institutions and training of peer group educators in all our communities ... social issue in.the developing worldl. In Nigeria .... and alcohol (illicit gin and stout-6. 1%). .... They are cheap, readily.

  5. Tertiary oil recovery: potential application and constraints

    Energy Technology Data Exchange (ETDEWEB)

    Geffen, C. A.

    1978-06-01

    The technology of tertiary oil recovery methods is described and potential economic and environmental constraints to future commercial application are identified. Oil recoverable by tertiary techniques represents a domestic resource of between 11- and 42-billion barrels. Estimates of additional oil supplies from tertiary methods by the year 2000 range from 1 to 8 million barrels per day, depending on the price of oil and the rate of technological development. The principal constraints to large-scale application of tertiary methods at the present time include environmental, economic and technological concerns. Regulatory action associated with the Clean Air Act Amendments of 1977 currently delay the expansion of thermal recovery operations in California and may discourage future projects. The high production costs of tertiary projects also hamper process implementation. Further testing and research is necessary to develop the technology of tertiary recovery methods and prove these techniques successful on a field-wide scale. To enable tertiary oil recovery to play a significant role in augmenting domestic energy supplies, further research and development is necessary. More accurate methods of determining reservoir structure and residual oil saturations are required, as well as means for assuring the technical feasibility and success of a tertiary method in different reservoir types. Technical process limitations must also be resolved. The severity of potential environmental impacts and constraints identified in this report should be determined. These concerns include the air pollutant emissions from steam generation in thermal processes; acceptable methods of brine disposal; damage due to runoff or accidental discharge of oil-rich chemicals into surface waters; the impacts of fluid injection on deep aquifers and the prevailing geological structure; and an adequate supply of high quality fresh water.

  6. 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.

  7. Tertiary Logistics in the Focus of All Logistics

    OpenAIRE

    Ratko Zelenika; Mirjana Grèiæ; Helga Pavliæ Skender

    2008-01-01

    Trade logistics, traffic logistics, transport logistics and warehouse logistics are just some of the tertiary logistics which enables production processes of all economic sector products and services. Tertiary logistics representing the tertiary economic sector is the most sofisticated and the most important logistics due to the characteristics of the tertiary sector as a service sector that promotes business conditions in all economic sectors. Accordingly, tertiary logistics has a crucial ro...

  8. European and Integration Studies

    Directory of Open Access Journals (Sweden)

    N. Yu. Kaveshnikov

    2014-01-01

    Full Text Available Soviet scientific school of pan-European integration studies began to emerge in the 1960s at the Institute of World Economy and International Relations (Russian Academy of Science. Among the leading scientists who have developed methodological approaches of Soviet integration studies were M.M. Maximova, Y.A. Borko, Y. Shishkov, L.I. Capercaillie. Later, a new center for integration studies became the Institute of Europe, created in 1987. It was led by such renowned scientists as Academicians V.V. Zhurkin and N.P. Shmelev. In the 1980s the subject of the integration process in Europe attracted attention of experts from MGIMO. An important role in the development of school of integration research in the USSR was played by a MGIMO professor, head of the chair of history of international relations and foreign policy of the USSR V.B. Knyazhinskiy. His work contributed to the deliverance of the national scientific community from skepticism about the prospects for European integration. Ideas of V.B. Knyazhinsky are developed today in MGIMO by his followers A.V. Mal'gin and T.V. Ur'eva. In the mid-1990s, having retired from diplomatic service, professor Yu. Matveevskiy started to work at MGIMO. With a considerable practical experience in the field, he produced a series of monographs on the history of European integration. In his works, he analyses the development of integration processes in Western Europe from their inception to the present day, showing the gradual maturation of the necessary spiritual and material prerequisites for the start of integration and traces the various stages of the "integration". In the late 1990s, the growing demand from the domestic business and government for professionals who are capable of interacting with the European Union, has produced the necessary supply in the form of educational programs based on accumulated scientific knowledge. Setting up a discipline "European Integration" was a major step in the development

  9. 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

  10. Overeducation among European University Graduates: A Comparative Analysis of Its Incidence and the Importance of Higher Education Differentiation

    Science.gov (United States)

    Barone, Carlo; Ortiz, Luis

    2011-01-01

    The incidence of overeducation in eight European countries is here assessed by means of multiple indicators. With the exception of Spain, the results reveal that overeducation is a minor risk amongst European tertiary graduates. Yet, the contrast between different indicators reveals the existence of an overeducation of a moderate kind in countries…

  11. Prevalence of age-related maculopathy in older Europeans: The European Eye Study (EUREYE)

    NARCIS (Netherlands)

    C. Augood (Cristina); J.R. Vingerling (Hans); P.T.V.M. de Jong (Paulus); U. Chakravarthy (Usha); J.H. Seland (Johan ); G. Soubrane; L. Tomazzoli (Laura); F. Topouzis (Fotis); G.C. Bentham (Graham ); M. Rahu; J. Vioque (Jesus); I.S. Young (Ian ); A.E. Fletcher (Astrid E.)

    2006-01-01

    textabstractObjective: To estimate the prevalence of age-related maculopathy in an older population from 7 European countries. Methods: Randomly sampled people 65 years and older were invited to an eye examination in centers across 7 European countries (Norway, Estonia, United Kingdom, France,

  12. Smart Utilization of Tertiary Instructional Modes

    Science.gov (United States)

    Hamilton, John; Tee, Singwhat

    2010-01-01

    This empirical research surveys first year tertiary business students across different campuses regarding their perceived views concerning traditional, blended and flexible instructional approaches. A structural equation modeling approach shows traditional instructional modes deliver lower levels of student-perceived learning quality, learning…

  13. 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.

  14. Adapting Cooperative Learning in Tertiary ELT

    Science.gov (United States)

    Ning, Huiping

    2011-01-01

    An updated guideline for tertiary ELT in China has shifted the emphasis to the development of learners' ability to communicate in English. Using group work and getting learners actively involved in the actual use of English are highlighted more than before. This article focuses on adapting cooperative learning methods for ELT with tertiary…

  15. Tertiary Aminourea-Catalyzed Enantioselective Iodolactonization

    Science.gov (United States)

    Veitch, Gemma E.

    2010-01-01

    Binding the anion: A highly enantioselective iodolactonization of 5-hexenoic acids has been achieved using a tertiary aminourea-catalyst. The use of catalytic iodine in this process is critical to enhancing both the reactivity and enantioselectivity of the stoichiometric I+source.The mechanism is proposed to involve binding of an iodonium imidate intermediate by the H-bond donor catalyst. PMID:20803601

  16. Tertiary Education and Training in Australia, 2009

    Science.gov (United States)

    National Centre for Vocational Education Research (NCVER), 2011

    2011-01-01

    Sourcing data from the National VET Provider Collection and the Higher Education Statistics Collection, this publication provides a summary of participation in tertiary education and training in Australia. It covers participation in Australian Qualifications Framework certificate I qualifications through to doctorates by research, as well as…

  17. Simple tertiary phosphines to hexaphosphane ligands: Syntheses ...

    Indian Academy of Sciences (India)

    Abstract. Designing efficient phosphorus-based ligands to make catalysts for homogeneous catalysis has been a great challenge for chemists. Despite a plethora of phosphorus ligands ranging from simple tertiary phosphines to polyphosphines are known, the enthusiasm to generate new ones is mainly due to the demand.

  18. Recruitment Of International Students Into Cameroon Tertiary ...

    African Journals Online (AJOL)

    This paper highlights the importance of Cameroon\\'s tertiary institutions\\' cooperation links with other African Universities given the rebirth of Organisation of African Unity as African Union, and the New Partnership for Africa Development (NEPAD). The present system of recruiting international students is haphazardly been ...

  19. Misconception of emergency contraception among tertiary school ...

    African Journals Online (AJOL)

    Community enlightenment about emergency contraception using specifically designed programmes, the formation of reproductive health clubs in our tertiary institutions and training of peer group educators in all our communities are advocated. Patent medicine dealers in our communities should have basic training in ...

  20. Sexual promiscuity among female undergraduates in tertiary ...

    African Journals Online (AJOL)

    The study focused on sexual promiscuity among female undergraduates and the attendant health implications. It was carried out in the tertiary institutions in Imo State using 415 final year degree students drawn from four institutions in the State. Three research questions were formulated to guide the study. The design was a ...

  1. HIV test counselling at a tertiary hospital

    African Journals Online (AJOL)

    AIDS training course presented either by the medical school or an AIDS training centre. In view of the perceived lack of training in general counselling, this would perhaps be most effective as part of a formal general counselling programme for all undergraduates. In a tertiary hospital one has the added benefit of a large.

  2. 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.

  3. Constructing Knowledge Societies : New Challenges for Tertiary Education

    OpenAIRE

    World Bank

    2002-01-01

    This report describes how tertiary education contributes to building up a country's capacity for participation in an increasingly knowledge-based world economy and investigates policy options for tertiary education that have the potential to enhance economic growth and reduce poverty. It examines the following questions: What is the importance of tertiary education for economic and social ...

  4. Profile of children admitted with seizures in a tertiary care hospital of Western Nepal

    OpenAIRE

    Adhikari, Sudhir; Sathian, Brijesh; Koirala, Deepak Prasad; Rao, Kalipatnam Seshagiri

    2013-01-01

    Background Seizure is one of the common causes of childhood hospitalization with significant mortality and morbidity. There is limited data regarding acute seizures episodes form the developing countries. Current study aims to find the common etiology of seizure and classify seizure types in various age groups presenting to tertiary center in Western Nepal. Methods This was a hospital based retrospective study carried out in the data retrieved from the records maintained in the Department of ...

  5. Incorporating Cross-Cultural Videoconferencing to Enhance Content and Language Integrated Learning (CLIL) at the Tertiary Level

    Science.gov (United States)

    Loranc-Paszylk, Barbara

    2016-01-01

    This paper attempts to provide evidence of cross-cultural videoconferencing affordances with reference to a Content and Language Integrated Learning (CLIL) context at the tertiary level. At the core of CLIL lie student-centered paradigms of teaching methodologies that invite task and project work and authentic and meaningful communication, while…

  6. Effect of person centered counselling on depressive symptoms ...

    African Journals Online (AJOL)

    Effect of person centered counselling on depressive symptoms among Type II diabetic patients attending the general outpatient Clinic of A Tertiary Hospital in North Central Nigeria. ... It is recommended that family physicians be trained to provide person centered counselling for depressed type II diabetes mellitus patients.

  7. 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

  8. Tertiary fatty amides as diesel fuel substitutes

    Energy Technology Data Exchange (ETDEWEB)

    Serdari, Aikaterini; Lois, Euripides; Stournas, Stamoulis [National Technical Univ. of Athens, Dept. of Chemical Engineering, Athens (Greece)

    2000-07-01

    This paper presents experimental results regarding the impact of adding different tertiary amides of fatty acids to mineral diesel fuel; an assessment of the behaviour of these compounds as possible diesel fuel extenders is also included. Measurements of cetane number, cold flow properties (cloud point, pour point and CFPP), density, kinematic viscosity, flash point and distillation temperatures are reported, while initial experiments concerning the effects on particulate emissions are also described. Most of the examined tertiary fatty amides esters have very good performance and they can be easily prepared from fatty acids (biomass). Such compounds or their blends could be used as mineral diesel fuel or even fatty acid methylesters (FAME, biodiesel) substitutes or extenders. (Author)

  9. Missed injury and the tertiary trauma survey.

    Science.gov (United States)

    Thomson, Charles B; Greaves, Ian

    2008-01-01

    Missed injury in the context of major trauma remains a persistent problem, both from a clinical and medico-legal point-of-view. Estimates of the incidence vary widely, dependent on the precise parameters of the studied population, the definition of missed injury and the extent of follow-up, but may be as high as 38%. The tertiary survey, in which formal repeated examination of the patient is undertaken after initial resuscitation and treatment have taken place, has been suggested as a way of identifying injuries not found at presentation. This paper appraises the concept of the tertiary survey, and also reviews the literature on missed injury in order to identify the risk factors, the types of injury and the reasons for error.

  10. 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.

  11. Exploring Tertiary Students' Understanding of Covalent Bonding

    Science.gov (United States)

    Coll, Richard K.; Treagust, David F.

    2002-02-01

    There has been little research into learners' mental models of chemical bonding at any level, let alone the tertiary level. Undergraduate and graduate students encounter a plethora of sophisticated and highly abstract mental models for chemical bonding, and this study sought to investigate if there are preferred mental models for the concept of covalent bonding for secondary, undergraduate, and graduate chemistry learners. In particular, it was of interest to see whether exposure to increasingly sophisticated mental models at different points in a chemistry education showed up in patterns of preference and use of models in interpreting common physical properties and phenomena. The study revealed that, despite evidencing expertise in a number of highly complex and mathematically sophisticated mental models, tertiary students, including graduates (MSc and PhD), show a strong preference for simple realistic mental models. Furthermore, the students struggled to use their mental models to explain the physical properties of covalently bonded substances.

  12. Regional tertiary cross sections: Texas Gulf Coast

    Energy Technology Data Exchange (ETDEWEB)

    Debout, D.G.; Luttrell, P.E.; Seo, J.H.

    1976-01-01

    Regional studies of the Frio Formation along the Texas Gulf Coast were conducted to evaluate potential geothermal energy from deep, geopressured sandstone reservoirs. Published regional cross sections, unpublished cross sections provided by several major oil companies, and extensive micropaleontological and electrical-log files at the Bureau of Economic Geology served as basic data. These sections are meant to show gross regional distribution of sand and shale facies both laterally and vertically throughout the entire Tertiary section along the Texas Gulf Coast.

  13. Alcohol consumption in tertiary education students

    Directory of Open Access Journals (Sweden)

    Reavley Nicola J

    2011-07-01

    Full Text Available Abstract Background Heavy alcohol consumption among adolescents and young adults is an issue of significant public concern. With approximately 50% of young people aged 18-24 attending tertiary education, there is an opportunity within these settings to implement programs that target risky drinking. The aim of the current study was to survey students and staff within a tertiary education institution to investigate patterns of alcohol use, alcohol-related problems, knowledge of current National Health and Medical Research Council (NHMRC guidelines for alcohol consumption and intentions to seek help for alcohol problems. Methods Students of an Australian metropolitan university (with staff as a comparison group participated in a telephone interview. Questions related to knowledge of NHMRC guidelines, drinking behaviour, alcohol-related problems and help-seeking intentions for alcohol problems. Level of psychological distress was also assessed. Results Of the completed interviews, 774 (65% were students and 422 (35% were staff. While staff were more likely to drink regularly, students were more likely to drink heavily. Alcohol consumption was significantly higher in students, in males and in those with a history of earlier onset drinking. In most cases, alcohol-related problems were more likely to occur in students. The majority of students and staff had accurate knowledge of the current NHMRC guidelines, but this was not associated with lower levels of risky drinking. Psychological distress was associated with patterns of risky drinking in students. Conclusions Our findings are consistent with previous studies of tertiary student populations, and highlight the disconnect between knowledge of relevant guidelines and actual behaviour. There is a clear need for interventions within tertiary education institutions that promote more effective means of coping with psychological distress and improve help-seeking for alcohol problems, particularly among

  14. SPEAKING STRATEGIES USED BY INDONESIAN TERTIARY STUDENTS

    Directory of Open Access Journals (Sweden)

    Wawa Puja Prabawa

    2016-06-01

    Full Text Available Speaking is considered to be difficult thing, moreover English as a foreign language. Students' performance depends on their personalities. Students who have low participation in speaking activity in the classroom lose their opportunity to practice their speaking skill which may cause poor speaking skill and achievement. However, some of students are active in speaking activity in the classroom that leads them to have good skill and achievement in speaking. This study attempts to reveal: (1 speaking strategies used by Indonesian tertiary students in terms of speaking English and strategies to improve their speaking ability, and (2 to identify speaking strategies mostly used by the students when they speak English and improve their speaking ability. This study is a descriptive research since its purpose is to describe the Indonesian tertiary students’ learning strategies in learning speaking English. The data from 15 tertiary students, who have good performance and achievement in speaking, from one of schools of higher education in Cimahi were collected using a 21 items questionnaire of a modified version of Strategy Inventory Language Learning (SILL and 5 items interview questions. The result of the study revealed that some speaking strategies are used in terms of speaking English and improve speaking ability, namely cognitive, metacognitive and compensation strategy. In the type of speaking strategy that mostly used by the student in terms of speaking English is compensation strategy, while cognitive strategy was indicated as the mostly speaking strategies used by the Indonesian tertiary students in improving their speaking ability. Considering to the study conducted, it is recommended to students that they should know what strategies that appropriate and can help them in learning speaking English. The students should be able to choose strategies they need in learning and analyze which strategies that give better effect on their own learning.

  15. EUROPEAN AUSTERITY WITHOUT GROWTH? EUROPEAN GROWTH WITHOUT EUROPEAN DEMOCRACY?

    Directory of Open Access Journals (Sweden)

    Montani Guido

    2011-07-01

    Full Text Available The European project is facing a crisis. Citizens no longer understand what the EU is about. Young people and the new ruling class have forgotten the clear message of the European project launched just after the Second World War "No wars ever again among Europeans." The founding fathers of the European Union are mentioned in history textbooks, but today Europe is felt as an irritating bureaucracy. In Europe, peace and economic stability are considered as a natural state, a gift from above. Why keep a useless EU alive? The state of the European Union is swiftly degenerating. In almost all the member states, the anti-European forces are gaining ground. Populism is not a new ideology and is not necessarily European: let's recall Peronism. In today's Europe populism is the new manifestation of nationalism. In Italy the Lega Nord is in Berlusconi's eurosceptic government. In France, the National Front is endangering UMP's hegemony. In Belgium the rows between the Flemish and the Walloons threatens the state's unity. In the Netherlands, Hungary, the Czech Republic, Austria and Finland, populist forces are either in the government or strongly influencing the government. National-populism is different from the nationalism of the past. De Gaulle's nationalism was an ideology founded on the "grandeur" of France's history and on a certain idea of Europe, which was "l'Europe de patrie", a kind of European unity accepting French leadership in world politics. Today national-populism is a form of micro-nationalism: it opposes the European project but without having a serious alternative. This is why populism is dangerous. Its real goal is not only the breaking down of the European Union but also the disintegration of the old nation states into micro-ethnic states, as what happened in former Yugoslavia.

  16. 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.

  17. The European NEO Coordination Centre

    Science.gov (United States)

    Perozzi, E.; Borgia, B.; Micheli, M.

    An operational approach to NEO (Near-Earth Object) hazard monitoring has been developed at European level within the framework of the Space Situational Awareness Program (SSA) of the European Space Agency (ESA). Through federating European assets and profiting of the expertise developed in European Universities and Research Centers, it has been possible to start the deployment of the so-called SSA NEO Segment. This initiative aims to provide a significant contribution to the worldwide effort to the discovery, follow-up and characterization of the near-Earth object population. A major achievement has been the inauguration in May 2013 of the ESA NEO Coordination Centre located at ESRIN (Frascati, Italy). The goal of the NEOCC Precursor Service operations is twofold: to make available updated information on the NEO population and the associated hazard and to contribute to optimize the NEO observational efforts. This is done by maintaining and improving a Web Portal publicly available at http://neo.ssa.esa.int and by performing follow-up observations through a network of collaborating telescopes and facilities. An overview of the SSA-NEO System and a summary of the first two years of NEOCC operations is presented.

  18. 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.

  19. Educating in European Identity?

    National Research Council Canada - National Science Library

    Enrique Banús

    2007-01-01

    In the last decades, the claim for a "European identity" has been manifested sometimes as a solution for the citizens' distance to the European project, sometimes also as a precondition for a further...

  20. 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.

  1. Effect of body mass index on histopathologic parameters: results of large European contemporary consecutive open radical prostatectomy series.

    Science.gov (United States)

    Isbarn, Hendrik; Jeldres, Claudio; Budäus, Lars; Salomon, Georg; Schlomm, Thorsten; Steuber, Thomas; Chun, Felix K H; Ahyai, Sascha; Capitanio, Umberto; Haese, Alexander; Heinzer, Hans; Huland, Hartwig; Graefen, Markus; Karakiewicz, Pierre

    2009-03-01

    To determine whether an increased body mass index (BMI) is a predictor of advanced pathologic findings in European men undergoing radical prostatectomy (RP). The relationship between obesity and prostate cancer is controversial. Studies, predominantly derived from the United States, have suggested that an increased BMI is a significant predictor of adverse pathologic findings in patients treated with open RP. From April 2005 to June 2008, 1538 consecutive patients were treated with open RP at a single tertiary referral center. We tested the effect of BMI on the rate of extracapsular extension, seminal vesicle invasion, lymph node invasion, and positive surgical margins in univariate and multivariate logistic regression models. The covariates consisted of clinical stage, prostate-specific antigen, biopsy Gleason score, age, prostate volume, and rate of nerve-sparing surgery. On multivariate analysis, both continuously coded and categorically coded BMI was unrelated to the rate of extracapsular extension (odds ratio [OR] 1.02, P = .5), seminal vesicle invasion (OR 1.03, P = .3), lymph node invasion (OR 0.98, P = .7), or positive surgical margins (OR 1.03, P = .3). Obese patients who are candidates for open RP should not expect to have worse pathologic findings after surgery than their nonobese counterparts. Differences in patients' weight and height between North America and Europe might explain the lack of adverse effects of an elevated BMI in this European cohort.

  2. Europeanization and transnational states

    DEFF Research Database (Denmark)

    Jacobsson, Bengt; Lægreid, Per; Pedersen, Ove K.

    This work investigates what happens to an organized political unit when it becomes part of a larger entity and, in particular, how increased European integration and the tentative moves towards a transnational state will affect the European Union's nation state. Europeanization and the transforma......This work investigates what happens to an organized political unit when it becomes part of a larger entity and, in particular, how increased European integration and the tentative moves towards a transnational state will affect the European Union's nation state. Europeanization...... in central government agencies. It concludes that the consequences of Europeanization can be described as the growth of a transnational administration where identities as well as loyalties are created in processes that transcend the borders of states....

  3. European Union Climate Change Objectives

    Energy Technology Data Exchange (ETDEWEB)

    Lewiner, C.

    2007-08-15

    In March 2007, the European Union Ministers asked Member States to commit to energy consumption and Greenhouse Gases (GHG), mainly CO2 emissions, reductions of 20%, as well as a portion of 20% of renewable energies in their energy production. The horizon of this 'three times 20% objective' is 2020. The underlying assumption is of course an improved security of energy (and electricity) supplies as well as a growing European economy with sustained tertiary and industrial employment. These objectives were articulated to respond to the present Climate Change issues by avoiding an increase of our Planet's temperature beyond 2 to 3 degrees. In the US, the current government has recognized that CO2 is an issue and has begun to take action, issuing a number of executive orders to reduce emissions. This follows a ruling by the US Supreme Court on CO2. It may be that what is happening in Europe will be a model that the US will follow. These different objectives are interlinked and each European country is in a different situation. Moreover, 2020 is a relatively short time horizon compared to the lead time for construction of large plants such as nuclear plants. It is also a short time frame for the industrialization, at reasonable costs, of carbon sequestration equipment, for the renovation of a significant portion of the existing buildings and houses, and for the switch of the present car fleet to electrical cars. More than 20% of the cars bought in 2007 will still be on the road in 2020. More than 80% of the refrigerators bought in 2007 will still be in operation in 2020, and less than 1/3 of the industrial and utility infrastructures in place today will be renewed by 2020. It is even shorter at the Research and Development time scale to find and industrialize new energy savings devices or low energy consumption and low carbon emitting equipment. One important question is also the net cost linked to these objectives that has not been evaluated today. The

  4. Predictors of Patient Satisfaction with Tertiary Hospitals in Korea

    Directory of Open Access Journals (Sweden)

    Hye-Sook Ham

    2015-01-01

    Full Text Available This study examined the general and system-related predictors of outpatient satisfaction with tertiary health care institutions in Korea. A cross-sectional descriptive study design was employed. The subjects were 1,194 outpatients recruited from 29 outpatient clinics of a university medical center in Korea. Measurements included 5 outpatient service domains (i.e., doctor service, nurse service, technician service, convenience, and physical environment of facility and patient satisfaction. Of the five domains, nurse service was the domain with the highest mean score M=4.21 and convenience was the domain with the lowest mean score M=3.77. The most significant predictor of patient satisfaction was the constructs of convenience β=0.21. The results of this study suggest that the concept of patient satisfaction with health care institutions in modern hospitals reflects an integrative process that includes not only the concerned health care personnel but also improved convenience such as user-friendly reservation system and comfortable waiting areas.

  5. Experience of intravitreal injections in a tertiary Hospital in Oman.

    Science.gov (United States)

    Al-Hinai, Ahmed S

    2015-01-01

    To find out statistical data regarding intravitreal injections in an outpatient department setup at a tertiary center in Oman. Retrospective chart review. Data collection of patients who underwent intravitreal injections from November 2009 to May 2013 at Sultan Qaboos University Hospital. Throughout a period of 42 months, a total of 711 intravitreal injections were performed. That included 214 patients (275 eyes). Around one-third of the eyes received two injections or more. The injected agents were bevacizumab (59.8%), ranibizumab (32.3%), triamcinolone (7.5%), and very few patients with endophthalmitis received intravitreal antibiotics and antifungal agents. The three most common indications for the injection therapy were diabetic macular edema (50.9%), choroidal neovascularization (24.3%), and retinal vein occlusive diseases (11.5%). Serious adverse events were rare, and they occurred as ocular (0.9% per patient) and systemic (3.3% per patient). There were 42 eyes received intravitreal triamcinolone, and 24% of them developed intraocular hypertension that required only medical treatment. Different intravitreal agents are currently used to treat many ocular diseases. Currently, therapy with intravitreal agents is very popular, and it carries a promising outcome with more efficiency and safety.

  6. Usage Center

    DEFF Research Database (Denmark)

    Kleinaltenkamp, Michael; Plewa, Carolin; Gudergan, Siegfried

    2017-01-01

    -actor value cocreation, this paper is the first to comprehensively andcoherently conceptualize the notion of a usage center. In doing so, the authorsbuild an important foundation for future theorizing related to the potentialemergence of usage centers as well as the cocreation of individual andcollective...

  7. Evaluation of the Special Tertiary Admissions Test (STAT)

    Science.gov (United States)

    Coates, Hamish; Friedman, Tim

    2010-01-01

    This paper reports findings from the first national Australian study of the predictive validity of the Special Tertiary Admissions Test (STAT). Background on tertiary admissions procedures in Australia is presented, followed by information on STAT and the research methods. The results affirm that STAT, through the provision of baseline and…

  8. Endourology in a Nigerian Tertiary Hospital – current level of ...

    African Journals Online (AJOL)

    Background: Endourology is rapidly advancing in developed countries. However, the level of practice in public tertiary hospitals in developing countries is abysmally low. Objective: To review the current practice of endourology in a Nigerian public tertiary hospital and discuss the challenges faced during the study period.

  9. 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 ...

  10. Opinions of Nigerian students in tertiary institutions on family size ...

    African Journals Online (AJOL)

    The study examined the opinions of Nigerian students in tertiary institutions on their ideal family size. It was conducted among students in four tertiary institutions in Edo State of Nigeria. A sample size of 454 final year students was randomly drawn from the halls of residence in the institutions using the stratified sampling ...

  11. Cost-minimization analysis of antimicrobial therapy in a tertiary ...

    African Journals Online (AJOL)

    Cost Minimization Analysis of antimicrobial therapy in a tertiary health care institution in a developing economy country was carried out. The most applicable tool for generic equivalent drugs was used in Ahmadu Bello University Teaching Hospital, a tertiary healthcare Institution in Nigeria, between 2005 and 2007. Relevant ...

  12. Conceptualising English as a lingua franca (ELF) as a tertiary ...

    African Journals Online (AJOL)

    This contribution draws on the notion of English as a lingua franca, especially as discussed in James (2006) and Smit (2010), to conceptualise English-medium tertiary education in settings where English functions as additional language and where tertiary education has a history of being undertaken in other, usually ...

  13. Solvent effects on the magnetic shielding of tertiary butyl alcohol ...

    African Journals Online (AJOL)

    The magnetic shielding and its polarizabilities, have been calculated for tertiary butyl alcohol and tertiary butyl amine. These have been used to rationalise the solvent shifts of the proton spectra of the interesting cosolvent systems with water recently measured by Kipkemboi, et al. Continuum solvation calculations and ...

  14. 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.…

  15. Pursuing Discipline and Ethical Issues in Tertiary Institutions in Nigeria

    African Journals Online (AJOL)

    Discipline and ethics are twin issues that tend to undermine the provision of quality education in tertiary institutions in Nigeria. This is because the overall goals of tertiary institutions as enunciated in the National Policy of. Education can hardly be achieved by all the stakeholders without strict conformity and adherence to the ...

  16. 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...

  17. 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.

  18. 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

  19. Grignard Synthesis of Various Tertiary Alcohols

    Science.gov (United States)

    Everett, T. Stephen

    1998-01-01

    A general Grignard procedure is presented for the synthesis of aliphatic, tertiary alcohols containing six to nine carbons. Without revealing the specific starting materials, students are challenged to identify their unknown products from physical (boiling points, refractive indices) and spectral (infrared O-H, C-H and fingerprint regions) data. Once a product is identified retro-synthetic considerations point to which alkyl halide and ketone were required as starting materials. This laboratory exercise in organic synthesis incorporates anhydrous techniques, distillation, and infrared analysis. RX + Mg ---> [RMgX] + R'R"C=O ---> [RR'R"COMgX] ---> RR'R"COH Criteria RX = C2-C5 1' alkyl bromide (unbranched) R'R"C=O = C3-C5 ketone RR'R"COH = C6-C9 3' alcohol

  20. Missed Opportunities for Influenza Vaccination Among Hospitalized Children With Influenza at a Tertiary Care Facility.

    Science.gov (United States)

    Rao, Suchitra; Williams, Joshua T B; Torok, Michelle R; Cunningham, Maureen A; Glodè, Mary P; Wilson, Karen M

    2016-09-01

    To identify the extent and characteristics of missed opportunities for influenza vaccination among children hospitalized with influenza at a tertiary children's hospital. We conducted a retrospective cohort study of hospitalized patients with polymerase chain reaction-confirmed influenza admitted to Children's Hospital Colorado from 2010 to 2014. We reviewed medical records for vaccination status and previous visits. The primary outcome was the proportion of underimmunized patients hospitalized with influenza with at least 1 missed opportunity visit (visit before influenza diagnosis in which an eligible patient did not receive the influenza vaccine). The relationship between sociodemographic characteristics and the primary outcome were examined using χ(2) tests and nonparametric tests, and variables with P vaccination. Multivariate analysis demonstrated that high-risk status (adjusted odds ratio 6.9, 95% confidence interval 3.8-12.4) was associated with increased odds of having a missed opportunity visit. Most missed opportunity visits were to subspecialty clinics (42%), and most visits (71%) occurred from September to November. More than 40% of hospitalizations for influenza in children are associated with at least 1 missed opportunity visit at a tertiary center. Our findings highlight the potential role of tertiary care institutions in increasing influenza vaccination rates among children. Copyright © 2016 by the American Academy of Pediatrics.

  1. Concentrações plasmáticas e eritrocitárias de zinco em idosos portadores e não-portadores de catarata senil em um serviço oftalmológico especializado de Teresina-Piauí Plasma and erythrocyte zinc concentrations in elderly patients with and without senile cataract in a tertiary eye care center at Teresina-Piauí

    Directory of Open Access Journals (Sweden)

    Fábio Martins Soares

    2008-10-01

    Full Text Available OBJETIVO: Determinar as concentrações plasmáticas e eritrocitárias de zinco em idosos portadores e não-portadores de catarata senil em um serviço oftalmológico especializado, em Teresina-Piauí. MÉTODOS: Estudo quantitativo, transversal e controlado, realizado no Hospital de Olhos Francisco Vilar, Piauí, Brasil. Participaram 56 idosos (37 mulheres, 19 homens sem condições associadas a modificações nos níveis de zinco ou aumento do risco de catarata. Escore > II foi utilizado para definir a presença de catarata, de acordo com o Lens Opacities Classification System II. As concentrações de zinco foram determinadas por espectrometria de absorção atômica em chama. Análise estatística incluiu os testes t de Student e qui-quadrado e 0,05 como nível de significância. RESULTADOS: Catarata senil foi identificada em 58,9% dos participantes, predominando o tipo nuclear (51,8%, seguido pelo cortical (26,8% e subcapsular posterior (8,9%. Deficiência de zinco no plasma (PURPOSE: To determine plasma and erythrocyte zinc concentrations in elderly with and without senile cataract in a tertiary eye care center at Teresina-Piauí. METHODS: A quantitative, transversal and controlled study was developed at the Hospital de Olhos Francisco Vilar, Piauí, Brasil. Fifty-six elderly subjects (37 females, 19 males with no known conditions that modify zinc blood levels or increase risk of cataract were included. A score >II was used to define cataract, according to Lens Opacities Classification System II. Plasma and erythrocyte zinc concentrations were determined by flame atomic absorption spectrometry. Statistical tests included Student's t and chi-square tests, with a probability level of 0.05 as significant. RESULTS: Senile cataract was present in 58.9% of the subjects. The most common type was nuclear (51.8%, followed by cortical (26.8% and posterior subcapsular (8.9%. Zinc deficiencies in plasma (<70 μg/dL and erythrocyte (<40 μg/gHb were

  2. 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

  3. 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.

  4. Groin Exploration for the Nonpalpable Testes: A Single Center ...

    African Journals Online (AJOL)

    Background: Management of non-palpable testes in Nigeria can be difficult due to late presentation and poor resources. Surgical exploration is often required for diagnosis and treatment. Aim: This study reviews the management outcome of clinically non-palpable testeis in a tertiary center in Nigeria. Materials and Methods: ...

  5. THE EUROPEAN BUSINESS CYCLE

    Directory of Open Access Journals (Sweden)

    Ignat Ion

    2009-05-01

    Full Text Available The construction of European Monetary Union has raised several questions about the existence of a common business cycle, a European one. The lack of cyclical synchronization would complicate the monetary and fiscal policies in the Union, being a negative

  6. 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...

  7. 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

  8. 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...

  9. European works councils

    DEFF Research Database (Denmark)

    Knudsen, Herman Lyhne

    2003-01-01

    The theme adressed by this paper is the opportunities for European Works Councils (EWCs) of gaining influence on corporate decisions in multinational companies.......The theme adressed by this paper is the opportunities for European Works Councils (EWCs) of gaining influence on corporate decisions in multinational companies....

  10. 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....

  11. Introduction: European climate leadership

    NARCIS (Netherlands)

    Wurzel, R.K.W.; Liefferink, J.D.; Connelly, J.

    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

  12. Europeanization : A Poststructuralist Approach

    NARCIS (Netherlands)

    Neuman-Stanivukovic, Senka

    2014-01-01

    This dissertation begins from the hypothesis that the direction and extent of Europeanization depends on domestic perception of the European Union and its norms. Accordingly, it was my empirical ambition to study how competing articulations of the EU and its norms constructed debates in EU member

  13. 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

  14. 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…

  15. Transcutaneous bowel sonography for inflammatory bowel disease is sensitive and specific when performed in a nonexpert low-volume North American center.

    Science.gov (United States)

    Sey, Michael Sai Lai; Gregor, Jamie; Chande, Nilesh; Ponich, Terry; Bhaduri, Mousumi; Lum, Andrea; Zaleski, Witek; Yan, Brian

    2013-08-01

    Transcutaneous bowel sonography is a nonionizing imaging modality used in inflammatory bowel disease. Although available in Europe, its uptake in North America has been limited. Since the accuracy of bowel sonography is highly operator dependent, low-volume centers in North America may not achieve the same diagnostic accuracy reported in the European literature. Our objective was to determine the diagnostic accuracy of bowel sonography in a nonexpert low-volume center. All cases of bowel sonography at a single tertiary care center during an 18-month period were reviewed. Bowel sonography was compared with reference standards, including small-bowel follow-through, computed tomography, magnetic resonance imaging, colonoscopy, and surgical findings. A total of 103 cases were included for analysis during the study period. The final diagnoses included Crohn disease (72), ulcerative colitis (8), hemolytic uremic syndrome (1), and normal (22). The sensitivity and specificity of bowel sonography for intestinal wall inflammation were 87.8% and 92.6%, respectively. In the subset of patients who had complications of Crohn disease, the sensitivity and specificity were 50% and 100% for fistulas and 14% and 100% for strictures. One patient had an abscess, which was detected by bowel sonography. Abnormal bowel sonographic findings contributed to the escalation of treatment in 55% of cases. Bowel sonography for inflammatory bowel disease can be performed in low-volume centers and provides diagnostic accuracy for luminal disease comparable with published data, although it is less sensitive for complications of Crohn disease.

  16. Potential impact of tertiary oil recovery

    Energy Technology Data Exchange (ETDEWEB)

    Kastrop, J.E.

    1975-11-01

    Tertiary oil recovery is America's energy ace-in-the-hole and the technology developed here over the past decade could well offer the rest of the world a big incremental boost in its future oil supplies. While U.S. producers are carefully engineering fields that have finished secondary phases of oil production, international operators are commencing pressure maintenance projects by water and gas injection, the first stage of improved oil recovery. Oil recovery authorities who have dealt with the problem for decades estimate that from 25 to 50 billion bbl could be recovered by relatively new sophisticated processes initially developed in the research laboratory and tested in the field. There are 4 basic processes that indicate promise of commercial applications. These are (1) hydrocarbon miscible which includes high-pressure gas drive, rich gas or LPG driven by gas; (2) carbon dioxide miscible with CO/sub 2/ driven by gas or water; (3) chemical flooding, such as surfactant, micellar slugs driven by an aqueous polymer solution; and (4) thermal processes.

  17. The Tertiary tectonics of the southeast Asia

    Energy Technology Data Exchange (ETDEWEB)

    Honza, Eiichi (Geological Survey of Japan, Tsukuba (Japan))

    1990-06-01

    Most of the terranes in eastern Asia appear to be relics of arcs, oceanic islands, and subduction complexes. They have collided and accreted from the inner (northwestern) side in China since the Silurian. They are characterized by three stages of Pacific and Tethys evolution. The first collision is related to the Pacific domain in the Permian in which these movements are not clearly reconstructed. The second collision is related to the closure of the Paleo-Tethys in the Late Triassic to Early Jurassic. The third is related to closure of the Neo-Tethys and the subsequent collision of India in the Tertiary. Southeast Asia is in one of the most enigmatic plate boundaries in the world, forming many small plates, collisions, and consumptions. This complication is also suggested to be a result of the northward movement of Australia since its break-up from Gondwanaland in the Cretaceous. During their evolution, most of them have associated with arcs. These arcs also have formed superimpositions on the older exotic blocks of terranes. They are reconstructed on the base of the regular duration on the formation of arcs and backarc basins, which can be seen in the Western Pacific Arc Chain.

  18. Overview the Tertiary Education in the capability approach. A propose to the discussion

    Directory of Open Access Journals (Sweden)

    Alejandra Boni Aristizábal

    2010-10-01

    Full Text Available The European tertiary world is probably undergoing the most important transformation since Humboldt; nowadays we are discussing, once more, on the big issues of education: what is its goal and how to get it. In this paper we would like to highlight the contribution that capability approach can bring into higher education. Firstly, we will present this approach and the list of 10 basic capabilities for higher education suggested by Melanie Walker. After that, we will show a practical experience carried out at the University of Sheffield in which we highlight the results in terms of capabilities of a project based on research-enhanced pedagogies. Lastly, we will summary some contributions and advantages that capability approach can bring into the building process of Higher Education Area and the future of higher education.

  19. Instrumental vaginal delivery - an assessment of use in a tertiary ...

    African Journals Online (AJOL)

    O'SHEHU

    Instrumental vaginal delivery - an assessment of use in a tertiary care centre. Constance E SHEHU. Joel C OMEMBELEDE. Dept of Obstetrics &. Gynaecology, Usmanu. Danfodiyo, University. Teaching Hospital Sokoto. NIGERIA. Author for Correspondence. Constance E SHEHU. Dept of Obstetrics &. Gynaecology, Usmanu.

  20. Aquatic Life Criteria - Methyl Tertiary-Butyl Ether (MTBE)

    Science.gov (United States)

    Information pertaining to the 1999 Acute and Chronic Ambient Aquatic Life Water Quality Criteria for Methyl Tertiary-Butyl Ether (MTBE) for freshwater and salt water. Information includes the safe levels of MTBE that should protect the majority of species.

  1. Language and Literature in Tertiary Education: The Case for Stylistics.

    Science.gov (United States)

    Buckledee, Steve

    2002-01-01

    Advocates the use of stylistics for teaching English-as-a-Foreign-Language at the tertiary level. Describes stylistics, discusses discourse conventions and grammatical structure, and examines stylistic analysis of a Shakespearian sonnet and a poem. (Author/VWL)

  2. DIRECT SYNTHESIS OF TERTIARY AMINES IN WATER USING MICROWAVES

    Science.gov (United States)

    A direct synthesis of tertiary amines is presented that proceeds expeditiously via N-alkylation of amines using alkyl halides in alkaline aqueous medium. This environmentally benign reaction is accelerated upon exposure to microwave irradiation resulting in shortened reaction tim...

  3. Pregnancy outcome in unbooked mothers at a tertiary health ...

    African Journals Online (AJOL)

    demographical characteristics and feto-maternal outcome in unbooked mothers who delivered at a tertiary referral ... Data obtained from the theatre records, delivery registers and case notes were analysed using the statistical package SPSS 20.

  4. 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 ...

  5. Primary Index Term Secondary Index Term Tertiary Index term ...

    Indian Academy of Sciences (India)

    chaubey

    Tertiary Index term. Geosciences. Solid earth. Tectonics. Structural Geology. Geodynamics. Seismology. Exploration geophysics. Seismic hazards. Geomagnetism. Mineralogy. Petrology. Metamorphic. Igneous. Sedimentary. Fossil fuels. Petroleum and coal. Isotope geology. Geochronology. Isotope geology. Landform and.

  6. Relative frequency of headache types: a longitudinal study in the tertiary care

    Directory of Open Access Journals (Sweden)

    Ariovaldo Alberto da Silva-Júnior

    2010-12-01

    Full Text Available In order to properly assess patients with primary headache, one needs to follow the cases up longitudinally. In Brazil, there were no studies using this methodology published after the publication of the latest issue of the International Classification of Headaches in 2004 - ICHD-2. This is especially important when we consider that it was only after such publication that we had the criteria used to classify some types of headaches which evolve with daily, or almost daily, spells, and which are very common in tertiary health care centers. OBJECTIVE: To assess the frequency of headache types in a tertiary health care center, in a longitudinal fashion. METHOD: We assessed 95 consecutive patients. These patients were diagnosed and classified according to the ICDH-2. The subjects were followed up for 18 months, they were treated and reassessed. RESULTS: Most of the individuals had more than one type of headache. Among those with episodic migraine in 2007, 6 developed chronic migraine in 2008, producing an incidence rate of 7.2%. Among those with chronic migraine in 2007, 9 remitted, producing a remission rate of 75%. In 2007, 24 individuals abused analgesic agents and 17 no longer showed abuse criteria in 2008 - when 7 new cases were found. CONCLUSION: The diagnosis of migraine remained stable. On the other hand, treatment brought about a reduction in the frequency of headaches caused by excessive use of analgesic, although the frequency of daily chronic headache was almost unaltered.

  7. Indications for and outcomes of tertiary referrals in refractive surgery.

    Science.gov (United States)

    Patryn, Eliza K; Vrijman, Violette; Nieuwendaal, Carla P; van der Meulen, Ivanka J E; Mourits, Maarten P; Lapid-Gortzak, Ruth

    2014-01-01

    To review the spectrum of disease, symptomatology, and management offered to patients referred for a second opinion after refractive surgery. A prospective cohort study was done on all patients referred from October 1, 2006, to September 30, 2011, to a tertiary eye clinic after refractive surgery of any kind (ie, corneal laser surgery, conductive keratoplasty, radial keratotomy, phakic implants, refractive lens exchanges, or any combination thereof). Data analysis was performed on all demographic and clinical aspects of this cohort, including the initial complaint, type of referral, number of complaints, procedure previously performed, diagnosis at our center, type of advice given, and rate and type of surgical intervention. One hundred thirty-one eyes (69 patients) were included. Corneal refractive surgery was performed in 82% (108 eyes), and 11% (14 eyes) were seen after phakic intraocular lens (PIOL) implantation and 7% (9 eyes) after refractive lens exchange. The most common diagnoses were tear film dysfunction (30 eyes, 23%), residual refractive error (25 eyes, 19%), and cataract (20 eyes, 15%). Most patients (42 patients, 61%) were treated conservatively. In 27 patients (39%), 36 eyes (28%) were managed surgically. Severe visual loss was seen in 1 eye. No major problems were found in most second opinions after refractive surgery referral. Dry eyes, small residual refractive error, or higher-order aberrations were the most common complaints. Surgical intervention was needed in 36 eyes (28%), almost half of which were cataract extractions. Severe visual loss was seen in 1 eye with a PIOL. There was no incidence of severe visual loss in keratorefractive and refractive lens exchange procedures. Copyright 2014, SLACK Incorporated.

  8. Mothers’ experiences of labour in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    M S Maputle

    2008-01-01

    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

  9. Primary salivary gland tumors in eastern Nepal tertiary care hospital.

    Science.gov (United States)

    Nepal, A; Chettri, S T; Joshi, R R; Bhattarai, M; Ghimire, A; Karki, S

    2010-04-01

    The knowledge of the distribution and pattern of salivary gland tumors in the tertiary care center can provide overview of the disease pattern in the region. It also helps in planning the strategies to treat the disease and launch the awareness program in the community to this largely curable disease. A retrospective observational study of all the salivary gland tumors treated in the department of Otolaryngology, B. P. Koirala Institute of Health Sciences during April 2004 to March 2009 was done. Age, sex, presenting features, radiological findings, histopathological type of the tumor and type of surgery were recorded and descriptive analysis was done to calculate frequencies, percentage and their relations. Out of total 51 cases, 81% (n=41) were benign and 19% (n=10) malignant tumors. Male to female ratio was 1:2.1. Mean age for benign and malignant tumors were 32.3 and 46.5 years respectively. Parotid tumor outnumbered all other sites comprising 69%, followed by submandiibular 18% and minor glands 13%. Pleomorphic adenoma was the commonest tumor (76%) of all primary salivary gland tumors. Benign to malignant tumor ratio of parotid, submandibular and minor glands were 6:1, 3.5:1 and 1.3:1 respectively. Adenoid cystic carcinoma (40%) and mucoepidermoid carcinoma (30%) were commonest malignant tumors. The principal site for salivary gland tumors in eastern Nepal population was the parotid and the pleomorphic adenoma outnumbered all other tumors. Most of the cases in both benign and malignant group presented with painless lump often misleading the gravity of disease.

  10. 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

  11. 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....

  12. Changes in Humoral and Cellular Immunity in Tertiary Peritonitis

    OpenAIRE

    Matviychuk, Oleh

    2017-01-01

    The objective of the research was to give a comparative characteristic of parameters of humoral and cellular immunity in the development of secondary and tertiary peritonitis.Materials and methods. The research enrolled 109 patients with secondary peritonitis, 20 of whom developed tertiary peritonitis. Changes in humoral and cellular immunity were evaluated by serial blood tests for the determination of leukocyte count, the relative number of lymphocytes, Ig A, M, and G levels, as well as by ...

  13. Update of European bioethics

    DEFF Research Database (Denmark)

    Rendtorff, Jacob Dahl

    2015-01-01

    , 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......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...... research in a presentation of the present understanding of the basic ethical principles in bioethics and biolaw....

  14. 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.

  15. 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.

  16. 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...

  17. 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)

  18. 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.

  19. The European University Landscape

    DEFF Research Database (Denmark)

    Daraio, Cinzia; Bonaccorsi, Andrea; Geuna, Aldo

    2011-01-01

    This paper provides a new and systematic characterization of 488 universities, from 11 European countries: Finland, France, Germany, Hungary, Italy, Netherlands, Norway, Portugal, Spain, Switzerland and UK. Using micro indicators built on the integrated Aquameth database, we characterize the Euro...

  20. 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......-economic resources. In a second step, the 28 EU member countries were clustered into six country clusters based on their representation of mobility styles. The country clusters indicate the existence of considerably different mobility cultures across the EU. Sub-regions can be identified that have highly different...... 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...

  1. European Cyber Security Policy

    OpenAIRE

    Bendiek, Annegret

    2012-01-01

    The gradually developing European cyber security policy tries to establish minimum standards in all EU member states with regard to prevention, resilience and international cooperation. It aims to foster national security without compromising democratic principles or unduly limiting individual liberties. However, it is hard to find a balance between these goals, and the EU’s measures thus inevitably raise questions about the democratic implications of European cyber security policy. Are the i...

  2. Timetabling on European Corridors

    OpenAIRE

    Lischke, Andreas; Führer, B. (Bernhard); Garavagno, G.

    2005-01-01

    The Path Allocation Re-engineering of Timetable Networks for European Railways (PARTNER) project aims to demonstrate a new way of train path allocation and assembly along international corridors towards a faster and more coordinated railway infrastructure capacity management. PARTNER will assist two neighbour infrastructure managers to develop a common understanding of the effects of international train paths. The results of a survey of European infrastructure managers and railway underta...

  3. European Physical Society awards

    CERN Multimedia

    2004-01-01

    The winners of the 2004 Accelerator Prizes, awarded by the European Physical Society's Interdivisional Group on Accelerators (EPS-IGA), have been announced. Vladmir Shiltsev (Fermilab) and Igor Meshkov (JINR, Joint Institute of Nuclear Research, Dubna) will be presented with their awards during the 9th European Particle Accelerator Conference, EPAC'04, on 8 July 2004 in Lucerne. Both physicists will also give a talk about their work. More details on: http://epac.web.cern.ch/

  4. European Banking Union

    OpenAIRE

    Breuss, Fritz

    2013-01-01

    The ongoing Euro crisis and the worse economic development in Europe than in the USA are grounded, not the least in the delayed implementation of reforms of the banking sector. Whereas the leaks in economic governance of EMU have been fixed the banking sector is still not stabilised, even five years after Lehman Brothers. From the grand solution of a "European Banking Union" (EBU) only the first pillar, the European Bank Supervision with the single supervisory mechanism (SSM) will come into e...

  5. European DHC Research Issues

    Energy Technology Data Exchange (ETDEWEB)

    Wiltshire, Robin; Williams, Jonathan (Building Research Establishment, BRE, Bucknalls Lane, Watford (United Kingdom)); Werner, Sven (Halmstad University, School of Business and Engineering, Halmstad (Sweden))

    2008-09-15

    Euroheat and Power is now working towards a European Technology Platform for District Heating and Cooling. In response to this important European DHC research initiative, a preliminary detailed list of research issues within 18 dimensions was elaborated and communicated to more than 100 people in February 2008. After additions and comments received, an updated list of research issues was again distributed in July 2008. This paper contains the current list of suggested research issues

  6. 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.

  7. An Examination of Referral Physician Attitudes Toward Brooke Army Medical Center as a Tertiary Care Medical Center

    Science.gov (United States)

    1986-09-01

    breach of etiquette is so severe that it means termination of the consultant-referring physician relationship. Referring physicians have indicated that...use and providing temporary meal cards for family members to eat in the dining facility are but a few of the measures which could be adopted. Most

  8. Efficacy of ovarian tissue cryopreservation in a major European center

    NARCIS (Netherlands)

    Bastings, L.; Liebenthron, J.; Westphal, J.R.; Beerendonk, C.C.M.; Ven, H. van de; Meinecke, B.; Montag, M.; Braat, D.D.M.; Peek, R.

    2014-01-01

    PURPOSE: To evaluate the effect of cryopreservation and thawing of ovarian tissue from oncological patients opting for fertility preservation on ovarian tissue viability. METHODS: In this prospective cohort study, the ovarian tissue viability before and after cryopreservation and thawing was

  9. Habermas on European Constitution and European Identity

    Directory of Open Access Journals (Sweden)

    Éva Biró-Kaszás

    2010-12-01

    Full Text Available For the last two decades or so philosophers have been reflecting on a set of practical and political concerns in connection with the new political structural arrangements beyond the nation-state. In this article two essays by Jürgen Habermas shall be examined. An attempt shall be made to tackle Habermas’ philosophical concepts of personal and collective identity as well as the role that a constitution may play in building the post-national constellation. It has been shown that Habermas has normative answers. Firstly, according to him, the fragile balance between the legal order and the particular cultures and traditions of a community has to be protected by the constitutional state. For that reason the political culture has to be “decoupled” from the majority culture. Secondly, the democratically structured attempt to achieve shared meaning has to find the delicate balance between the context-transcending universal normative claims and the claims of particular individual and collective life. Thirdly, it is possible to expand legally mediated civil solidarity trans-nationally, across Europe – we may recognize this development as the emergence of European identity –, since the process of democratic will-formation of citizens may get loose from the structures provided by the state if both shared democratic political cultures as well as a European-wide public sphere exist. The European Constitution may have a catalytic function in materialization of these conditions. It has been shown that in his deliberations Habermas tried to find a reflective equilibrium between the normative and the empirical.

  10. Relationship between polycystic ovary syndrome and ancestry in European Americans.

    Science.gov (United States)

    Bjonnes, Andrew C; Saxena, Richa; Welt, Corrine K

    2016-12-01

    To determine whether European Americans with polycystic ovary syndrome (PCOS) exhibit genetic differences associated with PCOS status and phenotypic features. Case-control association study in European Americans. Academic center. Women with PCOS diagnosed with the use of the National Institutes of Health criteria (n = 532) and control women with regular menstrual cycles and no evidence of hyperandrogenism (n = 432). Blood was drawn for measurement of sex steroids, metabolic parameters, and genotyping. Associations among PCOS status, phenotype, and genetic background identified with the use of principal component analysis. Principal component analysis identified five principal components (PCs). PC1 captured northwest-to-southeast European genetic variation and was associated with PCOS status. Acanthosis was associated with southern European ancestry, and larger waist:hip ratio was associated with northern European ancestry. PC2 was associated with east-to-west European genetic variation and cholesterol levels. These data provide evidence for genetic influence based on European ethnicity in women with PCOS. There is also evidence for a genetic component in the phenotypic features of PCOS within a mixed European population. The data point to the need to control for population stratification in genetic studies in women of mixed European ethnicity. They also emphasize the need for better studies of PCOS prevalence and phenotype as a function of genetic background. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  11. Demonstration of Sustainable Domestic and Tertiary Heating Systems using Agro/Forest/Wood Residues - Domoheat

    Energy Technology Data Exchange (ETDEWEB)

    Diaz-Miguel, M. Salve (ESCAN, S.A, Avda. Ferrol, 14, B-328029 Madrid (Spain)). e-mail: escan@escansa.com (and others)

    2008-10-15

    Potential of forest fuels in European Union reaches 40 million m3/year, the hectares of olive and vineyards are close to 4,7 million and 3,5 million respectively. Considering biomass residues have different characteristics, it exists high diversity of locally available raw-materials, as well as the possibility for raw material mixes, it is necessary to demonstrate the behaviour of new technologies with new raw materials and mixes, in order to facilitate their introduction in domestic and tertiary market. For the Demonstration and Investigation the Project DOMOHEAT was started, supported by the European Commission as a STREP Project. The project focuses on the demonstration of three innovative and sustainable medium size (60 - 100 kW) heating systems, (one for each country: Spain) for domestic and tertiary buildings, using lower quality wastes from agro/forest/wood production. Almond shell, pine cone, Olive pruning, chips from forest exploitation of Pines and Eucalyptus, pellets from sawdust and bark of Pine, will be the biomass raw materials (see fig. 1). The main objective of the project is to demonstrate the overall chains of three heating systems (one for each country), able to diversify the raw material (energy supply), reduce agro/forest/wood production problems and promoting the use of renewable thermal energy in European countries. Each heating system is based on a sustainable and integrated approach (fuel logistics and pre-treatment, energy production, maintenance rules, Normative). Raw material is a mix of fuels, which allow using the most economical fuel of the market, in addition it improves the availability, security of supply, and opportunities for demonstrate that heating from biomass is possible. Each combustion system designed (see fig. 2) is focused on technology tailored to special characteristics of biomass mix, in order to obtain better efficiency and minimum emissions: automatic cleaning system of the tubes for heat interchange, automatic

  12. Cost analysis of a disaster facility at an apex tertiary care trauma center of India.

    Science.gov (United States)

    Singh, Sheetal; Gupta, Shakti; Daga, Anoop; Siddharth, Vijaydeep; Wundavalli, LaxmiTej

    2016-01-01

    For the Commonwealth Games 2010, Jai Prakash Narayan Apex Trauma Centre (JPNATC) of India had been directed by the Director General Health Services and Ministry of Health and Family Welfare, Government of India, to set up a specialized unit for the definitive management of the injured/unwell athletes, officials, and related personnel coming for the Commonwealth Games in October 2010. The facility included a 20-bedded fully equipped ward, six ICU beds with ventilator capacity, one very very important person observation area, one perioperative management cubicle, and one fully modular and integrated operating room. The objective of this study was to calculate the cost of disaster facility at JPNATC, All India Institute of Medical Sciences, New Delhi. Traditional (average or gross) costing methodology was used to arrive at the cost for the provisioning of these services by this facility. The annual cost of providing services at disaster facility at JPNATC, New Delhi, was calculated to be INR 61,007,334.08 (US$ 983,989.258) while the per hour cost was calculated to be INR 7061.03 of the total cost toward the provisioning of services by disaster facility where 26% was the capital cost and 74% was the operating cost. Human resource caters to maximum chunk of the expenditures (47%). The results of this costing study will help in the future planning of resource allocation within the financial constraints (US$ 1 = INR 62 in the year 2013).

  13. Cost analysis of a disaster facility at an apex tertiary care trauma center of India

    OpenAIRE

    Sheetal Singh; Shakti Gupta; Anoop Daga; Vijaydeep Siddharth; LaxmiTej Wundavalli

    2016-01-01

    Introduction: For the Commonwealth Games 2010, Jai Prakash Narayan Apex Trauma Centre (JPNATC) of India had been directed by the Director General Health Services and Ministry of Health and Family Welfare, Government of India, to set up a specialized unit for the definitive management of the injured/unwell athletes, officials, and related personnel coming for the Commonwealth Games in October 2010. The facility included a 20-bedded fully equipped ward, six ICU beds with ventilator capacity, on...

  14. Cost analysis of a disaster facility at an apex tertiary care trauma center of India

    Directory of Open Access Journals (Sweden)

    Sheetal Singh

    2016-01-01

    Full Text Available Introduction: For the Commonwealth Games 2010, Jai Prakash Narayan Apex Trauma Centre (JPNATC of India had been directed by the Director General Health Services and Ministry of Health and Family Welfare, Government of India, to set up a specialized unit for the definitive management of the injured/unwell athletes, officials, and related personnel coming for the Commonwealth Games in October 2010. The facility included a 20-bedded fully equipped ward, six ICU beds with ventilator capacity, one very very important person observation area, one perioperative management cubicle, and one fully modular and integrated operating room. Objective: The objective of this study was to calculate the cost of disaster facility at JPNATC, All India Institute of Medical Sciences, New Delhi. Methodology: Traditional (average or gross costing methodology was used to arrive at the cost for the provisioning of these services by this facility. Results: The annual cost of providing services at disaster facility at JPNATC, New Delhi, was calculated to be INR 61,007,334.08 (US$ 983,989.258 while the per hour cost was calculated to be INR 7061.03 of the total cost toward the provisioning of services by disaster facility where 26% was the capital cost and 74% was the operating cost. Human resource caters to maximum chunk of the expenditures (47%. Conclusion: The results of this costing study will help in the future planning of resource allocation within the financial constraints (US$ 1 = INR 62 in the year 2013.

  15. Scalp Melanoma Diagnosed by Fine Needle Aspiration Cytology in a Tertiary Health Center

    Directory of Open Access Journals (Sweden)

    A. B. Zarami

    2015-01-01

    Full Text Available Melanoma is one of the most aggressive malignant skin neoplasms worldwide with more than 20% of world melanoma seen in black Africa and Asia. Late presentation due to ignorance, poverty, and lack of adequate health facility in Nigeria is always the norms. We present this case report because of precision in diagnosis, using fine needle aspiration cytology (FNAC to reemphasize that the technique is cheap, cost effective, and quick that can reduce the burden of incisional biopsy before definitive surgery and improve early detection of the disease especially in developing countries.

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

    African Journals Online (AJOL)

    Introduction: preterm birth is a dire complication of pregnancy that poses huge long-term medical and financial burdens for affected children, their families, and the health care system. The aim of the present study was to identify characteristics associated with preterm births at the Lagos University Teaching Hospital (LUTH), ...

  17. Delirium after cardiac surgery: A pilot study from a single tertiary referral center

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    Ashok K Kumar

    2017-01-01

    Full Text Available Background: Advances in cardiac surgery has shifted paradigm of management to perioperative psychological illnesses. Delirium is a state of altered consciousness with easy distraction of thoughts. The pathophysiology of this complication is not clear, but identification of risk factors is important for positive postoperative outcomes. The goal of the present study was to prospectively identify the incidence, motoric subtypes, and risk factors associated with development of delirium in cardiac surgical patients admitted to postoperative cardiac intensive care, using a validated delirium monitoring instrument. Materials and Methods: This is a prospective, observational study. This study included 120 patients of age 18-80 years, admitted to undergo cardiac surgery after applying inclusion and exclusion criteria. Specific preoperative, intraoperative, and postoperative data for possible risk factors were obtained. Once in a day, assessment of delirium was done. Continuous variables were measured as mean ± standard deviation, whereas categorical variables were described as proportions. Differences between groups were analyzed using Student′s t-test, Mann-Whitney U-test, or Chi-square test. Variables with a P < 0.1 were then used to develop a predictive model using stepwise logistic regression with bootstrapping. Results: Delirium was seen in 17.5% patients. The majority of cases were of hypoactive delirium type (85.72%. Multiple risk factors were found to be associated with delirium, and when logistic regression with bootstrapping applied to these risk factors, five independent variables were detected. History of hypertension (relative risk [RR] =6.7857, P = 0.0003, carotid artery disease (RR = 4.5000, P < 0.0001 in the form of stroke or hemorrhage, noninvasive ventilation (NIV use (RR = 5.0446, P < 0.0001, Intensive Care Unit (ICU stay more than 10 days (RR = 3.1630, P = 0.0021, and poor postoperative pain control (RR = 2.4958, P = 0.0063 was associated with postcardiac surgical delirium. Conclusions: Patients who developed delirium had systemic disease in the form of hypertension and cerebrovascular disease. Delirium was seen in patients who had higher postoperative pain scores, longer ICU stay, and NIV use. This study can be used to develop a predictive tool for diagnosing postcardiac surgical delirium.

  18. Sweet's syndrome: a retrospective study of 90 cases from a tertiary care center.

    Science.gov (United States)

    Amouri, Meriem; Masmoudi, Abdelrahmen; Ammar, Morsi; Boudaya, Sonia; Khabir, Abdelmajid; Boudawara, Tahia; Turki, Hamida

    2016-09-01

    Sweet's syndrome (SS) is a neutrophilic dermatosis characterized by the abrupt onset of cutaneous, systemic and histopathological alterations in response to different stimuli. The aim of this study was to assess the epidemioclinical, histological, and therapeutic features and outcomes of SS. A retrospective study of all patients diagnosed with SS over a 20-year period (1993-2012) was conducted. Data were analyzed using a level of significance of 5%. Ninety patients (mean age: 46.5 years) fulfilled the inclusion criteria. The ratio of women to men was 5. Significant associations emerged between dermohypodermic nodes and location on the lower limbs (P = 0.042), and vesiculobullous lesions and location on the legs (P = 0.030), dorsum of the hand (P = 0.015), and forearms (P = 0.003), and paraneoplastic forms (P = 0.012). The upper extremities were involved in the majority of patients (83.3%). Correlations were found between edema of the superficial dermis and vesiculobullous lesions and between leukocytoclastic vasculitis and atypical targetoid lesions. Sweet's syndrome was associated with cytomegalovirus infection (n = 1), inflammatory bowel disease (n = 4), neoplasm (n = 6), and pregnancy (n = 3). First-line treatment consisted of colchicine. To the best of the present authors' knowledge, this is the largest series of SS to be reported. Clinical presentations are similar to those described in the literature. Colchicine was efficient and facilitates the reduced use of corticosteroids. The association between SS and neoplasms should be considered in the context of vesiculobullous lesions. © 2016 The International Society of Dermatology.

  19. Variations in 30-day hospital readmission rates across primary care clinics within a tertiary referral center.

    Science.gov (United States)

    Tang, Ning; Maselli, Judith H; Gonzales, Ralph

    2014-11-01

    Reducing hospital readmissions is a national healthcare priority. Little is known about how readmission rates vary across unique primary care practices. To calculate all-cause 30-day hospital readmission rates at the level of individual primary care practices and identify factors associated with variations in these rates. Retrospective analysis Seven primary care clinics affiliated with the University of California, San Francisco (UCSF). Adults ≥18 years old with a primary care provider (PCP) at UCSF MEASUREMENTS: All-cause 30-day readmission rates were calculated for primary care clinics for discharges between July 1, 2009 and June 30, 2012. We built a model to identify demographic, clinical, and hospital factors associated with variation in rates. There were 12,564 discharges for patients belonging to the 7 clinics, with 8685 index discharges and 1032 readmissions. Readmission rates varied across practices, from 14.9% in Human Immunodeficiency Virus primary care and 7.7% in women's health. In multivariable analyses, factors associated with variation in readmission rates included: male gender (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.05-1.40), Medicare insurance (OR: 1.31, 95% CI: 1.05, 1.64; Ref = private), Medicare-Medicaid dual eligible (OR: 1.26, 95% CI: 1.01-1.56), multiple comorbidities, and admitting services. Patients with a departed PCP awaiting transfer assignment to a new PCP had an OR of 1.59 (95% CI: 1.16-2.17) compared with having a current faculty PCP. Primary care practices are important partners in improving care transitions and reducing hospital readmissions, and this study introduces a new way to view readmission rates. PCP turnover may be an important risk factor for hospital readmissions. © 2014 Society of Hospital Medicine.

  20. Case series on multimodal endoscopic therapy for gastric antral vascular ectasia, a tertiary center experience.

    Science.gov (United States)

    Matin, Tasnia; Naseemuddin, Mohammed; Shoreibah, Mohamed; Li, Peng; Kyanam Kabir Baig, Kondal; Wilcox, Charles Mel; Peter, Shajan

    2018-01-16

    To study and describe patients who underwent treatment for gastric antral vascular ectasia (GAVE) with different endoscopic treatment modalities. We reviewed patients with GAVE who underwent treatment at University of Alabama at Birmingham between March 1, 2012 and December 31, 2016. Included patients had an endoscopic diagnosis of GAVE with associated upper gastrointestinal bleeding or iron deficiency anemia. Seven out of 15 patients had classic watermelon description for GAVE, 1/15 with diffuse/honeycomb pattern and 6/15 with nodular GAVE per EGD description. Seven out of 15 patients required multimodal treatment. Four out of six of patients with endoscopically nodular GAVE required multimodal therapy. Overall, mean pre- and post-treatment hemoglobin (Hb) values were 8.2 ± 0.8 g/dL and 9.7 ± 1.6 g/dL, respectively ( P ≤ 0.05). Mean number of packed red blood cells transfusions before and after treatment was 3.8 ± 4.3 and 1.2 ± 1.7 ( P ≤ 0.05), respectively. Patients with nodular variant GAVE required multimodal approach more frequently than non-nodular variants. Patients responded well to multimodal therapy and saw decrease in transfusion rates and increase in Hb concentrations. Our findings suggest a multimodal approach may be beneficial in nodular variant GAVE.

  1. Epidemiology of chronic kidney disease in a Sri Lankan population: Experience of a tertiary care center

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    Eranga S Wijewickrama

    2011-01-01

    Full Text Available Chronic kidney disease (CKD is a growing problem in Sri Lanka. Diabetes and hypertension are the main contributors to the disease burden. A new form of CKD of uncertain etiology (CKD-u is the predominant form of CKD in certain parts of Sri Lanka, threatening to reach epidemic proportions. A cross-sectional descriptive study was carried out over a three-month period at the National Hospital of Sri Lanka to identify the underlying etiologic factors for the disease in a cohort of patients with CKD. A total of 200 patients were studied with a mean age of 50.57 years. Of them, 108 (54% were in CKD stage V. Majority of the patients were from the western province (137, 68.5% with only five (2.5% from provinces with high prevalence of CKD-u. The most common underlying causes of CKD were diabetes (88, 44% and hypertension (34, 17%. However, in patients younger than 40 years of age the most common cause was glomerulonephritis (20, 42.6%. Diabetes was the most common cause of CKD among patients from the western province (74, 54%. The prevalence of CKD-u was twice as high in patients from areas outside the western province compared with patients from this province (P > 0.05. The low prevalence of CKD-u in the study population could be the result of poor representation of patients from provinces with high prevalence of CKD-u.

  2. Urinary tract infections in the era of newer immunosuppressant agents : A tertiary care center study

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    Khanna Pallavi

    2010-01-01

    Full Text Available We studied the incidence and the risk factors predisposing to post transplantation urinary tract infection (UTI and the association with use of different immunosuppressive regimens. We performed a retrospective analysis of 152 recipients of renal transplantation over a period of two years. Seventy one (46.71% patients had culture positive UTI, Escherichia coli (45.1% being the commonest. Thirty four (22.39% patients had acute rejection and 14.4% of those had suffered UTI in the early post transplant period. Immunosuppression included induction with various anti-bodies and maintenance on antirejection medications. Trimethoprim-sulphamethoxazole was given as prophylaxis throughout the period. The UTI was treated according to microbiological sensitivity. 2.8% died due to urosepsis. In our retrospective analysis renal transplant recipients under the age of 45, female gender and diabetics suffered more UTI. Combination therapy with micro-emulsion form of cyclosporine A, prednisolone and azathioprine developed more UTI (P= 0.0418.

  3. Urethrography interpretation skills of urology and radiology residents at tertiary care medical centers.

    Science.gov (United States)

    Eswara, Jairam R; Song, Joseph B; Chang, Andrew J; Rosenstein, Daniel I; Gonzalez, Christopher M; Vetter, Joel M; Brandes, Steven B

    2014-06-01

    To assess the ability of urology and radiology residents to interpret retrograde urethrograms (RUGs) and voiding cystourethrograms (VCUGs). A standardized examination of 10 combination RUGs and VCUGs of the male urethra was administered to urology and radiology residents from all levels of training at Washington University, Stanford University, and Northwestern University. Residents were asked to evaluate stricture location(s) and length, if present. Sixty residents participated, consisting of 26 from Washington University, 15 from Stanford University, and 19 from Northwestern University. Average years of training for urology and radiology were 3.6 and 2.8 years, respectively (P=.01). Normal RUGs and VCUGs were recognized by 18 of 31 radiologists (58%) and 19 of 29 urologists (65.5%; P=.5). Anterior strictures were correctly identified in 145 of 403 (36%) and 165 of 377 (43.8%) responses by radiologists and urologists, respectively (P=.03). Posterior strictures were correctly identified in 20 of 62 (32.3%) and 10 of 58 (17.2%) responses by radiologists and urologists, respectively (P=.09). When both groups of residents were combined, anterior strictures were identified correctly more often than posterior strictures (39.7% vs 25%; Purology group (P=.30). In the presence of multiple strictures, accuracy declined to 7.26% (9 of 124) for the radiology group and 9.48% (11 of 116) for the urology group (P=.5), with a combined accuracy of 8.33% (20 of 240). Radiology and urology residents in the United States have poor skills at interpreting urethrography, especially when multiple strictures or posterior strictures are present. A formal educational program for RUG and VCUG interpretation should be designed and implemented into the radiology and urology resident curriculum. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS: Experience at a Tertiary Referral Center

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    Caitlin E. Helm

    2015-07-01

    Full Text Available Background: Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS is an autoimmune disorder presenting with obsessive compulsive disorder and/or tics. Like Sydenham’s chorea, its presumed pathogenesis consists of autoantibodies cross-reacting with neurons in response to a group A beta-hemolytic streptococcal infection (GASI. There are currently no diagnostic laboratory findings and management ranges from antibiotic prophylaxis to intravenous immunoglobulin to plasmapheresis. The diagnosis remains controversial, resulting in inconsistent referrals and significant patient anxiety. Methods: A retrospective study was performed on all patients referred to the Pediatric Infectious Disease Division with a pre-referral diagnosis of PANDAS. Patients were analyzed by demographics, medical history, co-morbidities, symptoms, prior treatment, laboratory tests, management strategies, and treatment outcomes. Results: From 2003 to 2013, there were 21 patients with a pre-referral diagnosis of PANDAS. Only five met the diagnostic criteria. No patient at referral had an objective scale to monitor symptoms. Eight referrals had a major psychiatric disorder, and none fulfilled diagnostic criteria (p<0.01. Discussion: The majority of the patients referred with a pre-diagnosis of PANDAS do not fulfill diagnostic criteria nor do they have objective criteria for symptom monitoring. Major psychiatric disorders do not seem to be associated with PANDAS, and better physician education may prevent misdiagnoses. Multidisciplinary management is recommended.

  5. Challenges in the Routine Praxis Diagnosis of Hydatidiform Mole: a Tertiary Health Center Experience.

    Science.gov (United States)

    Lelic, Melisa; Fatusic, Zlatan; Iljazovic, Ermina; Ramic, Suada; Markovic, Sergije; Alicelebic, Selma

    2017-08-01

    Hydatidiform moles (HM), presenting as complete (CHM) and partial (PHM) form, are rare pregnancy disorder. Diagnosis is based on clinical presentation, ultrasound imaging findings and pathological examination of products of conception. Protein p57, encoded by CKDN1C gene, is paternally imprinted and maternally expressed gene and provides quick insight in genetic basis of HM and allows distinction of CHM from all other conceptions. compare the preevacuational and pathohistological diagnosis with outcome of p57 immunostaining. All cases of HM diagnosed between January 2011 and December 2015 were included in this research. Maternal age, gestational age and input diagnosis data were recored. p57 immunostaining was performed in order to evaluate the diagnosis based on tissue slides examination. There were 198 cases of histologically confirmed HM, 185 PHM, 12 CHM and one case of undefined HM. Mean maternal age in the CHM group was 24,7 and in the PHM group 26,9 years, with no significant differences among these two groups (p=0,27). For CHM mean gestational age was estimated at eight and for PHM 9,2 gestational weeks. Pregnant woman older than 40 years present significant earlier compared with younger woman (p<0,01), and those younger than 20 years tend to present at the beginning of the second trimester more often than older women (p<0,05). In the CHM group, 9 (75%) input diagnoses were mola in obs, and 3 (25%) of them were signed as abortion, unlike the PHM where 126 (67%) were qualified as abortion, 35 (19%) as blighted ovum, and 26 (14%) were suggestive for molar pregnancy. p57 immunostaining results confirmed all pathohistological diagnosis of CHM whereas 8% of PHM demonstrated divergent p57 expression. PHM, compared with CHM, represent a greater diagnostic challenge for both gynecologist and pathologist even when presenting in more advanced pregnancies.

  6. Neurogenic vision loss: Causes and outcome. An experience from a tertiary center in Northern India

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    Rajesh Verma

    2014-01-01

    Full Text Available Introduction: Vision loss can be a consequence of numerous disorders of eye and neural pathway conveying visual input to brain. A variety of conditions can affect visual pathway producing neurogenic vision loss. The presentation and course of vision loss depends on the site of involvement and underlying etiology. We conducted this unprecedented study to evaluate the characteristics and outcome of various diseases of the visual pathway. Materials and Methods: In this prospective cohort study, we evaluated 64 patients with neurogenic visual impairment. Ophthalmological causes were excluded in all of them. Their presentation, ophthalmological characteristics and investigation findings were recorded. These patients were followed up till 6 months. Results: Out of 69 patients evaluated, 5 were excluded as they had ophthalmological abnormalities. The remaining 64 cases (113 eyes were enrolled. 54 cases were due to diseases of anterior visual pathway and rest 10 had cortical vision loss. The etiologic distribution is as follows: Isolated optic neuritis- 12 (19%, multiple sclerosis- 4 (6.3%, neuromyelitis optica- 5 (7.9%, tubercular meningitis- 15 (23.8%, non-arteritic ischemic optic neuropathy, ischemic optic neuropathy complicating cavernous sinus thrombosis, cryptococcal meningitis, malignant infiltration of optic nerve, Crouzon′s syndrome, calvarial thickening and traumatic occipital gliosis- 1 (1.6% case each, idiopathic intracranial hypertension, pituitary adenoma, acute disseminated encephalomyelitis, posterior reversible leukoencephalopathy- 3 (4.8% cases each, cortical venous thrombosis 5 (7.9%, subacute scleroing panencephalitis- 4 (6.3% cases. Conclusions: The diseases of anterior visual pathway were much more common than cortical vision loss. A majority of our patients had severe impairment of vision at presentation.

  7. Pattern of deaths in females in a tertiary health center, south-west Nigeria

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    Omoniyi-Esan GO

    2011-09-01

    Full Text Available Olutoyin Omoniyi-Esan1, Olaejirinde Olaofe2, Mary Onwubuya2, Oluseyi Fadahunsi2, Akinwumi Komolafe11Department of Morbid Anatomy and Forensic Medicine, College of Health Sciences, Obafemi Awolowo University, 2Departments of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, NigeriaPurpose: The aim of this study was to review autopsies to determine the pattern of deaths in females at Wesley Guild Hospital, Ilesa, Nigeria.Methods: A 9-year retrospective study was done of all autopsies done on females in the Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Wesley Guild Hospital, Ilesa, Nigeria, from January 2002 to December 2010. Records of all autopsies done on females during the period were reviewed.Results: During the study period 215 cases of female death were autopsied. The age range was 0-75 years (mean = 32.9. Deaths due to trauma were most common (57.2%, followed by obstetric deaths (15.8%. Deaths due to infections and cardiovascular diseases accounted for 13% and 5.6%, respectively. Injuries sustained from automobile accidents were responsible for 88.6% of all trauma deaths. Gunshot injuries accounted was 4.9% of these trauma deaths. The causes of death from automobile accidents included multiple injuries (49.5%, head injury (38.5%, and hypovolemia (8.3%. Obstetric deaths were predominantly due to uterine sepsis (51.5% and hemorrhagic shock (39.4%. About 39% of deaths from infection were due to septicemia. Acute bacterial meningitis, acute lobar pneumonia, and malaria caused 23.1%, 15.4%, and 7.7% of deaths from infections, respectively. Four cases of sudden unnatural deaths (other than trauma were recorded.Conclusion: Trauma was the most common cause of death in women autopsied in our hospital, and automobile injuries were the most common causes of these trauma deaths. Obstetric deaths ranked second. Sepsis and hemorrhage were the most common causes of these obstetric deaths. Deaths from eclampsia were low. Requests for autopsies on women who died from cancer were few. There is a need for clinicians to ascertain the actual cause of death in women who die from cancer.Keywords: females, mortality, autopsy

  8. Degree of anxiety in food allergic children in a tertiary care center.

    Science.gov (United States)

    Petrovic-Dovat, Lidija; Fausnight, Tracy; White, Amanda M; Zeiger, Timothy; Bansal, Pevitr S; Garg, Nidhi; Annapareddy, Jitendra; Iriana, Sarah; Slattery,