scholarly journals P.109 Causes of albuminocytologic dissociation and the impact of an age-adjusted reference limit on review of 2,627 CSF samples

2018 ◽  
Vol 45 (s2) ◽  
pp. S45-S45
Author(s):  
JA Brooks ◽  
C McCudden ◽  
A Breiner ◽  
P Bourque
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
Care Center ◽  
Tertiary Care ◽  
Common Finding ◽  
Blood Cell Count ◽  
Reference Limit ◽  
Number Of Patients ◽  
Upper Reference Limit ◽  
The Impact

Background: We set out to test the discriminative power of an age-adjusted upper reference limit (URL) for CSF total protein (CSF-TP) in identifying pathological causes of albuminocytologic dissociation (ACD). Methods: We reviewed the charts of 2,627 adult patients who underwent a lumbar puncture at a tertiary care center over a 20-year period. Samples with CSF-TP above 45 mg/dL (0.45 g/L) were included. Samples with white blood cell count > 5×109/L, red blood cell count > 50×109/L, and glucose < 2.5 mmol/L (45 mg/dL) were excluded. Patients with CSF-TP elevated above 45 mg/dL were considered to have ‘pseudo’ albuminocytologic dissociation (ACD) or ‘true’ ACD if their CSF-TP was in excess of age-adjusted norms. Results: Among all patients with ACD, a pathological source of CSF-TP elevation was identified in 57% (1490/2627) of cases, 51% of those with ‘pseudo’ ACD, and 75% with ‘true’ ACD (p< 0.001). Use of an age-adjusted upper reference limit favored the detection of polyneuropathy patients (13.5% proportionate increase) and excluded a larger number of patients with isolated headache (10.7% proportionate decrease; p < 0.0001). Conclusions: Elevated CSF-TP is a relatively common finding. Use of age-adjusted upper reference limits for CSF-TP values improve diagnostic specificity and help to avoid over-diagnosis of ACD.

scholarly journals Causes of albuminocytological dissociation and the impact of age-adjusted cerebrospinal fluid protein reference intervals: a retrospective chart review of 2627 samples collected at tertiary care centre

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e025348 ◽  
Author(s):  
John Alexander Brooks ◽  
Christopher McCudden ◽  
Ari Breiner ◽  
Pierre R Bourque
Keyword(s):  
Cerebrospinal Fluid ◽  
Cell Count ◽  
Tertiary Care ◽  
Common Finding ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Old Patients ◽  
Reference Limit ◽  
Upper Reference Limit ◽  
The Impact

ObjectiveWe set out to test the discriminative power of an age-adjusted upper reference limit for cerebrospinal fluid total protein (CSF-TP) in identifying clinically relevant causes of albuminocytological dissociation (ACD).MethodsWe reviewed the charts of 2627 patients who underwent a lumbar puncture at a tertiary care centre over a 20-year period. Samples with CSF-TP above 45 mg/dL (0.45 g/L) were included. Samples with white cell count >5×109/L, red cell count >50×109/L and glucose <2.5 mmol/L (45 mg/dL) were excluded as were samples with incomplete data and those taken from paediatric patients (ie, age <18 years old). Patients with CSF-TP elevated above 45 mg/dL were considered to have ‘pseudo’ ACD unless their CSF-TP was in excess of age-adjusted norms in which case they were considered to have ‘true’ ACD. Adjustment for sex was not applied to the age-adjusted norms although the importance of gender has been previously described.ResultsThe presence of ACD was associated with a broad range of neurological diagnoses. Among all 2627 patients with ACD, a clinical diagnosis explaining CSF-TP elevation was identified in 57% of cases. ‘True’ ACD was associated with a suitable diagnosis in 75% of cases, whereas patients with ‘pseudo’ ACD showed an appropriate diagnosis in only 51% of cases. Use of an age-adjusted upper reference limit favoured the detection of polyneuropathy patients (13.5% proportionate increase) and excluded a larger number of patients with isolated headache (10.7% proportionate decrease; p<0.0001).ConclusionsElevated CSF-TP is a common finding, with a range of underlying causes. Use of an age-adjusted upper reference limit for the CSF-TP value improves diagnostic specificity and helps to avoid overdiagnosis of ACD.

scholarly journals Paradigm Shift in Clinical Practice of Sexual Health in Men During COVID-19 Pandemic

2021 ◽  
pp. 263183182110323
Author(s):  
Aditya Prakash Sharma ◽  
Japleen Kaur ◽  
Ravimohan S. Mavuduru ◽  
Shrawan K. Singh
Keyword(s):  
Health Care ◽  
Sexual Health ◽  
Surgical Procedures ◽  
Care Center ◽  
Tertiary Care ◽  
Health Care Seeking ◽  
Care Seeking ◽  
Health Seeking ◽  
Number Of Patients ◽  
The Impact

Sexual health-care seeking behavior and practices have been affected during COVID-19 pandemic. The impact of COVID-19 on this subspecialty is far reaching. This study aimed to assess the impact of COVID-19 on health-care seeking practice pertaining to sexual health in men in our tertiary care center and review the relevant literature regarding impact of COVID-19 on sexual health seeking practice and challenges faced. Outpatient data was analyzed from January 2019 to April 2021. Patients awaiting surgical procedures due to COVID were documented. A narrative synthesis of literature based on systematic search using the keywords sexual health, sexual health seeking, sexual health practice, andrology, and COVID with operators “AND” and “OR” was carried out in three search engines PubMed, Scopus, and Embase. The study outcomes were obtained by comparing data of outpatient attendance and compiling the reviewed literature. The mean attendance fell significantly from 95.11±11.17 to 17.25±13.70 persons (P <.0001) per outpatient clinic, March 2020 being the reference point. Teleconsultation has taken over physical consultation. In 98/949 cases, teleconsult could not be provided despite registration. Over 25 patients were waiting for surgical procedures pertaining to andrology due to shut down of elective services. Similar trends have been reported from other countries. Number of patients seeking consultation for sexual health problems has dramatically decreased during COVID-19 era. Establishment of data safe teleconsultation facility and its widespread advertisement is needed to encourage patients to seek consult.

Abstract 14747: Dwindling Trends of Cardiology Admissions Amidst Covid-19 Pandemic in a Tertiary Care Center of Pakistan

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jamshed Ali ◽  
Osman Faheem ◽  
Pirbhat Shams ◽  
ghufran adnan ◽  
Maria Khan
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Electronic Record ◽  
Medical Attention ◽  
Care Hospital ◽  
Record System ◽  
Admission Rates ◽  
Cardiovascular Morbidity And Mortality ◽  
Number Of Patients ◽  
The Impact

Introduction: Social containment measures have been adopted globally to control COVID-19 outbreak. Reduction in hospital visits and inpatient admission rates have become cause for concern. Through this study we aimed to analyze the impact of SARS-CoV-2 virus Outbreak on cardiology inpatient admissions at a tertiary care hospital in Pakistan. Hypothesis: COVID-19 pandemic has resulted in significant decline in cardiology admissions. Methods: We conducted a retrospective study at our center. Admission log was accessed via electronic record system. Comparison was made for same months of 2019 and 2020 with regard to cardiology inpatient admissions. Results: A total of 239 patients were admitted to cardiology services in 2019 period and 106 in 2020 period with resultant reduction of 55.6%. Number of patients admitted to the coronary care unit were 179 and 78 respectively where as the numbers declined to 28 from 60 for cardiac step down. Reduction for admission numbered to 52.4% for males and 38.89% for females. 9.3% patients left against medical advice in 2019 and 3.4% in 2020. Conclusions: Our study concludes that numbers of cardiology admissions have dwindled. Possible explanation for this can be implementation of social containment and fear of acquiring infection. This has raised a question of whether a significant number of cardiovascular morbidity and mortality has occurred without seeking medical attention and has went unrecorded during the pandemic. This calls for stringent diagnostic measures in future to diagnose previously unrecorded burden.

Early Surgical Intervention for Fulminant Pseudomembranous Colitis

2008 ◽  
Vol 74 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Syed O. Ali ◽  
John P. Welch ◽  
Robert J. Dring
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Pseudomembranous Colitis ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Case Series ◽  
Hemodynamic Instability ◽  
Blood Cell Count

The objective of this study of a retrospective case series was to determine factors associated with survival after surgical intervention in pseudomembranous colitis (PMC). The study was conducted at a tertiary care medical center and comprised 36 patients who underwent colectomy for fulminant PMC from 1995 to 2006. Patients including 21 females ranged from 40 to 89 years of age (mean, 70 years). Comorbidities included diabetes (39%), cardiovascular disease (77%), chronic obstructive pulmonary disease (47%), and intake of immunosuppressive medications (45%). Seventy-two per cent received antibiotics in the previous 2 months. Only patients with a confirmation of PMC on pathology specimens were included in the study. All patients underwent colectomy. Patients were stratified into two groups: survivors and nonsurvivors. Various clinical factors/parameters used in the management of patients with PMC were studied in these two groups. Survival was correlated with mean white blood cell count (23,000 survivors versus 40,000 nonsurvivors, P < 0.01); multisystem organ failure (16 per cent survivors versus 47 per cent nonsurvivors, P < 0.05); and preoperative pressors (16 per cent survivors versus 47 per cent nonsurvivors, P < 0.05). Overall mortality for the study period was 47 per cent. Mortality rate analysis revealed a lower rate for the more recent years (32 per cent for 2000 to 2006 versus 65 per cent for 1995 to 1999, P < 0.05). In the more recent years, the time elapsing before colectomy was also lower (1.4 days versus 2.5 days, nonsignificant), and patients had less preoperative hemodynamic instability (70 per cent versus 31 per cent, P < 0.03). In one institution, survival after surgery for PMC was found to be associated with a mean white blood cell count (<37,000), nondependence on preoperative vasopressors, and surgical intervention before the onset of hemodynamic instability.

The impact of preapheresis white blood cell count on autologous peripheral blood stem cell collection efficiency and HSC infusion side effect rate

2018 ◽  
Vol 33 (3) ◽  
pp. 331-341 ◽  
Author(s):  
Araci. M. Sakashita ◽  
Andrea T. Kondo ◽  
Ana Paula H. Yokoyama ◽  
Sanny M. C. Lira ◽  
Carolina B. Bub ◽  
...  
Keyword(s):  
Stem Cell ◽  
Blood Cell ◽  
Cell Count ◽  
Peripheral Blood ◽  
Side Effect ◽  
Peripheral Blood Stem Cell ◽  
Collection Efficiency ◽  
Blood Cell Count ◽  
The Impact ◽  
Stem Cell Collection

scholarly journals Utility of computed tomography and derivation and validation of a score to identify an emergent outcome in 2,315 patients with suspected urinary tract stone

CJEM ◽  
2013 ◽  
Vol 15 (05) ◽  
pp. 261-269 ◽  
Author(s):  
F. Kris Aubrey-Bassler ◽  
Scott D. Lee ◽  
Richard B. Barter ◽  
Shabnam Asghari ◽  
Richard Cullen ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Blood Cell ◽  
Cell Count ◽  
Ct Scans ◽  
Potential Range ◽  
Blood Cell Count ◽  
Computed Tomographic ◽  
Urinary Tract Stone ◽  
The Impact ◽  
Predicted Risk

ABSTRACT Objective: Because a majority of urinary tract stones (UTSs) pass spontaneously and clinically significant alternative pathology is rare, we hypothesize that many computed tomographic (CT) scans to diagnose them are likely unnecessary. We sought to measure the impact of renal CT scans on resource use and to justify a prospective study to derive a score that predicts an emergent diagnosis in patients with suspected UTS by doing so in our retrospective series. Methods: We conducted a retrospective study of ED patients who had noncontrast CT of the abdomen for suspected UTS. A split-sample was used to derive and validate a score to predict the presence of an emergent diagnosis on CT. Results: Of the 2,315 patients (50.8% female, mean age 45 years), 49 (2.1%) had an emergent outcome observed on CT. An additional 12 (0.5%) patients had an urgent outcome and 239 (10.6%) had a urologic procedure within 8 weeks of the CT. Serum white blood cell count, highest temperature, urine red blood cell count, and the presence of abdominal pain were significant predictors of the primary outcome. A score derived using these predictors had a potential range of 22 (0.26% predicted risk, 0.5% actual risk of the outcome) to 6 (52% predicted risk). The score was moderately discriminatory with c-statistics of 0.752 (derivation) and 0.668 (validation) and accurate with Hosmer-Lemeshow statistics of 10.553 (p = 0.228, derivation) and 9.70 (p = 0.286, validation). Conclusions: A sensible, relevant score derived and validated on all patients presenting with symptoms suggestive of renal colic could be useful in reducing abdominal CT scan ordering.

Screening Patients Undergoing Total Hip or Knee Arthroplasty with Perioperative Urinalysis and the Effect of a Practice Change on Antimicrobial Use

2016 ◽  
Vol 38 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Samuel Bailin ◽  
Nicolas Noiseux ◽  
Jean M. Pottinger ◽  
Birgir Johannsson ◽  
Ambar Haleem ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Blood Cell Count ◽  
Total Hip ◽  
Number Of Patients ◽  
Prosthetic Joint Infections ◽  
Tract Infections

OBJECTIVETo identify predictors of treatment for urinary tract infections (UTI) among patients undergoing total hip (THA) or knee (TKA) arthroplasties and to assess an intervention based on these predictors.DESIGNWe conducted a retrospective cohort study of 200 consecutive patients undergoing THA/TKA between February 21, 2011, and June 30, 2011, to identify predictors of treatment for UTI and a prospective cohort study of 50 patients undergoing these procedures between May 21, 2012, and July 17, 2012, to assess the association of signs or symptoms and UTI treatment. We then conducted a before-and-after study to assess whether implementing an intervention affected the frequency of treatment for UTI before or after THA/TKA.SETTINGThe orthopedics department of a university health center.PATIENTSPatients undergoing THA or TKA.INTERVENTIONSurgeons revised their UTI screening and treatment practices.RESULTSPositive leukocyte esterase (P<.0001; P<.0001) and urine white blood cell count>5 (P=.01; P=.01) were associated with preoperative or postoperative UTI treatment. In the prospective study, 12 patients (24%) had signs and symptoms consistent with UTI. The number of patients treated for presumed UTI decreased 80.2% after the surgeons changed their practices, and surgical site infection (SSI) rates, including prosthetic joint infections (PJIs), did not increase.CONCLUSIONSUrine leukocyte esterase and white blood cell count were the strongest predictors of treatment for UTI before or after THA/TKA. The intervention was associated with a significant decrease in treatment for UTI, and SSI/PJI rates did not increase.Infect Control Hosp Epidemiol 2017;38:281–286

The Impact of the COVID-19 Pandemic on an Israeli Acute Care Surgery Unit: Fewer Patients, More Disease

2021 ◽  
pp. 000313482110111
Author(s):  
Yossi Maman ◽  
Adam Lee Goldstein ◽  
Uri Neeman ◽  
Yonatan Lessing ◽  
Lior Orbach ◽  
...  
Keyword(s):  
Health Care ◽  
Care Center ◽  
Tertiary Care ◽  
Acute Care Surgery ◽  
Charlson Comorbidity Index Score ◽  
Apache Ii Score ◽  
Number Of Patients ◽  
Significant Difference ◽  
Care Surgery ◽  
The Impact

Background The COVID-19 pandemic has transformed and affected every aspect of health care. Like any catastrophic event, the stress on hospitals to maintain a certain level of function is immense. Acute surgical pathologies cannot be prevented or curtailed; therefore, it is important to understand patterns and outcomes during catastrophes in order to optimize care and organize the health care system. Methods In a single urban tertiary care center, a retrospective study examined the first complete lockdown period of Israel during the COVID-19 pandemic. This was compared to the same time period the previous year. Results During the pandemic, time to hospitalization was significantly decreased. There was also an overall reduction in surgical admissions yet with a higher percentage being hospitalized for further treatment (69.2% vs 23.5%). The patients admitted during this time had a higher APACHE-II score and Charlson comorbidity index score. During the pandemic, time to surgery was decreased, there were less laparoscopic procedures, and more RBC units were used per patient. There were no differences in overall complications, except when sub-analyzed for major complications (9.7% vs 6.3%). There was no significant difference in overall in-house mortality or morbidity. Length of hospitalization was significantly decreased in the elderly population during the pandemic. Conclusion During the COVID-19 pandemic, despite a significantly less number of patients presenting to the hospital, there was a higher percentage of those admitted needing surgical intervention, and they were overall sicker than the previous year.

scholarly journals Retrospective Analysis of Early Impact of COVID-19 on Systemic Cancer Treatment—A Pilot Study

2021 ◽  
Vol 42 (01) ◽  
pp. 015-020
Author(s):  
Anakha Pattiyeil ◽  
Febin Antony ◽  
Sunu L Cyriac ◽  
Anilkumar Jose ◽  
Jini M. P.
Keyword(s):  
Cancer Care ◽  
Medical Oncology ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Drop ◽  
Relaxation Phase ◽  
Number Of Patients ◽  
Increased Risk ◽  
The Impact

Abstract Introduction Cancer care during the coronavirus disease 2019 (COVID-19) pandemic is challenging as the patients are at an increased risk of developing complications compared with the general population. Objectives This study was conducted to assess the impact of COVID-19 pandemic and nationwide lockdown on systemic cancer care. Materials and Methods This comparative descriptive study was conducted in the Department of Medical Oncology and Haematology in a tertiary care center in India. The study compared and analyzed the consecutive patient data of two different units in the Department of Medical Oncology in the pre-COVID phase (PCP) and post lockdown relaxation phase (PLRP). We represented the categorical data in frequency and percentage, and chi-squared test was used to analyze the variables. Results Patients were categorized based on demographic, disease-related, and hospital visit-related parameters and a significant drop noted in patients who utilized a prebooking facility (p = 0.0001), in the number of patients aged >50 years (p = 0.004), number of patients who presented with hematological malignancies (p = 0.006), and who came for follow-up (p = 0.0001). The other parameters remained statistically insignificant. Conclusions During PLRP, active systemic cancer care seems to have been less affected, whereas follow-up of patients and visits of elderly patients were significantly reduced. If the pandemic remains under control, cancer care may not get compromised. This shows the importance of flattening the curve for quality management of other diseases during a pandemic.

Protocol-Based Intravenous Fluid Hydration for Newly Created Ileostomies Decreases Readmissions Secondary to Dehydration

2020 ◽  
pp. 000313482097157
Author(s):  
Daniel J. Borsuk ◽  
Adam Studniarek ◽  
Slawomir J. Marecik ◽  
John J. Park ◽  
Kunal Kochar
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Emergency Department Visits ◽  
Sporadic Group ◽  
Nursing Support ◽  
Protocol Implementation ◽  
Number Of Patients ◽  
Intravenous Hydration ◽  
The Impact

Background Newly created ileostomies often result in patient readmission due to dehydration secondary to high ostomy output. Implementation of a mandatory home intravenous hydration protocol can avoid this. We aim to evaluate the impact of mandatory home intravenous hydration for patients with newly created ileostomies. Materials and Methods All patients at a single, tertiary care center who underwent ileostomy creation during a period of sporadic home intravenous hydration (February 2011-December 2013) and mandatory protocol hydration (March 2016-December 2018) were reviewed for incidence of dehydration, readmissions, and emergency department visits. Results 241 patients were evaluated. 119 were in the “sporadic” group and 122 were in the “protocol” group. Operative approach differed among both groups, with hydration protocol patients undergoing 15% less open procedures and 4.9% more hand-assisted laparoscopic procedures ( P = .0017). Prior to protocol implementation, 23.5% of patients were sent home with intravenous hydration. Length of hospital stay after index ileostomy creation was shorter for “protocol” patients by 3.3 days ( P < .0001). 15.1% of “sporadic” patients experienced dehydration as compared to 7.4% of “protocol” patients ( P = .0283). Following protocol implementation, the number of patients readmitted due to dehydration increased from 13 to 14 ( P = .01). Discussion Standardized, mandatory at-home intravenous hydration following ileostomy creation leads to a significant reduction in postoperative incidence of dehydration and dehydration-associated readmissions. This protocol should be followed for all patients with newly created ileostomies, so long as adequate home health nursing support and active surveillance are available.

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