scholarly journals Preoperative Plasmapheresis for Elective Thymectomy in Myasthenia Patient: Is It Necessary?

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Somcharoen Saeteng ◽  
Apichat Tantraworasin ◽  
Sophon Siwachat ◽  
Nirush Lertprasertsuke ◽  
Juntima Euathrongchit ◽  
...  
Keyword(s):  
Muscle Power ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Secondary Outcome ◽  
Myasthenic Crisis ◽  
Number Of Patients ◽  
History Of ◽  
Review Study

Background. Role of plasmapheresis before thymectomy remains controversial. The aim of this study is to determine the peri-operative and post-operative outcome of a thymectomy between performing and not performing a pre-operative plasmaphreresis. Patients and Methods. A retrospective chart review study was conducted in Chiang Mai University Hospital between January 2006 and December 2011. There were 86 myasthenia patients divided into two groups; Preoperative plasmapheresis group (PPG) and no preoperative plasmapheresis group (NPPG). The primary outcome involved post-operative extubation and the secondary outcome included post-operative complications, 28 day mortality and length of hospital stay. Results. Eighty-six patients were enrolled in this study. The number of patients who had a history of myasthenic crisis at any time or within one month in the PPG was significantly more than those in the NPPG. Muscle power and forced expiratory vital capacity in the NPPG was higher than that in the PPG. The postoperative extubation rate was similar in both groups. After controlling for the propensity score, there were no statistically significant differences in both of primary and secondary outcomes. Conclusion. The results of this study shows no significant differences between both groups in all outcomes, therefore the pre-operative plasmaphresis is not necessary for elective thymectomy.

Abstract W P333: Seizure as the Presenting Symptom of ICH Patient Characteristics and EEG Utilization

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kanika Arora ◽  
Alyssa Gadpaille ◽  
Karen C. Albright ◽  
Muhammad Alvi ◽  
Ayaz Khawaja ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Clinical Evidence ◽  
Patient Characteristics ◽  
Rhythmic Pattern ◽  
Epileptiform Discharges ◽  
Number Of Patients ◽  
Eeg Data ◽  
History Of ◽  
Ich Score

Background and Purpose: Seizures are the presenting symptom in a significant number of patients with spontaneous ICH. The role of EEG in the routine evaluation patients, with or without clinical evidence of seizures, is unclear. This study was undertaken to better understand seizures and the use of EEG in patients with ICH. Methods: Retrospective review of consecutive spontaneous ICH patients at our institution from 2008-2013. Patients were considered to have a seizure on presentation if a clinical evidence of a seizure was documented in the medical record; EEG data was not required to confirm seizure on presentation. Demographics, vascular risk factors, ICH score, and EEG findings were assessed. Results: Of 402 spontaneous ICH patients (mean age 63, 42% black, 43% female), 10% presented with seizure. Patients presenting with seizure were younger (mean age 65 vs. 54, p<.001). Compared to patients with ICH presenting without a seizure, blacks presented more frequently with seizure (62% vs. 40%, p=.009). A higher proportion of patients who presented with seizure had a history of alcohol use (50% vs. 27%, p=.008) and substance abuse (23% vs. 10%, p=.025). Patients who presented with seizure more frequently had cortical ICH (54% vs. 32%, p=.007). EEGs were performed more frequently in ICH patients that presented with seizure (66% vs. 19%, p<.001). Among patients with an EEG, epileptiform discharges or rhythmic pattern was more common in patients who presented with seizure (30% vs. 10%, p=.040) and with a cortical ICH (29% vs. 9%, p=.036). There were no significant differences in the proportion of patients that received EEG based on race, history of alcohol abuse, or history of substance abuse. Conclusions: Patients who presented with seizure were younger, black, and a higher proportion had a history of alcohol and substance abuse compared to patients with ICH who did not present with a seizure. Only 66% of those presenting with clinical seizure underwent EEG. Despite the prevalence of subclinical seizures in ICH patients, only 19% of patients who did not present with a seizure underwent EEG. Our study suggests that there may be room for improvement on the part of stroke neurologists in the diagnosis and management seizure of ICH patients.

Safety and Efficacy of Various Intravenous Insulin Infusion Rates in Patients With and Without Diabetes Presenting With Hypertriglyceridemia

2022 ◽  
pp. 106002802110701
Author(s):  
Francisco Ibarra ◽  
Kaitlyn Loi ◽  
Ann W. Vu
Keyword(s):  
Medical History ◽  
Insulin Infusion ◽  
Case Reports ◽  
Retrospective Chart Review ◽  
Acute Management ◽  
Past Medical History ◽  
Safety And Efficacy ◽  
Intravenous Insulin ◽  
Number Of Patients ◽  
History Of

Background The use of IV insulin infusions in the acute management of hypertriglyceridemia has only been evaluated in small observational studies and case reports. Objective To evaluate the safety and efficacy of IV insulin infusions in the acute management of hypertriglyceridemia. Methods This was a retrospective chart review of adult patients who received an IV insulin infusion for the acute management of hypertriglyceridemia. The primary efficacy and safety outcomes were the number of patients who achieved a triglyceride level <500 mg/dL and experienced hypoglycemia (<70 mg/dL), respectively. A subgroup analysis was performed to compare outcomes between patients with and without diabetes, in addition to the IV insulin infusion rate received. Results In the total population (n = 51), there were no statistically significant differences between the insulin intensity groups in the number of patients who achieved TG levels <500 mg/dL. Compared to patients with a past medical history of diabetes, more patients without a past medical history of diabetes achieved triglyceride levels <500 mg/dL (14% vs 53%, respectively, P < 0.001). The number of hypoglycemic events observed in patients with and without a past medical history of diabetes were 5 (14%) and 4 (27%), respectively ( P = 0.023). Conclusion and Relevance Our findings suggest that patients who present with lower initial TG levels are more likely to achieve TG levels <500 mg/dL. To minimize the risk of hypoglycemia providers should consider prescribing a concomitant dextrose infusion and limiting IV insulin infusion rates ≤ 0.075 units/kg/h.

scholarly journals Effect of national HIV testing recommendations and local interventions on HIV testing practices in a Swiss university hospital: a retrospective analysis between 2012 and 2015

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e021203
Author(s):  
Tosca Lazzarino ◽  
Sebastien Martenet ◽  
Rachel Mamin ◽  
Renaud A Du Pasquier ◽  
Solange Peters ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Hiv Testing ◽  
Retrospective Analysis ◽  
University Hospital ◽  
Secondary Outcome ◽  
Clinical Services ◽  
Demographic Profiles ◽  
Testing Rate ◽  
Number Of Patients ◽  
Living With Hiv

ObjectivesDespite HIV testing recommendations published by the Federal Office of Public Health (FOPH) since 2007, many individuals living with HIV are diagnosed late in Switzerland. The aim of this study is to examine the effect of the 2013 FOPH HIV testing recommendations on HIV testing rates.SettingTen clinical services at Lausanne University Hospital, Lausanne, Switzerland.ParticipantsPatients attending between 1 January 2012 and 31 December 2015.DesignRetrospective analysis using two existing hospital databases. HIV testing rates calculated as the percentage of tests performed (from the Immunology Service database) per number of patients seen (from the central hospital database).Primary and secondary outcome measuresThe primary outcome was testing rate change following the 2013 FOPH testing recommendations, comparing testing rates 2 years before and 2 years after their publication. Secondary outcomes were demographic factors of patients tested or not tested for HIV.Results147 884 patients were seen during the study period of whom 9653 (6.5%) were tested for HIV, with 34 new HIV diagnoses. Mean testing rate increased from 5.6% to 7.8% after the recommendations (p=0.001). Testing rate increases were most marked in services involved in clinical trials on HIV testing, whose staff had attended training seminars on testing indications and practice. Testing rates were lower among older (aged >50 years), female and Swiss patients compared with younger, male and non-Swiss patients, both globally (p=0.001) and in specific clinical services.ConclusionsThis simple two-database tool demonstrates clinical services in which HIV testing practice can be optimised. Improved testing rates in services involved in clinical trials on testing suggest that local engagement complements the effect of national recommendations. While, overall, HIV testing rates increased significantly over time, testing rates were lower among patients with similar demographic profiles to individuals diagnosed late in Switzerland.

The role of pyridostigmine in recovery from motor paralysis in a snakebite patient with an allergic reaction to anti-snake venom

2020 ◽  
Vol 50 (3) ◽  
pp. 238-239
Author(s):  
Vanita Ahuja ◽  
Anjuman Chander ◽  
Nishit Sawal
Keyword(s):  
Allergic Reaction ◽  
Snake Venom ◽  
Muscle Power ◽  
Motor Recovery ◽  
Motor Power ◽  
The Third ◽  
Motor Paralysis ◽  
History Of ◽  
Supportive Management

A 30-year-old woman presented as an emergency with a history of snakebite 5 h previously with signs of bulbar palsy, ptosis, respiratory distress and weakness of all four limbs. Mechanical ventilation, anti-snake venom (ASV) and supportive management were immediately instituted. With the third dose of ASV, an early anaphylactic reaction ensued. Subsequent management with corticosteroids and antihistamines over the next few days allowed consciousness to return but muscle power did not improve beyond 2/5. A trial of intravenous neostigmine with glycopyrrolate, however, improved motor power in all four limbs to 3/5. Oral pyridostigmine at 60 mg every 8 h allowed subsequent full motor recovery in all four extremities. We suggest consideration of pyridostigmine to promote motor recovery after an allergic reaction to ASV.

scholarly journals 665. Key Clinical and Laboratory Features in Early Diagnosis of Ehrlichiosis in an Endemic Area of Long Island, New York

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S240-S241
Author(s):  
Olga Kaplun ◽  
Kalie Smith ◽  
Teresa Khoo ◽  
Eric Spitzer ◽  
Fredric Weinbaum ◽  
...  
Keyword(s):  
New York ◽  
Clinical Presentation ◽  
Average Length ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Suffolk County ◽  
University Hospital ◽  
Laboratory Findings ◽  
Significant Difference

Abstract Background Human monocytic ehrlichiosis (HME) is a tick-borne disease caused by Ehrlichia chafeensis in the northeast United States. Suffolk County, New York has the highest amount of HME cases in NY (176 from 2010 to 2014). Our aim is to identify risk factors for HME and compare clinical presentation and laboratory findings of young vs. older adults. Methods A retrospective chart review from January 1, 2014 to December 31, 2017 was performed on all patients ≥18 years who presented to the ER at Stony Brook University Hospital (SBUH) or Stony Brook Southampton Hospital (SBSH) with (i) ICD-9 code 082.4 or ICD-10 code A77.40 and (ii) a positive E. Chafeensis PCR. Data were collected on demographics, clinical presentation, and laboratory results. Results Twenty-seven cases of HME were found and separated into Group 1 (G1, n = 10) or Group 2 (G2, n = 17) based on age (Table 1). G1 had a significantly higher chance of being Hispanic than G2. Twenty-four of the 27 patients (89%) were hospitalized with an average length of stay of 3.4 days (range 1–14 days).The only significant difference in clinical presentation was that G1 was more likely to have myalgia (P = 0.02). 40% or more of patients in both groups presented with an acute kidney injury and the average length of hospital stay in days was 4.0 ± 2.9 and 3.2 ± 3.1 for G1 and G2, respectively. The number of cases overall have increased 6.0% per year between 2014 and 2017. Thrombocytopenia presented in all cases. Conclusion. HME is prevalent in Suffolk County. Clinical presentation and laboratory findings were largely similar between the two groups, except the younger population more often presented with myalgia. A risk factor in this study was to be young and Hispanic, likely due to occupational exposure. Disclosures All authors: No reported disclosures.

Therapy Preference and Outcomes of Hydroxyurea for Pediatric Patients with Silent Cerebral Infarcts

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3531-3531
Author(s):  
Tullia Rushton ◽  
Inmaculada Aban ◽  
Daniel Young ◽  
Thomas H. Howard ◽  
Lee Hilliard ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Sample Size ◽  
Research Funding ◽  
Retrospective Chart Review ◽  
Initial Therapy ◽  
Pediatric Radiologist ◽  
Transfusion Therapy ◽  
Exact Test ◽  
Number Of Patients ◽  
History Of

Abstract Introduction: The Silent Infarct Transfusion (SIT) Trial demonstrated that transfusion therapy over three years, as compared to no sickle cell disease (SCD) modifying therapy, reduces the risk of new CNS events, defined as an overt stroke or new or enlarged silent cerebral infarct (SCI), in patients with SCI on screening MRI. Despite the significant reduction in CNS events with transfusion therapy, patients/caregivers may choose to decline chronic transfusion therapy for secondary CNS events. Hydroxyurea is known to decrease complications of SCD, and while its impact on new CNS events in patients with a SCI has not been tested in a randomized trial, it was offered as an alternative for patients who declined transfusion therapy. We evaluated therapy preference for prevention of new CNS events among patients with SCI on screening MRI and three year outcomes of patients with SCI that elected treatment with hydroxyurea at our institution. Methods: We performed a 15-year IRB approved retrospective chart review for all patients with the diagnosis of SCI at Children's of Alabama based on their original MRI report. Ninety-two patients were identified and subsequently confirmed by an additional pediatric radiologist to have suffered a SCI and had no history of a prior overt stroke while 39 patients were excluded because of their history of overt stroke prior to the detection of a SCI. We recorded the patient/caregiver initial preference for therapy and evaluated differences in therapy selection prior to, during, and post SIT Trial. We recommend annual or biennial follow-up MRI exams to evaluate for SCI progression and recorded and reviewed all subsequent MRIs and SCD therapies for overt stroke or new or enlarged SCI. To compare outcomes of hydroxyurea for secondary CNS events to the SIT Trial, we evaluated the 27 patients with SCI that were treated with hydroxyurea (HU) for their SCI and had a subsequent MRI/MRA at least three years after their initial diagnosis of SCI. Descriptive statistics and Fisher's exact test were performed using JMP10. Sample size was calculated for a superiority trial design using a power of 85% and alpha of 5% with PASS version 14. Results: We evaluated patient/caregiver therapy preference for secondary SCI prevention among 54 patients that were not receiving a SCD modifying therapy at the time of their index SCI. We identified a significantly higher number of patients/caregivers who, after discussion with their primary SCD provider about therapeutic options, elected to initiate transfusion or enroll in the SIT Trial prior to and during SIT Trial enrollment but a higher percentage of patients/families that elected to initiate hydroxyurea after enrollment (p=0.04). Three of 36 patients (8%) elected hydroxyurea prior to and during SIT Trial enrollment as compared to 6 of 18 patients (33%) post enrollment. Among 27 participants on HU at the time of their incident SCI finding on MRI, 25 (93%) participants elected to remain on HU while only two (11%) participants elected to change to chronic transfusion therapy. The two patients that switched to transfusion also had MRA abnormalities identified at the time of their incident SCI finding. To evaluate outcomes of HU for secondary SCI prevention, 27 participants were prescribed HU for at least three years and underwent serial MRI evaluations. Three of these 27 participants developed a new SCI. Four participants had an abnormal MRA at the time of their index MRI and five patients developed an abnormal MRA on subsequent studies. The three participants that had an additional SCI had normal MRA examinations. In comparison to the SIT Trial, which identified 2.0 and 4.8 new CNS events per 100 patient years at risk for transfusion and no therapy respectively, we identified 3.7 new CNS events per 100 patient years among patients prescribed hydroxyurea. Combining our results with that of SIT Trial, a sample size of 1100 participants would be required to conduct a trial to show the superiority of transfusion over HU for secondary SCI. Conclusion: While the SIT Trial showed chronic transfusion to be superior to no therapy in preventing new CNS events in patients with SCI, patients and caregivers at our institution prefer hydroxyurea to transfusion for initial therapy to prevent secondary CNS events. A randomized trial to show superiority of transfusion over hydroxyurea for secondary stroke prevention would require a sample size too large to be practical. Disclosures Lebensburger: NHLBI: Research Funding; American Society of Hematology, Scholar Award: Research Funding.

scholarly journals Postoperative atrial fibrillation: Target for stroke prevention?

2017 ◽  
Vol 2 (3) ◽  
pp. 222-228 ◽  
Author(s):  
Vincent Thijs ◽  
Robin Lemmens ◽  
Omar Farouque ◽  
Geoffrey Donnan ◽  
Hein Heidbuchel
Keyword(s):  
Atrial Fibrillation ◽  
Lifestyle Changes ◽  
Adverse Outcomes ◽  
Postoperative Atrial Fibrillation ◽  
Long Term Outcomes ◽  
Number Of Patients ◽  
History Of ◽  
Long Term Mortality

Purpose A substantial number of patients without a history of atrial fibrillation who undergo surgery develop one or more episodes of atrial fibrillation in the first few days after the operation. We studied whether postoperative transient atrial fibrillation is a risk factor for future atrial fibrillation, stroke and death. Method We performed a narrative review of the literature on epidemiology, mechanisms, risk of atrial fibrillation, stroke and death after postoperative atrial fibrillation. We reviewed antithrombotic guidelines on this topic and identified gaps in current management. Findings Patients with postoperative atrial fibrillation are at high risk of developing atrial fibrillation in the long term. Mortality is also increased. Most, but not all observational studies report a higher risk of stroke. The optimal antithrombotic regimen for patients with postoperative atrial fibrillation has not been defined. The role of lifestyle changes and of surgical occlusion of the left atrial appendage in preventing adverse outcomes after postoperative atrial fibrillation is not established. Conclusion Further studies are warranted to establish the optimal strategy to prevent adverse long-term outcomes after transient, postoperative atrial fibrillation.

scholarly journals Laparoscopy in acute abdomen between encouragement and inhibition

2019 ◽  
Vol 6 (10) ◽  
pp. 3507
Author(s):  
Mena Zarif Helmy ◽  
Ahmed Abdel Kahaar Aldardeer
Keyword(s):  
Abdominal Pain ◽  
Acute Abdomen ◽  
Acute Abdominal Pain ◽  
Past History ◽  
Abdominal Distension ◽  
X Ray ◽  
Main Complaint ◽  
Number Of Patients ◽  
History Of

Background: Laparoscopy has been a valuable technique in the treatment of acute abdominal diseases and can be considered either to diagnose or to treat selected cases.Methods: Here, we randomly select patients with acute abdominal pain in whom the diagnosis was not clear after ultrasonography and plain X-ray, we did diagnostic laparoscopy and according to its findings, we proceeded to surgical intervention. 50 cases with acute abdomen were included in this study in order to clarify the role of laparoscopy in the diagnosis and treatment of acute abdomen.Results: From the 50 patients, the main complaint was abdominal pain and presented in (100%) of patients, 38 of patients had vomiting, fever in 29 patients and 14 patients had abdominal distension, 7 patients had alteration in bowel habits and burning micturition in 6 patients. In this study, 10 patients had past history of previous surgery. By laparoscopy we could see the pathology in 46 patients and complete the management in all of patients but failed to reach the diagnosis in 2 cases and conversion to laparotomy in other 2 cases. Laparoscopic surgery mean was 47.9±12.4 minutes. Hospital stay mean was (1.851) days. Morbidity was 10%. No mortality was found in our study.Conclusions: Laparoscopy can be considered safe for diagnosis and effective in the treatment of patients with acute abdomen. It may be useful to avoid the unnecessary laparotomies in a large number of patients presented with acute abdominal pain.

scholarly journals Adult Acute Epiglottitis: An Eight - Year Experience in A Philippine Tertiary Government Hospital

2016 ◽  
Vol 31 (2) ◽  
pp. 20-23 ◽  
Author(s):  
Melanie Grace Y. Cruz ◽  
Natividad A. Almazan
Keyword(s):  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Government Hospital ◽  
Acute Epiglottitis ◽  
Intravenous Antibiotics ◽  
Clinical Presentations ◽  
History Of

Objective: To review cases of adult acute epiglottitis in a tertiary government hospital and describe the clinical presentations, diagnostics performed, management and outcomes. Methods: Study Design:            Retrospective Chart Review Setting:                       Tertiary Government Hospital Subjects: Records of patients admitted by or referred to the Department of Otolaryngology Head and Neck Surgery with a diagnosis of acute epiglottitis from January 2008 to August 2014 were identified from the department census and charts were retrieved from the Hospital Record Section and evaluated according to inclusion and exclusion criteria.  Information regarding demographic data, clinical features, laboratory and other diagnostic examinations, medical management, and length of hospital stay were collected. Results: There were 20 cases in seven years and eight months. Most were male, 18 to 37-years-old, presenting with dysphagia, odynophagia and a swollen epiglottis on laryngoscopy. Abnormal soft-tissue lateral radiographs of the neck and leukocytosis were seen in 73 % and 83% respectively. Intravenous antibiotics and corticosteroids were administered in all cases, and mean hospital stay was 11.2 days. Conclusion: Adult acute epiglottitis should be highly suspected in patients presenting with dysphagia, odynophagia, and muffling of the voice even with a normal oropharyngeal examination. History of respiratory infection, co-morbidities, smoking and alcohol intake, concomitant laryngeal pathology and supraglottic structure insults contribute to development of the disease.  Laryngoscopy is still the gold standard in diagnosis. Airway protection is mandatory but prophylactic intubation or tracheostomy are not advised.  Intravenous antibiotics are necessary and corticosteroids may be of benefit.  Keywords: epiglottitis, supraglottitis, epiglottis, adult, Philippines

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