Maintenance of Elective Patient Care at Berlin University Children's Hospital During the COVID-19 Pandemic

Background: In Germany, so far the COVID-19 pandemic evolved in two distinct waves, the first beginning in February and the second in July, 2020. The Berlin University Children's Hospital at Charité (BCH) had to ensure treatment for children not infected and infected with SARS-CoV-2. Prevention of nosocomial SARS-CoV-2 infection of patients and staff was a paramount goal. Pediatric hospitals worldwide discontinued elective treatments and established a centralized admission process.Methods: The response of BCH to the pandemic adapted to emerging evidence. This resulted in centralized admission via one ward exclusively dedicated to children with unclear SARS-CoV-2 status and discontinuation of elective treatment during the first wave, but maintenance of elective care and decentralized admissions during the second wave. We report numbers of patients treated and of nosocomial SARS-CoV-2 infections during the two waves of the pandemic.Results: During the first wave, weekly numbers of inpatient and outpatient cases declined by 37% (p < 0.001) and 29% (p = 0.003), respectively. During the second wave, however, inpatient case numbers were 7% higher (p = 0.06) and outpatient case numbers only 6% lower (p = 0.25), compared to the previous year. Only a minority of inpatients were tested positive for SARS-CoV-2 by RT-PCR (0.47% during the first, 0.63% during the second wave). No nosocomial infection of pediatric patients by SARS-CoV-2 occurred.Conclusion: In contrast to centralized admission via a ward exclusively dedicated to children with unclear SARS-CoV-2 status and discontinuation of elective treatments, maintenance of elective care and decentralized admission allowed the almost normal use of hospital resources, yet without increased risk of nosocomial infections with SARS-CoV-2. By this approach unwanted sequelae of withheld specialized pediatric non-emergency treatment to child and adolescent health may be avoided.

Applications of infusion therapy in the difficult form of tuberculosis

Objective. Analysis of the prevalence of the difficult cases of tuberculosis (TB) and assessment of the effectiveness of the treatment when using infusion anti-TB drugs in standard regimens. Materials and methods. A retrospective analysis was carried out for 2017-2019 of the electronic database the register of patients and the inpatient case history KU “Chernivtsi Regional Clinical TB Dispensary”. Results and discussion. From 16 to 46 % of patients with TB infection have concomitant signs of diabetes mellitus. In 58.9 % of patients with sensitive TB, the absorption capacity of the small intestine significantly decreases with a predominant decrease in the intestinal permeability index from 3.1 to 6 (in 21.9 % of cases). At multiple-drug resistance TB decrease the absorptive function of intestines is observed in 76,1 % of cases with the prevalence of severe degree of disturbance (in 42,3 % of patients). The proportion of severe forms of sensitive TB is more than 42 % of cases, of which 69.6±1.6 % were diagnosed with destruction. The share of common forms of TB among all cases of drug-resistant TB (DRTB) treated in 4th categories is 47 %, of which with destructive forms – 78.5±3.6 %. The frequency of adverse reactions increases in severe forms of DRTB and amounts to 38 % of all analyzed cases. Conclusions. Early detection of patients with severe forms of TB, especially in the presence of concomitant pathology, and their allocation into a separate category of “severe patients with TB” using parenteral forms of anti-TB drugs, especially in the early stages of treatment (during the intensive phase, which is the most critical period), it facilitates to reduce the unfavorable prognosis of the course of the underlying disease.

Pattern of Possible Drug-Drug Interactions among Different Specialties at an Indian Tertiary Care Teaching Hospital

To study the pattern of possible drug-drug interactions among different specialties at an Indian tertiary care teaching hospital. The present study was a retrospective study where the inpatient case records of psychiatry, chest & tuberculosis, gynecology & obstetrics and orthopedics were included. By using the software Micromedex 2.0, all the collected cases were screened for possible DDIs and the severity of the interactions was classified into minor, moderate and major. A total of 205 cases were screened for possible DDIs and about 120 (58.5%) cases were observed to be with possible DDIs. Among all the departments, moderate polypharmacy was observed to be more in the prescriptions (41.7%).A total of 314 possible DDIs were observed and most of the possible DDIs were of moderate severity (64.1%). Majority of the possible DDIs were found in the department of gynecology & obstetrics (42.4%) followed by the psychiatry department (29.6%). In order to reduce the DDIs, rationale prescriptions must be prescribed by considering the risk benefit ratio. Clinical pharmacists should take the responsibility in assisting all the prescribers for screening the possible DDIs in the prescriptions there by preventing them and providing a better pharmaceutical care in various specialties.

Histoplasmosis-Associated Hemophagocytic Lymphohistiocytosis: A Review of the Literature

Background. Histoplasmosis is an endemic fungal disease with diverse clinical presentations. Histoplasmosis-associated hemophagocytic lymphohistiocytosis (HLH) is a rare disorder with limited data regarding treatment and outcome. We described the clinical features, treatment, and outcomes of five patients in our institution with histoplasmosis-associated HLH. This review also summarizes the current literature about presentation, treatment, and outcome of this infection-related HLH entity. Methods. We searched the electronic medical records for patients with histoplasmosis-associated HLH at our institution from 1/1/2006 to 9/30/2017. Diagnosis of HLH was confirmed by chart review using the HLH-04 criteria. We also searched the current literature for case reports and case series. Results. Five cases of histoplasmosis-associated HLH were included from our institution. All five patients were diagnosed after 2010. The literature review yielded 60 additional cases of histoplasmosis-associated HLH. The most common underlying condition was HIV in 61% of cases. The majority of histoplasmosis patients (81%) were treated with amphotericin B formulations. Documented specific treatments for HLH were as follows: nine patients received steroids only, six patients received intravenous immunoglobulin (IVIG) only, three patients received dexamethasone and etoposide, two patients received etoposide, dexamethasone, and cyclosporine, two patients received steroids and IVIG, and one patient received Anakinra and IVIG. The inpatient case fatality rate was 31% with most of the deaths occurring within two weeks of hospital admission. Conclusions. Histoplasmosis-associated HLH among adults is an uncommon but serious complication with high associated mortality. Early antifungal therapy with a lipid formulation amphotericin B is critical. The initiation of immunosuppressive therapy with regimens like HLH-04 in this disease entity should be individualized.

A biosketch of William Richard Gowers with a new review of his inpatient case history notes

William Richard Gowers (1845–1915) spent his career working at the National Hospital for the Relief and Cure for the Paralyzed and Epileptic at Queen Square, in London, United Kingdom, and at the nearby University College Hospital. His “Manual of the Diseases of the Nervous System” and many published lectures were based almost entirely on his own clinical observations meticulously recorded in shorthand. In this paper, we have focused on an analysis of his inpatient case records from 1878 to 1911 preserved in the archives at the National Hospital for Neurology and Neurosurgery, Queen Square. We reviewed all 42 volumes and analyzed 2,478 patients. Between 1897 and 1909, a mean of 129.7 cases per year were admitted to the hospital under Gowers' care. We grouped the diagnoses in 12 different categories. Epilepsy (16.5%), followed by spinal cord diseases (10.3%), cerebrovascular diseases (9.5%), and functional disorders (7.9%) were the most common diagnoses.