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Tertiary Care Teaching Hospital (tertiary + care_teaching_hospital)
Selected AbstractsA Study of Triggers of Migraine in IndiaPAIN MEDICINE, Issue 1 2010Rama K. Yadav DM ABSTRACT Objective., To evaluate the migraine triggers in consecutive patients and correlate these with demographic and clinical variables. Design., A prospective study. Setting., Tertiary care teaching hospital. Subject and Methods., A total of 182 patients with migraine were included whose age ranged between 14 to 58 years and 131 were females. Duration of migraine ranged between 6 and 260 months. Endogenous and exogenous migraine triggers were inquired using a questionnaire. Severity of migraine, associated symptoms, and functional disability were recorded. Presence of trigger was correlated with various demographic and clinical variables. Results., Migraine triggers were present in 160 (87.9%) patients and included emotional stress in 70%, fasting in 46.3%, physical exhaustion or traveling in 52.5%, sleep deprivation in 44.4%, menstruation in 12.8%, and weather changes in 10.1% patients. Multiple triggers (>2) were present in 34.4% patients. Conclusion., The triggers in the Indian migraine patients are similar to other populations but for dietary factors. [source] Stiff Limb Syndrome: End of Spectrum or A Separate Entity?PAIN MEDICINE, Issue 3 2009Usha K. Misra DM ABSTRACT Background., Stiff-person syndrome is a rare disorder characterized by rigidity of axial or limb muscles with episodes of co-contraction of agonist and antagonist muscles during the spasms. In some patients axial or limb involvement may predominate and may have unusual manifestations. Design., Case report. Setting., Tertiary care teaching hospital. Patient., A 42-year-old farmer presented with seasonal occurrence of hiccup and vomiting during summer months for the last 3 years. He had painful lower limb spasms lasting for 2,3 minutes every 10,15 minutes for the past 20 days. His neurological examination was normal, erythrocyte sedimentation rate (ESR) was 50 mm at 1st hour, and cerebrospinal fluid protein 78 mg/dL without pleocytosis. Radiograph of chest, abdominal ultrasound, and craniospinal magnetic resonance imaging were normal. The patient improved on diazepam. Conclusion., Our patient is a forme fruste of stiff person syndrome with hiccups and vomiting due to diaphragmatic spasm. [source] Postobstructive Pulmonary Edema After Laryngospasm in the Otolaryngology PatientTHE LARYNGOSCOPE, Issue 9 2006Vishvesh M. Mehta MD Abstract Context: Post-obstructive pulmonary edema (PPE) is an uncommon complication which develops immediately after the onset of acute airway obstruction such as laryngospasm or epiglottitis (type I) or after the relief of chronic upper airway obstruction such as adenotonsillar hypertrophy (type II). Objective: To describe the development of type I PPE following laryngospasm in pediatric and adult patients undergoing otolaryngologic surgical procedures other than those for treatment of obstructive sleep apnea. Design: Retrospective case series of 13 otolaryngology patients from 1996 to 2003. Setting: Tertiary care teaching hospital and its affiliates. Patients: 13 patients (4 children, 9 adults, 5 males, 8 females) ranging in age from 9 months to 48 years. Results: Operative procedures included adenoidectomy, tonsillectomy, removal of an esophageal foreign body, microlaryngoscopy with papilloma excision, endoscopic sinus surgery, septorhinoplasty, and thyroidectomy. Six patients required reintubation. Treatment included positive pressure ventilation, oxygen therapy, and diuretics. Seven patients were discharged within 24 hours and the others were discharged between 2 and 8 days postoperatively. There were no mortalities. Conclusion: Laryngospasm resulting in PPE may occur in both children and adults after various otolaryngologic procedures. Among the subgroup of children, our study is the first to report its occurrence in healthy children without sleep apnea undergoing elective surgery. [source] Impact of Critical Bed Status on Emergency Department Patient Flow and OvercrowdingACADEMIC EMERGENCY MEDICINE, Issue 4 2003Stephen Liu MD Objective: To compare measurements of emergency department (ED) patient flow during periods of acute ED overcrowding and times of normal patient volume (NPV). Methods: Retrospective ED chart review comparing ED flow for patients treated in a tertiary care teaching hospital during periods of ED overcrowding, defined as critical bed status (CBS), and NPV. All periods of CBS during July 2001 were identified. CBS time intervals were matched with NPV times by month, day of the week, time of day, and number of care providers. All patients registered during these matched time intervals were reviewed. Times were collected for each of the following activities: check-in, bed placement, physician assessment, first intervention, and disposition. Corresponding intervals were calculated in minutes. Triage category was used as a marker of illness severity (1 = most severe, 5 = least severe). Descriptive statistics were performed. Results: One hundred eighteen patient charts were reviewed: 61 CBS and 57 NPV. There was no statistical difference in illness severity between the two groups. In the cumulative analysis, patients waited significantly longer for an ED bed (30.4 min, p = 0.01) but did not experience significant delays in other intervals. Triage category analysis revealed no significant difference in triage 2 patients. Intermediate-severity patients (triage 3) waited longer in every interval and significantly longer for physician assessment (30.8 min longer, p < 0.05). Low-severity patients (triage 4) waited longer for an ED bed (40 min, p = 0.02) but did not experience other significant delays. Conclusions: During times of acute overcrowding, the most significant delay occurs awaiting placement in the ED bed. [source] Impact of maternal body mass index on obstetric outcomeJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2007Meenakshi T. Sahu Abstract Aim:, The purpose of the present study was to correlate effect of maternal body mass index (BMI) on obstetric outcome. The studies conducted so far are from Western developed countries and there is a paucity of data from developing countries. Methods:, A prospective evaluation was carried out of 380 women in one unit of a tertiary care teaching hospital in North India from May 2005 to June 2006 on the effect of maternal BMI on pregnancy outcome. BMI was calculated as weight (kg) divided by height (m2). BMI was used to characterize women as lean (BMI < 19.8 kg/m2), normal (BMI 19.9,24.9 kg/m2), overweight (BMI 25,29.9 kg/m2) or obese (,30 kg/m2). Results:, Forty-six women (12.1%) out of 380 were underweight, 99 (26.1%) were overweight, 30 (7.9%) were obese and the remaining 205 (53.9%) had normal BMI. Anemia (P = 0.02) and low birthweight (P = 0.008) was significantly present among lean women. Obese women had a significant risk for gestational diabetes (P = 0.0004), pre-eclampsia (P = 0.004), cesarean delivery (P = 0.01) and macrosomia (P = 0.02). Conclusion:, Both lean and obese women carry a risk for adverse pregnancy outcome, therefore pregnant women should maintain a normal BMI to achieve a healthy pregnancy outcome. [source] Severe hypoglycemia during intensive insulin therapyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2009K.-M. KAUKONEN Background: Tight glycemic control reduces mortality in surgical intensive care patients and in long-term medical intensive care patients. A large study on intensive insulin therapy was prematurely discontinued due to safety issues. As the safety of intensive insulin therapy has been questioned, we screened all patients during a 17-month period to reveal the incidence of hypoglycemia and its effects on the outcome of the patients. Methods: All patients treated between February 2005 and June 2006 in two intensive care units (ICUs) of a tertiary care teaching hospital were included in the study. A nurse-driven intensive insulin therapy with a target blood glucose level of 4,6 mmol/l had been introduced earlier. The patients were divided into two groups according to the presence of severe hypoglycemia (,2.2 mmol/l). Results: One thousand two hundred and twenty-four patients (1124 treatment periods) were included. During the study period, 61,203 blood glucose measurements were performed, 2.6% of which were below and 52.6% above the target range. Severe hypoglycemia (glucose ,2.2 mmol/l) occurred in 25 patients (36 measurements). The incidence was 0.06% of the measurements and 2.3% of the patients. The median age, sex, Acute Physiology And Chronic Health Evaluation II, Simplified Acute Physiology Score II, diagnosis category, ICU or hospital length of stay did not differ between the groups. The hospital mortalities were 25% and 15% in patients with or without severe hypoglycemia, respectively (P=0.16). Conclusion: Severe hypoglycemia during intensive insulin therapy is rare in clinical practice compared with previous clinical trials. [source] Failure of Intimate Partner Violence Screening Among Patients With Substance Use DisordersACADEMIC EMERGENCY MEDICINE, Issue 8 2010Esther K. Choo MD ACADEMIC EMERGENCY MEDICINE 2010; 17:886,889 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, This study examined the relationship between substance use disorder (SUD) and intimate partner violence (IPV) screening and management practices in the emergency department (ED). Methods:, This was a retrospective cohort study of adult ED patients presenting to an urban, tertiary care teaching hospital over a 4-month period. An automated electronic data abstraction process identified consecutive patients and retrieved visit characteristics, including results of three violence screening questions, demographic data, triage acuity, time of visit, and International Classifications of Disease, 9th revision (ICD-9), diagnosis codes. Data on management were collected using a standardized abstraction tool by two reviewers masked to the study question. Multivariate logistic regression was used to determine predictors of screening and management. Results:, In 10,071 visits, 6,563 violence screens were completed. IPV screening was documented in 33.5% of patients with alcohol-related diagnoses (95% confidence interval [CI] = 27.7% to 39.3%, ,2 = 116.78, p < 0.001) and 53.3% of patients with drug-related diagnoses (95% CI = 44.3% to 62.3%, ,2 = 7.69, p = 0.006), compared to 66.1% of patients without these diagnoses (95% CI = 65.2% to 67.1%). In the multivariate analysis, alcohol (odds ratio [OR] = 0.30, 95% CI = 0.22 to 0.40) and drug use (OR = 0.56, 95% CI = 0.38 to 0.83) were associated with decreased odds of screening. Of completed screens, 429 (6.5%) were positive, but violence was addressed further in only 55.7% of patients. Substance abuse did not appear to affect the odds of having positive screens addressed further by providers (OR = 1.96, 95% CI = 0.39 to 10.14). Conclusions:, This study found an association between SUD and decreased odds of IPV screening. Failure to screen for IPV in the setting of substance use may represent a missed opportunity to address a critical health issue and be a barrier to successful intervention. [source] | ||||||||||