Cases Seen Research Articles

Characterization of Emergency Department Quality Assurance Cases Seen Within a Midwestern United States Health System.

Hospital quality-assurance (QA) processes, including peer-review committees, seek to identify high-risk areas. To characterize emergency department (ED) cases sent for QA review. A retrospective observational study was conducted of ED cases sent to a QA committee from November 2018 through July 2022 at three midwestern US hospitals. The QA records analyzed for these cases included the original incident report, case summary, and the committee determinations. One hundred and forty-seven cases were reviewed by the ED QA Committee. The most frequent referrals came from physicians. Common diagnostic categories included infectious (21%), cardiac (16%), gastrointestinal (11%), and neurologic (10%) concerns. Of the cases, 51% were considered nonpreventable, 33% were potentially preventable, and 9% were preventable. Inpatient boarding in the ED was explicitly implicated as a contributing factor in 6% of case reports. Peer physician reporting represent the largest referral source sent for review with the most frequent diagnostic categories, including infectious, cardiac, gastrointestinal, and neurological conditions. Preventable concerns were rare. This study provides a better understanding of the referral sources, diagnostic categories, and committee determinations in ED quality concerns. These results can target future investigations into case reporting and patient safety.

Prevalence and Pattern of Stroke Cases Seen at the Neurology Clinic of Physiotherapy Department, University of Port Harcourt Teaching Hospital, Port Harcourt: A Ten-Year Retrospective Study .

Background: Stroke is a condition of public health concern. It affects people of different age brackets, leading to long-term debilitation with a significant percentage of survivors left with permanent disabilities Methods: The study adopted a descriptive retrospective study design in which the data of a total of 338 adult male and female stroke patients who attended the neurology clinic of Physiotherapy Department, University of Port Harcourt Teaching Hospital (UPTH), between December 2012 and December 2022 were retrieved and studied following ethical clearance. Data were analysed using the Statistical Package for Social Science (SPSS) version 25. Descriptive statistics was used to present the data in frequency tables. Results: Majority of the stroke patients were male 208 (61.5%), married 300 (88.8%), and between the ages of 51 and 60 (28.7%). The most common type of stroke was ischaemic stroke 295 (87.2%) with majority between the age bracket of 61-70 (26.6%). First episode of stroke was the most prevalent 301 (89.0%) with majority of the survivors between the age bracket of 51-60 (25.7%). Hypertension was the most prevalent risk factor 195 (57.7%) and was also most prevalent among the age bracket of 51-60 (16.0%). Lastly, majority of the stroke patients had right sided hemiparesis 192 (56.9%). Conclusion: The risk factors and clinical presentation of stroke vary from individuals to individuals. Adequate education, counseling, medical, and financial support should be given to stroke survivors in order to prevent and manage the condition.

Prevalence of Acute Bronchiolitis in Infants: About 167 Cases Seen in Pediatric Consultation at the Reference Health Center of the Commune I of Bamako (Mali)

Introduction: Bronchiolitis is a common respiratory disease in pediatrics. Its acute onset manifestations are most often observed in infants under 24 months of age, but at this age the respiratory system remains immature. The main pathogen of acute bronchiolitis in infants is respiratory syncytial virus (RSV). Materials and method: This is a descriptive and prospective study of the acute bronchiolitis in infants aged 0 to 24 months received at the pediatric consultation of the Reference Health Center of the Commune I of Bamako de Mars 2019 to February 2020. Results: In 12 months, 167 cases of acute bronchiolitis were seen at the pediatric consultation. The prevalence of bronchiolitis was 1.85%, the average age of infants was 8 months, and the boy/girl sex ratio was 1.6. The month of September represented the peak (31.1%). Infants aged 1 to 10 months accounted for 60% of hospitalizations. Mortality was 5.4%. Conclusion: bronchiolitis is a common pediatric consultation pathology, it remains worrying for parents with a more or less negligible mortality rate.

54 Characterization of Emergency Department Quality Assurance Cases Seen Within a Midwestern United States Health System

54 Characterization of Emergency Department Quality Assurance Cases Seen Within a Midwestern United States Health System

Occlusive Syndrome Revealing Hirschsprung's Disease in Two Pediatric Cases Seen in Emergency in a Peripheral Hospital Department of Pediatric Surgery Fousseyni Daou Hospital in Kayes

Hirschsprung's disease is a congenital anomaly of the innervation of the distal intestine, usually limited to the rectum and colon, resulting in partial or total functional occlusion. It is one of the most common causes of obstruction in children. It is a rare pathology, but the diagnosis of which is becoming increasingly easy because of dill Omo pathology. We report two cases treated urgently in the pediatric surgery department of the Fousseyni Daou hospital in Kayes. Our objectives were to describe the clinical aspects and the management of an occlusive syndrome secondary to Hirschsprung's disease.

Spatial Distribution of Cancer Cases Seen in Three Major Public Hospitals in KwaZulu-Natal, South Africa.

Background:Noncommunicable diseases (NCDs) like cancer are posing a challenge in the health system especially in low- and middle-income countries (LMICs). In South Africa, cancer is under-reported due to the lack of a comprehensive cancer surveillance system. The limited knowledge on the extent of cancer burden has led to inaccurate allocation of public health resources. The aim of this study was to describe cancer incidence and spatial distribution of cancer cases seen at 3 main public oncology facilities in KwaZulu-Natal.Methods:In this retrospective study, cases of cancer observed from year 2015 to 2017 were extracted from medical records. The crude incidence rate was estimated for the total cancer cases and for different type of cancer reported over that period. Age-standardised incidence rates (ASR) per 100 000 was calculated per year using age groups and sex according to the district population data of KwaZulu-Natal. The comparisons of cancer diagnosed incidences were made between 11 districts using the ASR. Choropleth spatial maps and Moran’s Index were used to assess the ASR cancer spatial distribution along with geographical patterns among the districts. One sample chi-square test was used to assess the significant increase/decrease over time.Results:The study lost numerous cases due to incompleteness. A total of 4909 new cases were diagnosed with cancer during 2015 to 2017, 62% of which were female. Both uMgungundlovu and eThekwini districts had the highest ASR among district municipalities of KwaZulu-Natal for both male and female (83.6 per 100 000 per men year for men, 158.2 per 100 000 women per year, and 60.1 per 100 000 men per year and 96.9 per 100 000 women per year, respectively). Random distribution of reported cancer cases in KwaZulu-Natal was observed with a high concentration being in and around 2 metropolitan districts. Spatial variation showed a significant difference from year to year between the districts with the random spatial distribution. Overall, there was a significant decline of cancer incidences observed from 2015 to 2017 (P < .05) in the province.Conclusion:The overall cancer incidence in the study shows that female cancers (breast and cervical) are still on the rise and still need to be given priority as they were most prevalent in KwaZulu-Natal. Spatial analysis (choropleth maps) was used to show a pattern of higher concentration of cancer incidence in the north-western parts of the province.

Biopsies of Black African Skin: Analysis of 2547 Cases Seen at a Nigerian Tertiary Hospital

Biopsies of Black African Skin: Analysis of 2547 Cases Seen at a Nigerian Tertiary Hospital

Increase in FPIES Cases Seen in an Upstate New York University-Based Allergy Practice

Increase in FPIES Cases Seen in an Upstate New York University-Based Allergy Practice

Lassa Fever in Pregnancy: Report of 2 Cases Seen at the University College Hospital, Ibadan.

Lassa fever (LF), an acute viral haemorrhagic fever, is an endemic zoonotic viral infection in West Africa countries with up to 15% case fatality rate. Though a rodent-borne infection, it can also be transmitted from person to person during the care of sick relations or more commonly in health care settings as a nosocomial infection. Vertical transmission from mother to child has been documented. We report 2 cases of LF among pregnant women which were managed at the University College Hospital, Ibadan, between September and October 2014. Both patients were in their early 20s with only one surviving the disease. Both had supportive therapy but none had antiviral therapy. This report emphasized the importance of early presentation, high index of suspicion, prompt diagnosis, and early commencement of supportive therapy in the management of patients suspected with LF especially in the era of other viral haemorrhagic infections.

Mo1562 Inflammatory Fibroid Polyp of the Stomach: Clinical and Pathologic Characteristics of 28 Consecutive Cases Seen Over a 44-Month Period

Purpose: Gastric adenomas of intestinal differentiation are much more common than the more recently described adenomas of gastric differentiation. The purpose of this study was to compare the incidence and age at which adenomas of gastric phenotype occur compared to the more common intestinal type gastric adenomas. Methods: We used a large national pathology database of patients who undergo upper endoscopy at community-based surgery centers to determine the relative prevalence and associations of gastric foveolar adenomas, pyloric gland adenomas, and intestinal type adenomas. We extracted pertinent demographic, clinical, endoscopic, and histopathologic information from all patients who had a diagnosis of one of these three types of gastric polyps between 1/1/2008 and 11/1/2011. Frequency distributions and simple odd ratios were used to determine the significance of the associations. Results: From a total of 640,991 patients who underwent upper endoscopy (median age 58 years; 59.8% women), we identified a total of 549 with a diagnosis of gastric adenoma. Of those 443 (81%) were intestinal type, 77 (14%) were foveolar adenomas, and 29 (5%) were pyloric gland adenomas. In each case, the diagnosis was made on H&E stain. Intestinal-type gastric adenomas resembled colonic adenomas with loss of mucin, enlarged and elongated pseudostratified nuclei, and typically associated intestinal metaplasia with Paneth cells. Pyloric gland adenomas were composed of densely packed pyloric glands lined by cuboidal or short columnar cells, and a, typically, unremarkable surface epithelium. Foveolar adenomas featured a surface-predominant villous or papillary architecture with larger than normal foveolar cells and elongated nuclei. There was no significant difference between the median age of the different type of polyps (72 years for intestinal type, 77 for foveolar, and 73 for pyloric gland). There was, however, a significant predominance of women (86.2%) among pyloric gland adenomas (OR=3.86, p<0.01), but not among foveolar adenomas (55.8% women). A small fraction of the study group was known to have FAP (3.4% of intestinaltype adenomas, 2.6% of foveolar adenomas, and none of pyloric gland adenomas). Conclusion: Among a large nationwide population with endoscopy and biopsy for gastric adenomas, intestinal-type adenomas predominate, but almost 20% are of gastric phenotype and may be under-recognized. Our data also reaffirms previous studies that demonstrate a female predominance among pyloric gland adenomas.

Su1674 Helicobacter heilmannii Infection: Clinical and Pathologic Characteristics of 160 Consecutive Cases Seen Over a 44-Month Period

Su1674 Helicobacter heilmannii Infection: Clinical and Pathologic Characteristics of 160 Consecutive Cases Seen Over a 44-Month Period

Common Geriatrics Cases Seen by a General Practitioner in an Urban Area of Jharkhand State, India

Common Geriatrics Cases Seen by a General Practitioner in an Urban Area of Jharkhand State, India

Etiology of Genital Ulcer Disease. A Prospective Study of 278 Cases Seen in an STD Clinic in Paris

The goal of this study was to identify the causes and factors associated with genital ulcer disease (GUD) among patients attending a sexually transmitted disease (STD) clinic in Paris. This study was a prospective investigation of GUD cases. Data were collected from 1995 to 2005. In each case, a Dark Field Examination (DFE), Gram stain, inoculation onto Thayer Martin agar, Columbia agar and chocolate agar with 1% isovitalex and 20% fetal calf serum, PCR Chlamydia trachomatis (Amplicor Roche), culture for herpes simplex virus (HSV) on MRC 5 cells and PCR HSV (Argene Biosoft) were obtained from the ulceration. First Catch Urine (FCU) PCR for Chlamydia trachomatis and syphilis, HIV, HSV, and HBV serologies were also performed. A total 278 cases of GUD were investigated, 244 (88%) in men and 34 (12%) in women. Primary syphilis accounted for 98 cases (35%), genital herpes for 74 (27%), chancroid for 8 (3%), other infections for 12 (5%). In 91 (32%) patients, no identifiable microorganism was documented. Primary syphilis was more prevalent in MSMs (P < 0.0001), while genital herpes and chancroid were significantly associated with heterosexuality (both P < 0.0001). A high level of HIV infection (27%) was found, particularly in patients with primary syphilis (33%). In the univariate analysis, no statistical difference was found between syphilis and herpes according to clinical presentation, pain being the only item slightly more frequent in herpes (P = 0.06). In the multivariable model syphilis was associated with being MSM (OR: 51.3 [95% CI: 14.7-178.7], P < 0.001) and with an ulceration diameter >10 mm (OR: 9.2 [95% CI: 2.9-30.7], P < 0.001). Genital herpes was associated with HIV infection in the subgroup of MSWs (OR: 24.4 [2.4-247.7], P = 0.007). We did not find significant differences in the clinical presentation of the ulcers according to HIV status. The profound changes of the epidemiology of GUD during the decade, due to disappearance of chancroid and reemergence of infectious syphilis have led to a new distribution of pathogens, genital herpes, primary syphilis and GUD from unknown origin, accounting each for one third of cases. No clinical characteristic is predictive of the etiology, underlining the importance of performing a thorough microbiologic evaluation. Close association with HIV is still a major public health problem.

Retropharyngeal Tendinitis May be More Common Than We Think: A Report on 45 Cases Seen in Danish Chiropractic Clinics

Retropharyngeal Tendinitis May be More Common Than We Think: A Report on 45 Cases Seen in Danish Chiropractic Clinics

Retropharyngeal Tendinitis May be More Common Than We Think: A Report on 45 Cases Seen in Danish Chiropractic Clinics

Objective This study presents information from 45 cases of retropharyngeal tendinitis that were collected in Danish chiropractic clinics. Methods A practicing Danish chiropractor collected cases of retropharyngeal tendinitis from colleagues who were members of the Danish Society of Chiropractic and Clinical Biomechanics. Only cases where a patient history of acute severe neck pain, cervical stiffness, and dysphagia were considered, and these were supplemented with imaging in the form of x-rays, computed tomography, or magnetic resonance imaging scans. All cases were reviewed independently by the chiropractor and a medical radiologist with a specialty in musculoskeletal disorders before acceptance into this case series. Results Forty-five cases fulfilled the inclusion criteria and were included in this review. Sixteen of these were recruited from a single chiropractic practice. Nineteen were males and 26 were females with an average age of 48 years. All but 2 patients had the characteristic depositions of calcium hydroxyapatite in the tendon of the longus colli muscle, and the average diameter of the retropharyngeal space was 8.1 mm. Conclusions Patients presenting with a triad of acute severe neck pan, stiff neck, and dysphagia may have retropharyngeal tendinitis. This condition may be a more common than previously thought among patients presenting with acute neck pain in the primary health care sector.

Characteristics Of Tetanus Cases Seen Over A Ten Year Period In A Tertiary Health Facility In Benin City, Nigeria

Tetanus remains a great public health problem in developing sub-Saharan Africa and it is associated with high mortality. We evaluated the epidemiological characteristics and clinical profiles of tetanus cases seen in a tertiary health facility in Benin City, Nigeria between 1990 and 2000. All consecutive patients admitted in the Medical wards of the University Teaching Hospital, Benin City between 1990 and 2000 were recruited. It is a prospective study which analyzed all patients with tetanus within the study period. A total of 66 cases were admitted into the medical wards during this period, with a female preponderance (F/M = 1.4:1). The highest number of cases was in the age group 16-29 years. Majority was seen during the wet season and the commonest site of injuring was the lower limb. Injury from stepping on wood and cuts from cutlass accounted for most of the cases. The mean incubation period was 13.4+13.1 days and the mean onset time was 5.9+8.0 days. The mean duration of hospital stay was 21.8+13.3 days. The mortality rate was 27.4%. Severity of spasms, duration of hospital stay, incubation period, onset time, immunization status, socio-economic background and the type of initial care received affected mortality. Early diagnosis and emphasis on preventive strategies remain the bedrock of reduction of mortality in Sub-Saharan Africa. Keywords : Tetanus, Nigeria, sub-Saharan Africa, characteristics, mortality. Journal of Mining and Geology Vol. 5 (1&2) 2006: pp. 44-51

PEELIMINARY REPORT OF A DERMATOSIS DUE POSSIBLY TO MEPACRINE.* A DESCRIPTION OF 26 CASES SEEN IN ITALY.

British Journal of DermatologyVolume 58, Issue 11-12 p. 263-271 PEELIMINARY REPORT OF A DERMATOSIS DUE POSSIBLY TO MEPACRINE.* A DESCRIPTION OF 26 CASES SEEN IN ITALY. MAJOR G. A. GRANT PETERKIN M.B.E., R.A.M.C., MAJOR G. A. GRANT PETERKIN M.B.E., R.A.M.C. O.C. Dermatological Wing of a British General HospitalSearch for more papers by this authorMAJOR H. C. HAIR M.B.E., R.C.A.M.C., MAJOR H. C. HAIR M.B.E., R.C.A.M.C. Dermatologist at a Canadian General Hospital.Search for more papers by this author MAJOR G. A. GRANT PETERKIN M.B.E., R.A.M.C., MAJOR G. A. GRANT PETERKIN M.B.E., R.A.M.C. O.C. Dermatological Wing of a British General HospitalSearch for more papers by this authorMAJOR H. C. HAIR M.B.E., R.C.A.M.C., MAJOR H. C. HAIR M.B.E., R.C.A.M.C. Dermatologist at a Canadian General Hospital.Search for more papers by this author First published: November 1946 https://doi.org/10.1111/j.1365-2133.1946.tb11322.xCitations: 7 * Submitted for publication in 1944, but withheld by the War Office for security reasons. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume58, Issue11-12November 1946Pages 263-271 RelatedInformation

Clinical Cases Seen in Tsunami Hit Banda Aceh – From a Primary Health Care Perspective

The 2004 Indian Ocean earthquake and tsunami caused catastrophic damage to many cities on the rim of the Indian Ocean. Banda Aceh in Sumatra, Indonesia was particularly badly hit due to its close proximity to the epicenter. The Singapore Armed Forces Medical Team was one of the earliest medical teams to arrive in Banda Aceh, providing primary health care to the survivors. In the first 17 days of its operation, more than 2000 injured and sick were seen by the Medical Team at 2 locations within Banda Aceh. Approximately one-third of the patients suffered from infected superficial wounds on their limbs and faces. Many developed deep-seated necrosis of the skin tissue, requiring repeated wound dressing and debridement. Another one-third suffered from respiratory tract infection, some due to aspiration of sea water. There were relatively few major trauma and fracture cases seen, and there were a few cases of compression barotrauma of the tympanic membranes resulting from underwater immersion in the sea water. The casualty patterns seem consistent with those reported in other tsunami disasters, which differ distinctly from those seen in a pure earthquake disaster.

Leptospirosis Presenting with Mania and Psychosis: Four Consecutive Cases Seen in a Military Hospital in Turkey

To present the clinical features and the treatment alternatives of manic and psychotic symptoms in patients with leptospirosis. Clinical observation and diagnosis of four cases with leptospirosis presenting with psychiatric symptoms. Leptospirosis diagnoses were established by recovery of the organism from culture, macroagglutination tests, and dark field microscopy in all cases. Leptospira ELISA-Ig M was also positive in all cases. Microagglutination tests were positive in case 1 and case 2. All of the cases were also screened for other possible medical, infectious, and neurological disorders that could account for their clinical symptoms. Patients were treated with a combination of antibiotics, antipsychotics and mood stabilizers. The presence of manic and psychotic symptoms with fever and high transaminase and/or CPK levels in high risk occupational groups during rainy periods should alert the physician to the possibility of leptospirosis. The psychiatric symptoms are sensitive to anti-psychotics and mood stabilizers but not to antimicrobial treatment, suggesting that the psychiatric picture may not be related to direct invasion of the central nervous system by the infectious agent.

Paediatric Hodgkin’s Disease - A study of 232 Cases Seen at Gujarat Cancer &amp; Research Institute, Ahmedabad

Paediatric Hodgkin’s Disease - A study of 232 Cases Seen at Gujarat Cancer &amp; Research Institute, Ahmedabad