University Teaching Hospital Setting Research Articles

Retrospective Evaluation of Clinical and Clinicopathologic Findings, Case Management, and Outcome for Dogs and Cats Exposed to Micrurus fulvius (Eastern Coral Snake): 92 Cases (2021-2022).

This retrospective, observational study describes the clinical findings, case management trends, and outcomes of 83 dogs and nine cats exposed to eastern coral snakes in a university teaching hospital setting. The medical records of dogs and cats that received antivenom following coral snake exposure were reviewed. Data collected included signalment, time to antivenom administration, physical and laboratory characteristics at presentation, clinical course during hospitalization, length of hospitalization, and survival to discharge. The mean time from presentation to coral snake antivenom administration was 2.26 ± 1.46 h. Excluding cases where the owner declined in-hospital care, the mean hospitalization time for dogs and cats was 50.8 h and 34 h, respectively. The mean number of antivenom vials was 1.29 (1-4). Gastrointestinal signs (vomiting and ptyalism) occurred in 42.2% (35/83) of dogs and 33.3% (3/9) of cats. Peripheral neurologic system deficits (ataxia, paresis to plegia, absent reflexes, and hypoventilation) were noted in 19.6% (18/92) of dogs and cats. Hemolysis was also common in 37.9% (25/66) of dogs but was not observed in cats. Mechanical ventilation (MV) was indicated in 12% (10/83) of dogs but no cats. Acute kidney injury (AKI), while rare, was a common cause of euthanasia at 20% (2/5) and was the most common complication during MV at 44.4% (4/9). Pigmenturia/hemolysis occurred in 88.9% (8/9) of MV cases and in all cases with AKI. Despite delays in antivenom administration by several hours, dogs and cats with coral snake exposure have low mortality rates (6% of dogs (5/83) and 0% of cats). Gastrointestinal signs were common but were not predictive of progression to neurological signs. Thus, differentiating between coral snake exposure and envenomation before the onset of neurological signs remains challenging.

Lateralization of Ovarian Follicles

Background/Aim: To evaluate a possible lateralization of antral follicle count (AFC) based on the finding that endometriosis, if present, is more commonly found in the left hemipelvis. Methods: We evaluated the records of 6,617 baseline ultrasounds conducted at our Reproductive Center between 2007 and 2011 in a university teaching hospital setting. We included all ultrasounds with an AFC of 1 or greater and excluded those with incomplete documentation or with ovarian cyst, including endometriotic cysts (n = 909). The main outcome measure was the comparison of the number of antral follicles between the right and left ovary. Results: The number of antral follicles in the right ovary (median 18, range 15-22) was significantly higher than in the left ovary (median 16, range 13-20) among women with polycystic ovaries (PCO, AFC ≥24). Similarly, the number of antral follicles in the right ovary (median 8, range 6-10) was significantly higher than in the left ovary (median 7, range 5-9) in women with no PCO but normal ovarian reserve (AFC 10-23). Conclusions: In women with PCO and non-PCO with normal ovarian reserve, the right ovary contains a higher number of antral follicles than the left ovary.

Preinduction incentive spirometry versus deep breathing to improve apnea tolerance during induction of anesthesia in patients of abdominal sepsis

Abdominal sepsis is associated with varied degree of hypoxemia and atelactasis in the lung and can enhance the onset of desaturation of arterial blood during apnea. This study looked at methods to improve safety margin of apnea during induction of anesthesia in these high-risk patients. It was a randomized, single blind study on adult patients presenting for emergency laparotomy due to peritonitis in a university teaching hospital setting. In group 1 (IS) (n = 32), three sessions of incentive spirometry (IS) were performed within one hour before induction of anesthesia. In group 2 (DB) (n = 34), patients were subjected to deep breathing sessions in a similar manner. All patients received preoxygenation (100%) by mask for 3 min, followed by rapid-sequence induction of anesthesia using fentanyl, thiopental, and suxamethonium and endotracheal intubation. Patients were subjected to a period of apnea by keeping the end of the endotracheal tube open to air till they developed 95% hemoglobin saturation (SpO 2) by pulse oxymetry. Positive pressure ventilation was resumed at the end. We observed for hemodynamic changes, apnea time, and SpO 2 (100%) recovery time on resuming ventilation. Arterial blood gas samples were taken before intervention, after IS or DB, after preoxygenation, and at the end of apnea. One-way analysis of variance (ANOVA), X 2 test, Kaplan-Meier graph, and log-rank tests were applied to compare the two study groups. Oxygenation level in group 1 (265 ± 76.7 mmHg) patients was significantly (P < 0.001) higher than in group 2 (221 ± 61.8 mmHg)at the end of preoxygenation. The apnea time (median: lower bound - upper bound Confidence Interval apnea time) (272:240-279 s) in group 1 (IS) patients was significantly higher P < 0.05) than in group 2 (180:163-209 s) patients. Saturation recovery time (35:34-46 s) in group 1 (IS) patients was also quicker than in group 2 patients (48:44-58 s). IS in the preoperative period is superior to deep breathing sessions for improving apnea tolerance during induction of anesthesia in abdominal sepsis patients.

Supervisory needs of research doctoral students in a university teaching hospital setting

Teaching hospitals affiliated with universities are now common sites for research higher degree supervision. We hypothesised that the hospital environment poses unique challenges to supervision compared with the traditional university research institute setting. This study aimed to identify and rank important supervision issues in a clinical setting from the students' perspective. Using the Delphi method to explore issues and facilitate consensus, small group discussions were conducted with 10 research doctoral students from a tertiary teaching hospital. We identified supervision issues that are unique to the hospital-based context. These include the demands placed on supervisors combining clinical and supervisory roles, the challenges of academic medical/scientific writing and career issues for students who are already established in their professions. Other issues identified, common to all doctoral students, include differing expectations between students and supervisors (with students wanting support for their career plans, training in research skills and increasing autonomy and responsibility), supervisor access, quality and frequency of meetings, lack of training in writing and dealing with conflicts. Our research identified that postgraduate students of supervisors who combine clinical and supervisory roles report significant issues with supervision, some of which are unique to the clinical setting. Clinician researchers who supervise postgraduate students need to balance clinical and supervisory responsibilities, identify and negotiate student expectations early in candidature and provide career counselling to students who are already highly experienced. Furthermore, clinician supervisors should undertake postgraduate supervisor training programme tailored to the hospital setting to better support their students.

Hemoptisis amenazante: estudio de 154 pacientes

Background and objectivesThe natural history of life-threatening hemoptysis (LTH), a medical emergency, is ill defined. The objective of the study was to evaluate, in a university teaching hospital setting, the etiology, methods used, and evolution of LTH. Patients and methodsProspective study in which we enrolled 154 patients admitted for LTH over 3 consecutive years. Bronchoscopy and arteriography procedures were performed, as prescribed by the attending physician. Patient evolution was followed 5 years post-event. Result79.2% were male. Average age was 57 (SD 15) years. Bronchiectasis and active tuberculosis and its consequences were the predominant etiologies. A total of 4.5% patients died as a result of LTH. Bronchoscopy was more effective in identifying the bleeding than arteriography when the examination was performed during an episode of hemoptysis (84.2 versus 20.4%) (P<.001). When embolization or bronchoscopy were used as first measure, embolization was more effective in stabilizing bleeding than bronchoscopy (87 versus 53.5%) (P<.001) in admitted patients. LTH relapse was 10.7%, while it was lower with embolization. ConclusionsLeading causes were bronchiectasis and tuberculosis. While bronchoscopy during a hemoptysis episode was effective in identifying the source of the bleeding, artery embolization was more effective in stabilizing the patient both at the short and long term.

Bacterial contamination of blood and blood components in a tertiary hospital setting in Nigeria

Active screening of blood donors has practically eliminated viral pathogens during provision of transfusion services; however, transfusion-associated bacterial sepsis remains an important health-care concern. Currently, it is the most frequently reported cause of infectious transfusion-related fatalities. The aim of this study was to determine the prevalence of bacterial contamination in donor blood and/or blood products, and also to identify the isolated microorganism in a semi-urban university teaching hospital setting in Nigeria. The study was carried out at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria over a five-month period (May to September 2009). A total of 162 units of screened blood and blood products consisting of 160 (98.7%) refrigerated packed cells/whole blood and two (1.3%) platelet concentrate were randomly sampled following aseptic procedure. Samples were incubated at 370C for up to 7-days in Brain Heart Infusion growth medium. The identities of the isolated organisms were determined following standard microbiologic techniques. The resistance pattern of isolates to selected antimicrobial agents was also determined by the disc diffusion method. Overall prevalence of bacterial contamination in donated blood bank refrigerated blood is 8.8%. The organisms isolated were Gram-positive, namely, Staphylococcus aureus,coagulase negative staphylococcus, Bacillus sp,and Listeria sp. Resistance of the organisms to the antibiotics ranged from 29% to 100%. Bacterial contamination of blood and blood components for transfusion is common in Nigeria and it is a potential risk for hospital acquired infection. Key Words: bacterial contaminants, hospital-acquired infection, blood/blood components.

Limb trauma in a university teaching hospital setting

Limb trauma in a university teaching hospital setting

Robot-Assisted Laparoscopic Radical Hysterectomy. Is This a Transition Time?

Study Objective: The aim of this study is to summarize our early experience in robot- assisted laparoscopic radical hysterectomies in our department. Design: The retrospective clinical study. Setting: University teaching hospital setting. Patients: 35 early stage cervical carcinoma patients were operated by robot- assisted laparoscopic technique. Intervention: All the operations was performed by a same senior gyn-oncologic surgeon at the console and assisted by seven different assistant with a various degrees of laparoscopic surgical experience. Measurements and Main Results: The mean age of the patients was 45.83 years (range, 27-70 years). The mean operating time (skin-to skin) was 220 minutes (range, 110-550 minutes). The mean console time was 171.8 minutes (range, 60-445 minutes). The mean estimated blood loss was 59 ml (range, 10-300 ml). The mean estimated postoperative hospital stay was 3.2 days (range, 1-6 days). No robot related complications occurred and no convertions was reported. 5 recurrences and 2 deaths were observed during the median more then 24 months follow-up period. Conclusion: Robotic surgical systems are useful to translate open radical hysterectomy to laparoscopic radical hysterectomy. This relatively new technology has a potential to equip the gynecologic oncologist surgeon to perform a very precise and clean surgery and eventually to improve the postoperative better results, hopefully without compromising the oncologic outcomes.

The Clinical Practice of Interventional Radiology: A European Perspective

The purpose of this study was to determine the current clinical environment in which interventional radiology (IR) is practiced throughout Europe. A survey, comprising 12 questions on IR clinical practice, was sent to 1800 CIRSE members. Members were asked to return one survey per department. Two hundred seventy-four departments returned completed questionnaires, 22% from the United Kingdom (n = 60), 11% from Germany (n = 30), 8% from Austria (n = 23), and the remainder spread over Europe. Experts, with more than 10 years of IR experience, comprised 74% of the survey group. Almost one-third of the radiologists dedicated more than 80% of their clinical sessions to IR alone (27%; n = 75), with two-thirds practicing in a university teaching hospital setting (66%; n = 179). Few institutions have dedicated IR inpatient hospital beds (17%; n = 46), however, to compensate, day case beds are available (31%), IR admitting rights are in place (64% overall, 86% for in-patients, and 89% for day cases), and elective IR admissions can be made through other clinicians (87%). IR outpatient clinics are run at 26% of departments, with an average of two sessions per week. Dedicated nurses staff the majority of IR suites (82%), but clinical junior doctors are lacking (46%). Hospital management's refusing access to beds was the most commonly cited reason for not developing a clinical IR service (41%). In conclusion, there is marked variation across European centers in the current practice of IR. Half do not have dedicated junior doctors and only a small minority have inpatient hospital beds. If IR is to be maintained as a dedicated clinical specialty, these issues need to be addressed urgently.

Manual small incision cataract surgery in a United Kingdom university teaching hospital setting

To assess the complication rates and visual outcomes of manual small incision cataract surgery (MSICS) in a university teaching hospital setting. Retrospective audit encompassing a 3-year period looking at the visual outcomes, and intraoperative and postoperative complications of planned MSICS performed on brunescent cataracts. MSICS was performed in 55 eyes of 49 patients. Intraoperatively, zonular dehiscence without vitreous loss occurred in one eye (1.8%), and vitreous loss occurred in one eye (1.8%). Postoperative complications occurred in seven eyes (12.7%). The most common complication was raised intraocular pressure (three eyes, 5.5%). None developed endophthalmitis or dropped nucleus. Mean follow-up duration was 10.0 weeks. In 49 eyes (89.1%), vision improved postoperatively. Sixty five percent achieved a best-corrected vision of 6/12 or better. The mean postoperative astigmatism was significantly higher than preoperatively (1.40D vs. 0.99D, p = 0.02). MSICS is safe and effective for dense and brunescent cataracts in a UK university hospital setting. However, it was associated with a statistically significant increase in astigmatism postoperatively.

Quality Improvement Analysis of Developmental Care in Infants Less Than 1500 Grams at Birth

The study evaluated the effect of developmental care (DC) on short-term outcome, weight gain, and length of stay in very low-birth-weight infants (1000–1499 grams) and extremely low-birth-weight infants (<1000 grams at birth). The infants were cared for in the neonatal intensive care unit (NICU) at the University Hospital in Cincinnati. It was hypothesized that providing consistent DC to all babies in the NICU weighing 1500 grams or less at birth would increase weight gain and decrease length of stay. Data for both cohorts, predevelopmental care (preDC) and postdevelopmental care (postDC) were collected prospectively as part of the National Institutes of Health Neonatal NICU Research Network generic database on babies less than 1500 grams. This database included all variables studied and used in both cohorts. The study consisted of a pre-DC historic control and post-DC treatment group. The postDC period started 3 months after the entire staff had undergone a 4-day focused educational program on DC. This was done so that the data collected for the postDC group would occur after the initial learning curve for DC in the NICU. This study was carried out in a 50-bed level III NICU in a university teaching hospital setting. Infants weighing 1500 grams or less at birth between July of 1998 and July of 2002 were included. This population was divided into two groups: the preDC group (July 1998-July 2000) and the postDC group (2000–2002). Subgroups were then established by birth weight, less than 1000 and 1000 to 1499 grams, and the second subgroup used to separate groups less than 28 weeks gestational age and greater than 28 weeks gestational age. The total study population consisted of 292 infants. There was a statistically significant increase in weight at 36 weeks of age in the postDC period as compared to the preDC group for both the extremely low-birth-weight and very low-birth-weight groups (P < .05). The postDC group had a significant increase in the percentage of infants discharged by 40 weeks postconceptional age (P < .01). In conclusion, the successful introduction of a broad practice–based DC program in a university hospital NICU setting is described. This program coincided with significant improvement in weight gain and early discharge in preterm infants less than 1500 grams at birth. This is the first study to incorporate bubble continuous positive airway pressure into a DC regimen and the first National Institutes of Health Neonatal Network site to document positive benefits from the widespread implementation of DC practice across a single NICU.

Augmentation of Nasal Tip Projection Using the Inferior Turbinate

To introduce the use of inferior turbinate bone as an alternative autograft for augmentation of nasal tip projection and to assess maintenance of nasal tip projection, bone remodeling, graft shaping, and ease of harvesting. Thirteen consecutive patients in need of increased nasal tip projection underwent closed rhinoplasty during a prospective nonrandomized study in a university teaching hospital setting. An autologous demucosalized inferior turbinate bone graft was used as a columellar strut. Measurements of nasal tip projection were obtained using the Goode ratio. Photodocumentation and lateral soft tissue radiographs were obtained before surgery and between 30 and 38 months after surgery. In all patients, the results were as follows: (1) the inferior turbinate bone graft was easily harvested and molded into the appropriate-sized columellar strut; (2) the immediate postoperative nasal tip projection, as measured by the Goode ratio and visual assessment, was increased; and (3) the tip projections were maintained at the 30-month follow-up examination. Paired t tests revealed a statistically significant difference (P = .001 and P = .009) between preoperative and both immediate and long-term measurements. Comparison of immediate postoperative radiographs with those taken 2 years later demonstrated no remarkable change in appearance of the graft. The interior turbinate bone is a viable graft for augmenting nasal tip projection. Moreover, it maintains tip projection and needs little to no remodeling. The graft is easy to harvest, prepare, and place and can be used without requiring a second operative site.

Ophthofall: A risk factor for falls and fractures among Orthopaedic in-patients in Nigeria

Purpose: To determine prevalence, aetiology of visual impairment (VI), and potential target population of fall fractures among Orthopaedic patients. Methods: A three year prospective study at a University Teaching Hospital setting. Patient's informed consent and institution's ethical clearance were obtained. A protocol was established for patient's recruitment and structured questionnaires were drawn to extract information on the bio-data, pattern of fall fractures and ocular disorders. The ophthalmic status was assessed using Snellen's Visual acuity chart, funduscopy and tonometer. All the patients had plain radiography. CTscan was individualized. Data was analyzed using SPSS window version 11.The level of significance was taking as p<0.05. Results: Of the 148 fall fracture patients (FFP), 78(52.7%, males-74.4%; females-25.6%) had impaired vision .The mean age was 45.6+/12.3 years (range: 28-83years) and 49.3 FFP/year. The aetiology of visual impairment was correctable refractive errors 40.6%, pterygium 26.0%, glaucoma 8.1%, cataract 11.4% and age related macular degeneration 2.4%. Neuro-ophthalmic diseases such as ptosis, strabismus and non glaucomatous optic atrophy were seen in 6.5%. Also corneal opacity, retinal detachment and phtysis bulbi in 1.6% each. Fractures sustained were hip, pelvic, femoral, scapular, humeral, clavicle and spinal fractures. High level falls were commoner in the younger patients and VI in them was mainly due to advanced pterygium, refractive errors and monocular cataract. Prevalence of significant visual impairment increases from 45 years upwards (p< 0.003). Conclusion: The prevalence of visual impairment (VI) among Orthopedics in patients with fall fractures is high. VI could be causing falls or compounding the severity. Advanced pterygium was found to be a risk factor in these indigenous black African patients. To prevent fall fractures, routine screening eye tests should be incorporated into the medical assessment of all individuals whose job involves climbing.

Effect of Right Bundle Branch Block on Electrocardiographic Amplitudes, Including Combined Voltage Criteria Used for the Detection of Left Ventricular Hypertrophy

Although right bundle branch block (RBBB) delays right ventricular depolarization, its effect on cancellation of right and left ventricular forces within the QRS complex has not been quantified during stable temporal and physiological conditions. Systematic changes in QRS amplitude during transient RBBB bear directly on performance of standard ECG criteria for left ventricular hypertrophy (LVH), and these changes require quantification. We examined the instantaneous effect of RBBB on QRS amplitudes and LVH voltages in 40 patients who had intermittent complete RBBB during a single 10 sec standard 12-lead ECG recording, comprising 0.1% of approximately 400,000 consecutive ECGs in a university teaching hospital setting. Amplitudes were measured by magnifying graticule to the nearest 25 microvolts, averaged for up to 3 normal and 3 RBBB complexes, and compared by paired t test. RBBB was associated with an increase in initial QRS forces (RV1, RV2, and QV6) but significant decreases in mean mid-QRS amplitudes that reflect left ventricular depolarization (RaVL [-75 microvolts], SV1 [-389 microvolts], SV3 [-617 microvolts], RV5 [-100 microvolts], and RV6 [-123 microvolts]). All late QRS forces were increased with RBBB (R'V1, SV5, SI). As a result, combined voltages used for LVH criteria were significantly reduced by RBBB: Sokolow-Lyon voltage decreased from 1520 +/- 739 to 1014 +/- 512 microvolts (p < 0.001), and Cornell voltage decreased from 1438 +/- 683 to 746 +/- 399 microvolts (p < 0.001). RBBB is associated with significant reduction in "left ventricular" QRS amplitudes of the standard ECG, consistent with cancellation, rather than unmasking, of left ventricular mid-QRS forces by altered septal and delayed right ventricular depolarization. Because QRS voltages that are routinely combined for the detection of LVH are reduced in RBBB, standard LVH criteria will perform with lower sensitivity in patients with RBBB.

An observational study of Yasmin® in the management of women with polycystic ovary syndrome

BackgroundPolycystic ovary syndrome (PCOS) is the commonest endocrine disturbance affecting women in the reproductive age group and encompasses signs of hyperandrogenism, menstrual cycle disturbances and obesity. Some of the symptoms...

Randomized open-label trial of dolasetron for the control of nausea and vomiting associated with high-dose chemotherapy with hematopoietic stem cell transplantation

A prospective open-label trial was performed to compare the efficacy of dolasetron with that of ondansetron or granisetron (standard therapy) for prevention of nausea and vomiting associated with high-dose chemotherapy with or without total body irradiation followed by hematopoietic stem cell transplantation (HSCT). In a university teaching hospital setting, 62 patients were randomized to receive either dolasetron 100 mg daily or standard doses of ondansetron or granisetron. In addition to objective data such as number of episodes of emesis and quantity of rescue antiemetics required, 100 mm visual analogue scales were used to rate nausea, appetite, and changes in taste. A post-hoc subgroup analysis was performed between groups of patients that were matched for conditioning regimens. Sixty-five percent of the dolasetron-treated patients and 87% of patients in the standard therapy group achieved a major or complete response (P < .05) based on emetic episodes and nausea score. Patients in the standard therapy group used fewer rescue antiemetics and also rated more favorably on selected questions of the visual analogue scale. No differences in safety parameters or adverse effects were reported. At doses prescribed in this study, dolasetron was less effective than granisetron or ondansetron in preventing nausea and vomiting associated with high-dose chemotherapy/total body irradiation followed by HSCT.

A prospective study of the impact of patient preferences on life-sustaining treatment and hospital cost.

Ethicists advise that life-sustaining treatment decisions should be made in keeping with patient preferences. Until recently, there has been little systematic study of the impact of patient preferences on the use of various life-sustaining treatments or the consequent cost of hospital care. This prospective study was designed to answer the following questions: a) Do patient treatment preferences about the use of life-sustaining treatment influence the treatments they receive? and b) Do patient treatment preferences influence the total cost of their hospitalization? A prospective, cohort study. A university teaching hospital. Hospitalized patients, at least 50 yrs of age, with short life expectancy due to end-stage heart, lung, or liver disease, metastatic cancer, or lymphoma. None. Patients were interviewed to determine their desire for life-sustaining treatment and other characteristics and then were followed for 6 months to determine life-sustaining treatment use and costs during hospitalization. Two hundred forty-four patients were interviewed. Fifty-eight percent of patients expressed a desire for life-sustaining treatments to prolong life for 1 wk. During 245 subsequent hospitalizations, there were 20 episodes of mechanical ventilation, 63 episodes of intensive care, and 66 cancer treatments given. Bivariate and multivariate analyses showed no significant association between patient desire to receive treatment to prolong life and either life-sustaining treatment use (p = .59) or hospital costs (p = .20). In a university teaching hospital setting, there is no systematic evidence that patient preferences determine life-sustaining treatment use or hospital costs.

Insulin potentiation therapy: A new concept in the management of chronic degenerative disease

In insulin potentiation therapy the hormone insulin is used as an adjunct in the medical management of the chronic degenerative diseases including malignant neoplasia. In this, the recognized physiological action of insulin — that of increasing cell membrane permeability — is taken advantage of to potentiate the pharmacological actions of medications administered concurrently in the therapy. This potentiation occurs because of the heretofore unrecognized applicability of this membrane permeabilizing effect of insulin to a much wider range of tissues than is classicly accepted, and further the observed effect of this permeabilizing phenomenon as it relates to drug molecules, most importantly the antineoplastic agents. The historical context of insulin potentiation therapy is described, and scientific corroboration for its novel hypotheses is given. Insulin potentiation therapy represents a potentially revolutionary concept in the medical management of diseases and is, in the authors' opinion, deserving of intensive scientific investigation through in vitro and in vivo experimentation and properly conducted human clinical trials in a university teaching hospital setting.