Initial high rate of misdiagnosis in Crimean Congo haemorrhagic fever patients in an endemic region of Turkey

2009 ◽  
Vol 138 (1) ◽  
pp. 139-144 ◽  
Author(s):  
N. TASDELEN FISGIN ◽  
L. DOGANCI ◽  
E. TANYEL ◽  
N. TULEK
Keyword(s):  
Seasonal Pattern ◽  
Antiviral Treatment ◽  
Tertiary Care ◽  
High Rate ◽  
Haemorrhagic Fever ◽  
Endemic Region ◽  
Tertiary Care Centre ◽  
Number Of Patients ◽  
Epidemic Area ◽  
Crimean Congo Haemorrhagic Fever

SUMMARYCrimean Congo haemorrhagic fever (CCHF) has been an emerging tick-borne infection in some parts of Turkey since 2002, with a number of fatalities. Many of the initial non-specific symptoms of CCHF can mimic other common infections. Additionally, the seasonal pattern of the epidemic, and the waning attention of healthcare workers to the yearly index cases caused some delays in appropriate patient care and treatment. Between March 2004 and August 2008, 140 confirmed adult cases were evaluated retrospectively for initial diagnosis and treatment delays. This study clearly demonstrated that there are particular delays (4·8 days) in the referral system to initiate effective antiviral treatment in the tertiary-care centre which significantly affect fatality rates (P>0·05). A large number of patients (n=95, 68%) received an initial misdiagnosis of various infections other than CCHF. In conclusion, continuous medical education regarding CCHF in the epidemic area is essential in order to achieve a better survival rate from this deadly infection.

scholarly journals Knowledge, attitude and perceptions about Crimean Congo Haemorrhagic Fever (CCHF) among occupationally high-risk healthcare professionals of Pakistan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ali Ahmed ◽  
Muhammad Saqlain ◽  
Maria Tanveer ◽  
Azhar Hussain Tahir ◽  
Fakhar Ud-Din ◽  
...  
Keyword(s):  
At Risk ◽  
Health Care Professionals ◽  
Work Experience ◽  
Tertiary Care ◽  
Nosocomial Transmission ◽  
Haemorrhagic Fever ◽  
Sources Of Information ◽  
Validated Questionnaire ◽  
Low Middle Income Countries ◽  
Crimean Congo Haemorrhagic Fever

Abstract Background Crimean Congo Haemorrhagic Fever (CCHF), a tropically neglected infectious disease caused by Nairovirus, is endemic in low middle-income countries like Pakistan. Emergency health care professionals (HCPs) are at risk of contracting nosocomial transmission of CCHF. We, therefore, aim to analyze the knowledge, attitudes, and perceptions (KAP) of at-risk physicians, nurses, and pharmacists in Pakistan and the factors associated with good KAP. Method A validated questionnaire (Cronbach’s alpha 0.71) was used to collect data from HCPs in two CCHF endemic metropolitan cities of Pakistan by employing a cross-sectional study design. For data analysis percentages, chi-square test and Spearman correlation were applied by using SPSS version 22. Results Of the 478 participants, 56% (n = 268) were physicians, 37.4% (n = 179) were nurses, and 6.5% (n = 31) were pharmacists. The proportion of HCPs with good knowledge, attitude, and perception scores was 54.3%, 81, and 69%, respectively. Being a physician, having more work experience, having a higher age, working in tertiary care settings, were key factors for higher knowledge (p < 0.001). The correlation coefficient showed significant positive correlation between attitude- perception (r = 0.560, p < 0.001). Conclusion We have observed average knowledge of HCPs. Therefore, we recommend time to time education campaigns and workshops in highly endemic CCHF regions to be launched by health ministries and HCPs, in particular nurses, encouraged to follow authentic academic sources of information to prevent nosocomial transmission.

Evaluation of clinical and laboratory predictors of fatality in patients with Crimean-Congo haemorrhagic fever in a tertiary care hospital in Turkey

2010 ◽  
Vol 42 (6-7) ◽  
pp. 516-521 ◽  
Author(s):  
Cigdem Ataman Hatipoglu ◽  
Cemal Bulut ◽  
Meltem Arzu Yetkin ◽  
Gunay Tuncer Ertem ◽  
Fatma Sebnem Erdinc ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Haemorrhagic Fever ◽  
Crimean Congo Haemorrhagic Fever

scholarly journals Clinical spectrum of facial hypermelanosis: a descriptive study from a tertiary care centre

2020 ◽  
Vol 6 (2) ◽  
pp. 212
Author(s):  
Mohammed Thoyyib ◽  
Roshni Menon ◽  
Brinda G. David
Keyword(s):  
Tertiary Care ◽  
Clinical History ◽  
Climatic Conditions ◽  
Research Centre ◽  
Tertiary Care Centre ◽  
College Hospital ◽  
Pigmentary Disorders ◽  
Number Of Patients ◽  
The Face ◽  
Detailed Clinical History

<p class="abstract"><strong>Background:</strong> Facial melanosis (FM) which refers to brown, black or blue pigmentation over the face is a common cosmetic concern in Indian patients. This increased incidence could be due to remarkable diversity of Indian ethinic population. Pigmentary disorders of the face are a great cosmetic and psychological concern for the patients.</p><p class="abstract"><strong>Methods:</strong> This is an extensive descriptive clinico epidemiological study comprising of 1024 patients, conducted at Sri Venkateshwara Medical College Hospital and Research Centre, Puducherry, for a period of one and a half years. A detailed clinical history and examination was done, and all the clinical photographs and data were recorded. Necessary investigations like skin biopsy and patch testing was done wherever required.<strong></strong></p><p class="abstract"><strong>Results:</strong> The maximum number of patients belong to the age group of 21-35 years with a female predominance (67.2%). Among patients of FM, post inflammatory pigmentation (35.3%) was the most common comprising of 362 patients, followed by melasma (17.2%), periorbital melanosis (15.7%), seborrheic melanosis (7.5%) followed by other causes.</p><p><strong>Conclusions:</strong> FM is common in Indian skin, several of which have overlapping features, and some have defined clinical classification. Additionally, climatic conditions, cosmetic usage and social parameters predispose to the increased incidence of FM.</p>

scholarly journals Study of caesarean section at tertiary care centre: a retrospective study

2020 ◽  
Vol 9 (5) ◽  
pp. 2138
Author(s):  
Varsha Kose ◽  
Kumari Sadhvi
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Tertiary Care ◽  
Fetal Distress ◽  
High Rate ◽  
Audit And Feedback ◽  
Research Centre ◽  
Medical Sciences ◽  
Tertiary Care Centre ◽  
Failure Of Induction

Background: Caesarean section (C-section) is one of the most widely performed surgical procedure in obstetrics worldwide. The WHO guidelines revised in 1994 states that the proportion of C-section birth should range between 5-15% but both in developed and developing countries C-section rate is on the rise. This study was conducted to analyse the frequency and indications for C-section and associated maternal morbidity and mortality.Methods: This retrospective study was conducted over a period from January 2018 to May 2019 at the department of obstetrics and gynecology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Hingna, Nagpur, Maharashtra, India. Data of patients who delivered by C-section in our hospital during the defined study period were studied and statistically analysed according to various parameters namely, the frequency of caesarean section, its indications, age, parity and gestational age of the patient.Results: The total number of women delivered over the study period were 2811. Out of which C-sections were done in 1461 women (51.97%). Previous C-section was the leading indication in 35.72% women followed by fetal distress 14.09%, failure of induction 12.93%, arrest of labour 7.93%, PIH 7.18%, oligo/IUGR 6.50%, breech 4.44%, refusal of vaginal birth 4.24%, CPD 1.71%, bad obstetrics history (BOH) 1.43%, malpresentation 1.30%, prematurity 1.23%,  and multifetal gestation in 1.09% women. Two women had classical C-section 0.07. 14.09% women had various complications. There was no maternal mortality.Conclusions: A high rate of caesarean deliveries was observed. Individualization of the indication and careful evaluation, following standardized guidelines can help us to limit C-section. Audit and feedback are the best way to judge clinical practice and to reduce the frequency of caesarean section in any tertiary setup.

CLINICAL PROFILE OF OUTPATIENTS ATTENDING DERMATOLOGY DEPARTMENT DURING COVID-19 LOCKDOWN RELAXATION PERIOD IN A TERTIARY CARE CENTRE IN SOUTH INDIA – A CROSS-SECTIONAL ANALYTICAL STUDY

2021 ◽  
pp. 13-16
Author(s):  
Afthab Jameela Wahab ◽  
Pavithra Gunasekaran ◽  
P. Mohan ◽  
V. Sudha ◽  
L. Balamurugan ◽  
...  
Keyword(s):  
South India ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Dermatology Department ◽  
Cutaneous Manifestations ◽  
Relaxation Period ◽  
Number Of Patients ◽  
Outpatient Practice ◽  
The Impact

Background - The cutaneous manifestations of the novel coronavirus have been well documented. However, there are few studies that relate to the clinical prole of regular dermatology outpatients seeking treatment during the lockdown relaxation period braving the pandemic. With the Aim - view to determine the changes seen in dermatology outpatient practice, this study analysed the clinical prole of new patients attending the Dermatology Outpatient Department (OPD) during the COVID-19 lockdown relaxation period in a tertiary care centre in a metropolitan suburb in South India. New dermatology outpatients during the months of May, June, July and August Method - 2020 were included in the study. Outpatient data for this period was analysed and compared with corresponding data for the same period in the previous two years. There was a Result – decrease in the OP census, number of patients in the extremes of life as well as those with asymptomatic dermatoses. There was an increase in the number of patients with infections, particularly dermatophytosis. There was also a noteworthy absence of dermatological emergencies. Conclusion - In essence, our study shows the impact of COVID-19 pandemic on the routine dermatology outpatient services with signicant changes in the clinical prole of outpatient practice following lockdown relaxation.

APPENDICITIS IN PREGNANCY : OUR CLINICAL EXPERIENCE AT A TERTIARY CARE CENTRE

2021 ◽  
pp. 22-23
Author(s):  
Anil Kumar ◽  
Rekha Rani ◽  
Hamid Wani
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Correct Diagnosis ◽  
Tertiary Care ◽  
Fetal Loss ◽  
Common Symptom ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Lower Quadrant ◽  
Number Of Patients

Objective: Acute appendicitis is a common surgical condition presented to emergency. In this study we evaluated the clinical presentation, management and outcome of acute appendicitis complicating pregnancy at a tertiary care centre. Material And Methods: A total of 20 cases of pregnant women who were diagnosed as a case of acute appendicitis were studied from January 2018 to December 2020. Results: Total number of patients diagnosed with acute appendicitis were 20. There were 10 (50%) patients in rst trimester , 6 (30%) in second and 4 (20%) in the third trimester. Abdominal pain was the most common symptom seen in all patients. 12 (60%) patients were multigravida whereas 8 (40%) patients were primigravida. Duration of abdominal pain was 6 hours to 5 days with median of 30 hours. Right lower quadrant was the most common site of pain. Rebound tenderness was seen in 14 (70%) patients. Total leucocyte was raised in 14 (70%)cases. Ultrasound was done in all patients showing viable fetus and features of acute appendicitis in 12 (60%) cases. Surgery was done in 16 (80%) cases. Midline laparatomy was done in 3 patients whereas 4 (20%) patients were managed conservatively with antibiotics. Postoperative tocolytics were given in 6 patients. Postoperative complications such as wound infections seen in 5 cases and pelvic abscess in 1 case. Fetal loss was seen in 2 (10%)cases. Conclusion: Diagnosis of acute appendicitis during pregnancy can be difcult due to anatomical and biochemical changes during pregnancy. Correct diagnosis can be achieved by taking proper history, clinical examination and relevant investigations. Surgery remains the treatment of choice.

COVID-19: An Experience from a Tertiary Care Hospital of Nowshera

2020 ◽  
Vol 24 (2) ◽  
pp. 149-155
Author(s):  
Hamzullah Khan ◽  
Mohammad Zahid Khan ◽  
Mian Mohammad Naveed
Keyword(s):  
Tertiary Care ◽  
Relevant Information ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Epidemic Area ◽  
History Of ◽  
Severity Of The Disease ◽  
Age Range

Objective: To determine the frequency of COVID-19 and characteristics of patients presenting to the COVID-19 clinic at Qazi Hussain Ahmed Medical Complex (QHAMC) Nowshera. Methodology: This cross-sectional study was conducted from 21st Feb 2019 to April 8, 2020, in QHAMC Nowshera. Relevant information was collected on a pre-designed Performa prepared following the objectives of the study. Results: Out of 220 patients, 165(75%) were males, and 55(25%) females. 96(43.6%) of the patients were in the age range 18-30 years followed by 52(23.6%) in age range 31-45years and 17(7.7%) with age>60 years etc. Out of total the nasopharyngeal swabs of 26(11.6%) strong suspects were sent for PCR testing. 208(94.5%) were sent home while 12(5.5%) were advised quarantine. Forty-seven (21.4%) had a travel history to an epidemic area in the last 14 days. 51(23.2%) had a positive history of contact. Eighty-five (38.6%) had a fever and sore throat followed by 27(12.3%) with (fever & cough), 24(10.9%) with (cough and shortness of breath/dyspnea) and 14(6.4%) with a simple flue, etc. Out of 26 cases, 6(2.7%) were COVID-19 Positive, 12(5.5%) were negative and results of 8(3.6%) were still awaited. The PCR repeated the test for confirmed cases showed;  4(1.8%) negative, one died and one was refractory positive.  A positive correlation (p=0.03, r=0.4) of an increase in age with the severity of the disease/outcome was recorded. Conclusion: The frequency of infectivity with COVID-19 was 2.6%. A higher number of patients with mild symptoms attend the COVID clinic. The rate of infection and mortality was higher in age> 60 years.

Crimean-Congo haemorrhagic fever outbreak in Middle Anatolia: a multicentre study of clinical features and outcome measures

2005 ◽  
Vol 54 (4) ◽  
pp. 385-389 ◽  
Author(s):  
Mehmet Bakir ◽  
Mehmet Ugurlu ◽  
Basak Dokuzoguz ◽  
Hurrem Bodur ◽  
Mehmet A Tasyaran ◽  
...  
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Fatal Outcome ◽  
Hospital Costs ◽  
Retrospective Chart Review ◽  
Haemorrhagic Fever ◽  
Related Data ◽  
Cchf Virus ◽  
Crimean Congo Haemorrhagic Fever ◽  
Tertiary Care Hospitals

A Crimean-Congo haemorrhagic fever (CCHF) outbreak emerged from 2001 to 2003 in the Middle Anatolia region of Turkey. This study describes the clinical characteristics and outcome features of CCHF patients admitted to four tertiary care hospitals in Turkey. Definitive diagnosis was based on the detection of CCHF virus-specific IgM by ELISA or of genomic segments of the CCHF virus by RT-PCR. Related data were collected by a retrospective chart review. Hospital costs were extracted from the final discharge bills. Univariate and multivariate analyses were conducted to determine the independent predictors of mortality. CCHF virus-specific antibodies or genomic segments were detected in the sera of 99 cases. Seven cases that were treated with ribavirin were excluded from the study. Cases were mostly farmers (83 cases, 90 %), and 60 % had a tick-bite history before the onset of fever. Impaired consciousness and splenomegaly were independent predictors of a fatal outcome.

scholarly journals Haemophagocytosis in a patient with Crimean–Congo haemorrhagic fever

2007 ◽  
Vol 56 (8) ◽  
pp. 1126-1128 ◽  
Author(s):  
Atahan Cagatay ◽  
Mahir Kapmaz ◽  
Asli Karadeniz ◽  
Seniha Basaran ◽  
Mustafa Yenerel ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Severe Disease ◽  
Case Fatality ◽  
Haemorrhagic Fever ◽  
Rt Pcr ◽  
Patient History ◽  
Endemic Region ◽  
Cchf Virus ◽  
History Of ◽  
Crimean Congo Haemorrhagic Fever

Crimean–Congo haemorrhagic fever (CCHF) is a severe disease with a case fatality of 2.8 to 80 %. A patient dwelling in an endemic region for CCHF was admitted with fever preceding bleeding diathesis and pancytopenia. Despite no history of tick exposure, CCHF was highly suspected. With an oral ribavirin therapy, clinical and laboratory improvements were obtained. The diagnosis was confirmed by detection of IgM antibody to CCHF virus and positive RT-PCR. Although the main pathogenesis of CCHF infection is not elucidated yet, haemophagocytosis, a symptom rarely reported in viral haemorrhagic fevers, was observed in this case. Haemophagocytosis is suggested to have a role in the development of pancytopenia in CCHF, the mechanism of which still needs to be investigated, probably with cytokine studies. Together with clinical symptoms and patient history, haemophagocytosis may be an indicator for CCHF.

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