Bethesda Hospital

About: Bethesda Hospital is a healthcare organization based out in Ambur, Tamil Nadu, India. It is known for research contribution in the topics: Population & Helicobacter pylori. The organization has 386 authors who have published 472 publications receiving 15193 citations.

The Ottawa knee rule: avoiding unnecessary radiographs in sports.

Abstract: Physicians are often called upon to evaluate acute knee injuries. Radiographs are frequently ordered, but they may not be helpful for making the diagnosis and guiding treatment of soft-tissue injuries. A set of clinical criteria, called the Ottawa knee rule, has been established to predict when radiographs are truly necessary. The sensitivity and negative predictive value of the rule were both validated at 100% for fractures of the knee in adults. By using the Ottawa knee rule, at least 25% of unnecessary films can be avoided without risking patient safety. The rule has not specifically been studied among sports participants, but indications are that it can be useful in this population.

Residency Accreditation Standards

Abstract: TO THE EDITOR: The American Society of Hospital Pharmacists (ASHP) Commission on Credentialing recently voted to withdraw accreditation of our residency \"unless significant progress has been made in implementing a housewide unit-dose drug distribution program.\" This action comes as no surprise to us. We carefully chose not to provide what I call traditional unit-dose in our 360-bed hospital. If this sounds like heresy, let me continue. Our current drug distribution system is modified unit-dose.' We distribute twoto three-day supplies of completely labeled unit-dose medications to unit-dose carts, providing a system that is basically \"unit-dose\" in its presentation to nursing. We avoid liquid unit-dose because of high cost, but do extensive sterile syringe-filling to provide unit-doses of most injectable medications. Our iv admixture and total parenteral nutrition distribution is unit-dose. Modifying unit-dose has been positive for us. Our professional staff consists of 5.5 full-time equivalent pharmacists (including a working director) and one resident. Our personnel cost is 43 percent of most normal hospital pharmacies our size.' This small professional staff is totally involved in patient-oriented services through a clinical-liaison pharmacist approach.' Included in our services are: (1) an accredited poison control center for southeastern Ohio; (2) drug interaction surveillance and follow-up for all patients; (3) pharmacokinetic services-the pharmacy schedules all drug blood levels, interprets most, and provides kinetic consults as required; (4) patient education in diabetic classes, bedside medication instructions, discharge drug instructions for selected patients, and drug histories for selected patients; (5) medical staff involvementour pharmacists serve on seven medical staff committees; and (6) a drug information center for southeastern Ohio. To summarize, we have tried to professionalize our pharmacists' activities by borrowing time from unit-dose distribution methods. We believe that we have not given up effective drug distribution in the process. Abramowitz and Nold, writing in the American Journal ofHospital Pharmacy, discuss changes for drug distribution and clinical programs: \"Hospital pharmacists will be directed to cut costs in all areas, and the innovative abilities of the profession will be .... challenged. Changes in drug distribution systems will be necessary to achieve the goal of reducing costs while maintaining high standards of quality.\" It appears we have been able to accomplish much of what these authors suggest (complete clinical services, operational budget at 43 percent of the norm). I hope this letter serves as a mild form of protest. It is intended to point out the need for the ASHP to reevaluate the inflexibility of the unit-dose residency standard.

Strangulated external hernia.

Abstract: Thirty-six cases of strangulated external hernia were operated upon in Bethesda Hospital Ikachi, Eastern Nigeria, during a period of 27 months. Gut resection was necessary in nine. The causes of an increased case fatality rate after resection are reviewed. Three lesscommon conditions — Reduction en masse, lumbar hernia and Richter's hernia — are discussed. The overall case fatality rate from strangulated external hernia in Nigeria is not very different from that in Europe and the USA, although in Nigeria the resection rate is high.

Prevalence of metabolic disorders in obese triple negative breast cancer patients

Abstract: Introduction Obesity is a risk factor for hormone receptor positive breast cancer in postmenopausal women. However, the association between triple negative breast cancer risk and metabolic abnormalities is not yet clear. Moreover, little is known regarding the prevalence of these abnormalities in this group of women. Here we present the prevalence of metabolic abnormalities in a single cohort of obese postmenopausal triple negative breast cancer patients. Methods Monocentric, retrospective, single cohort analysis of triple negative breast cancer patients treated between January 2008 and December 2017 at Pius Hospital Oldenburg. For quantitative or numerical variables, central tendency and dispersion measures were used. Values are presented as mean number of patients or percentage. Results Among 2745 breast cancer cases, 43 obese postmenopausal patients with a mean age of 64 years (range 51 to 90) had triple negative breast cancer. Most were diagnosed with invasive ductal (n = 39; 90.7 %), high-grade carcinoma (n = 35; 81.4 %), with a tumor size between 2 and 5 cm (n = 19; 44.2 %). Half the cohort lacked lymph node involvement; 5 patients showed distant metastasis (11.6 %). The majority had no family history of breast cancer (n = 32; 74.4 %), were non-smokers (n = 37; 86 %), and had a history of pregnancy (n = 35; 81.4 %). Frequent metabolic abnormalities included hypertension (n = 31; 72.1 %) and dyslipidemia (n = 36; 83.7 %) whereas type 2 diabetes or glucose intolerance were less prevalent (n = 13; 30.2 %). Conclusion Hypertension and dyslipidemia were more prevalent in the study cohort than type 2 diabetes. Moderately obese patients were most frequently affected. These findings partially align with international studies which observed an association between triple negative breast cancer and elevated levels of blood glucose and triglycerides, but not between tumor disease and hypertension.

Syncope: A Very Atypical Presentation of COVID-19

Abstract: Possible COVID-19 patients have presented commonly to United States Emergency Departments. Patients presenting with cough, fever and shortness of breath are easy to identify as suspected cases. Unfortunately, not all COVID-19 patients present this way. Atypical presentations are a risk factor for healthcare worker (HCW) transmission of this disease. In this case report we describe the unusual case of COVID-19 presenting as syncope without any other risk factors. HCWs need to be aware of atypical COVID-19 presentations and to maintain proper use of personal protective equipment.