Med Peds Poster - 2019

Med Peds Poster - 2019https://scholarlycommons.libraryinfo.bhs.org/research_education/1003/thumbnail.jp

Medicine Posters - 2019

Medicine Posters - 2019https://scholarlycommons.libraryinfo.bhs.org/research_education/1004/thumbnail.jp

Autoimmune Limbic Encephalitis in a Patient with Acute Encephalopathy and Hyponatremia

Acute encephalopathy is a common clinical presentation for hospital admissions. Autoimmune encephalitis is a rare cause of encephalopathy which has increasingly been recognized over the last decade. The detection of various neuronal antibodies has helped diagnose these syndromes, but they have limited availability, mostly in the developed countries. We present a case of a middle-aged female presenting with memory impairment, gait disturbances, and hyponatremia. A clinical diagnosis of autoimmune limbic encephalitis was made based on faciobrachial dystonic seizures, SIADH, and MRI changes 10 days prior to autoantibody titer returned. Prompt treatment with steroids and intravenous immunoglobulin was started with improvement in her neurological symptoms. This case highlights the importance of considering autoimmune encephalitis syndromes in the differential diagnosis of patients with classical neurological presentations and prompt diagnosis and immunotherapy to improve neurological outcomes

High flow nasal oxygen therapy utilization: 7-year experience at a community teaching hospital

OBJECTIVE: To examine the use of high flow nasal cannula oxygen therapy (HFNC) between 2008 and 2014 in patients 18 years or older at a community teaching hospital. METHODS: Yearly utilization rates of HFNC, noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) were calculated among admissions with a set of cardiopulmonary diagnoses (heart failure, COPD, asthma or pneumonia). RESULTS: Among the 41,711 admissions with at least one of the above cardiopulmonary condition, HFNC was utilized in 1,128 or 27.0/1000; NIV was used in an average of 169/1000 and IMV in 231/1000. HFNC was accompanied by IMV or NIV 71.3% of the time. From 2008 to 2014 HFNC utilization increased an average of 17.5% annually; NIV increased by 10.2% annually while IMV\u27s utilization increased by 1.6% annually. The highest rate of change in HFNC use was among admissions with pneumonia and those with COPD. CONCLUSION: HFNC utilization increased steadily over a 7-year period at our hospital. Frequently, HFNC therapy was used in combination with other ventilatory modes to support patients\u27 respiration. Similar with other technologies in healthcare, the uptake of HFNC has preceded the evidence from robust clinical trials

An observational study of the management practices and outcomes of patients with new onset atrial fibrillation in non-cardiothoracic surgeries

BACKGROUND AND OBJECTIVE: Limited data exist on characteristics and management of patients with postoperative atrial fibrillation (POAF) after noncardiothoracic surgeries and on the relationship between symptoms and outcomes. We sought to describe clinical features, in-hospital practices and outcomes in patients with new POAF by the presence or absence of clinical symptoms. METHODS: Retrospective cohort study of adults with POAF in one tertiary center. RESULTS: Among the 99 patients who fulfilled the eligibility criteria, median age was 75 years (IQR 64-83) and 57.6% were male. Only thirty percent of patients with POAF were symptomatic. Rate control/conversion to sinus rhythm was achieved in ≤ 4 h in 56% of the patients and in 80% was maintained for ≥ 24 h. Anticoagulation was prescribed in 50% of those discharged in AF; the CHADS2-VASc score was not associated with anticoagulation prescribed. One third of patients were readmitted and half of them were in AF. Asymptomatic patients had lower median heart rate than symptomatic patients but no other clinical characteristics, or outcomes were different. CONCLUSIONS: Most patients with POAF were asymptomatic but their presentation or outcomes were similar with symptomatic patients. One in four discharged patients was prescribed anticoagulation and the CHADS2-VASC score was not associated with this decision. These findings have important implications for practice and future research. There is a need to better delineate the risk associated with transient versus persistent POAF, symptomatic versus asymptomatic POAF, as well as for clinical trials to determine optimal strategies to improve their outcomes