Divergent: Age, Frailty, and Atypical Presentations of COVID-19 in Hospitalized Patients

Abstract Background Although frailty has been associated with atypical manifestations of infections, little is known about COVID-19 presentations in hospitalized frail patients. We aimed to investigate the association between age, frailty, and clinical characteristics of COVID-19 in hospitalized middle-aged and older adults. Method Longitudinal observational study comprising 711 patients aged ≥50 years consecutively admitted to a university hospital dedicated to COVID-19 severe cases, between March and May 2020. We reviewed electronic medical records to collect data on demographics, comorbidities, COVID-19 signs/symptoms, and laboratory findings on admission. We defined frailty using the Clinical Frailty Scale (CFS = 1–9; frail ≥5). We also documented in-hospital mortality. We used logistic regressions to explore associations between age, frailty, and COVID-19 signs/symptoms; and between typical symptoms (fever, cough, dyspnea) and mortality. Results Participants had a mean age of 66 ± 11 years, and 43% were female. Overall, 25% were frail, and 37% died. The most common COVID-19 presentations were dyspnea (79%), cough (74%), and fever (62%), but patients aged ≥65 years were less likely to have a co-occurrence of typical symptoms, both in the absence (OR = 0.56; 95% CI = 0.39–0.79) and in the presence of frailty (OR = 0.52; 95% CI = 0.34–0.81). In contrast, older age and frailty were associated with unspecific presentations, including functional decline, acute mental change, and hypotension. After adjusting for age, sex, and frailty, reporting fever was associated with lower odds of mortality (OR = 0.70; 95% CI = 0.50–0.97). Conclusions Atypical COVID-19 presentations are common in frail and older hospitalized patients. Providers should be aware of unspecific disease manifestations during the management and follow-up of this population.

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Variables associated with frailty in a hospital population in Colombia

Geriatrics Gerontology and Aging ◽

10.5327/z2447-212320202000029 ◽

2020 ◽

Vol 14 (2) ◽

pp. 114-119

Author(s):

Diego Moreno Díaz ◽

Andrés Ochoa ◽

Mario Alberto Corzo ◽

Miguel Cadena Sanabria ◽

Claudia Lucía Figueroa

Keyword(s):

Functional Decline ◽

Predictive Ability ◽

Cross Sectional Study ◽

Hospitalized Patients ◽

Adverse Outcomes ◽

Cross Sectional ◽

Medicine Service ◽

Measurement Tools ◽

Hospitalized Older Adults

INTRODUCTION: Frailty predicts functional decline and could be associated with adverse outcomes such as disability, multiple hospitalizations, falls, loss of mobility, and cardiovascular disease. In Colombia 12.5% of prevalence has been reported. In the present study, the different clinical variables associated with frailty were evaluated in a population of hospitalized patients older than 65 years in Bucaramanga, Colombia, in order to predict the behavior of these variables to generate measurement tools of greater applicability than that of currently existing tools. METHODS: An analytical observational cross-sectional study with nonprobabilistic sampling was conducted from January 2016 to June 2017 in patients older than 65 years of follow-up > 48 hours by the internal medicine service. Fried criteria were used to evaluate patients on their last day of hospitalization. RESULTS: A total of 155 patients were included, of whom 60.6% were frail. A combined analysis of the variables that showed association with frailty revealed that a calf circumference lower than or equal to 31 cm, a gait speed lower than or equal to 0.8 m/s, and age above 75 years were associated with frailty. It was also shown that being male and having a BMI > 27 kg/m2 are protective factors for frailty. CONCLUSIONS: The prevalence of frailty in hospitalized older adults was higher than that reported in local studies for the community population. According to multivariate analysis, the variables, when analyzed together, have a predictive ability of 92% to estimate frailty in hospitalized patients.

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Posterior Urethral Valves (PUV): Experience of Follow up Over 7 years

Bangladesh Journal of Urology ◽

10.3329/bju.v15i2.45918 ◽

2020 ◽

Vol 15 (2) ◽

pp. 40-43

Author(s):

Sudip Das Gupta ◽

Nitai Pada Biswas ◽

Sanjib Kumar Roy ◽

Ma Kashem ◽

Akm Anwarul Islam ◽

...

Keyword(s):

Urinary Tract ◽

Posterior Urethral Valves ◽

University Hospital ◽

Voiding Cystourethrogram ◽

Laboratory Findings ◽

Urethral Valves ◽

Long Run ◽

Tract Infections ◽

Medical University

Objectives: Posterior urethral vale is one of the major common congenital obstructive urethral lesions in male children. Endoscopic fulguration with observation is the treatment of choice for posterior urethral valves (PUV). This prospective study was carried out to assess the outcome of endoscopic fulguration of posterior urethral valves based upon the clinical, radiological and laboratory findings. Methods : The study started in Bangabandhu Sheikh Mujib Medical University Hospital in October 2004 on 50 male children with posterior urethral valves who were treated with endoscopic fulguration and came for routine follow up. Diagnosis was established by voiding cystourethrogram (VCUG) and confirmed by urethrocystoscopic findings.. The patients came for follow up after valve ablation at three months interval up to 1 year, and at six months interval for seven years. Results: Mean age of the patients was 2 years ranging from 1 to 12 years old. At diagnosis mean serum creatinine level ± SD was 90.4±44.8 μmol /litre and it decreased to 58.3±11.4μmol/litre at the end of 7 years follow up. Hydronephrotic changes decreased from decreased from 84% to 2%. Proteinuria decreased from 38% to 4%.Urinary tract infections decreased from 58% to 8% at the end of last follow up. Conclusion: In this study patients improved dramatically following fulguration of posterior urethral valves. But these patients need regular follow up because some of these patients may develop ESRD in the long run. Bangladesh Journal of Urology, Vol. 15, No. 2, July 2012 p.40-43

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Clinical and Laboratory Characteristics of Kikuchi-Fujimoto Disease According to Age

Frontiers in Pediatrics ◽

10.3389/fped.2021.745506 ◽

2021 ◽

Vol 9 ◽

Author(s):

Hye-Young Kim ◽

Ha Young Jo ◽

Seong Heon Kim

Keyword(s):

Sex Ratio ◽

Recurrence Rate ◽

Clinical Features ◽

University Hospital ◽

Laboratory Findings ◽

Number Of Patients ◽

National University ◽

Male Sex ◽

Age And Sex

Background: Little information exists regarding the differences in the clinical and laboratory characteristics of Kikuchi-Fujimoto disease (KFD) according to age.Objective: To evaluate the clinical and laboratory characteristics of KFD according to age.Methods: The relevance of sex, age, clinical features, laboratory findings, courses, and follow-up results were retrospectively evaluated in patients diagnosed with KFD at Pusan National University Hospital between 2010 and 2020.Results: Eighty patients (46 children and 34 adults) with a mean age of 21.5 ± 11.8 years (range, 3–49 years) were included in the study. Those aged 10–19 years accounted for the largest number of patients (42.5%). Among children, the male sex ratio was higher, especially for patients aged ≤ 9 years. In adults, the female sex ratio was higher, especially for patients aged 20–29 years. Fever, tenderness in the lymph node, and skin rashes were more common in children, while myalgia and weight loss were more common in adults. In children, the recurrence rate was significantly higher among boys than among girls (15.8 vs. 0.0%, P = 0.001); lower platelet count and higher CRP levels were observed among boys than among girls. EBV and ANA positivity rates were higher in boys than in girls. In adults, the recurrence rate was significantly higher in women than in men (18.2 vs. 0.0%, P = 0.005). ANA positivity rates were higher in women than in men.Conclusion: The clinical features, laboratory findings, and recurrence of KFD may differ depending on age and sex. Clinicians should be aware of this.

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Cytomegalovirus Reactivation in Immunocompetent Mechanical Ventilation Patients: A Prospective Observational Study

10.21203/rs.3.rs-909572/v1 ◽

2021 ◽

Author(s):

Zhihui Zhang ◽

Xuesong Liu ◽

Ling Sang ◽

Sibei Chen ◽

Zhan Wu ◽

...

Keyword(s):

Mechanical Ventilation ◽

Observational Study ◽

Prospective Observational Study ◽

University Hospital ◽

Laboratory Findings ◽

Cytomegalovirus Reactivation ◽

Independent Risk Factors ◽

Cmv Reactivation ◽

Immunocompetent Patients

Abstract Background: Cytomegalovirus (CMV) reactivation is associated with adverse prognoses of critically ill patients. However, the epidemiology and predictors of CMV reactivation in immunocompetent patients receiving mechanical ventilation (MV) are not clear. The aim of this study was to investigate the epidemiology and predictors of CMV reactivation in immunocompetent patients requiring MV.Methods: A single-center, prospective observational study (conducted from June 30, 2017 to July 01, 2018) with a follow-up of 90 days (September 29, 2018) that included 71 CMV-seropositive immunocompetent patients with MV at a 37-bed university hospital general intensive care unit (ICU) in China. Routine detection of CMV DNAemia was performed once a week for 28 days (Days 1, 7, 14, 21, and 28). CMV serology, laboratory findings, and clinical data were obtained during hospitalization.Results: Among 71 patients, 13 (18.3%) showed CMV reactivation within 28 days in the ICU. The median time to reactivation was 7 days. CMV reactivation was related to various factors, including body mass index (BMI), sepsis, N-terminal pro-b-type natriuretic peptide (NT-proBNP), blood urea nitrogen (BUN), and hemoglobin (Hb) levels (P < 0.05). In the multivariate regression model, BMI, Hb level, and sepsis were independently associated with CMV reactivation patients (P < 0.05). Moreover, the area under the receiver operating characteristic (AUROC) of BMI, Hb, and BMI combined with Hb was 0.69, 0.70, and 0.76, respectively. The duration of MV, hospitalization expense, length of ICU stay, and 90-day all-cause mortality rate in patients with CMV reactivation was significantly higher than in those without CMV reactivation (P < 0.05).Conclusions: Among immunocompetent patients with MV, the incidence of CMV reactivation was 18.3%. CMV reactivation was associated with several adverse prognoses. BMI, Hb, and sepsis were independent risk factors for CMV reactivation. BMI and Hb may predict CMV reactivation.

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Cytomegalovirus reactivation in immunocompetent mechanical ventilation patients: a prospective observational study

BMC Infectious Diseases ◽

10.1186/s12879-021-06698-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhihui Zhang ◽

Xuesong Liu ◽

Ling Sang ◽

Sibei Chen ◽

Zhan Wu ◽

...

Keyword(s):

Mechanical Ventilation ◽

Observational Study ◽

Prospective Observational Study ◽

University Hospital ◽

Laboratory Findings ◽

Cytomegalovirus Reactivation ◽

Independent Risk Factors ◽

Cmv Reactivation ◽

Immunocompetent Patients

Abstract Background Cytomegalovirus (CMV) reactivation is associated with adverse prognoses of critically ill patients. However, the epidemiology and predictors of CMV reactivation in immunocompetent patients receiving mechanical ventilation (MV) are not clear. The aim of this study was to investigate the epidemiology and predictors of CMV reactivation in immunocompetent patients requiring MV. Methods A single-center, prospective observational study (conducted from June 30, 2017 to July 01, 2018) with a follow-up of 90 days (September 29, 2018) that included 71 CMV-seropositive immunocompetent patients with MV at a 37-bed university hospital general intensive care unit (ICU) in China. Routine detection of CMV DNAemia was performed once a week for 28 days (Days 1, 7, 14, 21, and 28). CMV serology, laboratory findings, and clinical data were obtained during hospitalization. Results Among 71 patients, 13 (18.3%) showed CMV reactivation within 28 days in the ICU. The median time to reactivation was 7 days. CMV reactivation was related to various factors, including body mass index (BMI), sepsis, N-terminal pro-b-type natriuretic peptide (NT-proBNP), blood urea nitrogen (BUN), and hemoglobin (Hb) levels (P < 0.05). In the multivariate regression model, BMI, Hb level, and sepsis were independently associated with CMV reactivation patients (P < 0.05). Moreover, the area under the receiver operating characteristic (AUROC) of BMI, Hb, and BMI combined with Hb was 0.69, 0.70, and 0.76, respectively. The duration of MV, hospitalization expense, length of ICU stay, and 90 day all-cause mortality rate in patients with CMV reactivation was significantly higher than in those without CMV reactivation (P < 0.05). Conclusions Among immunocompetent patients with MV, the incidence of CMV reactivation was 18.3%. CMV reactivation was associated with several adverse prognoses. BMI, Hb, and sepsis were independent risk factors for CMV reactivation. BMI and Hb may predict CMV reactivation.

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Follow-up of Osteomyelitis of Infants with Systemic Serum Parameters and Bone Scintigraphy

Nuklearmedizin ◽

10.1055/s-0038-1629824 ◽

1996 ◽

Vol 35 (04) ◽

pp. 116-121 ◽

Cited By ~ 4

Author(s):

G. E Fueger ◽

M. Vejda ◽

R. M. Aigner

Keyword(s):

Bone Scintigraphy ◽

Antibiotic Treatment ◽

Diagnostic Value ◽

Clinical Findings ◽

Laboratory Findings ◽

Radiographic Findings ◽

Serum Parameters ◽

Wbc Count ◽

Differential White Blood Cell

Summary Aim: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC). Methods: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography. Results: CRP was the most effective serum parameter for follow- up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment. Conclusion: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

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