scholarly journals 439. Clinical Characteristics and Mortality of an Initial Cohort of COVID-19 Patients in México City

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S287-S287
Author(s):  
Paulo F Castañeda-Mendez ◽  
José Luis Castillo-Álvarez ◽  
Armando Barragán-Reyes ◽  
Daniela Bay-Sansores ◽  
Jessica Isabel Pulido-Enríquez ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mexico City ◽  
Clinical Characteristics ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Case Series ◽  
Special Focus ◽  
Tertiary Care Center ◽  
Initial Cohort

Abstract Background As of today, more than 8 million people have been infected and around 440,000 of them have lost their lives due to complications of SARS-CoV-2 infection. The first confirmed case of COVID-19 in Mexico was on February 28, 2020, and currently, there are more than 150,300 confirmed cases and more than 17,500 deaths have been reported, this work presents the characteristics of the first cases on a tertiary care center with special focus on common comorbidities in Mexicans. Methods We conducted a case series of patients with the diagnosis of pneumonia due to SARS-CoV-2 virus admitted to a tertiary care center in Mexico City, between March 14th and May 4th, 2020. Data collected included demographic information, comorbidities, clinical presentation, and outcomes. Regarding clinical outcomes, we measured the need of admission to Intensive Care Unit (ICU), mortality during hospitalization, discharge, and patients that remained hospitalized. Results 85 patients were included, median age 53.5 years; 69.4% were male. Most common clinical manifestations at admission were fever (61, 71.8%), cough (29, 34.1%), headache (25, 29.4%) and dyspnea (22, 25.9%). Most common comorbidities were overweight (44/82, 53.6%), obesity (25/82, 30.5%), hypertension (18, 21.2%), and diabetes (17, 20%). 31 of 85 (36.5%) patients were diagnosed with critical disease, whereas 54 of 85 (63.5%) were classified as non-critical. In the 31 critically ill patients, the length of invasive mechanical ventilation was 13 days [range {2–45}]; 5 patients (16.1%) required tracheostomy. The mean of mechanical ventilation prior to tracheostomy was 19.8 days [range {14–25}]. In all patients, the total length of hospitalization was 12.1 days [range {2–52}], 14.8 days [range {3–52}] in ICU patients, and 6.7 days [range {2–30}] in floor unit patients. No readmissions were documented. Global mortality was 4.7% (9.6% in ICU, 1.8% in floor unit). Of the 4 deceased patients, 3 presented comorbidities (75%), while 1 was previously healthy, documenting massive pulmonary embolism as the cause of sudden death. Conclusion This study shows that the clinical characteristics in this initial cohort are not different that described elsewhere. Mortality is low but it is mainly related to prevalent comorbidities in the Mexican population. Disclosures All Authors: No reported disclosures

scholarly journals 381. HIV Patients with COVID-19 Hospitalized in a Tertiary Care Center in Mexico City

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S260-S260
Author(s):  
Cristian E Espejo Ortiz ◽  
Yamile G Serrano Pinto ◽  
Juan G Sierra Madero ◽  
Alvaro Lopez Iñiguez ◽  
Brenda Crabtree-Ramírez
Keyword(s):  
Hiv Infection ◽  
Mexico City ◽  
Clinical Characteristics ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Case Series ◽  
Care Hospital ◽  
Hiv Viral Load ◽  
Hiv Patients

Abstract Background The main risk factors for severe COVID-19 described are diabetes, hypertension, cardiovascular disease, obesity, chronic lung and renal disease. HIV infection has not been found to be an independent factor for severe COVID-19, however, only small case series of HIV and COVID-19 have been reported. The aim of this study is to describe clinical characteristics and outcomes of HIV positive patients with COVID-19 hospitalized in a tertiary care hospital in Mexico City. Methods A single-center review of HIV-infected patients diagnosed with COVID-19 was performed using medical records from March 1st, 2020 to May 20th, 2020. We describe the clinical characteristics and outcomes Results A total of 11 PLWH were diagnosed with COVID-19, only 9 were hospitalized and are described here. One died, 6 were discharged and 2 remain hospitalized (table 1). Overall, the median age was 46 years, all males and most (7/9) were on INSTI based ART regimen and undetectable HIV viral load (9/9), with a median of CD4 counts of 581 cell/mm3. The median days since onset of COVID19 symptoms was 7 days. 6/9 had at least one comorbidity: hypertension (3/9) and chronic kidney disease (3/9). 7/9 had body max index >25. 7/9 had moderate to severe lung disease, evidenced by computed tomography. 4/9 required invasive mechanical ventilation, and all were successfully extubated. Table 1. Characteristics and outcomes * Conclusion Most of the HIV patients who required hospitalization due to COVID19 had comorbidities. In spite of severe and critical presentations, most patients have recovered. Outcomes appear no different from those seen for non-HIV infected patients, however larger studies to determine the risk that HIV infection confers to COVID19 outcomes are needed. Disclosures All Authors: No reported disclosures

scholarly journals 567. Use of corticosteroids and COVID-19 mortality in patients with pneumonia in a tertiary care center in México City

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S348-S348
Author(s):  
Maria L Cabrera-Ruiz ◽  
José Luis Castillo-Álvarez ◽  
Armando Barragán-Reyes ◽  
Daniela Bay-Sansores ◽  
Jessica Isabel Pulido-Enríquez ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mexico City ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Tertiary Care Center ◽  
Demographic Information ◽  
Steroid Use ◽  
Small Cohort ◽  
Case Mortality

Abstract Background The use of corticosteroids, specifically dexamethasone has been associated to low mortality in COVID-19 patients. We present here the mortality related to the use of corticosteroids in the first two months of the SARS-CoV-2 outbreak in México City. Methods We conducted a case series of patients with the diagnosis of pneumonia due to SARS-CoV-2 virus admitted to a tertiary care center in Mexico City, between March 14th and May 14th, 2020. Data collected included demographic information, comorbidities, treatment and outcomes including mortality. Results We included 109 patients with diagnosis of COVID-19 associated pneumonia with computed tomography; 76(69.7%) were male and 33(30.3%) female with a median age of 52 yo (24–85) and 51 yo (25–81), respectively. Most common comorbidities were overweight (48.6%), obesity (35.8%), hypertension (23.8%), and diabetes (18.3%). Thirty-eight patients received corticosteroids (Methylprednisolone 30, Hydrocortisone 6 and dexamethasone and prednisone in on case). Mortality in those that used corticosteroids was 21% (8/38) and 5.6% for those that did not received (4/71), p=0.014. Forty cases needed mechanical ventilation from the beginning, and 24 of those received corticosteroids with a mortality of 29% (7/24), while the mortality was 18.7% (3/16) in those with no steroid use, p=0.45. Conclusion Mortality in our small cohort with predominantly use of methylprednisolone is not lower in those using steroids. In fact, mortality was significantly higher in those that received corticosteroids, while this significance was not maintained in those that needed immediate mechanical ventilation. Use of corticosteroids for COVID-19 patients with pneumonia, should be further investigated. Disclosures All Authors: No reported disclosures

Disseminated Tuberculosis: A 3-Year Case-Series Experience in a Tertiary Care Center

2021 ◽  
Vol 22 (5) ◽  
pp. 358-363
Author(s):  
Canan Gunduz Gurkan ◽  
◽  
Hamide Sekerbay ◽  
Aylin Babalik ◽  
◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Tertiary Care Center ◽  
Disseminated Tuberculosis

scholarly journals 468 Clinical characteristics, etiology, and treatment of erythema multiforme at a tertiary care center

2020 ◽  
Vol 140 (7) ◽  
pp. S62
Author(s):  
G. Shi ◽  
B. Kaffenberger ◽  
Y. Semenov ◽  
J. Choi ◽  
K. Williams ◽  
...  
Keyword(s):  
Erythema Multiforme ◽  
Clinical Characteristics ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

Long-Term Hearing Outcomes following Total Ossicular Reconstruction with Titanium Prostheses

2019 ◽  
Vol 161 (1) ◽  
pp. 123-129 ◽  
Author(s):  
C. Burton Wood ◽  
Robert Yawn ◽  
Anne Sun Lowery ◽  
Brendan P. O’Connell ◽  
David Haynes ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Ossicular Chain ◽  
Tertiary Care Center ◽  
Ossicular Chain Reconstruction ◽  
The Mean ◽  
Hearing Outcomes

Objective(1) Characterize a large cohort of patients undergoing total ossicular chain reconstruction with titanium prosthesis. (2) Analyze long-term hearing outcomes of the same cohort.Study DesignCase series with chart review.SettingTertiary care center.Subject and MethodsThis study reviews patients who underwent total ossicular chain reconstruction (OCR) with titanium prostheses (TORPs) at a single tertiary care center from 2005 to 2015. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if length of follow-up was 2 years or more. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 2 years.ResultsIn total, 153 patients were identified who met inclusion criteria. The mean age of included patients was 40 years (range, 6-89 years). Sixty patients (39%) had a history of OCR, and 120 patients (78%) had a diagnosis of cholesteatoma at the time of OCR. Preoperatively, the mean ABG was 36 ± 12, whereas the mean ABG at 2-year follow-up improved to 26 ± 13. This was statistically significant ( P < .0001) using a Wilcoxon matched-pairs signed rank test. Twelve patients (8%) required revision OCR. Two revisions were performed due to prosthesis extrusion (<1%).ConclusionTitanium prostheses lead to significant improvement in hearing over long periods. The results are sustained as far out as 5 years following surgery. In addition, rates of revision surgery with titanium TORPs are low. Based on this series, there are no readily identifiable predictors for outcomes following total OCR.

scholarly journals 1696. Epidemiology, Clinical Characteristics and Outcomes of Invasive Aspergillosis in a Tertiary Care Hospital in Mexico

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S621-S621
Author(s):  
Carla Marina Román-Montes ◽  
María F Gonzalez-Lara ◽  
Alfredo Ponce de Leon ◽  
Maria O Valenzuela-Almada ◽  
Andrea Rangel-Cordero
Keyword(s):  
Liver Failure ◽  
Invasive Aspergillosis ◽  
Clinical Characteristics ◽  
Care Center ◽  
Tertiary Care ◽  
Solid Organ ◽  
Cell Transplant ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Eortc Criteria

Abstract Background Invasive aspergillosis is an important cause of life-threatening infection in immunocompromised patients. The objective was to describe the epidemiology, clinical characteristics, and outcome of patients with invasive aspergillosis (IA) in a tertiary care center in Mexico. Methods A laboratory-based survey was done to identify patients with positive Aspergillus culture or galactomannan from 2014 to 2018. The medical records were reviewed to include patients with proven and probable IA, according to the EORTC criteria. Descriptive analysis of clinical characteristics and risk factors for 6-week mortality was made through X2, T-test or Mann–Whitney test. A multivariate logistic regression model including variables with a P-value of <0.2 in univariate analysis was made. Results 240 cases of IA were identified: 193 (80%) probable, 27 (11%) proven, and 20 (8.3%) not meeting the EORTC criteria but considered infection. 53% were male, median age was 44 years (IQR 28–58), 78 (32.5%) had acute leukemia (AL), 42 (17.5%) hematological neoplasia, 29 (12%) hematopoietic stem-cell transplant (HSCT), 25 (10.4%) solid-organ transplant and 44 (18.3%) autoimmune diseases, 17.5% patients with AL underwent induction remission chemotherapy of which 31% received antifungal prophylaxis. Among patients with IA, 183 (82%) had a positive galactomannan and 109 (45%) had a culture with Aspergillus. Eleven had > 1 species: 55/120 (46%) were A. fumigatus, 18 (15%) A. niger and 18 (15%) A. flavus. Pulmonary disease occurred in 214 (89%). 212 patients (88%) received antifungal treatment with a median duration of 42 days (IQR 20–42). 129 (61%) received voriconazole (VRC), 20 (8.3%) Amphotericin B and 20(8.3%) were randomized to a posaconazole vs. VRC trial. Six-week mortality was 35% (n = 85). Lymphopenia (OR 3.6; 95% CI 1.4–9.0), liver failure (OR 3.3; 95% CI 1.7–6.5) and older age (OR 1.03; 95% CI 1.01–1.05) (marginally) were independently associated with increased 6-week mortality. Conclusion 240 patients with IA were identified in a 5-year period in a tertiary care center. Most had hematological neoplasias and low prevalence of antimold prophylaxis due to economical reasons. Six-week mortality was 35%, nonsurvivors had liver failure and lymphopenia more often. Increased awareness to prevent IA is needed. Disclosures All authors: No reported disclosures.

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