scholarly journals 556. Ruxolitinib for the Management of Severe Pneumonia Caused by SARS-CoV-2. Exploring the Combination with dexamethasone

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S380-S380
Author(s):  
Aaron Molina ◽  
Alejandro Olmedo-Reneaum ◽  
Maria Del Rocio Reyes-Paniagua ◽  
Mariana Molina
Keyword(s):  
Mortality Rate ◽  
Severe Pneumonia ◽  
Complete Information ◽  
Supplemental Oxygen ◽  
Hospitalized Patients ◽  
Production Studies ◽  
Final Sample ◽  
Clinical Benefits ◽  
Open Prospective Study ◽  
Level Hospital

Abstract Background Mexico is one of the top five countries with a higher mortality rate of hospitalized patients of 30.1%. Since COVID-19 has been associated with immune dysregulation and hyper inflammation, JAK-12 inhibitors have been tested to reduce IL6 production. Studies have shown improvements when using ruxolitinib (rxb) in severely hospitalized patients with COVID-19. These have included patients in combination with corticosteroids such as dexamethasone (dxm). This work aims to test the response of hospitalized patients with severe or critical COVID-19 treated with rxb with or without dxm. Methods An experimental, open, prospective study in a single third-level hospital in Mexico was performed. The primary outcome was favorable clinical response defined as withdrawal or decline of supplementary oxygen. Secondary outcomes such as mean hospital stay, improvement in systemic inflammatory response parameters, and mortality were also evaluated. Statistical differences for baseline and final measure and the use and not use of dxm were estimated. The study included adults with SARS-CoV-2 infection confirmed with polymerase chain reaction, radiological pneumonia, and oxygen saturation less than 90%. Rxb was administered 5mg/12hrs/15days, IV dxm 6mg/day/10days. Results The final sample was 108 adults with complete information and informed consent. Sixty-two patients (57%) received only rxb. There were no differences between groups for any parameter at the beginning of treatment, and all patients were receiving supplemental oxygen. After 28-day follow-up, 70% reduce supplemental oxygen requirement (74% rxb and 71% rxb+dxm; p=0.628), 18% remained, and 2% increases support (1% with rxb, and 5% rxb+dxm; p< 0.001); 87% of patients were discharged (89% rxb and 85% rxb+dxm; p=0.603). In both groups, there was a significant reduction of CRP, LDH, and Ferritin on day 15. The mortality rate was 9% (no difference in groups; p=0.453), and a higher proportion died for Pseudomonas aeruginosa superinfection in the rxb+dxm group (p< 0.001). Differences for support oxygen at baseline and discharge Final health outcomes of patients with severe or critical COVID-19 in a third-level hospital in Mexico Conclusion The use of rxb could be considered as a treatment helping clinical improvement in hospitalized patients with severe COVID-19. Combination with dxm apparently did not add clinical benefits. It should be further evaluated. Disclosures All Authors: No reported disclosures

Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition

2017 ◽  
Vol 71 (1-2) ◽  
pp. 1-7 ◽  
Author(s):  
Emilia Gómez-Hoyos ◽  
Martín Cuesta ◽  
Nayade Del Prado-González ◽  
Pilar Matía ◽  
Natalia Pérez-Ferre ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Mortality Rate ◽  
Parenteral Nutrition ◽  
Demographic Data ◽  
Tertiary Hospital ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Control Subjects ◽  
Comorbidity Index

Background: The objective of the study was to determine the prevalence of hyponatremia (HN) and its associated morbimortality in hospitalized patients receiving parenteral nutrition (PN). Methods: A retrospective study including 222 patients receiving total PN (parenteral nutrition group [PNG]) over a 7-month period in a tertiary hospital and 176 matched to 179 control subjects without PN (control subjects group [CSG]). Demographic data, Charlson Comorbidity Index (CCI), date of HN detection-(serum sodium or SNa <135 mmol/L)-intrahospital mortality, and hospital length-of-stay (LOS) were registered. In the PNG, body mass index (BMI) and SNa before, during, and after PN were recorded. Results: HN was more prevalent in the PNG: 52.8 vs. 35.8% (p = 0.001), and independent of age, gender, or CCI (OR 1.8 [95% CI 1.1-2.8], p = 0.006). In patients on PN, sustained HN (75% of all intraindividual SNa <135 mmol/L) was associated with a higher mortality rate independent of age, gender, CCI, or BMI (OR 7.38 [95% CI 1.07-50.8], p = 0.042). The absence of HN in PN patients was associated with a shorter hospital LOS (<30 days) and was independent of other comorbidities (OR 3.89 [95% CI 2.11-7.18], p = 0.001). Conclusions: HN is more prevalent in patients on PN. Sustained HN is associated with a higher intrahospital mortality rate. Absence of HN is associated with a shorter hospital LOS.

Congenital syphilis as a cause of death in a newborn in 31st week of pregnancy – significance of testing for syphilis during pregnancy

2021 ◽  
Vol 86 (4) ◽  
pp. 242-245
Author(s):  
Lukáš Čapek ◽  
◽  
Aleš Toman
Keyword(s):  
Caesarean Section ◽  
Cause Of Death ◽  
Umbilical Cord ◽  
Preterm Labor ◽  
Congenital Syphilis ◽  
Severe Pneumonia ◽  
Blood Samples ◽  
Primigravid Woman ◽  
Objective Description ◽  
Level Hospital

Summary: Objective: Description of a case of newborn death after acute caesarean section in 31st week of pregnancy because of mother’s syphilitic infection. Results: Fifteen-years-old primigravid woman in 31st week of pregnancy was admitted to a secondary level hospital due to a high risk of preterm labor. The pregnancy was terminated with an acute caesarean section because of pathological cardiotocograph record. The newborn died after 35 min of resuscitation. Blood samples from the umbilical cord and mother’s blood taken by her gynecologist were positive for syphilis. In cooperation with a dermatologist, the treatment has been provided and reported to the National Referential Laboratory. The autopsy of the newborn had found severe pneumonia, necrotic lymphadenitis and pyocele. Conclusion: The diagnosis of congenital syphilis had been determined after the death of a preterm delivered newborn. Resuscitation had no chance to success because of syphilitic damage of the lungs.

scholarly journals Epidemiology and Factors Affecting Mortality of Hospitalized Patients with Disseminated Intravascular Coagulation in the United States

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2404-2404
Author(s):  
Arya Mariam Roy ◽  
Manojna Konda ◽  
Akshay Goel ◽  
Appalanaidu Sasapu
Keyword(s):  
United States ◽  
African Americans ◽  
Native Americans ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Disseminated Intravascular Coagulation ◽  
The United States ◽  
Hospitalized Patients ◽  
Northeast Region ◽  
Intravascular Coagulation

Introduction Disseminated Intravascular Coagulation (DIC) is a systemic coagulopathy which leads to widespread thrombosis and hemorrhage and ultimately results in multiorgan dysfunction. DIC usually occurs as a complication of illnesses like severe sepsis, malignancies, trauma, acute pancreatitis, burns, and obstetrical complications. The prognosis and mortality of DIC depend on the etiology, however, the mortality of DIC is known to be on the higher side. The aim of the study is to analyze if gender, race, regional differences have any association with the mortality of hospitalized patients with DIC. Method The National Inpatient Sample database from the Healthcare Cost and Utilization Project (HCUP) for the year 2016 was queried for data. We identified hospital admissions for DIC with the International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code D65. The data was analyzed with STATA 16.0 version and univariate and multivariate analysis were performed. We studied the characteristics of all such hospitalizations for the year 2016 and the factors associated with the in-hospital mortality rate (MR) of DIC. We used length of stay, cost of stay as an outcome to determine if gender, race, and location play a role in the mortality. Results A total of 8704 admissions were identified with a diagnosis of DIC during the year 2016. The mean age for admission was found to be 56.48± 0.22. The percentage of admissions in females and males did not have a notable difference (50.57% vs 49.43%). The disease specific MR for DIC was 47.7%. Admission during weekend vs weekdays did not carry a statistically significant difference in terms of MR. Females with DIC were less likely to die in the hospital when compared to males with DIC (OR= 0.906, CI 0.82 - 0.99, p= 0.031). Interestingly, African Americans (AA) with DIC admissions were found to have 24% more risk of dying when compared to Caucasians admitted with DIC (OR= 1.24, CI 1.10 - 1.39, P= 0.00), Native Americans (NA) has 67% more risk of dying when compared to Caucasians (OR= 1.67, CI 1.03 - 2.69, p= 0.035). The mortality rate of NA, AA, Caucasians with DIC was found to be 57%, 52%, 47% respectively. The MR was found to be highest in hospitals of the northeast region (52%), then hospitals in the south (47%), followed by west and mid-west (46%), p= 0.000. Patients admitted to west and mid-west were 24% less likely to die when compared to patients admitted to northeast region hospitals (OR= 0.76, p= 0.001). The average length of stay and cost of stay were also less in west and mid-west regions when compared to north east. The difference in outcomes persisted after adjusting for age, gender, race, hospital division, co-morbid conditions. Conclusion Our study demonstrated that African Americans and Native Americans with DIC have high risk of dying in the hospital. Also, there exists a difference between the mortality rate, length and cost of stay among different regions in the United States. More research is needed to elucidate the factors that might be impacting the location-based variation in mortality. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Effect of Anakinra in Hospitalized Patients with COVID-19: An Updated Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (19) ◽  
pp. 4462
Author(s):  
Konstantinos G. Kyriakoulis ◽  
Anastasios Kollias ◽  
Garyphallia Poulakou ◽  
Ioannis G. Kyriakoulis ◽  
Ioannis P. Trontzas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Interleukin 1 ◽  
Severe Pneumonia ◽  
Hospitalized Patients ◽  
Current Evidence ◽  
Adjusted Risk ◽  
Risk Of Death ◽  
The Impact

The role of immunomodulatory agents in the treatment of hospitalized patients with COVID-19 has been of increasing interest. Anakinra, an interleukin-1 inhibitor, has been shown to offer significant clinical benefits in patients with COVID-19 and hyperinflammation. An updated systematic review and meta-analysis regarding the impact of anakinra on the outcomes of hospitalized patients with COVID-19 was conducted. Studies, randomized or non-randomized with adjustment for confounders, reporting on the adjusted risk of death in patients treated with anakinra versus those not treated with anakinra were deemed eligible. A search was performed in PubMed/EMBASE databases, as well as in relevant websites, until 1 August 2021. The meta-analysis of six studies that fulfilled the inclusion criteria (n = 1553 patients with moderate to severe pneumonia, weighted age 64 years, men 66%, treated with anakinra 50%, intubated 3%) showed a pooled hazard ratio for death in patients treated with anakinra at 0.47 (95% confidence intervals 0.34, 0.65). A meta-regression analysis did not reveal any significant associations between the mean age, percentage of males, mean baseline C-reactive protein levels, mean time of administration since symptoms onset among the included studies and the hazard ratios for death. All studies were considered as low risk of bias. The current evidence, although derived mainly from observational studies, supports a beneficial role of anakinra in the treatment of selected patients with COVID-19.

scholarly journals Serum level of Vitamin D is associated with COVID-19 mortality rate in hospitalized patients

2021 ◽  
Vol 26 (1) ◽  
pp. 112
Author(s):  
MahinJamshidi Makiani ◽  
Azadeh Laali ◽  
Mitra Ranjbar ◽  
MohammadHadi Karbalaie Niya ◽  
Maryam Roham ◽  
...  
Keyword(s):  
Vitamin D ◽  
Mortality Rate ◽  
Serum Level ◽  
Hospitalized Patients

Chronic Pulmonary Insufficiency of Prematurity (CPIP)

PEDIATRICS ◽  
1975 ◽  
Vol 55 (1) ◽  
pp. 55-58
Author(s):  
Alfred N. Krauss ◽  
David B. Klain ◽  
Peter A. M. Auld
Keyword(s):  
Mortality Rate ◽  
Respiratory Distress ◽  
Premature Infants ◽  
Hyaline Membrane Disease ◽  
Supplemental Oxygen ◽  
Pulmonary Insufficiency ◽  
Radiologic Findings ◽  
Sense Of Security ◽  
Hyaline Membrane ◽  
False Sense

This report describes a syndrome of delayed respiratory distress occurring in premature infants usually under 1,250 gm at birth. Unlike hyaline membrane disease, this syndrome occurs after four to seven days in a previously healthy infant; also unlike hyaline membrane disease, it persists for two to four weeks. Chronic pulmonary insufficiency of prematurity (CPIP) carries a 10% to 20% mortality rate. The infants are frequently apneic, require supplemental oxygen, but lack the radiologic findings of hyaline membrane disease or bronchopulmonary dysplasia. When compared with nondistressed infants of similar birthweight, infants with CPIP demonstrate slowly progressive atelectasis, hypoxemia, and hypercapnia. Recovery is usually complete by 60 days of age. The importance of CPIP is that an awareness of its existence can eliminate a false sense of security, often communicated to anxious parents, during the four-to-seven-day grace period before its appearance is clinically obvious. The physiologic similarities between CPIP and hyaline membrane disease suggest that lack of surfactant may play a role in the pathogenesis of CPIP.

scholarly journals Norovirus Is the Most Frequent Cause of Diarrhea in Hospitalized Patients in Monterrey, Mexico

Pathogens ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 672
Author(s):  
Néstor Casillas-Vega ◽  
Fernanda Flores-Rodríguez ◽  
Israel Sotelo-Coronado ◽  
Magda Elizabeth Vera-García ◽  
Aldo García-Heredia ◽  
...  
Keyword(s):  
Entamoeba Histolytica ◽  
Microscopic Observation ◽  
Hospitalized Patients ◽  
Salmonella Spp ◽  
Fecal Samples ◽  
Clostridioides Difficile ◽  
Shigella Spp ◽  
Level Hospital ◽  
Clinical Problems ◽  
Campylobacter Spp

Little information is available regarding the pathogens that cause diarrhea in hospitalized patients who also have various clinical problems. The purpose of this study was to determine the presence of pathogens in fecal samples of hospitalized patients all suffering diarrhea in addition to other problems in Mexico. Diarrheic stools from 240 patients were obtained in a third-level hospital in Monterrey, Mexico. PCR was used for the detection of Salmonella spp., Shigella spp., Campylobacter spp., Yersinia spp., Aeromonas spp., Clostridioides difficile, and norovirus GI and GII. The presence of trophozoites, cysts of protozoa, eggs, and/or helminth larvae was determined by microscopic observation. Of the 240 patients analyzed, 40.4% presented at least one of the pathogens analyzed. Norovirus was the pathogen most frequently found (28.6%), followed by bacteria (11.7%), and parasites (8.3%). The majority of co-infections were parasites + norovirus, and bacteria + norovirus. Norovirus was detected mainly in children aged 0 to 10 years (9/15, 60%). Patients aged 0–20 years did not present co-infections. Entamoeba coli and Entamoeba histolytica were the most common parasites, (8/240), and Salmonella was the most prevalent bacteria (10/240). This information can help design specific strategies useful for hospitalized people with a compromised status.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Critical review of the evidence underlying management of glucocorticoid-induced hyperglycaemia

2018 ◽  
Vol 179 (4) ◽  
pp. R207-R218 ◽  
Author(s):  
Anjana Radhakutty ◽  
Morton G Burt
Keyword(s):  
Low Dose ◽  
Randomized Clinical Trials ◽  
Chronic Inflammatory Disease ◽  
Hospitalized Patients ◽  
Isophane Insulin ◽  
Wide Range ◽  
Clinical Benefits ◽  
High Doses ◽  
Bolus Insulin

Glucocorticoids are frequently prescribed to patients with a wide range of inflammatory and autoimmune diseases. The semi-synthetic glucocorticoid prednisolone is most commonly prescribed and in two main patterns. Prednisolone is prescribed short term at medium-high doses to treat an acute inflammatory illness or long term at lower doses to attenuate chronic inflammatory disease progression. In hospitalized patients with acute prednisolone-induced hyperglycaemia, there is a distinct circadian pattern of glucose elevation, which occurs predominantly in the afternoon and evening. As a morning dose of isophane insulin has a pharmacokinetic pattern that matches this pattern of glucose elevation, treatment comprising a basal dose of morning isophane insulin in combination with short-acting insulin boluses is generally recommended. However, evidence is lacking that isophane-based basal bolus insulin is more efficacious than other insulin regimens. In outpatients, low-dose prednisolone causes a small increase in post glucose-load glucose concentration but no change in overall glycaemic control as measured by glycosylated haemoglobin. If treatment is indicated, metformin has been shown to be effective and may attenuate other adverse effects of long-term prednisolone therapy. Further studies are necessary in order to identify factors underlying the variability in response to insulin therapy and clinical benefits of treatment in hospitalized patients with prednisolone-induced hyperglycaemia. In outpatients prescribed low-dose prednisolone, the cardiovascular risk associated with postprandial hyperglycaemia and efficacy of hypoglycaemic therapies should be evaluated in future randomized clinical trials.

scholarly journals Delivering Telerehabilitation to COVID-19 Inpatients:A Retrospective Chart Review Suggests It Is a Viable Option

2020 ◽  
Vol 16 (S1) ◽  
pp. 64-70
Author(s):  
Kelsey Rosen ◽  
Monika Patel ◽  
Cecelia Lawrence ◽  
Brianne Mooney
Keyword(s):  
Physical Therapy ◽  
Chart Review ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
Inpatient Rehabilitation ◽  
Supplemental Oxygen ◽  
Hospitalized Patients ◽  
Home Exercise ◽  
Viable Option ◽  
Therapeutic Exercises

Abstract Background Guidelines for physical therapy management of patients hospitalized with COVID-19 recommend limiting physical therapists’ contact with patients when possible. Telehealth has been viewed as “electronic personal protective equipment” during the COVID-19 pandemic; although telerehabilitation has been shown to be effective with outpatients, it is unknown whether it is a viable option for hospitalized patients. Purpose Our facility developed an algorithm for the use of a physical therapy telerehabilitation program for inpatients with COVID-19. We sought to investigate the safety and viability of the program. Methods We conducted a retrospective chart review of patients admitted with a diagnosis of COVID-19 who received either telerehabilitation only or a combination of telerehabilitation and in-person rehabilitation. Based on the algorithm, COVID-19 inpatients were selected to receive telerehabilitation if they could ambulate independently, could use technology, had stable vital signs, required minimal supplemental oxygen, and were cognitively intact. We analyzed data of inpatients who received telerehabilitation only, which included patient education, therapeutic exercises, and breathing techniques. Results Of 33 COVID-19 inpatients who received telerehabilitation, in-person rehabilitation, or a combination of the two, 12 patients received telerehabilitation only (age range, 33 to 65 years; all but one male). They demonstrated independence with their individualized home exercise programs in one to two sessions, did not require an in-person rehabilitation consultation, did not require increased oxygen, experienced no exacerbation of symptoms, and were discharged home. Conclusions Inpatient telerehabilitation appears to be a viable option for selected hospitalized patients with COVID-19 and may be a safe way of delivering inpatient rehabilitation to isolated or at-risk populations. At our hospital, the use of inpatient telerehabilitation reduced staff exposure while providing important education and services to patients. To our knowledge, no studies have investigated the use of telerehabilitation for hospitalized patients, including those with COVID-19. Our findings suggest that this innovative approach warrants further study.

scholarly journals Conceptual definitions of indicators for the nursing outcome "Knowledge: Fall Prevention"

2018 ◽  
Vol 71 (2) ◽  
pp. 431-439 ◽  
Author(s):  
Melissa de Freitas Luzia ◽  
Carla Argenta ◽  
Miriam de Abreu Almeida ◽  
Amália de Fátima Lucena
Keyword(s):  
Fall Prevention ◽  
Web Of Science ◽  
Hospitalized Patients ◽  
Nursing Outcomes ◽  
Theoretical Support ◽  
Nursing Diagnosis ◽  
Final Sample ◽  
Nursing Outcomes Classification ◽  
Outcome Knowledge ◽  
Over Time

ABSTRACT Objective: to construct conceptual definitions for indicators of nursing outcome Knowledge: Fall Prevention, selected for evaluation of hospitalized patients with the nursing diagnosis Risk for falls. Method: integrative literature review performed in the LILACS, MEDLINE and Web of Science databases, comprising articles published in English, Spanish and Portuguese languages from 2005 to 2015. Results: the final sample of the study was composed of 17 articles. The conceptualizations were constructed for 14 indicators of nursing outcome Knowledge: Fall Prevention focused on hospitalized patients. Conclusion: the theoretical support of the Nursing Outcomes Classification (NOC), through the process of constructing the conceptual definitions of the indicators of its results, allows nurses to accurately implement this classification in clinical practice and to evaluate the effectiveness of their interventions through the change of the patients' status over time.

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