Prevalence and clinical manifestations of dengue in older patients in Bangkok Hospital for Tropical Diseases, Thailand

Abstract Background The global incidence of dengue has increased with the ageing population. We examined the prevalence, clinical manifestations and risk factors associated with dengue severity among older patients. Methods A retrospective cohort study was conducted at a hospital in Thailand from 2013 to 2018. Data were collected from patient records. Older patients were those aged ≥60 y, whereas adult patients were aged at least 18 y but younger than 60 y. Results In total, 1822 patients were included in the study. The prevalence of older dengue was 7.96%. Older dengue patients were at a higher risk of developing dengue haemorrhagic fever (DHF) than adult dengue patients (40.69% vs 30.71%). Haematuria was significantly more frequent in older patients (24.82% vs 3.58%), whereas other clinical manifestations had similar frequencies between the groups. Multivariate logistic regression indicated that hypertension (adjusted OR [aOR]=3.549, 95% CI 1.498 to 8.407) and abdominal pain (aOR=10.904, 95% CI 1.037 to 114.710) were significantly associated with DHF among older patients. Conclusions Dengue is common in older adults, who also have a higher incidence of developing DHF. Older patients with dengue and comorbid hypertension and abdominal pain should be monitored for their increasing risk of DHF.

Download Full-text

Clinical Characteristics of Patients Infected With the Novel 2019 Coronavirus (SARS-Cov-2) in Guangzhou, China

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa187 ◽

2020 ◽

Vol 7 (6) ◽

Cited By ~ 7

Author(s):

Yaping Wang ◽

Baolin Liao ◽

Yan Guo ◽

Feng Li ◽

Chunliang Lei ◽

...

Keyword(s):

Incubation Period ◽

Severe Disease ◽

Clinical Manifestations ◽

Multivariate Logistic Regression Analysis ◽

Albumin Level ◽

Older Age ◽

The Novel ◽

Multivariate Logistic Regression ◽

Factors Associated ◽

Male Sex

Abstract Background The clinical manifestations and factors associated with the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections outside of Wuhan are not clearly understood. Methods All laboratory-confirmed cases with SARS-Cov-2 infection who were hospitalized and monitored in Guangzhou Eighth People’s Hospital were recruited from January 20 to February 10. Results A total of 275 patients were included in this study. The median patient age was 49 years, and 63.6% had exposure to Wuhan. The median virus incubation period was 6 days. Fever (70.5%) and dry cough (56.0%) were the most common symptoms. A decreased albumin level was found in 51.3% of patients, lymphopenia in 33.5%, and pneumonia based on chest computed tomography in 86%. Approximately 16% of patients (n = 45) had severe disease, and there were no deaths. Compared with patients with nonsevere disease, those with severe disease were older, had a higher frequency of coexisting conditions and pneumonia, and had a shorter incubation period (all P < .05). There were no differences between patients who likely contacted the virus in Wuhan and those who had no exposure to Wuhan. Multivariate logistic regression analysis indicated that older age, male sex, and decreased albumin level were independently associated with disease severity. Conclusions Most of the patients infected with SARS-CoV-2 in Guangzhou, China are not severe cases and patients with older age, male, and decreased albumin level were more likely to develop into severe ones.

Download Full-text

Time to diagnosis of tuberculosis is greater in older patients: a retrospective cohort review

ERJ Open Research ◽

10.1183/23120541.00228-2018 ◽

2019 ◽

Vol 5 (4) ◽

pp. 00228-2018 ◽

Cited By ~ 6

Author(s):

Aula Abbara ◽

Simon M. Collin ◽

Onn M. Kon ◽

Kevin Buell ◽

Adam Sullivan ◽

...

Keyword(s):

Symptom Onset ◽

Older Patients ◽

Retrospective Cohort ◽

Age Factors ◽

Multivariable Analysis ◽

Analysis Model ◽

Younger Patients ◽

Time To Treatment ◽

Factors Associated ◽

Age Related

IntroductionAge-related immunosenescence influences the presentation of tuberculosis (TB) in older patients. Here, we explore the clinical and radiological presentation of TB in the elderly and the factors associated with time to treatment for TB.MethodsThis is a retrospective cohort study comparing the clinical, radiological and demographic characteristics of TB patients aged ≥65 years with TB patients aged 18–64 years in a large cohort of TB patients in the UK. Factors associated with the time to presentation and time to treatment were identified using a multivariable analysis model.Results1023 patients were included in the analyses: 679 patients aged 18–64 years and 344 patients aged ≥65 years. “Classical” symptoms of TB (cough, haemoptysis, fever, nights sweats and weight loss) were less common among older patients with pulmonary TB (PTB) (p<0.05), but dyspnoea was more common among older patients (p=0.001). Time from presenting in secondary care to starting treatment was shorter in younger compared with older patients: 3 versus 15 days (p=0.001). When adjusted for age, factors associated with shorter time to treatment from symptom onset include sex (male versus female) (hazard ratio (HR) 1.23 (95% CI 1.05–1.46)), UK born (HR 1.23 (95% CI 1.05–1.46)) and HIV (HR 2.07 (95% CI 1.30–3.29)). Only age remained an independent predictor of time to treatment in a multivariable model (HR 0.98 (95% CI 0.98–0.99)). For those with PTB, chest radiography findings showed that cavitation and lymphadenopathy were more common among younger patients (p=0.001).ConclusionsOlder patients aged ≥65 years with TB had fewer “classical” clinical and radiological presentations of TB, which may explain longer times to starting treatment from symptom onset compared with younger patients aged <65 years.

Download Full-text

Intermittent abdominal pain in IgA vasculitis

Revista Paulista de Pediatria ◽

10.1590/1984-0462/2022/40/2020202 ◽

2022 ◽

Vol 40 ◽

Author(s):

Izabel Mantovani Buscatti ◽

Juliana Russo Simon ◽

Vivianne Saraiva Leitao Viana ◽

Tamima Mohamad Abou Arabi ◽

Vitor Cavalcanti Trindade ◽

...

Keyword(s):

Abdominal Pain ◽

Incomplete Data ◽

Complete Resolution ◽

Retrospective Cohort ◽

Demographic Data ◽

Clinical Manifestations ◽

Disease Course ◽

Iga Vasculitis ◽

Intermittent Abdominal Pain ◽

Rheumatology Unit

ABSTRACT Objective: To assess intermittent abdominal pain in IgA vasculitis patients and its relation to demographic data, clinical manifestations and treatments. Methods: A retrospective cohort study included 322 patients with IgA vasculitis (EULAR/PRINTO/PRES criteria) seen at the Pediatric Rheumatology Unit in the last 32 years. Sixteen patients were excluded due to incomplete data in medical charts. Intermittent abdominal pain was characterized by new abdominal pain after complete resolution in the first month of disease. Results: Intermittent abdominal pain was observed in 35/306 (11%) IgA vasculitis patients. The median time between first and second abdominal pain was 10 days (3–30 days). The main treatment of intermittent abdominal pain included glucocorticoid [n=26/35 (74%)] and/or ranitidine [n=22/35 (63%)]. Additional analysis showed that the frequency of intermittent purpura/petechiae (37 vs. 21%; p=0.027) and the median of purpura/petechiae duration [20 (3–90) vs. 14 (1–270) days; p=0.014] were significantly higher in IgA vasculitis patients with intermittent abdominal pain compared to those without. Gastrointestinal bleeding (49 vs. 13%; p<0.001), nephritis (71 vs. 45%; p=0.006), glucocorticoid (74 vs. 44%; p=0.001) and intravenous immunoglobulin use (6 vs. 0%; p=0.036) were also significantly higher in the former group. The frequency of ranitidine use was significantly higher in IgA vasculitis patients with intermittent abdominal pain versus without (63 vs. 28%; p<0.001), whereas the median of ranitidine duration was reduced in the former group [35 (2–90) vs. 60 (5–425) days; p=0.004]. Conclusions: Intermittent abdominal pain occurred in nearly a tenth of IgA vasculitis patients, in the first 30 days of disease, and was associated with other severe clinical features. Therefore, this study suggests that these patients should be followed strictly with clinical and laboratorial assessment, particularly during the first month of disease course.

Download Full-text

Venous Thromboembolism After Intraventricular Hemorrhage: Results From the CLEAR III Trial

Neurosurgery ◽

10.1093/neuros/nyy189 ◽

2018 ◽

Vol 84 (3) ◽

pp. 709-716 ◽

Cited By ~ 1

Author(s):

◽

Jharna N Shah ◽

Santosh B Murthy ◽

Rachel Dlugash ◽

Nichol McBee ◽

...

Keyword(s):

Venous Thromboembolism ◽

Intraventricular Hemorrhage ◽

Retrospective Cohort ◽

Standard Care ◽

Multivariate Logistic Regression Analysis ◽

Predictor Variable ◽

External Ventricular Drainage ◽

Multivariate Logistic Regression ◽

Timely Initiation ◽

Factors Associated

Abstract BACKGROUND Venous thromboembolism (VTE) after intracerebral hemorrhage is well studied, but data on patients with spontaneous intraventricular hemorrhage (IVH) are limited. OBJECTIVE To study the factors associated with VTE, association between VTE and clinical outcomes in IVH, and safety of VTE chemoprophylaxis in IVH treated with intraventricular catheters and thrombolysis. METHODS Retrospective cohort study of patients enrolled in the CLEAR III trial, a multicenter, randomized trial comparing external ventricular drainage, with administration of intraventricular alteplase vs placebo, for obstructive IVH. Predictor variable was incident VTE in the first 30 d. Outcome measures were factors associated with VTE, and death/severe disability (modified Rankin Score 4-6) at 6 mo. RESULTS Of the 500 patients with IVH, VTE occurred in 59 patients (11.8%) within the first 30 d. VTE chemoprophylaxis was initiated in 412 (82.4%) patients, but before VTE diagnosis in only 401 (80.2%) at median of 4 d (interquartile range, 1-8) from IVH onset, and was not associated with intracranial bleeding or catheter tract hemorrhage. In the multivariate logistic regression analysis, infection within 30 d (odds ratio, 1.80; confidence interval, 1.03-3.17) was significantly associated with higher odds of VTE occurrence. Starting VTE chemoprophylaxis after 72 h was additionally associated with VTE occurrence after the first week. CONCLUSION Infection and delay in timely initiation of VTE chemoprophylaxis were associated with VTE occurrence. VTE chemoprophylaxis in IVH appears safe and should not be delayed beyond standard care policies for ICH including when intraventricular catheter placement and thrombolytic therapy are performed.

Download Full-text

Incidence of Unintentional Flow of Contrast into the Facet Joints During Fluoroscopy-Guided Cervical Interlaminar Epidural Injections: A Retrospective Cohort Study

Pain Medicine ◽

10.1093/pm/pnaa080 ◽

2020 ◽

Vol 21 (7) ◽

pp. 1362-1368

Author(s):

Yoo Jung Park ◽

Joon-Yong Jung ◽

Gyuho Choe ◽

Yu Jung Lee ◽

Jiyoung Lee ◽

...

Keyword(s):

Odds Ratio ◽

Retrospective Cohort ◽

Adjusted Odds Ratio ◽

Epidural Injection ◽

Facet Joints ◽

Multivariate Logistic Regression ◽

Single Institution ◽

Factors Associated ◽

Epidural Injections ◽

Interlaminar Epidural Injection

Abstract Objective We sometimes encounter unintentional flow of contrast into the facet joints during cervical interlaminar epidural injection, which leads to false-positive epidural injection. The purposes of this study were to evaluate the rate of facet flow of contrast and to investigate various factors associated with injection into the space of Okada during fluoroscopy-guided cervical interlaminar epidural injection. Setting and Subjects Images from consecutive cases of fluoroscopy-guided cervical interlaminar epidural injection performed at a single institution between July 2015 and July 2018 were obtained and reviewed. Methods Cases of epidural injection were classified as either facet flow or no facet flow. Multivariate logistic regression was used to identify the predictive factors of unintended injection into the Okada space. Results A total of 2,006 cases were included. Intra-articular flow was identified in 6.0% of cases (121/2,006). All cases of flow of contrast into the facet joints were recognized, and appropriate epidurograms were obtained during the procedures. The highest rate of unintended facet flow of the contrast (10.1%, 44/436) occurred at C5–6. Cervical interlaminar epidural injection at C5–6 and above (adjusted odds ratio [aOR] = 1.929, P = 0.001) and the paramidline approach for epidural injection (aOR = 2.427, P < 0.001) were associated with injection into the space of Okada. Conclusions We detected injection into the space of Okada during fluoroscopy-guided cervical interlaminar epidural injection in 6.0% of procedures. Cervical interlaminar epidural injection at C5–6 and above and the paramidline approach for epidural injection were positive predictors of unintentional facet flow of the contrast.

Download Full-text

Risk Factors Associated with 30-Day Mortality in Older Patients with Influenza

Journal of Clinical Medicine ◽

10.3390/jcm10163521 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3521

Author(s):

Charles Guesneau ◽

Anne Sophie Boureau ◽

Céline Bourigault ◽

Gilles Berrut ◽

Didier Lepelletier ◽

...

Keyword(s):

Risk Factors ◽

Older Patients ◽

Retrospective Cohort ◽

Antiviral Treatment ◽

Prevention Measures ◽

Rt Pcr ◽

Short Term ◽

Factors Associated ◽

Cohort Design ◽

Short Term Mortality

Background: Influenza is a common viral condition, but factors related to short-term mortality have not been fully studied in older adults. Our objective was to determine whether there is an association between geriatric factors and 30-day mortality. Methods: This was a retrospective cohort design. All patients aged 75 years and over, with a diagnosis of influenza confirmed by a positive RT-PCR, were included. The primary endpoint was death within the 30 days after diagnosis. Results: 114 patients were included; 14 (12.3%) patients died within 30 days. In multivariate analysis these patients were older (OR: 1.37 95% CI (1.05, 1.79), p = 0.021), and had a lower ADL score (OR: 0.36 95% CI (0, 17; 0.75), p = 0.006), and a higher SOFA score (OR: 2.30 95% CI (1.07, 4.94), p = 0.03). Oseltamivir treatment, initiated within the first 48 h, was independently associated with survival (OR: 0.04 95% CI (0.002, 0.78), p = 0.034). Conclusions: Identification of mortality risk factors makes it possible to consider specific secondary prevention measures such as the rapid introduction of antiviral treatment. Combined with primary prevention, these measures could help to limit the mortality associated with influenza in older patients.

Download Full-text

Factors associated with survival in older patients affected by COVID-19: A retrospective cohort study

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2021.104349 ◽

2021 ◽

Vol 94 ◽

pp. 104349

Author(s):

Erkin Saeed Saifi ◽

Matteo Giorgi-Pierfranceschi ◽

Massimo Salvetti ◽

Letizia Maninetti ◽

Ilaria Cavalli ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Older Patients ◽

Retrospective Cohort ◽

Factors Associated

Download Full-text

Factors associated with admission to bed-based care: observational prospective cohort study in a multidisciplinary same day emergency care unit (SDEC)

BMC Geriatrics ◽

10.1186/s12877-020-01942-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tania C. N. Elias ◽

Jordan Bowen ◽

Royah Hassanzadeh ◽

Daniel S. Lasserson ◽

Sarah T. Pendlebury

Keyword(s):

Hospital Admission ◽

Emergency Care ◽

Older Patients ◽

Age Groups ◽

Initial Assessment ◽

Severe Illness ◽

Ageing Population ◽

Care Needs ◽

Quality Healthcare ◽

Factors Associated

Abstract Background The development of ambulatory emergency care services, now called ‘Same Day Emergency Care’ (SDEC) has been advocated to provide sustainable high quality healthcare in an ageing population. However, there are few data on SDEC and the factors associated with successful ambulatory care in frail older people. We therefore undertook a prospective observational study to determine i) the clinical characteristics and frailty burden of a cohort in an SDEC designed around the needs of older patients and ii) the factors associated with hospital admission within 30-days after initial assessment. Methods The study setting was the multidisciplinary Abingdon Emergency Medical Unit (EMU) located in a community hospital and led by a senior interface physician (geriatrician or general practitioner). Consecutive patients from August–December 2015 were assessed using a structured paper proforma including cognitive/delirium screen, comorbidities, functional, social, and nutritional status. Physiologic parameters were recorded. Illness severity was quantified using the Systemic Inflammatory Response Syndrome (SIRS> 1). Factors associated with hospitalization within 30-days were determined using multivariable logistic regression. Results Among 533 patients (median (IQR) age = 81 (68–87), 315 (59%) female), 453 (86%) were living at home but 283 (54%) required some form of care and 299 (56%) had Barthel< 20. Falls, urinary incontinence and dementia affected 81/189 (43%), 50 (26%) and 40 (21%) of those aged > 85 years.” Severe illness was present in 148 (28%) with broadly similar rates across age groups. Overall, 210 (39%) patients had a hospital admission within 30-days with higher rates in older patients: 96 (87%) of < 65 years remained on an ambulatory pathway versus only 91 (48%) of ≥ 85 years (p < 0.0001). Factors independently associated with hospital admission were severe illness (SIRS/point, OR = 1.46,95% CI = 1.15–1.87, p = 0.002) and markers of frailty: delirium (OR = 11.28,3.07–41.44, p < 0.0001), increased care needs (OR = 3.08,1.55–6.12, p = 0.001), transport requirement (OR = 1.92,1.13–3.27), and poor nutrition (OR = 1.13–3.79, p = 0.02). Conclusions Even in an SDEC with a multidisciplinary approach, rates of hospital admission in those with severe illness and frailty were high. Further studies are required to understand the key components of hospital bed-based care that need to be replicated by models delivering acute frailty care closer to home, and the feasibility, cost-effectiveness and patient/carer acceptability of such models.

Download Full-text

Etiologies, Clinical Manifestations, and Factors Associated with Severe Symptomatic Hyponatremia among Hospitalized Hyponatremia Patients

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.05.10937 ◽

2020 ◽

Vol 103 (5) ◽

pp. 465-471

Keyword(s):

Clinical Manifestations ◽

Cross Sectional Study ◽

Hospitalized Patients ◽

Sectional Study ◽

Close Attention ◽

Cross Sectional ◽

Factors Associated ◽

Present Cross Sectional Study ◽

Important Health ◽

Baseline Characteristics

Background: Hyponatremia is associated with unfavorable outcomes in many cases. The mainstay of hyponatremia treatment depends on its symptoms and etiology. However, etiologies, clinical manifestations, and factors associated with severe symptomatic hyponatremia have been rarely reported. Objective: To analyze and report etiologies, clinical manifestations, and factors associated with severe symptomatic hyponatremia. Materials and Methods: In the present cross-sectional study, the authors enrolled hospitalized patients with hyponatremia who had consulted a nephrologist between October 1, 2017, and October 31, 2018. Their baseline characteristics and clinical manifestations were recorded. Etiologies were confirmed by the attending nephrology staff. Factors associated with severe symptomatic hyponatremia were evaluated using logistic regression analysis. Results: One hundred patients were included in this study. The syndrome of inappropriate antidiuresis (SIAD), hypovolemia, and hydrochlorothiazide use were the leading hyponatremia etiologies. Hyponatremia etiologies differed between patients with community-acquired hyponatremia (n=50) and those with hospital-associated hyponatremia (n=50). Patients with communityacquired hyponatremia were older, presented with a higher frequency of severe symptomatic hyponatremia, and showed lower SNa-levels. Low SNa-levels were significantly associated with severe symptomatic hyponatremia (p=0.014). Conclusion: Hyponatremia remains an important health problem. SIAD, hypovolemia, and hydrochlorothiazide use are among the leading etiologies of hyponatremia. Low SNa-levels are associated with severe symptomatic hyponatremia; thus, physicians should pay close attention to low SNa-levels in hospitalized patients. Keywords: Hyponatremia, Symptomatic Hyponatremia, Community-acquired hyponatremia, Hospital-associated hyponatremia

Download Full-text