scholarly journals ASSOCIATION OF HYPERGLYCEMIA WITH HOSPITAL MORTALITY IN NONDIABETIC COVID-19 PATIENTS: A COHORT STUDY

2020 ◽  
Author(s):  
Manju Mamtani ◽  
Ambarish M. Athavale ◽  
Mohan Abraham ◽  
Jane Vernik ◽  
Amatur R Amarah ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Reference Group ◽  
Prior History ◽  
Increased Risk ◽  
History Of ◽  
Observational Cohort ◽  
Design And Methods

ABSTRACTObjectiveDiabetes is a known risk factor for mortality in Coronavirus disease 2019 (COVID-19) patients. Our objective was to identify prevalence of hyperglycemia in COVID-19 patients with and without prior diabetes and quantify its association with COVID-19 disease course.Research Design and MethodsThis observational cohort study included all consecutive COVID-19 patients admitted to John H Stroger Jr. Hospital, Chicago, IL from March 15, 2020 to May 15, 2020. The primary outcome was hospital mortality and the studied predictor was hyperglycemia (any blood glucose ≥7.78 mmol/L during hospitalization).ResultsOf 403 COVID-19 patients studied, 51 (12.7%) died. Hyperglycemia occurred in 228 (57%) patients; 83 of these hyperglycemic patients (36%) had no prior history of diabetes. Compared to the reference group no-diabetes/no-hyperglycemia patients the no-diabetes/hyperglycemia patients showed higher mortality [1.8% versus 20.5%, adjusted odds ratio 21.94 (95% confidence interval 4.04-119.0), p < 0.001]; improved prediction of death (p=0.0162) and faster progression to death (p=0.0051). Hyperglycemia within the first 24 and 48 hours was also significantly associated with mortality (odds ratio 2.15 and 3.31, respectively). Further, compared to the same reference group, the no-diabetes/hyperglycemia patients had higher likelihood of ICU admission (p<0.001), acute respiratory distress syndrome (p<0.001), mechanical ventilation (p<0.001), and a longer hospital stay in survivors (p<0.001).ConclusionsHyperglycemia without prior diabetes was common (21% of hospitalized COVID-19 patients) and was associated with an increased risk of and faster progression to death. Development of hyperglycemia in COVID-19 patients who do not have diabetes is an early indicator of progressive disease.

scholarly journals Genetic and pharmacological relationship between P-glycoprotein and increased cardiovascular risk associated with clarithromycin prescription: An epidemiological and genomic population-based cohort study in Scotland, UK

PLoS Medicine ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. e1003372
Author(s):  
Ify R. Mordi ◽  
Benjamin K. Chan ◽  
N. David Yanez ◽  
Colin N. A. Palmer ◽  
Chim C. Lang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Observational Cohort Study ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Nucleotide Polymorphisms ◽  
Major Pathway ◽  
P Glycoprotein ◽  
Increased Risk ◽  
History Of ◽  
Observational Cohort

Background There are conflicting reports regarding the association of the macrolide antibiotic clarithromycin with cardiovascular (CV) events. A possible explanation may be that this risk is partly mediated through drug–drug interactions and only evident in at-risk populations. To the best of our knowledge, no studies have examined whether this association might be mediated via P-glycoprotein (P-gp), a major pathway for clarithromycin metabolism. The aim of this study was to examine CV risk following prescription of clarithromycin versus amoxicillin and in particular, the association with P-gp, a major pathway for clarithromycin metabolism. Methods and findings We conducted an observational cohort study of patients prescribed clarithromycin or amoxicillin in the community in Tayside, Scotland (population approximately 400,000) between 1 January 2004 and 31 December 2014 and a genomic observational cohort study evaluating genotyped patients from the Genetics of Diabetes Audit and Research Tayside Scotland (GoDARTS) study, a longitudinal cohort study of 18,306 individuals with and without type 2 diabetes recruited between 1 December 1988 and 31 December 2015. Two single-nucleotide polymorphisms associated with P-gp activity were evaluated (rs1045642 and rs1128503 –AA genotype associated with lowest P-gp activity). The primary outcome for both analyses was CV hospitalization following prescription of clarithromycin versus amoxicillin at 0–14 days, 15–30 days, and 30 days to 1 year. In the observational cohort study, we calculated hazard ratios (HRs) adjusted for likelihood of receiving clarithromycin using inverse proportion of treatment weighting as a covariate, whereas in the pharmacogenomic study, HRs were adjusted for age, sex, history of myocardial infarction, and history of chronic obstructive pulmonary disease. The observational cohort study included 48,026 individuals with 205,227 discrete antibiotic prescribing episodes (34,074 clarithromycin, mean age 73 years, 42% male; 171,153 amoxicillin, mean age 74 years, 45% male). Clarithromycin use was significantly associated with increased risk of CV hospitalization compared with amoxicillin at both 0–14 days (HR 1.31; 95% CI 1.17–1.46, p < 0.001) and 30 days to 1 year (HR 1.13; 95% CI 1.06–1.19, p < 0.001), with the association at 0–14 days modified by use of P-gp inhibitors or substrates (interaction p-value: 0.029). In the pharmacogenomic study (13,544 individuals with 44,618 discrete prescribing episodes [37,497 amoxicillin, mean age 63 years, 56% male; 7,121 clarithromycin, mean age 66 years, 47% male]), when prescribed clarithromycin, individuals with genetically determined lower P-gp activity had a significantly increased risk of CV hospitalization at 30 days to 1 year compared with heterozygotes or those homozygous for the non-P-gp–lowering allele (rs1045642 AA: HR 1.39, 95% CI 1.20–1.60, p < 0.001, GG/GA: HR 0.99, 95% CI 0.89–1.10, p = 0.85, interaction p-value < 0.001 and rs1128503 AA 1.41, 95% CI 1.18–1.70, p < 0.001, GG/GA: HR 1.04, 95% CI 0.95–1.14, p = 0.43, interaction p-value < 0.001). The main limitation of our study is its observational nature, meaning that we are unable to definitively determine causality. Conclusions In this study, we observed that the increased risk of CV events with clarithromycin compared with amoxicillin was associated with an interaction with P-glycoprotein.

scholarly journals Clinical Implication of TSH Screening in Venous Thromboembolism Patients

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A826-A827
Author(s):  
Siroj Dejhansathit ◽  
Ana Marcella Rivas Mejia ◽  
Kenneth Nugent
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Thyroid Dysfunction ◽  
Chart Review ◽  
Medical Center ◽  
Prior History ◽  
Subclinical Hyperthyroidism ◽  
Multicenter Cohort Study ◽  
Increased Risk ◽  
History Of

Abstract Background: Venous thromboembolism (VTE) that have significant morbidity and mortality for patients in the community and hospital. A recent meta-analysis found a significantly increased risk of incidence VTE among patients with hyperthyroidism compared to patients without hyperthyroidism. To our knowledge, no study has attempted to explore whether screening for TSH levels in VTE patients leads to a diagnosis of undiagnosed thyroid dysfunction as VTE could be the first presenting symptom. Method: We conducted a retrospective cohort study and analyzed data of all patients treated at University Medical Center, Lubbock, Texas in 18-85 years of age with a diagnosis of DVT and/or PE in 2019. Qualitative chart review to identify cases of clinically significant TSH screening in VTE patients that leads to thyroid dysfunction diagnosis. Associations between variables tested using Student’s t-test, chi-square, and Fisher’s exact test. Results: Of total of 533 participants with diagnosis of VTE in 2019, 85 participants were included in the study. Seven participants (8.24%) were found to have high TSH level (&gt;4.2 mIU/mL). None of them was found to have low level of TSH. Participants in high TSH group were more likely to be female (71.43%) and Caucasian (71.43%). In high TSH group patients tended to have both PE and DVT diagnosis at the same admission (71.43%). Weight and BMI were significance higher than those with normal TSH level. Segna et al conducted a prospective multicenter cohort study on association between thyroid dysfunction and venous thromboembolism. The study measure thyroid hormones and thrombophilic biomarkers at 1 year after the acute VTE and follow for the recurrent VTE (rVTE). They found that after 20.8 months of follow-up, 9% developed rVTE. However, none of them was found in subclinical hyperthyroidism group. Furthermore, in their multi-variate analyses, the hazard ratio for rVTE was 0.80 (95%CI 0.23-2.81) subclinical hyperthyroidism compared with euthyroid participants. They concluded that subclinical hyperthyroidism may be associated with lower rVTE risks. Similarly, with Liviu study found hyperthyroidism was not associated with an increased risk of VTE. Qualitative chart review in our patients with high TSH resulted that none of them had history of tobacco use. One participant was on birth control pills with the history of cervical carcinoma. Conclusion:The association of thyroid dysfunction and the development of VTE is debated on the literature review. In our study we found multiple patients with high TSH level (8.24%) in VTE patients with no prior history of thyroid dysfunction. TSH could play an important role in hypercoagulable state. Subclinical hypothyroidism and/or hypothyroidism may induce a prothrombotic event. However, larger cohort studies with higher prevalence of high TSH participants are needed to prove a relationship between TSH level and VTE events.

Pharmacogenetics of sulfonylurea-induced hypoglycemia in Type 2 diabetes patients: the SUCLINGEN study

2021 ◽  
Author(s):  
Navin Kumar Loganadan ◽  
Hasniza Zaman Huri ◽  
Shireene Ratna Vethakkan ◽  
Zanariah Hussein
Keyword(s):  
Type 2 Diabetes ◽  
Odds Ratio ◽  
Gene Polymorphisms ◽  
Prospective Observational Study ◽  
Severe Hypoglycemia ◽  
Prior History ◽  
Increased Risk ◽  
History Of

Aim: This study investigated the incidence of sulfonylurea-induced hypoglycemia and its predictors in Type 2 diabetes (T2D) patients. Patients & methods: In this prospective, observational study, T2D patients on maximal sulfonylurea-metformin therapy >1 year were enrolled. Hypoglycemia was defined as having symptoms or a blood glucose level <3.9 mmol/l. Results: Of the 401 patients, 120 (29.9%) developed sulfonylurea-induced hypoglycemia during the 12-month follow-up. The ABCC8 rs757110, KCNJ11 rs5219, CDKAL1 rs7756992 and KCNQ1 rs2237892 gene polymorphisms were not associated with sulfonylurea-induced hypoglycemia (p > 0.05). Prior history of hypoglycemia admission (odds ratio = 16.44; 95% CI: 1.74–154.33, p = 0.014) independently predicted its risk. Conclusion: Sulfonylurea-treated T2D patients who experienced severe hypoglycemia are at increased risk of future hypoglycemia episodes.

scholarly journals Trajectories of Serum Sodium on In-Hospital and 1-Year Survival among Hospitalized Patients

2020 ◽  
Vol 15 (5) ◽  
pp. 600-607 ◽  
Author(s):  
Api Chewcharat ◽  
Charat Thongprayoon ◽  
Wisit Cheungpasitporn ◽  
Michael A. Mao ◽  
Sorkko Thirunavukkarasu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Serum Sodium ◽  
Odds Ratio ◽  
Reference Group ◽  
High Serum ◽  
Single Center ◽  
Outcome Comparison ◽  
One Year

Background and objectivesThis study aimed to investigate the association between in-hospital trajectories of serum sodium and risk of in-hospital and 1-year mortality in patients in hospital.Design, setting, participants, & measurementsThis is a single-center cohort study. All adult patients who were hospitalized from years 2011 through 2013 who had available admission serum sodium and at least three serum sodium measurements during hospitalization were included. The trend of serum sodium during hospitalization was analyzed using group-based trajectory modeling; the five main trajectories were grouped as follows: (1) stable normonatremia, (2) uncorrected hyponatremia, (3) borderline high serum sodium, (4) corrected hyponatremia, and (5) fluctuating serum sodium. The outcome of interest was in-hospital mortality and 1-year mortality. Stable normonatremia was used as the reference group for outcome comparison.ResultsA total of 43,539 patients were analyzed. Of these, 47% had stable normonatremia, 15% had uncorrected hyponatremia, 31% had borderline high serum sodium, 3% had corrected hyponatremia, and 5% had fluctuating serum sodium trajectory. In adjusted analysis, there was a higher in-hospital mortality among those with uncorrected hyponatremia (odds ratio [OR], 1.33; 95% CI, 1.06 to 1.67), borderline high serum sodium (OR, 1.66; 95% CI, 1.38 to 2.00), corrected hyponatremia (OR, 1.50; 95% CI, 1.02 to 2.20), and fluctuating serum sodium (OR, 4.61; 95% CI, 3.61 to 5.88), compared with those with the normonatremia trajectory. One-year mortality was higher among those with uncorrected hyponatremia (hazard ratio [HR], 1.28; 95% CI, 1.19 to 1.38), borderline high serum sodium (HR, 1.18; 95% CI, 1.11 to 1.26), corrected hyponatremia (HR, 1.24; 95% CI, 1.08 to 1.42), and fluctuating serum sodium (HR, 2.10; 95% CI, 1.89 to 2.33) compared with those with the normonatremia trajectory.ConclusionsMore than half of patients who had been hospitalized had an abnormal serum sodium trajectory during hospitalization. This study demonstrated that not only the absolute serum sodium levels but also their in-hospital trajectories were significantly associated with in-hospital and 1-year mortality. The highest in-hospital and 1-year mortality risk was associated with the fluctuating serum sodium trajectory.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_25_CJN.12281019.mp3

scholarly journals Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e034325 ◽  
Author(s):  
Charat Thongprayoon ◽  
Wisit Cheungpasitporn ◽  
Api Chewcharat ◽  
Michael A Mao ◽  
Kianoush B Kashani
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Primary Outcome ◽  
Reference Group ◽  
Tertiary Referral Hospital ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Ionised Calcium

ObjectivesThe objective of this study was to evaluate the risk of acute respiratory failure in all hospitalised patients based on admission serum ionised calcium.DesignA retrospective cohort study.SettingA tertiary referral hospital in Rochester, Minnesota, USA.ParticipantsAll hospitalised patients who had serum ionised calcium measurement within 24 hours of hospital admission from January 2009 to December 2013. Patients who were mechanically ventilated at admission were excluded.PredictorsAdmission serum ionised calcium levels was stratified into six groups: ≤4.39, 4.40–4.59, 4.60–4.79, 4.80–4.99, 5.00–5.19 and ≥5.20 mg/dL.Primary outcome measureThe primary outcome was the development of acute respiratory failure requiring mechanical ventilation during hospitalisation. Logistic regression analysis was fit to assess the independent risk of acute respiratory failure based on various admission serum ionised calcium, using serum ionised calcium of 5.00–5.19 mg/dL as the reference group.ResultsOf 25 709 eligible patients, with the mean serum ionised calcium of 4.8±0.4 mg/dL, acute respiratory failure requiring mechanical ventilation occurred in 2563 patients (10%). The incidence of acute respiratory failure was lowest when admission serum ionised calcium was 5.00–5.19 mg/dL, with the progressively increased risk of acute respiratory failure with decreased serum ionised calcium. In multivariate analysis with adjustment for potential confounders, the increased risk of acute respiratory failure requiring mechanical ventilation was significantly associated with admission serum ionised calcium of ≤4.39 (OR 2.52; 95% CI 2.12 to 3.00), 4.40–4.59 (OR 1.76; 95% CI 1.49 to 2.07) and 4.60–4.79 mg/dL (OR 1.48; 95% CI 1.27 to 1.72), compared with serum ionised calcium of 5.00–5.19 mg/dL. The risk of acute respiratory failure was not significantly increased when serum ionised calcium was at least 4.80 mg/dL.ConclusionThe increased risk of acute respiratory failure requiring mechanical ventilation was observed when admission serum ionised calcium was lower than 4.80 mg/dL in hospitalised patients.

scholarly journals Risk of Adverse Clinical Outcomes in Hyponatremic Adult Patients Hospitalized for Acute Medical Conditions: A Population-Based Cohort Study

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Alexander Kutz ◽  
Fahim Ebrahimi ◽  
Soheila Aghlmandi ◽  
Ulrich Wagner ◽  
Miluska Bromley ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Population Based ◽  
Control Group ◽  
Short Term ◽  
Patient Disposition ◽  
Increased Risk ◽  
Medical Inpatients

Abstract Context Hyponatremia has been associated with excess long-term morbidity and mortality. However, effects during hospitalization are poorly studied. Objective The objective of this work is to examine the association of hyponatremia with the risk of in-hospital mortality, 30-day readmission, and other short-term adverse events among medical inpatients. Design and Setting A population-based cohort study was conducted using a Swiss claims database of medical inpatients from January 2012 to December 2017 Patients Hyponatremic patients were 1:1 propensity-score matched with normonatremic medical inpatients. Main Outcome Measure The primary outcome was a composite of all-cause in-hospital mortality and 30-day hospital readmission. Secondary outcomes were intensive care unit (ICU) admission, intubation rate, length-of-hospital stay (LOS), and patient disposition after discharge. Results After matching, 94 352 patients were included in the cohort. Among 47 176 patients with hyponatremia, 8383 (17.8%) reached the primary outcome compared with 7994 (17.0%) in the matched control group (odds ratio [OR] 1.06 [95% CI, 1.02-1.10], P = .001). Hyponatremic patients were more likely to be admitted to the ICU (OR 1.43 [95% CI, 1.37-1.50], P &lt; .001), faced a 56% increase in prolonged LOS (95% CI, 1.52-1.60, P &lt; .001), and were admitted more often to a postacute care facility (OR 1.38 [95% CI 1.34-1.42, P &lt; .001). Of note, patients with the syndrome of inappropriate antidiuresis (SIAD) had lower in-hospital mortality (OR 0.67 [95% CI, 0.56-0.80], P &lt; .001) as compared with matched normonatremic controls. Conclusion In this study, hyponatremia was associated with increased risk of short-term adverse events, primarily driven by higher readmission rates, which was consistent among all outcomes except for decreased in-hospital mortality in SIAD patients.

scholarly journals Peripherally inserted central catheters lead to a high risk of venous thromboembolism in children

Blood ◽  
2020 ◽  
Vol 135 (3) ◽  
pp. 220-226 ◽  
Author(s):  
Julie Jaffray ◽  
Char Witmer ◽  
Sarah H. O’Brien ◽  
Rosa Diaz ◽  
Lingyun Ji ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Bloodstream Infections ◽  
Central Line ◽  
Prior History ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Increased Risk ◽  
History Of ◽  
Observational Cohort ◽  
Central Catheters

Abstract Venous thromboembolism (VTE) incidence in children has sharply increased with the majority of cases secondary to central venous catheters (CVCs). Among CVCs, the number of peripherally inserted central catheters (PICCs) placed has risen significantly. In this multicenter, prospective, observational cohort study, we enrolled patients aged 6 months to 18 years with newly placed PICCs or tunneled lines (TLs). We evaluated the incidence of VTE, central line–associated bloodstream infections (CLABSIs), and catheter malfunctions in PICCs and TLs, and risk factors of CVC-related VTE. A total of 1967 CVCs were included in the analysis. The incidence of CVC-related VTE was 5.9% ± 0.63%. The majority of the cases, 80%, were in subjects with PICCs, which had a significantly higher risk of catheter-related VTE than subjects with TLs (hazard ratio [HR] = 8.5; 95% confidence interval [CI], 3.1-23; P &lt; .001). PICCs were significantly more likely to have a CLABSI (HR = 1.6; 95% CI, 1.2-2.2; P = .002) and CVC malfunction (HR = 2.0; 95% CI, 1.6-2.4; P &lt; .001). Increased risk of CVC-related VTE was found in patients with a prior history of VTE (HR = 23; 95% CI, 4-127; P &lt; .001), multilumen CVC (HR = 3.9; 95% CI, 1.8-8.9; P = .003), and leukemia (HR = 3.5; 95% CI, 1.3-9.0; P = .031). Children with PICCs had a significantly higher incidence of catheter-related VTE, CLABSI, and CVC malfunction over TLs. The results suggest that pause be taken prior to placing CVCs, especially PICCs, due to the serious complications they have been shown to cause.

scholarly journals Hypoxemia, Bradycardia, and Multiple Laryngoscopy Attempts during Anesthetic Induction in Infants

2019 ◽  
Vol 131 (4) ◽  
pp. 830-839 ◽  
Author(s):  
Jorge A. Gálvez ◽  
Samuel Acquah ◽  
Luis Ahumada ◽  
Lingyu Cai ◽  
Marcia Polanski ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Primary Outcome ◽  
Cross Sectional ◽  
Emergency Procedures ◽  
Academic Center ◽  
Healthy Infants ◽  
Increased Risk ◽  
History Of ◽  
American Society

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background The infant airway is particularly vulnerable to trauma from repeated laryngoscopy attempts. Complications associated with elective tracheal intubations in anesthetized infants may be underappreciated. We conducted this study of anesthetized infants to determine the incidence of multiple laryngoscopy attempts during routine tracheal intubation and assess the association of laryngoscopy attempts with hypoxemia and bradycardia. Methods We conducted a retrospective cross-sectional cohort study of anesthetized infants (age less than or equal to 12 months) who underwent direct laryngoscopy for oral endotracheal intubation between January 24, 2015, and August 1, 2016. We excluded patients with a history of difficult intubation and emergency procedures. Our primary outcome was the incidence of hypoxemia or bradycardia during induction of anesthesia. We evaluated the relationship between laryngoscopy attempts and our primary outcome, adjusting for age, weight, American Society of Anesthesiologists status, staffing model, and encounter location. Results A total of 1,341 patients met our inclusion criteria, and 16% (n = 208) had multiple laryngoscopy attempts. The incidence of hypoxemia was 35% (n = 469) and bradycardia was 8.9% (n = 119). Hypoxemia and bradycardia occurred in 3.7% (n = 50) of patients. Multiple laryngoscopy attempts were associated with an increased risk of hypoxemia (adjusted odds ratio: 1.78, 95% CI: 1.30 to 2.43, P &lt; 0.001). There was no association between multiple laryngoscopy attempts and bradycardia (adjusted odds ratio: 1.23, 95% CI: 0.74 to 2.03, P = 0.255). Conclusions In a quaternary academic center, healthy infants undergoing routine tracheal intubations had a high incidence of multiple laryngoscopy attempts and associated hypoxemia episodes.

Risk of bone fractures after the diagnosis of adrenal adenomas: a population-based cohort study

2021 ◽  
Vol 184 (4) ◽  
pp. 597-606 ◽  
Author(s):  
Dingfeng Li ◽  
Ravinder Jeet Kaur ◽  
Catherine D Zhang ◽  
Andreas Ebbehoj ◽  
Sumitabh Singh ◽  
...  
Keyword(s):  
Cohort Study ◽  
Bone Fractures ◽  
Adrenal Adenoma ◽  
Population Based ◽  
Prior History ◽  
Outcomes Measures ◽  
Increased Risk ◽  
Common Causes ◽  
History Of

Objective Several small studies reported increased prevalence and incidence of asymptomatic vertebral fractures in patients with non-functioning adrenal adenomas and adenomas with mild autonomous cortisol secretion. However, the risk of symptomatic fractures at vertebrae, and at other sites remains unknown. Our objective was to determine the prevalence and incidence of symptomatic site-specific fractures in patients with adrenal adenomas. Design Population-based cohort study, Olmsted County, Minnesota, USA, 1995–2017. Methods Participants were the patients with adrenal adenoma and age/sex-matched referent subjects. Patients with overt hormone excess were excluded. Main outcomes measures were prevalence and incidence of bone fractures. Results Of 1004 patients with adrenal adenomas, 582 (58%) were women, and median age at diagnosis was 63 years (20–96). At the time of diagnosis, patients had a higher prevalence of previous fractures than referent subjects (any fracture: 47.9% vs 41.3%, P = 0.003, vertebral fracture: 6.4% vs 3.6%, P = 0.004, combined osteoporotic sites: 16.6% vs 13.3%, P = 0.04). Median duration of follow-up was 6.8 years (range: 0–21.9 years). After adjusting for age, sex, BMI, tobacco use, prior history of fracture, and common causes of secondary osteoporosis, patients with adenoma had hazard ratio of 1.27 (95% CI: 1.07–1.52) for developing a new fracture during follow up when compared to referent subjects. Conclusions Patients with adrenal adenomas have higher prevalence of fractures at the time of diagnosis and increased risk to develop new fractures when compared to referent subjects.

scholarly journals The incidence of myocarditis in patients with COVID-19 and in-hospital mortality.

2021 ◽  
Vol 28 (11) ◽  
pp. 1535-1538
Author(s):  
Muhammad Zahid Ali ◽  
Irfan Younus ◽  
Sohail Yousuf ◽  
Muhammad Javed ◽  
Khalil Iqbal ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Symptoms ◽  
Cardiac Injury ◽  
Prior History ◽  
P Value ◽  
Medical College ◽  
Co Morbidity ◽  
History Of ◽  
Observational Cohort ◽  
Chest X Ray

Objective: To determine the Incidence of myocarditis in patients with COVID-19 and in-hospital mortality. Study Design: Observational Cohort study. Setting: Aziz Bhatti Shaheed Teaching Hospital, Nawaz Sharif Medical College, Gujrat. Period: 15 to 30 March 2020. Material & Methods: Patients with positive PCR results for COVID-19 were included in this study after informed consent; patients with prior history of any cardiovascular, pulmonary or other co-morbidity were excluded while patients having history of hypertension, diabetes or smoking were included in the study. All the patients remain admitted for 14 days. Patients were evaluated clinically, by ECG, troponins and echocardiographically for diagnosis of myocarditis. Patients were managed conservatively. Incidence of myocarditis and in-hospital mortality was noted. Successful treatment towards hospital discharge was relief of clinical symptoms, a-febrile, clear chest X-Ray and at least two consecutive negative PCR for covid-19. P-value <0.05 was considered as significant. Data was analyzed with SPSS -23. Results: Out of fifty five, 5(9%) patients were diabetics and 4 were hypertensive. Five (9%) developed mild pneumonia which recovered conservatively and three (5.4%) patients developed myocarditis. One (1.8%) patient expired having myocarditis. Duration of follow up was only during hospital stay. So our in-hospital mortality was 1.8%, p value was calculated as significant < 0.05. Conclusion: Myocarditis is a known but less common complication of COVID-19. Cardiac injury is more in those with previously having cardiovascular or other co-morbidities. In healthy and immunocompetent population its incidence is quite low.

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