scholarly journals Gastrointestinal Symptoms and Outcomes in Hospitalized Coronavirus Disease 2019 Patients

2020 ◽  
Vol 38 (5) ◽  
pp. 373-379 ◽  
Author(s):  
Preethi Ramachandran ◽  
Ifeanyichkwu Onukogu ◽  
Snigdha Ghanta ◽  
Mahesh Gajendran ◽  
Abhilash Perisetti ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Primary Outcome ◽  
Medical Center ◽  
Gastrointestinal Symptoms ◽  
Laboratory Findings ◽  
Gi Symptoms ◽  
Significant Difference ◽  
Poor Outcomes ◽  
Time Of Admission ◽  
And Control

Introduction: Gastrointestinal (GI) symptoms are increasingly being recognized in coronavirus disease 2019 (COVID-19). It is unclear if the presence of GI symptoms is associated with poor outcomes in COVID-19. We aim to assess if GI symptoms could be used for prognostication in hospitalized patients with COVID-19. Methods: We retrospectively analyzed patients admitted to a tertiary medical center in Brooklyn, NY, from March 18, 2020, to March 31, 2020, with COVID-19. The patients’ medical charts were reviewed for the presence of GI symptoms at admission, including nausea, vomiting, diarrhea, and abdominal pain. COVID-19 patients with GI symptoms (cases) were compared with COVID-19 patients without GI symptoms (control). Results: A total of 150 hospitalized COVID-19 patients were included, of which 31 (20.6%) patients had at least 1 or more of the GI symptoms (cases). They were compared with the 119 COVID-19 patients without GI symptoms (controls). The average age among cases was 57.6 years (SD 17.2) and control was 63.3 years (SD 14.6). No statistically significant difference was noted in comorbidities and laboratory findings. The primary outcome was mortality, which did not differ between cases and controls (41.9 vs. 37.8%, p = 0.68). No statistically significant differences were noted in secondary outcomes, including the length of stay (LOS, 7.8 vs. 7.9 days, p = 0.87) and need for mechanical ventilation (29 vs. 26.9%, p = 0.82). Discussion: In our study, the presence of GI manifestations in COVID-19 at the time of admission was not associated with increased mortality, LOS, or mechanical ventilation.

scholarly journals HIV-1 Infection Does Not Change Disease Course or Inflammatory Pattern of SARS-CoV-2-Infected Patients Presenting at a Large Urban Medical Center in New York City

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Justin Laracy ◽  
Jason Zucker ◽  
Delivette Castor ◽  
Donald J McMahon ◽  
Tai Wei Guo ◽  
...  
Keyword(s):  
New York ◽  
Mechanical Ventilation ◽  
Medical Center ◽  
Inflammatory Marker ◽  
Admission Rate ◽  
Ventilation Rate ◽  
Urban Hospital ◽  
Hiv Diagnosis ◽  
Significant Difference ◽  
Study Population

Abstract Background The clinical impact of coronavirus disease 2019 (COVID-19) among people with HIV (PWH) remains unclear. In this retrospective cohort study of COVID-19, we compared clinical outcomes and laboratory parameters among PWH and controls. Methods Sixty-eight PWH diagnosed with COVID-19 were matched 1:4 to patients without known HIV diagnosis, drawn from a study population of all patients who were diagnosed with COVID-19 at an academic urban hospital. The primary outcome was death/discharge to hospice within 30 days of hospital presentation. Results PWH were more likely to be admitted from the emergency department than patients without HIV (91% vs 71%; P = .001). We observed no statistically significant difference between admitted PWH and patients without HIV in terms of 30-day mortality rate (19% vs 13%, respectively) or mechanical ventilation rate (18% vs 20%, respectively). PWH had higher erythrocyte sedimentation rates than controls on admission but did not differ in other inflammatory marker levels or nasopharyngeal/oropharyngeal severe acute respiratory syndrome coronavirus 2 viral load estimated by reverse transcriptase polymerase chain reaction cycle thresholds. Conclusions HIV infection status was associated with a higher admission rate; however, among hospitalized patients, PWH did not differ from HIV-uninfected controls by rate of mechanical ventilation or death/discharge to hospice.

scholarly journals Early versus deferred anti-SARS-CoV-2 convalescent plasma in patients admitted for COVID-19: A randomized phase II clinical trial

PLoS Medicine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. e1003415
Author(s):  
María Elvira Balcells ◽  
Luis Rojas ◽  
Nicole Le Corre ◽  
Constanza Martínez-Valdebenito ◽  
María Elena Ceballos ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Clearance Rate ◽  
Neutralizing Antibodies ◽  
Statistical Power ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Group Versus ◽  
Hospital Length Of Stay

Background Convalescent plasma (CP), despite limited evidence on its efficacy, is being widely used as a compassionate therapy for hospitalized patients with COVID-19. We aimed to evaluate the efficacy and safety of early CP therapy in COVID-19 progression. Methods and findings The study was an open-label, single-center randomized clinical trial performed in an academic medical center in Santiago, Chile, from May 10, 2020, to July 18, 2020, with final follow-up until August 17, 2020. The trial included patients hospitalized within the first 7 days of COVID-19 symptom onset, presenting risk factors for illness progression and not on mechanical ventilation. The intervention consisted of immediate CP (early plasma group) versus no CP unless developing prespecified criteria of deterioration (deferred plasma group). Additional standard treatment was allowed in both arms. The primary outcome was a composite of mechanical ventilation, hospitalization for >14 days, or death. The key secondary outcomes included time to respiratory failure, days of mechanical ventilation, hospital length of stay, mortality at 30 days, and SARS-CoV-2 real-time PCR clearance rate. Of 58 randomized patients (mean age, 65.8 years; 50% male), 57 (98.3%) completed the trial. A total of 13 (43.3%) participants from the deferred group received plasma based on clinical aggravation. We failed to find benefit in the primary outcome (32.1% versus 33.3%, odds ratio [OR] 0.95, 95% CI 0.32–2.84, p > 0.999) in the early versus deferred CP group. The in-hospital mortality rate was 17.9% versus 6.7% (OR 3.04, 95% CI 0.54–17.17 p = 0.246), mechanical ventilation 17.9% versus 6.7% (OR 3.04, 95% CI 0.54–17.17, p = 0.246), and prolonged hospitalization 21.4% versus 30.0% (OR 0.64, 95% CI, 0.19–2.10, p = 0.554) in the early versus deferred CP group, respectively. The viral clearance rate on day 3 (26% versus 8%, p = 0.204) and day 7 (38% versus 19%, p = 0.374) did not differ between groups. Two patients experienced serious adverse events within 6 hours after plasma transfusion. The main limitation of this study is the lack of statistical power to detect a smaller but clinically relevant therapeutic effect of CP, as well as not having confirmed neutralizing antibodies in donor before plasma infusion. Conclusions In the present study, we failed to find evidence of benefit in mortality, length of hospitalization, or mechanical ventilation requirement by immediate addition of CP therapy in the early stages of COVID-19 compared to its use only in case of patient deterioration. Trial registration NCT04375098.

scholarly journals Prevalence and pattern of gastrointestinal symptoms in patients with diabetes mellitus

2017 ◽  
Vol 11 (2) ◽  
pp. 56-60 ◽  
Author(s):  
Hafiza Lona ◽  
Shahjada Selim
Keyword(s):  
Diabetes Mellitus ◽  
Multiple Logistic Regression Analysis ◽  
Gastrointestinal Symptoms ◽  
Biochemical Parameter ◽  
Poor Quality ◽  
Cyclic Vomiting Syndrome ◽  
Female Ratio ◽  
Gi Symptoms ◽  
Significant Difference ◽  
Self Reporting Questionnaire

Background and objectives: Gastrointestinal (GI) disorders are contributor of increased morbidity and poor quality of life in individuals with diabetes mellitus (DM). Racial, nutritional and life style may influence GI disorders to a large extent. Thus, the burden of GI disorders and its determinants warrant investigation in individual population. Therefore, the present study was undertaken to explore the types of GI symptoms in Bangladeshi population with DM for more than 10 years of duration.Methodology: This observational study was conducted on patients with DM for more than 10 years of duration at the outpatient department of BIRDEM general hospital from July 2009 to June 2010. A total of 301 DM patients responded to self-reporting questionnaire (Bengali adaptation of Rome III diagnostic questionnaire). Then 91 participants were further studied for glycemic status, liver function, kidney function and basic defects of diabetes through homeostasis model assessment.Results: The median age of 301 study population was 55 years (range 25 to 84 years) and the male female ratio was 1: 0.74. Out of 301 DM cases, 273 (90.7%) had GI symptoms. Significantly (p<0.05) higher number of males (93.6%) had GI symptoms compared to females (86.7%). Among the clinical conditions, unspecified functional bowel disorder (UFBD) was present in 88.3% cases, followed by cyclic vomiting syndrome (38.1%) and functional fecal incontinence (20.9%). Single GI symptom was present in 123 (45.1%) cases while 32.6%, 12.5% and 9.9% had two, three and more than three GI symptoms respectively. No significant difference was found in any biochemical parameter between cases with and without GI symptoms. Multiple logistic regression analysis revealed sex and residence as poor predictors of UFBD while other variables did not show any significant relation/risk to UFBD.Conclusion: A large proportion of patients with long duration of DM had GI symptoms. A comprehensive management of diabetes requires attention to GI disorders.IMC J Med Sci 2017; 11(2): 56-60

scholarly journals The Effect of Oral Administration of Amantadine on Neurological Outcome of Patients With Diffuse Axonal Injury in ICU

2019 ◽  
Vol 13 ◽  
pp. 117906951882485 ◽  
Author(s):  
Rahman Abbasivash ◽  
Mohammad Amin Valizade Hasanloei ◽  
Aidin Kazempour ◽  
Ata Mahdkhah ◽  
Mir Mehdi Shaaf Ghoreishi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Oral Administration ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Double Blind ◽  
Neurological Outcomes ◽  
Double Blind Clinical Trial ◽  
Significant Difference ◽  
The Mean ◽  
Time Of Admission

Traumatic brain injury is a major cause of death and disability in adults. This study investigated the effect of oral administration of amantadine on the neurological outcomes of patients with diffuse axonal injury (DAI) in the intensive care unit (ICU). This double-blind clinical trial was conducted in the ICU of Imam Hospital in Urmia. Patients with DAI were intubated and received mechanical ventilation in the ICU. They were divided into 2 groups: patients receiving amantadine (A) and placebo (P). The acquired data were analyzed using SPSS, P < .05 significant level. Findings showed no significant difference between the 2 groups in age and sex. There was no significant difference between the mean Glasgow Coma Scale (GCS) at the time of admission and discharge, and the mean Glasgow Outcome Scale (GOS) of the patients in 2 groups. No significant difference was observed in the duration of mechanical ventilation, hospitalization, and mortality in both groups ( P > .05) in ICU. However, there was a significant difference between the mean GCS at the time of admission and discharge and death. Also, significant differences existed between the mean GOS in discharged and deceased patients ( P = .001). This study showed no significant difference between the mean GCS at the time of admission and discharge and the mean GOS of the discharged patients and the mortality rate in the 2 groups. However, there were clear statistical differences between these variables in discharged and deceased patients. It is recommended that further studies are conducted with a larger sample size.

scholarly journals Thoracic periaortic adipose tissue is increased in patients with subclinical hypothyroidism

2015 ◽  
Vol 172 (5) ◽  
pp. 553-559
Author(s):  
Ömer Akyürek ◽  
Duran Efe ◽  
Zeynettin Kaya
Keyword(s):  
Adipose Tissue ◽  
Subclinical Hypothyroidism ◽  
Smoking Status ◽  
Control Group ◽  
Laboratory Findings ◽  
Significant Difference ◽  
Sh Group ◽  
The Difference ◽  
And Control ◽  
Tsh Levels

ObjectiveTo evaluate thoracic periaortic adipose tissue (TAT) volume in patients with subclinical hypothyroidism (SH) in comparison with controls and in relation to cardiovascular risk factors.MethodsThe study population consisted of 28 newly diagnosed SH patients (mean (s.d.) age: 37.3 (±11.4) years, 85.7% were females) and 37 healthy volunteers (mean (s.d.) age: 35.3 (±10.7) years, 81.5% were females). Comparisons between patient and control groups used demographic characteristics, anthropometrics, and laboratory findings. All participants underwent thoracic radiographic assessment in the supine position, using an eight-slice multidetector computed tomography scanner and TAT volume was measured.ResultsThe TAT volume was determined to be 27.2 (±12.7) cm3 in the SH group and 16.3 (±8.1) cm3 in the control group, and the difference was statistically significant (P<0.001). In addition, TSH levels were significantly higher in the patient group compared with the control group (P<0.001). A significant correlation was also found between TSH levels and TAT volume (r=0.572; P<0.001). In SH patients, no significant difference was noted in TAT levels with respect to sex (P=0.383) or concomitant smoking status (P=0.426).ConclusionsOur findings indicate that SH patients have significantly higher TAT values than controls and that increased TAT levels correlate with increased TSH levels.

Tympanoplasty Results in Patients with Cleft Palate: An Age- and Procedure-Matched Comparison of Preliminary Results with Patients without Cleft Palate

2002 ◽  
Vol 126 (5) ◽  
pp. 518-523 ◽  
Author(s):  
Edward Gardner ◽  
John L. Dornhoffer
Keyword(s):  
Cleft Palate ◽  
Published Data ◽  
Otologic Surgery ◽  
Significant Difference ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Poor Outcomes ◽  
Matched Comparison ◽  
And Control ◽  
Palate Patient

OBJECTIVE: Because of continued eustachian tube abnormalities, the presence of a cleft palate repair has been thought to be associated with poor outcomes after tympanoplastic surgery. However, little published data exist regarding the results of major otologic surgery in patients with cleft palate. The objective of this study was to review our results of otologic surgery in these patients and compare results with those of age- and procedure-matched controls. METHODS: Our otologic database was used to identify patients with a repaired cleft palate who underwent otologic surgery between March 1994 and December 1999. Two control patients were identified for each cleft palate patient. Results of hearing, graft take, and need for postoperative pressure-equalizing tubes were compared. RESULTS: No significant difference existed between patients with a repaired cleft palate and control patients with regard to postoperative air-bone gap ( P = 0.6805), graft survival rate ( P = 1.00), and need for postoperative intubation ( P = 0.457). CONCLUSION: Results in patients with cleft palate appear to be similar to those in patients without cleft palate.

scholarly journals The effect of group-based education on gastrointestinal symptoms and quality of life in patients with celiac disease: randomized controlled clinical trial

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Zahra Akbari Namvar ◽  
Reza Mahdavi ◽  
Masood Shirmohammadi ◽  
Zeinab Nikniaz
Keyword(s):  
Quality Of Life ◽  
Celiac Disease ◽  
Gastrointestinal Symptoms ◽  
Control Group ◽  
Post Intervention ◽  
Sf 36 ◽  
Gi Symptoms ◽  
Significant Difference ◽  
The Mean

Abstract Background In this trial, we investigated the effect of a group-based education program on gastrointestinal (GI) symptoms and quality of life (QOL) in patients with celiac disease (CD). Method In the present study, 130 patients with CD who were on a GFD for at least 3 months, randomly assigned to receive group-based education (n = 66) or routine education in the celiac clinic (n = 64) for 3 months. We assessed gastrointestinal symptoms and quality of life using the gastrointestinal symptom rating scale (GSRS) questionnaire and SF-36 questionnaire at baseline and 3 months after interventions. Results The mean age of the participants was 37.57 ± 9.59 years. There were no significant differences between the two groups regarding the baseline values. Results showed that the mean score of total GSRS score in the intervention group was significantly lower compared with the control group 3 months post-intervention (p = 0.04). Also, there was a significant difference in the mean score of SF-36 between the two groups 3 months post-intervention (p = 0.02). Conclusion Results showed that group-based education was an effective intervention in patients with celiac disease to improve gastrointestinal symptoms and quality of life. Trial registration IRCT code: IRCT20080904001197N21; registration date: 5/23/2019.

scholarly journals Associations of Behavioral Disorders with Asthma in Iranian Children

2019 ◽  
Author(s):  
Mohammad Tajdini ◽  
Mohammad Effatpanah ◽  
Majid Zaki-Dizaji1 ◽  
Masoud Movahedi ◽  
Nima Parvaneh ◽  
...  
Keyword(s):  
Conduct Disorder ◽  
Attention Deficit ◽  
Medical Center ◽  
Care Center ◽  
Control Groups ◽  
Health Care Center ◽  
Oppositional Defiant ◽  
Significant Difference ◽  
Children With Asthma ◽  
And Control

Asthma is a common respiratory disease with huge economic burden leading to activity limitations, morbidity, and mortality. In this study, we aim to investigate the prevalence of Oppositional Defiant Disorder (ODD), Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) among children with asthma. This case-control study was performed in a pediatric referral health care center (Children's Medical Center in Tehran University of Medical Sciences) in 2017.With random selection, the 80 children with asthma and 92 controls with age range of 5 to 11 years were enrolled in this study. In addition to the demographic information and family history of allergy, asthma symptoms, and control quality evaluated with a validated Childhood Asthma Control Test (C-ACT). The mode of measurement for ADHD, ODD and CD was based on Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) psychiatric scales from clinical interviews conducted by child psychiatrists. Totally, 42.5% and 25% in the case and control groups had ADHD respectively with significant difference (p=0.01). Also, 25% and 5.4% in the case and control groups had ODD respectively with significant difference (p=0.001). But conduct disorder was 10% and 10.9% in case and control groups respectively without significant difference (p=0.8). Children with asthma were associated with exhibiting ADHD and ODD but not CD. Therefore, appropriate evaluation and treatment are needed for asthmatic children with attention-deficit and ODD symptoms. Besides, further research is needed to determine the etiological approach towards ADHD, ODD and asthma.

scholarly journals Combined anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalised patients with COVID-19: a propensity matched cohort study

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001785
Author(s):  
Kamal Matli ◽  
Nibal Chamoun ◽  
Aya Fares ◽  
Victor Zibara ◽  
Soad Al-Osta ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Icu Admission ◽  
Therapeutic Anticoagulation ◽  
Hospitalised Patients ◽  
Significant Difference ◽  
Prophylactic Anticoagulation ◽  
Improved Outcome

BackgroundCOVID-19 is a respiratory disease that results in a prothrombotic state manifesting as thrombotic, microthrombotic and thromboembolic events. As a result, several antithrombotic modalities have been implicated in the treatment of this disease. This study aimed to identify if therapeutic anticoagulation (TAC) or concurrent use of antiplatelet and anticoagulants was associated with an improved outcome in this patient population.MethodsA retrospective observational cohort study of adult patients admitted to a single university hospital for COVID-19 infection was performed. The primary outcome was a composite of in-hospital mortality, intensive care unit (ICU) admission or the need for mechanical ventilation. The secondary outcomes were each of the components of the primary outcome, in-hospital mortality, ICU admission, or the need for mechanical ventilation.Results242 patients were included in the study and divided into four subgroups: Therapeutic anticoagulation (TAC), prophylactic anticoagulation+antiplatelet (PACAP), TAC+antiplatelet (TACAP) and prophylactic anticoagulation (PAC) which was the reference for comparison. Multivariable Cox regression analysis and propensity matching were done and showed when compared with PAC, TACAP and TAC were associated with less in-hospital all-cause mortality with an adjusted HR (aHR) of 0.113 (95% CI 0.028 to 0.449) and 0.126 (95% CI 0.028 to 0.528), respectively. The number needed to treat in both subgroups was 11. Furthermore, PACAP was associated with a reduced risk of invasive mechanical ventilation with an aHR of 0.07 (95% CI 0.014 to 0.351). However, the was no statistically significant difference in the occurrence of major or minor bleeds, ICU admission or the composite outcome of in-hospital mortality, ICU admission or the need for mechanical ventilation.ConclusionThe use of combined anticoagulant and antiplatelet agents or TAC alone in hospitalised patients with COVID-19 was associated with a better outcome in comparison to PAC alone without an increase in the risk of major and minor bleeds. Sufficiently powered randomised controlled trials are needed to further evaluate the safety and efficacy of combining antiplatelet and anticoagulants agents or using TAC in the management of patients with COVID-19 infection.

P6460The significance of syncope as a presenting symptom in patients with intermediate risk pulmonary embolism

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S S Natanzon ◽  
R Beigel ◽  
F Chernomordik ◽  
I Mazin ◽  
R Herscovici ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Medical Center ◽  
Statistical Significance ◽  
Hemodynamic Instability ◽  
Inotropic Support ◽  
Intermediate Risk ◽  
Escalation Therapy ◽  
Significant Difference ◽  
Secondary Outcomes

Abstract Background Intermediate risk pulmonary emboli patients are a challenging group with high risk of recurrent VTE, hemodynamic instability and mortality. A gap of knowledge has emerged regarding predictors of clinical deterioration. The prognostic role of syncope presentation is debatable. We thought to investigate the ability of syncope to predict in-hospital complications and the need of escalation therapy among intermediate risk PE patients admitted to the ICCU. Methods Consecutive cohort of all patients hospitalized with a diagnosis of PE, classified as intermediate risk and admitted to the intensive cardiac care unit at the Sheba medical center between the years 2008–2016. Primary outcome: MACE consisting of either one of or a combination of: mechanical ventilation, hemodynamic instability and need for inotropic support, Secondary reperfusion and in-hospital mortality. Secondary outcomes: Each of the individual components including major bleeding and renal failure Results 213 intermediate risk PE patients were analyzed. 40 patients (19%) presented with syncope. Syncope patients had significant higher RV/LV ratio upon computed tomography (1.7±0.6 vs. 1.4±0.4, p=0.011). The presence of either moderate or severe RV dysfunction was more prevalent, without statistical significance (57.5% vs. 41%, p=0.076). Syncope patients had higher prevalence of escalation therapy (28.9% vs 9.4%, p=0.003), as well as in the following individual secondary endpoints: mechanical ventilation (10% vs 1.8%, p=0.026), hemodynamic instability (17.9% vs 2.9%, p=0.02), bleeding rates (15% vs 2.4%, p=0.004), and increased need of inotropic support (10% vs 0.6%, p=0.005). There was no significant difference in the need for reperfusion therapy, both surgical (5% vs. 0.6%, p=0.093) and non- surgical (7.5% vs 6.4%, p=0.732), and in-hospital mortality (2.5% vs 0%, p=0.190). Secondary Outcomes Conclusion The presence of syncope as a presenting symptom is associated with more complicated in-hospital clinical course. These patients warrant more aggressive monitoring and assessment for the need of escalation therapy.

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