scholarly journals Functional decline in hospitalized older patients with coronavirus disease 2019: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tomohiro Hosoda ◽  
Shota Hamada
Keyword(s):  
Barthel Index ◽  
Older Patients ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Functional Decline ◽  
Index Score ◽  
Sensitivity Analyses ◽  
Care Hospital ◽  
Barthel Index Score ◽  
D Dimer

Abstract Background This study aimed to determine the frequency of functional decline and to identify the factors related to a greater risk of functional decline among hospitalized older patients with coronavirus disease 2019 (COVID-19). Methods We reviewed the medical records of patients aged over 65 years who were admitted to a tertiary care hospital for COVID-19 over 1 year from February 2020. We evaluated the proportion of functional decline, which was defined as a decrease in the Barthel Index score from before the onset of COVID-19 to discharge. Multivariable logistic regression analyses were performed to evaluate the associations between the demographic and clinical characteristics of patients at admission and a greater risk of functional decline. Two sensitivity analyses with different inclusion criteria were performed: one in patients without very severe functional decline before the onset of COVID-19 (i.e., limited to those with Barthel Index score ≥ 25), and the other with a composite outcome of functional decline and death at discharge. Results The study included 132 patients with COVID-19; of these, 72 (54.5%) developed functional decline. The severity of COVID-19 did not differ between patients with functional decline and those without (P = 0.698). Factors associated with a greater risk of functional decline included female sex (adjusted odds ratio [aOR], 3.14; 95% confidence interval [CI], 1.25 to 7.94), Barthel Index score < 100 before the onset of COVID-19 (aOR, 13.73; 95% CI, 3.29 to 57.25), and elevation of plasma D-dimer level on admission (aOR, 3.19; 95% CI, 1.12 to 9.07). The sensitivity analyses yielded similar results to those of the main analysis. Conclusions Over half of the older patients who recovered from COVID-19 developed functional decline at discharge from a tertiary care hospital in Japan. Baseline activities of daily living impairment, female sex, and elevated plasma D-dimer levels at admission were associated with a greater risk of functional decline.

scholarly journals Neurological diagnoses in the emergency room: differences between younger and older patients

2011 ◽  
Vol 69 (2a) ◽  
pp. 212-216 ◽  
Author(s):  
Marcos C. Lange ◽  
Vera L. Braatz ◽  
Carolina Tomiyoshi ◽  
Felipe M. Nóvak ◽  
Artur F. Fernandes ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Emergency Room ◽  
Older Patients ◽  
Tertiary Care Hospital ◽  
Neurological Diseases ◽  
Tertiary Care ◽  
Primary Headache ◽  
Care Hospital ◽  
National Guidelines ◽  
And Training

Neurological diseases are prevalent in the emergency room (ER). The aim of this study was to compare the neurological diagnoses between younger and older patients evaluated in the ER of a tertiary care hospital. METHOD: Patients admitted to the ER who required neurological evaluation in the first 24 hours were separated into two groups based on age, <;50 years old and >50 years old. RESULTS: Cerebrovascular disease (59.6% vs. 21.8%, p<0.01) was most frequent in the >50 years old group. Seizures (8.1% vs. 18.6%, p<0.01) and primary headache (3.7% vs. 11.4%, p<0.01) were most frequent in the <;50 years old group. CONCLUSION: The current study demonstrated that these three neurological diagnoses represented the majority of the neurological evaluations in the ER. National guidelines for ER teams that treat these prevalent disorders must be included in clinical practice and training.

scholarly journals Prevalence and characteristics of venous thromboembolism in severe exacerbation of chronic obstructive pulmonary disease in a tertiary care hospital in India

2021 ◽  
Author(s):  
Soibam Pahel Meitei ◽  
Sudheer Tale ◽  
Arjun Kumar Negi ◽  
Ruchi Dua ◽  
Rohit Walia ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Venous Thromboembolism ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Lower Limbs ◽  
Chronic Obstructive ◽  
Care Hospital ◽  
Obstructive Pulmonary Disease ◽  
Test Probability ◽  
D Dimer

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) carries a high risk of venous thromboembolism (VTE). Pulmonary embolism (PE) and AECOPD increase the mortality and morbidity risk associated with each other. Racial and ethnic differences in VTE risk have been documented in multiple studies. However, there is a dearth of reliable Indian data on the same. This study was planned to find the prevalence of VTE in the setting of severe AECOPD in a tertiary care hospital in India and to identify the clinical, laboratory and radiological characteristics of VTE in severe AECOPD. A total of 156 consecutive patients admitted with severe AECOPD and meeting the specified inclusion and exclusion criteria were recruited. Thorough workup of all patients was done including ABG, serum D dimer, ECG, compression ultrasound of lower limbs and 2-D echocardiography. Patients with high pre-test probability score, or intermediate pre-test probability score at presentation with serum D dimer above the age adjusted cut-off underwent computerised tomography pulmonary angiography (CTPA).  Results were analysed using SPSS version 23.  Sixteen (10.3%) patients had VTE, 15 (93.75%) of them being cases of isolated PE. Female gender, higher cumulative past exposure to corticosteroid, higher alveolar-arterial gradient, right ventricular dysfunction, and higher mean pulmonary artery pressure were associated with increased risk for VTE. The prevalence of VTE in AECOPD in this study among an Indian population is higher than among other Asians, but lower than among the Blacks, the Caucasians and the Middle-East ethnicities. Since a vast majority of VTE presents as PE without DVT in the setting of AECOPD, the absence of deep vein thrombosis of lower limbs does not rule PE in the setting.

CORRELATION BETWEEN CT CHEST SEVERITY SCORE AND CLINICAL PARAMETERS AND BIOCHEMICAL MARKERS IN COVID 19 PATIENTS

2021 ◽  
pp. 25-28
Author(s):  
Pramodh Kumar ◽  
Konduru Aneesha ◽  
Ch. Radhika ◽  
Elaya Kumar ◽  
R. Srinivasan
Keyword(s):  
Severity Score ◽  
Biochemical Markers ◽  
Tamil Nadu ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Parameters ◽  
Care Hospital ◽  
Rt Pcr ◽  
The Relationship ◽  
D Dimer

AIM: To correlate between CT chest severity score in COVID 19 patients with Clinical [SpO2, RR, PaO2/FiO2] and Biochemical parameters [NLR ratio, CRP, D- Dimer values]. METHODS: A Retrospective, observational study was conducted in a tertiary care hospital in Kanchipuram, Tamil Nadu. 110 patients were admitted to the hospital with COVID 19 [RT PCR swab for COVID 19 positive and radiologically positive] between March 2021 to June 2021. The patient was clinically, radiologically, and biochemically evaluated. CT chest severity score was used to differentiate the patients into mild, moderate, and severe groups. The relationship between CT Severity score and Clinical parameters such as SpO2, RR, PaO2/FiO2 and Biochemical markers [ NLR ratio, CRP, D-Dimer] were studied. RESULTS: CT chest severity score was found to be positively correlated with decreased SpO2 levels, decreased PaO2/ FiO2, increased RR and elevated NLR ratio, D Dimer and CRP levels(P < 0.001). CONCLUSION: The 25 CT Severity score scores well with the Clinical parameters and biochemical markers. Our data suggest that CT Chest Severity Score correlates well with clinical parameters and biochemical markers.

scholarly journals Prevalence and outcomes of D dimer elevation among the COVID-19 patients in tertiary care hospital, Salem

2021 ◽  
Vol 10 (12) ◽  
pp. 4478
Author(s):  
Kirubhakaran Kanakaraju ◽  
MoogaambigaS Pandiyan ◽  
RangabashyamS Ranganathan ◽  
Arunkumar Asokan
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
D Dimer

scholarly journals Analysis of D-Dimer Levels among Covid -19 Positive Patients in a Tertiary Care Hospital in Bangalore

2021 ◽  
Vol 9 (2) ◽  
pp. 80-84
Author(s):  
Dr. Manasa. S ◽  
◽  
Dr. Venkatesh Vikram H. C ◽  
Keyword(s):  
Retrospective Study ◽  
Tertiary Care Hospital ◽  
Early Stage ◽  
Tertiary Care ◽  
Fibrin Clot ◽  
Coagulation Disorder ◽  
Care Hospital ◽  
Coagulation Disorders ◽  
Lab Test ◽  
D Dimer

Introduction: Pro-thrombotic changes are stimulated by Corona Virus as it has an affinity forendothelium and lung structures and this may explain its association with thrombotic events,reduction of pulmonary gas exchange, respiratory distress, and death. D-dimer is a specific markerof the breakdown of a fibrin clot and has been used as a diagnostic and prognostic marker in VTEand other coagulation disorders. Objectives: The objective of this study was to assess thecorrelation of the D-Dimer levels and disease severity among COVID-19 patients. Materials andmethods: This is a retrospective study done over 6 months from July 2020 to December 2020 in atertiary care hospital in Bangalore. All the COVID- 19 positive cases who were admitted to ourhospital were audited regarding the D-dimer levels during admission and the course of thetreatment. Results: Coagulation disorder occurred at the early stage of COVID-19 infection, with1066 (57.7%) patients having increased D-dimer levels. Out of 1846 COVID 19 patients 106(5.7%)patients died due to complications. 106 patients who deceased, all the patients had anincreased D dimer value either in the first lab test or in the consecutive tests. Among 106 patients56(52.8%) patients had increased D-dimer at the first lab test, 32 (30.1%) had D-dimer increasedat the second and 18(16.98%) in third lab tests. The increased D-dimer levels were closelyassociated with the progression of the disease and also the changes in the CT imaging. Conclusion:The increase in D-Dimer levels also increased the complications in the COVID-19 patient. So it isnecessary to continuously monitor D-dimer levels and labelled anticoagulation as management toolsfor COVID-19 disease to prevent complications and reduce interventions.

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