scholarly journals The syndrome of inappropriate antidiuresis after vaccination against COVID-19: case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gregor Lindner ◽  
Basil Ryser
Keyword(s):  
Vital Signs ◽  
Urine Osmolality ◽  
Clinical Findings ◽  
Fluid Restriction ◽  
Health State ◽  
Therapy Regimen ◽  
Reactive Protein ◽  
Basal Cortisol ◽  
Laboratory Investigations ◽  
Inappropriate Antidiuresis

Abstract Background The Syndrome of Inappropriate Antidiuresis (SIADH) has been described to be associated with a multitude of conditions and medications, including the severe acute respiratory syndrome coronavirus 2. We describe the case of a patient with newly diagnosed and symptomatic SIADH after receiving the second COVID-19 vaccination not explained otherwise. Case presentation A 79-year-old male person was admitted to the emergency department due to a worsening of his general health state expressed by weakness, fatigue and anorexia. Vital signs and clinical findings were normal, in particular the patient was considered to be euvolemic. Laboratory investigations revealed a serum sodium of 117 mmol/L, a serum osmolality of 241 mosm/kg and a urea of 1.2 mmol/L with creatinine within normal range. Urine chemistry showed a urine osmolality of 412 mosm/kg and urine sodium of 110 mmol/L. TSH, C-reactive protein, and basal cortisol levels were normal. Under therapy with balanced crystalloid fluids, hyponatremia worsened and in absence of diuretic medications, diagnosis of SIADH was made. Since fluid restriction was not sufficiently effective, oral urea was administered. Under this therapy regimen hyponatremia resolved. Conclusions Local as well as systemic reactions have been described for the new mRNA-based vaccines including pain and fever. Therefore, it is imaginable that the vaccine might trigger SIADH in some patients.

scholarly journals Spondylodiscitis: evaluation of patients in a tertiary hospital

2014 ◽  
Vol 8 (10) ◽  
pp. 1272-1276 ◽  
Author(s):  
Safak Kaya ◽  
Serdar Ercan ◽  
Sehmuz Kaya ◽  
Ulas Aktas ◽  
Kagan Kamasak ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Complete Blood Count ◽  
Tertiary Hospital ◽  
Clinical Findings ◽  
Low Back ◽  
Reactive Protein ◽  
Laboratory Investigations ◽  
Magnetic Resonance Imaging Mri ◽  
Radiological Methods ◽  
Shed Light

Introduction: Spondylodiscitis (SD) is an uncommon but important infection. The aim of this work was to study the risk factors, bacteriological features, clinical, laboratory and radiological findings of SD, and to shed light on the initial treatment. Methodology: A total of 107 patients who underwent treatment for SD were evaluated. The diagnosis of SD was defined by clinical findings, complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum tube agglutination (STA) test, Ziehl-Neelsen staining, culture, histopathology, and radiological methods such as magnetic resonance imaging (MRI) and computed tomography (CT) scans. Results: Of the 107 cases, ranging between 17 to 83 years of age, 64 (59.8%) were male. Twenty-seven (25.2%) patients had diabetes mellitus. Laboratory investigations revealed elevated CRP in 70 (65%) patients, elevated ESR in 65 (61%) patients, and elevated white blood cell (WBC) counts in 41 (38.3%) patients. Thirty-six (33.6%) patients were identified as having brucellar SD, and 5 (4.7%) patients were identified as having tuberculous SD. A total of 66 (61.6%) patients were determined to have pyogenic SD. The most frequently isolated microorganism was Staphylococcus aureus. Antibiotic therapy was given intravenously to all pyogenic SD patients. Conclusions: The incidence of SD has increased as a result of the higher life expectancy of older patients with chronic debilitating diseases and the increase of spinal surgical procedures. In patients with low back pain, SD should be considered as a diagnosis. For effective treatment, it is important to determine the etiology of the disease.

scholarly journals Study of clinical features and laboratory investigations for effective management of hyponatremia

2020 ◽  
Vol 9 (1) ◽  
pp. 112
Author(s):  
M. G. Bhutto ◽  
Sandeep B. R. ◽  
Sharath Kumar D. Shah ◽  
Shabaz .
Keyword(s):  
Hypertonic Saline ◽  
Clinical Features ◽  
Tertiary Care ◽  
Urine Osmolality ◽  
Underlying Disease ◽  
Fluid Restriction ◽  
Care Hospital ◽  
Electrolyte Disorder ◽  
Saline Administration ◽  
Laboratory Investigations

Background: Hyponatremia, a common electrolyte disorder is mostly observed in hospitalized elderly patients. It is a potential cause of morbidity, mortality and has significant economic impact on the patient and health care system. The aim of the present study was to investigate the risk factors, clinical features and management of hyponatremia in hospitalized patients to reduce its incidence and minimize the associated complications.Methods: Current study was conducted in a tertiary care hospital SSMC, Tumkur). Patients were evaluated for the underlying cause of hyponatremia through detailed history and physical examination followed by appropriate laboratory investigations based on urine sodium, serum and urine osmolality. Patients with hyponatremia were classified into categories based on clinical investigations and accordingly treated with suitable therapy.Results: Constitutional symptoms, confusion, fever, vomiting, respiratory symptoms, abdominal pain, loose stools, coma, convulsions and other miscellaneous symptoms were observed in history of hyponatremic patients. Most common etiology was found to be SIADH followed by extrarenal losses, renal failure, cirrhosis, CCF, drug in take and glucocorticoid deficiency. Management of hyponatremia was done using hypertonic saline, administration of diuretics, fluid restriction therapy, administration of vaptans and combination of hypertonic saline and vaptans as  treatment alternatives, no potential complications were observed during treatment of hyponatremia.Conclusions: The possible cause of hyponatremia should always be determined, asoutcomeinsevere hyponatremiais governed by etiology and not merely by serum sodium levels. The correction of hyponatremia helps to improve the prognosis of the underlying disease and to prevent further complications.

Predictors of response to fluid restriction in hyponatremic patients due to the syndrome of inappropriate antidiuresis

2015 ◽  
Author(s):  
Sophia Lengsfeld ◽  
Bettina Winzeler ◽  
Nicole Nigro ◽  
Isabelle Suter-Widmer ◽  
Philipp Schutz ◽  
...  
Keyword(s):  
Fluid Restriction ◽  
Predictors Of Response ◽  
Inappropriate Antidiuresis

Diagnostic value of procalcitonin, erythrocyte sedimentation rate (ESR), quantitative C-reactive protein (CRP) and clinical findings associated with osteomyelitis in patients with diabetic foot

2021 ◽  
pp. 1-7
Author(s):  
Zahra Soleimani ◽  
Fatemeh Amighi ◽  
Zarichehr Vakili ◽  
Mansooreh Momen-Heravi ◽  
Seyyed Alireza Moravveji
Keyword(s):  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Roc Curve ◽  
Diabetic Foot ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Diabetic Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation

BACKGROUND: The diagnosis of osteomyelitis is a key step of diabetic foot management. Procalcitonin (PCT) is a novel infection marker. This study aimed to investigate the diagnostic value of procalcitonin and other conventional infection markers and clinical findings in diagnosis of osteomyelitis in diabetic foot patients. METHODS AND MATERIALS: This diagnostic value study was carried out on ninety patients with diabetic infected foot ulcers admitted in Kashan Beheshti Hospital, 2016. After obtaining consent, 10 cc blood sample was taken for measuring serum PCT, CBC, ESR, CRP and FBS. Clinical characteristics of the wounds were noted. Magnetic resonance imaging of the foot was performed in all patients to diagnose osteomyelitis. All statistical analyses were done with the use of SPSS-16. RESULTS: PCT levels were 0.13 ± 0.02 ng/mili patients with osteomyelitis (n= 45) and 0.04 ± 0.02 ng/ml in patients without osteomyelitis (n= 45). PCT, Erythrocyte sedimentation rate and C-reactive protein was found significantly higher in patients with osteomyelitis (p< 0.001). The ROC curve was calculated for PCT. The area under the ROC curve for infection identification was 1 (p< 0.001). The best cut-off value for PCT was 0.085 ng/ml. Sensitivity, specificity, and positive and negative predictive values were 100%, 97.8%,97.8% and 100%, respectively. CONCLUSION: In this group of patients, PCT was useful to discriminate patients with bone infection. Also, Erythrocyte sedimentation rate and C-reactive protein can be used as a marker of osteomyelitis in diabetic patients.

scholarly journals Traumatic Reticuloperitonitis in Water Buffalo (Bubalus bubalis): Clinical Findings and the Associated Inflammatory Response

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Maged El-Ashker ◽  
Mohamed Salama ◽  
Mohamed El-Boshy
Keyword(s):  
Inflammatory Response ◽  
Water Buffalo ◽  
Bubalus Bubalis ◽  
Clinical Findings ◽  
Necrosis Factor Alpha ◽  
Reactive Protein ◽  
Amyloid A ◽  
Diagnostic Usefulness ◽  
Factor Alpha ◽  
Traumatic Reticuloperitonitis

The present study was carried out to describe the clinical picture of traumatic reticuloperitonitis (TRP) in water buffalo (Bubalus bubalis) and to evaluate the inflammatory and immunologic responses for this clinical condition. Twenty-two buffalo with acute local TRP were monitored in our study. Additionally, 10 clinically healthy buffalo were randomly selected and served as controls. Acute local TRP was initially diagnosed by clinical examination and confirmed by ultrasonographic (USG) examination and/or necropsy findings. Blood samples were collected from all examined buffalo to measure the respective levels of tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-6, IL-10 and interferon gamma (INF)-γ, serum amyloid A (SAA), C-reactive protein (CRP), haptoglobin (Hp), fibrinogen (Fb), and serum sialic acid (SSA). It was found that TNF-α, IL-1β, IL-6, IL-10, SAA, CRP, Hp, Fb, and SSA were significantly higher in buffalo with TRP than the controls. Our findings suggest that the examined immunologic variables were helpful in documenting the inflammatory response in buffalo with TRP. However, their diagnostic usefulness only becomes apparent when considered in tandem with the clinical findings for any given animal, its anamnesis, and a subsequent USG assessment. Due to the frequent complications of TRP, more accurate indicators of its occurrence and severity would be useful.

scholarly journals Early Warning Scores at time of ICU admission to Predict Mortality in critically ill COVID-19 Patients

2021 ◽  
pp. 1-15
Author(s):  
Asha Tyagi ◽  
Surbhi Tyagi ◽  
Ananya Agrawal ◽  
Aparna Mohan ◽  
Devansh Garg ◽  
...  
Keyword(s):  
Developing Country ◽  
Cox Regression ◽  
Vital Signs ◽  
Developed Countries ◽  
Operating Characteristics ◽  
Icu Mortality ◽  
Prospective Data ◽  
Icu Admission ◽  
Reactive Protein ◽  
Time Of Admission

Abstract Objective: To assess ability of NEWS2, SIRS, qSOFA and CRB-65 calculated at the time of Intensive Care Unit (ICU) admission for predicting ICU-mortality in patients of laboratory confirmed COVID-19 infection. Methods: This prospective data analysis was based on chart reviews for laboratory confirmed COVID-19 patients admitted to ICUs over a 1month period. The NEWS2, CURB-65, qSOFA and SIRS were calculated from the first recorded vital signs upon admission to ICU and assessed for predicting mortality. Results: Total of 140 patients aged between 18 to 95 years were included in the analysis of whom majority were >60 years (47.8%), with evidence of pre-existing comorbidities (67.1%). The commonest symptom at presentation was dyspnea (86.4%). Based upon the Receiver Operating Characteristics-Area Under Curve (AUC), the best discriminatory power to predict ICU mortality was for the CRB65 (AUC: 0.720 [95% CI: 0.630 – 0.811]) followed closely by NEWS2 (AUC: 0.712 [95% CI: 0.622 – 0.803]). Additionally, a multivariate cox regression model showed Glasgow Coma Score at time of admission [P < 0.001; adjusted Hazard Ratio = 0.808 (95% CI: 0.715-0.911)] to be the only significant predictor of ICU mortality. Conclusion: CRB65 and NEWS2 scores assessed at the time of ICU admission offer only a fair discriminatory value for predicting mortality. Further evaluation after adding laboratory markers such as C-reactive protein and D-dimer may yield a more useful prediction model. Much of the earlier data is from developed countries and uses scoring at time of hospital admission. This study was from a developing country, with the scores assessed at time of ICU admission, rather than the emergency department as with existing data from developed countries, for patients with moderate/severe COVID disease. Since the scores showed some utility for predicting ICU mortality even when measured at time of ICU admission, their use in allocation of limited ICU resources in a developing country merits further research.

scholarly journals MON-LB65 Lithium: The Culprit of Multiple Endocrinopathies

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Alice Yau ◽  
Gul Bahtiyar ◽  
Giovanna Rodriguez ◽  
Jose R Martinez Escudero
Keyword(s):  
Bipolar Disorder ◽  
Diabetes Insipidus ◽  
Mental Status ◽  
Nephrogenic Diabetes Insipidus ◽  
Kidney Injury ◽  
Urine Osmolality ◽  
Altered Mental Status ◽  
Clinical Findings ◽  
Volume Depletion ◽  
Collecting Tubules

Abstract Background: Lithium, commonly used to treat various psychiatric disorders such as bipolar disorder, can cause acute toxicity that presents with nausea, vomiting and diarrhea. Lithium can also cause life-threatening endocrine abnormalities, including hypercalcemia, hypernatremia, and both hypo- and hyperthyroidism. Clinical Case: A 61-year old female with hypothyroidism, bipolar disorder, hyperparathyroidism with two-gland parathyroidectomy on lithium for over 30 years presented with altered mental status. Initial labs revealed elevated creatinine 1.92 mg/dL (0.8-2.00mg/dL) compared to baseline 0.82 mg/dL, sodium 154 mg/dL (135-147 mg/dL), Corrected calcium 11.7 mg/dL (8.5-10.5 mg/dL), PTH 96 pg/mL (15-65 pg/mL), and high lithium levels 1.45 mmol/L (0.60-1.20 mmol/L). Further studies showed hypotonic polyuria with no increase in urine osmolality after desmopressin, consistent with nephrogenic diabetes insipidus. Lithium was held and she was treated with aggressive intravenous hydration with dextrose 5% water. Hypercalcemia is thought to result from increased secretion of PTH due to an increased set point at which calcium suppresses PTH release; this often resolves once lithium is stopped. Lithium can also unmask previously unrecognized mild hyperparathyroidism, and/or raise serum PTH concentrations independent of calcium levels.1 The drug interferes with the kidneys’ ability to concentrate urine in the collecting tubules by desensitizing response to antidiuretic hormone, causing diabetes insipidus. The resulting volume depletion from excessive urinary water loss in turn lead to acute kidney injury and hypernatremia.2 Hypothyroidism results from lithium-inhibited synthesis and release of thyroid hormones and decreases iodine trapping. Conclusion: Although these are infrequent complications of lithium use, they remain pertinent clinical findings to consider due to their morbidity. In this case, our patient may have avoided multiple chronic electrolyte abnormalities leading to altered mental status if lithium toxicity had been recognized earlier. References:1. García-Maldonado, Gerardo, and Rubén de Jesús Castro-García. “Endocrinological Disorders Related To The Medical Use Of Lithium. A Narrative Review”. Revista Colombiana De Psiquiatría (English Ed.), vol 48, no. 1, 2019, pp. 35-43. Elsevier BV, doi:10.1016/j.rcpeng.2018.12.005. 2. Tasci, E. “Lithium-Induced Nephrogenic Diabetes Insipidus Responsive To Desmopressin”. Acta Endocrinologica (Bucharest), vol 15, no. 2, 2019, pp. 270-271. ACTA Endocrinologica Foundation, doi:10.4183/aeb.2019.270.

scholarly journals IOT Based Health Monitoring System

2021 ◽  
Vol 9 (8) ◽  
pp. 1176-1178
Author(s):  
Sowmya G
Keyword(s):  
Monitoring System ◽  
Health Monitoring ◽  
Social Insurance ◽  
Vital Signs ◽  
Smart Phone ◽  
Smart Devices ◽  
The Internet ◽  
Health State ◽  
Health Monitoring System ◽  
Vital Parameters

Abstract: The increased use of smart phones and smart devices in the health zone has brought on extraordinary effect on the world’s critical care. The Internet of things is progressively permitting to coordinate sensors fit for associating with the Internet and give data on the health condition of patients. These technologies create an amazing change in medicinal services during pandemics. Likewise, many users are beneficiaries of the M-Health (Mobile Health) applications and E-Health (social insurance upheld by ICT) to enhance, help and assist continuously to specialists who help. The main aim of this ‘IOT Health Monitoring System’ is to build up a system fit for observing vital body signs such as body temperature, heart rate, pulse oximetry etc. The System is additionally equipped measuring Room Temperature and Humidity and Atmosphere CO level. To accomplish this, the system involves many sensors to display vital signs that can be interfaced to the doctor’s smart phone as well as caretakers’ smartphone. This prototype will upload the readings from the sensor to a server remotely and the information gathered will be accessible for analysis progressively. It has the capacity of reading and transmitting vital parameters measured to the cloud server and then to any Smartphone configured with Blynk App. These readings can be utilized to recognize the health state of the patient and necessary actions can be taken if the vital parameters are not in prescribed limits for a longer period. Keywords: IOT Health Monitoring System, Vital parameters, Blynk App

scholarly journals Clinical Characteristics and Outcomes of Diabetic COVID-19 patients in Kuwait

2020 ◽  
Author(s):  
Abdullah Alshukry ◽  
Mohammad Bu Abbas ◽  
Yaseen Ali ◽  
Barrak Alahmad ◽  
Abdullah A. Al-Shammari ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Clinical Laboratory ◽  
Fasting Blood Glucose ◽  
List Type ◽  
Laboratory Findings ◽  
Reactive Protein ◽  
Patients With Diabetes ◽  
Laboratory Investigations ◽  
Insight Into ◽  
Variable Clinical Presentation

AbstractBackgroundCOVID-19 has a highly variable clinical presentation, ranging from asymptomatic to severe respiratory symptoms and death. Diabetes seems to be one of the main comorbidities contributing to a worse COVID-19 outcome.ObjectiveIn here we analyze the clinical characteristics and outcomes of diabetic COVID-19 patients.MethodsIn this single-center, retrospective study of 417 consecutive COVID-19 patients, we analyze and compare disease severity, outcome, associated complications, and clinical laboratory findings between diabetic and non-diabetic COVID-19 patients.ResultsCOVID-19 patients with diabetes had more severe outcomes and higher mortality than non-diabetic COVID-19 patients. Diabetic COVID-19 patients had significantly higher prevalence of comorbidities, such as hypertension. Laboratory investigations also highlighted notably higher levels of C-reactive protein in diabetic COVID019 patients and lower estimated glomerular filtration rate. They also showed a higher incidence of complications.ConclusionDiabetes could be a major contributor to worsening outcomes in COVID-19 patients. Understanding the pathophysiology underlining these findings could provide insight into better management and improved outcome of such cases.Highlights of the StudyA significantly higher proportion of Diabetic COVID-19 patients required admission to the ICU.Higher fasting blood glucose was associated with higher risk of COVID-19 associated mortality.Diabetic COVID-19 patients had significantly higher incidence of complications including sepsis, ARDS, cardiac failure and renal failure.

A COMPARATIVE STUDY ON BIOASSAY AND RADIOIMMUNOASSAY OF VASOPRESSIN IN HUMAN URINE

1978 ◽  
Vol 87 (2) ◽  
pp. 283-291 ◽  
Author(s):  
Jens Dencker Christensen ◽  
Svend Erik Jensen
Keyword(s):  
Human Subjects ◽  
Extraction Procedure ◽  
Urine Osmolality ◽  
Exchange Chromatography ◽  
Biologically Active ◽  
Fluid Restriction ◽  
Healthy Human ◽  
Water Load ◽  
Second Peak ◽  
Total Fluid

ABSTRACT The excretion of vasopressin in urine from healthy human subjects under different stages of hydration was estimated in urine extracts by bioassay (rat antidiuresis) and radioimmunoassay. In normally hydrated subjects the excretion was 490 ± 164 μU/h and 430 ± 133 μU/h for bioassay and radioimmunoassay respectively (mean ± sem, n = 5). After total fluid restriction for 10 to 12 h the excretion increased to 1370 ± 329 μU/h for bioassay and 1163 ± 279 μU/h for radioimmunoassay (mean ± sem, n = 6). An oral water load (25 ml/kg) reduced the value to 169 μU/h (bioassay) and 118 μU/h (radioimmunoassay) (mean, n = 2). In general the biological estimations were 20 % higher than the immunological estimations (P < 0.01). The urinary vasopressin excretion was positively correlated to urine osmolality. Synthetic arginine vasopressin (AVP) and urine extracts were both heterogeneous in ion exchange chromatography. The immunoreactive material was always eluted in 2 peaks, situated at the same places in the elution diagram. The material in the second peak was biologically active. The first peak from the AVP standard was biologically inactive, whereas the same peak from urine extract was active. This peak was shown to be an artefact formed during the extraction procedure.

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