scholarly journals A descriptive study to quantify severity in patients with severe scrub typhus in hilly city of Northern India

2019 ◽  
Vol 6 (4) ◽  
pp. 1182
Author(s):  
Nishant Nadda ◽  
Nidhi Chauhan ◽  
Anjali Mahajan ◽  
Ankit Chaudhary ◽  
Kritika Katoch ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Financial Burden ◽  
Clinical Signs ◽  
Case Fatality ◽  
Cross Sectional Study ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Cross Sectional ◽  
Presenting Symptoms ◽  
Prompt Treatment

Background: Himachal Pradesh is an endemic area for scrub typhus. If not treated early, it can lead to life threatening complications. Therefore, more emphasis needs to be laid on the diagnosis and prompt treatment, so that mortality due to severe scrub typhus can be prevented. So, this study was done with an objective to study the clinical profile of patients diagnosed with severe scrub typhus and assess their severity using APACHE II score in IGMC, Shimla.Methods: Authors conducted a descriptive cross-sectional study in Indira Gandhi Medical College, Shimla over one year (June 2016-May 2017). Out of 538 confirmed scrub typhus cases, 58 severe cases were reported, and their severity was assessed with predefined criteria of sepsis and APACHE II score.Results: Mean age of males (50.18±18.6 yrs) was found to be more than that of females (45.52±14.5 yrs), the difference being statistically insignificant t(56)= -1.01, (P=0.32). Fever (100%), headache (84.5%), vomiting (79.3%) were the major presenting symptoms and tachycardia (96.5%), hypotension (87.9%), tachypnoea (94.8%) were the main clinical signs. The mean APACHE II score on admission was 16.25±5.0 with a predicted mortality of 23.5%, that was found to be less than actual reported hospital mortality (25.8%).Conclusions: APACHE II score was found reliable tool for risk stratification. Case fatality in diagnosed cases of severe scrub typhus was found high. Early diagnosis and prompt treatment according to guidelines would help in decreasing the mortality, financial burden on patient, society and health system.

scholarly journals The Relationship Between Apache Ii Score And Nurses’ Occupational Stress In Icu

2021 ◽  
Vol 17 (29) ◽  
pp. 19
Author(s):  
Pei-Ying Jao ◽  
Noreena Yi-Chin Liu ◽  
Hsiu-Lan Wu ◽  
Cheng-Hui Chou ◽  
Kuan-Chia Lin
Keyword(s):  
Occupational Stress ◽  
Cross Sectional Study ◽  
Stress Factors ◽  
Apache Ii ◽  
Teaching Hospitals ◽  
Apache Ii Score ◽  
Cross Sectional ◽  
Moderation Effect ◽  
Environment Policy ◽  
Nursing Stress

Occupational stress remains one of the major concerns among nurses working in ICU, which affects the individuals as well as the quality of patient care. This paper focuses on investigating the correlation between the ICU patient severity and the nurses’ occupational stress. The paper also identifies a number of occupational stress factors. A total of 81 ICU nurses from the teaching hospitals in Eastern Taiwan have been selected to take part in this study through purposive sampling. Cross-sectional study was adopted for this study and interviews were done through a structured questionnaire. The data was collected using the APACHE II scale and the Nursing Stress scale. The result of the correlation analysis between disease severity and occupational stress was found to be insignificant (p > .05). The regression model analysis shows that patient severity plays a moderation effect between nurses’ characteristics and occupational stress. The results of this study could serve as reference to policymakers and nursing administrators to create a supportive environment. Policy changes to improve the nurses’ working conditions were also proposed in this paper.

scholarly journals The Medical Outcomes Distribution and the Interpretation of Clinical Data Based on C4.5 Algorithm for the RCC Patients in Taiwan

2021 ◽  
Vol 11 (6) ◽  
pp. 2566
Author(s):  
Hsi-Chieh Lee ◽  
Ju-Hsia Liu ◽  
Ching-Sung Ho
Keyword(s):  
Care Center ◽  
Characteristic Curve ◽  
Cross Sectional Study ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Medical Outcomes ◽  
Chi Square ◽  
Related Factors ◽  
Cross Sectional ◽  
C4.5 Algorithm

The aim of our study is to explore the medical outcomes among patients in the respiratory care center (RCC) and related factors. A cross-sectional study was performed at a regional hospital in central Taiwan from January 2018 to December 2018. The sample consisted of 236 patients who received RCC medical services. The chi-square test, multiple ordinal logistic regression analyses, and C4.5 decision tree algorithm were performed. The risk factors for medical outcomes in critical or deceased patients were obesity (BMI ≥ 27.0) (OR = 2.426, 95% C.I. = 1.106–5.318, p = 0.027), being imported from home (OR = 2.104, 95% C.I. = 1.106–3.523, p = 0.005), and with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 25 (OR = 2.640, 95% C.I. = 1.283–5.433, p = 0.008). The results of the C4.5 algorithm showed a precision of 79.80%, a recall of 78.80%, an F-measure of 78.20%, a receiver operating characteristic curve (ROC) area of 89.20%, and a precision-recall curve (PRC) area of 81.70%. It is important to design effective intervention strategies for patients who are obese and with high APACHE II scores and propose timely treatments for the patients’ onset of disease at home. Moreover, by using the C4.5 algorithm, data can be interpreted in terms of decision trees to aid the understanding of the medical outcomes of the RCC patients.

scholarly journals Clinico- bacteriological profile of Community Acquired Pneumonia (CAP) in children aged 3-59 months: A cross sectional study

2021 ◽  
Vol 12 (5) ◽  
pp. 53-57
Author(s):  
Manoj Kumar Singh ◽  
Sheo Pratap Singh ◽  
Rajesh Kumar ◽  
Pankaj Kumar ◽  
Jafar Suhail ◽  
...  
Keyword(s):  
Blood Culture ◽  
Bacterial Culture ◽  
Clinical Signs ◽  
Cross Sectional Study ◽  
Community Acquired Pneumonia ◽  
Nasopharyngeal Swab ◽  
Cross Sectional ◽  
E Coli ◽  
Presenting Symptoms ◽  
Common Organism

Background: Worldwide community-acquired pneumonia (CAP) is the major cause of high mortality among under five children in India. After introduction of Pneumococcal and H. influenzae vaccination there is paucity of data regarding etiological profile of pneumonia. Aims and Objective: To evaluate the Clinico- epidemiological profile and etiology of community acquired pneumonia in children. Materials and Methods: We enrolled children aged 3-59 months with CAP (based on WHO criteria of tachypnea with cough or breathing difficulty) over 18 months and recorded presenting symptoms, clinical signs and chest radiography. We performed blood and nasopharyngeal swab (NPS) bacterial culture simultaneously to detect etiological agent of community acquired pneumonia in children. Results: Out of 150 cases of CAP, 90 % of caeses had cough and fever and nearly 80-90% cases had tachypnea and crackles on examination. Radiological findings suggestive of pneumonia was seen in 86% cases . Most common organism isolated was S aureus in both NPS culture (18.7 %) and blood culture (14.7 %). Other common organisms detected in NPS culture were S pneumoniae (6%), E Coli (4.7%), Klebsiella (4.7%), CONS (3.3%), and Pseudomonas (2.7%). In blood culture the common organism detected after S aureus was E coli (5.3%), S pneumoniae (3.3%), Klebsiella (3.3%), CONS( 3.8%), and Pseudomonas (2.5%). Conclusions: We observed that S aureus was the predominant etiological organism isolated in both blood and nasopharyngeal swab bacterial culture in patients suffering from community-acquired pneumonia.

scholarly journals Out-of-Pocket Costs and Perceived Financial Burden Associated with Prostate Cancer Treatment in a Quebec Remote Area: A Cross-Sectional Study

2020 ◽  
Vol 28 (1) ◽  
pp. 26-39
Author(s):  
Abir El-Haouly ◽  
Anais Lacasse ◽  
Hares El-Rami ◽  
Frederic Liandier ◽  
Alice Dragomir
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Financial Burden ◽  
Cross Sectional Study ◽  
University Education ◽  
School Level ◽  
Sectional Study ◽  
Cross Sectional ◽  
Perceived Burden ◽  
Out Of Pocket Costs

Background: In publicly funded healthcare systems, patients do not pay for medical visits but can experience costs stemming from travel or over-the-counter drugs. We lack information about the extent of this burden in Canadian remote regions. This study aimed to: (1) describe prostate cancer-related out-of-pocket costs and perceived financial burden, and (2) identify factors associated with such a perceived burden among prostate cancer patients living in a remote region of the province of Quebec (Canada). Methods: A cross-sectional study was conducted among 171 prostate cancer patients who consulted at the outpatient clinic of the Centre Hospitalier de Rouyn-Noranda. Results: The majority of patients (83%) had incurred out-of-pocket costs for their cancer care. The mean total cost incurred in the last three months was $517 and 22.3% reported a moderate, considerable or unsustainable burden. Multivariable analysis revealed that having incurred higher cancer-related out-of-pocket costs (OR: 1.001; 95%CI: 1.001–1.002) private drug insurance (vs. public, OR: 5.23; 95%CI: 1.13–24.17) was associated with a greater perceived financial burden. Having better physical health-related quality of life (OR: 0.95; 95%CI: 0.913–0.997), a university education (vs. elementary/high school level, OR: 0.03; 95%CI: 0.00–0.79), and an income between $40,000 and $79,999 (vs. ≤ $39,999, OR: 0.15; 95%CI: 0.03–0.69) were associated with a lower perceived burden. Conclusion: Prostate cancer patients incur out-of-pocket costs even if they were diagnosed many years ago and the perceived burden is significant. Greater attention should be paid to the development of services to help patients manage this burden.

scholarly journals Characteristics, Management, and Case-Fatality of Patients Hospitalized for Stroke with a Diagnosis of COVID-19 in France

2021 ◽  
pp. 1-7
Author(s):  
Amélie Gabet ◽  
Clémence Grave ◽  
Edouard Chatignoux ◽  
Philippe Tuppin ◽  
Yannick Béjot ◽  
...  
Keyword(s):  
Case Fatality ◽  
Cross Sectional Study ◽  
Primary Diagnosis ◽  
Index Hospitalization ◽  
Sectional Study ◽  
Stroke Patients ◽  
National Hospital ◽  
Cross Sectional ◽  
Increased Risk ◽  
Systèmes D’Information

<b><i>Introduction:</i></b> COVID-19 was found to be associated with an increased risk of stroke. This study aimed to compare characteristics, management, and outcomes of hospitalized stroke patients with or without a hospital diagnosis of CO­VID-19 at a nationwide scale. <b><i>Methods:</i></b> This is a cross-sectional study on all French hospitals covering the entire French population using the French national hospital discharge databases (<i>Programme de Médicalisation des Systèmes d’Information</i>, included in the <i>Système National des Données de Santé</i>). All patients hospitalized for stroke between 1 January and 14 June 2020 in France were selected. A diagnosis of COVID-19 was searched for during the index hospitalization for stroke or in a prior hospitalization that had occurred after 1 January 2020. <b><i>Results:</i></b> Among the 56,195 patients hospitalized for stroke, 800 (1.4%) had a concomitant COVID-19 diagnosis. Inhospital case-fatality rates were higher in stroke patients with COVID-19, particularly for patients with a primary diagnosis of COVID-19 (33.2%), as compared to patients hospitalized for stroke without CO­VID-19 diagnosis (14.1%). Similar findings were observed for 3-month case-fatality rates adjusted for age and sex that reached 41.7% in patients hospitalized for stroke with a concomitant primary diagnosis of COVID-19 versus 20.0% in strokes without COVID-19. <b><i>Conclusion:</i></b> Patients hospitalized for stroke with a concomitant COVID-19 diagnosis had a higher inhospital and 3 months case-fatality rates compared to patients hospitalized for stroke without a COVID-19 diagnosis. Further research is needed to better understand the excess of mortality related to these cases.

scholarly journals P0614URINARY EXOSOMAL MICRORNA-21 AS A MARKER OF SCRUB TYPHUS-ASSOCIATED ACUTE KIDNEY INJURY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
In O Sun ◽  
Kwang Young Lee ◽  
A Young Cho
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Scrub Typhus ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Total Leukocyte Count ◽  
Cross Sectional ◽  
Exosomal Mirna

Abstract Background and Aims Urinary microRNA (miRNA)-21 is reported to be a biomarker for detection of acute kidney injury (AKI). Analysis of urinary exsome may serve as a novel diagnostic approach in kidney disease. The aim of this study is to investigate the clinical significance of urinary exosomal miRNA-21 for AKI in patients with scrub typhus. Method In a cross-sectional study, we collected 138 urine samples at the time of admission from 145 patients with scrub typhus. For 25 patients with scrub typhus-associated AKI and 25 age, sex-matched scrub typhus patient without AKI, we measured miRNA-21 in urinary exosomal fraction and compared diagnostic value in predictiong AKI. Results Compared with patients in the non-AKI group, patients in the AKI group were more likely to have one or more comorbidity such as diabetes (50% vs. 5%, P&lt;0.01) and chronic kidney disease (8% vs. 0%, P&lt;0.01). Total leukocyte count were higher in patients with AKI than in those without AKI (10.40 × 103/ mL vs. 6.40 × 103/mL, P&lt;0.01). The levels of urinary miRNA-21 were higher in the AKI group than in the non-AKI group. Urinary exosomal miRNA-21 levels correlated directly with serum neutrophil gelatinase-associated lipocalin values and total leukocyte counts and inversely with estimated glomerular filtration rate. The receiver operator characteristics curve analysis for urinary exosomal miRNA-21 showed good discriminative power for the diagnosis of scrub typhus-associated AKI, with area under the curve value of 0.907. Conclusion Urinary exosomal miRNA-21 could be a surrogate markers for the diagnosis of scrub typhus–associated AKI.

scholarly journals Clinical suspicion and parathyroid carcinoma management

2006 ◽  
Vol 124 (1) ◽  
pp. 42-44 ◽  
Author(s):  
Fabio Luiz de Menezes Montenegro ◽  
Marcos Roberto Tavares ◽  
Marcelo Doria Durazzo ◽  
Claudio Roberto Cernea ◽  
Anói Castro Cordeiro ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Secondary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Clinical Signs ◽  
Neck Surgery ◽  
Cross Sectional Study ◽  
Clinical Suspicion ◽  
En Bloc ◽  
Cross Sectional ◽  
Adjacent Structures

CONTEXT AND OBJECTIVE: Adequate management of parathyroid carcinoma apparently relates to the surgeon’s ability to identify it at the first operation. The objective of this paper was to evaluate the role of clinical suspicion in the management of parathyroid carcinoma. DESIGN AND SETTING: Retrospective analysis of parathyroid carcinoma patients treated in Department of Head and Neck Surgery, Faculdade de Medicina da Universidade de São Paulo. METHODS: Cross-sectional study of 143 patients who underwent surgery from 1995 to 2000, due to hyperparathyroidism. These cases were reviewed to ascertain whether preoperative and intraoperative suspicion of parathyroid carcinoma were helpful during the operation, and which factors demonstrated the suspicion of cancer best. RESULTS: Among 66 patients with primary hyperparathyroidism there were four cases of parathyroid carcinoma (6.1%), and one case was found in secondary hyperparathyroidism (1.3%). Palpable nodules were found in five patients with primary hyperparathyroidism, four of them with parathyroid carcinoma. Preoperative levels of calcium in primary hyperparathyroidism with cancer patients varied from 12.0 mg/dl to 18.2 mg/dl. Two patients had gross macroscopic spread of the tumor to adjacent structures. Except for one patient, with extensive disease, tumors were resected en bloc. In secondary hyperparathyroidism, parathyroid carcinoma was found in a fifth mediastinal gland. One atypical adenoma was observed. CONCLUSIONS: High levels of calcium, palpable tumors and adherence to close structures are more common in parathyroid carcinoma. These clinical signs may be helpful for decision-making during parathyroid surgery.

scholarly journals The Characteristics of Mortality Predictor Scoring for Sepsis Patients in Haji Adam Malik Hospital

2021 ◽  
Vol 8 (10) ◽  
pp. 339-344
Author(s):  
Abdul Halim Harahap ◽  
Franciscus Ginting ◽  
Lenni Evalena Sihotang
Keyword(s):  
Sofa Score ◽  
Scoring System ◽  
Scoring Systems ◽  
Developed Countries ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Cross Sectional ◽  
Cross Sectional Design ◽  
Score Apache

Introduction: Sepsis is a leading cause of death in the Intensive Care Unit (ICU) in developed countries and its incidence is increasing. Many scoring systems are used to assess the severity of disease in patients admitted to the ICU. SOFA score to assess the degree of organ dysfunction in septic patients. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is most often used for patients admitted to the ICU. CCI scoring system to assess the effect of comorbid disease in critically ill patients on mortality. The study aimed to describe the characteristics of the use of scoring to predict patients’ mortality admitted to Haji Adam Malik Hospital. Methods: This is an observational study with a cross-sectional design. A total of 299 study subjects met the inclusion criteria and exclusion criteria, three types of scoring, namely SOFA score, APACHE II score, and CCI score were used to assess the prognosis of septic patients. Data analysis was performed using SPSS. P-value <0.05 was considered statistically significant. Results: A total of 252 people (84.3%) of sepsis patients died. The mean age of the septic patients who died was 54.25 years. The SOFA score ranged from 0-24, the median SOFA score in deceased sepsis patients was 5.0. The APACHE II score ranged from 0-71, the median APACHE II score in deceased sepsis patients was 23.0. The CCI score ranged from 0-37, the median CCI score in deceased sepsis patients was 5.0. Conclusion: Higher scores are associated with an increased probability of death in septic patients. Keywords: Sepsis; mortality predictor; SOFA score; APACHE II score, CCI score.

scholarly journals Predictors of COVID-19 Fatality: A Worldwide Analysis of the Pandemic over Time and in Latin America

2022 ◽  
Author(s):  
Dayana Rojas ◽  
Jorge Saavedra ◽  
Mariya Petrova ◽  
Yue Pan ◽  
José Szapocznik
Keyword(s):  
Latin America ◽  
Latin American ◽  
Strong Association ◽  
Case Fatality ◽  
Cross Sectional Study ◽  
Fatality Rate ◽  
Cross Sectional ◽  
The Difference ◽  
Latin American Countries ◽  
Risk Ratios

AbstractSARS-CoV-2 has infected over one hundred million people worldwide and has affected Latin America particularly severely in terms of both cases and deaths. This study aims to determine the association between SARS-CoV-2 testing and COVID-19 fatality rate worldwide over 8 months and to examine how this relationship differs between Latin America and all other countries. This cross-sectional study used March 2021 data from 169 countries. Multivariate regressions predicted COVID-19 fatality (outcome) from the number of SARS-CoV-2 tests (exposure), while controlling for other predictors. Results for March 2021 were compared to results from June 2020. Additionally, results for Latin America were also compared to all other countries except Latin American for March 2021. SARS-CoV-2 testing was associated with a significant decrease in COVID-19 fatality rate in both June 2020 and March 2021 (RR = 0.92; 95% CI 0.87–0.96 and RR = 0.86; 95% CI 0.74–1.00, respectively). SARS-CoV-2 testing was associated with a significant decrease in COVID-19 fatality rate in Latin American countries but not in all other countries (RR = 0.45; 95% CI 0.23–0.89 and RR = 0.95; 95% CI 0.82–1.11, respectively). However, the difference between the risk ratios for June 2020 and March 2021 and between the risk ratios for Latin America and all other countries were not statistically significant. Increased SARS-CoV-2 testing may be a significant predictor of lower COVID-19 case fatality rate, specifically in Latin American countries, due to the existence of a strong association, which may have driven the worldwide results.

scholarly journals CORRELATION BETWEEN LEVEL OF SOLUBLE FAS AND DEGREE OF SEPSIS SEVERITY BASED ON APACHE II SCORE

2018 ◽  
Vol 24 (3) ◽  
pp. 231
Author(s):  
Pauline Hadisiswoyo ◽  
Endang Retnowati ◽  
Erwin Astha Triyono
Keyword(s):  
Prediction Model ◽  
Scoring System ◽  
Linear Regression Analysis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Sepsis Severity ◽  
Cross Sectional ◽  
Chronic Health ◽  
Soluble Fas ◽  
Positive Correlations

A widely used scoring system to assess the severity of sepsis is Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II scoring system, however there are some disadvantages in using this. Other parameters are needed to predict severity and outcome of sepsis. Proinflammatory cytokines and Fas receptors are increased in sepsis and their concentration elevations are correlated with disease severity. An increase of soluble Fas level will follow increasing Fas receptors. This study aimed to prove any correlation between the level of soluble Fas and degree of sepsis severity based on APACHE II score. A cross-sectional observational study was conducted in January-June 2015 on 30 septic patients. APACHE II scores were calculated from the patients’physiological data, age, and chronic health problem status. Levels of soluble Fas were measured using the ELISA method (Human FAS/ CD95 (Factor-Related Apoptosis) ELISA Kit, Elabscience Biotechnology). Levels of soluble Fas ranged between 1,049-2,783 pg/mL (1,855.7 ± 477.27 pg/mL). APACHE II scores varied between 4-29 (17.2 ± 5.82). Significant positive correlations between levels of soluble Fas and APACHE II score (r=0.347, p=0.03) were found. A prediction model of soluble Fas levels based on APACHE II score was made. Linear regression analysis produced a prediction model of soluble Fas levels based on APACHE II score, in which soluble Fas level= 1,365.8 + 28.485 x APACHE II score.  

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