Evaluation of COVID-19 patients requiring oxygen therapy in a tertiary care teaching hospital

Background: COVID-19 disease is a public health emergency and declared as a pandemic in March 2020 by World Health Organization (WHO). Our aim was to study the clinical features, laboratory profile and outcome of COVID-19 patients needing oxygen therapy.Methods: All patients diagnosed to be having COVID-19 and SpO2 less than 94% on admission were included in the study. Detailed history, systemic examination and investigations were done and data was analyzed.Results: Out of 100 patients studied, 66% were males and 34% were females. Comorbidity was seen in 83% of cases, predominantly hypertension (30%) followed by diabetes mellitus (27%) and ischemic heart disease IHD (11%). Most common presenting complaints were breathlessness (84%) followed by dry cough (63%) and fever (48%). Mean values of absolute counts of neutrophils, lymphocytes, eosinophils and basophils were 4,835 cells/cu.mm, 1,332 cells/cumm, 66 cells/cumm and 86.5 cells/cumm respectively. Serum C-reactive protein (CRP) was raised in 90%, lactate dehydrogenase (LDH) in 96% and D-dimer in 64 % of cases on admission. Incidence of happy hypoxia was 16%. Mortality in our study was 2%. Greater the values of serum CRP, LDH, ferritin, lesser was the SpO2 of patients and greater the oxygen requirement. However no such correlation was found between D-Dimer and SpO2 of patients and their oxygen requirement.Conclusions: COVID-19 has varied presentations. The most common comorbidity was hypertension followed by diabetes mellitus. Serum inflammatory markers are raised in COVID disease. Eosinopenia can be a pointer towards COVID disease. One should be aware of the entity happy hypoxia seen in these patients.

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A brief-review of the risk factors for covid-19 severity

Revista de Saúde Pública ◽

10.11606/s1518-8787.2020054002481 ◽

2020 ◽

Vol 54 ◽

pp. 60 ◽

Cited By ~ 8

Author(s):

J. E. Rod ◽

Oscar Oviedo-Trespalacios ◽

Javier Cortes-Ramirez

Keyword(s):

Risk Factors ◽

Disease Severity ◽

World Health ◽

Future Research ◽

C Reactive Protein ◽

Reactive Protein ◽

History Of ◽

Health Organization ◽

High Consistency ◽

D Dimer

The World Health Organization has emphasized that one of the most important questions to address regarding the covid-19 pandemic is to understand risk factors for disease severity. We conducted a brief review that synthesizes the available evidence and provides a judgment on the consistency of the association between risk factors and a composite end-point of severe-fatal covid-19. Additionally, we also conducted a comparability analysis of risk factors across 17 studies. We found evidence supporting a total of 60 predictors for disease severity, of which seven were deemed of high consistency, 40 of medium and 13 of low. Among the factors with high consistency of association, we found age, C-reactive protein, D-dimer, albumin, body temperature, SOFA score and diabetes. The results suggest that diabetes might be the most consistent comorbidity predicting disease severity and that future research should carefully consider the comparability of reporting cases, factors, and outcomes along the different stages of the natural history of covid-19.

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Coagulation profile and correlation between D-dimer, inflammatory markers, and COVID-19 severity in an Indonesian national referral hospital

Journal of International Medical Research ◽

10.1177/03000605211059939 ◽

2021 ◽

Vol 49 (11) ◽

pp. 030006052110599

Author(s):

Lugyanti Sukrisman ◽

Robert Sinto

Keyword(s):

Inflammatory Markers ◽

Characteristic Curve ◽

Cross Sectional Study ◽

World Health ◽

Cross Sectional ◽

Ferritin Concentration ◽

Reactive Protein ◽

Health Organization ◽

National Referral Hospital ◽

D Dimer

Background Coagulopathy and inflammation are associated with coronavirus disease 2019 (COVID-19) severity. This study assessed D-dimer concentration and its correlation with inflammatory markers and COVID-19 severity. Methods This was a retrospective cross-sectional study involving 194 COVID-19 cases, with the severity of infection graded in accordance with the World Health Organization (WHO) guidelines. We measured D-dimer, C-reactive protein (CRP), and ferritin on admission and determined the cutoff values for D-dimer and CRP and evaluated the correlation between D-dimer and CRP and ferritin. Results Median D-dimer, CRP, and ferritin concentrations were 2240 µg/L, 73.2 mg/L, and 1173.8 µg/mL, respectively. The highest median D-dimer value was seen in mild and moderate acute respiratory distress syndrome (ARDS). The highest ferritin concentration was seen in severe ARDS. There was a significant correlation between D-dimer value and CRP (r = 0.327), but no significant correlation between D-dimer and ferritin (r = 0.101). The area under the receiver operating characteristic curve (AUC) for the combination of CRP ≥72.65 mg/L and D-dimer ≥1250 µg/L as a marker of COVID-19 severity was 0.722 (95% confidence interval (CI): 0.615–0.781). Conclusion The combination of CRP ≥72.65 mg/L and D-dimer ≥1250 µg/L can be used as marker of COVID-19 severity, with moderate accuracy.

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A pilot study comparing pattern of damage sustained among instruments from different surgical units in a tertiary care centre in Nepal – reappraising the role of instrument reprocessing in retaining their value

F1000Research ◽

10.12688/f1000research.13699.1 ◽

2018 ◽

Vol 7 ◽

pp. 102

Author(s):

Sunil Munakomi ◽

Roshan Shah ◽

Sangam Shrestha

Keyword(s):

Tertiary Care ◽

Health Spending ◽

Pivotal Role ◽

World Health ◽

Tertiary Care Centre ◽

Surgical Equipment ◽

Surgical Units ◽

Wear And Tear ◽

Health Organization

Background: The quality of instruments plays a pivotal role in governing safe operating room culture. The reprocessing system followed in the institution determines their durability thereby ensuring patient safety as well as minimizing health spending. Rigorous reprocessing in a centralized instrument reprocessing department by well trained staff following formulated guidelines helps to achieve the target of “safe surgery saves lives” as formulated by the World Health Organization. Methods: We sought to determine the patterns of wear and tear sustained among sets of surgical equipment from two surgical units that had been sent to the repair department within a year of their purchase. Analysis of similar changes in the joints of the instrument, as well as pattern of fractures sustained was performed. Results: All patterns of wear and tear were common in both the general surgical arm and neurosurgical counterpart, with the exception of fractures and mal-alignments. Similar study was performed examining changes in the joints. Stains were the most commonly observed change pattern in both sets of instruments. Fractures were most frequent in the working ends in both sets of instruments. Conclusion: There is an alarming incidence of wear and tear patterns in the instruments used in the surgical units, even within the first year of their use. This supports the strict implementation of reprocessing guidelines by well trained workers and their quality assessments via audit checks. The quality of the purchased instruments also plays a pivotal role.

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Diabetes Mellitus and Its Associated Risk Factors among adult Population in Bisha Province, Southwest of Saudi Arabia

Global Journal of Health Science ◽

10.5539/gjhs.v9n6p22 ◽

2016 ◽

Vol 9 (6) ◽

pp. 22 ◽

Cited By ~ 1

Author(s):

Abdullah M. Al-Shahrani ◽

Mohammed A. Al-Saleem ◽

Mohamed O’haj ◽

Faleh Th. Mohammed ◽

Mutasim E. Ibrahim

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Healthy Lifestyle ◽

Adult Population ◽

Cross Sectional Study ◽

World Health ◽

Cross Sectional ◽

Married Individuals ◽

Health Organization ◽

Associated Risk Factors

OBJECTIVES: To determine the prevalence and associated risk factors of diabetes mellitus (DM) among the adult population in Bisha province, Saudi Arabia.METHODS: A cross sectional study was conducted during December, 2015 using the World Health Organization STEPS wise approach for data collection. Blood glucose level and anthropometric measurements of blood pressure, height, weight, and waist circumference were performed per standard methods. Logistic regression analysis was used to assess the prevalence and risk of diabetes.RESULTS: Of 542 adult individuals included in the study, 13.3% (72) had diabetes, of which 8.1% were previously diagnosed and 5.2% represented new cases. The proportions of DM were 14.7% for men and 10.8% for women. Diabetes was significantly higher among married compared to unmarried individuals (19.3% vs 5.5 %; p<0.001) and among individuals aged ≥40 years old compared to those <40 years (31.3% vs 9.3%; p<0.001). The risk of diabetes was significantly increased with older age (Odds Ratio=4.470; 95% CI 2.264-7.614), married individuals (OR=4.097; 95% CI 2.188-7.672), weight/obesity (OR=2.827; 95% CI 1.567-5.072), hypertension (OR=4.383; 95% CI 2.085-9.214) and having a job (OR=2.327; 95% CI 1.347-4.02). The independent risk factors predicted diabetes were hypertension (Adjusted OR=2.897; 95% CI 1.269-66.13) and job patterns (Adjusted OR=2.793; 95% CI 1.064-7.329).CONCLUSION: Different risk factors alarming diabetes among adult population in Bisha province were detected. Strategies aimed to improving a healthy lifestyle are necessary to reduce the burden of the disease.

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Water Quality of the Trstionica River (Bosnia and Herzegovina)

Kemija u industriji ◽

10.15255/kui.2019.061 ◽

2020 ◽

Vol 69 (7-8) ◽

pp. 371-376

Author(s):

Šuhreta Delibašić ◽

Jasna Huremović ◽

Sabina Žero ◽

Sabina Gojak-Salimović

Keyword(s):

Water Quality ◽

Bosnia And Herzegovina ◽

Limit Of Detection ◽

Weather Conditions ◽

Ion Exchange Resin ◽

World Health ◽

Mean Values ◽

Significant Difference ◽

Health Organization

The present study was conducted to investigate the water quality of the Trstionica River, Bosnia and Herzegovina. The physicochemical properties (temperature, pH, conductivity, total solids after evaporation at 105 °C), content of metals (calcium (Ca), cadmium (Cd), chromium (Cr), copper (Cu), iron (Fe), magnesium (Mg), manganese (Mn), sodium (Na), nickel (Ni), lead (Pb) and zinc (Zn)), and anions (chloride (Cl–), and phosphate (PO43–)) were determined in water samples collected at seven locations during two sampling periods: unstable weather conditions (precipitation), and stable weather conditions (without precipitation). There was a significant difference in the content of individual parameters in the river water depending on the sampling time. For determination of metals concentrations, which were below the limit of detection, a preconcentration method using an ion-exchange resin was applied. The metals concentrations during the rainy day were in the order Ca > Mg > Na > Fe > Cu > Zn > Pb > Mn with mean values of 343, 6.03, 1.94, 0.18, 0.20, 0.03, 0.02, 0.01 mg dm–3, respectively, and during stable weather conditions: Ca > Mg > Na > Cu > Fe > Mn > Zn with mean values of 288, 7.62, 2.38, 0.11, 0.10, 0.01, 0.01 mg dm–3, respectively. Cd, Cr, and Ni concentrations were below limit of detection in both cases. Obtained values were compared with World Health Organization (WHO) regulations. The results showed that the Trstionica River in the investigated part of the stream meets most of the parameters required by the regulations. The correlation between analysed parameters was assessed, as well. Based on the calculated water quality index values, the water of Trstionica River falls into the category of excellent water.

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Laboratory Characteristics and Presentation of Multi-Organ Affection among Hospitalized Patients with SARS-CoV-2 Infection in Public Hospital in Bitola.

New Medical Innovations and Research ◽

10.31579/jnmir.2020/001 ◽

2020 ◽

Vol 1 (1) ◽

pp. 01-06

Author(s):

Biljana Ilkovska

Keyword(s):

Public Hospital ◽

Clinical Laboratory ◽

Vascular Inflammation ◽

World Health ◽

The Public ◽

Reactive Protein ◽

Therapy Decision ◽

Decision Making Processes ◽

Health Organization ◽

Glutamyl Transferase

Introduction: In December 2019, a highly infectious disease i.e. pneumonia caused by the coronavirus disease SARS-CoV-2, occurred in Wuhan, China, and the World Health Organization has declared its ongoing outbreak a pandemic. The clinical laboratory plays a key role in supporting the monitoring and management of SARS-CoV-2 disease. Material and methods: Our study describes the laboratory characteristics of 103, SARS-CoV-2 patients hospitalized in the public hospital Trifun Panovski in the period April - June 2020. Only two patients died as a result of the SARS-CoV-2. The most common laboratory abnormalities were: elevated lactate dehydrogenase (LDH) and C-reactive protein (CRP). Results: Leukocytosis was found in 23.3%, and leucopenia in 3% of patients with SARS – CoV-2. SARS-CoV-2 infection can be associated with myocardial injury, heart failure, vascular inflammation, myocarditis, cardiac arrhythmias, and hypoxic encephalopathy. We found increased values of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ –glutamyl transferase (γ –GT) in 35 – 50% of patients. We detected affected renal function in 10% of our patients with SARS – CoV 2. Conclusion:We identified potential biomarkers of disease severity. Our results provide guidance in risk assessment, clinical monitoring and therapy decision-making processes

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Chickenpox Mimicking Monkeypox in Adult with Diabetes Mellitus and Acute Kidney Injury: Diagnosis and Management

Berkala Ilmu Kesehatan Kulit dan Kelamin ◽

10.20473/bikk.v33.3.2021.213-223 ◽

2021 ◽

Vol 33 (3) ◽

pp. 213

Author(s):

Maya Wardiana ◽

Rahmadewi Rahmadewi ◽

Dwi Murtiastutik ◽

Sawitri Sawitri ◽

Damayanti Damayanti

Keyword(s):

Diabetes Mellitus ◽

Acute Kidney Injury ◽

Renal Function ◽

Kidney Injury ◽

Skin Lesions ◽

World Health ◽

Varicella Zoster ◽

Intravenous Acyclovir ◽

Acute Kidney Injury Diagnosis ◽

Health Organization

Background: Chickenpox caused by the varicella-zoster virus (VZV) in diabetes mellitus patients might exhibit similar clinical features with monkeypox, caused by monkeypox virus (MPXV). In May 2019, Singapore notified World Health Organization (WHO) of one laboratory-confirmed case of monkeypox. Considering Singapore is located near Indonesia, awareness about the possibility of an outbreak in Indonesia should be raised. Purpose: To report a case of chickenpox mimicking monkeypox in an adult with diabetes mellitus and acute kidney injury. Case: A 51-year-old male with poorly controlled diabetes mellitus was suspected to have a chickenpox differential diagnosis with monkeypox. His chief complaint was multiple blisters on his body and vomiting. There was a history of feeding a monkey. From dermatological status on facial, trunk, and extremities there were multiple pleomorphic vesicles. Laboratory results showed elevated renal function. Polymerase chain reaction (PCR) examination using VZV as primer revealed a positive result in the range of 810 bp. He was treated with intravenous acyclovir for 3 days and oral acyclovir for 7 days then discharged with improvement in skin lesions and normal renal function. Discussion: Chickenpox in adult and diabetes mellitus patients can give severe clinical manifestation mimicking monkeypox. PCR has a significant role especially when diagnosis could not be established from the physical examination. Acyclovir can be given as the therapy. Conclusion: Adult and poorly controlled diabetes mellitus are important risk factors associated with the severity and complication of chickenpox. A careful diagnostic approach and management are needed.

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ALTERAÇÕES MORFOLÓGICAS NO TECIDO ÓSSEO EM ANIMAIS TREINADOS EM ESTEIRA MOTORIZADA

BIOMOTRIZ ◽

10.33053/biomotriz.v14i2.25 ◽

2020 ◽

Vol 14 (2) ◽

pp. 3-12

Author(s):

Andreson Charles de Freitas Silva ◽

Priscilla de Oliveira Mendonça Freitas

Keyword(s):

Diabetes Mellitus ◽

World Health Organization ◽

World Health ◽

Health Organization

De acordo com a World Health Organization, o Diabetes Mellitus é uma síndrome de etiologia múltipla, ocasionada pela falta de insulina ou por uma incapacidade da insulina de exercer de forma eficaz sua função. O exercício físico é definido como toda atividade física planejada e repetitiva que tem por objetivo a melhoria das funções do organismo. A prática de pelo menos 150 minutos semanais de atividade com intensidade moderada é recomendada para pacientes com diabetes mellitus. O objetivo deste estudo foi investigar a influência do exercício físico no tecido ósseo de ratos diabéticos submetidos ao treinamento em esteira motorizada. Foram utilizados 12 animais, divididos em dois grupos: Diabético Sedentário (DS) que não praticava nenhum exercício e Diabético treinado (DT) submetidos ao exercício físico em esteira durante 10 semanas duas vezes por dia, com 6h de repouso entre uma sessão e outra, 5 dias por semana. O diabetes foi induzido através de injeção intraperitoneal de estreptozotocina (60mg/Kg, S.C; Sigma ChemicalCo.) dissolvida em tampão de citrato, pH 4.5. Realizamos, neste estudo, a mensuração das tíbias de ratos diabéticos para verificar a possível participação do exercício físico no desenvolvimento ósseo desses animais. Como resultado, verificou-se que o exercício foi capaz de promover de forma significativa o aumento nos diâmetros da diáfise e epífise distal, bem como aumento no comprimento e peso das tíbias do grupo (DT) vs (DS) com p<0,05.

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Quality of Life of Parents of Children with Type I Diabetes Mellitus, Baghdad 2017

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v17i2.536 ◽

2021 ◽

Vol 17 (2) ◽

pp. 107-114

Author(s):

Sadik Jaafar Shukur ◽

Wijdan Akram Hussein ◽

Nazik L. Kadhum

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

World Health Organization ◽

World Health ◽

Type I ◽

Healthy Children ◽

Social Domain ◽

Chronic Hyperglycemia ◽

Health Organization

Background: Diabetes is defined by the World Health Organization as a metabolic disorder characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. Families are co-regulating systems in which the stresses and strains of one family member affect the well-being of another member of the family. Caregivers of children with chronic illness report experiencing more parental stress than parents of healthy children. Objective: A descriptive cross-sectional study had been conducted in four centers of endocrine diseases in Baghdad city and data was collected by using self-administered questionnaire regarding quality of life adapted from World Health Organization. The study was conducted on six hundred participants. Data analysis was done by using frequency, percentage and mean and analytical statistics using Chi Square test. P value less than 0.05 was considered statistically significant. Results: The study showed that social domain had the highest mean score of (51.1) and that environmental domain had the lowest mean score of (38.9). The physical domain’s mean score was (40.2), while mean score of psychological domain was (46.2). The study reported that mothers of children with type 1 diabetes mellitus were more affected than fathers in physical, psychological and environmental domains. There was no difference between mothers and fathers in social domain of quality of life. Conclusion: It was concluded from the study that parents of diabetic children had generally poor quality of life that merits further investigations.

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Increment in Phototherapy After Adopting Delayed Cord Clamping Practice

Journal of Neonatology ◽

10.1177/09732179211060755 ◽

2021 ◽

pp. 097321792110607

Author(s):

Chinmay Chetan ◽

Nishant Banait ◽

Vikramaditya Athelli ◽

Bhvya Gupta ◽

Prince Pareek ◽

...

Keyword(s):

Tertiary Care ◽

World Health ◽

Care Hospital ◽

Delayed Cord Clamping ◽

Term Infants ◽

Cord Clamping ◽

Early Cord Clamping ◽

Baseline Characteristics ◽

Health Organization ◽

Larger Sample

Introduction: World Health Organization (WHO) in 2014 recommended delayed cord clamping (DCC) in all babies who cry immediately after birth. Despite many benefits, there are concerns of increased rate of phototherapy in babies receiving DCC. This study was done to determine the increment in the rate of phototherapy required in infants managed with DCC vs infants managed with early cord clamping (ECC). Methods: A retrospective observational study was conducted in a tertiary care hospital in Pune, India. All the infants born between January 2018 and July 2018, for whom ECC was done, were compared with infants who were born between January 2019 and July 2019, after DCC policy was adopted. All the infants with birth weight ≥2 kg and gestation ≥35 weeks, who were with their mother, were included. Baseline characteristics were compared for both the groups. American Academy of Pediatrics guidelines for treatment of neonatal jaundice were used to determine the need for phototherapy. Number of infants in both the groups who required phototherapy were compared. Results: The ECC group had 565 infants while DCC group had 731 infants. There was no difference in the baseline characteristics of the 2 groups. Jaundice requiring phototherapy was noted in 31% of infants in the ECC group, compared to 45% in infants in the DCC group (relative risk: 1.47 [1.27-1.71] [ P < .001]). Conclusion: In this study, DCC increased the need for phototherapy by 47% in late preterm and term infants. Randomized control trials with larger sample size are required to confirm this finding.

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