Clinical profile and outcome of patients with Coronavirus disease 2019 (COVID-19): a large-scale observational study from Tamil Nadu, India

Background: This study aims to assess the socio-demographic and clinical profile of the patients infected with SARS-CoV-2 in Tamil Nadu, India and to identify the associated prognostic determinants.Methods: Facility-level observational data pertaining to the case investigation of 15045 lab confirmed cases of COVID-19 reported in Tamil Nadu from March to June 2020 was used for the purpose of the study. The demographic and clinical profile of the COVID-19 confirmed cases and age-sex specific estimates of severity of illness were analysed. Determinants of prognosis were tested for statistical significance using Chi square and Student t test as appropriate.Results: The mean age was 40±7 years with a male predilection. Thirty six percent of the cases were symptomatic, with fever being the predominant symptom, followed by cough and breathlessness. The Case ICU rate and Case Fatality rate were found to be 6.2% and 2.9% respectively. Increasing age, male sex and underlying comorbid illness were found to significantly affect prognosis in these patients. However, it was observed that females experienced higher risk of severe illness and fatality in the younger age groups.Conclusions: While the observed findings reiterate the prognostic significance of age, gender and comorbidity as evidenced by other studies, the increased risk of severe illness and fatality among younger females provides a new direction for further research from a socio-epidemiological perspective.

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Abstract 16010: Congestive Heart Failure and Coronavirus Disease 2019 Illness Severity

Circulation ◽

10.1161/circ.142.suppl_3.16010 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Max Ruge ◽

Joanne Michelle D Gomez ◽

Gatha G Nair ◽

Setri Fugar ◽

Jeanne du Fay de Lavallaz ◽

...

Keyword(s):

Heart Failure ◽

At Risk ◽

Congestive Heart Failure ◽

Case Fatality ◽

Severity Of Illness ◽

Severe Infection ◽

Severe Illness ◽

Increased Risk ◽

History Of ◽

Male Sex

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has killed hundreds of thousands worldwide. Those with cardiovascular disease represent a vulnerable population with higher risk for contracting COVID-19 and worse prognosis with higher case fatality rates. Congestive heart failure (CHF) may lead to worsening COVID-19 symptoms. However, it is unclear if CHF is an independent risk factor for severe COVID-19 infection or if other accompanying comorbidities are responsible for the increased risk. Methods: From March to June 2020, data was obtained from adult patients diagnosed with COVID-19 infection who were admitted in the Rush University System for Health (RUSH) in Illinois. Heart failure patients, determined by ICD code assignments extracted from the electronic medical records, were identified. Multivariable logistic regression was performed between predictor variables and a composite outcome of severe infection consisting of Intensive Care Unit (ICU) admission, intubation, or in-hospital mortality. Results: In this cohort (n=1136), CHF [odds ratio (OR) 1.02] alone did not predict a more severe illness. Prior myocardial infarction [(MI), OR 3.55], history of atrial fibrillation [(AF), OR 2.14], and male sex (OR 1.55) were all significantly (p<0.001) associated with more severe COVID-19 illness course when controlling for CHF (Figure 1). In the 178 CHF patients, more advanced age (68.8 years vs. 63.8 years; p<0.05) and female sex (54.5% vs. 39.1%; p<0.05) were associated with increased severity of illness. Conclusions: Prior MI, history of AF, and male sex predicted more severe COVID-19 illness course in our cohort, but pre-existing heart failure alone did not. However, CHF patients who are females and older in age are at risk for severe infection. These findings help clinicians identify patients with comorbidities early at risk for severe COVID-19 illness.

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Study comparing the clinical profile of patients with stroke in diabetic and non-diabetic patients

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20194188 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1397

Author(s):

G. Sathish Kumar ◽

S. Rajeswaran ◽

U. B. Padmanaban

Keyword(s):

Tamil Nadu ◽

Statistical Significance ◽

Clinical Profile ◽

P Value ◽

Diabetic Patients ◽

Chi Square ◽

Cross Sectional ◽

Diabetic Population ◽

Magnetic Resonance Imaging Mri ◽

The Brain

Background: A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). Computed tomography (CT) and magnetic resonance imaging (MRI) was done to determine the type of stroke. Diabetes mellitus is a well-recognized risk factor for ischemic stroke. The study was undertaken to assess the clinical characteristics, outcome pattern and to compare the pattern of stroke in diabetics and non-diabetics.Methods: An observational cross-sectional prospective study wherein a hundred stroke patients being admitted to MGMGH, Trichy were sampled and the clinical profile along with outcome is compared in diabetic and non- diabetic populations and the statistical significance of the same.Results: The proportion of patients with poor outcome following stroke was significantly higher in diabetics compared with non-diabetic patients being chi square value was 37.6514 and p value was found to be significantly less than 0.0001.Conclusions: The study resulted the large hemorrhages are twice as much common in the diabetic population compared to the non-diabetic population , the incidence increases with the chronicity of diabetes and the outcome is superior in the non-diabetics compared to the diabetics admitted in Mahatma Gandhi Memorial Government Hospital, Tiruchirappalli, Tamil Nadu, India.

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COVID-19 and Its Symptoms’ Panoply: A Case-Control Study of 919 Suspected Cases in Locked-Down Ovar, Portugal

Portuguese Journal of Public Health ◽

10.1159/000514925 ◽

2021 ◽

pp. 1-8

Author(s):

Regina Sá ◽

Tiago Pinho-Bandeira ◽

Guilherme Queiroz ◽

Joana Matos ◽

João Duarte Ferreira ◽

...

Keyword(s):

Large Scale ◽

Case Control Study ◽

Statistical Significance ◽

Case Control ◽

Case Definition ◽

Suspected Case ◽

Risk Characteristics ◽

Increased Risk ◽

Wide Range ◽

Control Study

Background: Ovar was the first Portuguese municipality to declare active community transmission of SARS-CoV-2, with total lockdown decreed on March 17, 2020. This context provided conditions for a large-scale testing strategy, allowing a referral system considering other symptoms besides the ones that were part of the case definition (fever, cough, and dyspnea). This study aims to identify other symptoms associated with COVID-19 since it may clarify the pre-test probability of the occurrence of the disease. Methods: This case-control study uses primary care registers between March 29 and May 10, 2020 in Ovar municipality. Pre-test clinical and exposure-risk characteristics, reported by physicians, were collected through a form, and linked with their laboratory result. Results: The study population included a total of 919 patients, of whom 226 (24.6%) were COVID-19 cases and 693 were negative for SARS-CoV-2. Only 27.1% of the patients reporting contact with a confirmed or suspected case tested positive. In the multivariate analysis, statistical significance was obtained for headaches (OR 0.558), odynophagia (OR 0.273), anosmia (OR 2.360), and other symptoms (OR 2.157). The interaction of anosmia and odynophagia appeared as possibly relevant with a borderline statistically significant OR of 3.375. Conclusion: COVID-19 has a wide range of symptoms. Of the myriad described, the present study highlights anosmia itself and calls for additional studies on the interaction between anosmia and odynophagia. Headaches and odynophagia by themselves are not associated with an increased risk for the disease. These findings may help clinicians in deciding when to test, especially when other diseases with similar symptoms are more prevalent, namely in winter.

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The role of the renin–angiotensin–aldosterone system in preeclampsia: genetic polymorphisms and microRNA

Journal of Molecular Endocrinology ◽

10.1530/jme-12-0216 ◽

2013 ◽

Vol 50 (2) ◽

pp. R53-R66 ◽

Cited By ~ 19

Author(s):

Jie Yang ◽

Jianyu Shang ◽

Suli Zhang ◽

Hao Li ◽

Huirong Liu

Keyword(s):

Genetic Polymorphisms ◽

Large Scale ◽

Salt Water ◽

Prognostic Significance ◽

Neonatal Morbidity ◽

Well Being ◽

Normal Pregnancy ◽

Placental Perfusion ◽

Familial Predisposition ◽

Increased Risk

The compensatory alterations in the rennin–angiotensin–aldosterone system (RAAS) contribute to the salt–water balance and sufficient placental perfusion for the subsequent well-being of the mother and fetus during normal pregnancy and is characterized by an increase in almost all the components of RAAS. Preeclampsia, however, breaks homeostasis and leads to a disturbance of this delicate equilibrium in RAAS both for circulation and the uteroplacental unit. Despite being a major cause for maternal and neonatal morbidity and mortality, the pathogenesis of preeclampsia remains elusive, where RAAS has been long considered to be involved. Epidemiological studies have indicated that preeclampsia is a multifactorial disease with a strong familial predisposition regardless of variations in ethnic, socioeconomic, and geographic features. The heritable allelic variations, especially the genetic polymorphisms in RAAS, could be the foundation for the genetics of preeclampsia and hence are related to the development of preeclampsia. Furthermore, at a posttranscriptional level, miRNA can interact with the targeted site within the 3′-UTR of the RAAS gene and thereby might participate in the regulation of RAAS and the pathology of preeclampsia. In this review, we discuss the recent achievements of genetic polymorphisms, as well as the interactions between maternal and fetal genotypes, and miRNA posttranscriptional regulation associated with RAAS in preeclampsia. The results are controversial but utterly inspiring and attractive in terms of potential prognostic significance. Although many studies suggest positive associations with genetic mutations and increased risk for preeclampsia, more meticulously designed large-scale investigations are needed to avoid the interference from different variations.

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Clinical profile and predictors of outcome in children admitted to PICU with acute encephalitis syndrome

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20172512 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1214 ◽

Cited By ~ 1

Author(s):

Ekambaranath Sambasivam ◽

Jayakumar Muthaiyan ◽

Sreedivya Mohan ◽

Aravind Malayappan Ayyavoo ◽

Ganesh Jayachandran

Keyword(s):

Tamil Nadu ◽

Case Fatality ◽

Unknown Origin ◽

Clinical Profile ◽

Prognostic Indicators ◽

Predictors Of Outcome ◽

Diagnostic Challenge ◽

Female Ratio ◽

Acute Encephalitis Syndrome ◽

Acute Encephalitis

Background: Acute encephalitis syndrome (AES) is defined as the acute onset of fever and change in mental status (including symptoms such as confusion, disorientation, coma or inability to talk) and/or new onset seizures (excluding febrile seizures) in a person of any age at any time of the year. AES is reported mainly from Assam, Bihar, Tamil Nadu, Karnataka, Uttar Pradesh contributing approximately to 80% cases with case fatality rate of 20-25%. In view of paucity of clinical studies from Tamil Nadu, this study was undertaken to have a better insight on the clinical profile and prognostic indicators of AES in children. Objective of present work was to study the clinical profile and predictors of outcome of Acute encephalitis syndrome patients admitted in PICUMethods: This retrospective study was conducted in children with AES admitted to PICU, Stanley medical college over a period of 1year (May 2015-May 2016). 30 cases were studied. Clinical features, demography, immunisation status, and outcome were recorded. Results of blood investigations, peripheral smear, neuroimaging, CSF analysis and IgM ELISA for HSV, JE, CMV, Dengue were recorded and analysed.Results: Mean age of cases was 3.5±3.3years. Male to female ratio was 1.1:1. Etiology included HSV (6.67%), malaria (3.33%), dengue (3.33%), tubercular meningitis (3.33%), AES of unknown origin (83.3%) 11, Most common presentation was seizures 21 (70%). 17 (56.6%)presented with GCS <8. 11 (36.6%) required inotrope support, 16 (53.4%) were ventilated. Laboratorial findings included, leukocytosis in 17 (66.7%), dysglycemia in 12 children (39.99%), hyponatremia in 10 (33.33%), hypernatremia in 8 (26.67%) Mortality was observed in 11 cases (36.67%). Hyponatremia (p=0.02) and cases requiring ionotrope support on admission (p=0.0003) were significantly associated with mortality.Conclusions: There was no case of Japanese encephalitis. Hyponatremia being significantly associated with mortality among children with AES, warrants detailed evaluation to define the etiology which will aid in appropriate management. Maintaining euvolemia, prompt identification of shock and appropriate use of inotropes is of utmost importance. Varied and changing etiologies of AES poses a diagnostic challenge.

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Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka – An Observational Study

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2020.2.6.599 ◽

2020 ◽

Vol 2 (6) ◽

Author(s):

Mohammed Tarek Alam ◽

Rubaiul Murshed ◽

Pauline Francisca Gomes ◽

Zafor Md. Masud ◽

Sadia Saber ◽

...

Keyword(s):

Observational Study ◽

Large Scale ◽

Statistical Significance ◽

Healthcare Providers ◽

Tertiary Hospital ◽

Control Group ◽

P Value ◽

Chi Square ◽

Exposure Prophylaxis ◽

Experimental Group

Introduction: While multiple vaccines are undergoing clinical trial across the globe, we yearn for an FDA approved drug to protect us from the devastating pandemic for the time being. This study aims to determine the effectiveness of Ivermectin when administered as pre-exposure prophylaxis for COVID-19. Method: An observational study, with 118 healthcare providers who were enrolled purposively, was conducted in a tertiary hospital in Dhaka from May 2020 to August 2020. The subjects were divided into experimental and control groups; and the experimental group received an oral monthly dose of Ivermectin 12mg for 4 months. Both groups were exposed to COVID-19 positive patients admitted in the hospital during the course of study. The symptomatic subjects were evaluated by physical examination, COVID-19 RT-PCR and/or HRCT of chest. Differences between the variables were determined using the Chi-square test and the level of statistical significance was reached when p<0.05. Result: 73.3% (44 out of 60) subjects in control group were positive for COVID-19, whereas only 6.9% (4 out of 58) of the experimental group were diagnosed with COVID-19 (p-value < 0.05). Conclusion: Ivermectin, an FDA-approved, safe, cheap and widely available drug, should be subjected to large-scale trials all over the world to ascertain its effectiveness as pre-exposure prophylaxis for COVID-19.

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Outcome of COVID-19 in patients with chronic myeloid leukemia receiving tyrosine kinase inhibitors

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155220953198 ◽

2020 ◽

Vol 26 (7) ◽

pp. 1676-1682 ◽

Cited By ~ 2

Author(s):

Semih Başcı ◽

Naim Ata ◽

Fevzi Altuntaş ◽

Tuğçe Nur Yiğenoğlu ◽

Mehmet Sinan Dal ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Tyrosine Kinase ◽

Myeloid Leukemia ◽

Large Scale ◽

Kinase Inhibitor ◽

Statistical Significance ◽

Case Fatality ◽

Control Group ◽

Icu Admission ◽

Significant Difference

Introduction In this study, we aim to report the outcome of COVID-19 in chronic myeloid leukemia (CML) patients receiving tyrosine kinase inhibitor (TKI). Method The data of 16 laboratory-confirmed COVID-19 patients with CML receiving TKI and age, gender, and comorbid disease matched COVID-19 patients without cancer at a 3/1 ratio (n = 48), diagnosed between March 11, 2020 and May 22, 2020 and included in the Republic of Turkey, Ministry of Health database, were analyzed retrospectively. Results The rates of intensive care unit (ICU) admission, and mechanical ventilation (MV) support were lower in CML patients compared to the control group, however, these differences did not achieve statistical significance (p = 0.1, and p = 0.2, respectively). The length of hospital stay was shorter in CML patients compared with the control group; however, it was not statistically significant (p = 0.8). The case fatality rate (CFR) in COVID-19 patients with CML was 6.3%, and it was 12.8% in the control group. Although the CFR in CML patients with COVID-19 was lower compared to the control group, this difference did not achieve statistical significance (p = 0.5). When CML patients were divided into 3 groups according to the TKI, no significant difference was observed regarding the rate of ICU admission, MV support, CFR, the length of stay in both hospital and ICU (all p > 0.05). Conclusion This study highlights that large scale prospective and randomized studies should be conducted in order to investigate the role of TKIs in the treatment of COVID-19.

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Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1735164 ◽

2021 ◽

Author(s):

Centura R. Anbarasu ◽

Steven C. Mehl ◽

Raphael C. Sun ◽

Jorge I. Portuondo ◽

Andres F. Espinoza ◽

...

Keyword(s):

Retrospective Review ◽

Pectus Excavatum ◽

Statistical Significance ◽

Intercostal Nerve ◽

Nuss Procedure ◽

Operative Techniques ◽

Chi Square ◽

Patient Demographics ◽

Haller Index ◽

Increased Risk

Abstract Introduction The Nuss procedure is the most common and preferred operative correction of pectus excavatum. Surgeon preference and patient factors can result in variations in Nuss procedure technique. We hypothesize that certain techniques are associated with increased risk of complications. Materials and Methods We performed a single-center retrospective review of Nuss operations from 2016 to 2020. Variations in intraoperative techniques included sternal elevator (SE) use, number of bars placed, and usage of bilateral stabilizing sutures. Patient demographics, intraoperative data, and postoperative outcomes were reported as median with interquartile ranges or percentages. Statistical significance (p < 0.05) was determined with Wilcoxon's rank-sum and chi-square tests. Multivariate analysis was performed to control for introduction of intercostal nerve cryoablation and surgeon volume, and reported as odds ratio with 95% confidence interval. Results Two hundred and sixty-five patients were identified. Patients repaired with two bars were older with a larger Haller index (HI). Patient demographics were not significantly different for SE or stabilizing suture use. Placement of two bars was associated with significantly increased risk of readmission. Similarly, SE use was associated with increased risk of pleural effusion and readmission. Finally, the use of bilateral stabilizing sutures resulted in less frequent slipped bars without statistical significance. Conclusion Older patients with a larger HI were more likely to need two bars placed to repair pectus excavatum. Placement of multiple bars and SE use are associated with significantly higher odds of certain complications.

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Outcomes Associated With Vancomycin-Resistant Enterococci: A Meta-Analysis

Infection Control and Hospital Epidemiology ◽

10.1086/502271 ◽

2003 ◽

Vol 24 (9) ◽

pp. 690-698 ◽

Cited By ~ 115

Author(s):

Cassandra D. Salgado ◽

Barry M. Farr

Keyword(s):

Statistical Power ◽

Meta Analysis ◽

Case Fatality ◽

Severity Of Illness ◽

Adverse Outcomes ◽

Attributable Mortality ◽

Chi Square ◽

Inadequate Sample Size ◽

Excess Costs ◽

Vancomycin Resistant

AbstractBackground:Because patients with vancomycin-resistantEnterococcusbacteremia (VREB) usually have a higher severity of illness, it has been unclear whether VREB is worse than vancomycin-susceptibleEnterococcusbacteremia (VSEB).Methods:Data on morbidity and case fatality rates and costs were pooled from studies comparing VREB and VSEB, identified by Medline (January 1986 to April 2002) and meeting abstracts. Heterogeneity across studies was assessed with contingency table chi-square. Multivariate analyses (MVAs) controlling for other predictors were evaluated.Results:Thirteen studies compared case-fatality rates of VREB and VSEB. VREB case fatality was significantly higher (48.9% vs 19%; RR, 2.57; CI95, 2.27 to 2.91; attributable mortality = 30%). Five studies compared VREB with VSEB when bacteremia was the direct cause of death; VREB case fatality was significantly higher (39.1% vs 21.8%; RR, 1.79; CI95, 1.28 to 2.5; attributable mortality = 17%). Four MVAs found significant increases in case-fatality rates (OR 2.10 to 4.0), 3 showed trends toward increase (OR, 1.74 to 3.34 with wide confidence intervals), and 3 with low statistical power found no difference. VREB recurred in 16.9% versus 3.7% with VSEB (P< .0001). Three studies reported significant increases in LOS, costs, or both with VREB.Conclusion:Most studies have had inadequate sample size, inadequate adjustment for other predictors of adverse outcomes, or both, but available data suggest that VREB is associated with higher recurrence, mortality, and excess costs than VSEB including multiple studies adjusting for severity of illness.

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Social impact of menstrual problems among adolescent school girls in rural Tamil Nadu

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2016-0088 ◽

2017 ◽

Vol 30 (5) ◽

Cited By ~ 3

Author(s):

Rama Ravi ◽

Pankaj B. Shah ◽

Shanthi Edward ◽

Palani Gopal ◽

B.W.C. Sathiyasekaran

Keyword(s):

Adolescent Girls ◽

Tamil Nadu ◽

Social Impact ◽

Statistical Significance ◽

Holistic Approach ◽

Cross Sectional Study ◽

Study Data ◽

Psychosocial Impact ◽

Cross Sectional ◽

Increased Risk

Abstract Background Adolescence is a period of physiological, psychological and social transition between childhood and adulthood and is characterized by the onset of menstruation in girls. A adolescent girls are naïve about menstruation and they take time to adapt to these changes both socially and psychologically. This study was carried out to assess the psychosocial impact of menstrual problems among schoolgoing adolescent girls. Methods This study is a cross-sectional study carried out in 350 schoolgoing adolescent girls in the year 2012 in the Thiruvallur district of Tamil Nadu. Girls who attained menarche 1 year prior to the data collection were included in the study. Data regarding background characteristics and psychosocial impact of menstrual problems were collected. Data was analyzed using SPSS ver. 15 software. The χ2-test was carried out to assess the statistical significance at the 95% level of significance. Results The mean age of the participants was 14.7 years. In this study, 87.7% of the girls had at least one menstrual problem. Among these, 78.5% could not attend school during menstruation, 51.1% were unable to perform household/sports activities (p < 0.001). It was observed that dysmenorrhea and menorrhagia were at increased risk of absenting the girls from school (p < 0.05). Conclusion The key to a sound adolescent health programme is a holistic approach which also focuses on the psychological and social domain of health. This could be achieved by involving all the stakeholders like parents, teachers, etc. to work as a team. It is also essential to develop adolescent friendly health services at the grass root level.

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