scholarly journals Clinical and paraclinical predictive factors for in-hospital mortality in adult patients with COVID-19

2021 ◽  
Author(s):  
Seyed Alireza Mousavi ◽  
Reyhaneh Sadat Mousavi-Roknabadi ◽  
Fateme Nemati ◽  
Somaye Pourteimoori ◽  
Arefeh Ghorbani ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Ct Scan ◽  
Predictive Factors ◽  
Invasive Mechanical Ventilation ◽  
Cross Sectional Study ◽  
Study Data ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Non Invasive

Abstract Background Since December 2019, a type of coronavirus has emerged in Wuhan, China, which has become the focus of global attention due to an epidemic of pneumonia of unknown cause, called COVID-19. This study aimed to investigate the factors affecting in-hospital mortality of patients with COVID-19 hospitalized in one of the main hospital in central Iran. Methods This retrospective cross-sectional study (February 2019-May 2020) was conducted on patients with confirmed diagnosis COVID-19, who were admitted in Yazd Shahid Sadoughi Hospital, in middle of Iran. The patients with uncompleted or missed medical files were excluded from the study. Data were extracted from the patients' medical files and then analyzed. The patients were categorized as survivors and non-survivors groups, and they were compared. Results Totally, 573 patients were enrolled, that 356 (62.2%) were male. The mean ± SD of age was 56.29 ± 17.53 years, and 93 (16.23%) were died. All the complications were more in non-survivors. Intensive care unit (ICU) admission was in 20.5% of the patients which was more in non-survivors (P < 0.001). The results of multivariate logistic regression test showed that plural effusion in lung computed tomography (CT) scan (OR = 0.055, P = 0.009), white blood cell (WBC) (OR = 1.417, P = 0.022), serum albumin (OR = 0.009, P < 0.001), non-invasive mechanical ventilation (OR = 34.315, P < 0.001), and acute respiratory distress syndrome (ARDS) (OR = 66.039, P = 0.001) were achieved as the predictive factors for in-hospital mortality were the predictive factors for in-hospital mortality. Conclusion In-hospital mortality in patients with COVID-19 was about 16%. Plural effusion in lung CT scan, WBC, albumin, non-invasive mechanical ventilation, and ARDS were obtained as the predictive factors for in-hospital mortality.

scholarly journals Combined association of obesity and other cardiometabolic diseases with severe COVID-19 outcomes: a nationwide cross-sectional study of 21,773 Brazilian adult and elderly inpatients

2021 ◽  
Author(s):  
Natanael J Silva ◽  
Rita C Ribeiro-Silva ◽  
Andrea JF Ferreira ◽  
Camila SS Teixeira ◽  
Aline S Rocha ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Dose Response ◽  
Invasive Mechanical Ventilation ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Icu Admission ◽  
Non Invasive ◽  
Elderly Inpatients

Objective: To investigate the combined association of obesity, diabetes mellitus (DM), and cardiovascular disease (CVD) with severe COVID-19 outcomes in adult and elderly inpatients. Design: Cross-sectional study based on registry data from Brazil's influenza surveillance system. Setting: Public and private hospitals across Brazil. Participants: Eligible population included 21,942 inpatients aged 20 years or older with positive RT-PCR test for SARS-CoV-2 until Jun 9th, 2020. Main outcome measures: Severe COVID-19 outcomes were non-invasive and invasive mechanical ventilation use, ICU admission, and death. Multivariate analyses were conducted separately for adults (20-59 years) and elders (>=60 years) to test the combined association of obesity (without and with DM and/or CVD) and degrees of obesity with each outcome. Results: A sample of 8,848 adults and 12,925 elders were included. Among adults, obesity with DM and/or CVD showed higher prevalence of invasive (PR 3.76, 95%CI 2.82-5.01) and non-invasive mechanical ventilation use (2.06, 1.58-2.69), ICU admission (1.60, 1.40-1.83), and death (1.79, 1.45-2.21) compared with the group without obesity, DM, and CVD. In elders, obesity alone (without DM and CVD) had the highest prevalence of ICU admission (1.40, 1.07-1.82) and death (1.67, 1.00-2.80). In both age groups, obesity alone and combined with DM and/or CVD showed higher prevalence in all outcomes than DM and/or CVD. A dose-response association was observed between obesity and death in adults: class I 1.32 (1.05-1.66), class II 1.41 (1.06-1.87), and class III 1.77 (1.35-2.33). Conclusions: The combined association of obesity, diabetes, and/or CVD with severe COVID-19 outcomes may be stronger in adults than in elders. Obesity alone and combined with DM and/or CVD had more impact on the risk of COVID-19 severity than DM and/or CVD in both age groups. The study also supports an independent relationship of obesity with severe outcomes, including a dose-response association between degrees of obesity and death in adults. These findings suggest important implications for the clinical care of patients with obesity and severe COVID-19 and support the inclusion of people with obesity in the high-risk and vaccine priority groups for protection from SARS-CoV-2.

scholarly journals Combined association of obesity and other cardiometabolic diseases with severe COVID-19 outcomes: a nationwide cross-sectional study of 21 773 Brazilian adult and elderly inpatients

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e050739
Author(s):  
Natanael de Jesus Silva ◽  
Rita de Cássia Ribeiro-Silva ◽  
Andrêa Jacqueline Fortes Ferreira ◽  
Camila Silveira Silva Teixeira ◽  
Aline Santos Rocha ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Dose Response ◽  
Invasive Mechanical Ventilation ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Icu Admission ◽  
Non Invasive ◽  
Elderly Inpatients

ObjectivesTo investigate the combined association of obesity, diabetes mellitus (DM) and cardiovascular disease (CVD) with severe COVID-19 outcomes in adult and elderly inpatients.DesignCross-sectional study based on registry data from Brazil’s influenza surveillance system.SettingPublic and private hospitals across Brazil.ParticipantsEligible population included 21 942 inpatients aged ≥20 years with positive reverse transcription-PCR test for SARS-CoV-2 until 9 June 2020.Main outcome measuresSevere COVID-19 outcomes were non-invasive and invasive mechanical ventilation use, intensive care unit (ICU) admission and death. Multivariate analyses were conducted separately for adults (20–59 years) and elders (≥60 years) to test the combined association of obesity (without and with DM and/or CVD) and degrees of obesity with each outcome.ResultsA sample of 8848 adults and 12 925 elders were included. Among adults, obesity with DM and/or CVD showed higher prevalence of invasive (prevalence ratio 3.76, 95% CI 2.82 to 5.01) and non-invasive mechanical ventilation use (2.06, 1.58 to 2.69), ICU admission (1.60, 1.40 to 1.83) and death (1.79, 1.45 to 2.21) compared with the group without obesity, DM and CVD. In elders, obesity alone (without DM and CVD) had the highest prevalence of ICU admission (1.40, 1.07 to 1.82) and death (1.67, 1.00 to 2.80). In both age groups, obesity alone and combined with DM and/or CVD showed higher prevalence in all outcomes than DM and/or CVD. A dose–response association was observed between obesity and death in adults: class I 1.32 (1.05 to 1.66), class II 1.41 (1.06 to 1.87) and class III 1.77 (1.35 to 2.33).ConclusionsThe combined association of obesity, diabetes and/or CVD with severe COVID-19 outcomes may be stronger in adults than in elders. Obesity alone and combined with DM and/or CVD had more impact on the risk of COVID-19 severity than DM and/or CVD in both age groups. The study also supports an independent relationship of obesity with severe outcomes, including a dose–response association between degrees of obesity and death in adults.

scholarly journals Risk factors for severe outcomes in people with diabetes hospitalised for COVID-19: a cross-sectional database study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e051237
Author(s):  
Emilio Ortega ◽  
Rosa Corcoy ◽  
Mònica Gratacòs ◽  
Francesc Xavier Cos Claramunt ◽  
Manel Mata-Cases ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Male Sex ◽  
Poor Outcomes ◽  
The Relationship

AimThis study’s objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM).DesignThis was a cross-sectional study.SettingsWe used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain.Outcome measuresMultiple logistic regression analyses were used to identify variables associated with mortality and the composite of mortality or invasive mechanical ventilation (IMV) in the overall population, and stratified for the presence or absence of DM. Spline analysis was conducted on the entire population to investigate the relationship between glucose levels at admission and outcomes.ResultsOverall, 1621 individuals without DM and 448 with DM were identified in the database. Patients with DM were on average 5.1 years older than those without. The overall in-hospital mortality was 18.6% (N=301), and was higher among patients with DM than those without (26.3% vs 11.3%; p<0.001). DM was independently associated with death, and death or IMV (OR=2.33, 95% CI: 1.7 to 3.1 and OR=2.11, 95% CI: 1.6 to 2.8, respectively; p<0.001). In subjects with DM, the only variables independently associated with both outcomes were age >65 years, male sex and pre-existing chronic kidney disease. We observed a non-linear relationship between blood glucose levels at admission and risk of in-hospital mortality and death or IMV. The highest probability for each outcome (around 50%) was at random glucose of around 550 mg/dL (30.6 mmol/L), and the risks flattened above this value.ConclusionThe results confirm the high burden associated with DM in patients hospitalised with COVID-19 infection, particularly among men, the elderly and those with impaired kidney function. Moreover, hyperglycaemia on admission was strongly associated with poor outcomes, suggesting that personalised optimisation could help to improve outcome during the hospital stay.

Determination Of Factors Affecting Father-Baby Attachment

2021 ◽  
Vol 6 (14) ◽  
pp. 1-7
Author(s):  
Emine Serap ÇAĞAN ◽  
Birsen KARACA SAYDAM ◽  
Sinem GÜLÜMSER ATEŞ ◽  
Rabia EKTİ GENÇ ◽  
Esin ÇEBER TURFAN
Keyword(s):  
Cross Sectional Study ◽  
Study Data ◽  
Cross Sectional ◽  
Infant Attachment ◽  
Factors Affecting ◽  
Attachment Figure ◽  
Gynecology And Obstetrics ◽  
Significant Difference ◽  
Package Program ◽  
The Difference

Introduction: The primary attachment figure is mostly defined as the mother, and studies focus on the mother. However, in many babies, basic attachment is just as good with the father as with the mother. It is seen that there are very few studies in the literature investigating the correlations of father-infant attachment relationships.. The aim of this study is to determine the father-infant attachment status and to determine the factors affecting attachment. Method: The population of the cross-sectional study consisted of the spouses of all puerperant women hospitalized in the Gynecology and Obstetrics Clinic between September 1, 2018 and October 1, 2018. The sample size consisted of 156 fathers who agreed to participate in the study. Father identification form and father-infant attachment scale were used to collect the study data. The analysis of the data obtained from the research was carried out on the computer using the SPSS 16.0 package program. Results: 156 fathers participated in the study. The mean age of the fathers is 33.64±6.49, and 38.5% of them have a bachelor's degree. 91.0% of fathers stated that they felt ready for fatherhood. The fathers' Father-Infant Attachment Scale mean score was 82.60±7.72 In the analysis, the difference between the variables and the total score of the scale was found to be statistically insignificant (p>0.05). Discussion and Conclusion: At the end of the study, the bonding process of fathers participating in the study with their babies and the factors affecting this process were evaluated and it was seen that the father-infant attachment scale mean scores of the fathers participating in the study were high and were similar to other studies. In addition, when the basic factors affecting father-infant attachment were compared with the attachment scale mean score, it was found that there was no statistically significant difference.

Communication Difficulties and Psychoemotional Distress in Patients Receiving Mechanical Ventilation

2011 ◽  
Vol 20 (6) ◽  
pp. 470-479 ◽  
Author(s):  
Rabia Khalaila ◽  
Wajdi Zbidat ◽  
Kabaha Anwar ◽  
Abed Bayya ◽  
David M. Linton ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Psychological Distress ◽  
Endotracheal Tube ◽  
Structured Interview ◽  
Cross Sectional Study ◽  
Study Data ◽  
Cross Sectional ◽  
Stressful Experiences ◽  
Communication Methods

Background Difficulties in communication in intensive care patients receiving mechanical ventilation are a source of stressful experiences and psychoemotional distress. Objectives To examine the association between communication characteristics and psychoemotional distress among patients treated with mechanical ventilation in a medical intensive care unit and to identify factors that may be predictive of psychological outcomes. Methods A total of 65 critically ill patients, extubated within the preceding 72 hours, were included in this cross-sectional study. Data were collected by using a structured interview. Separate regression analysis of data on 3 psychoemotional outcomes (psychological distress, fear, and anger) were used for baseline variables, communication characteristics, and stressful experiences. Results Difficulty in communication was a positive predictor of patients’ psychological distress, and length of anesthesia was a negative predictor. Fear and anger were also positively related to difficulty in communication. In addition, the number of communication methods was negatively associated with feelings of fear and anger. Finally, the stressful experiences associated with the endotracheal tube were positively related to feelings of anger. Conclusions Patients treated with mechanical ventilation experience a moderate to extreme level of psychoemotional distress because they cannot speak and communicate their needs. Nurses should be aware of the patients’ need to communicate. Decreasing stressful experiences associated with the endotracheal tube and implementing more appropriate communication methods may reduce patients’ distress.

scholarly journals Does the approved tariff cover the actual cost of global surgical procedures?

2020 ◽  
Author(s):  
Ehsan Zarei ◽  
Maedehalsadadt Hashemi ◽  
Abbas Daneshkohan ◽  
Edris Kakemam
Keyword(s):  
Surgical Procedures ◽  
Cross Sectional Study ◽  
Study Data ◽  
Full Time ◽  
Actual Cost ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Supreme Council ◽  
The Difference

Abstract Background: Following the implementation of the health transformation plan in Iran and the significant increase in medical tariffs, it seems there is still a considerable gap between the actual cost of the Global Surgical procedures (GSPs) and the approved tariffs. The aim of this study was to compare the actual costs of GSPs with approved tariffs in hospitals affiliated to Qazvin University of Medical Sciences in 2016. Methods: In this cross-sectional study, data of 6,126 GSPs performed in three hospitals were extracted from Hospital Information System and approved tariffs were also obtained from the Supreme Council of Health Insurance. The difference between the average actual costs of a GSP and its tariff was considered as the tariff-actual cost gap. Regression test was used to determine the factors affecting the tariff-actual cost gap using SPSS.21. Results: The average actual cost of GPSs was 503 USD while the average tariff was 361 USD, indicating a significant negative gap between the approved tariffs and the actual cost of GPSs. In fact, for each procedure, the hospital suffered an average of 142 USD losses. In 54 of 63 GSPs, the average actual cost was 0.3% to 307.4% higher than the tariff. The highest negative gap was related to the “femoral fracture fixation" with -307.4%. The gap was higher in older patients, females, and patients with a longer stay, orthopedic specialty, and full-time surgeons (p<0.05). Conclusions: The findings of this study showed that tariffs covered only 71.8% of actual costs. It is suggested that in the tariff setting of GSPs, factors such as inflation rate, patient's age, comorbidity, disease severity, and hospital function (teaching or referral center) be considered. In addition, hospital management can also reduce the gap by modifying processes and managing resource consumption, especially medicines and consumables items.

Liver nodules after the Fontan operation: role of the computerised tomography scan

2021 ◽  
pp. 1-6
Author(s):  
Saviga Sethasathien ◽  
Suchaya Silvilairat ◽  
Rekwan Sittiwangkul ◽  
Krit Makonkawkeyoon ◽  
Yupada Pongprot ◽  
...  
Keyword(s):  
Ct Scan ◽  
Hepatic Vein ◽  
Fontan Operation ◽  
Cross Sectional Study ◽  
Fontan Patient ◽  
Cross Sectional ◽  
Liver Nodules ◽  
Non Invasive ◽  
Abdomen Ct ◽  
Upper Abdomen

Abstract Currently, there is an increasing prevalence of liver nodules in patients following the Fontan operation. The appropriate non-invasive modalities have been applied to assess a diagnosis of Fontan-associated liver disease. The aims of this study were to determine the prevalence and associated factors for the presence of liver nodules using CT scan. A cross-sectional study of 34 patients older than 15 years of age was recruited. Ultrasound upper abdomen, ultrasound liver elastography, and CT scan of the upper abdomen were performed after the Fontan operation. The median age of patients was 20 years (range 14–36 years). The median age at the Fontan operation was 7 years (range 5–17 years) and the duration after the Fontan operation was 12 years (range 4–22 years). The prevalence of liver nodules was 62% as detected by CT scans. Hepatic vein pressure in patients with liver nodules was significantly higher than in those without liver nodules. Hepatic vein pressure above 13 mmHg was a factor associated with liver nodules. There was little agreement between the ultrasound of the upper abdomen and CT scan of the upper abdomen in the evaluation of liver nodules. Hepatic pressure was the only associated factor for the occurrence of liver nodules in patients following the Fontan operation. The prevalence of liver nodules was very high after the Fontan operation. The upper abdomen CT scan should be performed for the surveillance of liver nodules in every Fontan patient over the age of 15 years.

scholarly journals Diabetes and Overweight/Obesity Are Independent, Nonadditive Risk Factors for In-Hospital Severity of COVID-19: An International, Multicenter Retrospective Meta-analysis

2021 ◽  
Author(s):  
Danielle K. Longmore ◽  
Jessica E. Miller ◽  
Siroon Bekkering ◽  
Christoph Saner ◽  
Edin Mifsud ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Invasive Ventilation ◽  
Site Specific ◽  
Non Invasive ◽  
Obesity And Diabetes ◽  
Non Invasive Ventilation

<a><b>OBJECTIVE</b><b> </b></a> <p>Obesity is an established risk factor for severe coronavirus disease 2019 (COVID-19) but the contribution of overweight and/or diabetes remain unclear. In a multi-center international study, we investigated if overweight, obesity and diabetes were independently associated with COVID-19 severity, and whether the body mass index (BMI)-associated risk was increased among those with diabetes. </p> <p> </p> <p><b>RESEARCH DESIGN & METHODS </b><b></b></p> <p>We retrospectively extracted data from health care records and regional databases of hospitalized adult patients with COVID-19 from 18 sites in 11 countries. We used standardized definitions and analyses to generate site-specific estimates, modelling the odds of each outcome (supplemental oxygen/non-invasive ventilation, invasive mechanical ventilation, and in-hospital mortality) by BMI category (reference, overweight, obese) adjusting for age, sex, and pre-specified co-morbidities. Subgroup analysis was performed on patients with pre-existing diabetes. Site-specific estimates were combined in a meta-analysis. </p> <p><u> </u></p> <p><b>RESULTS</b><b></b></p> <p>Among 7244 patients (65.6% overweight/obese), those with overweight were more likely to require oxygen/non-invasive ventilation (random effects adjusted odds ratio [aOR] 1.44 [95% CI 1.15-1.80]) and invasive mechanical ventilation (aOR 1.22 [CI 1.03-1.46]). There was no association between overweight and in-hospital mortality (aOR 0.88 [CI 0.74-1.04]). Similar effects were observed in patients with obesity or diabetes. In the subgroup analysis, the aOR for any outcome was not additionally increased in those with diabetes and overweight or obesity. </p> <p> </p> <p><b>CONCLUSIONS</b><b></b></p> <p>In adults hospitalized with COVID-19, overweight as well as obesity and diabetes were associated with increased odds of respiratory support but not mortality. In patients with diabetes, the odds of severe COVID-19 were not increased above the BMI-associated risk. </p>

scholarly journals A hospital based cross sectional study of acute pancreatitis with special reference to computed tomographic evaluation

2018 ◽  
Vol 5 (6) ◽  
pp. 1450
Author(s):  
Jyothi S. M. ◽  
Santosh U. Karpur
Keyword(s):  
Acute Pancreatitis ◽  
Ct Scan ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Computed Tomographic ◽  
Non Invasive ◽  
Precise Diagnosis ◽  
Acute Nature ◽  
Pancreatic Gland

Background: All suspected cases of acute pancreatitis should undergo CT scan. It is non invasive and reliable. CT scan is able to give complete picture of acute pancreatitis. The objective of the presentMethods: The present study was hospital based. 60 cases with evidence of acute pancreatitis were included. They were studied for 3 years from June 2015 to May 2018. CT scan was performed in all cases. CT features of the pancreas were noted and described.Results: Acute pancreatitis incidence was four times more in males compared to females i.e. 80% vs. 20%. CT scan showed that pancreatic gland was normal only in 16.7% of the cases. The contour was irregular in 66.7% of the cases. Eight cases showed necrosis. Less than 30% three patients (10%) had grade A acute pancreatitis. 28 cases were showing Phlegmonous changes. In 24 cases it was observed that lesser sac was affected.Conclusions: Authors conclude that for grading and staging of the pancreatitis of acute nature, CT scan is must and is very helpful to the clinicians. CT scan helps not only in precise diagnosis but also in predicting the proper prognosis of the patients who are affected by the pancreatitis of acute in nature.

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