scholarly journals Indicators of Adrenal Insufficiency in TB-suspect Patients Presenting with Signs and Symptoms of Adrenal Insufficiency at Three South African Hospitals in Pretoria

2020 ◽  
Vol 13 (1) ◽  
pp. 178-187
Author(s):  
Langalibalele H. Mabuza ◽  
Daniel F. Sarpong
Keyword(s):  
Adrenal Insufficiency ◽  
District Hospital ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Serum Glucose ◽  
Cd4 Count ◽  
Fasting Serum ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Fasting Serum Glucose

Background: Primary adrenal insufficiency occurs when the function of the adrenal cortex to produce cortisol is impaired. Infections, such as disseminated Tuberculosis (TB) and malignancies, are the major causes of Adrenal Insufficiency (AI) in developing countries. AI is characterized by specific symptoms, signs, and laboratory findings. Objective: To determine indicators of AI in TB-suspect patients presenting with signs and symptoms of AI. Methods: A cross-sectional study was conducted at the primary health care ward of Dr. George Mukhari Academic Hospital, Jubilee District Hospital, and Odi District Hospital. The population comprised all TB-suspects, from whom a sample of 75respondents was obtained. A researcher administered questionnaire was used to collect data related to their signs, symptoms, and laboratory findings. Results: Of the 75 respondents, 47 (62.37) and 28 (37.3%) were classified as Adrenal Sufficiency (AS) and AI, respectively. The most occurring symptoms were craving for salt, dry, itchy skin, and vomiting (prevalence: 79.7%, 68.1%, and 69.0%, respectively). Signs or symptoms by themselves did not discriminate persons with a high likelihood of AI. However, a fasting serum glucose (≤ 5.25 mmol/L), a positive GeneXpect, a low CD4 count (≤ 274.5 cells/ml), with a combination of signs and symptoms (9.5) constituted a discriminator for AI in TB-suspect patients (87.5% likelihood). Conclusion: A low fasting serum glucose, a positive GeneXpect, a low CD4 count with a minimum of ten signs and symptoms constitute a discriminator for AI in TB-suspect patients, necessitating treatment initiation to save patient lives in laboratory resource-limited settings.

scholarly journals Risk factors associated with COVID-19 Intensive Care Unit hospitalisation in Guyana: A cross-sectional study

2021 ◽  
Author(s):  
Steven A. Seepersaud
Keyword(s):  
Risk Factors ◽  
Retrospective Chart Review ◽  
Binary Logistic Regression ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Factors Associated ◽  
Independent Variables ◽  
Icu Admission

Objective The purpose of the study was to determine risk factors associated with COVID-19 ICU hospitalisation at Georgetown Public Hospital Corporation (GPHC), Guyana. Methods A retrospective chart-review was conducted on all COVID-19 admissions from March to September 2020. The predictive factors were demographics, comorbidities, signs and symptoms of COVID-19 and laboratory findings on admission. Descriptive frequency analysis was done for all independent variables and the Chi-square test was used to compare differences between groups where suitable. Univariate and multivariate binary logistic regression was used to examine the association between the independent variables and the risk for ICU hospitalisation. Results There were 136 patients with COVID-19 at GPHC during March to September 2020 and after exclusion, 135 patients were used in the study. There were 72 (53.4%) patients who required non-ICU care, while 63 (46.6%) ICU care and average age ± SD (median) was 51 ±16 (n= 49) and 56 ±18 (n= 60), respectively. In the multivariate regression model, the odds of ICU admission for those aged 40-65 was 0.14 (p <.01) compared to those > 65 years. Patients with class 2 and above obesity had higher odds of ICU admission compared to non-obese patients OR 11.09 (p= .006). Patients with 2 and 3 or more comorbidities also had higher odds of ICU admission compared to those with no comorbidities OR 7.83 (p= .03) and 132 (p <.001), respectively. Patients with LDH 228-454 U/L and > 454 U/L on admission had higher odds of ICU admission compared to those with normal LDH OR 19.88 (p= .001) and 23.32 (p= .001), respectively. Patients with albumin < 3.50 mg/dL on admission also had higher odds of ICU admission compared to those with normal albumin OR 5.78 (p= .005). Conclusion Risk factors associated with ICU hospitalisation were advanced age, obesity, multiple comorbidities, elevated LDH and low albumin. Protecting the population at risk for ICU admission and prioritizing them for vaccination is recommended to reduce the risk of running out of ICU capacity.

scholarly journals CO-St (COVID 19- study): impact of the management of men versus women in the treatment of Covid 19. A Multi-Centric Observational study

2021 ◽  
Author(s):  
Tiziana Ciarambino ◽  
filomena pietrantonio ◽  
Sara Rotunno ◽  
Alessandra Fiorentini ◽  
Rosalba Cipriani ◽  
...  
Keyword(s):  
Oxygen Therapy ◽  
Signs And Symptoms ◽  
Epidemiological Data ◽  
Cross Sectional Study ◽  
Antiviral Drugs ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Significant Difference ◽  
Rehabilitation Ward ◽  
Epidemiological Link

Background: from December 2019 and the spreading of syndemics, a lot of medical centers reg-istered data about their patients. In Italy, the most relevant quantity of patients was hospitalized in internal medicine wards. Methods: In this observational, retrospective cross-sectional study, all data of the COVID-19 patients, admitted Latio hospitals, from March 01 to December 31, 2020, were collected and their Epidemiological data, demographics, signs and symptoms on admission, comorbidities, laboratory findings, chest radiography and CT findings, treatment received and mortality rate were analyzed by gender to find any differences of gravity of disease. Clinician details were registered on database (one for every hospital). Cost analysis was performed by length of stay and antiviral drugs use, using point of view of Italian Healthcare System. Results: 2256 patients with mean age of 71.01 ± 28.02 years were included. For men, frequency of hyper-tension, COPD, use of oxygen therapy, Tocilizumab were significantly higher and epidemiolog-ical link was related to rehabilitation ward and community. The gender difference about hospi-talization was one day more for man. No strong significant difference by gender in the death rate was observed. Considering antiviral drugs and hospitalization, a man costs €1000 more than woman. Conclusions: In male patients, hypertension and COPD were observed more frequently and the epidemiological link was related to rehabilitation ward and community. In female sub-jects, the epidemiological link was related to Hospital and we observed significantly higher atypical chest-X ray. Tocilizumab, oxygen therapy and antiviral drugs were prescribed more in male subjects. No differences by gender we report in other treatments and outcomes. Future studies should be analyzed to get a more comprehensive understanding of COVID-19 by gender.

scholarly journals Serum Glucose Measurement after Five to Six Hours is Comparable to Eight Hours Overnight Fasting in Ramadan

2021 ◽  
Author(s):  
Ammar M.S. Almomin ◽  
Samih A. Odhaib ◽  
Mahmood T. Altemimi ◽  
Hussein A. Nwayyir ◽  
Ibrahim H. Hussein ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Serum Glucose ◽  
Glucose Measurement ◽  
Fasting Serum ◽  
Cross Sectional ◽  
Fasting Serum Glucose ◽  
Two Samples ◽  
Significant Difference ◽  
Overnight Fasting ◽  
Fasting Duration

Objectives: This study was done to evaluate whether a shorter fasting duration of five to six hours can be used as an alternative to the usually recommended eight hours fasting serum glucose measurement. Methods: An observational, cross-sectional study was conducted during Ramadan (May) 2019, on 200 individuals. Two fasting serum glucose (FSG) venous samples taken, the first after 5-6 hours after predawn meal (suhoor), and the second after 8 hours. Participants were divided into two groups; normal individuals, and those who have type 2 diabetes mellitus (T2DM). Patients with T2DM further subdivided into three groups: those without treatment, those on oral antidiabetic drugs (OAD), and those using insulin and OAD. Results: There was no significant difference between the mean FSG readings in mg/dL (mmol/L) between the first and second samples for healthy individuals, 104.5 ± 21.4 (5.79±1.18) and 104.8 ± 12.6 (5.82±0.7), respectively. Generally, the same is true for T2DM patients with FSG values of 235 ± 107 (13.04±5.94) and 230 ± 105 (12.77±5.83). Untreated T2DM patients have consecutive FSG readings of 194.0 ± 151.5 (10.77±8.41) and 193.9 ± 128.9 (10.76±7.15), respectively, in the two samples without significant difference. Patients using insulin and OAD showed similar pattern of FSG 268 ± 111 (14.87±6.16) and 269 ± 114 (14.93±6.33), respectively. The only significant difference was observed in patients on OAD which have 220 ± 78 (12.21±4.33) and 207 ± 77 (11.49±4.27) for their successive FSG samples. Conclusions: The overnight fasting duration of 5-6 hours, can give a comparable measurement of fasting serum glucose as that obtained by 8 hours. Keywords: Glucose; Fasting; Duration; Diabetes Mellitus

scholarly journals Suicidal ideation, psychopathology and associated factors among HIV-infected adults in Indonesia

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Youdiil Ophinni ◽  
Adrian ◽  
Kristiana Siste ◽  
Martina Wiwie ◽  
Gina Anindyajati ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Single Point ◽  
Cross Sectional Study ◽  
Anxiety Symptoms ◽  
Cd4 Count ◽  
Depression Symptoms ◽  
Early Screening ◽  
Cross Sectional ◽  
Aids Epidemic ◽  
Hiv Aids

Abstract Background Suicidal behavior is a prevalent psychiatric emergency in HIV-infected adults. Detection of suicidal ideation is important in planning early psychiatric intervention and optimizing HIV/AIDS management. Characterization of suicidal ideation among HIV-infected adults is crucial; however, practically there is no data in Indonesia, the country with the second largest burden of HIV/AIDS epidemic in Asia. This study aims to identify suicidal ideation and analyze the associated psychopathology and determining factors among HIV-infected adults in Indonesia. Methods An observational cross-sectional study was conducted among HIV-infected adults aged 18–65 years old receiving antiretroviral therapy (ART). Measurement using Symptom Checklist-90 (SCL-90) was performed to assess the existing psychopathology. Firth’s penalized logistic regression analysis was performed to identify factors associated with suicidal ideation. Results A total of 86 subjects were recruited. Most subjects were male (65.1%), median age was 35 years, and median latest CD4 count was 463 cells/μl. Lifetime suicidal ideation was identified in 20 subjects (23.3%). Mean SCL-90 T-score for depressive and anxiety symptoms were both significantly higher among subjects with suicidal ideation (M = 60.75, SD = 12.0, p = 0.000 and M = 57.9, SD = 2.8, p = 0.001, respectively) compared to those without. Bivariate analyses showed that lifetime suicidal ideation was associated with depressive and anxiety symptoms, non-marital status, CD4 count < 500 cells/μl, and efavirenz use. Multivariate analysis identified that a single-point increase in SCL-90 depression symptoms score (AOR 1.16, 95% CI 4.5–123.6, p = 0.000) and efavirenz use (AOR 5.00, 95% CI 1.02–24.6, p = 0.048) were significant independent factors related to suicidal ideation. Conclusion Suicidal ideation is commonly found among Indonesian HIV-infected adults on ART. Depressive symptoms and efavirenz use are independent factors related to the presence of suicidal ideation. Thus, early screening of psychopathology as well as substitution of efavirenz with other ART regiment are recommended to prevent suicide and improve HIV/AIDS management outcome.

Development of a prediction rule for diagnosing postoperative meningitis: a cross-sectional study

2018 ◽  
Vol 128 (1) ◽  
pp. 262-271 ◽  
Author(s):  
Olga Helena Hernández Ortiz ◽  
Héctor Iván García García ◽  
Fabián Muñoz Ramírez ◽  
Juan Sebastián Cardona Flórez ◽  
Bladimir Alejandro Gil Valencia ◽  
...  
Keyword(s):  
Prediction Rule ◽  
Cross Sectional Study ◽  
Serum Glucose ◽  
Csf Leak ◽  
Bivariate Analysis ◽  
Cross Sectional ◽  
Glucose Ratio ◽  
Neurosurgical Patients ◽  
Csf Lactate ◽  
Postoperative Meningitis

OBJECTIVEDiagnosing nosocomial meningitis (NM) in neurosurgical patients is difficult. The standard CSF test is not optimal and when it is obtained, CSF cultures are negative in as many as 70% of cases. The goal of this study was to develop a diagnostic prediction rule for postoperative meningitis using a combination of clinical, laboratory, and CSF variables, as well as risk factors (RFs) for CNS infection.METHODSA cross-sectional study was performed in 4 intensive care units in Medellín, Colombia. Patients with a history of neurosurgical procedures were selected at the onset of febrile symptoms and/or after an increase in acute-phase reactants. Their CSF was studied for suspicion of infection and a bivariate analysis was performed between the dependent variable (confirmed/probable NM) and the identified independent variables. Those variables with a p value ≤ 0.2 were fitted in a multiple logistic regression analysis with the same dependent variable. After determining the best model according to its discrimination and calibration, the β coefficient for each selected dichotomized variable obtained from the logistic regression model was used to construct the score for the prediction rule.RESULTSAmong 320 patients recruited for the study, 154 had confirmed or probable NM. Using bivariate analysis, 15 variables had statistical associations with the outcome: aneurysmal subarachnoid hemorrhage (aSAH), traumatic brain injury, CSF leak, positioning of external ventricular drains (EVDs), daily CSF draining via EVDs, intraventricular hemorrhage, neurological deterioration, age ≥ 50 years, surgical duration ≥ 220 minutes, blood loss during surgery ≥ 200 ml, C-reactive protein (CRP) ≥ 6 mg/dl, CSF/serum glucose ratio ≤ 0.4 mmol/L, CSF lactate ≥ 4 mmol/L, CSF leukocytes ≥ 250 cells, and CSF polymorphonuclear (PMN) neutrophils ≥ 50%. The multivariate analysis fitted a final model with 6 variables for the prediction rule (aSAH diagnosis: 1 point; CRP ≥ 6 mg/dl: 1 point; CSF/serum glucose ratio ≤ 0.4 mmol/L: 1 point; CSF leak: 1.5 points; CSF PMN neutrophils ≥ 50%: 1.5 points; and CSF lactate ≥ 4 mmol/L: 4 points) with good calibration (Hosmer-Lemeshow goodness of fit = 0.71) and discrimination (area under the receiver operating characteristic curve = 0.94).CONCLUSIONSThe prediction rule for diagnosing NM improves the diagnostic accuracy in neurosurgical patients with suspicion of infection. A score ≥ 6 points suggests a high probability of neuroinfection, for which antibiotic treatment should be considered. An independent validation of the rule in a different group of patients is warranted.

scholarly journals Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies

2010 ◽  
Vol 162 (3) ◽  
pp. 597-602 ◽  
Author(s):  
Stefanie Hahner ◽  
Melanie Loeffler ◽  
Benjamin Bleicken ◽  
Christiane Drechsler ◽  
Danijela Milovanovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adrenal Insufficiency ◽  
Educational Status ◽  
Cross Sectional Study ◽  
Sudden Onset ◽  
Stressful Events ◽  
Adrenal Crisis ◽  
Cross Sectional ◽  
Crisis Prevention ◽  
Dhea Treatment

ObjectiveAdrenal crisis (AC) is a life-threatening complication of adrenal insufficiency (AI). Here, we evaluated frequency, causes and risk factors of AC in patients with chronic AI.MethodsIn a cross-sectional study, 883 patients with AI were contacted by mail. Five-hundred and twenty-six patients agreed to participate and received a disease-specific questionnaire.ResultsFour-hundred and forty-four datasets were available for analysis (primary AI (PAI), n=254; secondary AI (SAI), n=190). Forty-two percent (PAI 47% and SAI 35%) reported at least one crisis. Three hundred and eighty-four AC in 6092 patient years were documented (frequency of 6.3 crises/100 patient years). Precipitating causes were mainly gastrointestinal infection and fever (45%) but also other stressful events (e.g. major pain, surgery, psychic distress, heat and pregnancy). Sudden onset of apparently unexplained AC was also reported (PAI 6.6% and SAI 12.7%). Patients with PAI reported more frequent emergency glucocorticoid administration (42.5 vs 28.4%, P=0.003). Crisis incidence was not influenced by educational status, body mass index, glucocorticoid dose, DHEA treatment, age at diagnosis, hypogonadism, hypothyroidism or GH deficiency. In PAI, patients with concomitant non-endocrine disease were at higher risk of crisis (odds ratio (OR)=2.02, 95% confidence interval (CI) 1.05–3.89, P=0.036). In SAI, female sex (OR=2.18, 95% CI 1.06–4.5, P=0.035) and diabetes insipidus (OR=2.71, 95% CI 1.22–5.99, P=0.014) were associated with higher crisis incidence.ConclusionAC occurs in a substantial proportion of patients with chronic AI, mainly triggered by infectious disease. Only a limited number of risk factors suitable for targeting prevention of AC were identified. These findings indicate the need for new concepts of crisis prevention in patients with AI.

A Cross-Sectional Study to Compare Differences on Clinical and Laboratory Findings in Children with Seropositive and Seronegative Lupus

2021 ◽  
Author(s):  
Shima Salehi ◽  
Rozita Hosseini Shamsabadi ◽  
Hassan Otukesh ◽  
Reza Shiari ◽  
Monir Sharafi
Keyword(s):  
Autoimmune Disease ◽  
Disease Diagnosis ◽  
Cross Sectional Study ◽  
Rapid Identification ◽  
The Body ◽  
Musculoskeletal Symptoms ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Significant Difference ◽  
History Of

Abstract Background: Lupus is an inflammatory and autoimmune disease that involves various tissues and organs of the body. Identification of diagnostic elements to rapid identification of seronegative lupus cases is very important in order to prevent morbidity and progression of disease. This study aimed to compare clinical and laboratory findings of seropositive cases with seronegative lupus patients. Methods: This cross-sectional analytic study was performed on 43 children (17 seronegative and 26 seropositive) with lupus who were admitted to Ali Asghar Hospital during 2007-2017. Seropositive patients had anti-nuclear antibody (ANA) titration >1/80, while seronegative patients had ANA titration <1/80 (at the time of disease diagnosis). Clinical and laboratory findings were compared between two groups.Results: Serositis in patients with ANA- was significantly higher than ANA+ (41.17% vs. 23.07%; p = 0.042). ANA- group had higher autoimmune disease history than ANA+ group (42.85% vs. 15.0%; p = 0.041). The family history of the disease in the ANA- group was greater than ANA+ group (50% vs. 23.52%). The percentage of hypertensive patients in ANA- group was higher than ANA+ group (52.94% vs. 26.92%; p = 0.037). Neurologic symptoms in ANA+ and ANA- groups were 38.46% and 17.64%, respectively (p = 0.043). The frequency of patients with thrombocytopenia in ANA+ group was significantly greater than ANA- group (32% vs. 12.5%; p=0.041). There was no significant difference in other clinical and laboratory findings between two groups. Conclusion: Seronegative lupus patients had higher percentage of musculoskeletal symptoms, autoimmune disease history, familial history of disease, and hypertension, while neurological and thrombocytopenia symptoms were higher in seropositive patients compared to seronegative cases. Therefore, evaluation of these factors can be helpful to diagnosis of seronegative patients.

scholarly journals Signs and symptoms in Gaucher Disease: priority nursing diagnoses

2018 ◽  
Vol 71 (1) ◽  
pp. 104-110 ◽  
Author(s):  
Márcia Koja Breigeiron ◽  
Vitória da Costa Moraes ◽  
Janice Carneiro Coelho
Keyword(s):  
Gaucher Disease ◽  
Bone Pain ◽  
Genetic Diagnosis ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Physical Mobility ◽  
Risk For Bleeding ◽  
Nursing Diagnoses

ABSTRACT Objective: Identify the signs and symptoms of patients with Gaucher Disease, inferring possible priority nursing diagnoses. Method: Cross-sectional study, developed in a specialized laboratory, between 2013 and 2015. The sample (n = 91) comprised the records of patients with genetic diagnosis for Gaucher Disease. The study respected research norms. Results: Prevalence of female sex (57.1%), age at diagnosis between 0 and 10 years, and origin from the Southeast Region of Brazil were prevalent. Hematologic changes, bone pain, hepatomegaly, splenomegaly, and fatigue were the most recurrent signs and symptoms. The inferred diagnoses for the studied population were: Risk for bleeding; Fatigue; Chronic pain and Acute pain; Impaired physical mobility; Imbalanced nutrition: less than body requirements; and Risk for Developmental Delay. Conclusion: The establishment of Priority Nursing Diagnoses based on signs and symptoms makes it possible to achieve expected outcomes for each individual in the care context.

scholarly journals Pain in emergency units: correlation with risk classification categories

2018 ◽  
Vol 26 (0) ◽  
Author(s):  
Wandressa Letícia Viveiros ◽  
Meiry Fernanda Pinto Okuno ◽  
Cássia Regina Vancini Campanharo ◽  
Maria Carolina Barbosa Teixeira Lopes ◽  
Gabriella Novelli Oliveira ◽  
...  
Keyword(s):  
Signs And Symptoms ◽  
Medical Specialty ◽  
Cross Sectional Study ◽  
Risk Classification ◽  
Moderate Intensity ◽  
Ratio Test ◽  
Intense Pain ◽  
Cross Sectional ◽  
Mild Pain

ABSTRACT Objectives: to correlate risk classification categories with the level of pain of patients in an emergency service. Method: cross-sectional study carried out in the Risk Classification of 611 patients. The variables studied were: age, gender, comorbidities, complaint duration, medical specialty, signs and symptoms, outcome, color attributed in the risk classification of and degree of pain. We used Analysis of Variance, a Chi-Square test and a Likelihood Ratio test. Results: the average age was 42.1 years (17.8); 59.9% were women; the green (58.9%) and yellow (22.7%) risk classification prevailed and hypertension (18.3%) was the most common Comorbidity. The most frequent pain intensity was moderate (25.9%). In the red category, patients presented a higher percentage of absence of pain; in the blue, mild pain; and in the green, yellow and orange categories, there was a greater percentage of intense pain (p < 0.0001). Conclusion: among the patients who presented pain, the majority reported moderate intensity. Regarding risk categories, most patients in the red category did not report pain. Those who were classified as green, yellow and orange, reported mostly intense pain. On the other hand, patients in the blue category reported predominantly mild pain.

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