scholarly journals CLINICAL AND LABORATORY FEATURES OF PULMONARY EMBOLISM IN PATIENTS WITH CORONAVIRUS INFECTION SARS-COV-2 AND ABDOMINAL OBESITY

2021 ◽  
Vol 19 (4) ◽  
pp. 444-450
Author(s):  
A. A. Pleshko ◽  
◽  
E. B. Petrova ◽  
◽  
◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Retrospective Analysis ◽  
Abdominal Obesity ◽  
Medical Records ◽  
Positive Relationship ◽  
Final Diagnosis ◽  
Computed Tomographic Angiography ◽  
Increased Risk ◽  
Laboratory Features ◽  
Coronavirus Infection

Background. At the present time more than 185 million people are infected with the new coronavirus infection (CVI) SARS-CoV-2, which caused COVID-19 pandemic according to WHO. The issue of increased risk of pulmonary embolism (PE) and associated severe course of the disease in persons with abdominal obesity (AO) is actively discussed in national and foreign publications. Objective of the study. To determine the clinical and laboratory features of PE in patients with abdominal obesity infected with SARS-CoV-2 Material and Methods. An analysis of 11.056 medical records of inpatients treated in the infectious disease departments for patients with COVID-19 of the 4th City Clinical Hospital named after N.E. Savchenko of Minsk during the period from April 1, 2020 to May 31, 2021 was performed. AO in subjects included in the retrospective analysis was determined according to WHO criteria as a body mass index greater than or equal to 30 kg/m2, waist circumference greater than 94 cm in men and 80 cm in women, respectively. To determine clinical and laboratory features of PE, as well as the effect of AO on the severity of this complication, inclusion/exclusion/exclusion criteria were developed and a sample of medical records of patients with COVID-19 (n=33), whose diagnosis of PE was verified by computed tomographic angiography of the chest (CTA chest) was formed. Clinical and instrumental parameters and laboratory characteristics were analyzed in the studied groups at the moment of admission to the hospital and at the time of PE development. Results. According to the results of a retrospective analysis of 11 056 medical records, the proportion of patients in whom the final diagnosis of PE was present was 3.68% (n=407), among whom AO was observed in 22.11% (n=90) of patients. The prevalence of subjects with impaired lipid metabolism among those included in the analysis was 11.38% (n=1259). PE developed in 90 patients with CVI and AO (0.81%) and in 317 patients without AO (2.87%). The prevalence of patients with PE (n=90) in the CVI and AO group (n=1259) was 7.15%; among those with CVI without AO (n=9797) - 3.24% (n=317). In the formed group with AO, C-reactive protein (CRP) and fibrinogen levels at hospitalization were higher than in the group of patients without AO: 116.64 (80.38-134.08) mg/L versus 30.21 (15.11-57.21) mg/L (U=36.04; p<0.01) and 6.97 (6.11 to 8.03) g/L versus 4.71 (4.02 to 5.59) g/L (U=12.0, p<0.01) respectively. On the day of suspected PE, CRP levels were higher in the group of patients with AO and COVID-19 than in the group of patients without AO: 71.01 (50.59-105.06) mg/L versus 34.01 (18.85-60.81) mg/L (U=49.00; p<0.05). In patients with CVI and PE, there was a moderate positive relationship between the presence of AO and the severe course of COVID-19 (r=0.41; p<0.05), AO and elevated fibrinogen levels on admission to the hospital (r=0.58 p <0.05), a strong positive relationship between the presence of AO and increased serum CRP level at the time of hospitalization (r = 0.76; p < 0.01), a moderate positive relationship between AO and CRP level determined at the time of development of PE (r = 0.51; p < 0.01). Conclusion. Among the patients with COVID-19 and AO complicated by the development of PE in comparison with patients without AR was determined a higher prevalence of individuals with a severe course of CVI (χ2=5,18; p<0.05), lower oxygen saturation values at admission and at the time of PE development (U =46.5; p<0.05) and (U=49.5; p<0.05), respectively, higher fibrinogen and CRP levels at the time of hospitalization (U=12.0; p<0.01) and (U=36.04; p<0.01), respectively, higher CRP values at the manifestation of PE (U=49.00; p<0.05). The obtained data indicates in favor of the fact that AO can be considered as a risk factor for the severe course of COVID-19. The pathophysiological basis of the development, course and prognosis of thromboembolic complications in patients with COVID-19 and AO requires further clarification during prospective follow-up of this category of patients.

scholarly journals D-dimer level has higher correlation with pulmonary embolism diagnosis than a clinical prediction score

2021 ◽  
Author(s):  
Joseph Lee ◽  
Ramin Alipour ◽  
Goran Mitric ◽  
Philip Masel ◽  
Jia Wen Chong
Keyword(s):  
Pulmonary Embolism ◽  
Medical Records ◽  
Risk Groups ◽  
Final Diagnosis ◽  
Prediction Score ◽  
Risk Category ◽  
Clinical Prediction ◽  
Pulmonary Embolism Diagnosis ◽  
The Absolute ◽  
D Dimer

Aim This study aimed to compare the predictive value of D-dimer and a clinical prediction score in diagnosis of pulmonary embolism (PE) as this could improve practice and reduce costs simultaneously. Method To achieve this, medical records of patients who presented to the Emergency Department of a large Australian metropolitan general hospital over 12 months and underwent DD testing were reviewed. The correlation coefficient (CC) was calculated using the Cramer’s V method. Results CC between low-, intermediate- and high-risk groups on their own and a final diagnosis of PE on imaging was 0.1332, 0.1278 and 0.0817, respectively. By contrast, the CC when using positive DD was higher for all categories: 0.7527, 0.6256 and 0.4195, respectively. For the age-adjusted DD, the correlations were higher than for the clinical prediction score but less than for the absolute DD; calculated at 0.6490, 0.4987 and 0.3550 for the respective groups. The overall CC for risk category was 0.1107; for a positive DD, it was 0.7033; for the age-adjusted DD, it was 0.5928. Conclusion Positive DD has a higher correlation with PE diagnosis than the clinical prediction score. DD assay, whether positive or negative, is therefore an invaluable test in assessment of patients with suspected PE and can help determine the need for tomographic imaging. The absolute DD is more useful than the age-adjusted value.

scholarly journals A Procedure for the Redefinition of Equivocal Results in Thyroid Function Tests

1980 ◽  
Vol 17 (5) ◽  
pp. 247-251
Author(s):  
David J Barnard ◽  
John P Bingle ◽  
C John Garratt
Keyword(s):  
Thyroid Hormone ◽  
Retrospective Analysis ◽  
Thyroid Function ◽  
Medical Records ◽  
Final Diagnosis ◽  
Thyroid Function Tests ◽  
Control Groups ◽  
Serum Thyroxine ◽  
New Information ◽  
Uptake Test

A retrospective analysis has been made of patients who had been classified (on the basis of measurements of serum thyroxine and thyroid hormone uptake test) as equivocal thyrotoxic (273 patients) or as equivocal hypothyroid (352 patients). The final diagnosis of these patients has been traced from their medical records. The results illustrate that control groups of euthyroid, thyrotoxic, and primary hypothyroid subjects differ from these equivocal groups. The populations initially classified as equivocal have been used to redefine the combinations of values obtained in the serum thyroxine and thyroid hormone uptake test which must be classed as equivocal. Using this redefinition, it is shown that a number of additional tests had been carried out when it could now be predicted with confidence that no useful new information would be obtained. The procedure described is not limited to tests of thyroid function and could easily be applied in most laboratories to redefine the ranges of results classified as equivocal.

Likelihood of a Subsequent Chemotherapy Induced Nausea and Vomiting Event In Patients with Hematologic Malignancies Receiving Chemotherapy.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3819-3819
Author(s):  
Bruce Feinberg ◽  
Lee S. Schwartzberg ◽  
James Gilmore ◽  
Sally Haislip ◽  
James Jackson ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Hematologic Malignancies ◽  
Emetogenic Chemotherapy ◽  
Nausea And Vomiting ◽  
Substantial Impact ◽  
Chemotherapy Administration ◽  
Increased Risk ◽  
Cancer Specialists

Abstract Abstract 3819 Objective: Chemotherapy induced nausea and vomiting (CINV) is a common side effect and can have a substantial impact on patient quality of life and subsequent health-related resource utilization. In addition to other risk factors including chemotherapy emetogenicity, patient age, gender, and alcohol use, patients with prior history of CINV may have an increased risk of CINV. This study assessed the increased likelihood of a subsequent CINV following a first chemotherapy administration CINV in patients with a hematologic cancer diagnosis receiving single-day low emetogenic chemotherapy (LEC), moderately emetogenic chemotherapy (MEC), or high emetogenic chemotherapy (HEC). Methods: A retrospective analysis was conducted utilizing a merged data set comprised of Georgia Cancer Specialists, Florida Cancer Specialists, and ACORN's electronic medical records databases (April 2006 – June 2010). Patients with any hematologic malignancy (those diagnosed with any leukemia, lymphoma, and/or myeloma (ICD-9-CM 200.xx-208.xx) who received at least two single-day chemotherapy administrations (oral or intravenous) and had no chemotherapy 3 months prior to first chemotherapy administration [index date] were included. Two cohorts: 1) patients with a first chemotherapy administration CINV event and 2) those with no first chemotherapy administration CINV event, were identified and followed for six months. Uncontrolled CINV events were identified through ICD-9-CM codes [nausea and vomiting (N&V)], CPT codes (hydration), rescue medications, N&V hospitalizations, and/or antiemetic therapy after last chemotherapy administration of the cycle. A multivariate logistic regression was conducted to assess the likelihood of subsequent CINV. The model controlled for differences in demographic and clinical variables between the two cohorts including age, gender, Charlson comorbidity index, number of chemotherapy administrations, days between chemotherapy administrations, anti-emetic prophylaxis use with first chemotherapy administration, and chemotherapy emetogenicity. Result: A total of 1,121 patients met the inclusion criteria; 247 (22.0%) experienced a CINV within six months. Of those patients with CINV, 68 patients (27.5%) encountered a CINV event with the first chemotherapy administration. These 68 patients were younger [55.9 (SD: 16.5) vs. 60.8 (SD: 16.1) years; p=0.016] and had fewer chemotherapy administrations [6.4 (SD: 3.0) vs. 8.1 (SD: 5.9); p=0.0189] as compared to patients with no CINV with the first chemotherapy administration. Unadjusted subsequent CINV rate was higher for patients with first chemotherapy administration CINV (33.8% vs. 17.0%; p=0.0005) as compared to patients without a CINV event during first chemotherapy administration. After controlling for differences in covariates, patients with first chemotherapy administration CINV were 2.8 times more likely to have a subsequent CINV compared to patients without a first chemotherapy administration CINV [Odds Ratio (OR): 2.84 (95% CI: 1.63 – 4.96); p=0.0002]. Conclusion: In this retrospective analysis using merged electronic medical records data, patients with hematologic malignancies receiving single-day chemotherapy who had a first chemotherapy administration CINV event were at increased risk of a subsequent CINV event versus those without a CINV event during the first chemotherapy administration. Disclosures: Jackson: Xcenda: Xcenda received funding to conduct the study. Jain:Xcenda: Xcenda received funding to conduct the study. Balu:Eisai, Inc.: Employment. Buchner:Eisai, Inc: Employment.

scholarly journals Routine screening for pulmonary embolism in COVID-19 patients at the emergency department: impact of D-dimer testing followed by CTPA

2021 ◽  
Author(s):  
Daniël A. Korevaar ◽  
Ilayda Aydemir ◽  
Maartje W. Minnema ◽  
Kaoutar Azijli ◽  
Ludo F. Beenen ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Anticoagulation Therapy ◽  
Final Diagnosis ◽  
Pulmonary Angiography ◽  
Considerable Proportion ◽  
University Hospitals ◽  
Screening Algorithm ◽  
Increased Risk ◽  
Complete Study ◽  
D Dimer

AbstractCOVID-19 patients have increased risk of pulmonary embolism (PE), but symptoms of both conditions overlap. Because screening algorithms for PE in COVID-19 patients are currently lacking, PE might be underdiagnosed. We evaluated a screening algorithm in which all patients presenting to the ED with suspected or confirmed COVID-19 routinely undergo D-dimer testing, followed by CT pulmonary angiography (CTPA) if D-dimer is ≥ 1.00 mg/L. Consecutive adult patients presenting to the ED of two university hospitals in Amsterdam, The Netherlands, between 01-10-2020 and 31-12-2020, who had a final diagnosis of COVID-19, were retrospectively included. D-dimer and CTPA results were obtained. Of 541 patients with a final diagnosis of COVID-19 presenting to the ED, 25 (4.6%) were excluded because D-dimer was missing, and 71 (13.1%) because they used anticoagulation therapy. Of 445 included patients, 185 (41.6%; 95%CI 37.0–46.3) had a D-dimer ≥ 1.00 mg/L. CTPA was performed in 169 of them, which showed PE in 26 (15.4%; 95%CI 10.3–21.7), resulting in an overall detection rate of 5.8% (95%CI 3.9–8.4) in the complete study group. In patients with and without PE at CTPA, median D-dimer was 9.84 (IQR 3.90–29.38) and 1.64 (IQR 1.17–3.01), respectively (p < 0.001). PE prevalence increased with increasing D-dimer, ranging from 1.2% (95%CI 0.0–6.4) if D-dimer was 1.00–1.99 mg/L, to 48.6% (95%CI 31.4–66.0) if D-dimer was ≥ 5.00 mg/L. In conclusion, by applying this screening algorithm, PE was identified in a considerable proportion of COVID-19 patients. Prospective management studies should assess if this algorithm safely rules-out PE if D-dimer is < 1.00 mg/L.

scholarly journals Incidence, characteristics, determinants and prognostic impact of recurrent syncope

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Zimmermann ◽  
J Du Fay De Lavallaz ◽  
T Nestelberger ◽  
D Gualandro ◽  
P Badertscher ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Coronary Intervention ◽  
Final Diagnosis ◽  
Major Adverse Cardiovascular Events ◽  
Unknown Etiology ◽  
Funding Source ◽  
Prognostic Impact ◽  
Lasso Regression ◽  
Recurrence Rates ◽  
Increased Risk

Abstract Background The incidence, characteristics, determinants, and prognostic impact of recurrent syncope are largely unknown, causing uncertainty for both patients and physicians. Methods We characterized recurrent syncope including sex-specific aspects and its impact on death and major adverse cardiovascular events (MACE) in a large prospective international multicenter study enrolling patients ≥40 years presenting with syncope to the emergency department (ED). Syncope etiology was centrally adjudicated by two independent and blinded cardiologists using all information becoming available during syncope work-up and 12-month follow-up. MACE were defined as a composite of all-cause death, acute myocardial infarction, surgical or percutaneous coronary intervention, life-threatening arrhythmia including cardiac arrest, pacemaker or implantable cardioverter defibrillator implantation, valve intervention, heart-failure, gastrointestinal bleeding or other bleeding requiring transfusion, intracranial hemorrhage, ischemic stroke or transient ischemic attack, sepsis and pulmonary embolism. Results Incidence of recurrent syncope among 1790 patients was 20% (95%-confidence interval (CI) 18% to 22%) within 24 months. Patients with an adjudicated final diagnosis of cardiac syncope (hazard ratio (HR) 1.50, 95%-CI 1.11 to 2.01) or syncope of unknown etiology even after central adjudication (HR 2.11, 95%-CI 1.54 to 2.89) had an increased risk for syncope recurrence (Figure). LASSO regression fit on all patient information available early in the ED identified more than three previous episodes of syncope as the only independent predictor for recurrent syncope (HR 2.13, 95%-CI 1.64 to 2.75). Recurrent syncope within the first 12 months after the index event carried an increased risk for all-cause death (HR 1.59, 95%-CI 1.06 to 2.38) and MACE (HR 2.24, 95%-CI 1.67 to 3.01), whereas recurrences after 12 months did not have a significant impact on outcome measures. Conclusion Recurrence rates of syncope are substantial and vary depending on syncope etiology. There seem to be no reliable patient characteristics available early on the ED that allow for the prediction of recurrent syncope with only a history of more than three previous syncope being associated with a higher risk for future recurrences. Importantly, recurrent syncope within the first 12 months carries an increased risk for death and MACE. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

scholarly journals An artificial neural network approach integrating plasma proteomics and genetic data identifies PLXNA4 as a new susceptibility locus for pulmonary embolism

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Misbah Razzaq ◽  
Maria Jesus Iglesias ◽  
Manal Ibrahim-Kosta ◽  
Louisa Goumidi ◽  
Omar Soukarieh ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Genome Wide Association Study ◽  
Susceptibility Gene ◽  
Biological Traits ◽  
Nucleotide Polymorphisms ◽  
Ann Model ◽  
Neural Network Approach ◽  
A Genome ◽  
Increased Risk ◽  
Artificial Neural

AbstractVenous thromboembolism is the third common cardiovascular disease and is composed of two entities, deep vein thrombosis (DVT) and its potential fatal form, pulmonary embolism (PE). While PE is observed in ~ 40% of patients with documented DVT, there is limited biomarkers that can help identifying patients at high PE risk. To fill this need, we implemented a two hidden-layers artificial neural networks (ANN) on 376 antibodies and 19 biological traits measured in the plasma of 1388 DVT patients, with or without PE, of the MARTHA study. We used the LIME algorithm to obtain a linear approximate of the resulting ANN prediction model. As MARTHA patients were typed for genotyping DNA arrays, a genome wide association study (GWAS) was conducted on the LIME estimate. Detected single nucleotide polymorphisms (SNPs) were tested for association with PE risk in MARTHA. Main findings were replicated in the EOVT study composed of 143 PE patients and 196 DVT only patients. The derived ANN model for PE achieved an accuracy of 0.89 and 0.79 in our training and testing sets, respectively. A GWAS on the LIME approximate identified a strong statistical association peak (rs1424597: p = 5.3 × 10–7) at the PLXNA4 locus. Homozygote carriers for the rs1424597-A allele were then more frequently observed in PE than in DVT patients from the MARTHA (2% vs. 0.4%, p = 0.005) and the EOVT (3% vs. 0%, p = 0.013) studies. In a sample of 112 COVID-19 patients known to have endotheliopathy leading to acute lung injury and an increased risk of PE, decreased PLXNA4 levels were associated (p = 0.025) with worsened respiratory function. Using an original integrated proteomics and genetics strategy, we identified PLXNA4 as a new susceptibility gene for PE whose exact role now needs to be further elucidated.

scholarly journals Detection of Prions in Brain Homogenates and CSF Samples Using a Second-Generation RT-QuIC Assay: A Useful Tool for Retrospective Analysis of Archived Samples

Pathogens ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 750
Author(s):  
Tibor Moško ◽  
Soňa Galušková ◽  
Radoslav Matěj ◽  
Magdalena Brůžová ◽  
Karel Holada
Keyword(s):  
Retrospective Analysis ◽  
Prion Disease ◽  
Second Generation ◽  
Prion Diseases ◽  
Neuropsychiatric Symptoms ◽  
Final Diagnosis ◽  
Post Mortem ◽  
Long Term Storage ◽  
Archived Samples

The possibilities for diagnosing prion diseases have shifted significantly over the last 10 years. The RT-QuIC assay option has been added for neuropsychiatric symptoms, supporting biomarkers and final post-mortem confirmation. Samples of brain homogenates used for final diagnosis, archived for many years, provide the possibility for retrospective studies. We used a second-generation RT-QuIC assay to detect seeding activity in different types of sporadic and genetic prion diseases in archival brain homogenates and post-mortem CSF samples that were 2 to 15 years old. Together, we tested 92 archival brain homogenates: 39 with definite prion disease, 28 with definite other neurological disease, and 25 with no signs of neurological disorders. The sensitivity and specificity of the assay were 97.4% and 100%, respectively. Differences were observed in gCJD E200K, compared to the sporadic CJD group. In 52 post-mortem CSF samples—24 with definite prion disease and 28 controls—we detected the inhibition of seeding reaction due to high protein content. Diluting the samples eliminated such inhibition and led to 95.8% sensitivity and 100% specificity of the assay. In conclusion, we proved the reliability of archived brain homogenates and post-mortem CSF samples for retrospective analysis by RT-QuIC after long-term storage, without changed reactivity.

scholarly journals Correlation between Potential Risk Factors and Pulmonary Embolism in Sarcoidosis Patients Timely Treated

2021 ◽  
Vol 10 (11) ◽  
pp. 2462
Author(s):  
Barbara Ruaro ◽  
Paola Confalonieri ◽  
Mario Santagiuliana ◽  
Barbara Wade ◽  
Elisa Baratella ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Potential Risk ◽  
Smoking Habit ◽  
Age At Diagnosis ◽  
Antiphospholipid Antibody ◽  
Increased Risk ◽  
Significant Difference ◽  
Antibody Positivity ◽  
Potential Risk Factors

Background. Some studies with inconclusive results have reported a link between sarcoidosis and an increased risk of pulmonary embolism (PE). This study aimed at assessing a possible correlation between potential risk factors and PE in sarcoidosis patients. Methods. A total of 256 sarcoidosis patients (84 males and 172 females; mean age at diagnosis 49 ± 13) were enrolled after giving written informed consent. Clinical evaluations, laboratory and radiology tests were performed to evaluate the presence of pulmonary embolism. Results. Fifteen sarcoidosis patients with PE (4 males and 11 females; mean age at diagnosis 50 ± 11), diagnosed by lung scintigraphy and 241 sarcoidosis patients without PE (80 males and 161 females; mean age at diagnosis 47 ± 13), were observed. There was a statistically significant increase of the presence of antiphospholipid antibodies in the sarcoidosis group with pulmonary embolism. There was no statistically significant difference between the two groups as to smoking habit, obesity or hereditary thrombophilia frequency (p > 0.05, respectively). Conclusions. This study demonstrates a significant correlation between the presence of antiphospholipid antibody positivity and the pulmonary embolism events in our sarcoidosis patients. Furthermore, we propose screening for these antibodies and monitoring, aimed at timely treatment.

scholarly journals Gender Differences in Psychosocial Outcomes of Hair Loss Resulting from Childhood Irradiation for Tinea Capitis

2021 ◽  
Vol 18 (15) ◽  
pp. 7825
Author(s):  
Liat Hoffer ◽  
Netta Achdut ◽  
Shifra Shvarts ◽  
Dorit Segal-Engelchin
Keyword(s):  
Gender Differences ◽  
Hair Loss ◽  
Medical Records ◽  
Tinea Capitis ◽  
Psychosocial Outcomes ◽  
Self Esteem ◽  
Psychosocial Needs ◽  
Increased Risk ◽  
Physical Health Problems ◽  
Physical Bullying

Recent studies have linked hair loss due to childhood irradiation for tinea capitis, a fungal infection of the scalp, to adverse psychosocial and health outcomes in women. However, no study to date has examined gender differences in the outcomes of this type of hair loss. The current study aimed to investigate gender differences in health and psychosocial outcomes of hair loss resulting from childhood irradiation for tinea capitis, and to identify the risk factors associated with depression in both men and women. Medical records held at the archives of the Israel National Center for Compensation of Scalp Ringworm Victims were retrospectively reviewed for 217 women and 105 men who received maximum disability compensation due to severe hair loss resulting from irradiation for tinea capitis. We found that women were at increased risk of developing psychosocial symptoms, including depression. Gender emerged as a significant predictor of depression, distinct from other predictors, such as marital status, age at radiation, exposure to verbal and physical bullying, low self-esteem, social anxiety, and physical health problems. Thus, the psychosocial needs of patients, particularly female patients, who were irradiated for tinea capitis during childhood need to be taken into account by the healthcare professionals treating them.

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