scholarly journals Anticoagulation is the Answer in Treating Non-Critical COVID-19 Patients

2021 ◽  
Author(s):  
Azad A Kabir
Keyword(s):  
Chart Review ◽  
Early Stage ◽  
Survival Rates ◽  
Factor Xa ◽  
Retrospective Chart Review ◽  
Oxygen Requirement ◽  
Direct Factor Xa Inhibitors ◽  
Dose Oral ◽  
Alveolar Capillary ◽  
D Dimer

All autopsy studies demonstrated widespread thrombosis and alveolar-capillary microthrombi as the cause of death among patients with COVID-19. The autopsy studies are the gold standard for diagnostic accuracy and therapeutic strategies for any clinical scenario. The author initially observed that patients already taking therapeutic dose oral direct factor Xa inhibitors for an unrelated reason, have significantly better survival rates than those not taking any anticoagulants. This influenced the author to conduct a retrospective chart review of the Jackson Hospital (Alabama) hospitalized patients to evaluate the effect of variable doses of anticoagulation among COVID-19 patients. The study found that serum inflammatory bio-marker D-Dimer trends are associated with changes in oxygen requirement among patients with COVID-19 if patients present at an early stage and titration of Enoxaparin (anticoagulation) dose based on D-Dimer trends leads to increased patient survival.

scholarly journals Anticoagulation is the answer in treating noncritical COVID-19 patients

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 1486-1492
Author(s):  
Azad A. Kabir
Keyword(s):  
Chart Review ◽  
Early Stage ◽  
Survival Rates ◽  
Factor Xa ◽  
Retrospective Chart Review ◽  
Oxygen Requirement ◽  
Clinical Scenarios ◽  
Direct Factor Xa Inhibitors ◽  
Alveolar Capillary ◽  
D Dimer

Abstract All autopsy studies demonstrated widespread thrombosis and alveolar-capillary microthrombi as the cause of death among patients with COVID-19. The autopsy studies are the gold-standard for diagnostic accuracy and therapeutic strategies for any clinical scenarios. The author initially observed that patients already taking therapeutic dose of oral direct factor Xa inhibitors for an unrelated reason, have significantly better survival rates than those not taking any anticoagulants. This influenced the author to conduct a retrospective chart review of the hospitalized patients in Jackson Hospital (Alabama) to evaluate the effect of variable doses of anticoagulation among COVID-19 patients. The study found that serum inflammatory bio-marker D-dimer trends are associated with changes in oxygen requirement among patients with COVID-19, if patients present at an early stage, and titration of Enoxaparin (anticoagulation) dose based on D-dimer trends leads to increased patient survival.

scholarly journals Oncological and Surgical Outcomes of Patients Treated by Transoral CO2 Laser Cordectomy for Early-Stage Glottic Squamous Cell Carcinoma: A Retrospective Chart Review

2020 ◽  
Vol 100 (1_suppl) ◽  
pp. 33S-37S ◽  
Author(s):  
Stéphane Hans ◽  
Lise Crevier-Buchman ◽  
Marta Circiu ◽  
Younes Chekkoury Idrissi ◽  
Léa Distinguin ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Surgical Procedures ◽  
Vocal Fold ◽  
Chart Review ◽  
Early Stage ◽  
Anterior Commissure ◽  
Retrospective Chart Review ◽  
Margin Status ◽  
Counter Pressure ◽  
Preservation Rate

Objective: To investigate the feasibility and the outcomes of transoral laser CO2 microsurgery (TLM) for resection of early-stage squamous cell carcinoma (SCC) of the vocal folds through several additional surgical procedures and tips improving the glottic exposure. Methods: Retrospective chart review of patients treated by TLM cordectomy in a single European University Hospital for early-stage vocal fold SCCs (Tis, T1a, T1b, and T2). The following TLM outcomes were studied regarding the tumor size (Tis and T1a vs T1b and T2) and the margin status (negative vs positive/suspicious): patient position; type of laryngoscope; requirement to external counter pressure; resection of supraglottic structures (eg, ventricular band, epiglottic petiole, and suprahyoid epiglottis); pre- and postoperative complications; overall survival; disease-specific survival (DSS); and disease-free survival (DFS). Results: A total of 148 patients were included. The TLM was realized in 95.3% of cases. External counter pressure, partial, or total vestibulectomy were necessary in 65.9%, 57.4%, and 4.2% of cases, respectively. A resection of the epiglottic petiole was required in 24.8% of cases. The realization of both epiglottis petiole resection and vestibulectomies were significantly higher in patients with T2 and T1b SCCs compared to those with T1a and Tis SCCs ( P = .01). Different procedure tips were described for improving the laryngeal exposition. The 5-year laryngeal preservation rate, DSS, and DFS were significantly better in patients without SCC involvement of the anterior commissure, and did not vary according to the margin status. The laryngeal exposure difficulties did not impact the margin status. Conclusion: The exposure of glottis is possible in 95% of cases of early-stage vocal cord SCC but requires the use of several additional surgical procedures, especially for anterior commissure SCCs. The SCC involvement of the vocal fold anterior commissure is associated with lower DSS, DFS, and laryngeal preservation rate.

Prognostic Value of D-Dimer in Stable Patients with Pulmonary Embolism

2011 ◽  
Vol 17 (6) ◽  
pp. E183-E185 ◽  
Author(s):  
Paul D. Stein ◽  
Muhammad Janjua ◽  
Fadi Matta ◽  
Ahmed Alrifai ◽  
Fadel Jaweesh ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Hospital Mortality ◽  
High Mortality ◽  
Prognostic Value ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
All Cause Mortality ◽  
D Dimer

Prognosis of pulmonary embolism (PE) based on levels ofD-dimer has shown mixed results, and data on in-hospital prognosis of stable patients are sparse. We assessed in-hospital prognosis in 292 stable patients with PE based on retrospective chart review using an arbitrarily selected value ofD-dimer ≥5000 ng/mL as cut-off level. In-hospital mortality from PE was 0% (0 of 222) withD-dimer <5000 ng/mL compared with 2.9% (2 of 70) withD-dimer ≥5000 ng/mL ( P = .06). In-hospital all-cause mortality was 2.3% (5 of 222) withD-dimer <5000 ng/mL compared with 2.9% (2 of 70) withD-dimer ≥5000 ng/mL (NS). Markedly elevated levels ofD-dimer, therefore, did not indicate a high mortality from PE or all-cause mortality during hospitalization.

scholarly journals P122: The evaluation of various point of care ultrasound features in Stanford type A aortic dissections

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S109-S109
Author(s):  
T. Chiang ◽  
G. Puri
Keyword(s):  
Emergency Department ◽  
Pericardial Effusion ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Chart Review ◽  
Point Of Care ◽  
Retrospective Chart Review ◽  
Type A ◽  
Point Of Care Ultrasound ◽  
D Dimer

Introduction: Type A aortic dissection(AD) is one of the most lethal diseases in medicine. Its mortality rate increases 1-2% per hour from the onset of symptoms to treatment. Timely diagnoses of ADs, therefore, are crucial to improve survival and decrease morbidity. There are various proposed clinical guidelines to help emergency physicians decide when a CTA is urgently needed with most widely quoted being the validated Aortic Dissection Detection Risk Score(ADD-RS) recommended by the American Heart Association. The addition of D-Dimer for further risk stratification has also been entertained. A recent article published in the American Journal of Emergency recommends using point of care ultrasound(POCUS) to expedite diagnosis. With the rising use of POCUS in the emergency department, it can be the missing link to timely AD diagnoses. This project aims to elucidate the prevalence of positive POCUS findings (pericardial effusion and dilated aortic root) in type A AD via a retrospective chart review. Methods: This study is a retrospective chart review of 200 patients with the diagnosis of AD treated at Southlake Regional Hospital. We included patients diagnosed with type A AD and excluded those diagnosed with type B AD. We collected data on their demographics, ADD-RS scores, investigation results, treatments, and clinical outcomes. The main focus of the chart review was on the presence of pericardial effusion or dilated aortic root on echocardiograms. Binomial statistical analysis was used to analyze the collected data. Results: We identified 126 patients with type A AD out of 200 charts reviewed. Thirteen (14% CI 8-23%, n = 93 p = 0.05) had wide mediastinum on their chest X-rays; twenty (95% CI 75-100%, n = 21 P = 0.05) had elevated D-dimer levels; and ninety-one (72% CI 64-80%, n = 126 p = 0.05) had positive ADD-RS. Only 88 out of 126 AD cases had documented echocardiograms. Sixty-eight (77% CI 67-86%, n = 88 p = 0.05) had either pericardial effusions or dilated aortic roots on their echocardiograms. Eighty-one (92% CI 84-95%, n = 88 p = 0.05) had either positive ADD-RS or positive echocardiogram findings, which is 20 (23% CI 14-33%, n = 88 P = 0.05) more cases than ADD-RS would have picked up alone. Conclusion: The absence of both pericardial effusion and dilated aortic root on echocardiogram in combination with a negative ADD-RS has a high sensitivity for ruling out type A AD. Our data support further research into the use of POCUS to expedite the diagnosis of type A AD in the emergency department.

The relationship between tumor size and stage in early versus advanced ovarian cancer: A retrospective chart review

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5580-5580
Author(s):  
L. E. Horvath ◽  
T. Werner ◽  
K. Jones
Keyword(s):  
Ovarian Cancer ◽  
Chart Review ◽  
Advanced Disease ◽  
Early Stage ◽  
Abdominal Cavity ◽  
Advanced Ovarian Cancer ◽  
Retrospective Chart Review ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Stage Disease

5580 Background: Ovarian cancer has a different prognosis between early (I and II) and advanced stage (III and IV). The mechanism of disease progression is unknown, but patients with advanced disease may have a higher propensity for seeding of the abdominal cavity early in the disease process than those with early stage. Theoretically if this is so, then patients with advanced stage should have smaller sized tumors than patients with early stage. Methods: This was a retrospective chart review of patients in the tumor registry in 2003 to 2006. Patients had epithelial ovarian cancer, other cell types were excluded. Only cases with documentation of surgical and pathologic staging and measured dimensions on pathologic specimen were included. Patient stage and all available dimensions measured on diseased ovaries were recorded. The dimensions for each patient were averaged into a single dimension for that patient, and then these measurements were totaled and averaged. Results: There were 110 patients analyzed: 85 with advanced disease, 25 with early stage. The average measurement was 4.8 cm in advanced disease, and was 10.7 cm in early stage disease. This difference was statistically significant (p < 0.001). Conclusions: Overall, patients with early stage ovarian cancer have diseased ovaries that are more than twice as large as those found in advanced disease. This finding supports the fact that early versus advanced ovarian cancer are 2 separate disease processes. Early stage grows locally and does not disseminate, and advanced stage disseminates while the tumor is still relatively small. Theoretically there may be a factor that separates these 2 into different diseases, where advanced disease patients have a substance produced by their tumor that allows for early dissemination, and early stage lacks this substance and only grows locally. Basic science research comparing the tissue microarrays of early versus advanced stage disease may be able to identify this difference. If the difference is found, perhaps therapy can be targeted against this difference. No significant financial relationships to disclose.

Assessment of Safety of Remdesivir in Covid −19 Patients with Estimated Glomerular Filtration Rate (eGFR) < 30 ml/min per 1.73 m^2

2021 ◽  
pp. 088506662110705
Author(s):  
Shan Wang ◽  
Christy Huynh ◽  
Shahidul Islam ◽  
Brian Malone ◽  
Naveed Masani ◽  
...  
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Therapeutic Option ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Secondary Outcome ◽  
Oxygen Requirement ◽  
End Of Treatment ◽  
Review Study ◽  
T1 And T2

Purpose Safety of remdesivir in patients with renal impairment is unknown. Incidence of liver injury secondary to remdesivir is also unknown. The objective of this study is to assess the incidence of acute kidney injury (AKI) and to trend the liver enzymes during remdesivir treatment and change in eGFR from baseline to end of treatment as well as 48 h post completion of remdesivir therapy. Methods This is a retrospective chart review study including adult patients admitted with COVID-19 receiving remdesivir with a baseline eGFR < 30 ml/min per 1.73 m^2 from December 2020 to May 2021. The primary outcome was to assess the incidence of AKI and hepatic injury. The secondary outcome was to assess the efficacy of remdesivir defined by change in oxygen requirement. Results Seventy-one patients were included in the study. Patients experienced an improvement in eGFR from baseline (T0) to end of remdesivir treatment (T1), as well as 48 h after the end of the treatment (T2) ( + 30.3% and + 30.6% respectively, P < .0001). Creatinine reduced from baseline (T0) to T1 and T2 (-20.9% and −20.5% respectively, P < .0001). Creatinine clearance improved from baseline to T1 and T2 ( + 26.6% and + 26.2% respectively, p < .0001). Elevation of aminotransferase (AST) was observed at T1 ( + 2.5%, P  =  .727), however, AST reduction was seen at T2 (-15.8%, P  =  .021). Elevation in alanine transaminase (ALT) was observed at T1 and T2 ( + 25% and + 12%, P  =  .004 and P  =  .137 respectively). Both direct and total bilirubin remained stable and were not significantly changed from baseline. Conclusion Our study showed that remdesivir use in renally-impaired patients with eGFR < 30 ml/min is safe. Remdesivir may be considered as a therapeutic option in this population with COVID-19 infection.

scholarly journals Survival Analysis of Occipital Nerve Stimulator Leads Placed under Fluoroscopic Guidance with and without Ultrasonography

2017 ◽  
Vol 7 (20;7) ◽  
pp. E1115-E1121
Author(s):  
James Harvey Jones
Keyword(s):  
Tobacco Use ◽  
Chart Review ◽  
Imaging Modality ◽  
Survival Rates ◽  
Retrospective Chart Review ◽  
Lead Removal ◽  
Patient Demographics ◽  
Significant Difference ◽  
Chronic Daily Headaches ◽  
Permanent Implant

Background: Electrical stimulation of the greater occipital nerves is performed to treat pain secondary to chronic daily headaches and occipital neuralgia. The use of fluoroscopy alone to guide the surgical placement of electrodes near the greater occipital nerves disregards the impact of tissue planes on lead stability and stimulation efficacy. Objective: We hypothesized that occipital neurostimulator (ONS) leads placed with ultrasonography combined with fluoroscopy would demonstrate increased survival rates and times when compared to ONS leads placed with fluoroscopy alone. Study Design: A 2-arm retrospective chart review. Setting: A single academic medical center. Methods: This retrospective chart review analyzed the procedure notes and demographic data of patients who underwent the permanent implant of an ONS lead between July 2012 and August 2015. Patient data included the diagnosis (reason for implant), smoking tobacco use, disability, and age. ONS lead data included the date of permanent implant, the imaging modality used during permanent implant (fluoroscopy with or without ultrasonography), and, if applicable, the date and reason for lead removal. A total of 21 patients (53 leads) were included for the review. Chi-squared tests, Fishers exact tests, 2-sample t-tests, and Wilcoxon rank-sum tests were used to compare fluoroscopy against combined fluoroscopy and ultrasonography as implant methods with respect to patient demographics. These tests were also used to evaluate the primary aim of this study, which was to compare the survival rates and times of ONS leads placed with combined ultrasonography and fluoroscopy versus those placed with fluoroscopy alone. Survival analysis was used to assess the effect of implant method, adjusted for patient demographics (age, smoking tobacco use, and disability), on the risk of lead explant. Results: Data from 21 patients were collected, including a total of 53 ONS leads. There was no statistically significant difference in the lead survival rate or time, disability, or patient age with respect to the implant method with or without ultrasonography. There was a statistically significant negative effect on the risk of explant with regards to lead removal in smoking patients compared to non-smoking patients (hazard ratio 0.36). There was also a statistically significant difference in smoking tobacco use with respect to the implant method, such that a greater number of patients whose leads were placed with combined fluoroscopy and ultrasonography had a history of smoking (P = 0.048). Limitations: This study is a retrospective chart review that had statistically significant differences in the patient groups and a small sample size. Conclusion: This study assessed the survival rates and times of ONS leads placed with ultrasonography and fluoroscopy versus fluoroscopy alone. We did not observe an effect to suggest that the incremental addition of ultrasound guidance to fluoroscopy as the intraoperative imaging modality used during the permanent implant of ONS leads yields statistically significant differences in lead survival rate or time. Medical comorbidities, including age and smoking status, may play a role in determining the risk of surgical revision and should be considered in future studies. Key words: Neuromodulation, peripheral nerve stimulation, occipital nerve stimulation, occipital neuralgia, chronic daily headaches, ultrasonograph

scholarly journals Prehospital vs. emergency department pronouncement of death: a cost analysis

CJEM ◽  
2001 ◽  
Vol 3 (01) ◽  
pp. 19-25 ◽  
Author(s):  
Mathew Cheung ◽  
Laurie Morrison ◽  
P. Richard Verbeek
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Chart Review ◽  
Survival Rates ◽  
Retrospective Chart Review ◽  
Total Cost ◽  
Physician Time ◽  
National Survival ◽  
The Cost ◽  
Hospital Cardiac Arrest

ABSTRACT Objective: National survival rates for out-of-hospital cardiac arrests are less than 5%, and substantial resources are associated with transporting cardiac arrest victims to hospital for emergency department (ED) resuscitation. The low overall survival rate and the identification of predictors of unsuccessful resuscitation have opened debate on the “futility” of transporting such patients to the ED. This study compares the costs of prehospital pronouncement of death to the costs of transporting patients to a hospital ED for physician pronouncement. Methods: The study was a retrospective chart review on a matched cohort of out-of-hospital cardiac arrest patients. Patients were included if documentation was adequate and ambulance response time was less than 8 minutes. A cohort of 20 patients pronounced dead in the field were matched to 20 patients pronounced dead in an ED. Cases were matched on 6 evidence-based predictors of unsuccessful resuscitation. Direct medical costs and mean physician and prehospital provider times were compared. Results: The total cost of pronouncement of death in the ED was $45.35 higher than the cost of field pronouncement (p &lt; 0.001). Paramedics spent more time delivering care when death was pronounced in the field (83.3 vs. 55.9 min; p &lt; 0.001). Base hospital physicians spent more time when patients were transported to hospital for ED pronouncement (16.3 vs. 4.3 min; p &lt; 0.001). Total provider time for field pronouncement was 15.5 min longer (p = 0.004), but field pronouncement consumed 12.0 min less physician time. Conclusions: Paramedic pronouncement of death in the field is less costly than transporting patients to hospital for physician pronouncement. Pronouncement in the field requires more paramedic time but less physician time.

Evaluation of enoxaparin dosing requirements in infants and children

2009 ◽  
Vol 101 (01) ◽  
pp. 86-92 ◽  
Author(s):  
Mark Belletrutti ◽  
Laszlo Bajzar ◽  
Karina Black ◽  
Stefan Kuhle ◽  
Michelle Bauman ◽  
...  
Keyword(s):  
Therapeutic Range ◽  
Chart Review ◽  
Standard Dose ◽  
Factor Xa ◽  
Retrospective Chart Review ◽  
Infants And Children ◽  
Starting Dose ◽  
Time Required ◽  
Initial Starting ◽  
In Infants And Children

SummaryIncreasing the starting dose of enoxaparin results in the early achievement of therapeutic anti-factor Xa levels in children receiving enoxaparin which is critical for effective therapy and the reduction of venipunctures. The aim of this study was: i) to determine the enoxaparin dose required to achieve therapeutic anti-factor Xa levels in infants and children, and ii) to establish whether increasing the starting dose of enoxaparin influenced the time required to reach the therapeutic range and the number of venipunctures required for dose-adjustment, and iii) the radiographic outcome of the thrombosis, where applicable. A retrospective chart review of children who received enoxaparin was carried out at the Stollery Children’s Hospital, Edmonton, Alberta, Canada. Patients treated with standard-dose enoxaparin (1.5 mg/kg for children ≤3 months of age, 1.0 mg/kg for children ≥3 months of age), were compared with children who received a higher initial starting dose of enoxaparin (1.7 mg/kg for children ≥3 months of age, 1.2 mg/kg for children ≥3 months of age). Infants <3 months required an enoxaparin dose of 1.83 mg/kg, and those who received an increased initial enoxaparin dose resulted in faster attainment of therapeutic anti-factor Xa levels requiring significantly fewer venipunctures. Similarly, infants ≥3–12 months, 1–5 years, and 6–18 years, require enoxaparin 1.48 mg/kg, 1.23 mg/kg and 1.13 mg/kg, respectively, in order to achieve a therapeutic anti-factor Xa level. In conclusion, increasing the starting dose of enoxaparin may result in more rapid attainment of therapeutic range with fewer venipunctures, dose adjustments, and without an increase in adverse events.

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