Acute Care of Older Patients with COVID-19: Clinical Characteristics and Outcomes

(1) Background: COVID-19 has become a global pandemic and older patients present higher mortality rates. However, studies on the characteristics of this population set are limited. The objective of this study is to describe clinical characteristics and outcomes of older patients hospitalized with COVID-19. (2) Methods: This retrospective cohort study was conducted from March to May 2020 and took place in three acute geriatric wards in France. Older patients hospitalized for COVID-19 infections were included. We collected clinical, radiological, and laboratory outcomes. (3) Results: Ninety-four patients were hospitalized and included in the final analysis. Mean age was 85.5 years and 55% were female. Sixty-four (68%) patients were confirmed COVID-19 cases and 30 (32%) were probable. A majority of patients were dependent (77%), 45% were malnourished, and the mean number of comorbidities was high in accordance with the CIRS-G score (12.3 ± 25.6). The leading causes of hospitalization were fever (30%), dyspnea (28%), and geriatric syndromes (falls, delirium, malaise) (18%). Upon follow-up, 32% presented acute respiratory failure and 30% a geriatric complication. Frailty and geriatric characteristics were not correlated with mortality. Acute respiratory failure (p = 0.03) and lymphopenia (p = 0.02) were significantly associated with mortality. (4) Conclusions: Among older patients hospitalized with COVID-19, clinical presentations were frequently atypical and complications occurred frequently. Frailty and geriatric characteristics were not correlated with mortality.

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CLINICAL CHARACTERISTICS, LABORATORY TESTS AND TREATMENT OUTCOME IN PATIENTS WITH ACUTE RESPIRATORY FAILURE REQUIRING INVASIVE MECHANICAL VENTILATOR IN INTENSIVE CARE UNIT AT HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2020.5.14 ◽

2020 ◽

pp. 99-105

Author(s):

Ha Vo Viet ◽

Quan Phan Van Minh

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Treatment Failure ◽

Clinical Characteristics ◽

Invasive Mechanical Ventilation ◽

Ventilator Associated Pneumonia ◽

Invasive Ventilation ◽

History Of ◽

The Mean

Ojectives: 1. To describe the clinical and subclinical characteristics of patients with acute respiratory failure requiring invasive ventilation. 2. To evaluate the outcome of acute respiratory failure treatment with invasive ventilation and factors related to treatment failure. Materials and Method: 51 patients diagnosed with acute respiratory failure requiring invasive mechanical ventilation in ICU at Hue University of Medicine and Pharmacy Hospital. The prospective cohort study. Results: The mean age was 69.6 ± 16.4. Tachypnea and agitation were the most common sign (51%). The mean APACHE II score was 20.2 ± 3.3. The mortality rate was 33.3%. The variables associated with treatment failure were age ≥ 70 tuổi (RR = 2.7; p < 0.05), history of chronic kidney disease (RR = 2.9; p < 0.05), sepsis as a cause of mechanical ventilation (RR = 2.5; p < 0.05), ventilator-associated pneumonia (RR = 2.4; p < 0.05) and renal dysfunction during treatment (RR =2.4; p < 0.05). Conclusion: The clinical characteristics of ARF patients requiring IMV were various and the mortality rate remained high. Risk factors for treatment failure included age ≥ 70, history of chronic kidney disease, sepsis as a cause of mechanical ventilation, ventilator-associated pneumonia and renal dysfunction during treatment. Keywords: acute respiratory failure, invasive ventilation, invasive mechanical ventilation

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SAT0267 ROLE OF AGGRESSIVE IMMUNOSUPPRESSION ON SUBGLOTTIC STENOSIS IN GRANULOMATOSIS WITH POLYANGIITIS: RETROSPECTIVE ANALYSIS OF A MONOCENTRIC COHORT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2582 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1076.1-1077

Author(s):

L. Moroni ◽

L. Giudice ◽

G. A. Ramirez ◽

S. Sartorelli ◽

A. Cariddi ◽

...

Keyword(s):

Medical Treatment ◽

Clinical Characteristics ◽

Granulomatosis With Polyangiitis ◽

Balloon Catheter ◽

Subglottic Stenosis ◽

Damage Accrual ◽

The Mean ◽

The One

Background:Subglottic stenosis (SGS) is defined as airway narrowing below the vocal cords and is a common and potentially life-threatening manifestation of Granulomatosis with Polyangiitis (GPA), with an estimated prevalence of 16-23% (1). Balloon catheter dilation is effective in GPA-related SGS, but relapses are frequent. Little is known about the role of immunosuppression in this setting.Objectives:to analyse the clinical characteristics of a monocentric GPA cohort, describe phenotype differences among patients with and without SGS and investigate the role of surgical and medical treatments on relapse risk and general outcome.Methods:Biopsy-proven patients with SGS were identified by review of medical charts among a cohort of patients with GPA, classified according to the algorithm of the European Medicine Agency (2). The clinical characteristics of patients with SGS were retrospectively collected over a median follow-up time of 15.9 years and compared to those of patients without SGS.Results:Fourteen patients with SGS-GPA were identified, with a female to male ratio of 1:1 and a prevalence of 29.2% among the cohort. The mean ± SD age at GPA onset was 30.8 ± 14.4 years, with a mean time from GPA diagnosis to SGS onset of 4.7 ± 4.2 years. ANCA were positive in 78.6% (54.0% anti-PR3, 18.1% anti-MPO and 27.9% IFI only). The mean Birmingham Vasculitis Activity Score (BVAS) at onset was 10.0 ± 5.6. The main clinical manifestations associated with SGS were crusty rhinitis (100%), sinusitis (78%), pulmonary disease (72.7%), otitis/mastoiditis (50%), glomerulonephritis (42.9%), orbital pseudotumor (28.6%). Six patients (42.9%) received medical treatment only, other six (42.9%) had one to three balloon dilations and two (14.2%) underwent four or more procedures. Eight patients had no SGS relapse (maximum one dilation) and they all received immunosuppression with rituximab (RTX), cyclophosphamide (CYC) or azathioprine (AZA). All patients who received no immunosuppression, methotrexate (MTX) or mycophenolate (MMF) had at least one relapse. Patients treated with MTX or MMF had a mean relapse-free survival of 13.1 months, which was comparable to the one of patients not receiving medical treatment (40.2 months; p=NS) and shorter than the one of patients receiving CYC or RTX (153.2 months; p=0.032). CYC use also inversely correlated with the number of surgical procedures (r=-0.691, p=0.006). Compared to patients without SGS (31 consecutive patients with at least 4 years of follow-up), patients with SGS-GPA had an earlier disease onset (mean age 30.8 vs 50.4 years; p<0.001), but with lower BVAS (mean 10.0 vs 15.3; p=0.013) and showed a higher prevalence of crusty rhinitis (100% vs 67.7%; p=0.019). No difference was observed in damage accrual over time between the two groups.Conclusion:Subglottic stenosis is highly prevalent in patients with GPA and may define a milder disease subset occurring more frequently in younger patients. MTX and MMF might be insufficient to prevent SGS relapses requiring balloon dilation. Aggressive immunosuppression (CYC or RTX) might have a non-redundant role in this setting and reduce the risk of relapses.References:[1]Quinn KA, et al. Subglottic stenosis and endobronchial disease in granulomatosis with polyangiitis. Rheumatology 2019; 58 (12), 2203-2211.[2]Watts R, et al. Development and validation of a consensus methodology for the classification of the ANCA associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 2007; 66: 222-7.Disclosure of Interests:Luca Moroni: None declared, Laura Giudice: None declared, Giuseppe Alvise Ramirez: None declared, Silvia Sartorelli: None declared, adriana cariddi: None declared, Angelo Carretta: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI., Consultant of: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI.

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Relationship between 24-h venous blood glucose variation and mortality among patients with acute respiratory failure

Scientific Reports ◽

10.1038/s41598-021-87409-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaoling Zhang ◽

Jingjing Zhang ◽

Jiamei Li ◽

Ya Gao ◽

Ruohan Li ◽

...

Keyword(s):

Blood Glucose ◽

Respiratory Failure ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Venous Blood ◽

Sensitivity Analyses ◽

Icu Mortality ◽

Logistic Regression Models ◽

The Mean ◽

The Relationship

AbstractEvidence indicates that glucose variation (GV) plays an important role in mortality of critically ill patients. We aimed to investigate the relationship between the coefficient of variation of 24-h venous blood glucose (24-hVBGCV) and mortality among patients with acute respiratory failure. The records of 1625 patients in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database were extracted. The 24-hVBGCV was calculated as the ratio of the standard deviation (SD) to the mean venous blood glucose level, expressed as a percentage. The outcomes included ICU mortality and in-hospital mortality. Participants were divided into three subgroups based on tertiles of 24-hVBGCV. Multivariable logistic regression models were used to evaluate the relationship between 24-hVBGCV and mortality. Sensitivity analyses were also performed in groups of patients with and without diabetes mellitus. Taking the lowest tertile as a reference, after adjustment for all the covariates, the highest tertile was significantly associated with ICU mortality [odds ratio (OR), 1.353; 95% confidence interval (CI), 1.018–1.797] and in-hospital mortality (OR, 1.319; 95% CI, 1.003–1.735), especially in the population without diabetes. The 24-hVBGCV may be associated with ICU and in-hospital mortality in patients with acute respiratory failure in the ICU, especially in those without diabetes.

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Neonatal Outcomes in Pregnant Women Infected with COVID-19 in Babol, North of Iran: A Retrospective Study with Short-Term Follow-Up

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2021/9952701 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Zahra Akbarian-Rad ◽

Mohsen Haghshenas Mojaveri ◽

Zinatossadat Bouzari ◽

Farzin Sadeghi ◽

Yousef Yahyapour ◽

...

Keyword(s):

Pregnant Women ◽

Clinical Characteristics ◽

Neonatal Outcomes ◽

Long Term Outcomes ◽

Short Term ◽

Reactive Protein ◽

Clinical Presentations ◽

North Of Iran

During the coronavirus disease 2019 (COVID-19) pandemic, the number of pregnant women and neonates suffering from COVID-19 increased. However, there is a lack of evidence on clinical characteristics and neonatal outcomes in pregnant women with COVID-19. We evaluated short-term outcomes (4 weeks postdischarge) and symptoms in neonates born to mothers infected with COVID-19. In this retrospective cohort study, we included all neonates born to pregnant women with COVID-19 admitted to Ayatollah Rohani Hospital, Babol, Iran, from February 10 to May 20, 2020. Clinical features, treatments, and neonatal outcomes were measured. Eight neonates were included in the current study. The mean gestational age and birth weight of newborns were 37 ± 3.19 weeks (30₊6-40) and 3077.50 ± 697.64 gr (1720-3900), respectively. Apgar score of the first and fifth minutes in all neonates was ≥8 and ≥9 out of 10, respectively. The most clinical presentations in symptomatic neonates were respiratory distress, tachypnea, vomiting, and feeding intolerance. This manifestation and high levels of serum C-reactive protein (CRP) in three infants are common in neonatal sepsis. The blood culture in all of them was negative. They have been successfully treated with our standard treatment. Our pregnant women showed a pattern of clinical characteristics and laboratory results similar to those described for nonpregnant COVID-19 infection. This study found no evidence of intrauterine or peripartum transmission of COVID-19 from mother to her child. Furthermore, the long-term outcomes of neonates need more study.

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Neonatal outcomes in pregnant women infected with COVID-19 in Babol, North of Iran: retrospective study with short-term follow-up

10.21203/rs.3.rs-341021/v1 ◽

2021 ◽

Author(s):

Zahra Akbarian-Rad ◽

Mohsen Haghshenas Mojaveri ◽

Zinatossadat Bouzari ◽

Farzin Sadeghi ◽

Yousef Yahyapour ◽

...

Keyword(s):

Pregnant Women ◽

Clinical Characteristics ◽

Neonatal Outcomes ◽

Short Term ◽

Post Discharge ◽

Reactive Protein ◽

Clinical Presentations ◽

North Of Iran

Abstract During the Coronavirus disease 2019 (COVID-19) pandemic, the number of pregnant women and neonates suffering from COVID-19 increased. However, there is a lack of evidence on clinical characteristics and neonatal outcomes in pregnant women with COVID-19. We evaluated short-term outcomes (4 weeks post-discharge) and symptoms in neonates born to mothers infected with COVID-19. In this retrospective cohort study, we included all neonates born to pregnant women with COVID-19 who were admitted to Ayatollah Rohani Hospital, Babol, Iran, from February 10 to May 20, 2020. Clinical features, treatments, and neonatal outcomes were measured. Eight neonates were included in the current study. The mean gestational age and birth weight of newborns were 37 ± 3.19 weeks (30₊6 − 40) and 3077.50 ± 697.64 gr (1720–3900) respectively. Apgar score of the first and fifth minutes in all neonates was ≥ 8 and ≥ 9 out of 10 respectively. The most clinical presentations in symptomatic neonates were respiratory distress, tachypnea, vomiting, and feeding intolerance. This manifestation and high levels of serum C-reactive protein (CRP), in three infants, are common in neonatal sepsis. The blood culture in all of them was negative. They have been successfully treated with our standard treatment. Our pregnant women showed a pattern of clinical characteristics and laboratory results almost similar to those described for non-pregnant COVID-19 infection. This study found no evidence of intrauterine or peripartum transmission of COVID-19 from mother to her child. Furthermore, the long-term outcomes of neonates need more study.

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Alphafetoprotein in screening for congenital hypothyroidism

Eastern Mediterranean Health Journal ◽

10.26719/2001.7.1-2.171 ◽

2001 ◽

Vol 7 (1-2) ◽

pp. 171-180

Author(s):

R. M. Shawky ◽

S. Abdel Fattah ◽

M. E. El Din Azzam ◽

M. M. Rafik ◽

A. Osman

Keyword(s):

Congenital Hypothyroidism ◽

Older Patients ◽

Thyroid Stimulating Hormone ◽

The Other ◽

Thyroid Status ◽

Term Neonates ◽

Significant Relationships ◽

The Mean ◽

Persistent Elevation

This study was conducted on 500 full-term neonates and 25 older patients with congenital hypothyroidism [CH], newly or previously diagnosed. Alphafetoprotein [AFP] was elevated in two neonates. In one, persistent elevation of AFP and thyroid stimulating hormone [TSH] with low thyroxine [T4] were found [congenital hypothyroidism]. In the other, AFP, TSH and T4 levels normalized [transient hypothyroidism]. The mean AFP level in new CH patients was significantly higher than in previously diagnosed patients, and was higher in CH patients than in controls. Significant relationships were found between AFP and T4, AFP and TSH, and AFP and age. AFP is a sensitive indicator of thyroid status and can be used as a screening test for hypothyroidism from the first day of life and in follow-up of CH patients.

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Outcomes and prognostic factors of patients with anti-melanoma differentiation-associated protein 5 and anti-aminoacyl-RNA synthetase antibodies positive idiopathic inflammatory myopathies in intensive care unit

10.21203/rs.3.rs-50120/v1 ◽

2020 ◽

Author(s):

Shiyao Wang ◽

Xinran Zhang ◽

Yanhong Ren ◽

Yi Zhang ◽

Ye Tian ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Prognostic Factors ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Serum Ferritin ◽

Factors Associated ◽

Overall Mortality

Abstract Background: This study aims to identify prognostic factors for mortality of patients with anti-melanoma differentiation-associated protein 5 (anti-MDA5) or anti-aminoacyl-RNA synthetase (anti-ARS) antibodies positive and acute respiratory failure in the intensive care unit.Methods: Clinical characteristics, laboratory test findings, imaging performance, and management were retrospectively collected in all cases with anti-MDA5 and anti-ARS antibodies positive, as well as follow-up survival data. Risk factors related to prognosis were identified by Cox regression analysis.Results: The 28-day mortality of all patients was 68.8% (n=44/64). The patients who died were more likely to have anti-MDA5 antibody(p<0.001), presented more Gottron papules(p=0.021) or heliotrope rash(p=0.008), had a relatively lower level of WBC(p=0.038), CRP(p=0.004), and had a higher level of LDH(p=0.029), serum ferritin(p=0.002). The main risk factors associated with 28-day mortality were anti-MDA5 antibody positive [HR 10.827 (95% CI: 4.261-27.514), p<0.001], presence of Gottron papules [2.299 (1.203-4.394), p=0.012], heliotrope rash [3.423 (1.773-6.606), p<0.001], and arthritis/arthralgia [2.365 (1.130-4.948), p=0.022). At a median of 14 (IQR 6.33-35.0) months of follow-up, the overall mortality of all patients was 75.0% (n=48/64). The non-survivors were more likely to own anti-MDA5 antibody(p<0.001), had a higher rate of Gottron papules(p=0.020) or heliotrope rash(p=0.014), had lower PFR(p=0.032) while ICU admission, and existed a higher level of serum ferritin(p=0.005). Main risk factors associated with overall mortality were consistent with risk factors for 28-day mortality. Conclusions: Anti-MDA5 antibody positive, presence of Gottron papules, heliotrope rash, or arthritis/arthralgia were the main independent risk factors of poor prognosis for IIM patients admitted to the ICU due to acute respiratory failure.

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Participant Retention in Follow-Up Studies of Acute Respiratory Failure Survivors

Respiratory Care ◽

10.4187/respcare.07461 ◽

2020 ◽

Vol 65 (9) ◽

pp. 1382-1391 ◽

Cited By ~ 1

Author(s):

Krishidhar Nunna ◽

Awsse Al-Ani ◽

Roozbeh Nikooie ◽

Lisa Aronson Friedman ◽

Vaishnavi Raman ◽

...

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Follow Up Studies ◽

Participant Retention

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Insights into the use of mesenchymal stem cells in COVID-19 mediated acute respiratory failure

npj Regenerative Medicine ◽

10.1038/s41536-020-00105-z ◽

2020 ◽

Vol 5 (1) ◽

Author(s):

Nisha Durand ◽

Jorge Mallea ◽

Abba C. Zubair

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Stromal Cells ◽

Distress Syndrome ◽

Respiratory Illness ◽

Shortness Of Breath ◽

Global Pandemic ◽

Hypoxic Respiratory Failure

Abstract The emergence of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) at the end of 2019 in Hubei province China, is now the cause of a global pandemic present in over 150 countries. COVID-19 is a respiratory illness with most subjects presenting with fever, cough and shortness of breath. In a subset of patients, COVID-19 progresses to hypoxic respiratory failure and acute respiratory distress syndrome (ARDS), both of which are mediated by widespread inflammation and a dysregulated immune response. Mesenchymal stem cells (MSCs), multipotent stromal cells that mediate immunomodulation and regeneration, could be of potential benefit to a subset of COVID-19 subjects with acute respiratory failure. In this review, we discuss key features of the current COVID-19 outbreak, and the rationale for MSC-based therapy in this setting, as well as the limitations associated with this therapeutic approach.

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Brainstem gangliogliomas: a retrospective series

Journal of Neurosurgery ◽

10.3171/2013.1.jns121323 ◽

2013 ◽

Vol 118 (4) ◽

pp. 884-888 ◽

Cited By ~ 23

Author(s):

Si Zhang ◽

Xiang Wang ◽

Xuesong Liu ◽

Yan Ju ◽

Xuhui Hui

Keyword(s):

Subtotal Resection ◽

Who Grade ◽

Duration Of Symptoms ◽

West China Hospital ◽

West China ◽

Clinical Presentations ◽

Close Observation ◽

The Mean ◽

Residual Lesions

Object The authors retrospectively analyzed data on brainstem gangliogliomas treated in their department and reviewed the pertinent literature to foster understanding of the preoperative characteristics, management, and clinical outcomes of this disease. Methods In 2006, the authors established a database of treated lesions of the posterior fossa. The epidemiology findings, clinical presentations, radiological investigations, pathological diagnoses, management, and prognosis for brainstem gangliogliomas were retrospectively analyzed. Results Between 2006 and 2012, 7 patients suffering from brainstem ganglioglioma were treated at the West China Hospital of Sichuan University. The mean age of the patients, mean duration of symptoms prior to diagnosis, and mean duration of follow-up were 28.6 years, 19.4 months, and 38.1 months, respectively. The main presentations were progressive cranial nerve deficits and cerebellar signs. Subtotal resection was achieved in 2 patients, and partial resection in 5. All tumors were pathologically diagnosed as WHO Grade I or II ganglioglioma. Radiotherapy and adjuvant chemotherapy were not administered. After 21–69 months of follow-up, patient symptoms were resolved or stable without aggravation, and MRI showed that the size of residual lesions was unchanged without progression or recurrence. Conclusions The diagnosis of brainstem ganglioglioma is of great importance given its favorable prognosis. The authors recommend the maximal safe resection followed by close observation without adjuvant therapy as the optimal treatment for this disease.

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