Đánh giá một số chỉ số huyết học và chuyển hóa liên quan đến kết cục điều trị của bệnh nhân Covid-19

Author(s):  
Thua Nguyen Tran

TÓM TẮT Mục tiêu: Đánh giá các chỉ số huyết học, chuyển hóa và số yếu tố liên quan đến kết cục điều trị của bệnh nhân COVID-19 tại trung tâm hồi sức COVID-19 bệnh viện Trung ương Huế. Đối tượng và phương pháp: Chúng tôi tiến hành một nghiên cứu mô tả cắt ngang tiến hành trên 225 bệnh nhân COVID-19 nặng và nguy kịch điều trị tại Trung tâm Hồi sức COVID-19, Bệnh viện Trung ương Huế từ tháng 9 đến tháng 11 năm 2021. Kết quả: Có sự liên quan giữa tuổi cao và tỷ lệ tử vong do COVID-19, nhóm tuổi trên 60 có nguy cơ tử vong cao gấp 2,0 lần nhóm từ 60 tuổi trở xuống. Các chỉ số huyết học về bạch cầu, tiểu cầu có sự khác biệt mang ý nghĩa thống kê giữa nhóm tử vong và nhóm ra viện. Số lượng bạch cầu ở nhóm tử vong cao hơn nhóm ra viện, 17,5 (13,4 - 25,3) ngàn/mm3 so với 9,4 (6,4 - 13,6) ngàn/mm3, p < 0,001. Tỷ lệ bạch cầu đa nhân trung tính ở nhóm tử vong cao hơn nhóm ra viện nhưng tỷ lệ bạch cầu Lympho lại thấp hơn. Chỉ số NLR có sự khác biệt đáng kể giữa nhóm tử vong và nhóm ra viện, 37,5 (20,1 - 52,8) so với 11,8 (4,4 - 22,6), NLR có khả năng dự đoán khá tốt tử vong do COVID-19 với AUC = 0,78. Khi sử dụng điểm cắt 22,25, NLR có độ nhạy/độ đặc hiệu trong dự đoán tử vong do COVID-19 là 74,2% và 74.5%. Có sự khác biệt mang ý nghĩa thống kê về số lượng tiểu cầu ở nhóm tử vong và nhóm ra viện, 166 (106 - 289) triệu/mm3 so với 236 (183 - 338) mm3. ABSTRACT ASSESSMENT OF HEMATOLOGIC AND METABOLIC INDICATORS CONTRIBUTING TO TREATMENT OUTCOMES OF COVID-19 PATIENTS Objectives: To evaluate hematological features and metabolic characteristics; and determine the contributing factors to the treatment outcome of COVID-19 patients. Methods: We conducted a cross-sectional descriptive study on 225 severe and critical COVID-19 patients treated at this COVID-19 Resuscitation Center from September 2021 to November 2021. Results: There was an association between age and mortality caused by COVID-19, the age group over 60 has a 2.0 times higher risk of death than the group aged 60 and under. The hematological indices of leukocytes and platelets had statistically significant differences between the mortality group and the group of hospital discharge. The number of white blood cells in the mortality group was higher than the hospital discharge group, 17.5 (13.4 - 25.3) thousand/mm3 compared with 9.4 (6.4 - 13.6 thousand/mm3, p < 0.001). The rate of neutrophils in the mortality group was higher than in the discharge group, but the rate of lymphocytes was lower. The NLR index had a significant difference between the mortality group and the discharge group, 37.5 (20.1 - 52.8) compared with 11.8 (4.4 - 22.6), NLR could well mortality - predictdue to COVID-19 with AUC = 0.78. Using the 22.25 cut - off, the NLR had a sensitivity/specificity in predicting COVID-19 mortality of 74.2% and 74.5%, respectively. There was a statistically significant difference in platelet counts in the mortality and discharge groups, 166 (106 - 289) million/mm3 versus 236 (183 - 338) mm3. Keywords: COVID-19, severe and critical patients, NRL, leukocytes, platelets, mortality

2021 ◽  
Vol 19 (4) ◽  
Author(s):  
V.K. Tashchuk ◽  
R.A. Nesterovska ◽  
V.O. Kalarash

Purpose – to investigate the distribution of hematological indices in patients withcardiac insufficiency.Material and methods. Data of 26 case histories with diagnosis of IHD have beenanalyzed. Patients with stable angina pectoris of II-III functional class (FC), Diffusecardiosclerosis, complicated in 17 patients with syndromic manifestations of HF II-IIIFC according to New York Heart Association (NYHA), made up group 1, and 9 patientswithout CH -group 2. Of the group 1 surveyed, there were 8 men and 9 women. Ratioindex of leucocytes and erythrocyte sedimentation rate (ESR): L/ESR=L×ESR/100;Neutrophil-lymphocyte ratio index (N/Li); Lymphocyte to monocyte ratio index (Li / Mo);Lymphocyte to eosinophil index (Li/ E) was used among hematological markers.Results. Analyzing the haemogram data, it was found that group 1 patients, unlike group2 patients, had a significantly higher overall white blood cell count (7,96±1,73) × 109and (4,22 ± 0,24) × 109; p<0,05 due to the number of neutrophils (69,41 ± 6,21) % ascompared to group 2 (51,78±1,79)%; p<0,05 as well as a lower level of lymphocyteswas defined in group 1 (22,06±4,07)% versus group 2 (38,55±1,01)%; p<0,05. In genderstudies, men show elevated levels of eosinophils (4,12±0,83)%, as opposed to women(1,56±0,73) %; p<0,05 and lower level of lymphocytes (18,38±1,69)% versus (25,33±2,24)%; p<0,05 and women had a high level of total white blood cells (9,36±0,66) ×109 thanmen (6,36±0,99)×109; p<0,05, in particular lymphocytes. Analysis of hematologicalindices showed that there was a statistically significant difference in determining theN / Li index, which was increased in group 1 patients (3,28±0,78) у.о versus group 2(1,34±0,05) у.о, p<0,05.Conclusion. In gender comparisons, there is an increase in lymphocytes among womencompared to men, so we can assume that women are less susceptible to systemicinflammation. The increase in the N/Li index ratio is due to severe cardiovascularconsequences among patients with coronary heart disease complicated by heart failure.


2020 ◽  
Vol 9 (12) ◽  
pp. 4031
Author(s):  
Chiara Lauri ◽  
Giancarlo Lauretti ◽  
Filippo Galli ◽  
Giuseppe Campagna ◽  
Simone Tetti ◽  
...  

Despite the application of EANM recommendations for radiolabelled white-blood-cells (WBC) scintigraphy, some cases still remain doubtful based only on visual analysis. The aim of this study was to investigate the role of semi-quantitative analysis and bone marrow scan (BMS) in solving doubtful cases. We retrospectively evaluated all [99mTc]HMPAO-WBC scintigraphies performed, in the last 7 years, for a suspected monolateral prosthetic joint infection (PJI). In doubtful cases, we used five different thresholds of increase of target-to-background (T/B) ratio, between delayed and late images, as criteria of positivity (5%, 10%, 15%, 20% and 30%). BMS were also analysed and sensitivity, specificity and accuracy of different methods were calculated according to final diagnosis. The sensitivity, specificity and accuracy were, respectively, 77.8%, 43.8% and 53.0% for the cut-off at 5%; 72.2%, 66.7% and 68.2% for the cut-off at 10%; 66.7%, 75.0% and 72.7% for the cut-off at 15%; 66.7%, 85.4% and 80.3% for the cut-off at 20%; 33.3%, 93.8% and 77.3% for the cut-off at 30%. BMS provided a significantly higher diagnostic performance than 5%, 10% and 15% thresholds. Conversely, we did not observe any statistically significant difference between BMS and the cut-off of more than 20%. Therefore, doubtful cases should be analysed semi-quantitatively. An increase in T/B ratio of more than 20% between delayed and late images, should be considered as a criterion of positivity, thus avoiding BMS.


Author(s):  
Bastiana Bastiana ◽  
Aryati Aryati ◽  
Dominicus Husada ◽  
M.Y. Probohoesodo

Early diagnosis of an infection and prompt administration of an antibiotic can dramatically reduce morbidity and mortality.Procalcitonin (PCT), a precursor of calcitonin, has been proposed as a marker of bacterial infection. The aim of this study is to assess theefficiency of procalcitonin in children for the diagnosis of bacterial vs. non bacterial infection. This was a prospective, cross-sectional study.The subjects were enrolled consecutively, consisting of feverish children (temperature ³38.5° C) admitted to the Pediatric EmergencyDepartment with ages up to 12 years old. The subjects were divided into two groups according to their final diagnosis, bacterial and nonbacterial infection. Serum PCT concentration was measured by enzyme linked fluorescent assay (ELFA) method. Sensitivity, specificity,positive predictive and negative predictive values, and receiver operating curve (ROC) of PCT were calculated. Out of 54 patients,24 (44.4%) had a final diagnosis of bacterial infection. PCT showed a wide concentration range in the bacterial infection group (median:1.09 ng/mL, lower (L)=0.05 ng/mL, upper (U)=128.7 ng/mL) compared with non bacterial infection group (0.21 ng/mL; L=0.05ng/mL; U=12.15 ng/mL). There was a significant difference in PCT between the 2 groups (p=0.020). ROC analysis demonstrated anarea under curve (AUC) of 0.686 (95% CI, 0.534 to 0.838). Using a cut-off point of 0.5 ng/mL, the sensitivity, and specificity, positivepredictive and negative predictive values of PCT were 66.7%, 76.7%, 69.6%, 74.2%, respectively. In this study, PCT may be useful fordifferentiation of bacterial vs. non bacterial infection in children.


2019 ◽  
Author(s):  
Timoléon TCHUINKAM ◽  
François Fopa ◽  
Anna Maria Doro-Altan ◽  
Innocent Djikolbe-Gondje ◽  
Maria Angeles Mendaza ◽  
...  

Abstract Background: Fever is the most frequent symptom for Malaria and HIV/AIDS, but it is non-specific; therefore it can’t be used efficiently in clinical diagnosis of malaria in hyperendemic zones. In hypoendemic areas of malaria, this assertion is not obvious, since people lack naturally acquired immunity. The present study aims at determining the Malaria-attributable fraction of fever episodes (MAFE) among HIV-positive patients in a hypoendemic highland area. Methods: During two-years prospective cross-sectional study, blood samples were collected from outpatients of an HIV/AIDS clinic and examined for the presence and density of malaria parasites. In addition to malaria related symptoms, some other patients’ data were recorded: sexe, age, body mass index (BMI), T-lymphocyte CD4 counts, viral loads, haemograms and transaminases measurements. Results: A total of 729 HIV-seropositive patients were enrolled into the study. Their mean Plasmodial infection rate and parasitaemia were: 0.823% and 1.050 parasites/µl of blood respectively; and were both significantly lower, compared to the control seronegative group, in contrast to our hypothesis. No significant difference was observed when the mean values of transaminases were compared between those with and without plasmodial infection. For the 119 (16.32%) febrile individuals found, the calculated MAFE was almost null (0.15%). Their mean CD4 count, red blood cells (RBC) count and haemoglobin rate were: 226 cell/µl, 3.83x10 6 RBC/µl and 10.4 g/dl respectively; and were all significantly lower than in the non-febrile group. However, malaria parasite infection rates and mean densities were similar in both groups. Likewise, there was no difference between: sex ratios, mean ages, BMI, total white blood cells counts and viral loads between the two groups. Conclusion: HIV infection in spite of the immunodeficiency induced does not enhance the risk of Plasmodium infection in hypoendemic highland settings. Even in the scarce cases of co-infection occurring here, malaria is rarely responsible for fever episodes. These fevers are indeed associated with higher anaemia and immunodeficiency, and likely due instead to opportunistic infectious diseases.


2017 ◽  
Vol 45 (2) ◽  
pp. 816-822 ◽  
Author(s):  
Tingyu Tang ◽  
Fang Liu ◽  
Xiaoling Lu ◽  
Qingdong Huang

Objective To evaluate the performance of GeneXpert MTB/RIF in diagnosing pulmonary tuberculosis (TB) in China. Methods This cross-sectional study included sputum specimens of 240 suspected TB cases. Specimens were examined by light microscopy for the presence of acid-fast bacilli, which were cultured by the BACTEC MGIT 960 (M960) system and detected by the GeneXpert MTB/RIF assay. The positive rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and average turnaround time of methods were evaluated. Results The positive rate was 36.6% (87/238) for the GeneXpert MTB/RIF assay and 34.0% (81/238) by M960 culture, with no significant difference between methods (χ2 = 0.33, p > 0.05). According to culture results, sensitivity of the GeneXpert MTB/RIF assay was 84.0% (68/81), specificity was 87.8% (129/147), the PPV was 78.2% (68/87), and the NPV was 87.2% (129/148). The agreement for results between Gene Xpert MTB/RIF and the M960 system was 82.8% and the Kappa value was 0.73. Conclusion The GeneXpert MTB/RIF assay is a simple, rapid, and accurate test for detecting Mycobacterium tuberculosis in sputum specimens.


2017 ◽  
Vol 6 (2) ◽  
pp. 134-146 ◽  
Author(s):  
Nualnong Wongtongkam

Purpose Violence directed at ambulance paramedics has attracted increasing public attention because of its major negative impact on the physical and psychological well-being of victims and productivity of organisations. The purpose of this paper is to explore the prevalence of violent incidents, contributing factors, burnout and post-traumatic symptoms among paramedics. Design/methodology/approach A cross-sectional survey was distributed in two ambulance services in Tasmania and South Australia, with self-administered instruments completed online. In total, 48 respondents completed questionnaires. Findings There were no significant differences between sites in timing of violent incidents, consequences of traumatic events or organisation provision. Surprisingly, over 90 per cent of paramedics had not been pushed, slapped, beaten, scratched or spat on in the previous month. There was a statistically significant difference between genders for being yelled at or verbally abused (p=0.02). When considering burnout, female paramedics showed significantly higher levels of emotional exhaustion t(37)=–2.32, p=0.02 and lower levels of career satisfaction than their male counterparts, t(37)=3.32, p=0.00. Originality/value Although prevalence rates of violent incidents seemed lower than expected, policy interventions to encourage female paramedics to display their professional identities and steps to enhance well-being and safety while on duty should be considered.


2011 ◽  
Vol 26 (S1) ◽  
pp. s143-s144
Author(s):  
H. Hatamabadi ◽  
P. Darbandsar ◽  
A. Abdalvand ◽  
H. Kariman ◽  
A. Arhamidolatabadi

ObjectivesMany of critically ill patients are being cared for prolonged periods in ED just because of limited number of ICU beds and utilize of ED as the entry point to the health care system. The aim of this study is evaluation efficiency of APACHE III scoring system in predicting mortality rate of the mentioned patients.Materials and MethodsThis cross-sectional, observational, analytic study was performed in one year period. A hundred patients remaining in ED and necessitating ICU hospitalizing were enrolled by the convenience type of non-probability sampling. Then, the APACHE III scores, predicted and observed mortality rates were calculated using of information obtained from patients' files, interview with the patients' family and performing required physical exams and lab tests.ResultsIn the assessment of 100 patients, men group were 56% (56) and women group 44% (44). The age of patients and the ED lengths of stay were 66.07 ± 19.92 years and 5.11 ± 3.79 days respectively. The average (± SD) of APACHE III score of the enrolled patients was 58.89 ± 18.24 and the predicted mortality rate calculated 32.73%; while, the total of observed mortality rate was 55%. The average (± SD) of APACHE III score of survivors and non-survivors were 48.63 ± 16.35 and 67.63 ± 14.84 respectively. So, there was a significant deference (p < 0.001). Also, there was a significant deference in the ED lengths of stay between survivors and non-survivors (3.20 ± 1.34 and 6.57 ± 4.40 respectively, p < 0.001).ConclusionIn our study, APACHE III score and ED lengths of stay were higher versus other studies in Iran and other countries; which show more critical patients presenting to our hospital and limited ICU beds versus patients. This study results nevertheless there was significant difference between predicted and observed mortality rates, the APACHE III scoring system is applicable to evaluating care, treatment and prognosis of ED patients, as is used in ICU.


2021 ◽  
pp. jim-2020-001747
Author(s):  
Ramin Tolouian ◽  
Zuber D Mulla ◽  
Hamidreza Jamaati ◽  
Abdolreza Babamahmoodi ◽  
Majid Marjani ◽  
...  

BackgroundBromhexine is a potent inhibitor of transmembrane serine protease 2 and appears to have an antiviral effect in controlling influenza and parainfluenza infection; however, its efficacy in COVID-19 is controversial.MethodsA group of hospitalized patients with confirmed COVID-19 pneumonia were randomized using 1:1 allocation to either standard treatment lopinavir/ritonavir and interferon beta-1a or bromhexine 8 mg four times a day in addition to standard therapy. The primary outcome was clinical improvement within 28 days, and the secondary outcome measures were time to hospital discharge, all-cause mortality, duration of mechanical ventilation, the temporal trend in 2019-nCoV reverse transcription-polymerase chain reaction positivity and the frequency of adverse drug events within 28 days from the start of medication.ResultsA total of 111 patients were enrolled in this randomized clinical trial and data from 100 patients (48 patients in the treatment arm and 52 patients in the control arm) were analyzed. There was no significant difference in the primary outcome of this study, which was clinical improvement. There was no significant difference in the average time to hospital discharge between the two arms. There were also no differences observed in the mean intensive care unit stay, frequency of intermittent mandatory ventilation, duration of supplemental oxygenation or risk of death by day 28 noted between the two arms.ConclusionBromhexine is not an effective treatment for hospitalized patients with COVID-19. The potential prevention benefits of bromhexine in asymptomatic postexposure or with mild infection managed in the community remain to be determined.


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Abdulmajid Almawazini ◽  
◽  
Saleh Jamaan Al Ghamdi ◽  
Chafik Ibrahim Hassan ◽  
Sami Ahmed Taha ◽  
...  

Introduction: Arrhythmias in children with structurally normal hearts are common and reported as the causes of many hospital admissions. Generally, the risk of death is low. Physical examination is important in children with arrhythmias. Objectives: This study aimed to review the common types and clinical presentations of arrhythmias in children with normal heart structures in Albaha, Saudi Arabia. Methodology: In this hospital-based retrospective cross-sectional study, the medical records of children were reviewed from January 2010 to December 2020. Results: Overall, 214 children were included in this study. The prevalence of arrhythmias was 27.10% in children aged 5-8 years; 18.7%, 8-12 years; 16.82%, 3-5 years; 16.35%, 1-3 years; 13.55%, 12-14 years; and 7.48%, <1 year. Arrhythmias were more frequent in females aged <5 years and in males aged >5 years; however, overall, there was no significant difference between females (47.20%) and males (52.80%). Supraventricular arrhythmias were the commonest and found in 85% of the children and ventricular arrhythmias were found in 15%. Sinus tachycardia was the most common type of arrhythmia, reported in 25% of the children. Conclusion: In general, arrhythmias in the children are asymptomatic. History, clinical examination, and electrocardiography are important for the diagnosis. Supraventricular arrhythmias are the most common. There is no significant difference between females and males with respect to the prevalence of arrhythmias.


Author(s):  
Vaibhav Munjal ◽  
Puneet Singh Talwar ◽  
Jagjit Singh ◽  
Mandeep Kumar ◽  
Ramandeep Gambhir

Background: Dental caries is a multifactorial disease with diet being one of the contributing factors. The influence of vegetarianism on the development of caries has scarcely been investigated in the past. Therefore, this study was done to evaluate the association of dental caries with frequency of sugar exposures and vegetarian / mixed diet.Methods: The present cross-sectional study was conducted among 2500 school children of 12 and 15 years age groups selected on the basis of simple random sampling from different schools of the city. Dental caries was recorded using Decayed, Missing and Filled teeth index (WHO modification, 1997) and correlated with the different dietary variables. Subjects were also segregated on the basis of diet: vegetarian and mixed. Statistical analysis was done using Student t-test and Pearson’s Correlation Coefficient.Results: The prevalence of dental caries in the 12 and 15 year age group of subjects consuming mixed diet was 83.36% and 86.47% respectively. It was lower in case of subjects on vegetarian diet. The correlation between DMFS and TSE, FSE and AMSE was found to be statistically significant (p<0.05) in the 12 year age-group. In the 15 year age-group the correlation of DMFS with TSE and LSE was also found to be statistically significant (p<0.05).Conclusions: There was no statistically significant difference in dental caries status among subjects in both the groups (vegetarian and mixed). However, there was significant association between sugar exposures and dental caries among subjects of both the age-groups.


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