Đánh giá nồng độ ferritin, D-dimer và độ nặng ở bệnh nhân Covid-19

2022 ◽  
Author(s):  
Thua Nguyen Tran
Keyword(s):  
Care Center ◽  
Plasma Concentrations ◽  
Health Sector ◽  
Clinical Signs ◽  
Area Under The Curve ◽  
Cross Sectional Study ◽  
Average Concentration ◽  
Cross Sectional ◽  
Ferritin Concentration ◽  
D Dimer

TÓM TẮT Đặt vấn đề: Việc điều trị bệnh nhân COVID-19 đặc biệt là những bệnh nhân nặng và nguy kịch vẫn là thách thức đối với nền y tế còn hạn chế trong bối cảnh hiện nay của nước ta. Vì vậy, việc dựa vào các dấu hiệu lâm sàng và các xét nghiệm sẵn có để đánh giá mức độ nặng và khả năng tiến triển nặng của bệnh là rất cần thiết để có hướng tiếp cận kịp thời. Trong đó ferritin và d-dimer được cho là các chỉ dấu sinh học có liên quan đến mức độ nặng của bệnh COVID 19. Nghiên cứu này nhằm: (1) Đánh giá tình trạng tăng nồng độ ferritin và nồng độ d-dimer huyết tương ở bệnh nhân COVID-19. (2) Xác định giá trị điểm cắt nồng độ d-dimer huyết tương nhằm tiên đoán mức độ nặng của bệnh nhân COVID-19. Phương pháp: Nghiên cứu mô tả cắt ngang trên 209 bệnh nhân mắc COVID-19 điều trị tại Trung tâm hồi sức tích cực người bệnh COVID-19 trực thuộc bệnh viện trung ương Huế tại thành phố Hồ Chí Minh từ tháng 08/2021 đến tháng 11/2019. Tất cả bệnh nhân được đánh giá mức độ nặng của bệnh COVID-19 dựa vào triệu chứng lâm sàng và độ bão hòa oxy máu, được tiến hành định lượng nồng độ ferritin và d-dimer. Tăng nồng độ ferritin được định nghĩa: ở nam là từ 400ng/ml trở lên và ở nữ là từ 150ng/ml trở lên, tăng nồng độ d-dimer là từ 500 ng/ml trở lên. Xử lý số liệu bằng phần mềm SPSS 16.0. Kết quả: Tỉ lệ tăng ferritin ở nhóm bệnh nhân nặng là 89,77%. Nồng độ d-dimer ở nhóm bệnh nhân nặng trung bình là 4732,43ng/ml. Khi nồng độ d-dimer > 1537ng/ml thì sẽ có nguy cơ là bệnh COVID-19 sẽ nặng với diện tích dưới đường cong (AUC) 0,699 (khoảng tin cậy 95%: 0,627 - 0,771); độ nhạy 57,95% và độ đặc hiệu 75,83%; p < 0,0001. Kết luận: Ferritin và d-dimer huyết tương là yếu tố liên quan độc lập với độ nặng của bệnh COVID-19. ABSTRACT EVALUATION OF THE PLASMA CONCENTRATIONS OF FERRITIN, D - DIMER AND SEVERITY IN COVID-19 PATIENTS Background: The treatment of COVID-19 patients, especially the severely ill and critically ill, is still a challenge for the limited health sector in the current context of our country. Therefore, it is necessary to rely on clinical signs and available tests to assess the severity and possibility of severe progression of the disease to have a timely approach. Among them, ferritin and d-dimer are thought to be biomarkers related to the severity of COVID-19 disease. Therefore, this study aims to evaluate the increase in plasma ferritin concentration and the plasma concentrations of d-dimer in COVID-19 patients and to determine the cut-off of d-dimer to prognosis the severity in COVID-19 patients. Methods: A cross - sectional study was performed on 209 COVID-19 patients at COVID-19 Intensive Care Center ofHue Central Hospital in Ho Chi Minh city from August 2021 to November 2021. All patients were evaluated the severity of disease based on symptoms, signs, and saturation of oxygen in the blood and were measured plasma concentration of ferritin and d-dimer. The increase ferritin concentration is defined as higher than 400ng/ml in men and 150ng/ml in women; d-dimer was elevated when ≥ 500ng/ml. Data were analyzed by SPSS version 16.0. Results: In the severe patient group, the increase ferritin concentration accounted for 89.77%, the average concentration of d-dimer was 4732.43ng/ml. When the d-dimer concentration was more than 1537ng/ml, there was a risk that COVID-19 would be severe with the area under the curve (AUC) 0.699 (95% CI: 0.627 - 0.771); sensitivity 57.95% and specificity 75.83%; p < 0.0001. Conclusion: Plasma ferritin and d-dimer concentrations are independent risk factors for severity in COVID-19 patients. Key words: Ferritin, d-dimer, COVID-19 patients.

Current situation of stress, anxiety, and depression of the health care workers working at the Health Care Center of Soc Son district, Hanoi, Vietnam, 2019

2021 ◽  
Vol 30 (9) ◽  
pp. 91-98
Author(s):  
Vu Ngoc Ha ◽  
Mac Dang Tuan ◽  
Nguyen Thanh Trung ◽  
Nguyen Ngoc Huan ◽  
Luu Thi Lien ◽  
...  
Keyword(s):  
Health Care ◽  
Mental Disorders ◽  
Health Care Workers ◽  
Care Center ◽  
Health Sector ◽  
Cross Sectional Study ◽  
Anxiety And Depression ◽  
Cross Sectional ◽  
Health Care Center ◽  
Care Workers

A cross-sectional study using DASS21 was performed in June 2019 on staff working at the commune health stations (CHSs), regional general clinics and district general clinics in Soc Son district, Hanoi to assess the mental disorders of the health care workers are working here. Among the 355 health care workers (HCWs) who participated, women accounted for 75.5%. People aged under 30 accounting for 33.5% of HCWs. Physicians, nurses take up 54.4%, and HCWs in the Soc Son district have worked in the health sector for more than ten years, accounting for 45.1%. The study shows that the rates of stress, anxiety, and depression were 13.8%, 25.4% and 16.6%, respectively. 31% of HCWs have at least one mental disorder, 8.2% of study subjects have all three manifestations of mental disorders, 8.4% of study subjects have two symptoms and 14.4% of the study subjects had only one manifestation. The rates of stress, anxiety, and depression were initially screened from the research results. The development of research directions for defnitive diagnosis and support for improving health care workers’ mental health should be integrated.

scholarly journals Coagulation profile and correlation between D-dimer, inflammatory markers, and COVID-19 severity in an Indonesian national referral hospital

2021 ◽  
Vol 49 (11) ◽  
pp. 030006052110599
Author(s):  
Lugyanti Sukrisman ◽  
Robert Sinto
Keyword(s):  
Inflammatory Markers ◽  
Characteristic Curve ◽  
Cross Sectional Study ◽  
World Health ◽  
Cross Sectional ◽  
Ferritin Concentration ◽  
Reactive Protein ◽  
Health Organization ◽  
National Referral Hospital ◽  
D Dimer

Background Coagulopathy and inflammation are associated with coronavirus disease 2019 (COVID-19) severity. This study assessed D-dimer concentration and its correlation with inflammatory markers and COVID-19 severity. Methods This was a retrospective cross-sectional study involving 194 COVID-19 cases, with the severity of infection graded in accordance with the World Health Organization (WHO) guidelines. We measured D-dimer, C-reactive protein (CRP), and ferritin on admission and determined the cutoff values for D-dimer and CRP and evaluated the correlation between D-dimer and CRP and ferritin. Results Median D-dimer, CRP, and ferritin concentrations were 2240 µg/L, 73.2 mg/L, and 1173.8 µg/mL, respectively. The highest median D-dimer value was seen in mild and moderate acute respiratory distress syndrome (ARDS). The highest ferritin concentration was seen in severe ARDS. There was a significant correlation between D-dimer value and CRP (r = 0.327), but no significant correlation between D-dimer and ferritin (r = 0.101). The area under the receiver operating characteristic curve (AUC) for the combination of CRP ≥72.65 mg/L and D-dimer ≥1250 µg/L as a marker of COVID-19 severity was 0.722 (95% confidence interval (CI): 0.615–0.781). Conclusion The combination of CRP ≥72.65 mg/L and D-dimer ≥1250 µg/L can be used as marker of COVID-19 severity, with moderate accuracy.

scholarly journals Application of D-Dimer in Prognosis of Pulmonary Embolism

2019 ◽  
Vol 05 (01) ◽  
pp. 015-018
Author(s):  
Urvashi Gupta ◽  
Jagannath S. Dhadwad ◽  
Prasad A. Gurjar ◽  
Dineshsingh Patil
Keyword(s):  
Pulmonary Embolism ◽  
Color Doppler ◽  
Care Center ◽  
Tertiary Care ◽  
False Negative ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Negative Results ◽  
Clinical Probability ◽  
D Dimer

Abstract Introduction Pulmonary embolism (PE) is a relatively common cardiovascular emergency. It can lead to a variety of outcomes, from potentially reversible right ventricular failure (by occluding the pulmonary arterial bed) to eventual death. The diagnosis of PE is often missed due to its nonspecific clinical presentation. Materials and Methods This is a descriptive cross-sectional study conducted at tertiary care center in India from October 1, 2016 to September 30, 2018, which includes 36 cases of PE. Institutional ethics committee clearance was obtained before start of the study. Written and informed consent was obtained from all patients. Patients were informed regarding purpose, procedures, risks, and benefits of the study in their own vernacular language. Results The age-wise distribution of patients in this study showed that most patients were up to 40 years amounting to 58.4% of cases. Sex-wise distribution also showed that most patients were male (66.7%). Fifty percent of the patients had no thrombosis on Color Doppler findings of the involved limb, and 31.25% had superficial venous thrombosis. Blood investigation revealed that 94.4% patients had troponin negative and 94.4% had D-dimer positive. This study also attempted to correlate the D-dimer findings and Well's score. It can be seen that as per Well's score, 13 patients were with high probability, 18 with moderate probability, and 5 with low probability. Conclusion This study states that D-dimer assays are highly sensitive and have a low rate of false-negative results. The assays have been found safe and effective when the clinical probability of PE is low. When the D-dimer result is negative in patients with low clinical probability of having PE, the presence of acute PE can be safely ruled out without diagnostic imaging.

Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

2021 ◽  
pp. 1-4
Author(s):  
Ruo S. Chen ◽  
Laurel O’Connor ◽  
Matthew R. Rebesco ◽  
Kara L. LaBarge ◽  
Edgar J. Remotti ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Endotracheal Tube Cuff ◽  
Cross Sectional ◽  
Tube Cuff ◽  
Respiratory Therapists ◽  
Significant Difference

Abstract Introduction: Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O. Objectives: While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers. Methods: This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded. Results: In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients. Conclusion: An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon.

scholarly journals P0614URINARY EXOSOMAL MICRORNA-21 AS A MARKER OF SCRUB TYPHUS-ASSOCIATED ACUTE KIDNEY INJURY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
In O Sun ◽  
Kwang Young Lee ◽  
A Young Cho
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Scrub Typhus ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Total Leukocyte Count ◽  
Cross Sectional ◽  
Exosomal Mirna

Abstract Background and Aims Urinary microRNA (miRNA)-21 is reported to be a biomarker for detection of acute kidney injury (AKI). Analysis of urinary exsome may serve as a novel diagnostic approach in kidney disease. The aim of this study is to investigate the clinical significance of urinary exosomal miRNA-21 for AKI in patients with scrub typhus. Method In a cross-sectional study, we collected 138 urine samples at the time of admission from 145 patients with scrub typhus. For 25 patients with scrub typhus-associated AKI and 25 age, sex-matched scrub typhus patient without AKI, we measured miRNA-21 in urinary exosomal fraction and compared diagnostic value in predictiong AKI. Results Compared with patients in the non-AKI group, patients in the AKI group were more likely to have one or more comorbidity such as diabetes (50% vs. 5%, P&lt;0.01) and chronic kidney disease (8% vs. 0%, P&lt;0.01). Total leukocyte count were higher in patients with AKI than in those without AKI (10.40 × 103/ mL vs. 6.40 × 103/mL, P&lt;0.01). The levels of urinary miRNA-21 were higher in the AKI group than in the non-AKI group. Urinary exosomal miRNA-21 levels correlated directly with serum neutrophil gelatinase-associated lipocalin values and total leukocyte counts and inversely with estimated glomerular filtration rate. The receiver operator characteristics curve analysis for urinary exosomal miRNA-21 showed good discriminative power for the diagnosis of scrub typhus-associated AKI, with area under the curve value of 0.907. Conclusion Urinary exosomal miRNA-21 could be a surrogate markers for the diagnosis of scrub typhus–associated AKI.

scholarly journals Influence ofABCC2andABCC4Polymorphisms on Tenofovir Plasma Concentrations in Thai HIV-Infected Patients

2015 ◽  
Vol 59 (6) ◽  
pp. 3240-3245 ◽  
Author(s):  
Kanokrat Rungtivasuwan ◽  
Anchalee Avihingsanon ◽  
Narukjaporn Thammajaruk ◽  
Siwaporn Mitruk ◽  
David M. Burger ◽  
...  
Keyword(s):  
Body Weight ◽  
Multivariate Analysis ◽  
Plasma Concentration ◽  
Protease Inhibitors ◽  
Demographic Data ◽  
Plasma Concentrations ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The Mean

ABSTRACTTenofovir (TFV) is eliminated by renal excretion, which is mediated through multidrug-resistant protein 2 (MRP2) and MRP4, encoded byABCC2andABCC4, respectively. Genetic polymorphisms of these transporters may affect the plasma concentrations of tenofovir. Therefore, the aim of this study was to investigate the influence of genetic and nongenetic factors on tenofovir plasma concentrations. A cross-sectional study was performed in Thai HIV-infected patients aged ≥18 years who had been receiving tenofovir disoproxil fumarate at 300 mg once daily for at least 6 months. A middose tenofovir plasma concentration was obtained. Multivariate analysis was performed to investigate whether there was an association between tenofovir plasma concentrations and demographic data, including age, sex, body weight, estimated glomerular filtration rate (eGFR), hepatitis B virus coinfection, hepatitis C virus coinfection, duration of tenofovir treatment, concomitant use of ritonavir-boosted protease inhibitors, and polymorphisms ofABCC2andABCC4. A total of 150 Thai HIV-infected patients were included. The mean age of the patients was 43.9 ± 7.2 years. The mean tenofovir plasma concentration was 100.3 ± 52.7 ng/ml. In multivariate analysis, a low body weight, a low eGFR, the concomitant use of ritonavir-boosted protease inhibitors, and theABCC44131T → G variation (genotype TG or GG) were independently associated with higher tenofovir plasma concentrations. After adjusting for weight, eGFR, and the concomitant use of ritonavir-boosted protease inhibitors, a 30% increase in the mean tenofovir plasma concentration was observed in patients having theABCC44131 TG or GG genotype. Both genetic and nongenetic factors affect tenofovir plasma concentrations. These factors should be considered when adjusting tenofovir dosage regimens to ensure the efficacy and safety of a drug. (This study has been registered at ClinicalTrials.gov under registration no. NCT01138241.)

A Comparison of Falls and Dizziness Handicap by Vestibular Diagnosis

2021 ◽  
pp. 1-10
Author(s):  
Ryan J. Huang ◽  
Sherri L. Smith ◽  
Libor Brezina ◽  
Kristal M. Riska
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Demographic Variables ◽  
Vestibular Migraine ◽  
Cross Sectional ◽  
Positional Vertigo ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Paroxysmal Positional Vertigo

Purpose There is a paucity of data that directly compares the falls rate and dizziness handicap of different vestibular diagnoses. The purpose of this study is to compare the falls rate and dizziness handicap of common vestibular diagnoses encountered among a cohort of vestibular patients at a single institution. Method We conducted a retrospective cross-sectional study of patients evaluated for dizziness at a tertiary care center vestibular clinic between August 1, 2017, and March 19, 2019. Vestibular diagnosis, demographic variables, comorbidities, falls status, and Dizziness Handicap Inventory (DHI) were extracted from the medical record for analysis. Associations between vestibular diagnosis and falls history or DHI were evaluated using multivariate logistic and linear regression, respectively. Results A total of 283 patients met our inclusion criteria with the following diagnoses: benign paroxysmal positional vertigo (BPPV; n = 55), acoustic neuroma ( n = 30), Ménière's disease ( n = 28), multiple vestibular diagnoses ( n = 15), vestibular migraine ( n = 135), or vestibular neuritis ( n = 20). After adjusting for age, sex, race, medications, and comorbidities, the odds of falling was 2.47 times greater (95% CI [1.08, 6.06], p = .039) and the DHI score was 11.66 points higher (95% CI [4.99, 18.33], p < .001) in those with vestibular migraine compared to those with BPPV. Other diagnoses were comparable to BPPV with respect to odds of falling and dizziness handicap. Conclusions Patients with vestibular migraine may suffer an increased risk of falls and dizziness handicap compared to patients with BPPV. Our findings highlight the need for timely evaluation and treatment of all patients with vestibular disease.

Prevalence and Risk Factors of work Related Musculo Skeletal Disorders (wrmsd’s) Among Doctors - A Cross Sectional Study

2021 ◽  
pp. 1-4
Author(s):  
Biju Azariah ◽  
◽  
Geethu Babu ◽  
Keyword(s):  
Risk Factors ◽  
Service Sector ◽  
Care Delivery ◽  
Tertiary Care ◽  
Health Sector ◽  
High Volume ◽  
Cross Sectional Study ◽  
Working Environment ◽  
Cross Sectional ◽  
Work Related

Work related musculoskeletal disorders (WRMSDs) have not only shown to impact the physical and pschycological comfort of the employee but also deteriorate the prospects of any production or service sector. The prevalence of WRMSDs, though studied extensively in various sectors, has been understudied in health sector, especially among doctors. This study which evaluated the prevalence and risk factors of these disorders among fifty cancer treating Radiation Oncologist at a Tertiary Care Cancer Centre in India had exposed out an alarming 68% prevalence of these disorders in the study population, with neck pain being the commonest site of these Muscloskeletal Disorders (MSDs). Several factors which could impact the development of MSDs were analysed. This higher incidence of MSDs is presumed to be because of extreme physical and mental stress of working in a high volume cancer care centre, persistent unhealthy postures during work, inadequate micropauses between works and uncomfortable working atmosphere. Adequate physician patient ratio, restricting the patient load, providing good physician friendly working environment and adequate mandatory breaks might significantly reduce the incidence of these disorders and can prevent the sagging of health care delivery.

scholarly journals Timing and reasons for antenatal care booking among women in a tertiary health care center in Southern Nigeria

2017 ◽  
Vol 6 (9) ◽  
pp. 3731 ◽  
Author(s):  
Ntiense Macaulay Utuk ◽  
Anyiekere Ekanem ◽  
Aniekan Monday Abasiattai
Keyword(s):  
Antenatal Care ◽  
Care Center ◽  
Mode Of Delivery ◽  
Cross Sectional Study ◽  
Safe Motherhood ◽  
Cross Sectional ◽  
Post Secondary ◽  
Health Care Center ◽  
Southern Nigeria ◽  
The Mean

Background: Antenatal care is one of the four pillars of safe motherhood and its benefits in preventing adverse feto-maternal outcome is proven. Commencement of antenatal care early has been shown to be key for this benefit to be fully realized. The aim of this study was to determine the antenatal booking pattern of pregnant women and its determinants in our environment.Methods: A cross sectional study of women attending the booking clinic in the University of Uyo Teaching Hospital, Akwa Ibom State, Southern Nigeria over a three-month period.Results: The mean age of the respondents was 28.5 years. The mean gestational age at booking was 18.3 weeks. The majority of the patients were married (94.1%). 68.1% had a post-secondary education. 33.5% of patients were nultiparous, while 3.5% were grand multiparous. The majority of patients (72.4%) booked late for antenatal care. Age group, marital status, mode of delivery was not significantly associated with timing of booking. High levels of patient’s education, high levels of husband’s education as well as grand multiparity were significantly associated with late booking (P<0.05). Majority (65.4%) of patients claimed that it was safe to book at any time during pregnancy.Conclusions: The majority of women booked late for antenatal care. In our study, we have found that general and health education, subsidisation of cost for antenatal care and introduction of focused antenatal care will help to reverse this trend.

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