scholarly journals The study of cardiotoxicity of hydroxychloroquine and azithromycine combination in hospitalized patients with COVID-19

2020 ◽  
Vol 11 (2) ◽  
pp. 29-39
Author(s):  
Yu. N. Belenkov ◽  
I. V. Menshikova ◽  
I. S. Ilgisonis ◽  
Yu. I. Naimann ◽  
Yu. V. Pak ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Qt Interval ◽  
Ministry Of Health ◽  
Cardiovascular Comorbidity ◽  
Corrected Qt Interval ◽  
Number Of Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Hydroxychloroquine (HCH) is included in guidelines for treatment of novel coronavirus infection (COVID-19). Data on increased risk of cardiovascular complications when using it have been published. Aim. To evaluate the safety and tolerability of HCH and azithromycine (AZM) combination for the treatment of the patients with COVID-19 in recommended by Russian Ministry of Health doses in real practice.Methods. 132 patients (62 men and 70 women of average age 59.2 ± 9.3 years), 59% of whom had cardiovascular comorbidities, were included in prospective сohort study. 112 patients took HCH + AZM (group 1) and 20 patients took other medications without potential cardiotoxicity (group 2). At the admission to the hospital and after 5–7 days of the treatment corrected QT interval was calculated, new rhythm and conduction disorders, other side effects and hospital mortality have been registering. Relative risk (RR) and 95% confidence interval (CI) were calculated. Results. Elongation of corrected QT-interval within the normal range was registered in 22.3% of patients in group 1 and in 15% — in group 2. An increase in the QT length to the upper limit of the norm (480 msec) was observed in 1.8% of patients in group 1. There were no statistically significant differences between the groups in the number of patients with prolonged QT interval (RR = 1.488, 95% CI: 0.496–4.466, р = 0.478). The occurrence of new arrhythmias, conduction disturbances and allergic reactions was not recorded. Tolerability of combination HCH + AZM was satisfactory in the majority of patients. The hospital mortality in group 1 was 1.8%, in group 2 — 5% without statistically significant difference (p = 0.374). Conclusion. A combination of HCL + AZM according to the scheme recommended by the Ministry of Health of the Russian Federation for the treatment of the patients with COVID-19 and cardiovascular comorbidity in inpatient conditions is safe.

scholarly journals The impact of COVID-19 on primary retinopexy in preventing retinal detachment in a tertiary eye hospital emergency department

2021 ◽  
pp. 112067212199472
Author(s):  
George Moussa ◽  
Emma Samia-Aly ◽  
Walter Andreatta ◽  
Kim Son Lett ◽  
Arijit Mitra ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Case Series ◽  
Significant Shift ◽  
Number Of Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
Male Patients ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Purpose: To review the effect of COVID-19 on rhegmatogenous retinal detachment (RRD) rate following primary retinopexy. Methods: Retrospective consecutive case series of 183 patients attending Birmingham and Midlands Eye Centre undergoing primary retinopexy (cryotherapy and laser) between March 23rd to June 30th in 2019 (Group 1) and 2020 (Group 2). Results: In total we reviewed 183 retinopexies, 122 in Group 1 and 61 in Group 2, a reduction of 50%. In Group 2 compared to Group 1, we showed a significant difference in characteristics of patients having primary retinopexy with an increase in proportion of male patients from 50 (41.0%) to 39 (63.9%) ( p = 0.005), increase in high myopes from 1 (0.8%) to 4 (6.6%) ( p = 0.043), more slit lamp laser retinopexy from 83 (68.0%) to 52 (85.2%) ( p = 0.013) and less cryopexy from 21 (17.2%) to 2 (3.3%) ( p = 0.008). In Group 2, primary retinopexy resulted in significantly more 3-month RRD rate 1 (0.8%) to 5 (8.2%) ( p = 0.016). There were no changes in number of patients requiring further retinopexy ( p = 1.000) Conclusion: This study demonstrates a reduction of primary retinopexy, an increased risk for RRD following primary retinopexy and a significant shift in type of primary retinopexy performed, demographics, operator and change in characteristics of type of retinal break observed during this pandemic. This study contributes to the growing literature of the secondary effects of the COVID-19 pandemic on other aspects of healthcare that is not just limited to the virus itself.

Abstract WP380: Thyrotoxicosis is Associated With Worse In-Hospital Mortality in Patients With Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sakiru O Isa ◽  
Olajide Buhari ◽  
Hameem Changezi
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
The Body ◽  
Significant Difference ◽  
History Of ◽  
Group 3 ◽  
Group 2 ◽  
Time Of Presentation ◽  
Group 1

Introduction: Hyperthyroidism increases the basal metabolic rate and affects most systems in the body. Patients with hyperthyroidism have been shown to have a higher incidence of ischemic stroke. There is a paucity of information regarding its effects on the short-term outcomes of patients admitted with ischemic stroke. Hypothesis: Hyperthyroidism is associated with worse in-hospital outcomes in patients admitted for ischemic stroke. Methods: We queried the National Inpatient Sample to identify adult patients(aged 18 and above) admitted for ischemic stroke between January 2011 and December 2014. We compared those with a history of hyperthyroidism (group 1) and thyrotoxicosis on admission (group 2) with the rest of the patients (group 3). The main outcome was in-hospital mortality. Secondary outcomes included the length of hospital stay and cost of hospitalization. We used the logistic regression model and adjusted for baseline characteristics and co-morbidities. Results: There were 643,786 patients in the study, 0.44% had a history of hyperthyroidism, and 0.01% had thyrotoxicosis at the time of presentation. The odd of mortality in group 1 compared to group 3 was 0.89, 95% CI 0.75-1.05, p=0.16 while in group 2 compared to group 3, it was 2.42, 95% CI 1.29-4.52, p<0.006. The mean length of stay was also longer in group 2 with a mean difference of 8.06, 95% CI 4.74 - 11.39, p<0.0001. Conclusion: From the study, there was no significant difference in in-hospital mortality between patients with previously diagnosed hyperthyroidism and those without diagnosed hyperthyroidism. Patients who had thyrotoxicosis on admission, on the other hand, had worse outcomes compared to patients without thyrotoxicosis.

Abstract 26: Thirty Day And Six Month All-cause Mortality After Stroke In Patients With And Without Dysphagia Screening.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Thomas M Hemmen ◽  
Rema Raman ◽  
Karin Ernstrom ◽  
Debra Paulson ◽  
Valerie Lake ◽  
...  
Keyword(s):  
Aspiration Pneumonia ◽  
Morbidity And Mortality ◽  
Categorical Variables ◽  
Stroke Severity ◽  
Continuous Variables ◽  
Admission Source ◽  
Increased Risk ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Background: Dysphagia is common after stroke and is associated with an increased risk for pulmonary complications and mortality. Current standards mandate screening for dysphagia before oral intake in all acute stroke patients. We aimed to show if this early screening affects long-term outcomes after stroke. Methods: We included all UCSD Medical Center discharges with diagnosis AIS, ICH and SAH between July 1 2008 and June 30 2011; and evaluated baseline demographics, admission diagnosis (AIS, ICH, SAH), admission source (ED or transfer) length of hospital stay (LOS), ICU-LOS, aspiration pneumonia, in-hospital, 30-day and 6-month mortality by public death records for all patients. Patients were grouped as: 1) no dysphagia screening performed, 2) Nil per os (NPO) until discharge, 3) dysphagia screening performed. Adjustments for stroke severity and CMI were not possible. Statistical comparisons were done with the Kruskal-Wallis test (continuous variables) or Fisher-Freeman-Halton test (categorical variables). For pairwise comparisons we used the Wilcoxon tests (continuous variables) or Fisher’s Exact test (categorical variables), with Holm’s adjusted p-values. Results: A total of 476 patients were included, Group 1: 47, Group 2: 119, Group 3: 310. There was no significant difference in age, gender, race/ethnicity, and diagnosis of HTN, DM, afib, prior stroke and admission source. More patients with SAH and ICH were in Group 2. Overall, LOS and ICU LOS, aspiration pneumonia, in-hospital, 30-day and 6-month mortality were found to be different among groups (p<0.0001). Pair-wise comparisons showed that all outcomes were significantly higher in Group 2, but similar between Groups 1 and 3 (NS). Conclusion: We found no difference in outcomes between patients who received dysphagia screening versus not (Group 1 vs 3). Excluding patients who were left NPO and are more likely to suffer from ICH, SAH with increased morbidity and mortality, it remains uncertain if a targeted early dysphagia screening can reduce morbidity and mortality after stroke. Further studies are needed to find the appropriate population that most benefits from dysphagia screening.

scholarly journals Frequency and severity of general surgical emergencies during the COVID-19 pandemic: single-centre experience from a large metropolitan teaching hospital

2020 ◽  
Vol 102 (6) ◽  
pp. 457-462 ◽  
Author(s):  
R Patel ◽  
AJ Hainsworth ◽  
K Devlin ◽  
JH Patel ◽  
A Karim
Keyword(s):  
Teaching Hospital ◽  
General Surgery ◽  
Trauma Centre ◽  
Early Warning Score ◽  
Emergency General Surgery ◽  
Number Of Patients ◽  
Major Trauma Centre ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Introduction The COVID-19 pandemic has put significant stress on healthcare systems globally. This study focuses on emergency general surgery services at a major trauma centre and teaching hospital. We aimed to identify whether the number of patients and the severity of their presentation has significantly changed since the implementation of a national lockdown. Materials and methods This study is a retrospective review of acute referrals (from general practice and accident and emergency) to the emergency general surgery team over a 14-day period before (group 1) and during (group 2) lockdown. Results A total of 151 patients were reviewed by the general surgical team in group 1 and 75 in group 2 (a 50.3% reduction). The number of days with symptoms prior to presentation was significantly shorter in group 1 compared with group 2 (3 vs 4, p = 0.04). There was no significant difference in the National Early Warning Score, white blood cell count, lymphocytes and C-reactive protein on admission between the two groups of patients. There were significantly fewer patients admitted after lockdown compared with pre-lockdown (66% vs 48%, p = 0.01). Length of hospital stay was significantly shorter during lockdown compared with pre-lockdown (5 days vs 4 days, p = 0.04). Conclusion Fewer patients were referred and admitted during lockdown compared with pre-lockdown, and the length of stay was also significantly reduced. There was also a delay in presentation to hospital, although these patients were not more unwell based on the scoring criteria used within this study.

scholarly journals Comparative study between open and laparoscopic lymphadenectomy (pelvic and para-aortic) in gynecological malignancies

2018 ◽  
Vol 5 (5) ◽  
pp. 1657
Author(s):  
Hytham R. Yassin ◽  
Soliman ALShakhs ◽  
Mohammed Hamed ◽  
Adel Karam ◽  
Mohammed Mouneer
Keyword(s):  
Comparative Study ◽  
Radical Surgery ◽  
Safe Procedure ◽  
Gynecological Malignancies ◽  
Number Of Patients ◽  
Significant Difference ◽  
Operative Complications ◽  
Group 2 ◽  
Group 1

Background: Objective of present study was to compare the results of lymphaenectomy (pelvic and para-aortic) between laparoscopy and laparotomy in gynecological malignancies.Methods: Authors analyze the results of 30 patients suffering from gynecological malignancies (Enometrial, Ovarian and cervical) submitted to surgery as apart of treatment. Patients were classified in Two Groups Group (1) included15 patients were submitted to open radical surgery and group (2) included 15 patients Were submitted to laparoscopic radical surgery between May 2016 and October 2017.Results: In present comparative study, there was significant difference regarding intra operative blood loss, operative time and post operative hospital stay (P<0.001) and there was no significant difference regarding intra-operative complications, post-operative complications, total number of lymph node harvested, number of positive lymphnodes (P>0.05).Conclusions: Laparoscopic lymphadenectomy is a technically feasible and safe procedure. Authors recommend further study in large number of patients with longer duration and follow up period for assessment of oncological out-come.

Primary or secondary Bentall-De Bono procedure: are the outcomes worse?

2019 ◽  
Vol 27 (4) ◽  
pp. 271-277
Author(s):  
Ameya Kaskar ◽  
Deepak V Bohra ◽  
Rahul Rao K ◽  
Varun Shetty ◽  
Devi Shetty
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Survival Rates ◽  
Median Sternotomy ◽  
Postoperative Mortality ◽  
Mortality And Morbidity ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Background The aim of this study was to compare the outcomes of a primary and secondary Bentall-De Bono procedure. Methods From 2008 to 2015 (8-year period), 308 patients underwent a Bentall-De Bono procedure in our institute. The mean age was 43 ± 13 years and 80% were men. Twenty-eight patients had prior cardiac surgery through a median sternotomy (group 1) and 280 underwent a primary Bentall-De Bono procedure (group 2). Various preoperative and perioperative parameters were analyzed before and after propensity-score matching. Results Before propensity-score matching, patients undergoing a secondary Bentall-De Bono procedure had a worse preoperative profile, as indicated by a higher EuroSCORE II ( p < 0.0001), with hospital mortality in group 1 of 14% (4/28) and 5% (14/280) in group 2 ( p = 0.069). After propensity-score matching, there was no significant difference in EuroSCORE II ( p = 0.922) or hospital mortality ( p = 0.729). After adjusting for the different variables, repeat sternotomy could not be identified as an independent predictor of postoperative mortality or morbidity. Survival at the end of 1 and 5 years in both groups showed no significant differences before or after propensity-score matching ( p = 0.328 and p = 0.356, respectively). In Cox multivariable regression analysis, reoperation was not identified as an independent factor for survival before ( p = 0.559) or after propensity-score matching ( p = 0.365). Conclusion A secondary Bentall-De Bono procedure can be performed with acceptable mortality and morbidity, and with midterm survival rates comparable to those of a primary Bentall-De Bono procedure.

COVID-19-associated healthcare worker depression: An increasingly common condition

2021 ◽  
Vol 9 (3) ◽  
pp. 93-97
Author(s):  
Kemal Koray Bal
Keyword(s):  
Healthcare Workers ◽  
Depressive Mood ◽  
Clinical Psychologist ◽  
Sufficient Information ◽  
Increased Risk ◽  
Significant Difference ◽  
Group 2 ◽  
Work Done ◽  
The Relationship ◽  
Group 1

OBJECTIVE: This study aimed to evaluate the mood of the employees of the ear-nose-throat (ENT) department with the Beck Depression Inventory (BDI) during the coronavirus disease 2019 (COVID-19) pandemic and determine the relationship between the mood and the quality and quantity of the work done. METHODS: A total of 62 healthcare workers (24 males, 38 females; mean age: 34.3±1.1 years; range 24 to 52 years) of our ENT clinic, who have been actively managing COVID-19 patients since April 2020, were included in the study. Those in the study were classified into two groups as nurses (Group 1) and doctors (Group 2). Group 1 consisted of 33 (53.2%) nurses, and Group 2 consisted of 29 (46.8%) doctors. The participants were assessed with a questionnaire by a clinical psychologist, and BDI was conducted to evaluate depressive mood in these individuals. RESULTS: A statistically significant difference was found between the groups in thinking they have sufficient knowledge on COVID-19, and the employees in Group 2 were more of the opinion that they did not have sufficient information (p=0.002). A statistically significant difference was found between the groups in terms of their viewpoint on the precautions against COVID-19 (p=0.001). Group 2 was more inclined to think that the precautions taken were inadequate (p=0.001). There was no statistically significant difference between the groups in terms of BDI severity, age, and BDI score (p=0.252, p=0.137, p=0.053, respectively). CONCLUSION: Employees of high-risk departments such as ENT may be more prone to a depressed mood. The increased risk of contamination in correlation with the work done can lead to increased BDI scores and depressive mood disorder.

scholarly journals Efficacy and opioid-sparing effect of interpleural bupivacaine in patients undergoing laparoscopic cholecystectomy: Prospective observational study (Running title: Efficacy of inter-pleural bupivacaine in laparoscopy)

2021 ◽  
Vol 43 (5-6) ◽  
pp. 103-110
Author(s):  
A.K. Prasath ◽  
Senthil Kumar ◽  
Mohanhariraj Angamuthammal ◽  
Agnes Evangleen
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Relief ◽  
Study Groups ◽  
P Value ◽  
Number Of Patients ◽  
Significant Difference ◽  
Vas Scores ◽  
The Difference ◽  
Group 2 ◽  
Group 1

Introduction: Laparoscopic cholecystectomy is considered minimally invasive, but pain following laparoscopy is moderate to severe, leading to increased morbidity and length of hospital stay. Various medications, including opioids, NSAIDs, and techniques like intraperitoneal local anesthetic infiltration, are used. In this study, we investigated interpleural block with bupivacaine for pain relief following laparoscopic cholecystectomy. Methods: A total of 60 patients were included in the study. 30 patients received 20 ml of 0.5% interpleural bupivacaine (group 1), and 30 patients recieved 20 ml of 0.9% normal saline (group 2). We recorded visual analog score (VAS), vital signs, and postoperative opioid requirements. Tramadol (2 mg/kg) was rescue medication if VAS ≥ 5. Results: Significant difference between study groups was recorded among VAS scores measured at 30 minutes, 1, 2, 6, 10, and 12 hours (p value < 0.05). The difference in VAS scores at 15 minutes and 14 hours between study groups was insignificant (p value > 0.05). The number of patients who received tramadol was 9 (30%) patients in group 1 and 29 (96.7%) patients in group 2. The difference in proportion for tramadol intake at 6 hours was significant among study groups (p-value < 0.05). Conclusion: Interpleural bupivacaine 20 ml of 0.5% used as analgesia reduces post-operative opioid requirement following laparoscopic cholecystectomy. Hence interpleural block can be safely used as a regional technique for pain relief following laparoscopic cholecystectomy.

scholarly journals Diabetes Mellitus: An Independent Risk Factor of In-Hospital Mortality in Patients with Infective Endocarditis in a New Era of Clinical Practice

2019 ◽  
Vol 16 (12) ◽  
pp. 2248 ◽  
Author(s):  
Lin ◽  
Chua ◽  
Chung ◽  
Hang ◽  
Tsai
Keyword(s):  
Diabetes Mellitus ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Early Identification ◽  
Multivariable Analysis ◽  
Increased Risk ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Infective endocarditis (IE) is a severe disease with a hospital mortality rate of 17%–25%. Early identification of IE patients with high risk of mortality may improve their clinical outcomes. Patients with diabetes mellitus (DM) who develop infective diseases are associated with worse outcomes. This study aimed to define the impact of DM on long-term mortality in IE patients. A total of 412 patients with definite IE from February 1999 to June 2012 were enrolled in this observational study and divided into 2 groups: group 1, patients with DM (n = 72) and group 2, patients without DM (n = 340). The overall in-hospital mortality rate for both groups combined was 20.2% and was higher in group 1 than in group 2 (41.7% vs. 16.5%, p < 0.01). Compared to patients without DM, patients with DM were older and associated with higher incidence of chronic diseases, less drug abuse, higher creatinine levels, and increased risk of Staphylococcus aureus infection (all p < 0.05). Moreover, they were more likely to have atypical clinical presentation and were associated with longer IE diagnosis time (all p < 0.05). In multivariable analysis, DM is an independent and significant predictor of mortality. The prognosis of IE patients with DM is still poor. Early identification and more aggressive treatment may be considered in IE patients with DM.

scholarly journals The Safty Profile of Blood Salvage Applied for Collected Blood With Amniotic Fluid During Cesarean Section

2021 ◽  
Author(s):  
Xiaoying Rong ◽  
Xiangyang Guo ◽  
Hong Zeng ◽  
Jun Wang ◽  
Mi Li ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Amniotic Fluid ◽  
Venous Blood ◽  
Fetal Hemoglobin ◽  
Elective Cesarean Section ◽  
Suction Device ◽  
Increased Risk ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Abstract Background: The guidelines of National Health Service(NHS) also recommended for use in obstetrics at increased risk of bleeding, requiring two sets to reduce amniotic fluid contamination, however, when comes to massive hemorrhage, it is may difficult to operate because the complex operation may delay time. The aim of the study was to detect the effect of amniotic fluid recovery on intraoperative cell salvage in obstetrics and provide evidence for clinical applications.Method: Thirty-four patients undergoing elective cesarean section were randomly divided into two groups. In group 1, the cumulative blood from the operation field, including the amniotic fluid, was collected using a single suction device for processing. In group 2, after suctioning away the amniotic fluid using another suction device for the cumulative blood from the operation field. From each group, four samples were taken, including maternal venous blood (sample I), blood before washing (sample II), blood after washing (sample III) and blood after filtration with a leukocyte filter (sample IV) , to detect serum potassium (K+), hemoglobin (Hb), white blood cell (WBC), fetal hemoglobin (HbF), alpha fetoprotein (AFP) and squamous cell (SC) levels.Results: The AFP, K+ and WBC levels of sample III and sample IV were significantly lower than sample I in group 1 and group 2 (P<0.05). Significantly more SCs were found in sample III than in sample I in group 1 and group 2 (P<0.05), but SCs of sample IV had no statistical difference compared to sample I in group 1 and group 2 (P>0.05). There was no significant difference in the K+, Hb, WBC, AFP and SC levels of sample IV between group 1 and group 2 (P>0.05). The HbF levels of sample III and sample IV were significantly higher in group 1 than in group 2 (P<0.05).Conclusion: There is little or no possibility for AF contamination to enter the re-infusion system when used in conjunction with a leucodepletion filter. In future, one set of suction device can be considered in obstetric emergency.Trial registration: ChiCTR1800015684, 2018.4.15

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