Does Pulmonary Embolism Differ Between Genders in Terms of Clinical, Laboratory Findings, Prognosis and Mortality?

INTRODUCTION: Pulmonary thromboembolism (PTE) is a disease that mortal and hardly diagnosed. Since findings of PTE are nonspesific diagnosed can be so hard sometimes. Major risk factors are malignancy, immobility, previous surgery, thrombophilia, advanced age, and genetic factors. Studies on the relationship between gender and prognosis in PTE have very different results. In this study, we aimed to evaluate gender differences in terms of prognosis, intensive care admission, laboratory, and radiological tests. METHODS: We retrospectively analyzed the data of 348 patients diagnosed with Acute PTE between January 2012 and December 2015. All of these patients were patients who applied to the emergency department of our center, which is a third step chest diseases hospital. We used the PTE guideline jointly designed by the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) for prognosis classifications. RESULTS: The mean age of the patients was 62.7, while the male patients were younger. Women's sPESI scores and mean ages were observed higher than men. Although women had more bad prognostic factors, no significant difference was found between both genders in terms of early mortality. DISCUSSION AND CONCLUSION: Although there is a difference between mean age and simplified Pulmonary Embolism Severity Index (sPESI) scores; no difference in early mortality between men and women. Gender studies in PTE are an area that is open to new studies, since the studies conducted on this subject give quite different results and these results may affect the follow-up protocols.

Download Full-text

COVID-19 infection: epidemiological, clinical, and radiological expression among adult population

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00341-9 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Eman Ragab ◽

Asrar Helal Mahrous ◽

Ghadeer Maher El Sheikh

Keyword(s):

Serum Ferritin ◽

Clinical Laboratory ◽

Adult Population ◽

Significant Risk ◽

High Serum ◽

Male Gender ◽

Lower Sensitivity ◽

Significant Difference ◽

D Dimer

Abstract Background High-resolution computed tomography (HRCT) has proved to be an important diagnostic tool throughout the COVID-19 pandemic outbreaks. Increasing number of the infected personnel and shortage of real-time transcriptase polymerase chain reaction (RT-PCR) as well as its lower sensitivity made the CT a backbone in diagnosis, assessment of severity, and follow-up of the cases. Results Two hundred forty patients were evaluated retrospectively for clinical, laboratory, and radiological expression in COVID-19 infection. One hundred eighty-six non-severe cases with home isolation and outpatient treatment and 54 severe cases needed hospitalization and oxygen support. Significant difference between both groups was encountered regarding the age, male gender, > 38° fever, dyspnea, chest pain, hypertension, ≤ 93 oxygen saturation, intensive care unit (ICU) admission, elevated D-dimer, high serum ferritin and troponin levels, and high CT-severity score (CT-SS) of the severe group. CT-SS showed a negative correlation with O2 saturation and patients’ outcome (r − 0.73/p 0.001 and r − 0.56/p 0.001, respectively). Bilateral peripherally distributed ground glass opacities (GGOs) were the commonest imaging feature similar to the literature. Conclusion Older age, male gender, smoking, hypertension, low O2 saturation, increased CT score, high serum ferritin, and high D-dimer level are the most significant risk factors for severe COVID-19 pneumonia. Follow-up of the recovered severe cases is recommended to depict possible post COVID-19 lung fibrosis.

Download Full-text

High incidence of patients lost to follow-up after venous thromboembolism diagnosis – Identifying an unmet need for targeted transition of care

Vascular ◽

10.1177/17085381211020969 ◽

2021 ◽

pp. 170853812110209

Author(s):

Rae S Rokosh ◽

Jack H Grazi ◽

David Ruohoniemi ◽

Eugene Yuriditsky ◽

James Horowitz ◽

...

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Time Of Day ◽

Transition Of Care ◽

Initial Discharge ◽

Significant Difference

Objectives Venous thromboembolism, including deep venous thrombosis and pulmonary embolism, is a major source of morbidity, mortality, and healthcare utilization. Given the prevalence of venous thromboembolism and its associated mortality, our study sought to identify factors associated with loss to follow-up in venous thromboembolism patients. Methods This is a single-center retrospective study of all consecutive admitted (inpatient) and emergency department patients diagnosed with acute venous thromboembolism via venous duplex examination and/or chest computed tomography from January 2018 to March 2019. Patients with chronic deep venous thrombosis and those diagnosed in the outpatient setting were excluded. Lost to venous thromboembolism-specific follow-up (LTFU) was defined as patients who did not follow up with vascular, cardiology, hematology, oncology, pulmonology, or primary care clinic for venous thromboembolism management at our institution within three months of initial discharge. Patients discharged to hospice or dead within 30 days of initial discharge were excluded from LTFU analysis. Statistical analysis was performed using STATA 16 (College Station, TX: StataCorp LLC) with a p-value of <0.05 set for significance. Results During the study period, 291 isolated deep venous thrombosis, 25 isolated pulmonary embolism, and 54 pulmonary embolism with associated deep venous thrombosis were identified in 370 patients. Of these patients, 129 (35%) were diagnosed in the emergency department and 241 (65%) in the inpatient setting. At discharge, 289 (78%) were on anticoagulation, 66 (18%) were not, and 15 (4%) were deceased. At the conclusion of the study, 120 patients (38%) had been LTFU, 85% of whom were discharged on anticoagulation. There was no statistically significant difference between those LTFU and those with follow-up with respect to age, gender, diagnosis time of day, venous thromboembolism anatomic location, discharge unit location, or anticoagulation choice at discharge. There was a non-significant trend toward longer inpatient length of stay among patients LTFU (16.2 days vs. 12.3 days, p = 0.07), and a significant increase in the proportion of LTFU patients discharged to a facility rather than home ( p = 0.02). On multivariate analysis, we found a 95% increase in the odds of being lost to venous thromboembolism-specific follow-up if discharged to a facility (OR 1.95, CI 1.1–3.6, p = 0.03) as opposed to home. Conclusions Our study demonstrates that over one-third of patients diagnosed with venous thromboembolism at our institution are lost to venous thromboembolism-specific follow-up, particularly those discharged to a facility. Our work suggests that significant improvement could be achieved by establishing a pathway for the targeted transition of care to a venous thromboembolism-specific follow-up clinic.

Download Full-text

Trends in risk stratification, in-hospital management and mortality of patients with acute pulmonary embolism: an analysis from China pUlmonary thromboembolism REgistry Study (CURES)

European Respiratory Journal ◽

10.1183/13993003.02963-2020 ◽

2021 ◽

pp. 2002963

Author(s):

Zhenguo Zhai ◽

Dingyi Wang ◽

Jieping Lei ◽

Yuanhua Yang ◽

Xiaomao Xu ◽

...

Keyword(s):

Pulmonary Embolism ◽

Risk Stratification ◽

Hospital Mortality ◽

Acute Pulmonary Embolism ◽

Severity Index ◽

Disease Diagnosis ◽

Initial Therapy ◽

European Respiratory Society ◽

Systemic Thrombolysis ◽

All Cause Mortality

BackgroundSimilar trends of management and in-hospital mortality of acute pulmonary embolism (PE) have been reported in European and American populations. However, these tendencies were not clear in Asian countries.ObjectivesWe retrospectively analyzed the trends of risk stratification, management and in-hospital mortality for patients with acute PE through a multicenter registry in China (CURES).MethodsAdult patients with acute symptomatic PE were included between 2009 and 2015. Trends in disease diagnosis, treatment and death in hospital were fully analyzed. Risk stratification was retrospectively classified by hemodynamical status and the simplified Pulmonary Embolism Severity Index (sPESI) score according to the 2014 European Society of Cardiology/European Respiratory Society guidelines.ResultsAmong overall 7438 patients, the proportions with high (hemodynamically instability), intermediate (sPESI≥1) and low (sPESI=0) risk were 4.2%, 67.1% and 28.7%, respectively. Computed tomographic pulmonary angiography was the widely employed diagnostic approach (87.6%) and anticoagulation was the frequently adopted initial therapy (83.7%). Between 2009 and 2015, a significant decline was observed for all-cause mortality (from 3.1% to 1.3%, adjusted Pfor trend=0.0003), with a concomitant reduction in use of initial systemic thrombolysis (from 14.8% to 5.0%, Pfor trend<0.0001). The common predictors for all-cause mortality shared by hemodynamically stable and unstable patients were co-existing cancer, older age, and impaired renal function.ConclusionsThe considerable reduction of mortality over years was accompanied by changes of initial treatment. These findings highlight the importance of risk stratification-guided management throughout the nation.

Download Full-text

Anticoagulant therapies for acute venous thromboembolism: a comparison between those discharged directly from the emergency department versus hospital in two Canadian cities

BMJ Open ◽

10.1136/bmjopen-2018-022063 ◽

2018 ◽

Vol 8 (10) ◽

pp. e022063 ◽

Cited By ~ 3

Author(s):

Tammy J Bungard ◽

Bruce Ritchie ◽

Jennifer Bolt ◽

William M Semchuk

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Severity Index ◽

Vein Thrombosis ◽

Risk Patients ◽

Acute Venous Thromboembolism ◽

Record Review ◽

Deep Vein

ObjectiveTo compare the characteristics/management of acute venous thromboembolism (VTE) for patients either discharged directly from the emergency department (ED) or hospitalised throughout a year within two urban cities in Canada.DesignRetrospective medical record review.SettingHospitals in Edmonton, Alberta (n=4) and Regina, Saskatchewan (n=2) from April 2014 to March 2015.ParticipantsAll patients discharged from the ED or hospital with acute deep vein thrombosis or pulmonary embolism (PE). Those having another indication for anticoagulant therapy, pregnant/breast feeding or anticipated lifespan <3 months were excluded.Primary and secondary outcomesPrimarily, to compare proportion of patients receiving traditional therapy (parenteral anticoagulant±warfarin) relative to a direct oral anticoagulant (DOAC) between the two cohorts. Secondarily, to assess differences with therapy selected based on clot burden and follow-up plans postdischarge.Results387 (25.2%) and 665 (72.5%) patients from the ED and hospital cohorts, respectively, were included. Compared with the ED cohort, those hospitalised were older (57.3 and 64.5 years; p<0.0001), more likely to have PE (35.7% vs 83.8%) with a simplified Pulmonary Embolism Severity Index (sPESI) ≥1 (31.2% vs 65.2%), cancer (14.7% and 22.3%; p=0.003) and pulmonary disease (10.1% and 20.6%; p<0.0001). For the ED and hospital cohorts, similar proportions of patients were prescribed traditional therapies (72.6% and 71.1%) and a DOAC (25.8% and 27.4%, respectively). For the ED cohort, DOAC use was similar between those with a sPESI score of 0 and ≥1 (35.1% and 34.9%, p=0.98) whereas for those hospitalised lower risk patients were more likely to receive a DOAC (31.4% and 23.8%, p<0.055). Follow-up was most common with family physicians for those hospitalised (51.5%), while specialists/VTE clinic was most common for those directly discharged from the ED (50.6%).ConclusionsTraditional and DOAC therapies were proportionately similar between the ED and hospitalised cohorts, despite clear differences in patient populations and follow-up patterns in the community.

Download Full-text

A Seven-year Follow-up Study of Patient Satisfaction with Three-implant-retained Mandibular Overdentures

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.5896 ◽

2021 ◽

Vol 9 (D) ◽

pp. 103-107

Author(s):

Hisham Samir ElGabry

Keyword(s):

Long Term Results ◽

Complete Dentures ◽

Patients Satisfaction ◽

Follow Up Study ◽

Group I ◽

Significant Difference ◽

Male Patients ◽

Group Ii ◽

Anterior Mandible

PURPOSE: This study aimed to compare patients’ satisfaction with mandibular overdentures retained by three-splinted implants versus conventional complete denture wearers during a 7-year follow-up study period. MATERIALS AND METHODS: Thirty edentulous male patients (mean age: 60 years) were carefully selected and divided into two equal groups. All patients received a new set of complete dentures. Group I patients received three implants in the anterior mandible and were connected after 3 months with bars, clips, and loaded. Group II patients received conventional complete dentures. Patients’ satisfaction was recorded for both groups at 3 weeks (baseline) and after 1, 3, 5, and 7 years. Patients were then asked to grade their overdentures/dentures on a visual analog scale and written questionnaire to evaluate their overall satisfaction. RESULTS: Satisfaction scores of Group I patients were found to be statistically significantly higher than that of Group II patients (p < 0.05) at 3, 5, and 7 years follow-up, meanwhile, no statistically significant difference was found at baseline or after 12 months. CONCLUSION: The long-term results suggest that three-implant-retained mandibular overdenture with a clip-bar attachment appears to be a successful rehabilitation strategy which is superior to conventional dentures for patients with advanced ridge resorption.

Download Full-text

Gender-related differences in clinical presentation, electrocardiography signs, laboratory markers and outcome in patients with acute pulmonary embolism

Vojnosanitetski pregled ◽

10.2298/vsp150716093o ◽

2016 ◽

Vol 73 (9) ◽

pp. 844-849 ◽

Cited By ~ 1

Author(s):

Slobodan Obradovic ◽

Boris Dzudovic ◽

Sinisa Rusovic ◽

Vesna Subota ◽

Dragana Obradovic

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Clinical Presentation ◽

Univariate Analysis ◽

Pulmonary Angiography ◽

Laboratory Findings ◽

Laboratory Markers ◽

Significant Difference ◽

Echocardiographic Examination ◽

Gender Specific Differences

Background/Aim. Acute pulmonary embolism (PE) is a potentially life threating event, but there are scarce data about genderrelated differences in this condition. The aim of this study was to identify gender-specific differences in clinical presentation, the diagnosis and outcome between male and female patients with PE. Methods. We analysed the data of 144 consecutive patients with PE (50% women) and compared female and male patients regarding clinical presentation, electrocardiography (ECG) signs, basic laboratory markers and six-month outcome. All the patients confirmed PE by visualized thrombus on the multidetector computed tomography with pulmonary angiography (MDCTPA), ECG and echocardiographic examination at admission. Results. Compared to the men, the women were older and a larger proportion of them was in the third tertile of age (66.0% vs 34.0%, p = 0.008). In univariate analysis the men more often had hemoptysis [OR (95% CI) 3.75 (1.16-12.11)], chest pain [OR (95% CI) 3.31 (1.57-7.00)] febrile state [OR (95% CI) 2.41 (1.12-5.22)] and pneumonia at PE presentation [OR (95% CI) 3.40 (1.25-9.22)] and less likely had heart decompensation early in the course of the disease [OR (95%CI) 0.48 (0.24-0.97)]. In the multivariate analysis a significant difference in the rate of pneumonia and acute heart failure between genders disappeared due to strong influence of age. There was no significant difference in the occurrence of typical ECG signs for PE between the genders. Women had higher level of admission glycaemia [7.7 mmol/L (5.5-8.2 mmol/L) vs 6.9 mmol/L (6.3-9.6 mmol/L), p = 0.006] and total number of leukocytes [10.5 x 109/L (8.8-12.7 x 109/L vs 8.7 x 109/L (7.0-11.6 x 109/L)), p = 0.007]. There was a trend toward higher plasma level of brain natriuretic peptide in women compared to men 127.1 pg/mL (55.0-484.0 pg/mL), p = 0.092] vs [90.3 pg/mL (39.2-308.5 pg/mL). The main 6-month outcomes, death and major bleeding, had similar frequencies in both sexes. Conclusion. There are several important differences between men and women in the clinical presentation of PE and basic laboratory findings which can influence the diagnosis and treatment of PE.

Download Full-text

Risk of Symptomatic Infection after Non-Primary Congenital Cytomegalovirus Infection

Microorganisms ◽

10.3390/microorganisms8050786 ◽

2020 ◽

Vol 8 (5) ◽

pp. 786

Author(s):

Alessandra Coscia ◽

Agata Leone ◽

Carlotta Rubino ◽

Ganna Galitska ◽

Matteo Biolatti ◽

...

Keyword(s):

Primary Infection ◽

Clinical Laboratory ◽

Congenital Infection ◽

Symptomatic Infection ◽

Symptomatic Disease ◽

Significant Difference ◽

Neonatal Care Unit ◽

Two Populations

Cytomegalovirus (CMV) is the leading cause of congenital infection. Its occurrence is phenotypically heterogeneous. The type of maternal infection, primary or non-primary, is an important factor related to the symptomatic disease, the primary infection was long considered the only cause of severe neonatal disease. We aimed to analyze the association of primary and non-primary infection with pathological outcomes in infants and with long-term sequelae at follow-up. This was a monocentric retrospective observational study on a population of 91 infants diagnosed with a CMV infection at the Neonatal Care Unit of Neonatology at the Sant’Anna Hospital of Turin during the period of June 2005 to December 2018. Infants underwent clinical, laboratory, and neuroradiological evaluations at birth. Subsequently, the patients were monitored in an auxological, neurodevelopment, and audiological follow-up. Regarding primary vs. non-primary infection, we found a higher percentage of incidence of symptomatic and neurological localized infection, as well as long-term sequelae in the latter. However, no significant difference between the two populations was found. We underline the possibility of re-infection in previously immunized mothers (non-primary infection) with unfavorable neonatal and long-term outcomes.

Download Full-text

Evaluation of crestal bone resorption around cylindrical and conical implants following 6 months of loading: A randomized clinical trial

European Journal of Dentistry ◽

10.4103/ejd.ejd_38_17 ◽

2017 ◽

Vol 11 (03) ◽

pp. 317-322 ◽

Cited By ~ 1

Author(s):

Naser Sargolzaie ◽

Hamid Reza Arab ◽

Marzieh Mohammadi Moghaddam

Keyword(s):

Bone Loss ◽

Chi Square ◽

Pocket Depth ◽

Significance Level ◽

Crestal Bone Loss ◽

Significant Difference ◽

Chi Square Test ◽

Male Patients ◽

Maxilla And Mandible

ABSTRACT Objective: The purpose of this clinical study was to evaluate the effect of implant body form (cylindrical and conical implants) on crestal bone levels during 6 months' follow-up after loading. Materials and Methods: A total of 32 SPI implants (19 conical implants/13 cylindrical implants) were randomly placed in 12 male patients using a submerged approach. None of the patients had compromising medical conditions or parafunctional habits. Periapical radiographs using the parallel technique were taken after clinical loading and 6 months later. Clinical indices including pocket depth and bleeding on probing (BOP) were recorded on 6-month follow-up. Data were analyzed by independent samples t-test and Chi-square test with a significance level of 0.05. Results: Six months after loading, crestal bone loss was 0.84 (±0.29) mm around the cylindrical implants and 0.73 (±0.62) mm around the conical types, which was not significantly different (P = 0.54). Pocket depth around the cylindrical and conical implants was 2.61 (±0.45) mm and 2.36 (±0.44) mm, respectively (P = 0.13). BOP was observed among 53.8% and 47.4% of the cylindrical implants and conical (P = 0.13). Bone loss and pocket depth in the maxilla and mandible had no significant difference (P = 0.46 and P = 0.09, respectively). Conclusion: In this study, although bone loss and clinical parameters were slightly higher in the cylindrical implants, there was no significant difference between the conical- and cylindrical-shaped implants.

Download Full-text

Impact of Vitamin D Therapy on the Progress COVID-19: Six Weeks Follow-Up Study of Vitamin D Deficient Elderly Diabetes Patients

Proceedings of Singapore Healthcare ◽

10.1177/20101058211041405 ◽

2021 ◽

pp. 201010582110414

Author(s):

Amin R. Soliman ◽

Tarek Samy Abdelaziz ◽

Ahmed Fathy

Keyword(s):

Vitamin D ◽

Large Scale ◽

Clinical Laboratory ◽

Vitamin D Supplementation ◽

Chronic Obstructive ◽

Vitamin D Levels ◽

Significant Difference ◽

Patients With Diabetes ◽

Diabetes Patients

Background Coronavirus disease-19 (COVID-19) is an ongoing pandemic causing considerable fatalities worldwide. Vitamin D modulates the immune response through effects on various cells, such as: macrophages, B and T lymphocytes, neutrophils, and dendritic cells. Aim To explore whether supplementation of vitamin D, in the form of a single intramuscular cholecalciferol injection, to patients with diabetes, COVID-19, and low vitamin D levels could improve the prognosis of those patients. Methods This was a placebo-controlled randomized prospective study. The study has two arms as follows: the intervention arm (40 vitamin D deficient diabetes elderly patients that acquired SARS-CoV-2), compared to the control arm (16 elderly diabetes patients, with deficient vitamin D with SARS-CoV-2). Patients in the intervention arm were given vitamin D as a single intramuscular injection (200,000 IU); patients in the control arm were given placebo. The primary outcome was mortality within 6 weeks of the diagnosis of COVID-19. Clinical, laboratory, treatment, and outcome data were recorded after 6 weeks of follow-up. Results No significant difference in 6 weeks mortality was observed between patients who received vitamin D and patients who received placebo (17.5% vs 18.8%, p = 0.838). Age, presence of hypertension, and chronic obstructive pulmonary disease were independent predictors of mortality at 6 weeks. Conclusion Vitamin D supplementation did not reduce the severity or mortality of COVID-19 at 6 weeks. Further large scale studies are required to explore the effect of vitamin D therapy on survival in patients with diabetes mellitus who acquire COVID-19.

Download Full-text

Gradually increased dyslipidemia in human immunodeficiency virus infected male patients with tenofovir plus lamivudine plus efavirenz primary treatment: a 3-year follow-up study

10.21203/rs.3.rs-55587/v1 ◽

2020 ◽

Author(s):

dafeng liu ◽

Bennan Zhao ◽

Xinyi Zhang ◽

Fengjiao Gao ◽

Jun Kang ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

T Cell ◽

Cd4 T Cell ◽

Infected Male ◽

Significant Difference ◽

Immunodeficiency Virus ◽

Male Patients ◽

Cd4 T Cell Count

Abstract IntroductionSince the start of highly active antiretroviral therapy (HAART) with TDF plus 3TC plus EFV, the long-term dynamic characteristics of lipid and purine metabolism in patients infected with human immunodeficiency virus (HIV) was unclear and worth studying.MethodsA prospective follow-up cohort study was the way. Sixty-one treatment-naive HIV infected male patients were divided into three groups based on the baseline CD4 + T cell count (26, 12, 23cases in < 200, from 200 to 350, > 350 three groups, respectively). Lipid and purine metabolism parameters of those patients within 144 weeks were analyzed.ResultTG, TC, LDL-c and HDL-c level all gradually increased within 144 weeks, but statistical significances of TC level and HDL-c level were only found (F = 4.214, 5.518, P = 0.001, 0.000 ,respectively). Moreover the percentage of hypercholesterolemia, hyper LDL cholesterolemia and hypertriglyceridemia all gradually increased, low HDL cholesterolemia gradually decreased, but there was only obvious difference of the latter (χ2 = 16.105, P = 0.0007).Furthermore the lower the baseline CD4 + T lymphocyte counts, the higher TG level, the lower TC level, LDL-c level and HDL-c level, but only significant difference of LDL-c level between three groups at baseline was found (F = 3.256,P = 0.0457).Although UA level and the percentages of hyperuricemia gradually increased within 144 weeks, but there was no significant difference between different follow-up time points groups and between three CD4 + T cell count groups (all P༞0.05).ConclusionsThese findings provide a reference for clinicians to monitor lipid metabolism parameters closely during long-term HAART with TDF plus 3TC plus EFV regimen.

Download Full-text