Predicting of poor outcomes in COVID-19 patients: Experience from an Argentinean hospital

Introduction: The pressure over health systems caused by the COVID-19 pandemic brought about the need to develop tools that would allow for the identification of those patients that require immediate attention. Our objective was to identify clinical and biochemical predictors of poor outcomes (PO) in a cohort of patients hospitalized due to COVID-19 in an Argentinean public hospital. Methods: Prospective cohort study conducted from March 3rd, 2020 to February 16th, 2021 in a tertiary care center in Santa Fe, Argentina. Clinical and biochemical characteristics of patients with COVID-19 pneumonia admitted consecutively were analyzed in order to identify predictors of a composite of poor outcomes (PO) -all-cause mortality and/or need for invasive mechanical ventilation. Results: 421 patients were included. The mean age was 56.13 ± 15.05 years. 57.0% were males. 79.7% presented at least one comorbidity. 27.7% (n=116) presented PO. In the multivariate analysis, a higher 4C-score and a higher LDH, as well as a lower SatO2/FiO2, were associated with a higher risk of PO. No variable reached an AUC of 0.800 in the ROC analysis. 4C-score presented a numerically higher AUC (0.766 IC 95% 0.715-0.817). Conclusions: Each point that the 4C-score increases, the risk of PO rises by 28%. Also, for every 100-units increase in LDH or 50-units decrease in SatO2/FiO2 at admission, there is a 20% increased risk of PO.

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Clinical profiles of diabetic foot ulcer patients undergoing major limb amputation at a tertiary care center in North-eastern Tanzania

BMC Surgery ◽

10.1186/s12893-021-01051-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ahmed Shabhay ◽

Pius Horumpende ◽

Zarina Shabhay ◽

Andrew Mganga ◽

Jeff Van Baal ◽

...

Keyword(s):

Blood Glucose ◽

Diabetic Foot ◽

Care Center ◽

Tertiary Care ◽

Limb Amputation ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Random Blood Glucose ◽

North Eastern ◽

The Mean

Abstract Background Diabetic foot ulcers complications are the major cause of non-traumatic major limb amputation. We aimed at assessing the clinical profiles of diabetic foot ulcer patients undergoing major limb amputation in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC), a tertiary care hospital in North-eastern Tanzania. Methods A cross—sectional hospital-based study was conducted from September 2018 through March 2019. Demographic data were obtained from structured questionnaires. Diabetic foot ulcers were graded according to the Meggitt-Wagner classification system. Hemoglobin and random blood glucose levels data were retrieved from patients’ files. Results A total of 60 patients were recruited in the study. More than half (31/60; 51.67%) were amputated. Thirty-five (58.33%) were males. Fifty-nine (98.33%) had type II diabetes. Nearly two-thirds (34/60; 56.67%) had duration of diabetes for more than 5 years. The mean age was 60.06 ± 11.33 years (range 30–87). The mean haemoglobin level was 10.20 ± 2.73 g/dl and 9.84 ± 2.69 g/dl among amputees. Nearly two thirds (42/60; 70.00%) had a haemoglobin level below 12 g/dl, with more than a half (23/42; 54.76%) undergoing major limb amputation. Two thirds (23/31; 74.19%) of all patients who underwent major limb amputation had mean hemoglobin level below 12 g/dl. The mean Random Blood Glucose (MRBG) was 13.18 ± 6.17 mmol/L and 14.16 ± 6.10 mmol/L for amputees. Almost two thirds of the study population i.e., 42/60(70.00%) had poor glycemic control with random blood glucose level above 10.0 mmol/L. More than half 23/42 (54.76%) of the patients with poor glycemic control underwent some form of major limb amputation; which is nearly two thirds (23/31; 74.19%) of the total amputees. Twenty-eight (46.67%) had Meggitt-Wagner classification grade 3, of which nearly two thirds (17:60.71%) underwent major limb amputation. Conclusion In this study, the cohort of patients suffering from diabetic foot ulcers treated in a tertiary care center in north-eastern Tanzania, the likelihood of amputation significantly correlated with the initial grade of the Meggit-Wagner ulcer classification. High blood glucose levels and anaemia seem to be also important risk factors but correlation did not reveal statistical significance.

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Daily Quality Control in CD3+and CD4+T Cell Estimation by the FACSCount System at a Tertiary Care Center in South India

Clinical and Vaccine Immunology ◽

10.1128/cvi.00246-12 ◽

2012 ◽

Vol 19 (10) ◽

pp. 1693-1696 ◽

Cited By ~ 3

Author(s):

Veena V. Ramalingam ◽

Monika Mani ◽

Vijayanand C. Sundaresan ◽

Ramesh J. Karunaiya ◽

Jaiprasath Sachithanandham ◽

...

Keyword(s):

Quality Control ◽

T Cell ◽

South India ◽

Care Center ◽

Tertiary Care ◽

Cd4 T Cell ◽

Internal Quality ◽

Cell Counts ◽

Resource Poor ◽

The Mean

ABSTRACTCD4+T cell count estimations are subject to high variations; hence, in this study, the previous day's tested samples were included routinely as the internal quality controls. The percentages of variation of the 2-day values were analyzed for 280 observations and the mean variation for CD4+and CD3+T cell counts ranged from 5.21% to 9.66%. This method is a good internal quality control (IQC) procedure for the estimation of CD3+and CD4+T cell counts in resource-poor settings.

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Abstract 15502: Clinical Outcomes in Patients Undergoing Non-cardiac Surgery Within 1 Year of Pci

Circulation ◽

10.1161/circ.142.suppl_3.15502 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Davide Cao ◽

Matthew A Levin ◽

Samantha Sartori ◽

Anastasios Roumeliotis ◽

Rishi Chandiramani ◽

...

Keyword(s):

Cardiac Surgery ◽

Antiplatelet Therapy ◽

Care Center ◽

Tertiary Care ◽

Coronary Intervention ◽

Secondary Outcome ◽

Cardiac Events ◽

Bleeding Events ◽

Target Vessel Revascularization ◽

Increased Risk

Introduction: Perioperative cardiovascular events are an important cause of morbidity and mortality associated with non-cardiac surgery (NCS), especially in patients with recent percutaneous coronary intervention (PCI) who require dual antiplatelet therapy. Objective: To illustrate the types and timing of different noncardiac surgeries occurring within 1 year of PCI, and to evaluate the risk of thrombotic and bleeding events according to perioperative antiplatelet management. Methods: All patients undergoing NCS within 1 year of PCI at a tertiary-care center between 2011 and 2018 were included. The primary outcome was major adverse cardiac events (MACE; composite of death, myocardial infarction, stent thrombosis or target vessel revascularization). The key secondary outcome was major bleeding, defined as ≥2 units of blood transfusion. All outcomes were evaluated at 30 days after NCS. Results: A total of 1092 NCS (corresponding to 747 patients) were included and classified by surgical risk (low: 50.9%, intermediate: 38.4%, high: 10.7%) and priority (elective: 88.5%, urgent/emergent: 11.5%). High-risk and urgent/emergent surgeries tended to occur earlier post-PCI compared to low-risk and elective ones ( Figure-A ). The incidence of MACE and bleeding was time-dependent, with an increased risk in surgeries occurring in the first 6 months post-PCI ( Figure-B ). Perioperative antiplatelet cessation occurred in 487 (44.6%) NCS and was more likely for intermediate-risk procedures and after 6 months of PCI. There was no significant association between antiplatelet cessation and cardiac events. Conclusions: Among patients undergoing NCS within 1 year of PCI, the perioperative risk of MACE is inversely related to time from PCI. Preoperative interruption of antiplatelet therapy was observed in less than half of all cases and was not associated with an increased risk of cardiac events.

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A Comparison of Falls and Dizziness Handicap by Vestibular Diagnosis

American Journal of Audiology ◽

10.1044/2021_aja-21-00086 ◽

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.

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A study of peripartum cardiomyopathy in a tertiary care center in India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170374 ◽

2017 ◽

Vol 6 (2) ◽

pp. 523 ◽

Cited By ~ 1

Author(s):

Aditi V. Joshi ◽

Michelle N. Fonseca ◽

Deepali S. Kharat-Kapote

Keyword(s):

Care Center ◽

Tertiary Care ◽

Fetal Outcome ◽

Peripartum Cardiomyopathy ◽

Early Interventions ◽

Tertiary Care Center ◽

Common Risk Factor ◽

The Mean ◽

Time Of Presentation ◽

Underlying Pathogenesis

Background: Peripartum cardiomyopathy is an idiopathic and reversible form of dilated cardiomyopathy. The aim of the study was to study the mean age of presentation of peripartum cardiomyopathy in pregnant patients over a period of 1 year in a tertiary health care and study the maternal and fetal outcome of patients with peripartum cardiomyopathy.Methods: A retrospective observational study with total of 22 patients with peripartum cardiomyopathy was diagnosed in a total of 10,279 deliveries conducted at LTMMC, Sion hospital between September 2014 to February 2016.Results: Our study revealed that most of the affected patients were young with the mean age at presentation being 26.8±4.29 years. Most of the patients were diagnosed in the postpartum period (63.6%). the most common risk factor was pre-eclampsia (22.7%) followed by anemia (18.2%). The mean Ejection fraction at the time of presentation was 25.3±9.8%. There were 2 (9.1%) intrauterine fetal deaths and 1 neonatal death.Conclusions: There is a need for more multi-centric studies in order to understand the underlying pathogenesis and to determine the possible early interventions to help provide better pregnancy outcome.

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Thyroid status and Treatment Response of Hypothyroid Infertile Women in Tertiary Care Center of Bangladesh

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v31i2.34216 ◽

2017 ◽

Vol 31 (2) ◽

pp. 86-89

Author(s):

Farzana Deeba ◽

Parveen Fatima ◽

Jesmine Banu ◽

Shakeela Ishrat ◽

Nurjahan Begum ◽

...

Keyword(s):

Subclinical Hypothyroidism ◽

Early Stage ◽

Care Center ◽

Tertiary Care ◽

Target Population ◽

Fertility Treatment ◽

Tertiary Care Centre ◽

Infertile Women ◽

The Mean ◽

Tsh Levels

Objective(s): Aim of this study was to find out the prevalence of hypothyroidism in infertile women as well as to assess their response to treatment.Materials and methods: This descriptive study was conducted in Infertility unit of Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Bangladesh, a tertiary care centre from January 2014 to December 2014. Four hundred women who visited infertility clinic of the department for fertility treatment were the target population for this study. Routine investigations such as CBC, Blood sugar 2 hours postparandial or GTT, TSH and Prolactin was done. Subclinical hypothyroidism was diagnosed when there was increased TSH and normal FT4. Hypothyroid patients were given Levothyroxin depending upon TSH levels and continued until end of the study. Patients were followed up for six months even if pregnancy was attained.Results: Out of 400 women 55% were primary and 45% were secondary subfertility. Mean duration of infertility was 4.5 ± 1.2 years. Ninety two (23%) patients were hypothyroid. Among them 66 (16.5%) were subclinical hypothyroid and 26 (6.5%) were frank hypothyroid. The mean TSH levels were 7.34 ± 2.13 ìIU/ml, and the mean PRL levels were 52.46 ± 11.17 ng/ml. Out of 92 infertile women diagnosed as hypothyroidism 75 (81.52%) women conceived after treatment with drugs for hypothyroidism (dose depending upon severity of hypothyroidism, i.e. TSH levels). More than 90% women had regular ovulation for consecutive three cycles after initiation of treatment.Conclusion: The normal TSH levels are the pre-requisite for fertilization. The decision to initiate thyroid replacement therapy in both clinical and subclinical hypothyroidism at early stage is justified in infertile women.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 86-89

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Factors Affecting Radiation Dose in Computed Tomography Angiograms for Pulmonary Embolism: A Retrospective Cohort Study

Journal of Clinical Imaging Science ◽

10.25259/jcis_168_2020 ◽

2020 ◽

Vol 10 ◽

pp. 74

Author(s):

Prashant Nagpal ◽

Sarv Priya ◽

Ali Eskandari ◽

Aidan Mullan ◽

Tanya Aggarwal ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Radiation Dose ◽

Care Center ◽

Tertiary Care ◽

Multivariate Logistic Regression Analysis ◽

Factors Affecting ◽

Model Based ◽

Pulmonary Angiogram ◽

The Mean

Objectives: Computed tomography pulmonary angiogram (CTPA) is one of the most commonly ordered and frequently overused tests. The purpose of this study was to evaluate the mean radiation dose to patients getting CTPA and to identify factors that are associated with higher dose. Material and Methods: This institutionally approved retrospective study included all patients who had a CTPA to rule out acute pulmonary embolism between 2016 and 2018 in a tertiary care center. Patient data (age, sex, body mass index [BMI], and patient location), CT scanner type, image reconstruction methodology, and radiation dose parameters (dose-length product [DLP]) were recorded. Effective dose estimates were obtained by multiplying DLP by conversion coefficient (0.014 mSv•mGy−1•cm−1). Multivariate logistic regression analysis was performed to determine the factors affecting the radiation dose. Results: There were 2342 patients (1099 men and 1243 women) with a mean age of 58.1 years (range 0.2–104.4 years) and BMI of 31.3 kg/m2 (range 12–91.5 kg/m2). The mean effective radiation dose was 5.512 mSv (median – 4.27 mSv; range 0.1–43.0 mSv). Patient factors, including BMI >25 kg/m2, male sex, age >18 years, and intensive care unit (ICU) location, were associated with significantly higher dose (P < 0.05). CT scanning using third generation dual-source scanner with model-based iterative reconstruction (IR) had significantly lower dose (mean: 4.90 mSv) versus single-source (64-slice) scanner with filtered back projection (mean: 9.29 mSv, P < 0.001). Conclusion: Patients with high BMI and ICU referrals are associated with high CT radiation dose. They are most likely to benefit by scanning on newer generation scanner using advance model-based IR techniques.

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Usefulness of the Non-Contact Tonometry in Out-Patient Screening

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v15i2.232 ◽

2016 ◽

Vol 15 (2) ◽

Author(s):

Satheesh Solomon T Selvin ◽

Chris Elsa Samson Jacob ◽

Thomas Kuriakose

Keyword(s):

Central Corneal Thickness ◽

Care Center ◽

Corneal Thickness ◽

Tertiary Care ◽

Cross Sectional Study ◽

Applanation Tonometry ◽

Cross Sectional ◽

Significant Difference ◽

Iop Measurement ◽

The Mean

Purpose: Goldmann applanation tonometry (GAT) is considered the gold standard for Intraocular Pressure (IOP) measurement. It has the disadvantages of being a contact device, need for a slit-lamp, non-portability and need of a skilled examiner. Many hospitals are using a Non Contact Tonometry (NCT) as a screening device to save clinician time, however the usefulness is not proved in terms of reliability. This study was aimed to determine the usefulness of the Air-puff tonometer (TONOREF NIDEK II, NIDEK CO., LTD., JAPAN) over a GAT in a tertiary care center. Design: Cross-sectional Study Methods: This was a cross-sectional, non interventional observational study conducted on 224 eyes (right eye) from 224 patients. All patients underwent the IOP measurement with both methods and a central corneal thickness (CCT) measured. The data was analyzed using SPSS 20.0 software. Results: The mean age of the patients was 40.3±11.29 years. There was a statistically significant difference (p<0.001) between the mean NCT and GAT readings which persisted even after correction for central corneal thickness. The correlation between NCT and GAT using Pearson’s correlation coefficient was strong irrespective of the corrections for their corneal thickness (r = 0.751 and 0.718 for uncorrected and corrected values respectively). The correlation of the individual clinicians for the readings varied from moderate to strong. The ROC curve showed the best sensitivity and specificity to occur at around 13 to 14 mmHg. Conclusion: NCT seems to overestimate the IOP at low ranges as compared to the GAT and underestimate at higher ranges. The crossover of the values is seen between 12 to 13 mmHg. The clinician should do an individualized analysis of his/her GAT measurements to the readings of the NCT machine at the clinic to obtain clinician specific nomogram.

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Study of antimicrobial use in paediatric inpatients in a tertiary care hospital in Ahmedabad, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20205430 ◽

2020 ◽

Vol 8 (1) ◽

pp. 35

Author(s):

Hetal N. Jeeyani ◽

Rutvik H. Parikh ◽

Sheena Sivanandan ◽

Harsh J. Muliya ◽

Shivam N. Badiyani ◽

...

Keyword(s):

Bacterial Resistance ◽

Tertiary Care ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Care Hospital ◽

Antimicrobial Drugs ◽

Prescribing Indicators ◽

Inappropriate Use ◽

Increased Risk ◽

The Mean

Background: Inappropriate use and overuse of antibiotics are important factors leading to increased bacterial resistance apart from increased risk of adverse reactions. The aim of this study was to derive antibiotic use percentage, study its pattern and compare antibiotic prescribing indicators with standard indicators.Methods: This prospective observational study was conducted from 1st August 2018 to 31st July 2019 on paediatric inpatients from 1 month to 14 years. All the relevant data was taken from the case records of patients at the time of discharge. The data included: age, sex, hospital stay, clinical diagnosis and details of antimicrobial treatment.Results: From 989 patients, 85.9% were diagnosed with infectious illness, of which 60.1% had viral and 36.7% had bacterial infection. The use of antimicrobial drugs was 42.7% and antibiotics was 40.4%. The mean number of antibiotics received was 1.13±0.31. 90% patients received single antibiotic. 88.8% drugs were prescribed by generic name and 99% drugs were prescribed from essential drug formulary. 17 different antibiotics were used out of which ceftriaxone (62.5%) was the most commonly used. Groupwise, antibiotic use was cephalosporins (68.4%), penicillin (20.2%), aminoglycosides (4.31%), fluoroquinolones (0.9%) and macrolides (0.22%). The use of higher antibiotics like vancomycin (3.86%) and carbapenems (0.68%) was quite less.Conclusions: The antibiotic use in our hospital was higher than the WHO standard but less as compared to majority of other studies. Use of cephalosporins was more and penicillin was less as compared to other studies. This suggests that there is a need of implementing antibiotic stewardship programs to enhance rational antibiotic prescribing.

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Abstract 092: No Change in Peripartum Cardiomyopathy Outcomes or Risk Factors Over the Past Decade

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.092 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Nivedita Basu ◽

Madeline Mahowald ◽

Kris Kawamoto ◽

Melinda Davis

Keyword(s):

Risk Factors ◽

Maternal Age ◽

Care Center ◽

Tertiary Care ◽

Temporal Trends ◽

Peripartum Cardiomyopathy ◽

Icd Implantation ◽

The Past ◽

Increased Risk

Background: Few studies have evaluated temporal trends in outcomes and risk factors for peripartum cardiomyopathy (PPCM). Prior research using administrative data could only assess short-term in-hospital adverse events. It has also been hypothesized that the incidence of PPCM is rising due to advancing maternal age and increased risk factors. Therefore, we examined long-term outcomes and prognostic factors to determine if there has been any change over the past decade. Methods: Patients seen at a tertiary care center between 2000 and 2011 with a diagnosis of PPCM were identified by ICD9 code 674.5x and confirmed by manual chart review. Year of diagnosis, clinical and demographic variables, echocardiographic data, and outcomes including myocardial recovery (defined as EF>=55%), ICD placement, LVAD, transplant, and death were reviewed for follow-up through November 2016. Results: Of 60 patients, 31 (52%) were diagnosed recently (2006-2011) and 29 (48%) were diagnosed prior to 2006 (1996-2005). There were no significant differences in the recent group compared to the past group in initial EF (19% vs 22%), final EF (39% vs 39%), and final recovery status (52% vs 48%). Similarly, there were no differences in rates of ICD implantation, LVAD/transplant, mortality, and years of survival. There were no differences in age at diagnosis or in rates of hypertension, smoking, or diabetes. Few patients in either category underwent a subsequent pregnancy. Mean years of follow-up (through 2016) were longer for those diagnosed prior to 2006 (8.3 years vs 3.4 years, p<0.001). Conclusions: There has been no improvement in outcomes for patients diagnosed with PPCM in the past decade. Maternal age and risk factors do not appear to be increasing. Despite advances in heart failure treatment and increased awareness of PPCM, more research about the management and follow-up of young mothers with PPCM is needed.

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