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2022 ◽  
Vol 11 (2) ◽  
pp. 409
Author(s):  
Claudia Bures ◽  
Yasmin Uluk ◽  
Mona Besmens ◽  
Aycan Akca ◽  
Eva-Maria Dobrindt ◽  
...  

Parathyroidectomy (PTX) is a mainstay of treating secondary hyperparathyroidism (SHPT) in patients with kidney failure in order to reduce the incidence of cardiovascular events (CVE), increase overall survival and improve quality of life. Perioperative hyperkalemia may lead to devastating cardiac complications. Distinct preoperative thresholds for serum potassium levels (SPL) were defined, but neither their usefulness nor consecutive risks are understood. This study compared the results and efficacy of different clinical procedures in preventing or treating perioperative hyperkalemia, including postoperative urgent hemodialysis (UHD). Methods: Patients from Charité-Universitätsmedizin Berlin and Rheinland Klinikum Lukaskrankenhaus, Neuss, undergoing PTX due to SHPT between 2008 and 2018 were analyzed retrospectively with regard to demographic parameters, surgery specific conditions and perioperative laboratory results. Comparisons of patient values from both centers with focus on perioperative hyperkalemia and the need for UHD were performed. Results: A total of 251 patients undergoing PTX for SHPT were included (Neuss: n = 121 (48%); Berlin: n = 130 (52%)). Perioperative hyperkalemia (SPL ≥ 5.5 mmol/L) was noted in 134 patients (53%). UHD on the day of surgery was performed especially in patients with intraoperative hyperkalemia, in females (n = 40 (16%) vs. n = 27 (11%); p = 0.023), in obese patients (n = 27 (40%) vs. n = 50 (28%), p = 0.040) and more often in patients treated in Neuss (n = 42 (35%) vs. 25 (19%); p = 0.006). For patients treated in Neuss, the intraoperative hyperkalemia cut-off level above 5.75 mmol/L was the most predictive factor for UHD (n = 30 (71%) vs. n = 8 (10%); p < 0.001). Concerning secondary effects of hyperkalemia or UHD, no patient died within the postoperative period, and only three patients suffered from acute CVE, with SPL > 5.5 mmol/L measured in only one patient. Conclusion: Perioperative values could not predict postoperative hyperkalemia with the need for UHD. Previously defined cut-off levels for SPL should be reconsidered, especially for patients undergoing PTX. Early postoperative dialysis in patients with postoperative hyperkalemia can be performed with a low risk for complications and may be indicated for all patients with increased perioperative SPL.


2022 ◽  
Author(s):  
Abdulmohsen Alahmad ◽  
Shady Abdulrahman Kamel

BACKGROUND On 10 September 2021, Al-Ahsa General Health Directorate reported unexpected number of patients had presented with gastrointestinal symptoms. All the patients gave a history of sharing a common meal as they ate from dinner was served at the mother's house the day before. OBJECTIVE We investigated to verify the outbreak, determine its magnitude, identify the source and implement control measures. METHODS A retrospective cohort design was conducted. Cases were defined as any person who ate dinner at the family gathering on the 9th of September 2021 and developed any or a combination of the following symptoms: diarrhea, vomiting, fever, or abdominal pain within 26 hours of food consumption. We collected information on demographics, symptoms, and food history using a semi-structured questionnaire. We reviewed hospital records for symptoms and Vital sings. We reviewed available laboratory results for cases, we conducted active case search to identify more cases. statistical analyses were performed using SPSS 21.0. RESULTS Twenty subjects were defined as cases (74%) and seven as non-cases (26%). among cases, 16 were females (80%), and 4 were males (20%). The ages ranged between 2–70 years. Among cases (59.3%) had vomiting, (59.3%) had a fever, (48.1%) developed diarrhea, (25%) abdominal pain. The incubation period ranged from 10-26 hours (mean 17.8). The relative risks and p- value were calculated for food items to assess the association between consumption of individual food items and subsequent illness. Among 8 food items consumed, red pasta with chicken (Relative Risk RR= 3.14, 95% CI = 3.2-424.6) and pizza (RR= 1.73, 95% CI = 1.74-42.2) were significantly associated with illness. CONCLUSIONS According to the epidemiological investigation, symptoms, incubation period, and laboratory results there might be some differential diagnosis, but we were unable to more definitively identify the source of the outbreak. We recommend more education to the households about food safety


2022 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Badrul Munir ◽  
Benny Arie Pradana ◽  
Widodo Mardi Santoso ◽  
Ria Damayanti ◽  
Catur Ari Setianto ◽  
...  

: Tuberculous meningoencephalitis (TBM) is the most severe, life-threatening form of tuberculosis that contributes to as much as 5% of cases of extrapulmonary tuberculosis. Emerging at the end of 2019, COVID-19 has been shown to affect various organs, including the brain. In this case report, a 21-year-old woman diagnosed with TBM, being in the intensive phase of tuberculous therapy, came with dysphagia and dysphonia as new complaints felt one day before admission accompanied by a positive meningeal sign, diplopia, and cephalgia, which became heavier after previously getting better. Cough and fever followed this complaint two days before admission. About the laboratory results, the PCR was positive for COVID-19, and CT scans showed increased leptomeningeal enhancement when compared with CT scan one month earlier. The patient received intravenous dexamethasone, anti-tuberculosis drugs, phenytoin, aspirin, oseltamivir, and hydroxychloroquine. The patient died four days after being hospitalized due to respiratory failure. This case report shows the coinfection of COVID-19 and TBM resulting in a poor tuberculosis treatment response and outcome.


2022 ◽  
pp. 10.1212/CPJ.0000000000001149
Author(s):  
Andrew J. Solomon ◽  
Georgina Arrambide ◽  
Wallace Brownlee ◽  
Anne H. Cross ◽  
María I. Gaitan ◽  
...  

AbstractPatients with a historical diagnosis of multiple sclerosis (MS) — a patient presenting with a diagnosis of MS made previously and by a different clinician — present specific diagnostic and therapeutic challenges in clinical practice. Application of the McDonald criteria is most straightforward when applied contemporaneously with a syndrome typical of an MS attack or relapse; however, retrospective application of the criteria in some patients with a historical diagnosis of MS can be problematic. Limited patient recollection of symptoms and evolution of neurological examination and MRI findings complicate confirmation of an earlier MS diagnosis and assessment of subsequent disease activity or clinical progression. Adequate records for review of prior clinical examinations, laboratory results, and/or MRI scans obtained at the time of diagnosis or during ensuing care may be inadequate or unavailable. This paper provides recommendations for a clinical approach to the evaluation of patients with a historical diagnosis of MS to aid diagnostic confirmation, avoid misdiagnosis, and inform therapeutic decision-making.


2022 ◽  
Author(s):  
Ira S. Hofer ◽  
Marina Kupina ◽  
Lori Laddaran ◽  
Eran Halperin

Abstract Introduction: Manuscripts that have successfully used machine learning (ML) to predict a variety of perioperative outcomes often use only a limited number of features selected by a clinician. We hypothesized that techniques leveraging a broad set of features for patient laboratory results, medications, and the surgical procedure name would improve performance as compared to a more limited set of features chosen by clinicians. Methods Feature vectors for laboratory results included 702 features total derived from 39 laboratory tests, medications consisted of a binary flag for 126 commonly used medications, procedure name used the Word2Vec package for create a vector of length 100. Nine models were trained: Baseline Features, one for each of the three types of data Baseline+Each data type (, all features, and then all features with feature reduction algorithm. Results Across both outcomes the models that contained all features (model 8) (Mortality ROC-AUC 94.42, PR-AUC 31.0; AKI ROC-AUC 92.47, PR-AUC 76.73) was superior to models with only subsets of features Conclusion Featurization techniques leveraging a broad away of clinical data can improve performance of perioperative prediction models.


Water ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 133
Author(s):  
Gopal Krishan ◽  
Mavidanam Someshwar Rao ◽  
Rajesh Vashisht ◽  
Anju Chaudhary ◽  
Jaswant Singh ◽  
...  

In recent decades, due to rapid increases in water demand and greater usage of water for irrigation from surface canals, waterlogging problems have been created in the southwest zone of Punjab, coupled with a stagnation in saline zone formation due to salinity ingression. To understand these salinity issues, the present study has been conducted in three districts (Muktsar, Fazilka, and Faridkot) of Punjab to understand the root cause. To this end, groundwater samples were collected from 142 piezometers developed at 40 sites. Electrical conductivity (EC) observations were taken in the field, and collected samples were analyzed for isotopes in the laboratory. Results found that salinity in groundwater arises from the combination of evaporation enrichment and salt dissolution. The dissolved salts may be acquired due to salts from aquifer materials or salts from surface soils dissolving and leaching down with the recharging water. Besides, the zone of interaction is mapped using stable isotopic composition. The study suggests that zone of interaction between aquifers can be effectively used in groundwater augmentation, management, and contamination control at regional and/or global scales to curb water demand in the future.


2022 ◽  
Vol 961 (1) ◽  
pp. 012031
Author(s):  
Rasool Kosaj ◽  
Rafid S Alboresha ◽  
Sadeq O Sulaiman

Abstract In this paper, the laboratory data were compared with computational fluid dynamics (CFD) Flow3D for predicting the beginning of sediment incipient motion in rigid boundary channel for two types of sands, irrigation, and sewer types, in rectangular flume (0.5*0.5)m cross-section. Tests were made for soil samples with different diameters, specific weights. The testing was performed in slopes ranging from 0.001-0.003 for irrigation types and 0.0025-0.025 for sewer types depending on the original parameter. The Flow-3D software has simulated the laboratory work using scouring models MPM and Nielsen. the relation between sediment incipient motion velocity, particle size, and channel bed slope was predicted. The results were relatively more than laboratory data for the MPM model, while grating convergence for Nielsen model, especially for small diameter sediment. Also, the laboratory results are more close to the results of Flow3D using the Nielsen model when the value of bed slope of the channel is greater, and vice versa when the slope decreases.


2022 ◽  
Vol 28 (1) ◽  
pp. 76-85
Author(s):  
Aya kh. Shaheed ◽  
Riyadh Z. Azzubaidi

This study aims to numerically simulate the flow of the salt wedge by using computational fluid dynamics, CFD. The accuracy of the numerical simulation model was assessed against published laboratory data. Twelve CFD model runs were conducted under the same laboratory conditions. The results showed that the propagation of the salt wedge is inversely proportional to the applied freshwater discharge and the bed slope of the flume.  The maximum propagation is obtained at the lowest discharge value and the minimum slope of the flume. The comparison between the published laboratory results and numerical simulation shows a good agreement. The range of the relative error varies between 0 and 16% with an average of 2% and a root mean square error of 0.18. Accordingly, the CFD software is quite valid to simulate the propagation of the salt wedge. 


2021 ◽  
Vol 3 (1) ◽  
pp. 22-34
Author(s):  
Puri Safitri Hanum ◽  
Qory’ Hanifa

The study's objective was to describe the effect of using high doses of N-acetylcysteine on severe COVID-19 patients. It was evaluated from the length of stay and by monitoring the drug use data, laboratory data, and clinical data at Bhayangkara H.S Samsoeri Mertojoso Hospital Surabaya. The data was collected retrospectively from patients' Health Medical Records who got high dose N-acetylcysteine in October 2020 – February 2021, with standard therapy: antivirus (Remdesivir), antibiotics, vitamins, symptomatic and comorbid therapy, anticoagulant, and corticosteroids (Dexamethasone) as inclusion criteria, then described descriptively. The observation result confirmed that the use of a high dose of N-acetylcysteine (NAC) [1 x 1200 – 5000 mg] po/iv had effective results as seen from the patients' length of stay, which was 12 days for patients without comorbid and 14 days for patients with comorbid like diabetes and/or hypertension. The use of high dose NAC showed improvement in the patients' clinical condition that is evaluated from improved oxygen saturation by 37%. In addition, the laboratory results are shown an improvement in thorax X-ray by 69% and inflammatory markers like CRP and d-dimer by 100%. Further research that uses a prospective method is needed to get a better result on the use of high-dose NAC in patients with severe COVID-19.


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