scholarly journals Managing Recurrent Clozapine-Induced Constipation in a Patient with Resistant Schizophrenia

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Silviu Tomulescu ◽  
Kim Uittenhove ◽  
Reda Boukakiou
Keyword(s):  
Side Effects ◽  
Case Fatality Rate ◽  
Surgical Intervention ◽  
Case Fatality ◽  
Fatality Rate ◽  
Augmentation Strategy

Clozapine is an effective antipsychotic for the treatment of resistant schizophrenia. However, clozapine can lead to serious side effects. One of the most common side effects is constipation and in rare cases ileus, which is associated with a considerable case fatality rate. Our patient exhibited repeated episodes of ileus while being treated with clozapine. We adapted the treatment of the patient in several ways to manage these severe side effects. First, we reduced clozapine dosage by opting for an augmentation strategy of clozapine through paliperidone. Then, we added linaclotide as a nonconventional laxative. We further adapted treatment after the occurrence of a volvulus prompting surgical intervention which revealed a malformation of the intestines’ peritoneal attachment. A gastrostomy to facilitate the treatment of any further episode was performed and bethanechol was introduced alongside linaclotide. Follow-up revealed the efficacy of our strategy involving the use of linaclotide in managing the side effects of clozapine in this patient.

scholarly journals Regional Differences in Epidemiological and Clinical Characteristics, Treatment, and Clinical Outcomes of COVID-19 in Wuhan and Remote Areas of Hubei Province

2021 ◽  
Vol 8 ◽  
Author(s):  
Honggang Ren ◽  
Xingyi Guo ◽  
Antonio Palazón-Bru ◽  
Pengcheng Yang ◽  
Nan Huo ◽  
...  
Keyword(s):  
Regional Differences ◽  
Case Fatality Rate ◽  
Clinical Characteristics ◽  
Case Fatality ◽  
Cross Sectional Study ◽  
Hubei Province ◽  
Fatality Rate ◽  
Cross Sectional ◽  
Suburban Areas

Background: The Coronavirus disease 2019 (COVID-19) pandemic has been a major threat to global health. Regional differences in epidemiological and clinical characteristics, treatment and outcomes of patients have not yet been investigated. This study was conducted to investigate these differences amongCOVID-19 patients in Hubei Province, China.Methods: This retrospective cross-sectional study analyzed data on 289 COVID-19 patients from designated hospitals in three regions:Urban (Wuhan Union West Hospital), Suburban areas of Wuhan (Hannan Hospital) and Enshi city, between February 8 and 20, 2020. The final date of follow-up was December 14th, 2020. The outcomes were case fatality rate and epidemiological and clinical data.Results: Urban Wuhan experienced a significantly higher case fatality rate (21.5%) than suburban Wuhan (5.23%) and rural area of Enshi (3.51%). Urban Wuhan had a higher proportion of patients on mechanical ventilation (24.05%) than suburban Wuhan (0%) and rural Enshi (3.57%). Treatment with glucocorticoids was equivalent in urban and suburban Wuhan (46.84 and 45.75%, respectively) and higher than Enshi (25.00%). Urban Wuhan had a higher proportion of patients with abnormal tests including liver function and serum electrolytes and a higher rate of pneumonia (p < 0.01 for all). Urban Wuhan also had a higher incidence of respiratory failure, heart disease, liver disease and shock, compared with the other two regions (all p < 0.05).Conclusions: Our findings revealed that there are regional differences in COVID-19. These findings provide novel insights into the distribution of appropriate resources for the prevention, control and treatment of COVID-19 for the global community.

scholarly journals Acuity level of care as a predictor of case fatality and prolonged hospital stay in patients with COVID-19: a hospital-based observational follow-up study from Pakistan

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045414
Author(s):  
Aysha Almas ◽  
Zain Mushtaq ◽  
Jette Moller
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Level Of Care ◽  
Fatality Rate ◽  
Follow Up Study ◽  
High Acuity

ObjectivesTo determine if there is an association between acuity level of care (ALC), case fatality and length of stay in patients admitted to hospital due to COVID-19.DesignA hospital-based observational follow-up study.SettingInternal Medicine Service of the Aga Khan University Hospital, Pakistan, from 26 February 2020 to 30 June 2020.ParticipantsAdult patients with confirmed COVID-19, aged ≥18 years.MethodsALC was categorised into low, intermediate and high level and patients were triaged using the standard emergency severity illness score. All patients were followed until the end of hospital admission for the outcome of case fatality and length of stay.ResultsA total of 822 patients with COVID-19 were admitted during the study period and 699 met inclusion criteria. The mean age was 54.5 years and 67% were males; 50.4% were triaged to low, 42.5% to intermediate and 7.2% to high acuity care. The overall case-fatality rate was 11.6%, with the highest (52%) in high acuity level followed by 16.2% in intermediate and 2% in low acuity care. Acuity level was associated with case fatality, with an HR (95% CI) of 5.0 (2.0 to 12.1) for high versus low acuity care and an HR of 2.7 (1.2, 6.4) for intermediate versus low acuity care, after adjusting for age, sex and common comorbidities including diabetes, hypertension, ischaemic heart disease and chronic lung disease. Similarly, acuity level was also associated with length of hospital stay.ConclusionHigh and intermediate acuity level is associated with higher case fatality rate and prolonged length of hospital stay in patients admitted with COVID-19. In resource-limited settings where the provision of high acuity care is limited, the intermediate care acuity could serve as a useful strategy to treat relatively less critical patients with COVID-19.

scholarly journals Survival of hospitalized COVID-19 patients in Northern Italy: a population-based cohort study by the ITA-COVID19 Network

2020 ◽  
Author(s):  
P. Giorgi Rossi ◽  
E. Ferroni ◽  
S. Spila Alegiani ◽  
G. Pitter ◽  
O. Leoni ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Case Fatality ◽  
Population Based ◽  
Northern Italy ◽  
Charlson Index ◽  
Fatality Rate ◽  
Survival Curves ◽  
Younger Patients ◽  
High Fatality Rate

AbstractBackgroundCOVID-19 case fatality rate in hospitalized patients varies across countries and studies, but reliable estimates specific for age, sex, and comorbidities are needed to design trials for COVID-19 interventions. Aim of this study is to provide population-based survival curves of hospitalized COVID-19 patients.MethodsA cohort study was conducted in Lombardy, Veneto, and Reggio Emilia using COVID-19 registries linked to hospital discharge databases containing patient clinical histories. All patients with positive SARS-CoV-2 RT-PCR test on oral/nasopharyngeal swabs hospitalized from 21st February to 21st April 2020 were identified. Kaplan Meier survival estimates were calculated at 14 and 30 days for death in any setting, stratifying by age, sex and Charlson Index.FindingsOverall, 42,926 hospitalized COVID-19 patients were identified. Patients’ median age was 69 years (IQR: 57-79), 62·6% were males, 69·4% had a Charlson Index of 0. In total, 11,205 (26·1%) patients died over a median follow-up of 24 days (IQR: 10-35). Survival curves showed that 22·0% of patients died within 14 days and 27·6% within 30 days of hospitalization. Survival was higher in younger patients and in females. Younger patients with comorbidities had a lower survival than older ones with comorbidities.InterpretationOver 27% of hospitalized COVID-19 patients died within one month in three areas of Northern Italy that were heavily affected by SARS-CoV-2 infection. Such a high fatality rate suggests that trials should focus on survival and have follow-up of at least one month.FundingThe study did not receive any external funding.Research in contextEvidence before this studyTwo recent systematic reviews with meta-analyses report case fatality rates of three to four percent in COVID-19 patients. Most studies on hospitalized cohorts report only slightly higher figures. These figures do not correspond to those derived from routinely collected clinical data in most European countries, reporting a 10% case fatality rate which has been increasing over time since the epidemic started.Robust and precise survival estimates of hospitalized COVID-19 patients which take into account prognostic factors such as age, sex and burden of comorbidities are needed to design appropriate phase II and phase III clinical studies of drugs targeting COVID-19.Added value of this studyIn this study we present the first survival estimates by age, sex and Charlson index for a large population-based cohort of Italian hospitalized COVID-19 patients.Implications of all the available evidenceOver 27% of COVID-19 patients died within one month from hospital admission. Such a high fatality rate suggests that studies should prioritize mortality as primary outcome. Furthermore, we found that the fatality rate reaches a plateau 30 days after hospitalization, suggesting that studies should have at least one month of follow up to observe deaths; shorter follow-up could lead to overestimation of treatment benefits.

Relevance of Group Milleri Streptococci in Thoracic Surgery: A Clinical Update

2007 ◽  
Vol 73 (5) ◽  
pp. 492-497 ◽  
Author(s):  
I. Stelzmueller ◽  
M. Biebl ◽  
N. Berger ◽  
M. Eller ◽  
J. Mendez ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Case Fatality Rate ◽  
Surgical Intervention ◽  
Case Fatality ◽  
Fatality Rate ◽  
Pleural Effusions ◽  
Congestive Heart Disease ◽  
Mediastinal Infection ◽  
Pleural Infection ◽  
Polymicrobial Infections

Group Milleri streptococci (GMS), a heterogeneous group of streptococci, are associated with purulent infections. This study was a retrospective analysis of all consecutive thoracic infections of GMS between 2001 and 2004. Of 246 surgical GMS infections, thoracic infections accounted for 4.5 per cent, including 10 pleural infections (eight empyemas and two infected pleural effusions) and one mediastinal infection. The etiology of pleural infection was parapneumonic (7), second to esophageal perforation (1), liver transplantation (1), and liver resection (1). Polymicrobial infections were present in 64 per cent. All patients underwent removal of the infected masses, including drainage (3), thoracoscopic decortication (5), thoracotomy with debridement (2), and incision with drainage (1). The case fatality rate was 9 per cent (there was one patient with congestive heart disease unfit to undergo surgical empyema evacuation) and the recurrence rate was 27.3 per cent (three patients). Combined antibiotic/surgical treatment was successful in all other cases. GMS isolates were susceptible to clindamycin and all β-lactam antibiotics except ceftazidime, but were resistant to aminoglycosides. If found intrathoracically, GMS frequently progress to severe empyema. Therefore, timely removal of pleural collection by percutaneous drainage or surgical intervention seems indicated. If surgery is required, thoracoscopic decortication may be the preferred approach.

Death due to recurrent thromboembolism among younger healthier individuals hospitalized for idiopathic pulmonary embolism

2008 ◽  
Vol 99 (04) ◽  
pp. 683-690 ◽  
Author(s):  
Hong Zhou ◽  
Susan Murin ◽  
Richard White
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Fatality Rate ◽  
Thromboembolic Pulmonary Hypertension ◽  
The Mean ◽  
First Time ◽  
Acute Pe

SummaryThe incidence of death due to recurrent pulmonary embolism (PE) after a first-time idiopathic PE is not well defined. We conducted a retrospective study of patients age 18 to 56 years who had idiopathic PE between 1994–2001.The incidence and cause of death within five years was determined using linked discharge records and a master death registry. A total of 3,456 patients had a first-time idiopathic PE. The rate of recurrent VTE 0–6 months after the index event was 13.1%/year, and 2.9%/year 6–60 months after the event. During the mean follow-up of 3.2 years 118 (3.4%, 95% confidence interval [CI]=2.8–4.1%) patients died. Fifty-two (44%) deaths occurred <29 days after the index PE (case-fatality rate =1.5%,95%CI=1.1–2.0%). Among the 66 cases (1.9%) that died after 28 days, 18 (0.52%) were due to recurrent PE or its sequelae: eight had recurrent PE alone, five had recurrent PE and a serious co-morbid illness, and five had thromboembolic pulmonary hypertension with or without acute PE. The person-time rate of death (deaths per 100 patientyears) attributed to any recurrent thromboembolism 6–60 months after the event was 0.16% (95%CI=0.1–0.26%). Ten of the 18 (56%) late thromboembolic deaths reflected a first-time recurrent PE. The 28-day case-fatality rate for recurrentVTE was 2.8% (95%CI= 1.5–4.9%).In this cohort of younger patients with idiopathic PE, the rate of death due to recurrentVTE, particularly to first-time recurrent PE, was low. Among the patients who died of thromboembolism >28 days after the index PE, 28% had developed pulmonary hypertension.

scholarly journals Clinical and Epidemiological Data of COVID-19 from Regensburg, Germany – A Retrospective analysis of 1084 consecutive cases

2020 ◽  
Author(s):  
Benedikt M J Lampl ◽  
Matthias Buczovsky ◽  
Gabriele Martin ◽  
Helen Schmied ◽  
Michael Leitzmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Epidemiological Data ◽  
Clinical Severity ◽  
Symptom Duration ◽  
Fatality Rate ◽  
Duration Of Symptoms ◽  
Chronic Heart Disease

Abstract Background: COVID-19 is a new syndrome caused by the recently emerged SARS-CoV-2. We collected clinical and epidemiologic data in an almost complete cohort of SARS-CoV-2 positive individuals from Regensburg, Germany, from March 2020 to May 2020.Methods: Retrospective cohort of consecutive COVID-19 cases recorded between March 7, 2020 and May 24, 2020 as part of an infection control investigation program, with prospective follow-up interviews gathering information on type and duration of symptoms and COVID-19 risk factors until June 26, 2020.Results: Of 1,089 total cases, 1,084 (99.6%) cases were included. The incidence during the time period was 315.4/100,000, lower than in the superordinate government district Oberpfalz (468,5/100,000) and the overall state of Bavaria (359.7/100,000). The case fatality rate was 2.1%. Among fatal cases, the mean age was 74.4 years and 87% presented with known risk factors, most commonly chronic heart disease, chronic lung disease, kidney disease, and diabetes mellitus. 897 cases (82,7%) showed at least one symptom, most frequently cough (45%) and fever (41%). Further, 18% of cases suffered from odour/taste disorder. 17% of total cases reported no symptoms. The median duration of general illness was 10 days. During follow-up, 8,9% of 419 interviewed cases reported at least one symptom lasting at least 6 weeks, and fatigue was the most frequent persistent symptom. Discussion: We report data on type and duration of symptoms, and clinical severity of nearly all (99,5%) patients with SARS-CoV-2 recorded from March 2020 to May 2020 in Regensburg. A broad range of symptoms and symptom duration was seen, some of them lasting several weeks. The case fatality rate was 2.1%. Asymptomatic cases may be underrepresented due to the nature of the study.

Impact of surgical intervention timing on the case fatality rate for Fournier's gangrene: an analysis of 379 cases

2012 ◽  
Vol 110 (11c) ◽  
pp. E1096-E1100 ◽  
Author(s):  
Toru Sugihara ◽  
Hideo Yasunaga ◽  
Hiromasa Horiguchi ◽  
Tetsuya Fujimura ◽  
Kazuhiko Ohe ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Surgical Intervention ◽  
Case Fatality ◽  
Fournier’S Gangrene ◽  
Fatality Rate ◽  
Fournier's Gangrene

scholarly journals Case fatality rate in patients with COVID-19 infection and its relationship with length of follow up

2020 ◽  
Vol 128 ◽  
pp. 104415 ◽  
Author(s):  
Paolo Giorgi Rossi ◽  
Serena Broccoli ◽  
Paola Angelini
Keyword(s):  
Case Fatality Rate ◽  
Case Fatality ◽  
Fatality Rate

A Meta-Analysis of Case Fatality Rates of Recurrent Venous Thromboembolism and Major Bleeding in Patients with Cancer

2020 ◽  
Vol 120 (04) ◽  
pp. 702-713 ◽  
Author(s):  
Alym Abdulla ◽  
Wendy M. Davis ◽  
Namali Ratnaweera ◽  
Elena Szefer ◽  
Brooke Ballantyne Scott ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Case Fatality Rate ◽  
Meta Analysis ◽  
Case Fatality ◽  
Fatality Rate ◽  
Patients With Cancer ◽  
Recurrent Venous Thromboembolism ◽  
Recurrent Vte

Abstract Background Knowing the case fatality rates of recurrent venous thromboembolism (VTE) and major bleeding is important for weighing the relative risks and benefits of anticoagulation and deciding on the duration of anticoagulant therapy, but these rates are uncertain in patients with cancer-associated thrombosis. Methods We performed a systematic review and a meta-analysis to determine the incidence of recurrent VTE and major bleeding and their respective case fatality rates in patients with cancer-associated VTE. Results Our analysis included 29 studies (15 prospective cohort studies and 14 randomized controlled trials) from 1980 to January 2019. Data from 8,000 cancer patients with 4,786 patient-years of follow-up were summarized. Rates of recurrent VTE and fatal recurrent VTE were 23.7 (95% confidence interval [CI]: 20.1–27.8) and 1.9 (95% CI: 0.8–4.0) per 100 patient-years of follow-up, respectively, with a case fatality rate of 14.8% (95% CI: 6.6–30.1%). The rates of major bleeding and fatal major bleeding events were 13.1 (95% CI: 10.3–16.7) and 0.8 (95% CI: 0.3–2.1) per 100 patient-years of follow-up, respectively, with a case fatality rate of 8.9% (95% CI: 3.5–21.1%). While the estimates of case fatality vary by anticoagulation regimen and study design, the differences between them were not statistically significant. Conclusion In cancer patients receiving anticoagulation, the case fatality rate of recurrent VTE is higher than the case fatality rate of major bleeding. These findings may help to inform decisions regarding the management of anticoagulation in patients with active cancer and VTE.

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