scholarly journals Evaluation of the clinical profile, laboratory parameters and outcome of two hundred COVID-19 patients from a tertiary centre in India

2020 ◽  
Vol 90 (4) ◽  
Author(s):  
Nitesh Gupta ◽  
Pranav Ish ◽  
Rohit Kumar ◽  
Nishanth Dev ◽  
Siddharth Raj Yadav ◽  
...  

COVID-19 is a pandemic with over 5 million cases worldwide. The disease has imposed a huge burden on health resources. Evaluation of clinical and epidemiological profiles of such patients can help in understanding and managing the outbreak more efficiently. This study was a prospective observational analysis of 200 diagnosed COVID-19 patients admitted to a tertiary care center from 20th march to 8th May 2020. All these patients were positive for COVID-19 by an oro-nasopharyngeal swab-rtPCR based testing. Analyses of demographic factors, clinical characteristics, comorbidities, laboratory parameters, and the outcomes were performed. The mean age of the population was 40 years with a slight male predominance (116 patients out of 200, 58%). A majority of the patients (147, 73.5 %) were symptomatic, with fever being the most common symptom (109, 54.5%), followed by cough (91, 45.5%). An older age, presence of symptoms and their duration, leukocytosis, a high quick SOFA score, a high modified SOFA score, need for ventilator support, an AST level more than 3 times the upper limit of normal (ULN), and a serum creatinine level of 2 mg/dl or greater were at a significantly higher risk of ICU admission and mortality. Presence of diabetes mellitus, AST > three times ULN, serum creatinine 2 mg/dl or higher, and a qSOFA score of 1 or higher were all associated with significantly greater odds of critical care requirement. Triage and severity assessment helps in deciding the requirement for a hospital stay and ICU admission for COVID-19 which can easily be done using clinical and laboratory parameters. A mild, moderate and severe category approach with defined criteria and treatment guidelines will help in judicious utilization of health-care resources, especially for developing countries like India.   *Other members of the Safdarjung Hospital COVID-19 working group: Balvinder Singh (Microbiology), MK Sen (Pulmonary Medicine), Shibdas Chakrabarti (Pulmonary Medicine), NK Gupta (Pulmonary medicine), AJ Mahendran (Pulmonary Medicine), Ramesh Meena (Medicine), G Usha (Anaesthesiology), Santvana Kohli (Anaesthesiology), Sahil Diwan (Anaesthesiology), Rushika Saksena (Microbiology), Vikramjeet Dutta (Microbiology), Anupam Kr Anveshi (Microbiology) 

Author(s):  
Subrata Kumar Das ◽  
Saptadipa Das

<p class="abstract"><strong>Background:</strong> The aim was to evaluate the parameters of metabolic syndrome (MS) in patients of alopecia areata and to investigate the possibility of an existing relationship between MS and alopecia areata (AA).</p><p class="abstract"><strong>Methods:</strong> This cross-sectional observational study included 50 patients with AA who attended OPD of department of dermatology at a tertiary care center during a period of 1 year. Clinical and laboratory parameters were noted in each patient.<strong></strong></p><p class="abstract"><strong>Results:</strong> This study included 50 patients with AA (33 males and 17 females). In the present study maximum number of patients belonged to the age group 20-30 years with 23 patients, followed by 30-40 years with 17  patients. Most of the study subjects, 17 were college students and number of employees were 15. Out of 50 patients 44  had patch(es) and 2 patient had alopecia totalis. In this study out of 50 patients, 38 had mild AA, 7 had AA and 5 patients had severe AA. No significant derangement of clinical and laboratory parameters of MS observed in patients of AA.</p><p class="abstract"><strong>Conclusions:</strong> In the present study we did not observe any significant derangement of clinical and laboratory parameters of  MS  in patients of alopecia areata.</p>


2020 ◽  
Vol 2 (2) ◽  
pp. 35-40
Author(s):  
Jagat Narayan Rajbanshi ◽  
Pankaj Raj Nepal

 Background: Intracerebral hemorrhage (ICH) is an irreversible phenomenon inside the brain parenchyma resulting in mild to severe neurological deficit. Based on etiology it is broadly divided into primary and secondary. Primary ICH is usually due to the rupture of Charcot-Bouchard aneurysm and chronic hypertension. Charcot – Bouchard aneurysms are supposed to get formed due to lipohyalinosis. With the aim to evaluate the outcome of primary ICH admitted to our institute this study is performed. Materials and methods: This is a prospective analytical study, where all the consecutive patients of the primary ICH were collected. Quantitative variables like age, the volume of hematoma, midline shift, GCS, and systolic blood pressure (SBP) were presented as mean and standard deviation (S.D). Whereas, qualitative variables like gender, site, and side of hematoma, type of treatment, best motor response were presented in frequency and percentage. The outcome of the patient was measured using the Glasgow outcome scale (GOS) and the association between qualitative/quantitative variables and GOS was done using the chi-square test or Fischer exact test whenever applicable in SPSS20. Results: There were a total of 31 patients with a mean age of 59.81(S. D 15.8) year and male predominance (74%). The mean volume of hematoma was 40 ml. Similarly, midline shift ranged from zero to 14 mm. The majority of primary ICH were located in basal ganglia (35%) and on the right side (52%). The mean GCS at presentation was 12.1 (S.D 2.166). Mean Systolic blood pressure was 163.77 mmHg (S.D 34.6 mmHg) with maximum SBP up to 240mmHg. There was a 14% mortality in this study group with favorable outcome (GOS 4 and 5) in 82%. GOS was significantly associated with the volume of hematoma and midline shift. Conclusion: The outcome of primary ICH is strongly associated with the volume of hematoma and midline shift. They were generally associated with hypertension with a mean systolic blood pressure of >160 mm Hg.


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jill Vanmassenhove ◽  
Johan Steen ◽  
Johan Decruyenaere ◽  
Dominique Benoit ◽  
Eric Adriaan J Hoste ◽  
...  

Abstract Background and Aims The reported incidence of Acute Kidney Injury (AKI) at the intensive care unit (ICU) is variable. Although the Kidney Disease Improving Global Outcome (K-DIGO) improved harmonisation of this definition, there is remaining variability in the actual implementation of this AKI definition, with variable interpretation of the urinary output (UO) criterion, and of the baseline serum creatinine (Screa) criterion. This hampers progress of our understanding of the clinical concept AKI and leads to confusion and unclarity when interpreting models to predict AKI or associated outcomes. With the advent of big data and artificial intelligence based decision algorithms, this problem will only become more of interest, as the user will not know what exactly the construct AKI in the application used means and represents. Therefore, we intended to explore the impact of different interpretations of the Screa and the UO criterium as presented in the K-DIGO definition on the incidence of AKI stage 2. Method We included all patients of an electronic health data system applied in a tertiary ICU between 2013 and 2017. Sequential Organ Failure Assessment (SOFA) score was calculated, and gender, age, weight and mortality at ICU and in hospital were extracted. All serum creatinine (sCrea) values during ICU stay and hospitalisation were extracted, as were UO data, with their time stamps. In addition, all available Screa data up to 1 year before ICU admission were retrieved from a dataset external to the ICU. AKI was defined according to KDIGO stage 2, using different possible interpretations of the Screa and/or the UO criterion. For the evolution of Screa as compared to a baseline value, we sued either a value directly available to ICU staff (def 1), a presumed eGFR of 75ml/min (def 2), the first available value after admission to ICU (def 3), the lowest value during the current hospitalisation before ICU admission (def 4), the lowest value before the hospitalisation episode as found in an external dataset (def 5). For the UO criterion, we also applied two criteria in line with K-DIGO stage 2: a UO below 6ml/kg during a 12 hour block (def 6) or a UO below 0.5ml/kg/hour during each of 12 consecutive one hour intervals (def 7). Def 8 identified patients who did not comply with any of the definitions (1-7), so who had no AKI according to any definition. Definition 9 and 10 identified patients who complied with at least one out of the Screa criteria 1-5 (def 9) or out of the UO criteria (def 10). Definition 11 identified patients who complied both with at least one Screa and one UO criterium. Results Our dataset included 16433 ICU admissions (34.7% female, age 60.7±16.4 years). Overall, 8.1% of patients died at ICU, and another 5.2% during their hospitalisation. The SOFA score at admission was 6.9±4.1. The incidence of AKI according to the stage 2 definition of K-DIGO varied according to the interpretation of the diagnostic criteria from 4.3% when baseline creatinine was defined as the first ICU value, to 35.3% when the UO criterium was interpreted as a UO below 6ml/kg over a 12 hour block (fig). Only half of patients (53.7%) did not comply with any of the definitions (def 8), 10.9% and 19.7% complied with one of the Screa (def 9) OR one of the UO criteria (def 10) respectively, and 15.7% complied with both (def 11). There was substantial reclassification across the different definitions. Conclusion Unclarity on the actual interpretation of the Screa and UO criteria used in the K-DIGO definition of AKI leads to substantial differences in incidence of AKI, and also with substantial reclassification according to different definitions. This is especially concerning in an era of big data and automated decision support, as clinicians might not know which construct of AKI is actually being represented.


Author(s):  
Ajay Mishra ◽  
Aditya Binu ◽  
George Abraham ◽  
Harshad Vanjare ◽  
Tina George ◽  
...  

AbstractBackgroundNeurological complications following snake and scorpion bite are diverse. Literature regarding patterns of cerebrovascular injury (CVI) and outcomes among these patients is scarce. This is a descriptive study of the clinical profile, brain imaging findings, mechanisms of injury, vascular territory involvement and outcomes of CVI following scorpion and snake envenomation, in a tertiary care center in South India.MethodologyPatients with scorpion sting- and snake envenomation-related complications were retrospectively enrolled. Neuroimaging was performed on five patients with each envenomation, and they were found to have neurological involvement. On imaging, three patients were found to have a CVI. Clinical, radiological parameters and outcomes of these patients were studied. We also performed a review of the literature and analyzed the finding of all the cases.ResultIn all, three patients each had evidence of CVI in imaging. An additional 32 reports of scorpion sting-related CVI and 35 reports of snake envenomation-related CVI were identified from the literature. There was a male predominance among these patients. Mean age of the patients with scorpion sting was 42.8 years as compared with 33 years for the patients with snake envenomation. Features of severe envenomation were present in all patients. Persistently depressed sensorium and new-onset focal neurological deficits were seen in 70% of all patients. Infarcts were seen in 88% of patients with snake envenomation and 53% of patients with a scorpion sting. Mortality was 28% among patients with a scorpion sting as compared with 8% with snake envenomation.ConclusionCerebrovascular injuries are uncommon neurological manifestations following scorpion and snake envenomation. These tend to occur in younger patients. Infarcts are more common than bleeds.


2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Nucksheeba Aziz Bhat ◽  
Farhat Mustafa ◽  
Rayees Yousuf Sheikh ◽  
Imtiyaz Wani

Abstract Background Hypercalcemia is known to cause acute kidney injury (AKI). Literature related to hypercalcemic AKI is predominantly in the form of case reports and case series. The purpose of this study is to find the incidence, etiology, and course of hypercalcemia-induced AKI in a non-critical care setting. To our knowledge, this is the first study done to look for the incidence, etiology, and course of hypercalcemia-induced AKI in a non-critical care setting. This is a prospective observational study conducted in the Department of Medicine in a tertiary care center from Jammu and Kashmir, India, from June 2010 to June 2012. Patients admitted with hypercalcemia were assessed for AKI and evaluated and treated for hypercalcemia. Renal function was monitored during hospitalization and at 1 month of discharge. AKI and hypercalcemia were arbitrarily defined as serum creatinine > 1.5 mg/dl and corrected serum calcium of ≥ 11.5 mg/dl (as per reference hospital lab), respectively. Results Thirty patients are included. Hyperparathyroidism and multiple myeloma accounted for 13(43.3%) and 10 (33.3%) cases, respectively. Mean ±SD corrected serum calcium at diagnosis and after treatment at 1 month was 13.56 ± 1.86 mg/dl and 9.49±1.35 mg/dl, respectively; p < 0.001. Mean ±SD serum creatinine at baseline and after treatment of hypercalcemia was 2.87 ±1.68 mg/dl and 1.49±1.34 mg/dl, respectively; p < 0.001. Twenty-three (76.7%) patients had AKI. AKI recovered after treating hypercalcemia in 25 (83.3 %) patients. Mean ± SD days taken for the decrease in serum creatinine to ≤ 1.5 mg/dl was 8.28 ± 4.17 days. Mean ± SD serum creatinine after treatment of hypercalcemia in hyperparathyroidism group versus non-parathyroid group was 0.97 ± 0.35 mg/dl and 1.88 ±1.67 mg/dl, respectively; p value 0.009. Conclusions Hypercalcemia is commonly associated with AKI. Primary hyperparathyroidism and multiple myeloma account for the majority of the cases. Hypercalcemic AKI with primary hyperparathyroidism is less common and the outcome is better, as compared to non-hyperparathyroidism-related causes. AKI is reversible in most cases.


2020 ◽  
Author(s):  
Deepali Kumar ◽  
Victor H Ferreira ◽  
Andrzej Chruscinski ◽  
Vathany Kulasingam ◽  
Trevor J Pugh ◽  
...  

We screened three separate cohorts of healthcare workers for SARS-CoV-2 via nasopharyngeal swab PCR. A seroprevalence analysis using multiple assays was performed in a subgroup. The asymptomatic health care worker cohorts had a combined positivity rate of 29/5776 (0.50%, 95%CI 0.32-0.75) compared to the symptomatic cohort rate of 54/1597 (3.4%) (ratio of symptomatic to asymptomatic 6.8:1). Sequencing demonstrated several variants. The seroprevalence (n=996) was 1.4-3.4% depending on assay. Protein microarray analysis showed differing SARS-CoV-2 protein reactivities and helped define likely true positives vs. suspected false positives. Routine screening of asymptomatic health care workers helps identify a significant proportion of infections.


2021 ◽  
Vol 8 (10) ◽  
pp. 367-370
Author(s):  
Siva Saranappa ◽  
Jennifer Wu

Background: Anemia is the most commonly observed hematological diseases in children. The World Health Organization (WHO) has estimated that globally, 1.62 billion people are anemic, with the highest prevalence of anemia (47.4%) among preschool-aged children. Of these 293 million children, 89 million live in India. Aim: This study aims to evaluate the factors causing anemia in children aged between 6 months and 5 years and its prevalence within this age group. Methods: This study is a prospective observational study conducted in KIMS Hospital, Bengaluru, Karnataka. A total of 200 children in the age group of 6 months–5 years with features of anemia or having hemoglobin <11 g/dl were included in the study for a duration of 18 months between January 2019 and June 2020. Detailed history was recorded and examination findings were noted. The data collected were tabulated and statistically analyzed accordingly. Results: About 57.5% of the children with anemia fell between the age group of 6 months and 2 years and 42.5% of children were in the age groups of 2–5 years. A male predominance was seen (61%) with male-to-female ratio of approximately 1.56:1. Most of the children were found to have mild (46%) and moderate anemia (46%) with only a minority (8%) presenting with severe anemia. About 56.5% of the children had a normal nutritional status while 41% were malnourished and 2.5% had both wasting and stunting. Exclusive breastfeeding (for 6 months) history was present in 59% of the children. These children belonged mostly to the upper lower (45%) and lower middle (41%) socioeconomic status. This study also showed anemia in children most commonly presented majorly with concurrent involvement of the respiratory system (31%) followed by infectious diseases (30%) and gastrointestinal disorders (23%). Conclusion: The current study concludes that iron deficiency anemia is a multifactorial hematological disease. Learning about the predisposing risk factors can help to adopt the necessary precautions to prevent anemia in these children. Improving the nutritional status of the children by involving parents and counseling them regarding important feeding practices can help to prevent anemia.


Med Phoenix ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 48-51
Author(s):  
Amit Jha

Background: Discharging ear is a common symptom among the patients presenting in ENT OPD for consultation. The commonest cause for discharging ear is chronic otitis media. Poverty, ignorance, crowded living conditions due to large families, poor sanitation, and lack of personal and environmental hygiene are some of the main factors behind the prevalence of chronic otitis media. National medical college and teaching hospital is a tertiary care center located in Birgunj metropolitan city in central Nepal. It caters to thousands of patients with discharging ear each year.Methods: This qualitative, descriptive study was carried out in department of ENT-HNS at National Medical College and Teaching Hospital located Birgunj-15, Parsa, Province no. 2 of Nepal for duration of one year from August 1, 2014 to July 30, 2015. Two hundred and five (205) adult patients with complains of unilateral          discharging ear were included in the study.Results: Mostly female patients and those in the age group of 15-30 years from Bara and Parsa districts of Nepal including the areas around the Indo-Nepal border avail the services of department of ENT-HNS of National medical college and teaching hospital.Conclusions: The delivery of ENT-HNS services to the concerned patients is insufficient and inefficient owning to various factors. The government of Nepal and India along with National medical college and teaching hospital can work together to improve the situation. Med Phoenix. Vol. 3, Issue. 1, 2018, Page: 48-51 


2017 ◽  
Vol 34 (10) ◽  
pp. 844-850
Author(s):  
Phillip Huyett ◽  
Nicholas R. Rowan ◽  
Berrylin J. Ferguson ◽  
Stella Lee ◽  
Eric W. Wang

Background: The association between intensive care unit (ICU) sinusitis and the development of lower airway infections remains unclear. The objective of this study was to determine the correlation between the development of radiographic sinus opacification and pneumonia in the neurologic ICU setting. Methods: A retrospective review of head computed tomography or magnetic resonance imaging of 612 patients admitted to the neurocritical care unit at a tertiary care center from April 2013 through April 2014 was performed. Paranasal sinus opacification was measured using Lund-Mackay scores (LMS). A diagnosis of pneumonia was determined by the ICU team from radiographic, laboratory, and pulmonary data. Exclusion criteria included a history of endonasal surgery, sinonasal malignancy, facial fractures, ICU admission less than 3 days, or inadequate imaging. Results: Worsening sinus opacification occurred in 42.6% of patients and pneumonia in 18.5% of patients during ICU admission. Of the patients who developed pneumonia, 71.7% also developed worsening sinus opacification ( P < .001). In 80.2% of cases, the sinus opacification developed prior to the diagnosis of pneumonia. The mean highest LMS for patients who developed pneumonia was 4.24 compared to 1.99 in patients who did not develop pneumonia ( P < .001). Sinus air–fluid levels or complete sinus opacification occurred in a larger proportion of patients who developed pneumonia (46.9% vs 19.4%, P < .001). Mortality rates for patients with no pneumonia or sinusitis, pneumonia only, sinusitis only, and sinusitis with pneumonia were 7.6%, 15.6%, 18.3%, and 25.9%, respectively ( P < .001). Conclusions: This study finds a strong relationship between worsening sinus opacification in the neurologic ICU patient to the development of hospital-acquired pneumonia and increased mortality.


2021 ◽  
Vol 42 (02) ◽  
pp. 130-134
Author(s):  
Satyabrata Roy Chowdhoury ◽  
Himanshu Sekhar Biswas ◽  
Sumantra Raut ◽  
Subhajit Bhakta ◽  
Atanu Roy ◽  
...  

Abstract Introduction Pediatric oncology patients presumably are one of the most vulnerable groups during this ongoing coronavirus disease 2019 (COVID-19) pandemic. Not only they are immunocompromised thanks to their inherent disease and treatment regimens, but delay in initiation and maintenance of their treatment in this pandemic era also poses great concern. But the magnitude of this effect on pediatric oncology patients has not been well established due to paucity of data. Objective This study was proposed to assess clinicoepidemiological profile and outcome of the pediatric oncology patients who were infected with severe acute respiratory syndrome coronavirus 2 virus attending a COVID-19 care facility. Materials and Methods This was a prospective observational study conducted in a tertiary care hospital. All confirmed oncology patients up to age 12 years who either attended the oncology outpatient department or referred to COVID-19 care center from other cancer treatment facility were included in the study from May 2020 to September 2020. Data on demography, clinical features, investigations, treatment, complications, and outcome were collected. Descriptive statistical analysis was performed and common relevant investigations were compared between non-intensive care unit (ICU) and ICU group. Results The rate of COVID-19 positivity among the pediatric oncology patient attending oncology clinic of the hospital is 8.21%. Total 28 patients (12 from oncology clinic of our hospital and 16 from other hospitals referred to our COVID-19 unit) were included in our study. The most common malignancy was acute lymphoblastic leukemia (64.28%). The most common symptom was fever (64.28%). Oxygen therapy was needed for 42.85% patients. Eight patients required ICU admission (two required invasive ventilation and one required noninvasive ventilation). Positive C-reactive protein value was associated with severe disease requiring ICU admission. Mean delay in starting chemotherapy in newly diagnosed cases was 28.77 days (standard deviation = 9.67). One newly diagnosed patient expired due to preexisting disease. Conclusion Though vulnerable, most of the pediatric oncology patients suffered a mild COVID-19 infection without any significant COVID-19-related morbidity and mortality. There is a significant delay in starting specific oncology therapy, that is, chemotherapy as a result of the ongoing COVID-19 pandemic in newly diagnosed pediatric oncology patients, which can increase morbidities and mortality related to malignancy.


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