scholarly journals A new scoring system for Covid-19 in patients on hemodialysis: Modified Early Warning score

Praxis medica ◽  
2021 ◽  
Vol 50 (1-2) ◽  
pp. 1-6
Author(s):  
Radojica Stolić ◽  
Dragica Bukumirić ◽  
Milena Jovanović ◽  
Tomislav Nikolić ◽  
Tatjana Labudović ◽  
...  
Keyword(s):  
Early Warning ◽  
Ad Hoc ◽  
Serum Lactate ◽  
Early Warning Score ◽  
Serum Lactate Dehydrogenase ◽  
Monocyte Count ◽  
Laboratory Findings ◽  
Arterial Blood ◽  
Corona Virus ◽  
Significant Difference

Introduction. At the very beginning of the Corona virus epidemic there was not enough data on whether hemodialysis patients have a higher risk for Corona virus infection and which factors may affect the severity of clinical picture. Objective. The aim of the study was to determine the significance of the Modified Early Warning Assessment (MEWS) score for the assessment of coronavirus disease exacerbation. Methods. The research was conducted in COVID dialysis, as a retrospective, descriptive-analytical study, at the University Clinical Center Kragujevac, Serbia, which was organized ad-hoc for treatment of SARS-Cov-2 infection positive patients, which are transfered from Center for Hemodialysis "Ćuprija". They were evaluated routine laboratory findings, demographic and gender structure, arterial blood pressure, presence of comorbidities and residual diuresis, duration of dialysis, radiological evaluation of lungs, determination of MEWS score were the parameters that were monitored. The results were monitored on admission and and in the end of treatment. Results. A statistically significant difference was registered in serum lactate dehydrogenase concentration (486 ± 107.62 vs. 423.7 ± 92.4 U/L); p = 0.022 and absolute monocyte count (0.46 ± 0.15 vs. 0.67 ± 0.34 x 103; p = 0.008). The significant increase in MEWS score was also found (b = 0.017; p = 0.030). There was a positive correlation between increase of MEWS score and age (b = 0.027; p = 0.002) and arterial hypertension as a concomitant comorbidity (b = 0.700; p = 0.033). Conclusion. In the observed period, there was a significant increase in the degree of MEWS score of dialysis patients who had SARS-Cov-2 infection.

Mechanism of hemoglobin-induced protection against endotoxemia in rats: a ferritin-independent pathway

1997 ◽  
Vol 272 (2) ◽  
pp. L268-L275 ◽  
Author(s):  
L. Otterbein ◽  
B. Y. Chin ◽  
S. L. Otterbein ◽  
V. C. Lowe ◽  
H. E. Fessler ◽  
...  
Keyword(s):  
Tissue Injury ◽  
Lethal Dose ◽  
White Blood Cells ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
Heme Oxygenase 1 ◽  
Necrosis Factor Alpha ◽  
Physiological Basis ◽  
Arterial Blood ◽  
Normal Mean

Hemoglobin (Hb) induces heme oxygenase-1 (HO-1), which catalyzes the breakdown of heme to bilirubin, and ferritin. Rats pretreated with Hb have been shown to survive lethal doses of lipopolysaccharide (LPS; see L. Otterbein, S. L. Sylvester, and A. M. Choi. Am. J. Respir. Cell Mol. Biol. 13: 595-601, 1995). The physiological basis of this increased survival and the mechanism(s) involved in the protection against LPS by Hb are unknown. Here we investigated 1) the effects of Hb on the hemodynamic and biochemical parameters of LPS-induced tissue injury and 2) the mechanism(s) by which Hb conferred protection against shock and tissue injury. Hb-treated rats maintained normal mean arterial blood pressure, whereas control rats experienced cardiovascular collapse after a lethal dose of LPS. Hepatic and renal functions, peripheral white blood cells, serum lactate dehydrogenase, and phosphate also remained normal after LPS in Hb-treated rats. Hb also attenuated LPS-induced neutrophil alveolitis and tumor necrosis factor-alpha levels. Pretreatment with both desferoxamine, which, like ferritin, can bind iron, and with exogenous apoferritin failed to protect against LPS. In contrast, treatment with Hb plus desferoxamine, which induced HO-1 but not ferritin, did protect against LPS. Treatment with iron-dextran, which induced ferritin but not HO-1, did not protect against LPS. We conclude that Hb pretreatment reduces the inflammatory and physiological consequences of LPS and that the Hb-induced protection against LPS is dependent on HO-1 and not ferritin induction.

scholarly journals LDH LEVEL IN ACUTE ORGANOPHOSPHORUS POISONING AND ITS RELATION WITH SEVERITY AND MORTALITY: A TERTIARY CARE HOSPITAL EXPERIENCE

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Suresh Kumar Nagar ◽  
Maniram Kumhar ◽  
V. B. Singh ◽  
Mayank Srivastav
Keyword(s):  
Organophosphorus Compounds ◽  
Tertiary Care ◽  
Crop Protection ◽  
Serum Lactate ◽  
Spectrophotometric Analysis ◽  
Serum Lactate Dehydrogenase ◽  
Care Hospital ◽  
Significant Difference ◽  
Organophosphorus Poisoning ◽  
Acute Organophosphorus Poisoning

Background: Organophosphorus compounds have been widely used for a few decades in agriculture for crop protection and pest control. In India Organophosphorus poisoning is the most common. The objective of our study was to measure the  LDH Level in acute organophosphorus poisoning Methods: This study was conducted among minimum 100 patients acute organophosphorus poisoning admitted in Casualty ward, MICU and attending medical ward of JLN hospital, Ajmer during Aug 2018 to July 2020. Serum lactate dehydrogenase estimation by spectrophotometric analysis using Beckman Coalter AU 680 Results: These were significantly higher among deaths on day 1 and 3(810±372.99 and 1027.09±458.26, respectively) in comparison to survivors on day 1 and 3 (538.18±300.42 and 365.19±175.49, respectively). Significant difference was found between mean values of different levels of severity of LDH on day 1 and 3. Conclusion: In conclusion, this study found that Serum LDH can be used as biomarker in diagnosis or stratifying severity of acute OP poisoning, as it is cheap and easily available, especially in developing countries. Serial measurements of serum LDH levels in acute OP poisoning can predict the prognosis. Keywords: LDH, OP poisoning, Severity

Use of the Modified Early Warning Score and Serum Lactate to Prevent Cardiopulmonary Arrest in Hematology-Oncology Patients

2013 ◽  
Vol 29 (6) ◽  
pp. 530-537 ◽  
Author(s):  
Robert S. Young ◽  
Barbara H. Gobel ◽  
Mark Schumacher ◽  
Jungwha Lee ◽  
Charlotta Weaver ◽  
...  
Keyword(s):  
Early Warning ◽  
Cardiopulmonary Arrest ◽  
Serum Lactate ◽  
Early Warning Score ◽  
Oncology Patients

scholarly journals Effects of Early Warning Score (EWS) Tutorial Simulation on Nurses' Knowledge and Clinical Performance

2019 ◽  
Vol 9 (2) ◽  
pp. 231-241
Author(s):  
Roshy Damayanti ◽  
Yanny Trisyani ◽  
Aan Nuraeni
Keyword(s):  
Early Warning ◽  
Clinical Performance ◽  
Intervention Group ◽  
Early Warning Score ◽  
Control Group ◽  
Training Methods ◽  
Chi Square ◽  
Significant Difference ◽  
And Control ◽  
Nurses Knowledge

Background: The Early Warning Score (EWS) system has been recommended for early identification tool of deterioration. However, its implementation has not been optimal; one of which is due to the low level of knowledge and understanding of EWS among nurses.Purpose: This study aimed to determine the effects of EWS tutorial simulation on nurses’ knowledge and clinical performance.Methods: This study employed a pretest posttest quasi-experimental design with a control group. Purposive sampling was used to recruit the samples of 42 respondents each in the intervention group and control group. The data were collected using the questionnaires to measure the knowledge and clinical performance, and analyzed using Chi square, Wilcoxon and Mann-Whitney tests.Results: The results showed that there were differences in the pre-test and post-test of knowledge and clinical performance in the intervention group and control group (p<0.001). There was also a significant difference in clinical performance between the intervention group and the control group (p<0.001). However, no significant difference in knowledge was found between.Conclusions: Tutorial simulation of EWS had an effect on increasing nurses’ clinical performance. Although there was no significant difference in knowledge between the intervention group and the control group, but the intervention group showed a better value than the control group. EWS tutorial simulation can be used as one of the training methods to increase nurses' knowledge and clinical performance in EWS.

Treatment of Indolent B-Cell Nonfollicular Lymphomas: Final Results of the LL01 Randomized Trial of the Gruppo Italiano per lo Studio dei Linfomi

2003 ◽  
Vol 21 (8) ◽  
pp. 1459-1465 ◽  
Author(s):  
Luca Baldini ◽  
Maura Brugiatelli ◽  
Stefano Luminari ◽  
Marco Lombardo ◽  
Francesco Merli ◽  
...  
Keyword(s):  
B Cell ◽  
Univariate Analysis ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Progression Free Survival ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
High Dose ◽  
Free Survival ◽  
Significant Difference

Purpose: To evaluate the effect of epirubicin on therapeutic response and survival in patients with indolent nonfollicular B-cell lymphomas (INFL) treated with pulsed high-dose chlorambucil. Patients and Methods: A total of 170 untreated patients with advanced/active INFL were randomly assigned to receive either eight cycles of high-dose chlorambucil (15 mg/m2/d) plus prednisone (100 mg/d) for 5 days (HD-CHL-P; arm A) or eight cycles of HD-CHL-P plus epirubicin 60 mg/m2 intravenous on day 1 (arm B). The responding patients were randomly assigned to either maintenance therapy with interferon alfa (IFNα-2a; 3 MU, three times weekly) for 12 months or observation. Results: There were 160 assessable patients (82 males, 78 females; median age, 63 years; range, 33 to 77 years); 77 patients were assigned to arm A, and 83 were assigned to arm B. Induction therapy led to 47 complete responses (CRs; 29.4%) and 68 partial responses (PRs; 42.5%), with no significant difference between the two arms (60 CR + PR in arm A [77.9%] and 55 CR + PR in arm B [66.3%]; P = .07). After a median follow-up of 38 months (range, 2 to 103 months), there was no between-group difference in overall survival (OS; P = .45), failure-free survival (P = .07), or progression-free survival (PFS; P = .5). Eighty-eight patients were randomly assigned to either IFNα-2a (n = 43) or observation (n = 45), without any difference in 3-year PFS (44% and 42%, respectively). Univariate analysis showed that OS was influenced by age, anemia, serum lactate dehydrogenase levels, and International Prognostic Index distribution; multivariate analysis identified age and anemia as having influence on OS. Conclusion: HD-CHL-P treatment outcome in INFL patients was good (50% 3-year PFS, minimal toxicity, and low costs); epirubicin did not add any advantage. One-year IFNα maintenance treatment did not prolong response duration.

scholarly journals Comparison of the National Early Warning Score (NEWS) and the Modified Early Warning Score (MEWS) for predicting admission and in-hospital mortality in elderly patients in the pre-hospital setting and in the emergency department

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6947 ◽  
Author(s):  
Toshiya Mitsunaga ◽  
Izumu Hasegawa ◽  
Masahiko Uzura ◽  
Kenji Okuno ◽  
Kei Otani ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Early Warning ◽  
Pressure Pulse ◽  
Vital Signs ◽  
Early Warning Score ◽  
Single Centre ◽  
Peripheral Oxygen Saturation ◽  
Significant Difference ◽  
National Early Warning Score

The aim of this study is to evaluate the usefulness of the pre-hospital National Early Warning Score (pNEWS) and the pre-hospital Modified Early Warning Score (pMEWS) for predicting admission and in-hospital mortality in elderly patients presenting to the emergency department (ED). We also compare the value of the pNEWS with that of the ED NEWS (eNEWS) and ED MEWS (eMEWS) for predicting admission and in-hospital mortality. This retrospective, single-centre observational study was carried out in the ED of Jikei University Kashiwa Hospital, in Chiba, Japan, from 1st April 2017 to 31st March 2018. All patients aged 65 years or older were included in this study. The pNEWS/eNEWS were derived from seven common physiological vital signs: respiratory rate, peripheral oxygen saturation, the presence of inhaled oxygen parameters, body temperature, systolic blood pressure, pulse rate and Alert, responds to Voice, responds to Pain, Unresponsive (AVPU) score, whereas the pMEWS/eMEWS were derived from six common physiological vital signs: respiratory rate, peripheral oxygen saturation, body temperature, systolic blood pressure, pulse rate and AVPU score. Discrimination was assessed by plotting the receiver operating characteristic (ROC) curve and calculating the area under the ROC curve (AUC). The median pNEWS, pMEWS, eNEWS and eMEWS were significantly higher at admission than at discharge (p < 0.001). The median pNEWS, pMEWS, eNEWS and eMEWS of non-survivors were significantly higher than those of the survivors (p < 0.001). The AUC for predicting admission was 0.559 for the pNEWS and 0.547 for the pMEWS. There was no significant difference between the AUCs of the pNEWS and the pMEWS for predicting admission (p = 0.102). The AUCs for predicting in-hospital mortality were 0.678 for the pNEWS and 0.652 for the pMEWS. There was no significant difference between the AUCs of the pNEWS and the pMEWS for predicting in-hospital mortality (p = 0.081). The AUC for predicting admission was 0.628 for the eNEWS and 0.591 for the eMEWS. The AUC of the eNEWS was significantly greater than that of the eMEWS for predicting admission (p < 0.001). The AUC for predicting in-hospital mortality was 0.789 for the eNEWS and 0.720 for the eMEWS. The AUC of the eNEWS was significantly greater than that of the eMEWS for predicting in-hospital mortality (p < 0.001). For admission and in-hospital mortality, the AUC of the eNEWS was significantly greater than that of the pNEWS (p < 0.001, p < 0.001), and the AUC of the eMEWS was significantly greater than that of the pMEWS (p < 0.01, p < 0.05). Our single-centre study has demonstrated the low utility of the pNEWS and the pMEWS as predictors of admission and in-hospital mortality in elderly patients, whereas the eNEWS and the eMEWS predicted admission and in-hospital mortality more accurately. Evidence from multicentre studies is needed before introducing pre-hospital versions of risk-scoring systems.

scholarly journals Sex Differences in an Italian Pediatric Population Covid-19 Positive

2020 ◽  
Author(s):  
Elisabetta Straface ◽  
Isabella Tarissi De Jacobis ◽  
Rosa Vona ◽  
Camilla Cittadini ◽  
Alessandra Marchesi ◽  
...  
Keyword(s):  
Sex Differences ◽  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
C Reactive Protein ◽  
Laboratory Findings ◽  
Reactive Protein ◽  
Males And Females ◽  
Multiple Drugs

Abstract Background: Since December 2019 coronavirus disease (COVID-19) emerged in Wuhan and spread rapidly worldwide. Despite the high number of people affected, data on clinical features and prognostic factors in children and adolescents are limited. We propose a retrospective study aimed to identify sex differences in a pediatric population with COVI-19.Methods: A pediatric population admitted with COVID-19 to Bambino Gesù Children's Hospital of Rome (Italy) in the period from March to May 2020 has been studied taking into account sex differences. Medical history, comorbidities, symptoms and laboratory findings were obtained from patients' electronic medical records. Results: In 37 patients (19 males and 18 females) we found that: i) fever and cough were the dominant symptoms, while gastrointestinal symptoms were rare; and ii) all ages of childhood were susceptible to COVID-19. Moreover, we found that females with COVID-19 were older than males (p < 0.01); required more days of hospitalization (p < 0.04); needed of treatment with multiple drugs; and had higher serum lactate dehydrogenase values (p < 0.04) than males. Conversely, males had, although not significant, higher values of C reactive protein and erythrocyte sedimentation rate than females.Conclusions: Based on the data listed above sex differences were detected in an Italian pediatric population. Compared to the adults we found that COVID-19 infection in children is a non-severe inflammatory disease in both males and females. In any case, many detailed studies should be conducted.

Association of plasma tumor DNA (ptDNA) with increased risk of venous thromboembolism (VTE) in metastatic castration resistant prostate cancer patients (mCRPC).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5048-5048
Author(s):  
Vincenza Conteduca ◽  
Emanuela Scarpi ◽  
Daniel Wetterskog ◽  
Fabio Ferroni ◽  
Alice Rossi ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
Castration Resistant Prostate Cancer ◽  
Targeted Next Generation Sequencing ◽  
Castration Resistant ◽  
Increased Risk ◽  
Significant Difference ◽  
Signaling Inhibitors ◽  
Pre Treatment

5048 Background: Cancer is a risk factor for VTE. In mCRPC, ptDNA is an independent predictor of outcome ( Romanel, Sci Transl Med 2015; Conteduca, Br J Cancer 2020). We firstly aimed to investigate the association between ptDNA and VTE in mCRPC men treated with androgen receptor signaling inhibitors (ARSI) Methods: This prospective biomarker study included mCRPC patients treated with abiraterone and enzalutamide from April 2013 to December 2018. We excluded patients with a previous VTE history and/or ongoing anticoagulation. Targeted next-generation sequencing was performed to determine ptDNA fraction from pre-treatment plasma samples. Assessment of VTE risk based on survival analysis was performed using cumulative incidence function and estimating sub-distributional hazard ratio (SHR) Results: Median age of 180 enrolled patients was 74 years (range 42-90). Of these, 60 (33.3%) were chemotherapy-naive. At a median follow-up of 58 months (range 0.5-111.0), 21 patients experienced VTE (venous thrombosis and/or pulmonary embolism) with a cumulative incidence of VTE at 12 months of 17.1% (95% CI 10.3-23.9). Before starting ARSI, ptDNA fraction above median value of 0.175, presence of visceral metastasis (mets), prior chemotherapy and serum lactate dehydrogenase (LDH) were significantly associated with higher incidence of VTE compared with patients with no thrombosis (12-month estimate, 18.6 vs 3.5%, P=0.0003; 44.4 vs 14.8%, P=0.015; 24.7 vs 4.5%, P=0.006; and 30.0 vs 13.5%, P=0.050, respectively). In the multivariate analysis (Table) including baseline ptDNA level, visceral, liver and lung mets, number of lesions, LDH, high ptDNA fraction was the only independent factor associated with the risk of thrombosis (HR 5.78, 95% confidence interval [CI] 1.63-20.44, P=0.006). All these patients received anticoagulant therapy for VTE. No ARSI discontinuation and VTE-related death were reported, and no significant difference in progression-free/overall survival was observed in mCRPC patients with and without VTE. Conclusions: These results suggest that baseline ptDNA fraction in mCRPC patients treated with ARSI is associated with increased risk of VTE. These patients may be followed up more closely for the risk of VTE and the need for a primary thromboprophylaxis should be taken into account in mCRPC with elevated ptDNA concentration. Validation of these findings in larger multicenter trials is warranted.[Table: see text]

scholarly journals Impact of pericardial fluid glucose level and computed tomography attenuation values on diagnosis of malignancy-related pericardial effusion

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takashi Nakamura ◽  
Mana Okune ◽  
Masakazu Yasuda ◽  
Heitaro Watanabe ◽  
Masafumi Ueno ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pericardial Effusion ◽  
Glucose Level ◽  
Serum Lactate ◽  
Pericardial Fluid ◽  
Serum Lactate Dehydrogenase ◽  
Predictive Values ◽  
Ct Attenuation ◽  
Significant Difference ◽  
Attenuation Values

Abstract Background We evaluated malignancy according to the characteristics of pericardial fluid in symptomatic Japanese patients undergoing pericardiocentesis and computed tomography (CT). Methods This was a retrospective, single-center, observational study of 125 symptomatic patients undergoing pericardiocentesis. The patients were classified into two groups: a malignancy group and a non-malignancy group, according to the primary disease and cytology of the pericardial effusion (PE). We compared the pericardial fluid sample and CT measurements between both groups. Results All patients were diagnosed as having exudative PE by Light’s criteria. PE with malignant cells was demonstrated in 76.8% of the malignancy group patients. Pericardial to serum lactate dehydrogenase (LDH) ratio > 0.6, as one of Light’s criteria, was associated with malignancy (p = 0.017). Lower serum brain natriuretic peptide (BNP) concentration was also associated with malignancy (BNP: 126.9 ± 89.8 pg/ml vs 409.2 ± 97.7 pg/ml, malignancy vs non-malignancy groups, respectively; p = 0.037). A significant difference was observed in pericardial fluid glucose level between the malignancy and non-malignancy groups (pericardial fluid glucose: 78.24 ± 48.29 mg/dl vs 98.41 ± 44.85, respectively; p = 0.048). Moreover, CT attenuation values (Hounsfield units (HU)) tended to be higher in the malignancy group vs the non-malignancy group (22.7 [interquartile range (IQR), 17.4–26.0] vs 17.4 [IQR, 13.7–26.4], respectively; p = 0.08). The sensitivity and specificity of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 40.9% and 89.6%, respectively, in the malignancy group. The positive- and negative predictive values of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 85.7% and 50.0%, respectively, in the malignancy group. Pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were cutoff values associated with malignancy (p = 0.012). Conclusions Lower pericardial fluid glucose level with higher CT attenuation values may suggest malignancy-related PE.

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