Navigating the waves in Colombia: a cohort study of inpatient care during four COVID-19 waves

ABSTRACT Introduction: Understanding the intricate dynamics between different waves of the COVID-19 pandemic and the corresponding variations in clinical outcomes is essential for informed public health decision-making. Comprehensive insights into these fluctuations can guide resource allocation, healthcare policies, and the development of effective interventions. This study aimed to compare the characteristics and clinical outcomes of COVID-19 at peak transmission points by including all patients attended during the first four pandemic waves in a referral center in Colombia. Material and methods: In a prospective observational study of 2733 patients, clinical and demographic data were extracted from the Fundacion Valle de Lili's COVID-19 Registry, focusing on ICU admission, Invasive Mechanical Ventilation (IMV), length of hospital stay, and mortality. Results: Our analysis unveiled substantial shifts in patient care patterns. Notably, the proportion of patients receiving glucocorticoid therapy and experiencing secondary infections exhibited a pronounced decrease across waves (p < 0.001). Remarkably, there was a significant reduction in ICU admissions (62.83% vs. 51.23% vs. 58.23% vs. 46.70 %, p < 0.001), Invasive Mechanical Ventilation (IMV) usage (39.25% vs. 32.22% vs. 31.22% vs. 21.55 %, p < 0.001), and Length of Hospital Stay (LOS) (9 vs. 8 vs. 8 vs. 8 days, p < 0.001) over the successive waves. Surprisingly, hospital mortality remained stable at approximately 18-20 % (p > 0.05). Notably, vaccination coverage with one or more doses surged from 0 % during the initial waves to 66.71 % in the fourth wave. Conclusions: Our findings emphasize the critical importance of adapting healthcare strategies to the evolving dynamics of the pandemic. The reduction in ICU admissions, IMV utilization, and LOS, coupled with the rise in vaccination rates, underscores the adaptability of healthcare systems. Hospital mortality's persistence may warrant further exploration of treatment strategies. These insights can inform public health responses, helping policymakers allocate resources effectively and tailor interventions to specific phases of the pandemic.

Clinical presentations among adult patients with tuberculous meningitis

Background: Bangladesh is a country with a high burden of pulmonary as well as extrapulmonary tuberculosis. TBM is a particularly important public health issue in our country. Identifying prognostic predictors would improve the quality of management and ultimately will prevent long-term mortality and morbidity. The aim of the study was to observe and identify the most common clinical presentations among patients with tuberculous meningitis. Methods: This hospital-based prospective cohort study was carried out at the in-patient Department of Clinical Neurology at the National Institute of Neurosciences and Hospital (NINS and H), Dhaka, Bangladesh from October 2016 to September 2017, 1 year. A total of 54 patients admitted to the hospital with features of tuberculous meningitis (TBM) were selected for the study following inclusion and exclusion criteria. Results: Over 70% of patients were adolescents or young adults with a mean age of 28.2±12.3 years. The majority (48.2%) of the participants were from TBM stage II, while 37% were from stage III of TBM. Fever, headache, and systematic symptoms were the most frequent clinical presentations. The median delay in treatment was 30 days. Interruption in anti-TB treatment was reported in 3 (9.3%) cases. Conclusions: The study found that among possible TBM cases, the most frequent clinical features were fever, headache, and systematic symptoms. Focal neurological deficit and cerebral nerve palsy also had a high prevalence among the participants. The majority of the participants were young adults and female prevalence was high in the present study. The majority were from stage II TB among the study participants.

Clinical presentations among adult patients with tuberculous meningitis

Background: Bangladesh is a country with a high burden of pulmonary as well as extrapulmonary tuberculosis. TBM is a particularly important public health issue in our country. Identifying prognostic predictors would improve the quality of management and ultimately will prevent long-term mortality and morbidity. The aim of the study was to observe and identify the most common clinical presentations among patients with tuberculous meningitis. Methods: This hospital-based prospective cohort study was carried out at the in-patient Department of Clinical Neurology at the National Institute of Neurosciences and Hospital (NINS and H), Dhaka, Bangladesh from October 2016 to September 2017, 1 year. A total of 54 patients admitted to the hospital with features of tuberculous meningitis (TBM) were selected for the study following inclusion and exclusion criteria. Results: Over 70% of patients were adolescents or young adults with a mean age of 28.2±12.3 years. The majority (48.2%) of the participants were from TBM stage II, while 37% were from stage III of TBM. Fever, headache, and systematic symptoms were the most frequent clinical presentations. The median delay in treatment was 30 days. Interruption in anti-TB treatment was reported in 3 (9.3%) cases. Conclusions: The study found that among possible TBM cases, the most frequent clinical features were fever, headache, and systematic symptoms. Focal neurological deficit and cerebral nerve palsy also had a high prevalence among the participants. The majority of the participants were young adults and female prevalence was high in the present study. The majority were from stage II TB among the study participants.

Study of clinical presentations of lung cancer in tertiary level hospital

Background: Lung cancer is the most common cancer diagnosed worldwide. It is also the leading contributor to cancer-related mortality, resulting in around 1.38 million cancer deaths per year worldwide. The aim and objective of the study was to study the clinical presentations including paraneoplastic manifestations and metastatic effects of lung cancer and to identify reasons for delay in diagnosis of lung cancer. Methods:Hospital based observational study was conducted on 100 consecutive cases. Results: Mean age ofthe cases with lung cancer was 56.36 years and 30% of the cases. Male predominance was seen with 63% males to 37% females. Tobacco smoking was present in 59% cases while exposure to second hand smoke and biomass fuel was seen in 11% and 9% patients. Most common presenting symptoms were cough (22.21%), chest pain (16.13%), fever (14.37%), dyspnea (11%) and hemoptysis (5.22%). Most common type of lung tumor was Adenocarcinoma (53%) followed by Small cell carcinoma (22%) and Squamous cell carcinoma (19%). Mutation analysis by molecular testing where possible in 76.66% NSCLC cases and showed with RAS (26.19%), EGFR (23.8%), ALK1 (11.9%) and ROS (4.7%) mutation. Stage I and II of lung cancer was seen in 17% cases while stage III and IV was seen in 39% and 44% cases respectively. Conclusions:Present study shown tobacco smoking as the most common risk factor in the causation of lung cancer (59%) followed by passive smoking (11%) and biomass fuel exposure (9%). Mortality in the present study was 72% in 2 years of follow up and Median survival in the study was 11 months. We recommend high index of suspicion in the high-riskgroups as smokers and those with chronic respiratory diseases to avoid delay in diagnosis.

Clinical and epidemiological characteristics of patients with suspected primary immunodeficiency disorders attending Alexandria University Children's Hospital

Background: Current study was conducted to determine the clinical and epidemiological characteristics of patients with suspected primary immunodeficiencies (PID) seen at Alexandria University Children's Hospital.Methods: Eighty one patients with suspected PID were seen at Alexandria University Children's Hospital in one year in the period from September 2016 to October 2017. Demographic data of the patients as well as data related to their disease status were taken and evaluation sheet was developed for all patients.Results: About 61.7% of patients satisfied the criteria of PID based on WHO Scientific Committee. According to modified IUIS classification predominant antibody deficiency was the commonest (34%) followed by other well defined immunodeficiency syndromes (30%), combined immunodeficiencies (16%), phagocytic defects (14%), diseases of immune dysregulation 4% and complement deficiencies (2%). The most frequent disorder was X-linked agammagloulinemia (XLA) (22%). The mean age at diagnosis was 27.4 months. The consanguinity rate was 55.5%. A positive Family history was a strong pointer to diagnosis for PID (46.9%). The commonest clinical presentation was pneumonia (82.7%). 28.4% of patients died from infections. As observed in other patient registries, diagnostic delay remains the major cause of morbidity and mortality.Conclusions: Primary immunodeficiency disorders are not rare in Egyptian children. Creating awareness of PID should be targeted at hospital pediatricians and families with history of PID and this may reveal more cases within the community. The observed high frequency of combined T- and B-cell immunodeficiencies in this cohort made it a health issue in Egypt as in other developing countries.

Progress in the study for immune escape-related mutation in the S region of hepatitis B virus / 解放军医学杂志

Hepatitis B virus (HBV) infection could lead to different clinical presentations and disease progresses, including acute and chronic hepatitis B, liver cirrhosis, hepatocellular carcinoma, and occult HBV infection, in which the interaction between virus and host plays an important role. Because HBV reverse transcriptase is lack of correction function, HBV is prone to generate mutations under the pressure of host immune response and antiviral drug treatment. Some mutations in the HBV S gene-encoding region can significantly attenuate antibody immune response against HBV and therefore affect clinical presentations and disease progression. Such mutations are termed immune escape-related mutations. In this paper, we mainly review the structure and functional characteristics of HBV S gene, the causes and forms of the immune escape-related mutation, its influence on clinical presentations and antiviral treatment response, as well as clinical detection methods.

Etiological Factors, Clinical Presentations And Treatment Outcome Of Cervical Lymphadenopathy: An Observational Descriptive Study

Aim: To study various etiological factors, clinical presentations of cervical lymphadenopathy. To study the manage-ment and outcome of cervical lymphadenopathy Method:Proper clinical history was first noted, local and systemic examination was performed and a clinical diagnosis was made. Gender wise distribution, presenting symptoms, site distribution, and treatment outcome were noted. Result:Gender wise distribution of male and female was 52%, and 48%, commonest site of primary in cases of metastatic Secondaries was tongue followed by oesophagus and thyroid. After proper diagnosis confirmed by Histopathology (biopsy), treatment constituted properly-Cases of Tubercular Lymphadenitis (49 cases) were Started on Anti-tubercular treatment, all were showed improvement in symptoms. Cases of Reactive lymphadenitis (26 cases) started on antibiotics, all recovered well. Among 14 Cases of Metastatic secondaries, 5 cases were given Chemotherapy/Radiotherapy after expert oncologist opinion out of which 3 showed improved symptoms and 2 were expired, 6 cases were operated out of which 5 showed improved symptoms and 1 expired post operatively, 3 cases were referred to specialized oncological and oncosurgical center for further man-agement. All 6 Lymphoma cases were started on chemotherapy after expert oncologist opinion showed improve-ment in symptoms. Conclusion:Commonest site of primary in cases of metastatic Secondaries was tongue followed by oesophagus and thyroid. Anti-tubercular treatment for tubercular lymphadenitis was highly satisfactory with im-provement in almost all patients. Surgery was restricted as an adjuvant to chemotherapy, as diagnostic biopsy, for treatment of abscess/sinuses and for a lymph nodes that do not resolve with chemotherapy. Non-tuberculous non-neoplastic lesions can be best managed by conservatively.

"Saber hacer con" Efectos de un goce de época / "Know how to do with" Effects of a vintage enjoyment

Este artículo se organiza en torno a dos ejes principales: la época actual desde una mirada psicoanalítica y los efectos que ésta conlleva en la clínica contemporánea. No se puede aislar al sujeto y sus síntomas/ fenómenos del devenir de nuestras sociedades. A nivel general, el mundo actual ha puesto de relieve un amplio campo de patologías y presentaciones clínicas: cortes en el cuerpo, fanatismos, comunidades que se congregan en las redes sociales incitando a manifestaciones de violencia y autocastigo (la ballena azul), el aumento creciente de la obesidad en la población mundial, la multiplicación de conductas compulsivas en el marco del empuje al goce sin medidas, el recrudecimiento de los fenómenos de discriminación y segregación (bullying, restricciones inmigratorias, racismo). Incluso, se constata que la clínica de la psicosis también se ha visto modificada desde su presentación sintomática hasta los posibles modos de estabilización. A nivel particular, en lo que respecta a la población que es asistida en hospitales públicos, advertimos también que el contexto cultural, social y económico condicionan las presentaciones clínicas y la orientación del tratamiento, o mejor llamado desde el discurso psicoanalítico, la dirección de la cura. Asimismo, resulta fundamental mencionar que la experiencia analítica, más allá de tener presente el contexto del paciente, trabaja siempre desde la singularidad de cada caso y las soluciones que cada sujeto arma para hacer frente a su malestar. Es nuestra intención abordar dichas problemáticas a la luz de una mirada clínica.

This article is organized around two main axis: the present time from a psychoanalytic point of view and the effects that this entails in the contemporary clinic. We cannot isolate the subject and its symptoms / phenomena from our societies. Today's world has highlighted a wide range of pathologies and clinical presentations: cuts in the body, fanaticism, communities that congregate in social networks inciting violence and self-punishment (the blue whale), the increasing number of obesity in the world population, the multiplication of compulsive behaviors within the framework of the enjoyment without measures, the intensification of the phenomena of discrimination and segregation (bullying, immigration restrictions, racism) are some of the many manifestations which are currently observed. In addition, we observe that clinical psychosis has also been modified in present time from its symptomatic presentation to possible modes of stabilization. In particular, regarding population assisted in public hospitals, we also notice that the cultural, social and economic context conditions clinical presentations and orientation of treatments and the direction of the cure. It is also important to mention that analytical experience, beyond having in mind the context of the patient, always works from the singularity of each case and the solutions that each one builds to deal with their discomfort. It is our intention to face these issues in light of a clinical view.

Este artigo está organizado em dois eixos principais: a época atual desde um olhar psicanalítico e os efeitos deste na clínica contemporânea. O sujeito e seus sintomas / fenômenos/ não se pode isolar do decorrer de nossas sociedades. Em termos gerais, pode-se dizer que o mundo atual salientou um amplo campo de patologias e apresentações clínicas: cortes no corpo, fanatismos, comunidades que se juntam nas redes sociais incitando a manifestações de violência e auto punição (a baleia azul), o acréscimo da obesidade na população mundial e de condutas compulsivas no entorno que impulsiona o gozo sem medida, bem como o reaparecimento dos fenômenos de discriminação e segregação (bullying, restrições imigratórias, racismo). Verifica-se, até, que a clínica da psicose também tem sido alterada em sua apresentação o sintomática e nos possíveis modos de estabilização. No particular, relativo à população que é assistida nos hospitais públicos, revela-se também que o contexto cultural, social e econômico condicionam as apresentações clínicas e a orientação do tratamento, ou de acordo com o discurso psicanalítico, a direção da cura. De igual maneira, é fundamental mencionar q a experiência psicanalítica além de considerar o contexto do paciente, trabalha sempre desde a singularidade de cada caso e das soluções que cada sujeito cria para enfrentarse com seu mal-estar. Nosso intuito é abordar tal problemática à luz de um olhar clínico.

Determinants of Primary Pyomyositis in Northern Uganda.

Aim: To describe the determinants of primary pyomyositis in Northern Uganda. Study Design and Setting: A case-control and a cohort study designs were conducted in Hospitals in Northern Uganda. Methods: Primary pyomyositis patients were consecutively recruited and followed to discharge. Controls had minor trauma and were age and sex matched with cases. Patients were admitted, investigated (clinical features, imaging, hematology, clinical chemistry and histology from muscle biopsy); managed surgically and followed up to discharge. Those that did not meet the inclusion criteria for diagnosis histologically were excluded. Ethical approval was obtained from Gulu University IRB. Results: The determinants of primary pyomyositis were: HIV positivity with low CD4 counts (<250 cells/ml) (χ2=11.748; p<0.001; aOR 11.292 at 95% CI (0.698,182.707) (p=0.088)); clinical features of immunosuppression/AIDS (χ2=12.70; p<0.001; aOR 6.50 at 95% CI (0.000,2.500) (p=0.850)); High serum creatinine level (χ2=20.191; p<0.001; aOR 6.070 at 95% CI (0.289,127.545) (p=0.317)) and Low serum albumin (malnutrition) (χ2=103.247; p<0.001; aOR 226.004 at 95% CI (13.449, 3797.786) (p<0.001)). Conclusion: The determinant of primary pyomyositis was low serum albumin (malnutrition) while clinical features of immunosuppression/AIDS, high serum creatinine level and HIV positivity with low CD4 counts were risk factors but not independent predictors of this disease.

Avaliação de fatores epidemiológicos, micológicos, clínicos e terapêuticos associados à esporotricose / Evaluation of epidemiological, mycological, clinical and therapeutic factors associated with sporotrichosis

Esporotricose é uma micose subcutânea causada pelo fungo dimórfico previamente descrito como uma única espécie, Sporothrix schenckii, agora entendido como um complexo de diferentes espécies de interesse clínico. A região metropolitana do Rio de Janeiro constitui área hiperendêmica de esporotricose zoonótica transmitida por gatos desde 1998. Clinicamente tem se caracterizado por formas clínicas pouco usuais, manifestações de hipersensibilidade e um número crescente de pacientes coinfectados com HIV. Este estudo teve como objetivo avaliar fatores epidemiológicos, micológicos, clínicos e terapêuticos associados às diversas formas clínicas de pacientes com esporotricose. Foram utilizados o banco hospitalar de registros de pacientes e o banco de cepas do laboratório de micologia do Instituto de Pesquisa Clínica Evandro Chagas (IPEC), bem como técnicas de identificação genotípica e laboratoriais clássicas para determinação de virulência e fenótipo dos isolados fúngicos. Foi verificado que a dacriocistite aguda (quatro casos entre 2008 e 2010) é uma manifestação da esporotricose que evolui com complicações (fístula e dacriocistite crônica) necessitando reparação cirúrgica. A Síndrome de Sweet foi observada em três pacientes até 2010 e deve ser incorporada como manifestação de hipersensibilidade da esporotricose...

Sporotrichosis is a subcutaneous mycosis caused by the dimorphic fungus previously described as a single species, Sporothrix schenckii, now understood as a complex of different species of clinical interest. The metropolitan region of Rio de Janeiro is an endemic area of zoonotic sporotrichosis transmitted by cats since 1998. Clinically, it has been characterized by unusual clinical presentations, manifestations of hypersensitivity and an increasing number of patients coinfected with HIV. This study aimed to evaluate epidemiological, mycological, clinical and therapeutic factors associated with different clinical aspects of patients with sporotrichosis. The hospital database of patient records and the stock strains of the laboratory of mycology of Instituto de Pesquisa Clínica Evandro Chagas (IPEC) were used, as well as techniques for genotypic identification and classical laboratory tools for determination of virulence and phenotype of the fungal isolates. It was found that acute dacryocystitis (4 cases between 2008 and 2010) is a manifestation of sporotrichosis which evolves with complications (fistula and chronic dacryocystitis) requiring surgical repair. Sweet syndrome was observed in three patients until 2010 and should be incorporated as a manifestation of hypersensitivity of sporotrichosis...

Leprosy neuropathy: clinical presentations / Neuropatia da lepra: apresentacoes clinicas

Leprosy is a chronic infectious peripheral neuropathy caused by Mycobacterium leprae. The different clinical presentations of the disease are determined by the quality of the host immune response. Early detection of leprosy and treatment by multidrug therapy are the most important steps in preventing deformity and disability. Thus the early recognition of the clinical leprosy presentation is essential. Mononeuritis, mononeuritis multiplex (MM), polyneuritis (MM summation) are the most frequent. The frequent anesthetic skin lesions are absent in the pure neuritic leprosy presentation form. Isolated peripheral nerve involvement is common, including the cranial ones. Arthritic presentation is occasionally seen, usually misdiagnosed as rheumatoid arthritis. Attention should be given to autonomic dysfunctions in leprosy. There are clinical presentations with severe neuropathic pain - painful small-fiber neuropathy. Leprous late-onset neuropathy (LLON) clinical presentation should be considered facing a patient who develop an inflammatory neuropathy many years after a previous skin leprosy treatment.

A hanseníase é uma neuropatia periférica infecciosa, crônica, causada pelo Mycobacterium leprae. As diferentes apresentações clínicas são determinadas pela qualidade da resposta imune do hospedeiro. O diagnóstico precoce e a multi-droga terapia são os passos mais importantes na prevenção de deformidades e incapacidades. Dessa forma, o reconhecimento precoce da apresentação clínica da hanseníase é essencial. Mononeurites, mononeurites múltipla (MM), polineurite (superposição de MM) são as mais frequentes. As frequentes lesões anestésicas de pele estão ausentes na forma neurítica pura. Comprometimento de nervo isolado é comum, inclusive os cranianos. Apresentação com artrite é ocasionalmente vista, erroneamente diagnosticada como artrite reumatóide. Atenção deve ser dada às disfunções autonômicas na hanseníase. Há apresentações clínicas com dor neuropática grave - neuropatia dolorosa de pequenas fibras. Neuropatia de início tardio (LLON) é apresentação clínica que deve ser considerada frente a paciente que desenvolve neuropatia inflamatória muitos anos depois de tratamento prévio da lepra cutânea.

Paracoccidioidomicosis crónica: reporte de un caso / Chronic paracoccidioidomycosis: a case report

El pulmón es el órgano frecuentemente más afectado por paracoccidioidomicosis, con manifestaciones clínicas y radiológicas similares a otras patologías.Presentamos el caso: agricultor de 58 años, con síntomas de tos, expectoraciónhemoptoica, fiebre, pérdida de peso y astenia. El diagnóstico fue confirmado con directo de lavado broncoalveolar y serología. El paciente fue tratado con itraconazol durante 6 meses con seguimiento clínico, radiológico e inmunodifusion.

The lung is the organ but frequently affected by Paracoccidioidomycosis, with similar clinical and radiological manifestations to other pathologies. We present the case, 58 year-old farmer, with symptoms of cough, blood-tinged sputum, fever, lost of weight and fatigue. The diagnoses it was confirmed with direct of having washed broncoalveolar, serología. The patient was treated with itraconazol during6 months with clinical, radiological pursuit and inmunodiffusion.

Clinical analysis of ovarian pregnancy / 대한주산의학회잡지

OBJECTIVE: To evaluate the early diagnostic key of ovarian pregnancy. METHODS: A Retrospective case study of 31 cases of ovarian pregnancies treated between 1990 and 2007 at Kangnam St. Mary's hospital Catholic University of Korea was performed. The maternal age, obstetric history, clinical symptoms, sonographic findings, preceding factors, diagnostic modalities, and surgical treatment methods were investigated. RESULT: 31 ovarian pregnancies, diagnosed between 1990 and 2007, comprised (31/1176) 2.6% of all ectopic pregnancies. The most common sonographic finding was fluid collection surrounding the ovary and an ipsilateral enlarged ovary (83.9%). Presenting symptoms were similar to those of tubal pregnancies. Before 1997, wedge resection was done mostly by laparotomy (15/16 cases, 93.8 %) and from then on by laparoscopy (8/14 cases, 57.1%). CONCLUSION: Ovarian pregnancy should be suspected in young woman with symptom of lower abdominal pain, history of pelvic adhesion and sonographic finding of fluid collection around ovary or enlarged ovary for an early diagnosis. Early diagnosis and management can preserve fertility and ovarian function.

Clinical Analysis of Syringomyelia

Eight patients were diagnosed as syringomyelia by MRI at the Department of Neurosurgery of Maryknoll hosptial, Pusan from April, 1990 to April, 1991. The causes were chiari type 1 malformation(2 cases), neoplasm(1 case), trauma(1 case) and idiopathic(4 cases). Six procedures were performed in the five patients. The procedures were foramen magmum decompression(1 case), formen magmum decompression combined syringosubarachnoid shunt(1 case), syringosubarachnoid(1 case), syringoperitioneal(2 cases) and syringopleural shunts(1 case). We have reviewed the modes of clinical presentations, diagnostic evaluations and surgical considerations.