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Introduction: Acute kidney injury (AKI) is prevalent in the coronavirus disease-2019 (COVID-19). There are little data on the relationship between renal dysfunction and COVID-19 prognosis. Objectives: The aim of this research was to investigate the effects of AKI in COVID-19 patients hospitalized to the Golestan and Razi hospitals in Ahvaz, Iran. Patients and Methods: In this retrospective cohort study, a total of 194 COVID-19 patients were included, consisting of 79 patients with AKI and 115 patients without AKI. Primary and secondary outcomes were compared between the two groups. Results: According to the findings, mortality was significantly different between the two groups, and mortality was higher in the AKI group (P < 0.001). The mean length of hospital stay was statistically significantly higher in the AKI group (P = 0.024). Moreover, there was a significant correlation between intensive care unit (ICU) admission and the study group (P < 0.001). Staging of AKI group were seen as;stage I (49.37%), stage II (36.71%), and stage III (13.92%). No significant correlation was observed between outcome and the stages of AKI (P = 0.496). Furthermore, 14 patients (17.72%) needed renal replacement therapy (RRT) in the AKI group. Conclusion: Although AKI is a common finding in COVID-19 patients, most patients were in stage I disease, which returned to normal after COVID-19 treatment. According to our research, COVID-19 rarely leads to serious and persistent kidney injury. However, the risk of death is increased in COVID-19 patients with AKI. Therefore, it is necessary to evaluate the renal function tests during the course of disease. [ FROM AUTHOR]
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Radiation therapy has an increasing role in the management of patients with metastatic cancer. The integration of ablative versus palliative techniques with surgical and systemic approaches is complex, and inefficient care delivery can lead to prolonged hospitalizations that are inconsistent with palliative goals. A dedicated Inpatient Radiation Oncology Consult (IROC) service was created to provide rapid access to palliative radiotherapy. We previously reported the short-term impact of the IROC service in reducing hospital length of stay (LOS), and here we provide an update on long-term improvements in patient care, focusing on quality-of-care metrics including hospital LOS, use of hypofractionated approaches, and prognosis-appropriate care. We retrospectively compared inpatient radiation oncology consults placed in the 12 months preceding IROC (N = 1,507) to those placed during a 12-month period after IROC implementation (N = 1,509). The dates for calendar-matched cohorts were selected to minimize potential confounding from practice changes related to the first peak of the COVID-19 pandemic. We analyzed continuous variables using the Mann-Whitney test and categorical variables using the Fisher's exact test. The IROC service was associated with reduced hospital length of stay for all consults (mean difference 1.0 day, P = 0.045). IROC led to shorter inpatient radiotherapy courses (mean 5.8 vs. 5.0 days, P = 0.007, and this reduction was greatest for patients discharged to hospice (mean 5.2 vs. 3.7 days, P = 0.033). Compared to pre-IROC patients, IROC patients were more likely to receive hypofractionated treatment (≤ 5 fractions;pre-IROC, N = 405/551 (74%) vs. IROC, N = 433/528 (82%), P = 0.001). Notably, the trend toward fewer prescribed fractions was not due to increased uptake of inpatient stereotactic regimens (N = 84/551 (15%) vs. N = 87/528 (16%), pre-IROC vs. IROC, respectively, P = 0.560). Death within 60 days of inpatient radiation therapy decreased under IROC (pre-IROC, N = 227/551 (41%) vs. IROC, N = 184/528 (35%), P = 0.033). A dedicated inpatient radiation oncology consult (IROC) service was associated with long-term reductions in hospital length of stay. Prognosis-appropriate care was improved through shorter treatment courses and decreased delivery of radiation to patients discharged to hospice or with limited survival. Our findings demonstrate the value of a dedicated program addressing the appropriate delivery of radiotherapy to hospitalized patients and highlight opportunities to stratify patients appropriate for ablative versus palliative treatments. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Objectives: On March 2020, the WHO declared coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is associated with various clinical syndromes, with electrolytes imbalances involved. This review aims to quantify the prevalence and outcomes of hyponatremia among COVID-19 patients, as well as to review the underlying pathophysiological mechanisms of hyponatremia among these patients. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines, we conducted a systematic literature search using the electronic databases of Google Scholar, MEDLINE (PubMed), WHO Virtual Health Library, and ScienceDirect, without limitations regarding gender, geographical area, race or publication date, up until December 13, 2021. Primary outcomes measured were mortality, intensive care unit (ICU) admission, assisted ventilation need, and length of hospital stay (LOS). Secondary outcome was the mechanism underlying hyponatremia among COVID-19 patients. Results: From a total of 52 included studies, 23 underwent quantitative analysis. For the primary outcomes;proportions, odds ratios (OR), and standardized mean difference (SMD) were calculated using random effects model. The prevalence of hyponatremia was found to be 25.8%. Hyponatremia was found to be significantly associated with increased odds for mortality (OR = 1.97[95% CI, 1.50–2.59]), ICU admission (OR = 1.91 [95% CI, 1.56–2.35]), assisted ventilation need (OR = 2.04 [95% CI, 1.73– 2.38]), and with increased LOS (SMD of 5.74 h [95% CI, 0.092–0.385]). Regarding the mechanisms underlying hyponatremia, syndrome of inappropriate anti-diuretic hormone secretion (SIADH) was most commonly reported, followed by adrenal insufficiency, and finally hypovolemic hyponatremia due to gastrointestinal losses. Conclusion: Hyponatremia among COVID-19 patients is generally associated with poor outcomes, with SIADH being the most common underlying mechanism. [ FROM AUTHOR] Copyright of Journal of Health Sciences (Qassim University) is the property of Journal of Health Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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BACKGROUND Ambulatory Emergency Care is a novel healthcare paradigm that has not yet been adopted locally. The aim of this study was to determine how many patients admitted to medical wards in Mater Dei Hospital between January 2020 and December 2020 could have been managed in an ambulatory setting. METHODS We determined which patients had a length of stay of less than 24 hours as well as calculated the Amb score for each patient, postulating these two criteria as effective markers of patients that could be selected for ambulatory management. With the unfolding of the COVID-19 worldwide pandemic, data collection stopped in March 2020. A total of 54 patients were randomly sampled from post-take medical ward rounds and data pertaining to their medical admission was recorded. RESULTS 20.37% of patients had a length of stay of less than 24 hours whilst 44.4% of patients had an Amb score of 5 or more. 18.5% of patients were found to have an Amb score of 5 or more AND a length of stay of less than 24 hours. A moderate negative correlation (rs = -0.66) between a high Amb Score and a short length of stay was demonstrated. Lower respiratory tract infection and Chest pain were the two commonest provisional diagnoses making up 37.0% of all admissions. Conclusions One in every 4.6 patients could benefit from ambulatory emergency management. We hypothesize that such a service would help reduce pressures on the current local healthcare system, improving emergency department throughput and patient satisfaction. [ FROM AUTHOR] Copyright of Malta Medical Journal is the property of University of Malta, Faculty of Medicine & Surgery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Objective: To report the early experience, the relationship of surgical site infection after pelvi-acetabular fracture fixation with certain possible risk factors, and organizational protocol for emergency pelvic surgery currently being used during the COVID-19 pandemic by an integrated team of orthopedic surgeons. Study Design: Prospective study. Setting: Department of Orthopedic and Spine Surgery, "Ghurki Trust Teaching Hospital Lahore, Pakistan. Period: March 2020, to August 2020. Material & Methods: A total of 25 patients diagnosed with acetabular fractures were included. Fracture patterns were classified according to judet and letournel and young burgess classification systems. Factors studied included patient's age, gender, body mass index, fracture pattern, type of surgery, comorbidities, smoking status, associated injuries, surgical site infections and mortality. Results: In a total of 25 patients, 21(84.0%) were male and 4(16.0%) female patients with overall mean age as 38.04±14.58 years. Overall, mean BMI was 23.20±2.60 kg/m2. There were 12(48.0%) patiens who had hypertension while 4 (16.0%) smokers. There were 21 (84.0%) patients who did not have any associated injuries while 3 (12.0%) had the associated extremities. The mean hospital stay of the patients was 5.08±0.76 days. The results revealed no significant association of Gender with these parameters (p > 0.001). Conclusion: There is no added risk of infection and mortality for the provision of emergency trauma services to pelvi-acetabular fractured patients even during panic and pandemic situations. [ FROM AUTHOR] Copyright of Professional Medical Journal is the property of Professional Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Demographics, hospital stay data, and overall outcomes were then reviewed and compared with patients who acquired COVID-19 from the community. The relative uniformity in demographics suggests that all patients admitted to the hospital setting are at risk of infection with COVID-19. Yet little is known about the true incidence of hospital-acquired COVID-19 (HAC), as well as the magnitude of its effect on clinical outcomes. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Duration of mechanical intubation (14.7 vs. 18.5 d, p = 0.078), ICU length of stay (16.4 vs. 21.3 d, p = 0.033), and hospital length of stay (22.5 vs 27.8 d, p = 0.039) were all shorter in the ED-intubated population. B Introduction: b Patients receiving mechanical ventilation frequently require sedation and analgesia within the emergency department (ED) and intensive care unit (ICU) to appropriately control pain and agitation. B Conclusions: b Time to analgesia post-intubation in COVID-19 patients was shorter in patients intubated in the ICU versus the ED, and this finding is similar to previously published data in non-COVID-19 populations. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Objective: SARS-CoV-2 is a probable causative agent of severe disease both in children and adults. In this study, we aimed to evaluate the management of hospitalized severe pediatric COVID-19 patients. Methods: Data on the management of 21 children under the age of 18 who were hospitalized with severe COVID-19 between March 2020 and May 2020 were included in this study. Results: A total of 1109 patients, including 888 outpatients and 221 inpatients, were included in this study. 91 (41.1%) of the 221 hospitalized children were PCR positive for SARS-CoV-2. 21 (23%) of 91 COVID-19 patients were considered severe COVID-19. 10 (47.6%) were females and 11 (52.4%) were males, with a mean±standard deviation (SD) age of 14.4±2.7 years (range;9 years-17.6 years). The most prevalent symptoms at admission were fever (80.9%), cough (76.1%), shortness of breath (23.8%) and myalgia (23.8%). 4 (19%) of 21 patients had underlying diseases. 19 (90.4%) patients were in close contact with confirmed cases in the family. All patients had typical findings on lung computed tomography (CT) and the major CT abnormalities observed were ground-glass opacities. Two patients who needed respiratory support received favipiravir treatment. The mean hospital stay was 7.34±2.65 (5-16) days. Clinical improvement was achieved in all patients. Conclusion: The clinical course of COVID-19 in children is milder and has a better prognosis than adults, but it should be kept in mind that severe cases are defined in the pediatric patient group and these patients should be followed closely. (English) [ FROM AUTHOR] Amaç: SARS-CoV-2, hem çocuklarda hem de yetişkinlerde ciddi hastalığın olası bir etkenidir. Bu çalışmada, hastanede yatan ağır çocuk COVID-19 hastalarının yönetimini değerlendirmeyi amaçladık. Gereç ve Yöntem: Mart 2020 ile Mayıs 2020 tarihleri arasında 18 yaş altı ağır COVID-19'lu hastanede yatan 21 çocuğun yönetimine ilişkin veriler bu çalışmaya dahil edildi. Bulgular: Bu çalışmada 888 ayaktan ve 221 yatan hasta olmak üzere toplam 1109 hasta toplandı. Hastanede yatan 221 çocuğun 91'i (%41.1) SARS-CoV-2 için PCR pozitifti. Doksan bir COVID-19 hastasının 21'i (%23) şiddetli COVID-19 olarak kabul edildi. Onu (%47.6) kız, 11'i (%52.4) erkek olup, yaşları ortalama±standart sapma (SS) 14.4±2.7 yıl (aralık;9 yıl-17.6 yıl) olarak saptandı. En sık başvuru semptomları ateş (%80.9), öksürük (%76.1), nefes darlığı (%23.8) ve miyalji (%23.8) idi. Yirmi bir hastanın dördünde (%19) altta yatan hastalık vardı. On dokuz (%90.4) hasta ailede doğrulanmış olgularla yakın temas halindeydi. Tüm hastalarda tipik olarak akciğer bilgisayarlı tomografi (BT) bulguları vardı ve başlıca gözlenen BT anormallikleri buzlu cam opasiteleriydi. Solunum desteğine ihtiyaç duyan iki hasta favipiravir tedavisi aldı. Ortalama hastanede kalış süresi 7.34±2.65 (5-16) gündü. Tüm hastalarda klinik iyileşme sağlandı. Sonuç: Çocuklarda COVID-19'un yetişkinlere göre klinik seyri daha hafiftir ve daha iyi prognozu vardır ancak çocuk hasta grubunda ciddi olgular tanımlandığı ve bu hastaların yakından takip edilmesi gerektiği akılda tutulmalıdır. (Turkish) [ FROM AUTHOR] Copyright of Southern Clinics of Istanbul Eurasia is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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B Introduction: b Adult racial and ethnic minorities in the U.S. with COVID-19 are known to have worse outcomes. We used multivariable logistic and linear regression analysis to examine associations between race and ethnicity and critical illness, hospital and ICU length of stay and hospital mortality. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
BACKGROUND: There is no identified pharmacological therapy for COVID-19 patients, where potential therapeutic strategies are underway to determine effective therapy under such unprecedented pandemic. Therefore, combination therapies may have the potential of alleviating the patient's outcome. This study aimed at comparing the efficacy of two different combination regimens in improving outcomes of patients infected by novel coronavirus (COVID-19). METHODS: This is a single centered, retrospective, observational study of 60 laboratory-confirmed COVID-19 positive inpatients (≥18 years old) at two wards of the Baqiyatallah Hospital, Tehran, Iran. Patient's data including clinical and laboratory parameters were recorded. According to the drug regimen, the patients were divided into two groups; group I who received regimen I consisting azithromycin, prednisolone, naproxen, and lopinavir/ritonavir and group II who received regimen II including meropenem, levofloxacin, vancomycin, hydroxychloroquine, and oseltamivir. RESULTS: The oxygen saturation (SpO2) and temperature were positively changed in patients receiving regimen I compared to regimen II (P = 0.013 and P = 0.012, respectively). The serum level of C-reactive protein (CRP) changed positively in group I (P < 0.001). Although there was a significant difference in platelets between both groups (75.44 vs 51.62, P < 0.001), their change did not clinically differ between two groups. The findings indicated a significant difference of the average length of stay in hospitals (ALOS) between two groups, where the patients under regimen I showed a shorter ALOS (6.97 vs 9.93, P = 0.001). CONCLUSION: This study revealed the beneficial effect of the short-term use of low-dose prednisolone in combination with azithromycin, naproxen and lopinavir/ritonavir (regimen I), in decreasing ALOS compared to regimen II. Since there is still lack of evidence for safety of this regimen, further investigation in our ongoing follow-up to deal with COVID-19 pneumonia is underway. Graphical abstract.