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BACKGROUND: The coronavirus pandemic has had an extremely negative impact on the patients with diabetes mellitus (DM both in terms of a more severe course of COVID-19 and an increased risk of death. AIM: Analysis of risk factors for death due to COVID-19 in patients with DM type 1 and type 2 (DM1 and DM2). MATERIALS AND METHODS: Retrospective analysis of the database of the national diabetes register (NDR), which included DM patients with COVID-19 and reported virus infection outcome (recovery/or death) in 15 712 DM1 and 322 279 DM2 patients during a 2-year follow-up period (01/02/2020 to 03/04/2022) (discharge date)). RESULTS: Case fatality rate in patients with DM, who underwent COVID-19 was 17.1% (DM1-8.8%;DM2-17.5%). As a result of multivariate regression analysis of seven significant factors in DM1 and thirteen in DM2 (evaluated by univariate anlisys), a number of the most important predictors of risk for fatal outcome were identified: in DM1 these were age >= 65 years (OR =4.01, 95% CI: 1.42-11.36), presence of arterial hypertension (AH) (OR =2.72, 95% CI: 1.03-7.16) and diabetic foot syndrome (DFS) (OR = 7.22, 95% CI: 1.98-26.29);for T2DM: age >= 65 years (OR =2.53, 95% CI: 1.96-3.27), male (OR =1.51, 95% CI: 1.23-1.84), duration DM >= 10 years (OR =2.01, 95% CI: 1.61-2.51), BMI >= 30 kg/m2 (OR =1.26, 95% CI: 1.02-1.55), ASCVD/CKD (OR =1.49, 95% CI: 1.01-2.04), history of diabetic coma (OR =12.97, 95% CI: 1.89-88.99) and presence of disability ( OR =1.40, 95% CI: 1.14-1.73). In T2DM, the type of antidiabetic therapy (ADT) prior to COVID-19 (last visit before the development of infection) had a significant impact: Insulin therapy (OR = 1.64, 95% CI: 1.30-2.07), sulfonylureas (SU) (OR =1.51, 95% CI: 1.23-1.84));dipeptidyl peptidase-4 inhibitor (iDPP-4) therapy (OR =0.57, 95% CI: 0.39-0.83) and sodium- glucose cotransporter-2 inhibitor (iSGLT2) therapy (OR =0.64, 95% CI: 0.46-0.88). Vaccination was the most important protective factor in both types of DM: DM1 OR =0.19, 95% CI: 0.06-0.59;SD2 OR =0.20, 95% CI: 0.16-0.26. CONCLUSION: The common risk factor for fatal outcome in both DM1 and DM2 was age >= 65 years;in DM1 - history of hypertension and DFS, in DM2 - male sex, diabetes duration >= 10 years, BMI >= 30 kg/m2, history of ASCVD/CKD and diabetic coma, disability. In T2DM, significant differences in risk were observed depending on the type of ADT: insulin and SU therapy were factors that increased the risk of death, whereas therapy with iDPP-4 and iSGLT2 reduced the risk of death. Vaccination reduced the risk of death in DM1 and DM2 by 5.2 and 5-fold, respectively.
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BACKGROUND: The coronavirus pandemic has had an extremely negative impact on the patients with diabetes mellitus (DM both in terms of a more severe course of COVID -19 and an increased risk of death. AIM: Analysis of risk factors for death due to COVID -19 in patients with DM type 1 and type 2 (DM1 and DM2). MATERIALS AND METHODS: Retrospective analysis of the database of the national diabetes register (NDR), which included DM patients with COVID-19 and reported virus infection outcome (recovery/or death) in 15 712 DM1 and 322 279 DM2 patients during a 2-year follow-up period (01/02/2020 to 03/04/2022) (discharge date)). RESULT(S): Case fatality rate in patients with DM, who underwent COVID -19 was 17.1% (DM1-8.8%;DM2-17.5%). As a result of multivariate regression analysis of seven significant factors in DM1 and thirteen in DM2 (evaluated by univariate anlisys), a number of the most important predictors of risk for fatal outcome were identified: in DM1 these were age >=65 years (OR =4.01, 95% CI: 1.42-11.36), presence of arterial hypertension (AH) (OR =2.72, 95% CI: 1.03 -7.16) and diabetic foot syndrome (DFS) (OR = 7.22, 95% CI: 1.98-26.29);for T2DM: age >= 65 years (OR =2.53, 95% CI: 1.96-3.27), male (OR =1.51, 95% CI: 1.23-1.84), duration DM >=10 years (OR =2.01, 95% CI: 1.61-2.51), BMI >= 30 kg/m2 (OR =1.26, 95% CI: 1.02-1.55), ASCVD/CKD (OR =1.49, 95% CI: 1.01-2.04), history of diabetic coma (OR =12.97, 95% CI: 1.89-88.99) and presence of disability (OR =1.40, 95% CI: 1.14-1.73). In T2DM, the type of antidiabetic therapy (ADT) prior to COVID -19 (last visit before the development of infection) had a significant impact: Insulin therapy (OR = 1.64, 95% CI: 1.30-2.07), sulfonylureas (SU) (OR =1.51, 95% CI: 1.23-1.84));dipeptidyl peptidase-4 inhibitor (iDPP-4) therapy (OR =0.57, 95% CI: 0.39-0.83) and sodium-glucose cotransporter-2 inhibitor (iSGLT2) therapy (OR =0.64, 95% CI: 0.46-0.88). Vaccination was the most important protective factor in both types of DM: DM1 OR =0.19, 95% CI: 0.06-0.59;SD2 OR =0.20, 95% CI: 0.16-0.26. CONCLUSION(S): The common risk factor for fatal outcome in both DM1 and DM2 was age >=65 years;in DM1 - history of hypertension and DFS, in DM2 - male sex, diabetes duration >=10 years, BMI >=30 kg/m2, history of ASCVD/CKD and diabetic coma, disability. In T2DM, significant differences in risk were observed depending on the type of ADT: insulin and SU therapy were factors that increased the risk of death, whereas therapy with iDPP-4 and iSGLT2 reduced the risk of death. Vaccination reduced the risk of death in DM1 and DM2 by 5.2 and 5-fold, respectively.Copyright © Endocrinology Research Centre, 2022.
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BackgroundSince the announcement of COVID-19 as a pandemic infection, several studies have been performed to discuss the clinical picture, laboratory finding, and imaging features of this disease. The aim of this study is to demarcate the imaging features of novel coronavirus infected pneumonia (NCIP) in different age groups and outline the relation between radiological aspect, including CT severity, and clinical aspect, including age, oxygen saturation, and fatal outcome. We implemented a prospective observational study enrolled 299 laboratory-confirmed COVID-19 patients (169 males and 130 females;age range = 2–91 years;mean age = 38.4 ± 17.2). All patients were submitted to chest CT with multi-planar reconstruction. The imaging features of NCIP in different age groups were described. The relations between CT severity and age, oxygen saturation, and fatal outcome were evaluated.ResultsThe most predominant CT features were bilateral (75.4%), posterior (66.3%), pleural-based (93.5%), lower lobe involvement (89.8%), and ground-glass opacity (94.7%). ROC curve analysis revealed that the optimal cutoff age that was highly exposed to moderate and severe stages of NCIP was 38 years old (AUC = 0.77, p < 0.001). NCIP was noted in 42.6% below 40-year-old age group compared to 84% above 40-year-old age group. The CT severity was significantly related to age and fatal outcome (p < 0.001). Anterior, centrilobular, hilar, apical, and middle lobe involvements had a significant relation to below 90% oxygen saturation. A significant negative correlation was found between CT severity and oxygen saturation (r = − 0.49, p < 0.001). Crazy-paving pattern, anterior aspect, hilar, centrilobular involvement, and moderate and severe stages had a statistically significant relation to higher mortality.ConclusionThe current study confirmed the value of CT as a prognostic predictor in NCIP through demonstration of the strong relation between CT severity and age, oxygen saturation, and the fatal outcome. In the era of COVID-19 pandemic, this study is considered to be an extension to other studies discussing chest CT features of COVID-19 in different age groups with demarcation of the relation of chest CT severity to different pattern and distribution of NCIP, age, oxygen saturation, and mortality rate.
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BACKGROUND: Coronavirus Disease 2019 (COVID-19) is currently a global pandemic. Information about predicting mortality in severe COVID-19 remains unclear. METHODS: A total of 151 COVID-19 in-patients from January 23 to March 8, 2020, were divided into severe and critically severe groups and survival and mortality groups. Differences in the clinical and imaging data between the groups were analyzed. Factors associated with COVID-19 mortality were analyzed by logistic regression, and a mortality prediction model was developed. RESULTS: Many clinical and imaging indices were significantly different between groups, including age, epidemic history, medical history, duration of symptoms before admission, routine blood parameters, inflammatory-related factors, Na+, myocardial zymogram, liver and renal function, coagulation function, fraction of inspired oxygen and complications. The proportions of patients with imaging Stage III and a comprehensive computed tomography score were significantly increased in the mortality group. Factors in the prediction model included patient age, cardiac injury, acute kidney injury, and acute respiratory distress syndrome. The area under the receiver operating characteristic curve of the prediction model was 0.9593. CONCLUSIONS: The clinical and imaging data reflected the severity of COVID-19 pneumonia. The mortality prediction model might be a promising method to help clinicians quickly identify COVID-19 patients who are at high risk of death.
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OBJECTIVE: To determine the incidence of MIS-C in Brazil, describe the clinical and sociodemographic characteristics of the pediatric population affected by MIS-C and compare mortality and lethality outcomes with isolated Covid-19 and MIS-C cases. METHODS: Observational and retrospective cohort study of cases of MIS-C associated with Covid-19 in the Brazilian population between 04/01/2020 and 04/17/2021. Data from the Ministry of Health's epidemiological bulletin up to the 15th epidemiological week of 2021, were used. The analyzes were descriptive through absolute and relative frequencies. The significance level is 5% in Stata 16.0 package. RESULTS: Between 04/01/2020 and 04/07/2021, 903 cases of MIS-C associated with Covid-19 were notified in Brazil, of which, the largest part (55.26%) were male, between 0 and 4 years old (45.29%), from the Southeast region (38.76%). The deaths (61; 6.7%) were higher in the female gender, between 0 and 4 years old (47.54%) and in the Southeast region (34.43%). It was identified that the risk of death by MIS-C related to Covid-19 is 5.29 (CI = 2.83; 9.87 and P-value = <0.001) times higher in adolescents from 15-19 years old than in other age groups when compared to 0-4 years old children. Also, the residency in North region was as risk factor to death (RR = 3.72, IC = 1.29; 10.74 e P-value = 0.008). CONCLUSION: In this study, despite the numbers showing more deaths from zero to 4 years old, the risk for teenagers is notably higher. In addition, Brazil's Northern region is a risk factor that reaffirms social inequality and poor access to health.
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BACKGROUND: The coronavirus pandemic has had an extremely negative impact on the patients with diabetes mellitus (DM both in terms of a more severe course of COVID -19 and an increased risk of death. AIM: Analysis of risk factors for death due to COVID -19 in patients with DM type 1 and type 2 (DM1 and DM2). MATERIALS AND METHODS: Retrospective analysis of the database of the national diabetes register (NDR), which included DM patients with COVID-19 and reported virus infection outcome (recovery/or death) in 15 712 DM1 and 322 279 DM2 patients during a 2-year follow-up period (01/02/2020 to 03/04/2022) (discharge date)). RESULT(S): Case fatality rate in patients with DM, who underwent COVID -19 was 17.1% (DM1-8.8%;DM2-17.5%). As a result of multivariate regression analysis of seven significant factors in DM1 and thirteen in DM2 (evaluated by univariate anlisys), a number of the most important predictors of risk for fatal outcome were identified: in DM1 these were age >=65 years (OR =4.01, 95% CI: 1.42-11.36), presence of arterial hypertension (AH) (OR =2.72, 95% CI: 1.03 -7.16) and diabetic foot syndrome (DFS) (OR = 7.22, 95% CI: 1.98-26.29);for T2DM: age >= 65 years (OR =2.53, 95% CI: 1.96-3.27), male (OR =1.51, 95% CI: 1.23-1.84), duration DM >=10 years (OR =2.01, 95% CI: 1.61-2.51), BMI >= 30 kg/m2 (OR =1.26, 95% CI: 1.02-1.55), ASCVD/CKD (OR =1.49, 95% CI: 1.01-2.04), history of diabetic coma (OR =12.97, 95% CI: 1.89-88.99) and presence of disability (OR =1.40, 95% CI: 1.14-1.73). In T2DM, the type of antidiabetic therapy (ADT) prior to COVID -19 (last visit before the development of infection) had a significant impact: Insulin therapy (OR = 1.64, 95% CI: 1.30-2.07), sulfonylureas (SU) (OR =1.51, 95% CI: 1.23-1.84));dipeptidyl peptidase-4 inhibitor (iDPP-4) therapy (OR =0.57, 95% CI: 0.39-0.83) and sodium-glucose cotransporter-2 inhibitor (iSGLT2) therapy (OR =0.64, 95% CI: 0.46-0.88). Vaccination was the most important protective factor in both types of DM: DM1 OR =0.19, 95% CI: 0.06-0.59;SD2 OR =0.20, 95% CI: 0.16-0.26. CONCLUSION(S): The common risk factor for fatal outcome in both DM1 and DM2 was age >=65 years;in DM1 - history of hypertension and DFS, in DM2 - male sex, diabetes duration >=10 years, BMI >=30 kg/m2, history of ASCVD/CKD and diabetic coma, disability. In T2DM, significant differences in risk were observed depending on the type of ADT: insulin and SU therapy were factors that increased the risk of death, whereas therapy with iDPP-4 and iSGLT2 reduced the risk of death. Vaccination reduced the risk of death in DM1 and DM2 by 5.2 and 5-fold, respectively. Copyright © Endocrinology Research Centre, 2022.
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BACKGROUND: The coronavirus pandemic has had an extremely negative impact on the patients with diabetes mellitus (DM both in terms of a more severe course of COVID -19 and an increased risk of death. AIM: Analysis of risk factors for death due to COVID -19 in patients with DM type 1 and type 2 (DM1 and DM2). MATERIALS AND METHODS: Retrospective analysis of the database of the national diabetes register (NDR), which included DM patients with COVID-19 and reported virus infection outcome (recovery/or death) in 15 712 DM1 and 322 279 DM2 patients during a 2-year follow-up period (01/02/2020 to 03/04/2022) (discharge date)). RESULT(S): Case fatality rate in patients with DM, who underwent COVID -19 was 17.1% (DM1-8.8%;DM2-17.5%). As a result of multivariate regression analysis of seven significant factors in DM1 and thirteen in DM2 (evaluated by univariate anlisys), a number of the most important predictors of risk for fatal outcome were identified: in DM1 these were age >=65 years (OR =4.01, 95% CI: 1.42-11.36), presence of arterial hypertension (AH) (OR =2.72, 95% CI: 1.03 -7.16) and diabetic foot syndrome (DFS) (OR = 7.22, 95% CI: 1.98-26.29);for T2DM: age >= 65 years (OR =2.53, 95% CI: 1.96-3.27), male (OR =1.51, 95% CI: 1.23-1.84), duration DM >=10 years (OR =2.01, 95% CI: 1.61-2.51), BMI >= 30 kg/m2 (OR =1.26, 95% CI: 1.02-1.55), ASCVD/CKD (OR =1.49, 95% CI: 1.01-2.04), history of diabetic coma (OR =12.97, 95% CI: 1.89-88.99) and presence of disability (OR =1.40, 95% CI: 1.14-1.73). In T2DM, the type of antidiabetic therapy (ADT) prior to COVID -19 (last visit before the development of infection) had a significant impact: Insulin therapy (OR = 1.64, 95% CI: 1.30-2.07), sulfonylureas (SU) (OR =1.51, 95% CI: 1.23-1.84));dipeptidyl peptidase-4 inhibitor (iDPP-4) therapy (OR =0.57, 95% CI: 0.39-0.83) and sodium-glucose cotransporter-2 inhibitor (iSGLT2) therapy (OR =0.64, 95% CI: 0.46-0.88). Vaccination was the most important protective factor in both types of DM: DM1 OR =0.19, 95% CI: 0.06-0.59;SD2 OR =0.20, 95% CI: 0.16-0.26. CONCLUSION(S): The common risk factor for fatal outcome in both DM1 and DM2 was age >=65 years;in DM1 - history of hypertension and DFS, in DM2 - male sex, diabetes duration >=10 years, BMI >=30 kg/m2, history of ASCVD/CKD and diabetic coma, disability. In T2DM, significant differences in risk were observed depending on the type of ADT: insulin and SU therapy were factors that increased the risk of death, whereas therapy with iDPP-4 and iSGLT2 reduced the risk of death. Vaccination reduced the risk of death in DM1 and DM2 by 5.2 and 5-fold, respectively. Copyright © Endocrinology Research Centre, 2022.
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BACKGROUND: This study aimed to investigate pregnancy frequency and evaluate the factors affecting live births in hemodialysis (HD) patients. METHODS: Female HD patients whose pregnancy was retrospectively reported between January 1, 2014, and December 31, 2019. The duration of HD, primary disease, and the information on whether the pregnancy resulted in abortion, stillbirth, or live birth, whether the HD duration was prolonged after diagnosing the pregnancy and whether it accompanied preeclampsia were recorded. RESULTS: In this study, we reached 9038 HD female patients' data in the study. A total of 235 pregnancies were detected in 145 patients. The mean age was 35.42 (35 ± 7.4) years. The mean age at first gestation was 30.8 ± 6.5 years. The average birth week was 32 (28 -36) weeks. A total of 53.8% (no = 78) of the patients had live birth, 51.7% (no = 70) had at least one abortion in the first 20 weeks, and 13.1% (no = 19) had at least one stillbirth after 20 weeks. The rate of patients' increased numbers of dialysis sessions during pregnancy was 71.7%. The abortion rate was 22.4% in those with increased HD sessions, whereas 79.3% in those not increased HD sessions (p < 0.001). Live birth frequency was 67.2% in the increased HD sessions group and 3.4% in those who did not differ in HD sessions (p < 0.001). DISCUSSION: For the first time, we reported pregnancy outcomes in HD female patients, covering all regions of Turkey. It has been observed that;increasing the number of HD sessions in dialysis patients will decrease fetal and maternal complications and increase live birth rates.
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Objective: to analyze the relationship between the concern and fear of COVID-19 with fatalism in the daily work of nurses. Method: analytical cross-sectional study carried out with a total of 449 nurses. Data collection was performed using instruments validated in Peru. In the analysis, the Shapiro-Wilk test and the Spearman correlation coefficient were used, and two multiple regression models were estimated, with variable selection in stages. Results: nurses had a moderate level of fatalism and a low level of fear and concern about COVID-19. The first statistical model, which included sociodemographic variables, explains only 3% of the fatalism variance. However, a second model that includes fear and perception explains 33% of it. Conclusion: Worry, fear and having been diagnosed with COVID-19 were predictors of fatalism. It is suggested the implementation of psycho-emotional interventions in daily work-aimed at Nursing professionals who present high levels of fear or concern-to reduce fatalism and prevent fatal consequences of the pandemic and promote health. © 2022 Revista Latino-Americana de Enfermagem.
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Objective: To study the features of the coronavirus infection course in cardiosurgical and thoracic patients to determine the factors potentially affecting the possibility of lethal outcome. To identify the predictors of fatal outcome based on the analyses of the features of the coronavirus infection course in this category of patients. Material and methods: During the analyzed period 80 patients from the departments of thoracic surgery and cardiac surgery were transferred to the infectious diseases department: 20 patients from the cardiac surgery department (CSD) – group 1;60 patients from the thoracic surgery departments (TSD) – group 2. A control group number 3 consisting of 59 non-thoracic and non-cardiosurgical patients was also formed. According to the disease outcome the patients were divided into two groups: group 1 – fatal outcome, group 2 – recovery. Results: Out of 80 patients, lethal outcome was recorded in 25 cases: 22 patients of the thoracic profile (36% of the total number of transferred from this department) and 3 patients of the cardiosurgical profile (15% of the total number of those transferred from the cardiac surgery department). 20 out of 20 cardiac patients had been operated on the day before, 49 out of 60 thoracic patients also underwent surgery. 3 people from the group of non-operated patients transferred from departments of thoracic surgery died. Moreover, after pneumonectomy, fatal outcome was recorded in 7 out of 8 cases (87.5%). Conclusion: During the analyses of indicators it was revealed that the number of fatal outcomes in patients of the thoracic profile with COVID-19 infection is higher than of the cardiosurgical profile and in the infectious diseases department. Presumably, this is due to the fact that coronavirus infection affects the lungs to a greater extent, and in patients with a thoracic profile (in particular, those who have undergone resection interventions), the volume of the lung parenchyma is initially reduced. This is confirmed particularly by the highest percentage of fatal outcomes after pneumonectomy. Cardiosurgical patients after surgical interventions do not have a reduction in the functioning lung parenchyma, which creates an additional “reserve” for recovery. Moreover, men predominate among patients of the thoracic profile, with the survival rate lower in all groups compared to women. Patients transferred from thoracic departments showed higher rates of systemic inflammation, which indicates a more severe course of the viral infection and the possible development of complications. When analyzing the predictors of lethal outcome, the following factors were identified: male gender and, in general, a more severe course of a viral infection (low saturation, a high percentage of lung lesions on CT, more pronounced changes in laboratory screening). The studied factors are associated with a large number of fatal outcomes in thoracic and cardiac surgery patients. Among the factors that do not affect the prognosis are diabetes mellitus, stroke and myocardial infarction in history. Thus, patients diagnosed with coronavirus infection that developed after thoracic surgery had the most unfavorable prognosis. The revealed patterns are of interest for optimizing the routing of this category of patients in order to prevent coronavirus infection. © 2022 Scientific Research Institute — Ochapovsky Clinical Regional Hospital no. 1. All Rights Reserved.
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OBJECTIVE: To study predictors of unfavorable outcomes in ischemic stroke associated with COVID-19. MATERIAL AND METHODS: A retrospective analysis of 173 case histories of patients with ischemic stroke and COVID-19 was carried out. The average age was 68.64±11.39 (95% CI 66.93-70.35; median 92, mean 34) years. By gender, women predominated (64.16%). Fatal outcome was observed in 62 (35.84%) patients. Risk factors were studied using binary logistic regression. RESULTS: The risk of a fatal stroke in a univariate analysis was established in the presence of a general severe condition of the patient and a number of other factors, which included the severity of COVID-19, acute coronary syndrome, multiple organ failure, the need for a ventilator, a history of kidney disease, pneumonia, high NIHSS score, oxygen partial pressure level, respiratory rate, number of hospitalizations, complete blood count (erythrocytes, hemoglobin, hematocrit, leukocytes, neutrophils), coagulogram, glucose, liver and kidney markers (bilirubin, aspartate aminotransferase, alanine aminotransferase, creatinine, urea), levels of creatine phosphokinase, lactate dehydrogenase and C-reactive protein. A model based on multivariate analysis was used, which makes it possible to predict the probability of a fatal outcome. A regression function was obtained, which included the content of C-reactive protein, urea and NIHSS score. In patients with a value of 35% and above, there was an increased risk of death, in the case of a value below 35%, a favorable outcome was assumed. The model was statistically significant (p<0.001). The sensitivity and specificity of the model were 88.9% and 97.9%, respectively. CONCLUSION: The revealed predictors of the probability of a fatal stroke outcome can be guidelines for a Coctor in choosing a patient management strategy at different stages of patient care.
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COVID-19 , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , UreaRESUMEN
Background: Coronavirus (COVID-19) represents a global public health crisis that is causing significant deaths and affecting health systems around the world. There are several risk factors for the severity of infection, complications and mortality of COVID-19. One of them is blood group. The aim of this study was to investigate the relationship between blood group and rate of covid 19 disease. Methods: A cross sectional study was performed on 130 patients over 18 years of age admitted in ICU of Shohada Tajrish Hospital between August 2020 and April 2021.The positive COVID-19 diagnosis was confirmed by polymerase chain reaction (PCR) test. Blood groups were determined and then, we monitored and followed up the patients' outcome during staying in ICU, the need for intubation, recovery and death. Data were collected using a questionnaire and analyzed by Pearson correlation coefficient and stepwise multiple regression analysis. Results were determined based on Fisher’s exact test. P<0.05 was considered significant. Results: 60 (46.1%) patients had blood type A, (20%) 26 patients blood type AB, 12 (9.2%) patients’ blood type B and (24.7%) 32 patients blood type O. Blood group A was significantly higher in these patients. 55 patients (42.3%) were female and 75 patients (57.7%) were male. Their mean age was 43.19±19.05. Totally, 43.1% of hospitalized patients were intubated regardless of blood type. The number of cases requiring intubation was higher in people with positive blood type A. The lowest need for intubation was seen in blood type B negative. Blood group A positive (39.6%) and then AB negative (33.3%) had the highest mortality rate. Death was not observed in blood group A negative, B negative, B positive and O negative. Conclusion: The number of patients with COVID-19 with blood type A was significantly higher (46.1%). The most common blood group in these patients was A and the lowest was blood group B. The number of cases requiring intubation was higher in people with positive blood type A. Copyright © 2022 Behnaz et al.
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BACKGROUND: The empirical prescription of antibiotics to inpatients with Coronavirus Disease 2019 (COVID-19) is frequent despite uncommon bacterial coinfections. Current knowledge of the effect of antibiotics on the survival of hospitalized children with COVID-19 is limited. OBJECTIVE: To characterize the survival experience of children with laboratory-positive COVID-19 in whom antibiotics were prescribed at hospital admission. METHODS: A retrospective cohort study was conducted in Mexico, with children hospitalized due to COVID-19 from March 2020 to December 2021. Data from 1601 patients were analyzed using the Kaplan-Meier method and the log-rank test. We computed hazard ratios (HR) and 95% confidence intervals (CI) to evaluate the effect of the analyzed exposures on disease outcomes. RESULTS: Antibiotics were prescribed to 13.2% ([Formula: see text] = 211) of enrolled children and a higher mortality rate [14.9 (95% CI 10.1-19.8) vs. 8.3 (95% CI 6.8-9.8)] per 1000 person-days, [Formula: see text] < 0.001) was found among them. At any given cut-off, survival functions were lower in antibiotic-positive inpatients ([Formula: see text] < 0.001). In the multiple model, antibiotic prescription was associated with a 50% increase in the risk of fatal outcome (HR = 1.50, 95% CI 1.01-2.22). A longer interval between illness onset and healthcare-seeking and pneumonia at hospital admission was associated with a poorer prognosis. CONCLUSIONS: Our results suggest that antibiotic prescription in children hospitalized due to COVID-19 is associated with decreased survival. If later replicated, these findings highlight the need for rational antibiotics in these patients.
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Tratamiento Farmacológico de COVID-19 , Antibacterianos/uso terapéutico , Niño , Humanos , Pacientes Internos , Prescripciones , Estudios RetrospectivosRESUMEN
A case of massive muscular bleeding of iliopsoas resulting in lethal exsanguination is presented. The intramuscular bleeding occurred spontaneously in an old man with heart failure, presented to the emergency department after the acute onset of shortness of breath, and treated with therapeutic doses of antiplatelets and heparin to prevent thrombosis. On the sixth day of recovery, pain in the left lumbar region develops while there was a decrease in hemoglobin level. Computed tomography (CT) scan revealed a 10 × 3 cm hematoma of the left iliac muscle. The treatment was immediately stopped, but within 6 hours, the death was confirmed. The autopsy revealed that the hematoma, and its increased size since the latest imaging assessment, was the leading cause of death. Particularly in older patients with comorbidity, even in those with clotting parameters in the therapeutic range, the potential for fatal result of iliopsoas muscle bleeding should be considered. Identifying potential patience with increased risk of this complication could be important, especially in pandemic time of COVID-19, when the use of anticoagulant therapy-both for treatment and for prevention of severe disease-has become massive and addressed also to people without previous and specific pathologies.
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COVID-19 , Músculos Psoas , Anciano , Autopsia , COVID-19/complicaciones , Resultado Fatal , Hematoma/etiología , Hemorragia/patología , Humanos , Masculino , Músculos Psoas/diagnóstico por imagen , Músculos Psoas/patologíaRESUMEN
OBJECTIVES: to provide an outline of the factors mainly influencing severe disease and fatal outcome among Italian COVID-19 patients in the pre-vaccination phase, also describing the impact of the scenarios driven by variants, vaccines, and available therapies. DESIGN: a literature search was carried out for peer-reviewed articles searching for COVID-19 and prognosis, including severe disease and death. SETTING AND PARTICIPANTS: Italian patients with COVID-19. MAIN OUTCOME MEASURES: the association between risk factors and severe disease and death as the main outcomes was assessed through epidemiological measures, including relative risk, odds ratio, and hazard ratio. RESULTS: advanced age, obesity, overweight, non-0 blood group, and male gender were the factors more associated with severe disease. Fatal outcome mostly correlated with old age, non-0 blood group, and obesity, together with cardiovascular diseases, diabetes, hypertension, cancer, chronic kidney disease, and acute kidney injury. CONCLUSIONS: clinical and epidemiological characteristics of the Italian population, integrated with omics data, could be highly valuable to stratify risk of worse prognosis among patients, and to address targeted prevention and treatment interventions.
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Antígenos de Grupos Sanguíneos , COVID-19 , COVID-19/epidemiología , Humanos , Recién Nacido , Italia/epidemiología , Masculino , Obesidad/epidemiología , Medicina de Precisión , Pronóstico , Salud Pública , SARS-CoV-2 , VacunaciónRESUMEN
Objective. Detection of additional factors favoring progression of COVID-19 and developing lethal outcomes in hospitalized patients. Materials and methods. Analysis of 98 medical records of lethal cases of patients that underwent hospitalization with diagnosis of COVID-19 associated pneumonia of two in-patient facilities of the Amur oblast and Khabarovsk krai was performed. Two groups were formed: first included medical records of patients hospitalized in severe condition (n = 52) and second group included patients with state of moderate severity (n = 46). Length of hospitalization stay, time from admission to the medical facility to progression of the disease, time from hospitalization to death and bacterial pathogens species composition isolated from lungs tissue autopsy material were analyzed. Statistical assessment of obtained data was performed with StatSoft Statistica 12.0. Results. Majority of patients of 1st and 2nd groups (66.7 ± 6.80% and 69.6 ± 6.78%) were hospitalized on fourth day of the COVID-19 clinical manifestations onset or later. Two thirds of patients hospitalized in severe condition progressed to critical health status on 1st–3rd day of hospitalization. Majority of second group patients (65.2 ± 7.02%) deteriorated from moderate severity to severe health condition on 4th–14th day of hospital stay. Bacteriological assessment analysis of autopsy material revealed that material obtained from first group showed more frequent absence of bacterial flora growth compared with second group both in the Amur oblast (44.4 ± 9.74% и 29.4 ± 11.39%) and in the Khabarovsk krai (в 40.0 ± 10.0% and 27.6 ± 8.45% of cases). Klebsiella pneumoniae (57.7 ± 5.86%) and Candida spp. (18.3 ± 4.59%) were revealed more frequently in the structure of diagnosed pathogens. Substantial proportion of pathogens (81.7 ± 4.59%) were isolated in autopsy material of patients which hospital stay was 4 days and longer. Prolonged hospital stay was associated with more frequent detection of K. pneumoniae and Candida spp. in patients that suffered from COVID-19 pneumonia and eventually died from the disease. With duration of hospitalization of 4 days and longer Acinetobacter baumannii – an extremely virulent pathogen with natural drug resistance was isolated from autopsy material. Conclusion. Factors influencing unfavorable outcomes of COVID-19 include signs of secondary bacterial infection as well as detection of aggressive drug-resistant bacterial microflora that most likely had nosocomial origin due to prolonged hospitalization. © 2021, Dynasty Publishing House. All rights reserved.
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Introduction: despite its relatively low case-fatality rate, COVID-19 is a concern with high mortality and morbidity of hospitalized cases. This study was conducted to assess the relationship between time to consultation, presence of respiratory complications at hospital admission and fatal outcome of COVID-19 cases. Methods: this was a case control study with data collected from records of all patients admitted in the Bafoussam Regional Hospital (BRH) from March 2020 to April 2021. Cases were patients with a fatal outcome and controls were patients that were discharged. The association between the delay in seeking care, dyspnea and blood oxygen level at admission, and fatal outcome was assessed by estimating crude and adjusted odd ratio. Results: of 400 included patients, 239 (59.75%) were male, 84 (23.73%) health professionals and 144 (36.0%) aged 64 years and above. On admission, 236 patients presented at least one sign of respiratory complication. The mean duration of hospitalization was 11.4 days and 120 (30.0%) admitted patients died. Seeking care before the end of the first day of symptom onset (adjusted (A) OR=0.44 [0.21-0.97]) or within the first three days (AOR=0.48 [0.26-0.89]) significantly reduced the risk of fatal outcome, whereas waiting seven days (AOR=0.74 [0.42-1.33]) did not change this risk. Presenting dyspnea (AOR=2.39 [1.32-4.31]) or blood oxygen level <95% (AOR=3.67 [1.37-9.83]) significantly increased the risk of fatal outcome. Conclusion: mortality was one in three patients. Early arrival at the hospital helped to reduce the risk of mortality unlike presenting respiratory complication that increased the risk. Health interventions contributing for early detection and link of COVID-19 cases to care before respiratory complications occur are expected to reduce mortality in COVID-19 patients.
Asunto(s)
COVID-19 , Camerún/epidemiología , Estudios de Casos y Controles , Disnea/epidemiología , Disnea/etiología , Femenino , Hospitales , Humanos , MasculinoRESUMEN
In one year of the coronavirus disease 2019 (COVID-19) pandemic, many studies have described the different metabolic changes occurring in COVID-19 patients, linking these alterations to the disease severity. However, a complete metabolic signature of the most severe cases, especially those with a fatal outcome, is still missing. Our study retrospectively analyzes the metabolome profiles of 75 COVID-19 patients with moderate and severe symptoms admitted to Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (Lombardy Region, Italy) following SARS-CoV-2 infection between March and April 2020. Italy was the first Western country to experience COVID-19, and the Lombardy Region was the epicenter of the Italian COVID-19 pandemic. This cohort shows a higher mortality rate compared to others; therefore, it represents a unique opportunity to investigate the underlying metabolic profiles of the first COVID-19 patients in Italy and to identify the potential biomarkers related to the disease prognosis and fatal outcome. IMPORTANCE Understanding the metabolic alterations occurring during an infection is a key element for identifying potential indicators of the disease prognosis, which are fundamental for developing efficient diagnostic tools and offering the best therapeutic treatment to the patient. Here, exploiting high-throughput metabolomics data, we identified the first metabolic profile associated with a fatal outcome, not correlated with preexisting clinical conditions or the oxygen demand at the moment of diagnosis. Overall, our results contribute to a better understanding of COVID-19-related metabolic disruption and may represent a useful starting point for the identification of independent prognostic factors to be employed in therapeutic practice.