Identification of clinical features associated with mortality in COVID-19 patients

BackgroundTo prevent infectious diseases, it is necessary to understand how they are spread and their clinical features. Early identification of risk factors and clinical features is needed to identify critically ill patients, provide suitable treatments, and prevent mortality. MethodsWe conducted a prospective study on COVID-19 patients referred to a tertiary hospital in Iran between March and November 2020. Of the 3008 patients (mean age 59.3{+/-}18.7 years, range 1 to 100 years), 1324 were women. We investigated COVID-19 related mortality and its association with clinical features including headache, chest pain, symptoms on CT, hospitalization, time to infection, history of neurological disorders, having a single or multiple risk factors, fever, myalgia, dizziness, seizure, abdominal pain, nausea, vomiting, diarrhoea and anorexia. FindingsThere was a significant association between COVID-19 mortality and old age, headache, chest pain, respiratory distress, low respiratory rate, oxygen saturation less than 93%, need for a mechanical ventilator, having symptoms on CT, hospitalization, time to infection, history of hypertension, neurological disorders, cardiovascular diseases and having a risk factor or multiple risk factors. In contrast, there was no significant association between mortality and gender, fever, myalgia, dizziness, seizure, abdominal pain, nausea, vomiting, diarrhoea and anorexia. InterpretationOur results might help identify early symptoms related to COVID-19 and better manage patients clinically.

Colorectal stenting for management of acute malignant bowel obstruction in advanced colorectal cancer in Iran.

INTRODUCTION: Enteral stenting is used increasingly as a palliative treatment of gastrointestinal malignant or non-malignant obstructions. This aim of this study was to evaluate the role of endoscopic stent implantation for palliation of acute colorectal cancer obstruction in critical patients. METHODS: This study was performed prospectively with 8 patients suffering clinical manifestations of acute bowel obstruction with severe co-morbid diseases that caused them to be inoperable. They were treated by semi-elective stent insertion after primary resuscitation. Gentle dilation of stricture with balloon or buginage was performed under fluoroscopy and colonoscopy in gastrointestinal ward without complete preparation. Then an uncovered self-expanding metal stent was inserted over guide wire in the location of the tumor. RESULTS: Endoscopic stent implantation could be successfully performed in six patients. In early days after stent insertion; general condition of patients gradually improved, and symptoms of acute obstruction was relieved. In two of the cases stent was inserted with difficulty due to very tortuous and complex strictures. Complications of stenting in this study were very rare. Displacement of stent after successful insertion was not seen. Of our studied patients, two died after 2 months, one after 4 months and three of them after 7-8 months. The cause of death in these patients was advanced metastatic lesion in liver, lung, bone and severe underlying disease such as heart failure. CONCLUSION: Endoscopic stent implantation seems to be an effective and safe palliative approach for management of emergency conditions of acute colonic obstruction in inoperable patients with advanced colorectal cancer.

Combination of thrombolytic therapy and angioplastic stent insertion in a patient with Budd-Chiari syndrome.

A 31-year-old female who had well-established polycythemia vera one year before, presented with the sudden onset. She had severe ascites and hepatic encephalopathy 12 d prior to admission. Real-time ultrasonography revealed a supra hepatic thrombosis extending toward the inferior vena cava (lVC). Thrombolytic therapy with systemic streptokinase (250000 IU loading + 100000 IU/h infusion) was started. At the end of 72 h infusion, the patient's general condition improved. A color Doppler ultrasonography then showed complete and partial resolution of the thrombosis in the supra hepatic vein and IVC, respectively. Despite this good response, 12 d later, the symptoms recurred. Venography detected complete obstruction of the lVC. Percutaneous balloon angioplasty with stent insertion was performed successfully and the patient was discharged without any evidence of liver disease. A combination of systemic streptokinase and radiological intervention was effective in our patient.