Clinical Medicine Research

ISSN Online: 2326-9057 ISSN Print: 2326-9049

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Volume 10, Issue 1, January 2021

  • Authors: Cesar Maquilon Ortiz, Jonas Alberto Gongora, Monica Antolini Toledo, Nicolas Fernando Valdes, Angela Benavente, Maria Gabriela Bofill, Macarena Urra, Diego Rojas Carvajal, Javiera Huidobro Navarro, Bernardita Alvarado Breton, Maria Carolina Asenjo, Cherie Gutierrez Rojas, Jose Gajardo, Patricia Cisternas, Guillermo Garcia, Juan Pablo Peralta, Lenny Loor Garcia, Annelise Sepulveda, Cecilia Tapia, Luis Fernando Mallea, Felipe Rivera, Ezio Parodi, Jyh Kae Nien

    Abstract: On June 04, 2020, Chile had 113,628 cases COVID-19, 1275 deaths, 1450 patients were on invasive mechanical ventilation (IMV). The objective was describing the characteristics on admission and their relationship with the condition at discharge of patients with positive real-time polymerase chain reaction test for SARS CoV-2 (RT-PCR) in a tertiary health center. Methods: Retrospective and observational cohort study of 529 consecutive patients with positive RT-PCR for SARS CoV-2, discharged between March 14 and June 4, 2020 from Clinica Davila, Santiago. Demographic data, laboratory tests, Quality Adjusted Life Years (QALY), medical insurance, ventilatory assistance, and discharge condition were collected. Differences were evaluated by chi-square test, student’s t test, or Mann–Whitney U test. Logistic regression analysis was performed to identify variables that were predictive of condition at discharge. Results: A total of 529 patients were included (median age, 49 years [interquartile range {IQR}, 37-62; range, 0-97 years]; 45% women). The most common comorbidities were hypertension (171, 32.3%) and diabetes mellitus (98, 18.5%), On admission 352 patients (66.5%) had respiratory symptoms and 177 (33.4%) had other symptoms or other diagnoses. The median (IQR) PaO2 / FiO2 on admission of survivors, non-survivors and transferred were 316 (261-360), 167 (80-268) and 212 (130-261) respectively. At discharge, 448 (84.7%) were survivors, 54 (10.2%) non-survivors, and 27 (5.1%) were transferred to other centers. Median age of survivors and non-survivors was 46 (36-59) and 75.5 (66-84) years. Of the 116 patients (21,9%) who received support ventilation, 67 were discharged alive (57.8%), 28 died (24%), and 21 (18%) were transferred to another hospital. The variables associated with risk of death were: age ≥ 60 years (OR 15.3; 95% CI: 7.25–32.2; P = 0.001); QALY score ≤ 15 points (OR 14.01; 95% CI: 4.82 -40.67; P = 0.001); state health insurance (OR, 2.82; 95% CI: 1.38–5.77; P = 0.004); PaO2 / FiO2 on admission ≤ 200 (OR 5.2; 95% CI: 1.94-13.94; P = 0.001) and high sensitivity T Troponin ≥ 15 ng / L (OR 5.16; 95% CI: 1.95-13.64; P = 0.001). Conclusions: this cohort showed that on admission COVID-19 patients, the PaO2 / FiO2, creatinine and high sensitivity T troponin at the described cut-off points had prognostic value. At discharge, the non-survivors were the older, most often had state health insurance and their QALY scores were significantly lower.

    Received: Dec. 13, 2020 Accepted: Dec. 28, 2020 Published: Jan. 4, 2021

    DOI: 10.11648/j.cmr.20211001.11 View: Downloads:

  • Authors: Anna-Maria Borissovа, Boyana Trifonova, Lilia Dakovska, Eugenia Mihailova, Mircho Vukov

    Abstract: Hyperglycemia is one of the most common conditions during pregnancy. The International Diabetes Federation (IDF) estimates that one in six live births (16.8%) are in women with some form of Hyperglycemia during pregnancy. The aim is to analyze the frequency of Hyperglycemia during pregnancy through a cross-sectional multicenter population-based study in 84 settlements in Bulgaria, as well as to study the dynamics of this frequency during pregnancy. Material: We studied 547 pregnant women with a mean age of 30±5 years, divided into two groups - up to 24 gestational week – g.w. (n-386, 70.6%) and after 24 g.w. (n-161, 29.4%). Methods: BMI before pregnancy and the current one at the time of the study were calculated. A two-hour, 75 g oral glucose tolerance test (OGTT) was performed. Plasma glucose was quantitatively determined using enzymatic reference method with hexokinase (Roche reagent) on Cobas е501 analyzer, in one Central laboratory on the day of the blood sampling. The results were in mmol / l. The statistical analysis was performed using standard SPSS 13.0 for Windows. Results: Hyperglycemia was observed in 79 (14.4%) pregnant women after fasting state or in the course of classic OGTT, according to the criteria of WHO’2019, FIGO’2015, NICE’2015, and in the remaining 468 (85.6%) pregnant women - Normoglycemia. There was no significant difference in the level of glycemia between the three trimesters for each of the points of OGTT (0, 60, 120 minutes) in the subgroups of pregnant women with Hyperglycemia (up to 12 g.w, 13-24 g.w, after 24 g.w.). It turned out that the number and frequency of pregnant women with Hyperglycemia in the period up to 24 g.w. is 7.5% (29/386) and increases in the period after 24 g.w. reaching 31% (50/161), P < 0.01. According to the generally accepted population diagnostic criteria for diabetes in non-pregnant women, we found that 8.9% (7/79) of pregnant women with Hyperglycemia had Diabetes in Pregnancy (DIP), all of whom had a risk factor for Diabetes (two of them even 3 risk factors). Conclusion: As soon as pregnancy is established, verbal screening for diabetes risk factors should be performed as a first step in selecting pregnant women for glucose tolerance screening with classic OGTT to determine the glucose status of the pregnant woman.

    Received: Dec. 16, 2020 Accepted: Dec. 23, 2020 Published: Jan. 18, 2021

    DOI: 10.11648/j.cmr.20211001.12 View: Downloads:

  • Authors: Edem Komi Mossi, Abdou Razak Moukaila, Dzidzonu Komi Nemi, Waina Kodjo, Sodjehoun Apeti, Agbeko Kodjo Djagadou, Abago Balaka, Awalou l Mohaman Djibri

    Abstract: Introduction: Venous thromboembolic disease is a common condition. Many risk factors can contribute to its occurrence. The aim of this study is to describe the risk factors of venous thromboembolic diseases and the results of the etiological assessment. Methodology: This was a retrospective and descriptive study that took place in the internal medicine department of the Sylvanus Olympio University in Lomé, from January 1, 2016 to December 31, 2017. It included all patients of both sexes aged 18 and over hospitalized for deep vein thrombosis regardless of the site and / or documented pulmonary embolism. Results: We had collected 51 cases of venous thromboembolic disease. The mean age of the patients was 52.9 ± 17.1 years with a male predominance (52.9%). Deep venous thrombosis (DVT) of the lower limbs was the most frequent location (68.5%). In our study, 59.3% of patients presented at least one risk factor before any etiological assessment. No risk factor was found in nine patients (17.8%). The main risk factors encountered were: obesity (17.6%), HIV infection (13.7%), diabetes (11.8%), neoplasias (7.8%), and prolonged bed rest (7.8%). An etiology was found in 13.7% of cases, including 3 cases of thrombophilia and 4 cases of neoplasia. Conclusion: Obesity and HIV infection are the most common risk factors for venous thromboembolic diseases. Neoplasias are the most common etiologies after etiological investigation.

    Received: Jan. 6, 2021 Accepted: Jan. 18, 2021 Published: Jan. 25, 2021

    DOI: 10.11648/j.cmr.20211001.13 View: Downloads:

  • Authors: Orhay Mirzapolos, Ryan Wagner, April Brill, Fred Lepore

    Abstract: Acute chest pain is one of the most common presentations to the emergency department yet only about 10% of these cases are diagnosed with acute coronary syndrome. Emergency physicians are faced with the dilemma of determining the etiology of the chest pain and appropriately dispositioning the patient. The HEART score was created as a decision tool to aide emergency physicians in risk-stratification of chest pain patients. Despite the growing evidence surrounding the use of the HEART score, there remains a paucity of literature involving its efficacy in community hospitals in the United States. This is a multicenter retrospective validation study conducted on 500 patients with the chief complaint of chest pain who subsequently underwent diagnostic or therapeutic coronary angiography from 2013 to 2015 at four community hospitals. The HEART score was calculated based on emergency department documentations. The study found that a positive coronary angiogram had a higher percentage of high risk HEART scores than low risk HEART scores. The majority of positive coronary angiograms among the four campuses had HEART scores between the 4-6 range, the intermediate category. This data parallels the larger validation studies previously published pertaining to the HEART score. Thus, the HEART score is a valid screening score for determining risk of a major adverse cardiac event and facilitates disposition of patients from emergency departments in community hospitals.

    Received: Jan. 4, 2021 Accepted: Jan. 12, 2021 Published: Jan. 25, 2021

    DOI: 10.11648/j.cmr.20211001.14 View: Downloads:

  • Authors: Emem Abasi Bassey, Matthias Gabriel Abah, Christopher Azubuike Opone, Aniekan Linus Jackson

    Abstract: Introduction: The Rhesus (Rh) antigen is the most polymorphic of human blood group systems second only to the ABO in transfusion and transplantation medicine with significance in iso-immunization which can cause haemolytic disease of the foetus and newborn. This study was carried out to determine the prevalence of Rhesus negativity amongst antenatal clinic attendees in the University of Uyo Teaching Hospital. Methodology: This was a 5-year retrospective study carried out between March 1st, 2012 and February 28th, 2017. Data containing the ABO and Rhesus blood group of all antenatal clinic attendees was collected from the Laboratory registers and analysed using Microsoft excel. Results: The prevalence rate of Rhesus D negative women was 4.40%. The average yearly attendance was 2861 women. The commonest blood group was O with 8232 (57.54%), followed by blood group A, 3416 (23.88%) and blood group B, 2388 (16.69%) while the least common blood group was AB, 271 (1.89%). Most Rhesus D-negative women were of blood group O; 382 (60.78%), followed by group A; 142 (22.58%), and blood group B was 94 (14.49%). AB blood group was the least; 11 (1.70%). Sensitization rate among the 629 Rhesus D-negative women was 1.11%. Conclusion: The prevalence of rhesus negativity is low in the population studied with an ABO distribution that mirrored the antenatal population, hence the overall need for immunoprophylaxis. It is however very necessary to educate and counsel all non-sensitized Rhesus negative women on the need for antenatal and post-partum immuno-prophylaxis as well as public enlightenment on the rationale for Rhesus typing, especially among women.

    Received: Jan. 4, 2021 Accepted: Jan. 22, 2021 Published: Feb. 9, 2021

    DOI: 10.11648/j.cmr.20211001.15 View: Downloads:

  • Authors: Lingli Cai, Yuanzong Song, Ning Zhang, Meixue Chen, Weiju Chen, Qingran Lin

    Abstract: Background: Citrin deficiency is an autosomal recessive genetic disorder caused by SLC25A13 genetic mutations. Understandably, Neonatal Intrahepatic Cholestasis caused by Citrin Deficiency (NICCD) was one of its clinical phenotypes, usually occurred in the neonatal period or infancy. The effective treatment of dietary intervention and symptomatic support may provide an avenue for clinicians to reduce liver damage and improve clinical prognosis. Objective: We report a 5-month-old infant diagnosed with Neonatal Intrahepatic Cholestasis caused by Citrin Deficiency (NICCD), coexisting Respiratory Syncytial Virus (RSV) infection. Method: The patient presented with rhinorrhea and cough, jaundiced skin and sclera, fat faces and hepatomegaly. Simultaneously, the child’s mother performed obvious anxious emotion. Infection control, nutrition management, and psychological guidance for the caregiver during hospitalization to discharge were achieved. Meanwhile, effective health education also plays a good role in these interventions. Result: After half a month, the patient’s infection was given controlled. Jaundice and hepatomegaly were improved gradually. Followeing up for 2 months, the clinical symptoms for NICCD were disappeared and the caregiver’s anxiety was alleviated effectively. The importance of follow-up and support longitudinally to improve the quality of life for patients is emphasized. Conclusion: Therefore, this study provided primary while valuable nursing care experience for NICCD with RSV infection patients.

    Received: Feb. 5, 2021 Accepted: Feb. 15, 2021 Published: Feb. 26, 2021

    DOI: 10.11648/j.cmr.20211001.16 View: Downloads:

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