Main Comorbidities Research Articles

Analysis of the clinical and sociodemographic characteristics of patients undergoing Myocardial Revascularization Surgery

Introduction: The occurrence of cardiovascular diseases has been encouraging all over the world, and Myocardial Revascularization Surgery (CABG), when indicated, has been showing good results. Objective: To identify the clinical and sociodemographic characteristics of patients admitted to CABG. Methods: Cross-sectional, retrospective, descriptive and analytical study of the electronic medical records of a University Hospital. Results: The sample consisted of 57 patients, 77.2% male and 22.8% female, 50.9% were married, and 40.3% were overweight. The main comorbidities were cardiovascular (82.5%) and metabolic (77.2%). The mean length of stay on MV (Mechanical Ventilation) was 1.40 ± 3.87 days, length of stay in the Coronary Unit (CCU) 6.26 ± 4.07 days, and length of hospital stay of 26.88 days ± 24.48 days. Conclusion: Most patients who underwent CABG were men, married and overweight. The most prevalent comorbidities were cardiovascular and metabolic. As for the days on MV, men spent more days intubated than women, but the latter stayed longer in the CCU and hospitalized.

Anterior vs non-anterior ST-segment elevation myocardial infarction: incidence of reinfarction and target vessel failure

Abstract Funding Acknowledgements Type of funding sources: None. Background and purpose Left anterior descending (LAD) coronary artery occlusion has been associated with worse short-term outcomes and overall worse prognosis, there is still unclear data about the long-term risk of reinfarction in relation to the index culprit vessel. Methods In this retrospective cohort study, between 2008 and 2013, a total of 584 patients were admitted with STEMI and were subject to emergent percutaneous coronary intervention (PCI). Of those, 535 (91.6%) were alive at hospital discharge, from which 532 were considered for the analysis, after excluding the missing cases. We stratified the individuals according to the culprit vessel in two groups: anterior myocardial infarction (MI) (LAD or left main stem (LM)), and non-anterior MI (circumflex (CX) or right coronary artery (RCA)). We followed the cases for a maximum of 8 years, censoring every event beyond. The primary endpoints were reinfarction and target vessel failure (TVF). Secondary endpoints included all-cause mortality, heart failure (HF) hospitalization and stroke. Mann-Whitney-U and Chi-square tests were used to compare baseline characteristics. Kaplan-Meyer survival analysis was used to obtain the survival curves. Univariate and multivariate analysis were done using Cox regression models. Results Of the 532 individuals included in the analysis, 395 (74.2%) were men and the median age was 61 (+/- 19.8) years. The most common culprit vessel was RCA (45.5%), followed by LAD (41.2%), CX (13.2%), and lastly LM (0.20%). The median follow-up time was 6.94 (+/- 2.38) years. Overall, the anterior MI group presented at a higher Killip class (20.0% vs 14.8% in Killip class II-IV; p = 0.046) and had higher peak plasma level of high-sensitivity troponin T (6.16 vs 3.66 ng/ml; p < 0.001), suggesting larger infarct area. Left ventricle ejection fraction (LVEF) at discharge was also lower in the anterior MI group (reduced in 78,3% vs 43.4%; p < 0.001). Multivessel disease was more common in the non-anterior MI group (49.5% vs 60.9%; p = 0.005), as was PCI of non-culprit vessels (15.5% vs 22.8%; p = 0.037) and the use of bare-metal stents (20.0 vs 51.6%; p < 0.001). There were no significant differences between the groups regarding the main comorbidities, except for peripheral artery disease, more common in the non-anterior MI group (4.10 vs 10.0%; p = 0.011). There was a higher risk of reinfarction in the non-anterior MI group which persisted after relevant variable adjustment (Adjusted hazard ratio 1.96; 95% CI [1.08 – 3.67]; p = 0.027) (Figure 1). There were no significant differences regarding the risk of TVF or any of the secondary outcomes. Conclusions Although LAD/LM occlusion is thought to carry a worse short-term prognosis, non-anterior STEMI appears to be associated with a higher long-term risk of reinfarction. Despite higher rates of reinfarction, non-anterior STEMI patients have not been shown to have an excess mortality of HF hospitalizations in this cohort.

Remote vessels vs culprit-only angioplasty in ST-segment elevation myocardial infarction: reinfarction and all-cause mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background and purpose In ST-segment elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease (MVCAD), remote-vessel percutaneous coronary intervention (PCI) has been associated with a reduction in the incidence of reinfarction when compared to a culprit-only revascularization strategy. Overall effects on long-term all-cause mortality are still unclear. Methods Between 2008 and 2013, a total of 584 consecutive patients were admitted with STEMI. 535 survived to discharge, from which 302 (56,5%) had MVCAD and were included in the analysis. We stratified the patients according to the revascularization strategy in two groups: culprit-lesion-only PCI and PCI of non-culprit vessels with angiographic significant stenosis. Patients were followed for 8 years. The primary endpoints were reinfarction in any vessel and all-cause death. Secondary endpoints included target vessel failure (TVF) (any repeat revascularization in the index culprit vessel), heart failure (HF) hospitalization and stroke. Results Of the 302 cases, 217 (74.2%) were men and the median age was 63 years. 150 (49.7%) had 2-vessel, 152 (50.3%) had 3-vessel disease and 104 (34.4%) underwent non-culprit vessel PCI. The mean follow-up time was 6.95 (± 2.29) years. Overall, the culprit-lesion-only group was older (median: 66 vs 59.5 years; p < 0.001) and had a lower proportion of smokers (41.9% vs 59.6%; p = 0.003). There were no significant differences between the groups’ other main comorbidities. The culprit-lesion-only group had a shorter hospital stay (median: 7.0 vs 7.5; p = 0.013), despite presenting at higher Killip class (24.4% vs 10.6% in Killip II-IV; p = 0.004). Regarding index PCI, no-reflow phenomenon was more common in the culprit-lesion-only group (7.1% vs 1.0%; p = 0.020), where the use of drug-eluted stents was more prevalent in the remote-vessel PCI group (69.2% vs 47.0%; p = 0.001). There was a higher risk of reinfarction (Adjusted hazard ratio (HR) 2.46; 95% CI [1.12 – 5.38]; p = 0.008) and TVF (Adjusted HR 2.37; 95% CI [1.02 – 5.48]; p = 0.044) in the culprit-lesion-only PCI group after relevant variable adjustment, with no significant differences in all-cause mortality. There were no significant differences in any of the remaining secondary outcomes. Conclusions Randomized trials and successive metanalysis have demonstrated benefit in complete revascularization after STEMI regarding the incidence of reinfarction and cardiovascular death. However, the long term impact on all-cause death is still unclear. This study corroborates the main findings in the literature, while suggesting lack of effect on overall mortality on a long-term follow-up.

Telemonitoring heart failure in a remote region: data from cardiac implantable electronic devices

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart failure (HF) represents an important burden to the medical system attending to its high prevalence and high risk of hospital admissions by decompensations. Remote monitoring (RM) systems using invasive and non-invasive parameters were developed to anticipate clinical deterioration in patients with cardiac implantable electronic devices (CIEDs). Objective To characterize a cohort of patients with HF and CIEDs in an outermost region. We aimed to accessed data from monitoring device algorithms and to analyze the real impact in clinical decompensations, hospital admissions and all-cause mortality. Methods Retrospectively multicenter cohort study included 211 patients with HFrEF and CIEDs, between 2010 and 2020. This study population was divided into two specific groups: Group A including patients with RM data and Group B including patients who receive usual care at regular hospital consultations. RM technology applied used different parameters to access the risk of worsening HF and stablishing an alert threshold. Results Out of 211 patients enrolled, 75% were male and 44.8% were in NYHA functional class II at the time of device implantation. One-hundred and twenty (56.9%) received in-home monitoring system (89% Latitude® and 10.8% Carelink®), corresponding to the Group A. The remaining 91 patients (43.1%) were included in Group B. Forty-nine patients (40.8%) had transvenous implantable cardioverter defibrillator (ICD), 13 (10.8%) had a subcutaneous ICD, 54 (45%) a cardiac resynchronization therapy (CRT) defibrillator and 4 (3.3%) a CRT pacemaker. Group A patients did not have coronary artery disease (p 0.047) and were younger than patients in Group B (median age 66 years, IQR 55 – 73; median age 70 years, IQR 63 – 77). No other statistically differences in main comorbidities were detected between groups. The number of atrial fibrillation (AF) episodes and AF burden was higher in Group A during the follow-up (p 0.006) as well as non-sustained ventricular tachycardia episodes (p 0.016). However, no differences were accessed in emergency department (ED) admissions or heart failure hospitalizations (HFH) by decompensation for patients in group A who received alerts versus patients who not received (p 0.178 and p 0.748, respectively) nor between group A and B (p 0.921 and p 0.213, respectively). Patients in group A had a lower all-cause mortality rate (p < 0.001) and cardiovascular mortality (p 0.002), but no difference in life-threatening ventricular events occurred. Conclusion In our cohort of HF patients, remote monitoring allowed the premature detection and the correct quantification of arrhythmic events but did not reflect any difference in ED nor HFH by decompensation. Instead, RM system demonstrates ability to reduce global mortality when compared to conventional care. More data about the application of this system and the ideal tracking algorithms are necessary.

Social isolation stress favors cardiometabolic comorbidities of sleep apnea

Sleep apnea (SA) is a multifactorial and sex-specific respiratory disorder characterized by repeated respiratory arrests during sleep. However, the origins of this disease are not clearly identified. Chronic stress increases risk for obesity, hypertension, and depression, which are common comorbidities of SA. With the increasing prevalence of obesity and about one-third of the world population reported feeling stressed, the study of the impact of stress on respiratory homeostasis has never been so relevant. Since chronic stress induces the main comorbidities of SA, we hypothesized that social isolation (SI) stress induces sex-specific cardiorespiratory and metabolic disorders in rats similar to patients with SA.80 Sprague Dawley male and female rats (8 weeks old) were kept in: 1) standard housing (2/cage; controls) or in 2) social isolation (1/cage). At the end of the three-week protocol, apneas were quantified by whole-body plethysmography during sleep; respiratory variability was assessed by Poincaré plot analysis. Cardiovascular measurements were obtained by tail cuff, body composition by preclinical magnetic resonance, and plasma leptin and corticosterone levels by multiplex immunoassay. The amount of food was weighed before and after the experiments to calculate the intake.By comparison with controls, SI elevated corticosterone levels in male but not females. SI increased the apnea index in intact rat by 21% and augmented respiratory instability. SI also increased blood pressure (+11mmHg) and food intake (+11g/day); however, females had lower increases than males. In males, SI increases weight gains, fat mass, and decreases plasma leptin levels; these effects were not observed in females.SI promotes the emergence of apnea and respiratory instability during sleep. Since the cardiorespiratory and metabolic disturbances are similar to clinical features of SA patient, we propose that stress plays an important role in the etiology of SA. SI offers a novel and unique opportunity to study the origins and pathophysiology of SA. This research is supported by operating grants from the Canadian Institutes of Health Research (CIRH, RK and VJ). N.J.M. was supported by a Sentinel North Partnered Research Chair in Sleep Pharmacometabolism and a Fonds de Recherche du Quebec Sante (FRQS) Research Scholar J1 award. MG is the recipient of a doctoral scholarship from the FRQS. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Stroke in Young Adults in Spain: Epidemiology and Risk Factors by Age.

Recent research has highlighted an increased incidence of ischemic stroke (IS) in young adults, along with a higher percentage of vascular risk factors at younger ages. This study aimed to estimate the in-hospital incidence of IS and associated comorbidities by sex and age group in Spain. A retrospective analysis of the Spain Nationwide Inpatient Sample database from 2016 to 2019 was conducted, which included adult patients with IS. In-hospital incidence and mortality rates were estimated, and a descriptive analysis of the main comorbidities was performed, stratified by sex and age groups. A total of 186,487 patients were included, with a median age of 77 (IQR 66-85) years and 53.3% were male. Of these, 9162 (5%) were aged between 18 and 50 years. The estimated incidence of IS in adults younger than 50 years ranged from 11.9 to 13.5 per 100,000 inhabitants during the study period, with a higher incidence in men. The overall in-hospital mortality was 12.6%. Young adults with IS had a higher prevalence of most vascular risk factors compared to the general Spanish population, with a specific distribution according to sex and age. This study provides estimates of the incidence of IS and the prevalence of vascular risk factors and comorbidities associated with IS in Spain, stratified by sex and age, using a national registry of hospital admissions. These findings should be considered in terms of both primary and secondary prevention strategies.

Characterizing Hospital Admissions in Persons with Parkinson’s Disease: 10-Year Retrospective Study of Administrative Data in Alberta, Canada (P10-11.015)

<h3>Objective:</h3> To characterize the landscape of province-wide hospital admissions in persons with Parkinson’s disease (PD) and inform future healthcare improvement in this population. <h3>Background:</h3> Persons with PD tend to have longer hospital stays and are more likely to suffer from adverse events. The province of Alberta, Canada has a single healthcare provider (Alberta Health Services), permitting collection of population-level data from all healthcare facilities. <h3>Design/Methods:</h3> We performed a population-based, retrospective cohort study using discharge abstract data for all persons admitted to hospital from 2011 through 2021, in Alberta. We extracted data from the Discharge Abstract Database (DAD), which contains ICD-10-CA coded diagnoses for all patients discharged from hospital. Hospitalizations with PD as both main and pre-admission comorbid diagnoses were identified using the ICD-10-CA G20 (PD) and F02.3 (Dementia in PD) codes. <h3>Results:</h3> A total of 17168 hospitalizations were identified during the study period. Mean age was 78 (SD 9 years), and 39% (6761) were female. Median length of hospital stay was 12 days (interquartile range 27). For most patients, the attending service was family practice/general practice (67%, 11496), followed by internal medicine (16%, 2763), orthopedics (6%, 959), psychiatry (3%, 504), and neurology (3%, 497). In-hospital adverse events occurred in 11% (1857) of admissions; 1% (122) were life-threatening. The outcome in 54% (9289) of admissions was discharge home, 24% (4099) long-term care, and 13% (2244) to rehab or other acute care facility. In-hospital mortality was 7% (1225). <h3>Conclusions:</h3> Our study describes the landscape of PD hospitalization in a Canadian context. The main admitting specialties are family practice and internal medicine, and over half of patients are discharged home. Future directions include further analysis of this data to understand predictors for adverse outcomes and guide care delivery improvement. <b>Disclosure:</b> Dr. Mahjoub has nothing to disclose. Dr. Peters has nothing to disclose.

Potentially inappropriate prescriptions in geriatric patients hospitalized in the internal medicine department of a referral hospital in Mexico.

Potentially inappropriate prescription (PIP) constitutes a risk for the development of adverse effects of a drug that outweigh its benefits, which can be considered inappropriate medication use. To describe the prevalence of PIP in geriatric patients hospitalized at the internal medicine department of a referral hospital in Mexico. Cross-sectional, descriptive design, with simple allocation of medical records from patients older than 65 years hospitalized between January 2016 and August 2017. The STOPP/START criteria were applied to identify the number of PIPs, the number of prescribed medications, number and type of comorbidities, as well as days of hospital stay. A prevalence of PIP of 73.3% was identified, with main comorbidities being hypertension and type 2 diabetes mellitus. A total of 1,885 prescribed medications were quantified; mean hospital stay was 6.3 days. A high prevalence of PIP was identified in hospitalized geriatric patients, hence the importance of applying the STOPP/START criteria and of the role of the pharmacist for validating the prescription prior to drug administration.

The Predictors of Postoperative Cerebrospinal Fluid Leak in Endoscopic Endonasal Pituitary Surgery: The Role of Tumor Volume.

Objectives Postoperative cerebrospinal fluid (Po-CSF) leak is still a challenging complication of endoscopic endonasal skull base surgery. However, data describing the predictive factors of Po-CSF leak in pure pituitary adenomas is lacking. Aim of this study is to determine the risk factors of Po-CSF leak in a pituitary adenoma group operated via pure transsellar endoscopic approach. Design This is a retrospective cohort study. Setting A single-center academic hospital. Participants Patients operated for a pituitary adenoma between 2015 and 2021 and followed up until June 2022 were included. Main Outcome Measures Demographics, comorbidities, imaging, and outcome were recorded. Univariate and multivariate logistic regression analyses were used to determine the risk factors of Po-CSF leak. Results Of the total 170 patients with a mean age of 47.5 ± 13.8 (min: 15; max: 80), 11 (6.5%) had Po-CSF leak. Univariate analysis revealed age, diabetes mellitus (DM), and tumor volume as predictors of Po-CSF leak. According to the receiver operating characteristic analysis, 7.5 cm 3 of tumor volume was found to be a good cutoff value with a sensitivity of 82% and a specificity of 75%. Hence, multivariable logistic regression model adjusted by age showed that a tumor volume of > 7.5 cm 3 (odds ratio [OR]: 22.9; 95% confidence interval [CI]: 3.8-135.9, p = 0.001) and DM (OR: 8.9; 95% CI: 1.7-46.5; p = 0.010) are strong independent risk factors of Po-CSF leak in pure endoscopic endonasal pituitary surgery. Conclusion Besides younger age and DM, a cutoff value for tumor volume > 7.5 cm 3 is the most remarkable risk factor for Po-CSF leak in pure endoscopic pituitary surgery. These patients should carefully be assessed preoperatively and potential preemptive surgical strategies should be taken into consideration to avoid complications.

Risks Factor after Surgical Site Infection with and without Mesh Incisional Hernia

Background: Systemic problems, mesh infections, and hernia recurrence have all been related to wound infections that appear after a hernia repair. Objective: To assess the risks factor after surgical site infection with and without mesh incisional hernia. Methodology: The study was a Prospective interventional study which was conducted in Department of Colorectal Surgery Bangabandhu Sheikh Mujib Medical University from April, 2019- September, 2020 using a semi-structured questionnaire through face to face interview. Data were analysed using a computer programme SPSS 24.0 version. Result: The mean age of no mesh group was 55.83±8.42 years while the mesh group was 53.29±9.81 years. A majority of male patients in both, no mesh (70.8%) and mesh (66.7%), groups. The mean BMI of no mesh group was 25.13±5.49 while the mesh group was 26.98±4.46. 3 patients at 4th week and 1 patient at 3rd month had infection in no mesh group. And, 7 patients at 4th week, 2 at 3rd month and 1 patient at 6th month had infection in the mesh group. There was no difference statistically between no mesh and mesh groups (p=0.094, p=0.472 and p=0.280 at 4th week, 3rd month and 6th month, respectively. Conclusion: Obesity, tobacco use, and diabetes mellitus are the three main patient comorbidities that can be modified and are substantially linked to postoperative surgical site infection in hernia surgery. Weight reduction, quitting smoking, and diabetes management are all part of preoperative optimization.

Cardiac Involvement in COVID-19: A Matter Close to the Heart, Beyond the Acute Illness

Human infection with the SARS-CoV-2 virus and COVID-19 have been ravaging the entire world since December 2019. As of February 17, 2023, records from the World Health Organization point to more than 756 million confirmed cases and approximately 6,845,000 deaths. In Brazil, until this date, approximately 36,961,000 cases have been reported, with about 698,000 deaths. Among the deaths, the main comorbidities reported are heart disease (40%), diabetes (28%), obesity (10%), neurological diseases (5%), kidney diseases (5%), and pneumopathies (5%). Furthermore, [...]

Dental Infection Requiring Hospitalisation Is a Public Health Problem in Australia: A Systematic Review Demonstrating an Urgent Need for Published Data

Background: The aim of this systematic review was to analyse the published literature on dental infections leading to hospitalisations in Australia. It was hoped that understanding the patterns and trends would form a basis for improved preventive and management policies. Methods: An electronic search was performed using Web of Science, Medline via Ovid and Google Scholar. Inclusion and exclusion criteria were applied. The included studies were analysed for demographics, aetiology, management, length of hospital stay and outcome of dental infections requiring hospitalisation. Results: Nine retrospective studies were eligible for inclusion. A total of 2196 cases of dental infections leading to hospitalisations were reported, with a male predominance (55-67%). Mental health issues, illicit substance abuse and immunosuppression were the main associated comorbidities (up to 58%). Dental caries (59-90%) and pericoronitis (10-19%) were the leading causes of dental infections. Empirical antibiotics were utilised in up to 75% of cases prior to hospital presentation. Six mortalities were reported. Conclusions: The available published data show that dental infection is a significant public health problem. However, only general conclusions were possible due to the variably small sample size and data collection that was inconsistent and incomplete across studies. Improved data collection is required to develop policies for prevention and management.

Comorbidities associated with maternal mortality from COVID-19 in Mexico.

In Mexico, there is a syndemic in pregnant women, where the epidemic of obesity and chronic diseases coexists with that of coronavirus disease 2019 (COVID-19), which has been associated with a higher risk of maternal mortality. To evaluate the association of comorbidities during pregnancy with maternal mortality from COVID-19 in Mexico. SISVER COVID-19 databases and epidemiological surveillance reports on maternal mortality were used. Multivariate logistic regression models were used to evaluate the association of comorbidities with maternal deaths from COVID-19. A total of 29,416 pregnant women were evaluated, out of which 39% were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); the risk of maternal mortality was 3.24 times higher (p < 0.01) for positive in comparison with negative women. COVID-19 is the leading cause of maternal death since July 2020 and explains more than 50% of total deaths in 2021. Chronic kidney disease (odds ratio [OR]: 4.11; p < 0.01) and diabetes (OR: 2.53; p < 0.01) were the two main comorbidities that were positively associated with maternal death from COVID-19. Comorbidities during pregnancy that are possibly associated with an increase in the inflammatory response and an alteration of the immune response increase the risk of maternal death from COVID-19 in Mexican pregnant women.

Epidemiology of hospitalized patients with COVID-19 in a tertiary care hospital.

COVID-19, caused by the betacoronavirus SARS-CoV-2, has overwhelmed the world's health systems. To describe the epidemiological characteristics of patients treated in a tertiary care hospital. A retrospective cohort study of patients diagnosed with or suspected of having COVID-19 from March 23 to July 31, 2020 was conducted. 4,401 patients were hospitalized at Central Military Hospital, out of which 35 % were beneficiaries, 26 % civilians, 28 % active military personnel, and only 11 %, retired military personnel. Male gender predominated, both in hospitalized patients and in those who died, as well as the O+ group and absence of comorbidities; among the observed comorbidities, the main ones were overweight and diabetes. Hospitalized patients' median age was 49 years, while median age of those who died was 62 years; women older than 51 years had a higher risk of dying. Adjusted case fatality rate was 18.5 %; 50 % died within the first six days. In this study, the epidemiological characteristics and main comorbidities in Mexican patients with SARS-CoV-2 infection were identified.

25. Hypertension as the Main Comorbidity Diseases in Covid-19 Patients with Diabetes Mellitus: A Single Centre in North Sumatera, Indonesia

Background: The outbreak of coronavirus disease 2019 (COVID-19) is the leading worldwide healthcare problem. Clinical observations have shown that patients with acute respiratory syndrome coronavirus 2 infection admitted to the hospital were more often those with diabetes mellitus (DM) or hypertension, and a meta-analysis confirmed these findings. Studies of co-morbidities associated with an unfavorable outcome pointed to hypertension and DM as the main comorbid disease along with cardiovascular disease, and chronic obstructive lung disease. Objective: to investigate the clinical characteristics, comorbidities, presenting symptoms, laboratory results, and outcomes Method: All patients aged 18 years or older, who were admitted to Universitas Sumatera Utara Hospital for COVID-19 and confirmed with DM, during June 2020 - December 2021 were included in this retrospective study. The discharge summary, states whether the patient is recovered or dead at the end of the hospital stay. Result: This study was conducted on 141 inpatients, admitted to hospital for COVID-19. Of a total of 90 patients who were confirmed with DM (63.8%), only 37 patients fulfilling the inclusion and exclusion criteria with comorbidities of hypertension (35·1%), cardiovascular disease (10·8%), chronic kidney disease (8·1%), chronic obstructive lung disease (7·1%), and without comorbidities other than DM (13.5%). Mean age was 60.7 (±11.11) years; 54.1% of the patients were male. The most common symptoms were cough (70.3%). Diarrhea was uncommon (8.1%). 35.1% of these patients died. Conclusion: The most frequent comorbidities in this study of COVID-19 patients with DM are hypertension

Clinical Characteristic of Different SARS-CoV-2 Variants in South Kalimantan, Indonesia: A Case Study

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has undergone various mutations of Corona Virus Disease 2019 (COVID-19). The World Health Organization (WHO) has designated B.1.617.2 (Delta) and B.1.1.529 (Omicron) as variants of concern (VOC). Since clinical features and epidemiological characteristics of patients infected with SARS-CoV-2 variants remain largely unknown, especially in Indonesia, this study aimed to identify the clinical characteristics of COVID-19 patients from South Kalimantan, Indonesia.Methods: Data from medical records of COVID-19 patients at Ulin General Hospital Banjarmasin from June 2021 to February 2022 were randomly extracted, containing demographic data, comorbidities, and laboratory data, as well as the type of virus. Results: In total, 32 patients were included, 9 were infected with delta, 14 with probable omicrons, and 9 with non-VOC. Patients in the probable Omicron group were significantly older than other groups (median age 64 years old, range 54–73 years; p=0.049), had hypertension as the dominant comorbidity (85.7%; p=0.039), the onset appeared slightly earlier (median 3 days; range 2-3 days, p=0.062), with no anosmia symptom (p=0.006). Critical illness predominated and mostly survived in all variants but was not statistically significant (p=0.590 and 0.726, respectively). The three variants showed similarities in laboratory findings; hence, statistical analysis suggested that the leucocytes differed significantly (p=0.020).Conclusions: Patients with the likely Omicron variant are much older, have hypertension as their main comorbidity, do not have any symptoms of anosmia, and have higher leukocyte counts compared to other variants.

New coronavirus infection in pediatric practice: clinical and epidemiological features of COVID-19 in the city of Smolensk

The aim of the study was to study the clinical and epidemiological features of the new COVID-19 coronavirus infection in children hospitalized in the infectious department. Material and methods . 249 case histories of patients from 0 to 18 years of age who are on inpatient treatment at «Clinical Hospital N1» in Smolensk for the period from April 2020 to July 2022 were studied by the continuous sampling method. Verification of a new coronavirus infection was carried out by examining smears from the nasopharynx and oropharynx for the presence of SARS-CoV-2 by real-time PCR. Results . The prevalence of patients from 1 to 3 (19.3%, 49.1%) and from 6—15 (15.8%, 50.5%) years was revealed both in 2020 and in 2021 and the first half of 2022. No significant differences in gender were found. The largest number of cases in 2020 was registered in April (16%) and November (14%), in 2021 — in December (18%) and November (16%). The prevailing severity in both 2020 and 2021, 2022 was the average severity (63% , 72%, 93%, respectively). The main syndromes of COVID-19 have been identified: intoxication syndrome, respiratory catarrhal syndrome, bronchopulmonary, intestinal. Bilateral pneumonia was most often detected (47% in 2020 , 44% in 2021, 62% in 2022), right-sided pneumonia (33% in 2020, 30% in 2021, 31% in 2022 ), and left-sided pneumonia (20%, 26% and 7%, respectively). The main comorbid pathologies are noted, and cases of somatic diseases first registered against the background of COVID-19 are described.

A low BUN/creatinine ratio predicts histologically confirmed acute interstitial nephritis

IntroductionIn hospitalized patients with acute renal injury (AKI), acute tubulointerstitial nephritis (AIN) constitutes one of the leading etiologies. The objective of this study was to identify clinical and biochemical variables in patients with AKI associated with kidney biopsy-confirmed AIN.MethodsFor our prospective study, we recruited hospitalized patients aged 18 years and older who were diagnosed with AKI based on biochemical criteria. Prior to enrollment, each patient was assessed with a complete metabolic panel and a kidney biopsy.ResultsThe study consisted of 42 patients (with a mean age of 45 years) and equal numbers of male and female patients. Diabetes and hypertension were the main comorbidities. Nineteen patients had histological findings consistent with AIN. There was a correlation between histology and the BUN/creatinine ratio (BCR) (r = -0.57, p = 0.001). The optimal Youden point for classifying AIN via a receiver operating characteristic (ROC) curve analysis was a BCR ≤ 12 (AUC = 0.73, p = 0.024). Additionally, in diagnosing AIN, BCR had a sensitivity of 76%, a specificity of 81%, a positive predictive value of 81%, a negative predictive value of 76%, and OR of 14 (95% CI = 2.6 to 75.7, p = 0.021). In the multivariable analysis, BCR was the sole variable associated with AIN.ConclusionA BCR ≤ 12 identifies AIN in patients with AKI. This study is the first to prospectively assess the relationship between renal biopsy results and BCR.

Clinical Aspects Of Hypertensive Patients With COVID-19 Hospitalized In A Campaign Hospital In Northeast Brazil

Background In view of the absence of effective therapy for COVID-19, many studies have been conducted seeking to identify determining factors for the development of severe forms, aiming to direct efforts to avoid the worst outcomes in patients susceptible to severe conditions. One of the main comorbidities associated with complicated forms of the disease is systemic arterial hypertension (SAH). Objective To assess aspects of the clinical, demographic, laboratory, and radiological characteristics of hypertensive patients with COVID-19 to contribute to [...]

Effect of Immuno-Nutrition on Malnutrition, Inflammatory Response and Clinical Course of Semi-Critically Ill COVID-19 Patients: A Pilot Perspective Study.

The SARS-COV 2 pandemic has hit on our lives since early 2020. During different contagion waves, both malnutrition and overweight significantly correlated with patient mortality. Immune-nutrition (IN) has shown promising results in the clinical course of pediatric inflammatory bowel disease (IBD) and in both the rate of extubation and mortality of patients admitted to an intensive care unit (ICU). Thus, we wanted to assess the effects of IN on a clinical course of patients admitted to a semi-intensive COVID-19 Unit during the fourth wave of contagion that occurred at the end of 2021. we prospectively enrolled patients admitted to the semi-intensive COVID-19 Unit of San Benedetto General hospital. All patients had a biochemical, anthropometric, high-resolution tomography chest scan (HRCT) and complete nutritional assessments at the time of admission, after oral administration of immune-nutrition (IN) formula, and at 15 days interval follow-up. we enrolled 34 consecutive patients (age 70.3 ± 5.4 years, 6 F, BMI 27.0 ± 0.5 kg/m2). Main comorbidities were diabetes (20%, type 2 90 %), hyperuricemia (15%), hypertension (38%), chronic ischemic heart disease (8 %), COPD (8%), anxiety syndrome (5%), and depression (5%). 58% of patients were affected as moderately-to-severely overweight; mini nutritional assessment (MNA) score (4.8 ± 0.7) and phase angle (PA) values (3.8 ± 0.5) suggestive of malnutrition were present in 15% of patients, mainly with a history of cancer. After 15 days upon admission, we recorded 3 deaths (mean age 75.7 ± 5.1 years, BMI 26.3 ± 0.7 kg/m2) and 4 patients were admitted to the ICU. Following IN formula administration, inflammatory markers significantly decreased (p < 0.05) while BMI and PA did not worsen. These latter findings were not observed in a historical control group that did not receive IN. Only one patient needed protein-rich formula administration. in this overweight COVID-19 population immune-nutrition prevented malnutrition development with a significant decrease of inflammatory markers.