Proportion Of Severe Patients Research Articles

Clinical manifestations of COVID-19 infection in dialysis patients and protective effect of COVID-19 vaccine.

COVID-19 infection poses a special challenge to patients with dialysis patients. The purpose of this study was to evaluate the clinical manifestations of dialysis patients with COVID-19 and the protective effect of the vaccine. We included 41 studies based on big data, mainly analyzing the clinical symptoms of dialysis patients with COVID-19, the proportion of severe patients before and after vaccination, and the humoral reaction of vaccine in the body. 6.1% to 35.7% of dialysis patients with COVID-19 developed respiratory distress symptoms and needed to be admitted to an intensive care unit for mechanical ventilation. The incidence and mortality of COVID-19 in dialysis patients before vaccination were 5.5% and 1.1%, respectively, and decreased to 4.5% and 0.6% in breakthrough infected patients. There was no statistical difference in serum conversion rates between dialysis patients and healthy controls, but the neutralizing antibody titer in the control group was 1922 (IQR 533 to 3186) AU/mL, and the neutralizing antibody titer in dialysis patients significantly decreased to 367 (IQR 171 to 1650) AU/mL (P=0.046). Dialysis is associated with an increased risk of severe COVID-19, and generally has a poor seroconversion response to vaccines. It also confirms the protective effect of vaccines on high-risk populations such as dialysis.

Study of CT-Guided Localization in Pulmonary Nodule Resection.

Objective In recent years, with the attention of the general people to health, the surgical treatment of small nodules has become necessary. However, some nodules are too small, too deep, or difficult to reach, and it is difficult to accurately locate small nodules in the process of routine resection. In order to solve this problem and increase the success rate of puncture surgery, this study analyzed the application value of zoning localization method guided by CT in patients with pulmonary nodules. Methods The clinical history of patients with pulmonary nodules treated in Anhui Third Affiliated Hospital was retrospectively studied and analyzed. 97 patients with solitary pulmonary nodules treated in Anhui Third Affiliated Hospital from June 2021 to August 2021 were divided into observation group and reference group according to whether CT-guided localization method was used during operation. The operation rate, 1-year survival rate, recurrence rate, and pulmonary nodule metastasis rate of the two groups were compared; the results showed that the CT-guided zonal localization method was long and short, accurate, safe, and reliable. Comprehensive comparison through market survey on postoperative recovery compares the variability of patient data by using the statistical bivariatet-calibration method and using sensitivity specificity to analyze whether the CT-guided positioning method has advantages.Results The data underlying the results presented in the study are available within the manuscript. The results showed that there were 37 cases of pulmonary nodules, accounting for 38.14%; there were 8 patients with lung cancer, accounting for 8.24%; the proportion of diagnosis and analysis results of pulmonary nodules in hospitalized patients was significant; the medical history and clinical diagnosis information of 37 patients with pulmonary nodules were tracked and analyzed in detail. The diagnostic results were as follows: 8 patients (21.62%) with stage I, 11 patients (29.72%) with stage II, and 18 patients (48.64%) with stage III. The proportion of severe patients in the third stage was significantly higher than that in the first two stages; the results of CT-guided localization and conventional surgical resection were T < 10.000 and P < 0.05; the observation of prognosis and quality of life in the later stage of resection treatment showed that the observation group had obvious advantages over the reference group in terms of postoperative survival rate, recurrence rate, and nodule deterioration rate. The results show that the CT-guided zoning positioning operation is accurate, safe, and reliable.Conclusion The application of the CT-guided localization in the surgical treatment of pulmonary nodules is more safe and reliable. It can not only reduce the trauma but also improve the success rate of operation and reduce postoperative complications. It has the value of clinical promotion.

Outcome of COVID-19 in interstitial lung disease patients treated with anti-inflammatory drugs and antiviral drugs

A recent study reported that patients with interstitial lung disease (ILD) are at increased risk of death from coronavirus disease 2019 (COVID-19). However, there are no studies on the outcome of COVID-19 patients with preexisting ILD treated with corticosteroids or antiviral drugs. We extracted 26 patients with preexisting ILD by medical records and HRCT pattern. Of 503 patients with COVID-19, we selected 52 patients as control matched for age and sex. Twenty out of the 26 ILD patients (76.9%) received corticosteroid therapy, and 23 patients (88.5%) also received antiviral treatment with remdesivir or favipiravir. Although no statistical difference was found, the proportion of severe patients in ILD group tended to be higher than in non-ILD group (23.1% vs. 42.3%; p = 0.114). Also, mortality rate in ILD group tended to be higher than in non-ILD patients (11.5% vs. 3.8%; p = 0.326). In univariate analysis to evaluate risk factors for severe condition, diagnosis of idiopathic pulmonary fibrosis, usual interstitial pneumonia pattern, and honeycomb lung were not risk factors of severe disease. Treatment with corticosteroids, antiviral drugs, and immunosuppressive agents may affect the outcome of COVID-19 patients with ILD.

Elevated blood and cerebrospinal fluid glucose levels affect the severity and short-term prognosis of Guillain-Barré syndrome

ABSTRACT Objective This study aimed to explore the correlation of elevated glucose levels in the blood and cerebrospinal fluid with the progression and short-term prognosis of Guillain-Barré syndrome (GBS). Methods The medical records of 982 patients who were diagnosed with GBS in 31 representative tertiary hospitals, located in 14 provinces in southern China, were collected and retrospectively reviewed. Patients were grouped according to the levels of fasting plasma glucose (FPG) and cerebrospinal fluid (CSF) glucose, as well as the concentration of blood hemoglobinAlc (HbA1c). The Hughes grade scale was used to quantify functional outcomes. Results Compared to patients with normal FPG and CSF glucose levels, those in the high FPG and high CSF glucose groups were characterized by a higher proportion of severe patients (HFGS ≥ 3) at admission (58.8 vs. 73.1, P = 0.000; 57.6 vs. 71.2, P = 0.000), at nadir (67.4 vs. 83.0, P = 0.000; 66.2 vs. 80.4, P = 0.000), and at discharge (29.8 vs. 46.3, P = 0.000; 26.4 vs. 45.0, P = 0.000). Patients in the high HbA1c group also had more severe disability at admission (74.6 vs. 56.1, P = 0.005) and at nadir (80.3 vs. 64.3, P = 0.012) compared to the normal HbA1c group. Moreover, elevated levels of FPG and CSF glucose were significantly correlated with more severe disability at admission, at nadir, and at discharge. Conclusions The present study showed that elevated glucose levels in the blood and cerebrospinal fluid were associated with the severity and short-term prognosis of GBS. Trial registration chicTR-RRc-17,014,152. Abbreviations GBS, Guillain-Barré syndrome; FPG, fasting plasma glucose; CSF, cerebrospinal fluid; HFGS, Hughes Functional Grading Scale; HbA1c, hemoglobin A1c. DM, diabetes mellitus; NCS, nerve conduction study; AIDP, acute inflammatory demyelinating polyneuropathy; AMAN, acute motor axonal neuropathy; AMSAN, acute motor sensory axonal neuropathy; MV, mechanical ventilation.

Coronavirus disease 2019 in Northeastern Sichuan: clinical characteristics and treatment analysis of 59 cases

To analyze the epidemiological, clinical characteristics and treatment of coronavirus disease 2019 (COVID-19) in Northeastern Sichuan, and summarize experience in time to provide reference for clinical diagnosis and treatment. A retrospective study was conducted. Fifty-nine patients with COVID-19 admitted to Bazhong Central Hospital and Dazhou Central Hospital from January 27th to February 9th, 2020 were selected as the subjects. The data of demography, epidemiology, laboratory examination, chest CT and related clinical treatment were collected. According to the severity of the disease, the patients were divided into three types: mild, general and severe types, and the differences of the above indices among different clinical types were compared. (1) General information and epidemiology: 31 cases (52.5%) were male, 28 cases (47.5%) were female, the average age was (42.0±16.4) years old, and the patients over 40 years old accounted for the largest proportion (35 cases, 59.3%). The proportion of clinical type was 72.9% (43 cases) in general type, and 62.7% (37 cases) were imported type. With the increase of disease severity, the average age of patients also showed a significant increase trend [the age of the mild, general and severe patients were (30.9±13.6), (42.7±15.3), (55.8±18.9) years old, P < 0.01]. The proportion of patients with more than one basic disease in severe patients was significantly higher than those in mild and general patients [66.7% (4/6) vs. 20.0% (2/10), 9.3% (4/43), both P < 0.05]. In the distribution of clinical symptoms, the proportion of severe patients with chest distress/dyspnea was significantly higher than those in mild and general patients [66.7% (4/6) vs. 10.0% (1/10), 11.6% (5/43), both P < 0.05]. (2) Laboratory examination index: the total number of white blood cell count (WBC), neutrophils count (NEU), C-reactive protein (CRP) in severe patients were higher than those in mild patients and general patients [WBC (×109/L): 7.21±4.35 vs. 5.85±1.69, 5.43±2.04; NEU (×109/L): 6.09±4.43 vs. 3.95±1.45, 3.54±1.83; CRP (mg/L): 16.00 (8.20, 46.43) vs. 5.00 (0.00, 16.13), 15.00 (3.13, 28.58)], the albumin (Alb) level in severe patients was lower than those in mild and general patients (g/L: 38.00±5.35 vs. 49.23±5.27, 39.81±2.15, both P < 0.05), while the hemoglobin (Hb) level in mild patients was higher than that in severe and general patients (g/L: 155.2±12.1 vs. 141.3±6.8, 131.1±11.7, both P < 0.05). (3) Chest imaging: the CT manifestations of typical cases were single or multiple ground glass shadows. With the progress of the disease, the focus gradually increased, the scope gradually expanded, and multiple solid shadows of lung lobes were involved. (4) Treatment: all patients received at least 2 kinds of antiviral therapy, and the application rate of Interferon and Ribavirin in severe patients were higher than those in mild and general patients [100.0% (6/6) vs. 80.0% (8/10), 97.7% (42/43); 83.3% (5/6) vs. 0% (0/10), 20.9% (9/43); all P < 0.05]. (5) Prognosis: until March 6th 2020, 50 patients (84.8%) were discharged from the hospital after rehabilitation, and the remaining 9 patients were still under treatment, none deaths. The proportion of severe patients with chest distress/dyspnea is higher, the older the patients are and the more basic diseases are, the more likely they are to develop into severe type. High resolution chest CT could be considered for suspected cases or even fever patients, which may show the progress of the disease.

Guillain-Barr\xe9 syndrome triggered by surgery in a Chinese population: a multicenter retrospective study

BackgroundSurgery is a potential trigger of Guillain-Barré syndrome (GBS), a disorder which leads to an autoimmune-mediated attack of peripheral nerves. The present study was designed to explore clinical features of post-surgical GBS compared with those of general GBS in order to provide better clinical advice to patients undergoing surgery.MethodsThe medical records of GBS patients who were seen at 31 tertiary hospitals in southern China between January 1, 2013 and September 30, 2016 were retrospectively analyzed. Post-surgical GBS was defined as symptoms of GBS within 6 weeks after surgery. Clinical features of post-surgical GBS are described and are compared with general GBS.ResultsAmong the 1001 GBS patient cases examined in this study, 45 (4.5%) patient cases exhibited symptoms of GBS within 6 weeks of undergoing surgery. Within this group, 36 (80.0%) patients developed initial symptoms of limb weakness. The average interval between surgery and symptom onset was 13.31 days. The most common type of surgery which triggered GBS was orthopedic surgery, followed by neurological surgery. Compared to general GBS, post-surgical GBS was characterized by a higher proportion of severe patients (Hughes functional grading scale (HFGS) score ≥ 3) upon admission and at nadir, higher HFGS scores at discharge, and longer hospital stays. Post-surgical GBS patients also had a significantly higher frequency of the acute motor axonal neuropathy subtype (37.9 vs. 14.2, respectively; P = 0.001).ConclusionSurgery is probably a potential trigger factor for GBS, especially orthopedic surgery. Infections secondary to surgery may play a role. The possibility of preceding (post-operative) infections was not excluded in this study. Clinical presentation of post-surgical GBS is characterized by a more severe course and poorer prognosis, and should be closely monitored.Trial registrationchicTR-RRc-17,014,152.

Coronavirus diseases 2019 and kidney injury: a brief review based on current evidence.

Coronavirus diseases 2019 and kidney injury: a brief review based on current evidence.

Comparison of Prevalence and Risk Factors in COPD Patients With and Without History of Smoking

A prospective cross-sectional study to compare the prevalence and risk factors in chronic pulmonary obstructive disease (COPD) patient with and without a history of smoking. This was an observational study conducted in the department of respiratory medicine, Chettinad Hospital and Research Institute (CHRI), Kancheepuram. A total of 206 patients with COPD, diagnosed as per GOLD criteria were enrolled in the study. Out of 206 COPD patients, 164 (79.61%) were men, and 42 (20.4%) were women and their mean age was 62.88 (± 9.53). The prevalence of COPD patients in smokers/ex-smokers were 125 (60.7%) and 81 (39.3%) in never smokers. There were 75 patients (92.59%) in the never smoker cohort and 72 patients (57.6%) in the ex-smoker/smoker cohort found to have at least one non-smoking risk factor for COPD. Biomass Exposure (39.50%), Passive Smoking (22.22%, P=), Co-existing Asthma (22.22%) were the non-smoking risk factors which were found to be present significantly higher in never smokers than smokers/ex-smokers, and the difference was statistically significant (&lt;0.05). A higher proportion of severe patients were in smokers/ex-smokers than non- smokers (41.6% vs 27. 1%). Patients with moderate disease in both groups were found to be of equal proportion (12% vs 11. 11%). The results of the study reiterate that a significant proportion of COPD patients were never smokers and prevalence of non-smoking risk factors were more common in that population.

Classification of emphysematous pancreatitis and its relation to prognosis.

Emphysematous pancreatitis (EP) is a subtype of infectious pancreatic necrosis (IPN). It is characterized by the accumulation of gas inside or around the pancreatic necrotic tissue. This study aims to investigate the relation between classification and prognosis of EP, and to provide guidance for clinical diagnosis and treatment of IPN. A prospective cohort of 228 cases of IPN from January 2010 to June 2020 in the Department of General Surgery of Xiangya Hospital, Central South University were analyzed. Among them, 120 cases without peritoneal/retroperitoneal surgical intervention before admission were included. The 120 cases of IPN were classified into the EP group and the non-EP group. The general clinical information and results of pathogenic microorganism between the EP and the non-EP group were compared. EP patients were divided into early-EP (within 2 weeks of onset) and late-EP (after 2 weeks of onset) according to the presence timing of air bubble sign, and they were divided into extensive-EP and common-EP according to the distribution characteristics of bubble sign. The clinical characteristics between the survivors and non-survivors of both IPN and EP were compared. Among the 120 IPN patients, 25 (20.8%) were EP patients and 95 (79.2%) were non-EP patients. According to the classifications, 8 were early-EP (32.0%) and 17 were late-EP (68.0%); 15 were common-EP (60.0%) and 10 were extensive-EP (40.0%). There was no significant difference in gender, age, etiology, and mortality between the EP group and the non-EP group (all P>0.05). The percentage of Escherichia coli infection in the EP group was significantly higher than that in non-EP group (52.0% vs 16.5%, P<0.05). Among the 120 IPN patients, 35 died (IPN non-survivors) and 85 patients survived (IPN survivors). The mortality rate of IPN was 29.2%. There was no significant difference in gender, age, and etiology between the IPN non-survivors and the IPN survivors (all P>0.05). The proportion of severe patients in IPN non-survivors was significantly higher than that in the IPN survivors (97.1% vs 54.1%, P<0.05). Among the 25 cases of EP, 8 died (EP non-survivors) and 17 survived (EP survivors). The mortality rate of EP was 32.0%. There was no significant difference in gender, age, etiology, and time from gas detected to surgical intervention between the EP non-survivors and the EP survivors (all P>0.05). The proportion of early-EP and extensive-EP in the EP non-survivors was significantly higher than that in the EP survivors (both P<0.05). The mortality was up to 100% in the early- and extensive-EP patients. All of the EP non-survivors were severe patients, while 58.8% of the EP survivors were moderate or severe patients, the difference was statistically significant (P<0.05). All of the EP survivors underwent step-up surgical treatment strategy. Air bubble sign is not associated with the prognosis of IPN. Early- and extensive-EP often indicate worse prognosis. Aggressive surgical intervention based on step-up approach should be considered with priority.

Pertussis epidemiology and effect of vaccination among diagnosed children at Vietnam, 2015-2018.

To evaluate effect and costs of pertussis vaccination at Vietnam National Children's Hospital. Pertussis cases were defined by positive laboratory tests of children under 5years January 2015-June 2018, and data on patient characteristics, clinical data and hospitalisation costs were collected through patient records. Of 909 inpatients, 400 (44%) were <2months, the age for first DPT vaccination, and mechanical ventilation was more common than in children >2months (9% vs 4%, OR=2.3, CI 1.3-3.9), as well as persistent cough (99%), violent cough (87%) and pneumonia (91%). Comparing non-vaccinated (172 cases, 19%) and DPT vaccinated patients >2months of age hospitalisation was 106-fold higher (149.6 vs 1.39 per 100000 population), and proportion of severe patients, length of hospital stay and hospitalisation costs were significantly greater (23.9% vs 12.8%; 13 vs 10days; 826 USD vs 582 USD, CI 23-423, P=.03). Incidence and proportion of complications among under 2-month infants were higher than in older patients. DPT vaccination protects children from pertussis infection, and in case of pertussis infection decreases severity. Results indicate that the Ministry of Health should consider adding a booster vaccine for pregnant women in an extended vaccination programme.

Ongoing outbreak of human adenovirus-associated acute respiratory illness in the Republic of Korea military, 2013 to 2018.

Background/AimsHuman adenovirus type 55 (HAdV-55), an emerging epidemic strain, has caused several large outbreaks in the Korean military since 2014, and HAdV-associated acute respiratory illness (HAdV-ARI) has been continuously reported thereafter.MethodsTo evaluate the epidemiologic characteristics of HAdV-ARI in the Korean military, we analyzed respiratory virus polymerase chain reaction (RV-PCR) results, pneumonia surveillance results, and severe HAdV cases from all 14 Korean military hospitals from January 2013 to May 2018 and compared these data with nationwide RV surveillance data for the civilian population.ResultsA total of 14,630 RV-PCRs was performed at military hospitals. HAdV (45.4%) was the most frequently detected RV, followed by human rhinovirus (12.3%) and influenza virus (6.3%). The percentage of the military positive for HAdV was significantly greater than the percentage of civilians positive for HAdV throughout the study period, with a large outbreak occurring during the winter to spring of 2014 to 2015. The outbreak continued until the end of the study, and non-seasonal detections increased over time. The reported number of pneumonia patients also increased during the outbreak. Case fatality rate was 0.075% overall but 15.6% in patients with respiratory failure. The proportion of severe patients did not change significantly during the study period.ConclusionsA large HAdV outbreak is currently ongoing in the Korean military, with a trend away from seasonality, and HAdV-55 is likely the predominant strain. Persistent efforts to control the outbreak, HAdV type-specific surveillance, and vaccine development are required.

Abstract 112: 12-Month Healthcare Utilization and Expenditures in Medicare Advantage Patients With Mitral Regurgitation From the Medical Outcomes Research for Effectiveness and Economics Registry

Background: Mitral Regurgitation (MR) is associated with significant health care costs. This study aims to quantify the financial healthcare burden of Medicare Advantage (MA) patients across all MR patients from the Medical Outcomes Research for Effectiveness and Economics (MORE2) Registry. Methods: MA patients with a minimum of 1 inpatient or 2 outpatient claims for MR from 2008-2014 were reviewed. The index date was defined as a first inpatient claim or second outpatient claim. A 6-month pre-period (baseline) and 6-month post (washout) after index was used to define baseline etiology and severity. Three MR cohorts were defined: (1) Functional MR (FMR) was defined by the presence of heart failure during washout; (2) Degenerative MR (DMR) was defined by presence of chordal rupture or the absence of both heart failure and ischemia; and (3) Uncharacterized MR (UMR) was defined by patients otherwise not meeting the criteria for FMR or DMR. sMR was defined by a history of MR surgery, a diagnosis of atrial fibrillation or pulmonary hypertension, chordal rupture (DMR only), or record of two or more echocardiograms (per clinical guidelines) during washout. Demographics, comorbidities, healthcare utilization, and all-cause expenditures were summarized. Results: Of the 164,682 MA patients with MR who met inclusion criteria, 70,452 (43%) had FMR, 51,399 (31%) had DMR, and 42,831 (26%) had UMR. Average age (SD) was similar across cohorts: 74 (7.95), 72 (8.46), and 74 (7.45) years for FMR, DMR, and UMR, respectively. Proportion of severe patients and Charlson Comorbidity Index (CCI) indicates that the FMR cohort was “sicker” as compared to the others: FMR (41,325 [59% of 70,452]; CCI 4.56), DMR (16,169 [32% of 51,399]; CCI 1.67), and UMR (16,131 [38% of 42,831]; CCI 2.80). 2,079 patients (1.26% of total 164,682) received mitral valve surgery at index or washout with the highest occurrence in FMR patients (1,663), followed by UMR (327) and DMR (89). When comparing across the MR cohorts, the FMR cohort had higher rates of hospital admission, but length of stay was similar between cohorts (FMR [19.9%, 4-days], DMR [9.4%, 4-days], and UMR [13.6%, 3-days]). FMR had the highest annual all-cause healthcare costs (SD) ($22,569, [$59,876]), followed by UMR ($14,735 [$32,070]) and DMR ($10,485 [$23,934]). Conclusions: MR in the Medicare Advantage population is associated with a substantial health care burden, with FMR patients having the highest cost and utilization patterns. This population should, therefore, have access to innovative treatment options that relieve symptoms and reduce economic burden.