Pub Date : 2022-07-01DOI: 10.4103/2221-6189.355326
Praphull Deepankar, G. Kumar, Jyoti Kr Dinkar, Rishav Mittal
Objective: To explore risk factors of mucormycosis in COVID-19 recovered patients. Methods: A total of 101 patients, who were diagnosed with mucormycosis after recovery from COVID-19 and admitted to the Indira Gandhi Institute of Medical Sciences, Patna, a tertiary care hospital in India, were included in the study. The presenting clinical features and associated risk factors were assessed and analyzed subsequently. Results: Of 101, 68 (67.3%) were males, and 33 (32.7%) were females. A total of 89 (88.1%) patients were between 46 and 65 years old. The most common subtypes were rhino-ocular (61.4%), followed by paranasal sinuses (16.8%), rhino-ocular cerebral (16.8%), ocular (3.0%), and pulmonary (2.0%). Diabetes mellitus was present in 71% of cases of mucormycosis as co-morbidities. A total of 76.2% of patients were given systemic corticosteroids in oral or intravenous form during COVID-19 treatment. Severe COVID-19 was present in 45.5% of patients with mucormycosis, while the moderate infection was present in 35.6% of mucormycosis. Most patients had gap between the onset of mucormycosis and COVID-19 <15 d. Conclusions: A lethal confluence of uncontrolled diabetes mellitus, corticosteroid usage, and COVID-19 could cause a dramatic rise in mucormycosis. So, clinicians must be aware of these risk factors in patients suffering as well as recovering from COVID-19 to prevent mucormycosis.
{"title":"Associated risk factors for post−COVID−19 mucormycosis at a tertiary care centre: A cross−sectional study","authors":"Praphull Deepankar, G. Kumar, Jyoti Kr Dinkar, Rishav Mittal","doi":"10.4103/2221-6189.355326","DOIUrl":"https://doi.org/10.4103/2221-6189.355326","url":null,"abstract":"Objective: To explore risk factors of mucormycosis in COVID-19 recovered patients. Methods: A total of 101 patients, who were diagnosed with mucormycosis after recovery from COVID-19 and admitted to the Indira Gandhi Institute of Medical Sciences, Patna, a tertiary care hospital in India, were included in the study. The presenting clinical features and associated risk factors were assessed and analyzed subsequently. Results: Of 101, 68 (67.3%) were males, and 33 (32.7%) were females. A total of 89 (88.1%) patients were between 46 and 65 years old. The most common subtypes were rhino-ocular (61.4%), followed by paranasal sinuses (16.8%), rhino-ocular cerebral (16.8%), ocular (3.0%), and pulmonary (2.0%). Diabetes mellitus was present in 71% of cases of mucormycosis as co-morbidities. A total of 76.2% of patients were given systemic corticosteroids in oral or intravenous form during COVID-19 treatment. Severe COVID-19 was present in 45.5% of patients with mucormycosis, while the moderate infection was present in 35.6% of mucormycosis. Most patients had gap between the onset of mucormycosis and COVID-19 <15 d. Conclusions: A lethal confluence of uncontrolled diabetes mellitus, corticosteroid usage, and COVID-19 could cause a dramatic rise in mucormycosis. So, clinicians must be aware of these risk factors in patients suffering as well as recovering from COVID-19 to prevent mucormycosis.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46379761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/2221-6189.355310
Aref Zarei, H. Modir, Behnam Mahmoodiyeh, A. Kamali, Farzad Zamani-Barsari
Objective: To compare effect of midazolam, dexmedetomidine, and ketamine as oral premedication on pediatric sedation and ease of parental separation anxiety in anesthesia induction. Methods: This multicenter, prospective, randomized, double-blind, clinical trial focused on a pediatric population aged 2-7 years (n=153) with the American Society of Anesthesiologists I-II who required elective surgery. The patients were stratified into three intervention groups: midazolam, ketamine, and dexmedetomidine. Hemodynamic parameters (blood pressure, heart rate, and oxygen saturation) every 5 min until induction of anesthesia along with non-hemodynamic factors, comprised of sedation score before the administration and at the time of being separated from the parents, as well as parental separation anxiety scale, acceptance of anesthesia induction, and side effects were recorded and compared. Results: No statistically significant difference in oxygen saturation, heart rate, blood pressure, duration of surgery, time to achieve an Aldrete score of 9-10, or sedation score was noted in the study groups. More patients in the dexmedetomidine and midazolam groups could better ease parental separation anxiety than the ketamine group (P=0.001). Moreover, fewer patients accept anesthesia induction (P=0.001) and more had side effects in the ketamine group (P=0.047). Conclusions: Our findings indicate that compared to the ketamine group, dexmedetomidine and midazolam are better in easing parental separation anxiety and accepting induction of anesthesia with fewer side effects. Dexmedetomidine and midazolam may be considered better choices. However, the final choice hinges on the patient′s specific physical condition and the anesthesiologist′s preference. Clinical registarion: This study is registered in the Iranian Registry Clinical Trial center with the clinical trial code of IRCT20211007052693N1.
{"title":"Effect of oral premedication of midazolam, ketamine, and dexmedetomidine on pediatric sedation and ease of parental separation in anesthesia induction for elective surgery: A randomized clinical trial","authors":"Aref Zarei, H. Modir, Behnam Mahmoodiyeh, A. Kamali, Farzad Zamani-Barsari","doi":"10.4103/2221-6189.355310","DOIUrl":"https://doi.org/10.4103/2221-6189.355310","url":null,"abstract":"Objective: To compare effect of midazolam, dexmedetomidine, and ketamine as oral premedication on pediatric sedation and ease of parental separation anxiety in anesthesia induction. Methods: This multicenter, prospective, randomized, double-blind, clinical trial focused on a pediatric population aged 2-7 years (n=153) with the American Society of Anesthesiologists I-II who required elective surgery. The patients were stratified into three intervention groups: midazolam, ketamine, and dexmedetomidine. Hemodynamic parameters (blood pressure, heart rate, and oxygen saturation) every 5 min until induction of anesthesia along with non-hemodynamic factors, comprised of sedation score before the administration and at the time of being separated from the parents, as well as parental separation anxiety scale, acceptance of anesthesia induction, and side effects were recorded and compared. Results: No statistically significant difference in oxygen saturation, heart rate, blood pressure, duration of surgery, time to achieve an Aldrete score of 9-10, or sedation score was noted in the study groups. More patients in the dexmedetomidine and midazolam groups could better ease parental separation anxiety than the ketamine group (P=0.001). Moreover, fewer patients accept anesthesia induction (P=0.001) and more had side effects in the ketamine group (P=0.047). Conclusions: Our findings indicate that compared to the ketamine group, dexmedetomidine and midazolam are better in easing parental separation anxiety and accepting induction of anesthesia with fewer side effects. Dexmedetomidine and midazolam may be considered better choices. However, the final choice hinges on the patient′s specific physical condition and the anesthesiologist′s preference. Clinical registarion: This study is registered in the Iranian Registry Clinical Trial center with the clinical trial code of IRCT20211007052693N1.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47979002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/2221-6189.355308
Razieh Avan, Afrooz Mazidimoradi, H. Salehiniya
Unbalanced magnesium levels in the body, like other minerals, are a factor that is important in the severity and mortality of COVID-19. This study was designed to investigate the relationship between serum magnesium levels and clinical outcomes in COVID-19 patients. In this systematic review, a comprehensive search was performed in PubMed, Scopus, and Web of Science databases until September 2021 by using the keywords COVID-19, severe acute respiratory syndrome coronavirus 2, coronavirus disease, SARS- COV-infection 2, SARS-COV-2, COVID 19, and magnesium. End-Note X7 software was used to manage the studies. Articles that evaluated effect of magnesium on COVID-19 were included in the analysis. After reviewing several articles,12 studies were finally included in the ultimate analysis. The studies show that hypomagnesemia and hypermagnesemia are both factors that increase mortality in patients with COVID-19, even in one study, hypomagnesemia is the cause of doubling thedeaths in COVID-19 patients. Some studies have also found a negative correlation between magnesium deficiency and infectionseverity, while some others have reported no correlation between magnesium level and disease severity. According to the important role of magnesium in the body and its involvement in many physiological reactions, as well as differences in physical and physiological conditions of COVID-19 patients, in addition to the need for studies with larger sample sizes, monitoring and maintaining normal serum magnesium levels during the disease seems necessary as a therapeutic target, especially in patients admitted to the intensive care unit.
与其他矿物质一样，体内镁水平失衡是新冠肺炎严重程度和死亡率的重要因素。本研究旨在研究新冠肺炎患者血清镁水平与临床结果之间的关系。在这篇系统综述中，在PubMed、Scopus和Web of Science数据库中使用关键字新冠肺炎、严重急性呼吸综合征冠状病毒2、冠状病毒疾病、SARS-COV-感染2、SARS-COV-2、COVID 19和镁进行了全面搜索，直到2021年9月。结束注释X7软件用于管理研究。分析中包括了评估镁对新冠肺炎影响的文章。在回顾了几篇文章后，最终将12项研究纳入最终分析。研究表明，低镁血症和高镁血症都是增加新冠肺炎患者死亡率的因素，即使在一项研究中，低镁症也是导致新冠肺炎患者死亡率翻倍的原因。一些研究还发现镁缺乏与传染性之间存在负相关，而另一些研究则报告镁水平与疾病严重程度之间没有相关性。根据镁在身体中的重要作用及其在许多生理反应中的参与，以及新冠肺炎患者身体和生理状况的差异，除了需要更大样本量的研究外，在疾病期间监测和维持正常的血清镁水平似乎是必要的治疗目标，尤其是在入住重症监护室的患者中。
{"title":"Effect of magnesium on severity and mortality of COVID–19 patients: A systematic review","authors":"Razieh Avan, Afrooz Mazidimoradi, H. Salehiniya","doi":"10.4103/2221-6189.355308","DOIUrl":"https://doi.org/10.4103/2221-6189.355308","url":null,"abstract":"Unbalanced magnesium levels in the body, like other minerals, are a factor that is important in the severity and mortality of COVID-19. This study was designed to investigate the relationship between serum magnesium levels and clinical outcomes in COVID-19 patients. In this systematic review, a comprehensive search was performed in PubMed, Scopus, and Web of Science databases until September 2021 by using the keywords COVID-19, severe acute respiratory syndrome coronavirus 2, coronavirus disease, SARS- COV-infection 2, SARS-COV-2, COVID 19, and magnesium. End-Note X7 software was used to manage the studies. Articles that evaluated effect of magnesium on COVID-19 were included in the analysis. After reviewing several articles,12 studies were finally included in the ultimate analysis. The studies show that hypomagnesemia and hypermagnesemia are both factors that increase mortality in patients with COVID-19, even in one study, hypomagnesemia is the cause of doubling thedeaths in COVID-19 patients. Some studies have also found a negative correlation between magnesium deficiency and infectionseverity, while some others have reported no correlation between magnesium level and disease severity. According to the important role of magnesium in the body and its involvement in many physiological reactions, as well as differences in physical and physiological conditions of COVID-19 patients, in addition to the need for studies with larger sample sizes, monitoring and maintaining normal serum magnesium levels during the disease seems necessary as a therapeutic target, especially in patients admitted to the intensive care unit.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46328466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/2221-6189.355328
Gautam Jesrani, A. Syal, Samiksha Gupta, Monica Gupta, Yajur Arya
Rationale: Delayed post-hypoxic leukoencephalopathy (DPHL) is usually an overlooked condition, which arises as a result of a multitude of reversible and irreversible conditions. Patient’s Concern: A 50-year-old female with a history of epilepsy, who developed DPHL 12 days after respiratory failure secondary to barbiturate toxicity. Diagnosis: DPHL on magnetic resonance imaging of the brain. Interventions: Mechanical ventilation was initiated for respiratory failure and hemodialysis for barbiturate toxicity. Outcomes: The patient developed akinetic mutism due to infirmity and had a residual disability, which led to permanent dependency. Lessons: The diagnosis of DPHL is often delayed or missed, given the rarity of this condition and its inconsistent clinical symptomatology. Diagnostic delay can be avoided by early recognition of the classical “delayed onset” symptoms.
{"title":"Delayed post−hypoxic leukoencephalopathy following barbiturate overdose: A case report","authors":"Gautam Jesrani, A. Syal, Samiksha Gupta, Monica Gupta, Yajur Arya","doi":"10.4103/2221-6189.355328","DOIUrl":"https://doi.org/10.4103/2221-6189.355328","url":null,"abstract":"Rationale: Delayed post-hypoxic leukoencephalopathy (DPHL) is usually an overlooked condition, which arises as a result of a multitude of reversible and irreversible conditions. Patient’s Concern: A 50-year-old female with a history of epilepsy, who developed DPHL 12 days after respiratory failure secondary to barbiturate toxicity. Diagnosis: DPHL on magnetic resonance imaging of the brain. Interventions: Mechanical ventilation was initiated for respiratory failure and hemodialysis for barbiturate toxicity. Outcomes: The patient developed akinetic mutism due to infirmity and had a residual disability, which led to permanent dependency. Lessons: The diagnosis of DPHL is often delayed or missed, given the rarity of this condition and its inconsistent clinical symptomatology. Diagnostic delay can be avoided by early recognition of the classical “delayed onset” symptoms.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48595714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To identify helpful laboratory paprameters for the diagnosis and prognosis of COVID-19. Methods: An observational retrospective study was conducted to analyze the biological profile of COVID-19 patients hospitalized in the Unit of Pulmonology at Setif hospital between January and December 2021. Patients were divided into two groups: the infection group and the control group with patients admitted for other pathologies. The infected group was further divided according to the course of the disease into non-severe and severe subgroups. Clinical and laboratory parameters and outcomes of admitted patients were collected. Results: The infection group included 293 patients, of whom 237 were in the non-severe subgroup and 56 in the severe subgroup. The control group included 88 patients. The results showed higher white blood cells, neutrophils, blood glucose, urea, creatinine, transaminases, triglycerides, C-reactive protein, lactate dehydrogenase, and lower levels of lymphocyte, monocyte and platelet counts, serum sodium concentration, and albumin. According to ROC curves, urea, alanine aminotransferase, C-reactive protein, and albumin were effective diagnosis indices on admission while neutrophil, lymphocyte, monocyte, glycemia, aspartate aminotransferase, and lactate dehydrogenase were effective during follow-up. Conclusions: Some biological parameters such as neutrophil, lymphocyte, monocyte, glycemia, aspartate aminotransferase, and lactate dehydrogenase are useful for the diagnosis of COVID-19.
{"title":"Different routine laboratory tests in assessment of COVID–19: A case–control study","authors":"Imene Adouani, Tassaadit Bendaoud, Hadjer Belaaliat, Wahiba Teniou, Faiza Keriou, F. Djabi","doi":"10.4103/2221-6189.355311","DOIUrl":"https://doi.org/10.4103/2221-6189.355311","url":null,"abstract":"Objective: To identify helpful laboratory paprameters for the diagnosis and prognosis of COVID-19. Methods: An observational retrospective study was conducted to analyze the biological profile of COVID-19 patients hospitalized in the Unit of Pulmonology at Setif hospital between January and December 2021. Patients were divided into two groups: the infection group and the control group with patients admitted for other pathologies. The infected group was further divided according to the course of the disease into non-severe and severe subgroups. Clinical and laboratory parameters and outcomes of admitted patients were collected. Results: The infection group included 293 patients, of whom 237 were in the non-severe subgroup and 56 in the severe subgroup. The control group included 88 patients. The results showed higher white blood cells, neutrophils, blood glucose, urea, creatinine, transaminases, triglycerides, C-reactive protein, lactate dehydrogenase, and lower levels of lymphocyte, monocyte and platelet counts, serum sodium concentration, and albumin. According to ROC curves, urea, alanine aminotransferase, C-reactive protein, and albumin were effective diagnosis indices on admission while neutrophil, lymphocyte, monocyte, glycemia, aspartate aminotransferase, and lactate dehydrogenase were effective during follow-up. Conclusions: Some biological parameters such as neutrophil, lymphocyte, monocyte, glycemia, aspartate aminotransferase, and lactate dehydrogenase are useful for the diagnosis of COVID-19.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45458629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/2221-6189.355327
Neeraj Kumar, Sushant Satyapriya, S. Tahaseen, Kunal Singh, Abhyuday Kumar
Rationale: The impact of COVID-19 in patients with autoimmune liver disease treated with immunosuppressive therapy has not been described so far. This case report describes the clinical course of a patient with autoimmune hepatitis (AIH) who developed COVID-19 and the features of cytokine syndrome leading to its deterioration in our intensive care unit. Patient’s Concern: A 28-year-old male presented with generalized anasarca for two weeks and chronic liver disease for 8 months. Diagnosis: AIH and Covid-19 with features of cytokine storm syndrome. Interventions: Intravenous furosemide, mannitol, syrup lactulose, steroids (prednisolone 40 mg), azathioprine 1 mg/kg body weight, rifaximin, vitamin K, and blood products. Outcomes: The patient had hepatic encephalopathy and AIH and died on the 10th day after admission despite ventilatory support, sustained low-efficiency hemodialysis, and resuscition. Lessons: The dramatic release of cytokines and the inflammatory-immune responses not only alter the pathophysiology but also affects the onset and severity of disease progression in patients with AIH.
{"title":"Severe progression of autoimmune hepatitis in a young COVID-19 adult patient: A case report","authors":"Neeraj Kumar, Sushant Satyapriya, S. Tahaseen, Kunal Singh, Abhyuday Kumar","doi":"10.4103/2221-6189.355327","DOIUrl":"https://doi.org/10.4103/2221-6189.355327","url":null,"abstract":"Rationale: The impact of COVID-19 in patients with autoimmune liver disease treated with immunosuppressive therapy has not been described so far. This case report describes the clinical course of a patient with autoimmune hepatitis (AIH) who developed COVID-19 and the features of cytokine syndrome leading to its deterioration in our intensive care unit. Patient’s Concern: A 28-year-old male presented with generalized anasarca for two weeks and chronic liver disease for 8 months. Diagnosis: AIH and Covid-19 with features of cytokine storm syndrome. Interventions: Intravenous furosemide, mannitol, syrup lactulose, steroids (prednisolone 40 mg), azathioprine 1 mg/kg body weight, rifaximin, vitamin K, and blood products. Outcomes: The patient had hepatic encephalopathy and AIH and died on the 10th day after admission despite ventilatory support, sustained low-efficiency hemodialysis, and resuscition. Lessons: The dramatic release of cytokines and the inflammatory-immune responses not only alter the pathophysiology but also affects the onset and severity of disease progression in patients with AIH.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45755679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.4103/2221-6189.342667
G. Michael
{"title":"Early severity predictors of snakebite envenomation in the southern region of Tunisia","authors":"G. Michael","doi":"10.4103/2221-6189.342667","DOIUrl":"https://doi.org/10.4103/2221-6189.342667","url":null,"abstract":"","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46033524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.4103/2221-6189.342661
D. Akyol, Z. Çukurova, E. Tulubas, G. Yıldız, M. Sabaz
Objective: To investigate the effects of perioperative goal-directed fluid therapy (GDFT) on intraoperative fluid balance, postoperative morbidity, and mortality. Methods: This is a prospective randomized study, and 90 patients who underwent elective open gastrointestinal cancer surgery between April 2017 and May 2018 were included. Patients were randomized into 2 groups that received liberal fluid therapy (the LFT group, n=45) and goal-directed fluid therapy (the GDFT group, n=45). Patients’ Colorectal Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM) physiological score, Charlson Comorbidity Index (CCI), perioperative vasopressor and inotrope use, postoperative AKIN classification, postoperative intensive care unit (ICU) hospitalization, hospital stay, and 30-day mortality were recorded. Results: The volume of crystalloid used perioperatively and the total volume of fluid were significantly lower in the GDFT group compared to the LFT group (P<0.05). CR-POSSUM physiological score and CCI were significantly higher in the GDFT group (P<0.05). Although perioperative vasopressor and inotrope use was significantly higher in the GDFT group (P<0.05), postoperative acute kidney injury development was not affected. Postoperative mortality was determined to be similar in both groups (P>0.05). Conclusion: Although GDFT was demonstrated to be a good alternative method to LFT in open gastrointestinal cancer surgery, and it can prevent perioperative fluid overload, and the postoperative results are comparable in the two groups.
{"title":"Goal-directed fluid therapy in gastrointestinal cancer surgery: A prospective randomized study","authors":"D. Akyol, Z. Çukurova, E. Tulubas, G. Yıldız, M. Sabaz","doi":"10.4103/2221-6189.342661","DOIUrl":"https://doi.org/10.4103/2221-6189.342661","url":null,"abstract":"Objective: To investigate the effects of perioperative goal-directed fluid therapy (GDFT) on intraoperative fluid balance, postoperative morbidity, and mortality. Methods: This is a prospective randomized study, and 90 patients who underwent elective open gastrointestinal cancer surgery between April 2017 and May 2018 were included. Patients were randomized into 2 groups that received liberal fluid therapy (the LFT group, n=45) and goal-directed fluid therapy (the GDFT group, n=45). Patients’ Colorectal Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM) physiological score, Charlson Comorbidity Index (CCI), perioperative vasopressor and inotrope use, postoperative AKIN classification, postoperative intensive care unit (ICU) hospitalization, hospital stay, and 30-day mortality were recorded. Results: The volume of crystalloid used perioperatively and the total volume of fluid were significantly lower in the GDFT group compared to the LFT group (P<0.05). CR-POSSUM physiological score and CCI were significantly higher in the GDFT group (P<0.05). Although perioperative vasopressor and inotrope use was significantly higher in the GDFT group (P<0.05), postoperative acute kidney injury development was not affected. Postoperative mortality was determined to be similar in both groups (P>0.05). Conclusion: Although GDFT was demonstrated to be a good alternative method to LFT in open gastrointestinal cancer surgery, and it can prevent perioperative fluid overload, and the postoperative results are comparable in the two groups.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45500894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.4103/2221-6189.342666
Degang Wang, Jianjiao Chen
Rationale: Emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment. The disease is often misdiagnosed due to its diversity of clinical manifestations. Patient’s concern: A 62-year-old woman was admitted to the emergency department following a 12-hour history of abdominal pain and dyspnea. Physical examination showed percussion pain on the right costovertebral angle. Besides, she had a history of diabetes mellitus and urinary calculus. Diagnosis: Emphysematous pyelonephritis. Intervention: The patient accepted antishock therapy, tight glucose control, and broad-spectrum anti-infective therapy. After stabilization of the general condition, an ultrasound-guided percutaneous nephrostomy was performed. Outcome: Her conditions became stable over the following days. She presented a favorable clinical course, with normalization of renal function and positive improvements in imaging findings in a month. Lessons: Early diagnosis and rapid medical management are the keys to successful treatment. CT is an important method for the diagnosis of emphysematous pyelonephritis. For patients with severe lesions, percutaneous renal drainage combined with active anti-infection should be given in time.
{"title":"An alveolate kidney: A case report of emphysema pyelonephritis","authors":"Degang Wang, Jianjiao Chen","doi":"10.4103/2221-6189.342666","DOIUrl":"https://doi.org/10.4103/2221-6189.342666","url":null,"abstract":"Rationale: Emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment. The disease is often misdiagnosed due to its diversity of clinical manifestations. Patient’s concern: A 62-year-old woman was admitted to the emergency department following a 12-hour history of abdominal pain and dyspnea. Physical examination showed percussion pain on the right costovertebral angle. Besides, she had a history of diabetes mellitus and urinary calculus. Diagnosis: Emphysematous pyelonephritis. Intervention: The patient accepted antishock therapy, tight glucose control, and broad-spectrum anti-infective therapy. After stabilization of the general condition, an ultrasound-guided percutaneous nephrostomy was performed. Outcome: Her conditions became stable over the following days. She presented a favorable clinical course, with normalization of renal function and positive improvements in imaging findings in a month. Lessons: Early diagnosis and rapid medical management are the keys to successful treatment. CT is an important method for the diagnosis of emphysematous pyelonephritis. For patients with severe lesions, percutaneous renal drainage combined with active anti-infection should be given in time.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45199957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.4103/2221-6189.342664
H. Nehara, Sahdev Kumawat, R. Kularia, J. Amareshwara, P. Batar, Vivek Goudgaon
Objective: To determine the association between body weight and COVID-19 outcomes. Methods: This is a retrospective cohort study of COVID-19 patients admitted in a dedicated COVID-19 hospital, a tertiary health care center, between May and June 2021. Demographic data and baseline variables, including age, sex, body mass index (BMI), and comorbidities were collected. Outcomes (death or mechanical ventilation) of the patients with different BMI, age, comorbidities, and qSOFA scores were compared. Besides, the risk factors for death or mechanical ventilation were determined. Results: The mean age of the subjects was (51.8±14.7) years old, and 233 (74.2%) were male. There were 103 (32.8%) patients with normal weight, 143 (45.5%) patients were overweight, and 68 (21.7%) patients were obese. In-hospital deaths and need of mechanical ventilations were significantly higher in the obese and the overweight group compared to the normal weight group, in age group ≥65 years compared to <65 years, in patients with ≥1 comorbidities compared to patients without comorbidities, in patients with qSOFA scores ≥2 compared to patients with qSOFA scores<2. There was a significantly increased risk of death (RR: 4.1, 95% CI 1.0-17.4, P=0.04) and significantly increased need of mechanical ventilation (RR: 5.2, 95% CI 1.8-15.2, P=0.002) in the obese patients compared with those with normal weight after controlling other covariates. Conclusion: Obesity is one of the significant risk factors for adverse outcomes in COVID-19 patients and should be considered during management.
目的:确定体重与COVID-19结局的关系。方法:对2021年5月至6月在三级卫生保健中心COVID-19专科医院住院的COVID-19患者进行回顾性队列研究。收集人口统计数据和基线变量，包括年龄、性别、体重指数(BMI)和合并症。比较不同BMI、年龄、合并症和qSOFA评分患者的结局(死亡或机械通气)。此外，确定死亡或机械通气的危险因素。结果:患者平均年龄(51.8±14.7)岁，男性233例(74.2%)。体重正常103例(32.8%)，超重143例(45.5%)，肥胖68例(21.7%)。肥胖和超重组的住院死亡率和机械通气需求明显高于正常体重组，年龄≥65岁组高于<65岁组，有≥1个合并症的患者高于无合并症的患者，qSOFA评分≥2的患者高于qSOFA评分<2的患者。在控制其他相关变量后，肥胖患者的死亡风险(RR: 4.1, 95% CI 1.0 ~ 17.4, P=0.04)和机械通气需求(RR: 5.2, 95% CI 1.8 ~ 15.2, P=0.002)显著高于体重正常患者。结论:肥胖是新冠肺炎患者不良结局的重要危险因素之一，应在治疗过程中予以考虑。
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