Random Occurrence or Real Association? Primary Hyperparathyroidism in a Young Man With Sickle Cell Disease.

A 32-year-old man with sickle cell disease (SCD) was admitted to the hospital for sickle cell crisis, during which laboratory workup revealed primary hyperparathyroidism. His treatment regimen included hydration, calcitonin, and calcimimetics. A parathyroid nuclear scan revealed anomalous parathyroid tissue. The precise relationship between primary hyperparathyroidism (PHPT) and SCD remains incompletely understood but may involve factors such as vitamin D deficiency, elevated erythropoietin levels, and the influence of growth factors on the development of parathyroid adenomas. Furthermore, the concurrent occurrence of both PHPT and SCD at an earlier age may potentiate adverse long-term outcomes. Effective management of PHPT in SCD entails addressing hypercalcemia and treating the underlying cause of hyperparathyroidism. While a potential association between PHPT and SCD exists, further research is essential to better elucidate their interaction, prevalence, clinical presentations, and outcomes.

The Risk of and Associated Demographic and Laboratory Variables for Amputations for Inpatients with Diabetic Foot Ulcers.

OBJECTIVE: Diabetic foot ulcers (DFUs) are a leading cause of morbidity and mortality, which disproportionately impacts underserved populations. This study aimed to provide data regarding the rates and outcomes of amputation in patients admitted with DFU in our health system, which cares for an ethnically diverse and underserved population. METHODS: This retrospective study examined the electronic medical records of adult patients hospitalized with DFU at 3 hospitals in our health system between June 1, 2016, and May 31, 2021. RESULTS: Among 650 patients admitted with DFU, 88% self-identified as non-White race. Male sex (odds ratio [OR], 0.62), low body mass index (OR, 0.98), and history of smoking (OR, 1.45) were significantly associated with amputation during the study period. A higher erythrocyte sedimentation rate (OR, 1.01), C-reactive protein level (OR, 1.05), and white blood cell count (OR, 1.11) and low albumin level (OR, 0.41) were found to be significantly associated with amputation versus no amputation during admission. The amputation risk during the index admission for DFU was 44%. CONCLUSION: Our study identified a high DFU-related amputation risk (44%) among adult patients who were mostly Black and/or Hispanic. The significant risk factors associated with DFU amputation included male sex, low body mass index, smoking, and high levels inflammation or low levels of albumin during admission. Many of these patients required multidisciplinary care and intravenous antibiotic therapy, necessitating a longer length of stay and high readmission rate.

Conocimientos, actitudes y prácticas sobre la COVID-19 en adultos de la República Dominicana / Knowledge, attitudes and practices regarding COVID-19 in adults from the Dominican Republic

Introducción: Con la aparición del nuevo miembro de la familia coronavirus, SARS-CoV-2, la humanidad inició una batalla contra una enfermedad hasta el momento desconocida, la COVID-19. Objetivo: Determinar los conocimientos, actitudes y prácticas sobre la COVID-19 al inicio del estado de emergencia en la población adulta dominicana. Métodos: Se realizó un estudio de corte transversal, entre el 3 y el 17 de abril de 2020. El instrumento de recolección fue un cuestionario en línea con 4 secciones; características sociodemográficas, conocimientos, actitudes y prácticas sobre la COVID-19. La muestra estuvo integrada por 1861 participantes. Resultados: El 45,7 por ciento de los integrantes conocía que en ausencia de fiebre un infectado puede transmitir el virus a otro, 27,7 por ciento consideró suficiente la información circulante en la población dominicana, 32,2 por ciento confiaba que el gobierno dominicano controlaría la pandemia, 91,7 por ciento usaba mascarillas en multitudes. Conclusiones: Los resultados revelan un alto nivel de conocimiento, actitudes optimistas y prácticas adecuadas sobre la COVID-19 durante el brote inicial de la enfermedad en el país. República Dominicana enfrenta un gran desafío para controlar la transmisión del virus, pero a diferencia de otros países, una proporción significativa de los participantes no confían en las capacidades de las instituciones gubernamentales para su control. Aunque se deben realizar otros estudios a nivel comunitario en niveles socioeconómicos más bajos(AU)

Introduction: With the appearance of a new member in the coronavirus family, SARS-CoV-2, humanity started a battle against a hitherto unknown disease, COVID-19. Objective: To determine the knowledge, attitudes and practices concerning COVID-19 at the beginning of the emergency in the Dominican adult population. Methods: A cross-sectional study was conducted between April 3 and 17, 2020. The data collection instrument was an online questionnaire with four sections: sociodemographic characteristics, knowledge, attitudes and practices concerning COVID-19. The sample consisted of 1861 participants. Results: 45.7 percent of the members knew that, in the absence of fever, an infected person can transmit the virus to another person. 27.7 percent considered the information circulating in the Dominican population as sufficient. 32.2 percent trusted that the Dominican government would control the pandemic. 91.7 percent wore face masks in crowded places. Conclusions: The results reveal a high level of knowledge, optimistic attitudes and appropriate practices concerning COVID-19 during the initial outbreak of the disease in the country. The Dominican Republic faces a great challenge to control the transmission of the virus; but, unlike other countries, a significant proportion of the participants do not trust the capacities of government institutions to control it. However, other studies should be carried out at the community or at lower socioeconomic levels(AU)

Anticoagulación sostenible en COVID-19: Revisión de predicción de gravedad y razonamiento clínico / Sustainable anticoagulation in COVID-19: Review of severity prediction and clinical reasoning

RESUMEN Objetivo Identificar el fenómeno procoagulante en pacientes SARS-CoV- 2 y proponer orientación terapéutica sostenible para países de bajos ingresos. Método Se realizó una revisión sistemática que identificó cinco estudios observacionales de un escrutinio a partir de 78 resultados. Se examinaron 712 pacientes y los resultados fueron agrupados según mortalidad y severidad. La comparación de los grupos se interpretó mediante estadística descriptiva. Resultado Los valores del dímero D se asociaron significativamente en todas las observaciones a mayor severidad y mortalidad. La protrombina se asoció, en algunas observaciones, a mayor mortalidad; en cuanto a severidad, los resultados fueron inconclusos. Conclusión El COVID-19 tiene importante actividad procoagulante y su tratamiento oportuno puede alterar el pronóstico. La evidencia explorada avala métodos sostenibles. Se necesita más evidencia para mejorar el manejo. Se recomienda un abordaje sistemático temprano de los pacientes con medidas terapéuticas sostenibles a la medida del sistema de salud.

ABSTRACT Objective To identify the procoagulant phenomenon in SARS-CoV-2 patients and propose sustainable therapeutic guidance for low-income countries. Methods A systematic review was conducted. It identified 5 observational studies from a scrutiny from 78 results. 712 patients were examined and the results were grouped according to mortality and severity. The comparison of the groups was interpreted using descriptive statistics. Results D-dimer values were significantly associated with greater severity and mortality. Prothrombin was associated in some observations with higher mortality, but in terms of severity it was inconclusive. Conclusion COVID-19 disease has significant procoagulant activity and its timely treatment can alter the prognosis. The explored evidence supports sustainable methods. More evidence is needed to improve management. An early systematic approach to patients with sustainable therapeutic measures tailored to the health system is recommended.

[Sustainable anticoagulation in COVID-19: Review of severity prediction and clinical reasoning]. / Anticoagulación sostenible en COVID-19: Revisión de predicción de gravedad y razonamiento clínico.

OBJECTIVE: To identify the procoagulant phenomenon in SARS-CoV-2 patients and propose sustainable therapeutic guidance for low-income countries. METHODS: A systematic review was conducted. It identified 5 observational studies from a scrutiny from 78 results. 712 patients were examined and the results were grouped according to mortality and severity. The comparison of the groups was interpreted using descriptive statistics. RESULTS: D-dimer values were significantly associated with greater severity and mortality. Prothrombin was associated in some observations with higher mortality, but in terms of severity it was inconclusive. CONCLUSION: COVID-19 disease has significant procoagulant activity and its timely treatment can alter the prognosis. The explored evidence supports sustainable methods. More evidence is needed to improve management. An early systematic approach to patients with sustainable therapeutic measures tailored to the health system is recommended.

OBJETIVO: Identificar el fenómeno procoagulante en pacientes SARS-CoV- 2 y proponer orientación terapéutica sostenible para países de bajos ingresos. MÉTODO: Se realizó una revisión sistemática que identificó cinco estudios observacionales de un escrutinio a partir de 78 resultados. Se examinaron 712 pacientes y los resultados fueron agrupados según mortalidad y severidad. La comparación de los grupos se interpretó mediante estadística descriptiva. RESULTADO: Los valores del dímero D se asociaron significativamente en todas las observaciones a mayor severidad y mortalidad. La protrombina se asoció, en algunas observaciones, a mayor mortalidad; en cuanto a severidad, los resultados fueron inconclusos. CONCLUSIÓN: El COVID-19 tiene importante actividad procoagulante y su tratamiento oportuno puede alterar el pronóstico. La evidencia explorada avala métodos sostenibles. Se necesita más evidencia para mejorar el manejo. Se recomienda un abordaje sistemático temprano de los pacientes con medidas terapéuticas sostenibles a la medida del sistema de salud.