Predictors of mortality among hospitalized hypertensive patients with COVID-19 during third and fourth waves in Pakistan.

INTRODUCTION: Hypertension significantly contributes to the severity and mortality of COVID-19 patients. It has also been a risk factor for prolonged hospitalization and the need for intensive care. However, the data is still evolving. Therefore, this study investigated the predictors of mortality among hypertensive COVID-19 patients. METHODOLOGY: A single-center cohort study was performed at Indus Hospital and Health Network, Karachi, Pakistan, between April 1, 2021, and October 31, 2021. This study included 333 hospitalized hypertensive COVID-19 patients and evaluated their clinical characteristics and survival outcomes. A multivariate logistic regression model was applied in IBM SPSS 27.0 to determine the predictors of mortality. RESULTS: The majority of patients were females (54.7%), the median age was 62 [55-70] years, with co-existing diabetes (56.5%) and severely ill (52.6%). The independent predictors of mortality identified were age ≥ 65 years (aOR 20.89, 95% CI, 5.81-75.15; p < 0.001), pulse rate (aOR 1.03, 95% CI 1.01-1.63; p = 0.006), serum creatinine (aOR 1.34, 95% CI 1.11-1.63; p = 0.002), use of antibiotics (aOR 3.40, 95% CI 1.29-8.98; p = 0.014)), corticosteroid (aOR 49.68, 95% CI 1.83-1350.31; p = 0.020), and who needed high flow oxygen supply (aOR 13.08, 95% CI 1.70-100.54; p < 0.001), non-invasive mechanical ventilation (aOR 229.01, 95% CI 29.30-1789.71; p < 0.001) and invasive mechanical ventilation (aOR 379.54, 95% CI 36.60-3935.87; p < 0.001). CONCLUSIONS: Our study suggests that older age, elevated pulse rate, serum creatinine, use of antibiotics and corticosteroids, and the need for mechanical ventilation predict mortality among hypertensive COVID-19.

Venous thromboembolism prevention protocol for adapting prophylaxis recommendations to the potential risk post total knee replacement: a randomized controlled trial.

BACKGROUND: Total knee replacement (TKR) is a major orthopedic surgery that is considered high risk for the development of venous thromboembolism (VTE). OBJECTIVE: The aim of this study is to evaluate the clinical outcomes that resulted from the use of a new proposed VTE risk stratification protocol for selecting a suitable extended VTE prophylaxis for post TKR surgery patients administered in conjunction with patient education programs. METHOD: A randomized controlled trial was conducted in two medical centers in Saudi Arabia. A total of 242 patients were enrolled in the study, 121 patients in each group. The experimental group (A) was assessed by using the proposed VTE risk stratification protocol and also took part in patient education programs about TKR and its complications. The control group (B) was assessed by using the 2005 Caprini risk assessment tool and no education programs were given to this group. Both groups were followed for 35 days post operation. RESULTS: The mean age of the participants was 65.86 (SD 8.67) and the majority of them were female 137 (56.6%). The mean body mass index of the study sample was 32.46 (SD 5.51). There were no significant differences between the two groups except for surgery type; the proportion of bilateral TKR in group A was higher than in group B (69/121 (28.5%) vs. 40/121(16.5%), p<0.05). There were no confirmed pulmonary embolism cases in the study sample and diagnosis of deep-vein thrombosis was confirmed in 12/242 (5.0%) of patients: 1/121 (0.8%) in group A and 11/121 (9.1%) in group B (p<0.05). The readmission rate for all patients was 2.5% (6/242), all of whom were in group B (p<0.05). CONCLUSION: The proposed VTE risk stratification protocol that was applied in conjunction with patient education programs reduced VTE complications and readmission events, post TKR surgery. Trial Registration: ClinicalTrials.gov: Identifier: NCT04031859.

Psychometric properties of the Malay version of the Osteoporosis Health Belief Scale (OHBS-M) among Type 2 diabetic patients.

AIMS: The aims of this study were to translate and examine the psychometric properties of the Malaysian version of the Osteoporosis Health Belief Scale (OHBS-M) among type 2 diabetes patients (T2DM) and to assess the correlation between osteoporosis knowledge, health belief and self-efficacy scales, as well as assess the osteoporosis risk in the sample population using quantitative ultrasound measurement (QUS). METHODS: A standard 'forward-backward' procedure was used to translate OHBS into the Malay language, which was then validated with a convenience sample of 250 T2DM. Bone mineral density (BMD) measurements were carried out using QUS at the calcaneus. RESULTS: The mean score of OHBS-M was 158.31 ± 20.80. The Fleiss' kappa, content validity ratio range and content validity index were 0.99, 0.75-1.00 and 0.88, respectively. Seven factors of the OHBS-M were identified using exploratory factor analysis and were confirmed through confirmatory factor analysis. Internal consistency and test-retest reliability values were 0.89 and 0.555, respectively. In addition, only 22% had a normal BMD (low risk of abnormal BMD), while osteopenia and osteoporosis were 57.6% and 20.4% (considered as high risk of abnormal BMD), respectively. CONCLUSION: The results showed that the OHBS-M is a reliable and valid instrument for measuring health belief toward osteoporosis in diabetic patients. In addition, it is an appropriate tool to identify patients needing a bone health-promoting intervention regarding lifestyle behavior changes in a clinical setting. Moreover, the sample population showed high risk of osteoporosis and would subsequently benefit from dual-energy x-ray absorptiometry scanning for definite evaluation and treatment.