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1.
BMC Infect Dis ; 21(1): 158, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33557785

RESUMEN

INTRODUCTION: Increasing evidence indicate that coronavirus disease 2019 (COVID-19) is companied by renal dysfunction. However, the association of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)-induced renal dysfunction with prognosis remains obscure. MATERIALS AND METHODS: All 154 patients with COVID-19 were recruited from the Second People's Hospital of Fuyang City in Anhui, China. Demographic characteristics and laboratory data were extracted. Renal dysfunction was evaluated and its prognosis was followed up based on a retrospective cohort study. RESULTS: There were 125 (81.2%) mild and 29 (18.8%) severe cases in 154 COVID-19 patients. On admission, 16 (10.4%) subjects were accompanied with renal dysfunction. Serum creatinine and cystatin C were increased and estimated glomerular filtration rate (eGFR) was decreased in severe patients compared with those in mild patients. Renal dysfunction was more prevalent in severe patients. Using multivariate logistic regression, we found that male gender, older age and hypertension were three importantly independent risk factors for renal dysfunction in COVID-19 patients. Follow-up study found that at least one renal function marker of 3.33% patients remained abnormal in 2 weeks after discharge. CONCLUSION: Male elderly COVID-19 patients with hypertension elevates the risk of renal dysfunction. SARS-CoV-2-induced renal dysfunction are not fully recovered in 2 weeks after discharge.


Asunto(s)
/complicaciones , Enfermedades Renales/complicaciones , Riñón/fisiopatología , Adulto , Factores de Edad , Anciano , China , Creatinina/sangre , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Humanos , Hipertensión/complicaciones , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
2.
Medicine (Baltimore) ; 100(4): e23990, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530196

RESUMEN

ABSTRACT: The association between anemia and body mass index (BMI) in Koreans, considering kidney function, has not been clarified. Thus, we aimed to examine the association between anemia and BMI among Korean adults aged ≥19 years.This retrospective cross-sectional study evaluated male and female Korean adults aged ≥19 years who participated in the 5th, 6th, and 7th Korean National Health and Nutrition Examination Surveys (KNHANES) conducted between 2010 and 2017 were used. The participants were classified as underweight, normal weight, and overweight according to their BMI. Anemia was defined as hemoglobin levels of <13 g/dL for men and <12 g/dL for women according to the World Health Organization standards. Kidney function was evaluated according to the estimated glomerular filtration rate (eGFR), with abnormal kidney function in men defined as eGFR <60 mL/min/1.73 m2. Clinicodemographic variables were analyzed using logistic regression adjusted for weight. After propensity score matching (PSM), 6596 study participants were divided into 2 groups of 3298 participants each. Additionally, subgroup analysis by sex and kidney function was performed.On PSM, similar distribution patterns were obtained between the anemia and non-anemia groups; significant differences in BMI; kidney function; level of hemoglobin, hematocrit, and serum creatinine; iron intake; and eGFR were also observed between these groups. Anemia and BMI showed a significant association in both crude and adjusted logistic regression models. In model 2, which was adjusted for age, sex, education level, household income, alcohol consumption, smoking status, and exercise period, underweight men with abnormal kidney function showed a significantly higher risk of anemia than did normal weight men (odds ratio [OR]: 3.27; 95% confidence interval [CI]: 1.25-8.57; P = .016). Meanwhile, overweight men showed a significantly lower risk of anemia than did normal weight men (OR: 0.48; 95% CI: 0.33-0.70, P < .001).Anemia is associated with BMI according to sex. Compared with normal weight men, underweight men with abnormal kidney function had a significantly higher prevalence of anemia after adjusting for kidney function and sex, thus highlighting their need for careful management for anemia.


Asunto(s)
Anemia/epidemiología , Índice de Masa Corporal , Insuficiencia Renal/epidemiología , Adulto , Anciano , Peso Corporal , Creatinina/sangre , Estudios Transversales , Femenino , Tasa de Filtración Glomerular , Conductas Relacionadas con la Salud , Encuestas Epidemiológicas , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , República de Corea/epidemiología , Factores de Riesgo , Factores Socioeconómicos , Adulto Joven
3.
Medicine (Baltimore) ; 100(4): e24162, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530207

RESUMEN

ABSTRACT: Nosocomial infections (NI) are common complications after cardiac surgery. To date, there have been few manuscripts investigating NI in the intensive care unit after cardiac surgery. Our study was designed to investigate the characteristics of the distribution of pathogenic bacteria, antibiotic resistance and risk factors for NI.A total of 1360 patients received standard postoperative care, including antibiotic prophylaxis. Microbiological examinations of sputum, blood, catheter tips and excrement were performed as clinically indicated to isolate pathogens. Thirty potential associated variables were collected and compared between the 2 different groups according to the development of NI using univariate and multivariate analyses.Eighty-nine patients (6.54%) acquired a microbiologically documented NI. There was a significant difference in mortality between the 2 groups with or without postoperative NI (23.60% vs 2.28%, P < .00). A total of 98 pathogens (73.13%) were isolated from sputum, 32 pathogens (23.88%) from blood and only 1 (0.75%) from urine. Three (2.24%) surgical site infections were detected, including 2 superficial surgical site infections and 1 mediastinitis. The most common pathogens were Gram-negative bacteria (78.36%), followed by Gram-positive bacteria (14.93%) and fungi (6.71%). The major pathogenic species had different levels of drug resistance, and most of them exhibited multidrug resistance. Six out of thirty variables were identified as independent risk factors for the development of NI, namely, duration of surgery, low cardiac output syndrome, continuous veno-venous hemofiltration, mechanical ventilation time, reintubation and tracheostomy.We analyzed the characteristics of the distribution of pathogens, antibiotic resistance and risk factors for NI in our center and provided some suggestions for clinical practice. In addition to antibiotic treatment, avoidance of risk factors and aggressive infection control measures may be crucial to stop or prevent outbreaks.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Infección Hospitalaria/etiología , Infección Hospitalaria/microbiología , Factores de Edad , Antibacterianos/administración & dosificación , Profilaxis Antibiótica/métodos , Índice de Masa Corporal , Creatinina/sangre , Infección Hospitalaria/epidemiología , Farmacorresistencia Bacteriana , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Fumar/epidemiología , Infección de la Herida Quirúrgica/epidemiología
4.
Yonsei Med J ; 62(2): 164-171, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33527796

RESUMEN

PURPOSE: Calcineurin inhibitor (CNI) use has improved lung transplantation outcomes. However, significant perioperative complications in patients receiving CNI can deteriorate the early course of lung transplantation. To date, there is no consensus regarding the optimal agent for the induction regimen after lung transplantation. We aimed to determine the efficacy of basiliximab induction with delayed CNI initiation in the prevention of acute complications without compromising immunosuppression in high-risk patients. MATERIALS AND METHODS: Between January 2013 and December 2019, 236 patients at a single lung transplant center were retrospectively reviewed. Forty-one patients (17.4%) received basiliximab induction, and 195 patients (82.6%) received a routine triple-drug regimen without induction. The primary endpoint was postoperative acute kidney injury with several other postoperative outcomes as secondary end-points. RESULTS: Preoperatively, the induction group had a higher proportion of patients who were admitted before transplantation (95.1% vs. 47.7%, p<0.001) and received intensive unit care (90.2% vs. 33.8%, p<0.001) and extracorporeal membrane oxygenation (ECMO) (87.8% vs. 20.0%, p<0.001) compared to the non-induction group. No significant differences were observed in the incidence of acute rejection between groups (p=0.657), although lower incidence of postoperative complications, including acute kidney injuries or culture-proven infections, were observed in the induction group. However, the differences were not statistically significant. A subgroup analysis of high-risk and preoperative ECMO support groups showed similar results. CONCLUSION: Basiliximab induction with delayed CNI initiation for high-risk patients might decrease the incidence of perioperative complications, including acute renal failure, without increasing the risk of acute rejection.


Asunto(s)
Basiliximab/uso terapéutico , Inhibidores de la Calcineurina/uso terapéutico , Trasplante de Pulmón , Creatinina/sangre , Oxigenación por Membrana Extracorpórea , Femenino , Rechazo de Injerto/prevención & control , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/tratamiento farmacológico , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
5.
J Int Med Res ; 49(2): 300060521990248, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33541176

RESUMEN

OBJECTIVE: Lead is a toxic heavy metal, which causes irreversible damage in children. Oxidative stress is the underlying mechanism of lead toxicity, and monitoring oxidative stress of lead poisoning children in vivo is important. Our study aimed to investigate blood serum levels of biochemical parameters, including albumin, bilirubin, creatinine, and uric acid, which are regarded as non-enzymatic antioxidants, in children with lead poisoning. METHODS: We studied 355 children with lead poisoning and 355 age- and sex-matched controls. We analyzed clinical characteristics and measured serum levels of total protein, globulin, albumin, bilirubin, aspartate aminotransferase (AST), alanine aminotransferase, urea, and creatinine. RESULTS: We found that albumin, bilirubin, urea, and creatinine levels were significantly lower and AST, total protein, and globulin levels were higher in children with lead poisoning than in controls. Direct bilirubin, albumin, total protein, urea, creatinine, and AST levels were associated with lead poisoning after adjustment for other covariates. Spearman analysis showed that direct bilirubin, albumin, and urea levels were independent indicators (i.e., not related to hemoglobin or weight), while creatinine levels showed a moderate correlation with weight. CONCLUSION: Lead interferes with the non-enzymatic antioxidant system in children, and lead poisoning results in a decrease in serum bilirubin levels.


Asunto(s)
Bilirrubina/sangre , Intoxicación por Plomo/sangre , Plomo/toxicidad , Estrés Oxidativo/efectos de los fármacos , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Estudios de Casos y Controles , Niño , Preescolar , Creatinina/sangre , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Albúmina Sérica Humana/análisis , Ácido Úrico/sangre
6.
Medicine (Baltimore) ; 100(6): e24643, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578588

RESUMEN

ABSTRACT: Coronary slow flow phenomenon (CSFP) is a coronary artery disease in which coronary angiography shows no obvious stenosis, but there is a delay in blood flow perfusion. The etiopathogenic mechanisms of CSFP are still unclear. The aim of the present study was to investigate the role of clinical characteristics in patients with CSFP, and to provide a reference for exploring the potential mechanisms of CSFP. Patients with angiographically normal epicardial arteries were enrolled (145 patients with CSFP and 145 normal controls). Collected clinical information and laboratory indexes, which measured by peripheral venous blood samples before coronary angiography. Logistic regression analysis was performed for statistical analysis. The present study found 19 clinical and laboratory indexes with statistical differences between the two groups in univariate analysis. Multivariate analysis showed that monocyte count, haemoglobin, serum creatinine and globulin were independent predictors of CSFP. Moreover, the monocyte count, haemoglobin, creatinine and globulin levels were significantly higher in the CSFP patients than the controls, with positive associations between these parameters and the extent of CSFP. In addition, ROC analysis showed the diagnostic value of the above indexes for CSFP.


Asunto(s)
Enfermedad de la Arteria Coronaria/fisiopatología , Vasos Coronarios/fisiopatología , Fenómeno de no Reflujo/epidemiología , Fenómeno de no Reflujo/fisiopatología , Anciano , Estudios de Casos y Controles , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Circulación Coronaria/fisiología , Creatinina/sangre , Femenino , Globulinas/metabolismo , Hemoglobinas/análisis , Humanos , Recuento de Leucocitos/métodos , Masculino , Persona de Mediana Edad , Monocitos/citología , Fenómeno de no Reflujo/sangre , Fenómeno de no Reflujo/diagnóstico por imagen , Estudios Retrospectivos
7.
Medicine (Baltimore) ; 100(6): e24671, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578598

RESUMEN

ABSTRACT: The mortality rate of patients diagnosed with sepsis is high. To date, many markers in sepsis patients have been studied to diagnose, determine their prognosis, and contribute to treatment. These studies were conducted in both experimental and clinical settings, but clinical trials remain limited. Therefore, more well-planned clinical studies are needed in patients with sepsis.The current study aimed to examine the prognostic role of signal peptide-CUB-epidermal growth factor-like domain-containing protein 1 (SCUBE-1) in sepsis and sepsis-related mortality. We also wanted to study its relationship with inflammatory markers and scoring systems.This prospective, cross-sectional, observational study included a total of 187 sepsis cases treated in the intensive care unit. Venous samples were obtained after diagnosis. The patients were separated into 2 groups: (1) the survivor group who were discharged or transferred within 28 days of the first diagnosis and (2) the nonsurvivor group who died within 28 days of the first diagnosis.The SCUBE-1, C-reactive protein, procalcitonin, creatinine, lactate values, acute physiology and chronic health evaluation 2, sequential organ failure assessment scores were significantly higher in the survivor group, and platelets were higher in the survivor group. In addition, SCUBE-1 positively correlated with the inflammatory markers C-reactive protein, lactate, sequential organ failure assessment, and acute physiology and chronic health evaluation 2. Additionally, the SCUBE-1 value predicts 28-day mortality, and the optimal cutoff value for predicting mortality is 4,73 pg/mL.Sepsis is a disease with high mortality. SCUBE-1 can be used as a new prognostic factor for sepsis patients.


Asunto(s)
Biomarcadores/metabolismo , Proteínas de Unión al Calcio/metabolismo , Unidades de Cuidados Intensivos/estadística & datos numéricos , Sepsis/metabolismo , Sobrevivientes/estadística & datos numéricos , APACHE , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/metabolismo , Estudios de Casos y Controles , Reglas de Decisión Clínica , Creatinina/sangre , Estudios Transversales , Femenino , Humanos , Ácido Láctico/análisis , Masculino , Mortalidad/tendencias , Puntuaciones en la Disfunción de Órganos , Polipéptido alfa Relacionado con Calcitonina/metabolismo , Pronóstico , Estudios Prospectivos , Sepsis/diagnóstico , Sepsis/mortalidad , Turquia/epidemiología
8.
BMJ Case Rep ; 14(2)2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33558377

RESUMEN

A 43-year-old African American man presented with right upper quadrant pain and elevated blood pressure. Investigations revealed elevated lipase, hypercalcaemia and elevated creatinine. CT abdomen with contrast revealed extensive intraabdominal lymphadenopathy with an initial suspicion for a lymphoproliferative malignancy. Patient was managed for acute pancreatitis, with further workup of hypercalcaemia revealing an elevated ACE level. Inguinal lymph node biopsy confirmed a non-caseating granuloma leading to the diagnosis of sarcoidosis.


Asunto(s)
Enfermedades Pancreáticas/diagnóstico , Pancreatitis/etiología , Sarcoidosis/diagnóstico , Lesión Renal Aguda/etiología , Corticoesteroides/uso terapéutico , Adulto , Biopsia , Creatinina/sangre , Diagnóstico Diferencial , Humanos , Hipercalcemia/etiología , Lipasa/sangre , Ganglios Linfáticos/patología , Masculino , Enfermedades Pancreáticas/diagnóstico por imagen , Enfermedades Pancreáticas/tratamiento farmacológico , Sarcoidosis/diagnóstico por imagen , Sarcoidosis/tratamiento farmacológico , Tomografía Computarizada por Rayos X
9.
PLoS One ; 16(1): e0244779, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33400721

RESUMEN

BACKGROUND: Currently, the SARS-CoV-2 promptly spread across China and around the world. However, there are controversies about whether preexisting chronic kidney disease (CKD) and acute kidney injury complication (AKI) are involved in the COVID-19 pandemic. MEASUREMENTS: Studies reported the kidney outcomes in different severity of COVID-19 were included in this study. Standardized mean differences or odds ratios were calculated by employing Review Manager meta-analysis software. RESULTS: Thirty-six trials were included in this systematic review with a total of 6395 COVID-19 patients. The overall effects indicated that preexisting CKD (OR = 3.28), complication of AKI (OR = 11.02), serum creatinine (SMD = 0.68), abnormal serum creatinine (OR = 4.86), blood urea nitrogen (SMD = 1.95), abnormal blood urea nitrogen (OR = 6.53), received continuous renal replacement therapy (CRRT) (OR = 23.63) were significantly increased in severe group than that in nonsevere group. Additionally, the complication of AKI (OR = 13.92) and blood urea nitrogen (SMD = 1.18) were remarkably elevated in the critical group than that in the severe group. CONCLUSIONS: CKD and AKI are susceptible to occur in patients with severe COVID-19. CRRT is applied frequently in severe COVID-19 patients than that in nonsevere COVID-19 patients. The risk of AKI is higher in the critical group than that in the severe group.


Asunto(s)
Lesión Renal Aguda/epidemiología , Insuficiencia Renal Crónica/epidemiología , Lesión Renal Aguda/sangre , Nitrógeno de la Urea Sanguínea , China/epidemiología , Creatinina/sangre , Humanos , Oportunidad Relativa , Pandemias , Insuficiencia Renal Crónica/sangre , Resultado del Tratamiento
10.
Int Heart J ; 62(1): 193-196, 2021 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-33455988
11.
JACC Clin Electrophysiol ; 7(1): 16-25, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33478708

RESUMEN

OBJECTIVES: This study aimed to characterize corrected QT (QTc) prolongation in a cohort of hospitalized patients with coronavirus disease-2019 (COVID-19) who were treated with hydroxychloroquine and azithromycin (HCQ/AZM). BACKGROUND: HCQ/AZM is being widely used to treat COVID-19 despite the known risk of QT interval prolongation and the unknown risk of arrhythmogenesis in this population. METHODS: A retrospective cohort of COVID-19 hospitalized patients treated with HCQ/AZM was reviewed. The QTc interval was calculated before drug administration and for the first 5 days following initiation. The primary endpoint was the magnitude of QTc prolongation, and factors associated with QTc prolongation. Secondary endpoints were incidences of sustained ventricular tachycardia or ventricular fibrillation and all-cause mortality. RESULTS: Among 415 patients who received concomitant HCQ/AZM, the mean QTc increased from 443 ± 25 ms to a maximum of 473 ± 40 ms (87 [21%] patients had a QTc ≥500 ms). Factors associated with QTc prolongation ≥500 ms were age (p < 0.001), body mass index <30 kg/m2 (p = 0.005), heart failure (p < 0.001), elevated creatinine (p = 0.005), and peak troponin (p < 0.001). The change in QTc was not associated with death over the short period of the study in a population in which mortality was already high (hazard ratio: 0.998; p = 0.607). No primary high-grade ventricular arrhythmias were observed. CONCLUSIONS: An increase in QTc was seen in hospitalized patients with COVID-19 treated with HCQ/AZM. Several clinical factors were associated with greater QTc prolongation. Changes in QTc were not associated with increased risk of death.


Asunto(s)
Antibacterianos/efectos adversos , Azitromicina/efectos adversos , Inhibidores Enzimáticos/efectos adversos , Hidroxicloroquina/efectos adversos , Síndrome de QT Prolongado/inducido químicamente , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Comorbilidad , Creatinina/sangre , Quimioterapia Combinada , Electrocardiografía , Femenino , Insuficiencia Cardíaca/epidemiología , Hospitalización , Humanos , Síndrome de QT Prolongado/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Troponina I/sangre
12.
Clin Lab ; 67(1)2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33491433

RESUMEN

BACKGROUND: Since December 2019, a series of pneumonia cases caused by COVID-19 emerged in Wuhan, Hubei Province, China. People are generally susceptible to COVID-19 because people lack immunity to this new virus. With the spread of this epidemic disease from Wuhan, a national outbreak soon appeared, and now many countries have this disease. Unfortunately, no effective drug for COVID-19 treatment has been found so far. METHODS: We designed a retrospective study based on patients admitted to The Affiliated Infectious Hospital of Soochow University from January 22, 2020, to February 25, 2020, with diagnosed COVID-19. We analyzed correlations between RT-PCR negative time and laboratory indicators, then divided all cases into 2 groups according to oxygenation index, data of RT-PCR negative time and related laboratory indicators of the two groups were com-pared. RESULTS: We collected 84 confirmed patients whose RT-PCR had turned negative, including 23 patients with the lowest oxygenation index ≤ 300 mmHg and 61 patients had > 300 mmHg. There was a positive correlation between the RT-PCR negative time and age, WBC count, LDH, SCr. There were statistically significant differences in fever numbers, WBC count, lymphocyte count, CRP, ALT, AST, albumin, LDH, SCr, D-dimer, and fibrinogen between the two groups based on the oxygenation index. CONCLUSIONS: Age, WBC count, LDH, and SCr may be related to the duration of COVID-19 disease. Fever, WBC count, lymphocyte count, CRP, ALT, AST, albumin, LDH, SCr, D-dimer, and fibrinogen are related to the severity of acute lung injury.


Asunto(s)
Lesión Pulmonar Aguda/diagnóstico , Análisis Químico de la Sangre , /complicaciones , Lesión Pulmonar Aguda/sangre , Lesión Pulmonar Aguda/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Biomarcadores/sangre , Proteína C-Reactiva/análisis , /virología , Niño , Preescolar , China , Creatinina/sangre , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Lactante , Recién Nacido , L-Lactato Deshidrogenasa/sangre , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Valor Predictivo de las Pruebas , Pronóstico , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Albúmina Sérica Humana/análisis , Índice de Severidad de la Enfermedad , Factores de Tiempo , Adulto Joven
13.
Swiss Med Wkly ; 151: w20420, 2021 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-33516166

RESUMEN

The authors present the case of a 58-year-old man with the unique combination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and, later on, haemophagocytic lymphohistiocytosis admitted to the intensive care unit. During his ICU stay the patient developed a variety of complications including acute respiratory distress syndrome, pulmonary embolism, right heart failure and suspected HLH leading to multiorgan failure and death. Despite the proven diagnosis of haemophagocytic lymphohistiocytosis, the excessively high ferritin levels of the patient did not seem fully explained by this diagnosis. Therefore, the authors want to highlight different causes of hyperferritinaemia in critically ill patients and underline the importance of differential diagnoses when interpreting continuously rising ferritin levels.


Asunto(s)
Lesión Renal Aguda/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Fallo Hepático/fisiopatología , Linfohistiocitosis Hemofagocítica/fisiopatología , Embolia Pulmonar/fisiopatología , Lesión Renal Aguda/sangre , Lesión Renal Aguda/etiología , Alanina Transaminasa/sangre , /complicaciones , Creatinina/sangre , Progresión de la Enfermedad , Resultado Fatal , Insuficiencia Cardíaca/etiología , Humanos , Fallo Hepático/sangre , Fallo Hepático/etiología , Linfohistiocitosis Hemofagocítica/etiología , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/fisiopatología , Embolia Pulmonar/etiología , /fisiopatología , /terapia
14.
BMC Infect Dis ; 21(1): 113, 2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33494706

RESUMEN

BACKGROUND: To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia. METHODS: A total of 156 patients diagnosed with COVID-19 pneumonia at the Central Hospital of Wuhan from January 29, 2020, to March 20, 2020, and 20 healthy individuals were enrolled in this single-centered retrospective study. The epidemiological parameters, clinical presentations, underlying diseases, laboratory test results, and disease outcomes were collected and analyzed. RESULTS: The median age of all enrolled patients was 66 years. At least one underlying disease was identified in 101 COVID-19 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea, and fatigue. Compared to survival cases, patients who died during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate, and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received antibiotics and anti-viral treatment. In addition, 60 patients received corticosteroids, and 51 received intravenous immunoglobulin infusion. Forty-four patients received noninvasive ventilation and 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]), and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio] = 1.098, 95% CI [confidence interval]: 1.006-1.199, P = 0.037), shorter duration from onset to admission (OR = 0.853, 95% CI: 0.750-0.969, P = 0.015) and elevated lactate level upon admission (OR = 2.689, 95% CI: 1.044-6.926, P = 0.040) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR = 0.787, 95% CI: 0.686-0.903, P = 0.001) indicated a better prognosis. CONCLUSIONS: In this study, we discovered that age, duration from onset to admission, LYM (%), and lactate level upon admission were independent factors that affecting the in-hospital mortality rate.


Asunto(s)
/mortalidad , Mortalidad Hospitalaria , Adolescente , Corticoesteroides/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , /complicaciones , Enfermedades Cardiovasculares/epidemiología , Niño , China/epidemiología , Comorbilidad , Tos , Creatina Quinasa/sangre , Creatinina/sangre , Diabetes Mellitus/epidemiología , Brotes de Enfermedades , Femenino , Fiebre , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Hospitalización , Humanos , Hipertensión/epidemiología , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , L-Lactato Deshidrogenasa/sangre , Ácido Láctico/sangre , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Respiración Artificial , Insuficiencia Respiratoria/etiología , Estudios Retrospectivos , Factores de Riesgo , Sepsis/etiología , Albúmina Sérica/metabolismo , Choque Séptico/etiología , Adulto Joven
15.
BMC Infect Dis ; 21(1): 114, 2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33494713

RESUMEN

BACKGROUND: To investigate the effects of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blockers (ARBs) administration to hypertension patients with the coronavirus disease 2019 (COVID-19) induced pneumonia. METHODS: We recorded the recovery status of 67 inpatients with hypertension and COVID-19 induced pneumonia in the Raytheon Mountain Hospital in Wuhan during February 12, 2020 and March 30, 2020. Patients treated with ACEI or ARBs were categorized in group A (n = 22), while patients who were not administered either ACEI or ARBs were categorized into group B (n = 45). We did a comparative analysis of various parameters such as the pneumonia progression, length-of-stay in the hospital, and the level of alanine aminotransferase (ALT), serum creatinine (Cr), and creatine kinase (CK) between the day when these patients were admitted to the hospital and the day when the treatment ended. RESULTS: These 67 hypertension cases counted for 33.17% of the total COVID-19 patients. There was no significant difference in the usage of drug treatment of COVID-19 between groups A and B (p > 0.05). During the treatment, 1 case in group A and 3 cases in group B progressed from mild pneumonia into severe pneumonia. Eventually, all patients were cured and discharged after treatment, and no recurrence of COVID-2019 induced pneumonia occurred after the discharge. The length of stays was shorter in group A as compared with group B, but there was no significant difference (p > 0.05). There was also no significant difference in other general parameters between the patients of the groups A and B on the day of admission to the hospital (p > 0.05). The ALT, CK, and Cr levels did not significantly differ between groups A and B on the day of admission and the day of discharge (p > 0.05). CONCLUSIONS: To treat the hypertension patients with COVID-19 caused pneumonia, anti-hypertensive drugs (ACEs and ARBs) may be used according to the relative guidelines. The treatment regimen with these drugs does not need to be altered for the COVID-19 patients.


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Hipertensión/tratamiento farmacológico , Anciano , Alanina Transaminasa/sangre , Antihipertensivos , Creatina Quinasa/sangre , Creatinina/sangre , Progresión de la Enfermedad , Femenino , Hospitalización , Humanos , Hipertensión/complicaciones , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Mortalidad , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad
16.
BMC Surg ; 21(1): 62, 2021 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-33499844

RESUMEN

BACKGROUND: In hospitalized patients, abnormal plasma electrolyte concentrations are frequent and have been linked to poor outcomes following acute surgery. The aim of this study was to assess whether preoperative plasma levels of potassium, sodium, and creatinine at the time of admission were associated with 30-day mortality in patients following open abdominal surgery. METHODS: This was a single-center register-based retrospective study. By means of electronic search in a maintained surgery database, all patients (n = 4177) aged ≥ 60 years old undergoing open surgery in our department from January 2000 to May 2013 were identified. Plasma was assessed within 30 days prior to surgery. The primary endpoint was 30-day postoperative mortality. The association between mortality and plasma levels of potassium, sodium, and creatinine were examined using Cox proportional hazard models. RESULTS: A total of 3690 patients were included in the study cohort. The rates of abnormal preoperative plasma levels were 36, 41, and 38% for potassium, sodium, and creatinine, respectively. The overall 30 day mortality was 20%. A predictive algorithm for 30 day mortality following abdominal surgery was constructed by means of logistic regression showing excellent distinction between patients with and without a fatal postoperative outcome. CONCLUSION: Apart from demographic factors (age, sex, and emergency surgery), preoperative imbalance in potassium, sodium and creatinine levels were significant independent predictors of early mortality following open abdominal surgery.


Asunto(s)
Abdomen , Creatinina , Potasio , Sodio , Procedimientos Quirúrgicos Operativos , Abdomen/cirugía , Estudios de Cohortes , Creatinina/sangre , Humanos , Potasio/sangre , Cuidados Preoperatorios , Estudios Retrospectivos , Factores de Riesgo , Sodio/sangre , Procedimientos Quirúrgicos Operativos/mortalidad , Resultado del Tratamiento
17.
Yonsei Med J ; 62(1): 41-49, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33381933

RESUMEN

PURPOSE: Oral adsorbents delay disease progression and improve uremic symptoms in patients with chronic kidney disease (CKD). DW-7202 is a newly developed oral adsorbent with high adsorptive selectivity for uremic toxins. We evaluated patient preference for and adherence to DW-7202 versus AST-120 therapy and compared treatment efficacy and safety in patients with pre-dialysis CKD. MATERIALS AND METHODS: A seven-center, randomized, open-label, two-way crossover, active-controlled, phase IV clinical trial was conducted. Patients with stable CKD were randomly assigned to receive DW-7202 (capsule type) or AST-120 (granule type) for 12 weeks. The groups then switched to the other adsorbent and took it for the next 12 weeks. Patient preference was the primary outcome. Secondary outcomes included changes in estimated glomerular filtration rate (eGFR) and serum creatinine, cystatin C, and indoxyl sulfate (IS) levels. RESULTS: Significantly more patients preferred DW-7202 than AST-120 (p<0.001). Patient adherence improved after switching from AST-120 to DW-7202; there was no apparent change in adherence after switching from DW-7202 to AST-120. Changes in eGFR and serum creatinine, cystatin C, and IS levels were not significantly different according to adsorbent type. There was also no significant difference in the incidences of adverse events during treatment with DW-7202 and AST-120. CONCLUSION: DW-7202 can be considered as an alternative to AST-120 in patients who cannot tolerate or show poor adherence to granule type adsorbents. Further studies to evaluate factors affecting patient preferences and improved adherence are warranted (Clinical trial registration No. NCT02681952).


Asunto(s)
Insuficiencia Renal Crónica/tratamiento farmacológico , Adsorción , Carbono/administración & dosificación , Carbono/uso terapéutico , Creatinina/sangre , Estudios Cruzados , Cistatina C/sangre , Progresión de la Enfermedad , Femenino , Tasa de Filtración Glomerular/efectos de los fármacos , Humanos , Indicán/sangre , Masculino , Persona de Mediana Edad , Óxidos/administración & dosificación , Óxidos/uso terapéutico , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/fisiopatología , Resultado del Tratamiento
18.
PLoS One ; 15(12): e0243780, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33315944

RESUMEN

The purpose of this study was to investigate the effect of acute kidney injury (AKI) on the prognosis of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). A total of 347 HCC patients with Child-Pugh class A and pre-TACE serum creatinine (SCr) ≤1.5 mg/dL undergoing TACE as an initial therapy 2000-2014 were analyzed. Overall survival with related risk factors including AKI was investigated. We assessed AKI based on the International Club of Ascites (ICA)-AKI criteria. The mean age was 60.9 years. Of 347 patients, death was observed in 109 patients (31.4%). The mean SCr levels at pre-TACE, one day, two months, and four months after TACE were 0.9, 0.9, 0.9, and 1.1 mg/dL, respectively. The AKI within four months after TACE developed in 37 patients (11%). The AKI stages were non-AKI in 310 (89%), stage 1 in 10 (3%), stage 2 in 10 (3%), and stage 3 in 17 patients (5%). Multivariable analysis showed that the risk factors for overall survival were serum albumin ≤3.5 g/dL (hazard ratio [HR] 1.58, p = 0.027), BCLC stage B (HR 2.07, p = 0.008), BCLC stage C (HR 3.96, p<0.001), bilobar tumor location (HR 1.66, p = 0.022), AKI stage 1 (HR 6.09, p<0.001), AKI stage 2 (HR 8.51, p<0.001), and AKI stage 3 (HR 17.64, p<0.001). AKI is a crucial prognostic factor for overall survival in HCC patients undergoing TACE. The assessment of AKI based on the ICA-AKI criteria can facilitate evaluation of the prognosis of HCC patients undergoing TACE.


Asunto(s)
Lesión Renal Aguda/etiología , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/efectos adversos , Neoplasias Hepáticas/terapia , Anciano , Antineoplásicos/administración & dosificación , Carcinoma Hepatocelular/mortalidad , Creatinina/sangre , Doxorrubicina/administración & dosificación , Femenino , Humanos , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Oportunidad Relativa , Pronóstico , Modelos de Riesgos Proporcionales , Factores de Riesgo , Albúmina Sérica/análisis , Índice de Severidad de la Enfermedad , Tasa de Supervivencia
19.
Lancet Digit Health ; 2(10): e526-e536, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33328047

RESUMEN

BACKGROUND: The application of deep learning to retinal photographs has yielded promising results in predicting age, sex, blood pressure, and haematological parameters. However, the broader applicability of retinal photograph-based deep learning for predicting other systemic biomarkers and the generalisability of this approach to various populations remains unexplored. METHODS: With use of 236 257 retinal photographs from seven diverse Asian and European cohorts (two health screening centres in South Korea, the Beijing Eye Study, three cohorts in the Singapore Epidemiology of Eye Diseases study, and the UK Biobank), we evaluated the capacities of 47 deep-learning algorithms to predict 47 systemic biomarkers as outcome variables, including demographic factors (age and sex); body composition measurements; blood pressure; haematological parameters; lipid profiles; biochemical measures; biomarkers related to liver function, thyroid function, kidney function, and inflammation; and diabetes. The standard neural network architecture of VGG16 was adopted for model development. FINDINGS: In addition to previously reported systemic biomarkers, we showed quantification of body composition indices (muscle mass, height, and bodyweight) and creatinine from retinal photographs. Body muscle mass could be predicted with an R2 of 0·52 (95% CI 0·51-0·53) in the internal test set, and of 0·33 (0·30-0·35) in one external test set with muscle mass measurement available. The R2 value for the prediction of height was 0·42 (0·40-0·43), of bodyweight was 0·36 (0·34-0·37), and of creatinine was 0·38 (0·37-0·40) in the internal test set. However, the performances were poorer in external test sets (with the lowest performance in the European cohort), with R2 values ranging between 0·08 and 0·28 for height, 0·04 and 0·19 for bodyweight, and 0·01 and 0·26 for creatinine. Of the 47 systemic biomarkers, 37 could not be predicted well from retinal photographs via deep learning (R2≤0·14 across all external test sets). INTERPRETATION: Our work provides new insights into the potential use of retinal photographs to predict systemic biomarkers, including body composition indices and serum creatinine, using deep learning in populations with a similar ethnic background. Further evaluations are warranted to validate these findings and evaluate the clinical utility of these algorithms. FUNDING: Agency for Science, Technology, and Research and National Medical Research Council, Singapore; Korea Institute for Advancement of Technology.


Asunto(s)
Algoritmos , Composición Corporal , Creatinina/sangre , Aprendizaje Profundo , Procesamiento de Imagen Asistido por Computador/métodos , Modelos Biológicos , Retina , Área Bajo la Curva , Asia , Beijing , Biomarcadores , Grupos Étnicos , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculos , Redes Neurales de la Computación , Fotograbar , Curva ROC , República de Corea , Singapur , Reino Unido
20.
Rev. enferm. UERJ ; 28: e51034, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1118073

RESUMEN

Objetivo: verificar se a redução da taxa de hemoglobina no pós-operatório de revascularização do miocárdio interfere na função renal dos pacientes. Método: estudo observacional e prospectivo, desenvolvido entre fevereiro e junho de 2016, com 51 pacientes que realizaram cirurgia de revascularização do miocárdio em um hospital especializado em cardiologia do Distrito Federal. Os dados foram coletados por meio de um instrumento estruturado. O teste exato de Fisher, Qui-quadrado e Kruskal Wallis foram empregados para análise estatística. Considerou-se significativo resultados com p≤0,05. Projeto de pesquisa aprovado pelo Comitê de Ética, protocolo 44999215.9.0000.0026. Resultados: entre os pacientes, 45 (78,9%) evoluíram com lesão renal aguda após revascularização do miocárdio. Idade mais elevada (64±9 anos, p=0,05), tempo de circulação extracorpórea (p=0,05), índice de massa corporal (p=0,02), uso de antibióticos (p=0,03) e redução da taxa de hemoglobina (p=0,04), contribuíram para lesão renal aguda. Conclusão: a redução da taxa de hemoglobina foi associada estatisticamente à lesão renal aguda após revascularização do miocárdio.


Objective: to determine whether decreased hemoglobin rate after myocardial revascularization surgery interferes with patients' renal function. Method: this prospective, observational study was conducted between February and June 2016 with 51 patients who underwent myocardial revascularization surgery at a specialist cardiology hospital specializing in the Federal District. Data were collected using a structured instrument. The Fisher's exact, Chi-square and Kruskal-Wallis tests were used for statistical analysis. Results were considered significant at p ≤ 0.05. The research project was approved by the research ethics committee (Protocol 44999215.9.0000.0026). Results: it was observed that 45 patients (78.9%) developed acute kidney injury after myocardial revascularization. Oldest age (64 ± 9 years, p = 0.05), cardiopulmonary bypass time (p = 0.05), body mass index (p = 0.02), use of antibiotics (p = 0.03), and decreased hemoglobin rate (p = 0.04) contributed to acute kidney injury. Conclusion: decreased hemoglobin rate was statistically associated with acute kidney injury following myocardial revascularization.


Objetivo: verificar si la reduciendo la tasa de hemoglobina en el postoperatorio de revascularización miocárdica interfiere con la función renal de los pacientes. Método: estudio observacional prospectivo realizado entre febrero y junio de 2016 con 51 pacientes que se sometieron a una cirugía de revascularización miocárdica en un hospital especializado en cardiología en el Distrito Federal. Los datos fueron recolectados utilizando un instrumento estructurado. La prueba exacta de Fisher, Chicuadrado y Kruskal-Wallis se utilizaron para el análisis estadístico. Los resultados se consideraron significativos con p≤0.05. Proyecto de investigación aprobado por el Comité de Ética, protocolo 44999215.9.0000.0026. Resultados: se observó que 45 (78,9%) pacientes desarrollaron lesión renal aguda después de la revascularización miocárdica. Edad avanzada (64 ± 9 años, p = 0.05), tiempo de circulación corporal extra (p = 0.05), índice de masa corporal (p = 0.02), uso de antibióticos (p = 0.03) y tasa de hemoglobina reducida (p = 0.04), contribuyó a lesión renal aguda. Conclusión: reduciendo la tasa de hemoglobina contribuyó a lesión renal aguda después de la revascularización miocárdica.


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Hemoglobinas , Lesión Renal Aguda , Revascularización Miocárdica , Cuidados Posoperatorios , Brasil , Estudios Prospectivos , Creatinina/sangre , Estudio Observacional , Atención de Enfermería
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