المؤلفون: Renin Chang, Yao-Min Hung, Hei-Tung Yip, Wei-Hsin Hung, Jie Sung, Wen-Yee Chen, James Cheng-Chung Wei, Lu-Ting Chiu

المصدر: QJM: An International Journal of Medicine. 115:587-595

مصطلحات موضوعية: medicine.medical_specialty, Population, Antivenom, Taiwan, Snake Bites, Cohort Studies, medicine, Humans, education, Stroke, Retrospective Studies, education.field_of_study, Antivenins, Venoms, business.industry, Hazard ratio, Retrospective cohort study, General Medicine, medicine.disease, Confidence interval, Hemorrhagic Stroke, Emergency medicine, Propensity score matching, business, Cohort study

الوصف: Summary Background and purpose Stroke is a rare complication of snakebites, but may lead to serious sequelae. We aimed to explore the relationship between venomous snakebite and the risk for acute stroke, in a nationwide population-based cohort study. Methods This retrospective cohort study used claims data between 1 January 2000 and 31 December 2012, from the Taiwan National Health Insurance Research Database. The study included data of patients aged 18 years or older with venomous snakebite (n = 535), matched for propensity score with controls without venomous snakebite (n = 2140). The follow-up period was the duration from the initial diagnosis of venomous snakebite and administration of antivenom to the date of an acute stroke, or until 31 December 2013. The competing risk model was used to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) of stroke, ischemic stroke and hemorrhagic stroke, after adjusting for demographic and other possible stroke risk factors. Results The adjusted HR for the venomous snakebite group compared with the control group was 2.68 for hemorrhagic stroke (95% CI = 1.35-5.33). Stratified analysis showed that the older age group (>65 years old) had a higher risk of hemorrhagic stroke. A 2.72-fold significant increase in the risk for hemorrhagic stroke was observed following venomous snakebite with antivenom usage (95% CI = 1.41–5.26). Conclusion Venomous snakebite is associated with an increased risk of hemorrhagic stroke after the use of antivenom. Further study of the underlying mechanism is warranted.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::88a1672425e4dd1bbd0c6b2f7cff89f8
https://doi.org/10.1093/qjmed/hcab259

المؤلفون: Saraschandra Vallabhajosyula, Rajkumar Doshi, Ardaas Kanwar, Sri Harsha Patlolla, Pranathi R Sundaragiri, Wisit Cheungpasitporn, Singh Mandeep

المصدر: QJM: An International Journal of Medicine. 115:530-536

مصطلحات موضوعية: Adult, medicine.medical_specialty, business.industry, medicine.medical_treatment, Myocardial Infarction, Percutaneous coronary intervention, Length of hospitalization, General Medicine, Odds ratio, Seasonality, medicine.disease, United States, Confidence interval, Heart Arrest, Percutaneous Coronary Intervention, Internal medicine, Conventional PCI, medicine, Humans, Hospital Mortality, Seasons, Myocardial infarction, business, Hospital stay, Retrospective Studies

الوصف: Summary Background There are limited data on the influence of seasons on the outcomes of acute myocardial infarction-cardiac arrest (AMI-CA). Aim To evaluate the outcomes of AMI-CA by seasons in the United States Design Retrospective cohort study Methods Using the National Inpatient Sample from 2000 to 2017, adult (>18 years) admissions with AMI-CA were identified. Seasons were defined by the month of admission as spring, summer, fall and winter. The outcomes of interest were prevalence of AMI-CA, in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI), hospital length of stay, hospitalization costs and discharge disposition. Results Of the 10 880 856 AMI admissions, 546 334 (5.0%) were complicated by CA, with a higher prevalence in fall and winter (5.1% each) compared to summer (5.0%) and spring (4.9%). Baseline characteristics of AMI-CA admissions admitted in various seasons were largely similar. Compared to AMI-CA admissions in spring, summer and fall, AMI-CA admissions in winter had slightly lower rates of coronary angiography (63.3–64.3% vs. 61.4%) and PCI (47.2–48.4% vs. 45.6%). Compared to those admitted in the spring, adjusted in-hospital mortality was higher for winter {46.8% vs. 44.2%; odds ratio (OR) 1.08 [95% confidence interval (CI) 1.06–1.10]; P Conclusions AMI-CA admissions in the winter were associated with lower rates of coronary angiography and PCI, and higher rates of in-hospital mortality compared to the other seasons.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::bcbc31886e4419656e84bfd8775e07eb
https://doi.org/10.1093/qjmed/hcab246

المؤلفون: Nima Yaftian, Isa Khan, Elizabeth Brookes, Jonathan Darby, Andrew Newcomb, Andrew Wilson

المصدر: QJM: An International Journal of Medicine. 115:463-468

مصطلحات موضوعية: medicine.medical_specialty, education.field_of_study, Multivariate analysis, Endocarditis, business.industry, Proportional hazards model, Population, Endocarditis, Bacterial, General Medicine, medicine.disease, Risk Factors, Infective endocarditis, Internal medicine, Epidemiology, medicine, Humans, Substance Abuse, Intravenous, business, education, Survival analysis, Retrospective Studies, Cohort study

الوصف: Summary Background Infective endocarditis (IE) remains a life-threatening condition. Intravenous drug use (IVDU) adds to the clinical challenge associated with IE due to clinical aberrations caused by the social issues associated with this population. Aim To improve survival, this study aimed to characterize the contemporary IVDU-associated IE population seen at our tertiary hospital, determine their long-term outcomes and find risk factors associated with mortality. Design Retrospective observational cohort study. Methods A total of 79 patients accounting for 89 presentations were treated for IVDU-associated IE at St Vincent’s Hospital Melbourne (SVHM) between 1999 and 2015. Patients were followed-up until death or January 2021. The primary outcome was all-cause mortality and Kaplan–Meier survival analysis was used to calculate long-term survival estimates. Cox proportional hazards analysis was used to examine risk factors for mortality. Results The IVDU population treated at SVHM had a high rate of multivalvular IE, at 18.98%. Multivariate analysis revealed that multivalvular IE is significantly associated with an increased risk of mortality in a dose–dependent relationship (two valves affected: HR = 4.73, P = 0.006, three valves affected: HR = 14.19, P = 0.014). The IVDU population has survival estimates of 83.78% (95%CI: 73.21–90.45%) at 1-year and 64.98% (95%CI: 50.94–75.92%) at 15-years. Conclusion IVDU patients have high rates of multivalvular endocarditis, which is associated with increased risk of mortality and difficult to identify on echocardiography. Clinicians should be suspicious of multivalve involvement in the IVDU population and decisions related to medical management/intervention should be made with the understanding that these patients are at a higher risk of death.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2d2d89c7dd030782bbbf8753a933f9bf
https://doi.org/10.1093/qjmed/hcab225

المؤلفون: Lynne Arrol, David S Wald

المصدر: QJM: An International Journal of Medicine. 115:450-454

مصطلحات موضوعية: medicine.medical_specialty, Informed Consent, business.industry, Incidence, Consent to treatment, Incidence (epidemiology), General Medicine, Animation, medicine.disease, Cardiac surgery, Intervention (counseling), London, Complaint, medicine, Humans, Observational study, Medical emergency, Major complication, business

الوصف: Summary Background Introduction of digital animations to explain medical procedures before consent to treatment (animation-supported consent) has been shown to improve patient-reported understanding of a procedure’s benefits, risks and alternatives. Aim We examined whether introduction of animation-supported consent is associated with a change in the incidence of complaints and serious incidents due to failure to inform. Methods Multi-language animations explaining 10 cardiac procedures, in coronary intervention, electrophysiology and cardiac surgery, (www.explainmyprocedure.com) were introduced at a London cardiac centre from April 2019. Complaints and serious incidents due to failure to inform were identified from the hospital Datix database for the two years before introducing animation-supported consent (no animation group) and the two years afterwards (animation group), together with the total number of procedures and major complications recorded during these periods. We compared the incidence of complaints and serious incidents, expressed as a proportion of the number of major complications, recorded during each period. Results There were 580 complications among 21 855 procedures performed in the no animation group and 411 complications among 18 254 procedures in the animation group. There were 14 complaints or serious incidents due to failure to inform in the no animation group and 3 in the animation group; rates of 2.41% (14/580) and 0.73% (3/411), respectively (P Conclusion In this observational comparison, introduction of animation-supported consent was associated with a 70% reduction in complaints or serious incidents due to failure to inform before consent. This has significant quality and cost implications for improving consent pathways in clinical practice.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::33352dfe04e79fd45e0c8efc65b45733
https://doi.org/10.1093/qjmed/hcab211

المؤلفون: Gavin Barlow, Patrick J. Lillie, C. Walsh, Z Wellbelove

المصدر: QJM: An International Journal of Medicine. 114:105-110

مصطلحات موضوعية: medicine.medical_specialty, Respiratory rate, Organ Dysfunction Scores, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Sepsis, Internal medicine, Streptococcus pneumoniae, Escherichia coli, medicine, Humans, Hospital Mortality, 030212 general & internal medicine, Aged, Retrospective Studies, Receiver operating characteristic, business.industry, 030208 emergency & critical care medicine, General Medicine, Prognosis, medicine.disease, Early warning score, Systemic inflammatory response syndrome, Pneumonia, Blood pressure, ROC Curve, Cohort, business

الوصف: Summary Background Blood stream infections (BSIs) are associated with significant short-term mortality. There are many different scoring systems for assessing the severity of BSI. Aim We studied confusion, urea, respiratory rate, blood pressure, age 65(CURB65), Confusion Respiratory Rate, Blood pressure, age 65(CRB65), quick sequential organ failure assessment (qSOFA), systemic inflammatory response syndrome (SIRS) and National Early Warning Score (NEWS) and assessed how effective they were at predicting 30-day mortality across three separate BSI cohorts. Design A retrospective analysis was performed on three established BSI cohorts: (i) All cause BSI, (ii) Escherichia coli and (iii) Streptococcus pneumoniae. Methods The performance characteristics (sensitivity, specificity, positive predictive value, negative predictive value and area under receiver operating curve [AUROC]) for the prediction of 30-day mortality were calculated for the 5 scores using clinically relevant cut-offs. Results 528 patients were included: All cause BSI—148, E. coli—191 and S. pneumoniae—189. Overall, 30-day mortality was 22%. In predicting mortality, the AUROC for CURB65 and CRB65 were superior compared with qSOFA, SIRS and NEWS in the all cause BSI (0.72, 0.70, 0.66, 0.51 and 0.53) and E. coli cohorts (0.81, 0.76, 0.73, 0.55 and 0.71). In the pneumococcal cohort, CURB65, CRB65, qSOFA and NEWS were broadly equal (0.63, 0.65, 0.66 and 0.62), but all were superior to SIRS (0.57). CURB65, CRB65 and qSOFA had considerably higher accuracy than SIRS or NEWS across all cohorts. Conclusion CURB65 was superior to other scores in predicting 30-day mortality in the E. coli and all cause BSI cohorts. Further research is required to assess the potential of broadening the application of CURB65 beyond pneumonia.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::985075d3cc2c53275d0e7a11445fedba
https://doi.org/10.1093/qjmed/hcaa300

المؤلفون: Weiguo Hu, Jialin Liu, Wei Chen, Ruoming Tan, Hongping Qu, Zhitao Yang, Xiaogang Xiang

المصدر: QJM: An International Journal of Medicine

مصطلحات موضوعية: medicine.medical_specialty, ARDS, Coronavirus disease 2019 (COVID-19), Vitamin C, SARS-CoV-2, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19, Retrospective cohort study, Ascorbic Acid, General Medicine, Glycyrrhizic Acid, medicine.disease, New onset, Diammonium Glycyrrhizinate, Internal medicine, Cohort, medicine, Humans, Original Article, AcademicSubjects/MED00010, business, Retrospective Studies

الوصف: Summary Background The current global coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown limited responses to medical treatments. Aims To observe the effect of combination treatment of giammonium glycyrrhizinate and vitamin C (DV) on the prognoses of patients with COVID-19. Methods This retrospective observational study recruited 207 COVID-19 patients from Tongji Hospital, patients were assigned to DV and non-DV groups on the basis of the DV treatment. To make the results more credible, a propensity score matching (PSM) approach was adopted at a 1:3 ratio to determine the participants. Logistic analysis was used to assess the effect of DV therapy in the progress of COVID-19. Results In the DV group, the new-onset incidence rate of acute respiratory distress syndrome (ARDS) after admission was clearly lower than that in the non-DV group (DV vs. non-DV groups, 15.2% vs. 35.7%; P = 0.002). Compared with the non-DV group, the DV group showed fewer new onset of complications (such as ARDS, acute liver injury and acute myocardial injury) (DV vs. non-DV groups, 19.6% vs. 46.1%; P = 0.000). Moreover, DG+VC may help to recover the count of NK cells and decrease the level of sIL-2R. Conclusions DG+VC might be a promising candidate for preventing the deterioration of COVID-19 patients, which is worthy to be studied in large and perspective cohort.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b709bbcce6c3988d387fa7b8c4f0f9c5
https://doi.org/10.1093/qjmed/hcab184

المؤلفون: R Chouhan, Soorya Suresh, Jamshed Nayer, A. K. Nair, P Aggarwal, Rachana Bhat, Ankit Kumar Sahu, J A Majeed, A Ramaswami, Gagandeep Singh, Immaculata Xess, Naveet Wig, Dikshi Gupta, Roshan Mathew, Meera Ekka, Ajay Kumar, Alok Thakar

المصدر: QJM: An International Journal of Medicine

مصطلحات موضوعية: Adult, Male, Pediatrics, medicine.medical_specialty, Disease, Single Center, Diabetes mellitus, Humans, Mucormycosis, Medicine, Risk factor, Retrospective Studies, Original Paper, SARS-CoV-2, business.industry, COVID-19, General Medicine, Emergency department, medicine.disease, Radiological weapon, Female, Observational study, AcademicSubjects/MED00010, Emergency Service, Hospital, business

الوصف: Summary Background Mucormycosis (MM) is a deadly opportunistic fungal infection and a large surge in COVID-19-associated mucormycosis (CAM) is occurring in India. Aim Our aim was to delineate the clinico-epidemiological profile and identify risk factors of CAM patients presenting to the Emergency Department (ED). Design This was a retrospective, single-centre, observational study. Methods We included patients who presented with clinical features or diagnosed MM and who were previously treated for COVID-19 in last 3 months of presentation (recent COVID-19) or currently being treated for COVID-19 (active COVID-19). Information regarding clinical features of CAM, possible risk factors, examination findings, diagnostic workup including imaging and treatment details were collected. Results Seventy CAM patients (median age: 44.5 years, 60% males) with active (75.7%) or recent COVID-19 (24.3%) who presented to the ED in between 6 May 2021 and 1 June 2021, were included. A median duration of 20 days (interquartile range: 13.5–25) was present between the onset of COVID-19 symptoms and the onset of CAM symptoms. Ninety-three percent patients had at least one risk factor. Most common risk factors were diabetes mellitus (70%) and steroid use for COVID-19 disease (70%). After clinical, microbiological and radiological workup, final diagnosis of rhino-orbital CAM was made in most patients (68.6%). Systemic antifungals were started in the ED and urgent surgical debridement was planned. Conclusion COVID-19 infection along with its medical management have increased patient susceptibility to MM.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ce9304911dd4a8b200a974d6e27e1a19
https://doi.org/10.1093/qjmed/hcab190

المؤلفون: Deepak Saxena, V P Varna, Komal Shah, Apurvakumar Pandya

المصدر: QJM: An International Journal of Medicine. 114:447-453

مصطلحات موضوعية: medicine.medical_specialty, Adolescent, MEDLINE, Disease, CINAHL, Cochrane Library, Pediatrics, vitamin D deficiency, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Vitamin D and neurology, Humans, 030212 general & internal medicine, Vitamin D, Child, SARS-CoV-2, business.industry, Risk of infection, COVID-19, General Medicine, Prognosis, Vitamin D Deficiency, medicine.disease, 030228 respiratory system, Meta-analysis, business

الوصف: We aim to study the relationship between vitamin D level, risk and severity of Coronavirus disease of 2019 (COVID-19) infection in pediatric population through systematic review. We searched PubMed, CINAHL, EMBASE, Cochrane Library and Google Scholar from December 2019 to June 2021 for retrieving articles studying association between vitamin D deficiencies with COVID-19. Qualitative details were synthesized in evidence table and quantitative data was used for deriving pooled estimate through meta-analysis. After initial search of 2261 articles, eight eligible studies (two reviews) were included in the systematic review. Meta-analysis of the quantitative data (six studies) showed pooled prevalence of vitamin D deficiency as 45.91% (95% CI: 25.148–67.450). In infected pediatric patients, low levels of vitamin D increased the risk of severe disease (odds ratio–5.5; 95% CI: 1.560–19.515; P = 0.008). It was also found that children and adolescents having vitamin D deficiency had greater risk of COVID infection as compared to patients with normal vitamin D levels. Improvement in disease severity with vitamin D supplementation was also noted. The systematic review showed that almost half of the pediatric COVID patients suffer from vitamin D deficiency. It is also clear that the low level of vitamin D is associated with greater risk of infection and poorer outcome in pediatrics.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4e02edf27d5d0d951748b4fc347c7843
https://doi.org/10.1093/qjmed/hcab202

المؤلفون: Apurvakumar Pandya, Yogini Kandre, Vishakh Saraf, Komal Shah, Mudita Upadhyaya, Dileep Mavalankar, Deepak Saxena

المصدر: QJM: An International Journal of Medicine

مصطلحات موضوعية: medicine.medical_specialty, Pediatrics, Adolescent, Population, Asymptomatic, Epidemiology, medicine, Humans, Mortality, Child, education, education.field_of_study, SARS-CoV-2, business.industry, Mortality rate, COVID-19, General Medicine, Publication bias, medicine.disease, Comorbidity, Systematic review, Cough, Biomarker (medicine), Original Article, medicine.symptom, AcademicSubjects/MED00010, Radiology, business, Biomarkers

الوصف: Summary Background Given the limited and diverse nature of published literature related to COVID-19 in pediatrics, it is imperative to provide evidence-based summary of disease characteristics for guiding policy decisions. We aim to provide comprehensive overview of epidemiological, clinical and biomarker profile of COVID-19 infection in pediatric population. Methods For this umbrella review, published systematic reviews from PubMed and pre-print databases were screened. Literature search was conducted from December 2019 to April 2021. Details of clinical, radiological and laboratory features were collected from each review. Qualitative observations were synthesized and pooled prevalence of mortality and asymptomatic cases were assessed using meta-analysis. Results Evidence synthesis of 38 systematic reviews included total 1145 studies and 334 398 children and adolescents. Review revealed that COVID-19 is relatively milder with better prognosis in pediatrics. However, patients with comorbidity are at higher risk. Meta-analysis of reviews showed that 21.17% (95% CI: 17.818–24.729) of the patients were asymptomatic and mortality rate was 0.12% (95% CI: 0.0356–0.246). Though there was no publication bias, significant heterogeneity was observed. Fever (48–64%) and cough (35–55.9%) were common symptoms, affecting almost every alternate patient. Ground-glass opacities (prevalence range: 27.4–61.5%) was most frequent radiographic observation. Rise in C-reactive protein, lactate dehydrogenase and D-dimer ranged from 14% to 54%, 12.2–50% and 0.3–67%, respectively. Some of the included reviews (44.7%-AMSTAR; 13.2%-GRADE) were of lower quality. Conclusion Current umbrella review provides most updated information regarding characteristics of COVID-19 infection in pediatrics and can be used to guide policy decision regarding vaccination prioritization, early screening and identification of at-risk population.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c67dd01f66d263a57dfecf2324b857a1
https://doi.org/10.1093/qjmed/hcab206

المؤلفون: Devender Kumar, Ashish Bhalla, Sunil Sethi, Ashok Kumar Pannu, Nadim Rahman, Rakesh Yadav, Mandeep Garg, Atul Saroch

المصدر: QJM: An International Journal of Medicine. 115:381-387

مصطلحات موضوعية: Adult, Pediatrics, medicine.medical_specialty, Tuberculosis, India, Tuberculous meningitis, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Older patients, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Young adult, Prospective cohort study, Survival rate, Aged, Geriatrics, business.industry, Headache, General Medicine, medicine.disease, Tuberculosis, Meningeal, Vomiting, medicine.symptom, business, 030217 neurology & neurosurgery

الوصف: Summary Objective Although the elderly population remains at high risk for tuberculosis, studies addressing tuberculous meningitis (TBM) in this age group are scarce. The present study aimed to evaluate the spectrum and outcome of geriatric TBM and document differences between older and young patients. Methods A prospective cohort study was conducted in the adult TBM patients admitted at PGIMER, Chandigarh (India). Consecutive older patients aged 60 years and above were enrolled from January 2019 to December 2020, and young adults aged 18–59 years were enrolled from July 2019 to December 2019. Results Fifty-five older patients with a mean age of 66.6 years and 73 young patients with a mean age of 35.1 years were enrolled. At admission, older patients were more likely to have altered mental status (96.4% vs. 78.1%, P = 0.003) and advanced disease with British medical research council staging 2 or 3 (98.2% vs. 89.0%, P = 0.043); however, headache (38.2% vs. 67.1%, P = 0.001), vomiting (18.2% vs. 35.6%, P = 0.030) and fever (80.0% vs. 91.8%, P = 0.052) were less common. Cerebrospinal fluid (CSF) abnormalities were less marked in older patients, with a significant difference in median total cells (70 vs. 110/µl, P = 0.013). Hydrocephalous and infarct were common neuroimaging abnormalities in both groups; however, tuberculomas were significantly less in the elderly (15.1% vs. 35.2%, P = 0.012). Older patients had a significantly low survival rate (56.4% vs. 76.7%, P = 0.021). Conclusion Significant differences in clinical, CSF and radiological characteristics exist between elderly and young TBM patients, with survival remains dismal in the elderly.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8f995038ca260993f7ace7395e7a9974
https://doi.org/10.1093/qjmed/hcab162