Journal of Acute Disease
Issue 5,2024 Table of Contents
2024(5):167-172.
DOI: 10.4103/jad.jad_83_24
Abstract:
Objective: To validate a better scoring system between CURB- 65 and the pneumonia severity index (PSI) to predict the need for intensive care unit admission and 30-day mortality in patients with COVID-19 pneumonia.
Methods: A retrospective cohort study was conducted on patients in a tertiary care hospital in Kota, Rajasthan. Relevant data about history, and general and systemic examination with laboratory investigations was collected. Patients were categorized into different risk groups for ICU admission and 30-day mortality according to CURB-65 and PSI. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve were calculated. Continuous variables, means and percentages were compared using the t-test for numerical data and the Chi-square test for nominal data.
Results: 100 patients who tested positive for SARS-CoV-2 by RT PCR were included; 67 were male and 33 were female. 58 patients had severe disease (SpO2≤90%) and 30 patients died. CURB- 65 had an area under the curve (AUC) of 0.81 for predicting ICU admission, with a sensitivity of 92% and a specificity of 54% for high risk patients. Meanwhile, PSI had an AUC of 0.88, with a sensitivity of 83% and a specificity of 73% in high risk patients. In addition, CURB-65 had an AUC of 0.79 for predicting 30-day mortality, with a sensitivity of 60% and a specificity of 89% in high risk patients. PSI had an AUC of 0.71 for predicting 30-day mortality, with a sensitivity of 90% and a specificity of 46% in high risk patients.
Conclusions: This single-centre retrospective study involving a cohort of COVID-19 patients demonstrates that CURB-65 and PSI are powerful tools for predicting mortality. However, PSI appears to be slightly better at predicting the need for intensive care unit admission in high-risk patients.
Objective: To validate a better scoring system between CURB- 65 and the pneumonia severity index (PSI) to predict the need for intensive care unit admission and 30-day mortality in patients with COVID-19 pneumonia.
Methods: A retrospective cohort study was conducted on patients in a tertiary care hospital in Kota, Rajasthan. Relevant data about history, and general and systemic examination with laboratory investigations was collected. Patients were categorized into different risk groups for ICU admission and 30-day mortality according to CURB-65 and PSI. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve were calculated. Continuous variables, means and percentages were compared using the t-test for numerical data and the Chi-square test for nominal data.
Results: 100 patients who tested positive for SARS-CoV-2 by RT PCR were included; 67 were male and 33 were female. 58 patients had severe disease (SpO2≤90%) and 30 patients died. CURB- 65 had an area under the curve (AUC) of 0.81 for predicting ICU admission, with a sensitivity of 92% and a specificity of 54% for high risk patients. Meanwhile, PSI had an AUC of 0.88, with a sensitivity of 83% and a specificity of 73% in high risk patients. In addition, CURB-65 had an AUC of 0.79 for predicting 30-day mortality, with a sensitivity of 60% and a specificity of 89% in high risk patients. PSI had an AUC of 0.71 for predicting 30-day mortality, with a sensitivity of 90% and a specificity of 46% in high risk patients.
Conclusions: This single-centre retrospective study involving a cohort of COVID-19 patients demonstrates that CURB-65 and PSI are powerful tools for predicting mortality. However, PSI appears to be slightly better at predicting the need for intensive care unit admission in high-risk patients.
Nioosha Ahmadi
,
Hossein Lajmiri
,
Saeedeh Ebrahimi
,
Hadi Razavi Nikoo
,
Mehrdad Farrokhnia
,
Elham Heidari
,
Elham Mousavi
2024(5):173-178.
DOI: 10.4103/jad.jad_80_24
Abstract:
Objective: To assess the changes in gene expression of activation induced cytidine deaminase (AID) in COVID-19 patients and its relationship with the presence of autoantibodies in those ones.
Methods: This retrospective study was carried out among COVID-19 patients’ serum and peripheral blood mononuclear cells that were archived at the main COVID-19 referral centers in Iran from January to March 2022. The titer of autoantibodies in the serum of healthy and COVID-19 subjects was investigated by serological tests. Then, the AID gene expression in peripheral blood mononuclear cells in two groups was evaluated using the real-time polymerase chain reaction method.
Results: 100 patients were included. In total, 8% and 1% of patients had a significant titer of anti-citrullinated protein antibody and antinuclear antibody autoantibodies, respectively, and those suffered from at least one comorbidity. No patient was positive for antiphospholipid autoantibody. Moreover, no significant changes were observed in the titer of autoantibodies between healthy subjects and patients. Furthermore, the increase in the expression of the AID gene was not significant in two groups.
Conclusions: The presence of autoantibodies in COVID-19 patients might be linked to the previous underlying disease.
Objective: To assess the changes in gene expression of activation induced cytidine deaminase (AID) in COVID-19 patients and its relationship with the presence of autoantibodies in those ones.
Methods: This retrospective study was carried out among COVID-19 patients’ serum and peripheral blood mononuclear cells that were archived at the main COVID-19 referral centers in Iran from January to March 2022. The titer of autoantibodies in the serum of healthy and COVID-19 subjects was investigated by serological tests. Then, the AID gene expression in peripheral blood mononuclear cells in two groups was evaluated using the real-time polymerase chain reaction method.
Results: 100 patients were included. In total, 8% and 1% of patients had a significant titer of anti-citrullinated protein antibody and antinuclear antibody autoantibodies, respectively, and those suffered from at least one comorbidity. No patient was positive for antiphospholipid autoantibody. Moreover, no significant changes were observed in the titer of autoantibodies between healthy subjects and patients. Furthermore, the increase in the expression of the AID gene was not significant in two groups.
Conclusions: The presence of autoantibodies in COVID-19 patients might be linked to the previous underlying disease.
2024(5):179-184.
DOI: 10.4103/jad.jad_97_24
Abstract:
Objective: To investigate the epidemiology of injuries and risk factors in Raipur, Chhattisgarh, India.
Methods: A community-based cross-sectional study was conducted in 10 selected wards of Raipur. Data were collected from injured individuals using a structured questionnaire. Socio-demographic characteristics, injury mechanisms, medical care-seeking behavior, and outcomes were assessed.
Results: 312 individuals with injuries were included, with 193 men and 119 women. Males were more likely to be injured than females (61.86% v.s. 38.14%). Younger adults aged 21-30 were at highest risk (21.5%). The most common injuries were falls (38.8%) and road traffic accidents (34.9%). Injuries occurring on-road are the most frequent, followed by, at home with a highly significant association (P<0.001). Most individuals sought medical care (90.1%), primarily in private facilities (51.3%).
Conclusions: This study provides valuable insights into the epidemiology of injuries in Raipur. The findings can inform the development of evidence-based interventions to reduce the burden of injuries and improve the health and well-being of the population.
Objective: To investigate the epidemiology of injuries and risk factors in Raipur, Chhattisgarh, India.
Methods: A community-based cross-sectional study was conducted in 10 selected wards of Raipur. Data were collected from injured individuals using a structured questionnaire. Socio-demographic characteristics, injury mechanisms, medical care-seeking behavior, and outcomes were assessed.
Results: 312 individuals with injuries were included, with 193 men and 119 women. Males were more likely to be injured than females (61.86% v.s. 38.14%). Younger adults aged 21-30 were at highest risk (21.5%). The most common injuries were falls (38.8%) and road traffic accidents (34.9%). Injuries occurring on-road are the most frequent, followed by, at home with a highly significant association (P<0.001). Most individuals sought medical care (90.1%), primarily in private facilities (51.3%).
Conclusions: This study provides valuable insights into the epidemiology of injuries in Raipur. The findings can inform the development of evidence-based interventions to reduce the burden of injuries and improve the health and well-being of the population.
2024(5):185-192.
DOI: 10.4103/jad.jad_89_24
Abstract:
Objective: To evaluate thyroid dysfunction prevalence and its consequences in high-risk pregnant women and their children.
Methods: In this retrospective cohort study, data from high-risk pregnant women who were referred to a governmental referral hospital in Qom, Iran from March to August 2022 were collected. The thyroid disorders were determined according to the 2017 American Thyroid Association guidelines. The predictors of a mother's hypothyroidism and its fetal and maternal consequences were assessed. Independent t-test, Chi-square test, and logistic regression were used for bivariate and multivariate analysis.
Results: 293 women were included. The prevalence of hypothyroidism and hyperthyroidism based on the thyroid stimulating hormone classification was 32.5% and 2.0%. The prevalence of subclinical and overt hypothyroidism was 6.1% and 4.1%, and the prevalence of subclinical and overt hyperthyroidism was 2.4% and 1.4%, respectively. Family history of thyroid disorders was the most important predictor of hypothyroidism during pregnancy (OR=2.6, 95% CI=1.0-6.6, P=0.002), while preterm delivery (OR=2.2, 95% CI=1.3-6.8, P=0.220) and elevated neonate thyroid stimulating hormone (OR=1.2, 95% CI=1.1-1.3, P=0.041) were the most important consequence of hypothyroidism.
Conclusions: Hypothyroidism is a highly prevalent thyroid disorder in high-risk pregnant women. Thyroid function screening should be performed in all pregnant women to increase the detection of subclinical and overt hypothyroidism during pregnancy.
Objective: To evaluate thyroid dysfunction prevalence and its consequences in high-risk pregnant women and their children.
Methods: In this retrospective cohort study, data from high-risk pregnant women who were referred to a governmental referral hospital in Qom, Iran from March to August 2022 were collected. The thyroid disorders were determined according to the 2017 American Thyroid Association guidelines. The predictors of a mother's hypothyroidism and its fetal and maternal consequences were assessed. Independent t-test, Chi-square test, and logistic regression were used for bivariate and multivariate analysis.
Results: 293 women were included. The prevalence of hypothyroidism and hyperthyroidism based on the thyroid stimulating hormone classification was 32.5% and 2.0%. The prevalence of subclinical and overt hypothyroidism was 6.1% and 4.1%, and the prevalence of subclinical and overt hyperthyroidism was 2.4% and 1.4%, respectively. Family history of thyroid disorders was the most important predictor of hypothyroidism during pregnancy (OR=2.6, 95% CI=1.0-6.6, P=0.002), while preterm delivery (OR=2.2, 95% CI=1.3-6.8, P=0.220) and elevated neonate thyroid stimulating hormone (OR=1.2, 95% CI=1.1-1.3, P=0.041) were the most important consequence of hypothyroidism.
Conclusions: Hypothyroidism is a highly prevalent thyroid disorder in high-risk pregnant women. Thyroid function screening should be performed in all pregnant women to increase the detection of subclinical and overt hypothyroidism during pregnancy.
2024(5):193-195.
DOI: 10.4103/jad.jad_31_24
Abstract:
Rationale: This case highlights the rare yet critical diagnosis of hypermagnesemia in a preterm infant, who presented with symptoms mimicking necrotizing enterocolitis. It underscores the importance of considering hypermagnesemia as a differential diagnosis in neonatal respiratory distress and gastrointestinal symptoms, even when the cause is not immediately apparent.
Patient’s Concern: An extremely low birth infant with respiratory distress further had episodes of apnoea and cyanosis. The infant eventually exhibited abdominal distension and bilious vomiting, symptoms mimicking necrotizing enterocolitis.
Diagnosis: The infant’s clinical features were attributed to hypermagnesemia, despite no magnesium being administered and no apparent cause identified. Screening the apparently asymptomatic mother confirmed a serum magnesium level of 4 mg/dL, suggesting transplacental transfer as the likely cause of the neonate’s condition.
Interventions: The newborn was treated supportively with adequate hydration and maintenance calcium gluconate.
Outcomes: Magnesium levels decreased, and the baby showed signs of improvement.
Lessons: Hypermagnesemia, though uncommon, should be investigated and considered even when the symptoms are not apparent.
Rationale: This case highlights the rare yet critical diagnosis of hypermagnesemia in a preterm infant, who presented with symptoms mimicking necrotizing enterocolitis. It underscores the importance of considering hypermagnesemia as a differential diagnosis in neonatal respiratory distress and gastrointestinal symptoms, even when the cause is not immediately apparent.
Patient’s Concern: An extremely low birth infant with respiratory distress further had episodes of apnoea and cyanosis. The infant eventually exhibited abdominal distension and bilious vomiting, symptoms mimicking necrotizing enterocolitis.
Diagnosis: The infant’s clinical features were attributed to hypermagnesemia, despite no magnesium being administered and no apparent cause identified. Screening the apparently asymptomatic mother confirmed a serum magnesium level of 4 mg/dL, suggesting transplacental transfer as the likely cause of the neonate’s condition.
Interventions: The newborn was treated supportively with adequate hydration and maintenance calcium gluconate.
Outcomes: Magnesium levels decreased, and the baby showed signs of improvement.
Lessons: Hypermagnesemia, though uncommon, should be investigated and considered even when the symptoms are not apparent.
2024(5):196-198.
DOI: 10.4103/jad.jad_108_24
Abstract:
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