Covid 19 study in a rural health service

-
I've conducted a retrospective study on covid 19 patients evaluating their clinical course and risk factors for mortality. The following is the abstract of the paper I'm currently working on.


A retrospective analysis of the clinical course and the risk factors for mortality in covid 19 patients in a rural health center
Abstract:
Introduction:
In December, 2019, Wuhan city, China, became the centre of an outbreak for pneumonia of unknown cause. By January, 2020, Chinese scientists had isolated a novel coronavirus, severe acute respiratory syndrome coronavirus, from these patients with virus-infected pneumonia, which was later designated coronavirus disease 2019 (COVID-19) in February, 2020, by WHO.
In this study we discuss the various clinical presentations and the risk factors for mortality observed in  covid 19 patients.

Materials and methods:
This is a retrospective study conducted at Kamineni Insitute of Medical Scineces, Narketpally including 34 inpatients who were tested positive by SARS COV2 RNA.

Results:
Among  34 patients ,  65% were men and 35% were women.  9 patients died during hospitalization and 25 patients were discharged. The most common comorbidity found in these patients were Hypertension ( 35%), Diabetes Mellitus (32%), followed by chronic kidney disease (8%), Hypothyroid (5%). The most common risk observed among patients who died were older age and a high D dimer and  modified SOFA score value.

Discussion:

We observed that the most common risk factor among our patients was Hypertension followed by Diabetes Mellitus with 9% being diagnosed with denovo Diabetes Mellitus type 2 after presentation.
The mortality rates were high among the elderly patients and it was also noted that  the modified SOFA score and d Dimers were high among these patients.
Older age has been reported as an important independent predictor of mortality in SARS and MERS.
The age-dependent defects in T-cell and B-cell function and the excess production of type 2 cytokines could lead to a deficiency in control of viral replication and more prolonged proinflammatory responses, potentially leading to poor outcome.
SOFA score is a good diagnostic marker for sepsis and septic shock, and reflects the state and degree of multi-organ dysfunction
High levels of d-dimer have a reported association with 28-day mortality in patients with infection or sepsis identified in the emergency department.

Conclusion:
In this study we throw some light on the clinical presentation and the risk factors for mortality observed in  covid 19 patients which would help us anticipate the patient's prognosis.

References:
1.The immunopathogenesis of sepsis in elderly patients.
Clin Infect Dis. 2005; 41: S504-S512
2. Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong.
Ann Intern Med. 2003; 139: 715-723
3. Serial evaluation of the SOFA score to predict outcome in critically ill patients.
JAMA. 2001; 286: 1754-1758
4. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).
JAMA. 2016; 315: 801-810
5. D-dimer is a significant prognostic factor in patients with suspected infection and sepsis.
Am J Emerg Med. 2012; 30: 1991-1999

Comments

Post a Comment

Popular posts from this blog

DAYS IN NEPHROLOGY

-
Image
My day started on 9th May 2020 with Morning rounds of my patients in Nephrology ward with my intern. At around 11am , A Patient presented to the casualty, A 60 year old man, Farmer from a local village, Occasional Alcoholic since 25 years and Chronic Beedi Smoker since 25 years, who was diagnosed to be hypertensive and diabetic 6 months back.  He apparently had no medical issues until an year back when he started getting breathless on walking for a few miles and he gradually started experiencing breathlessness even on rest, on & off though he had no complains of associated chest pain, palpitations, nausea, vomitings or associated giddiness. One fine morning, before he started for work he observed his feet were swollen upto his ankles for which he decided not to consult a doctor and managed by resting for a few days. Over the next few days the swelling in his feet gradually progressed up to his thighs and it alarmed him when he had developed facial puffiness. He also started
Read more

62 year old woman with breathlessness

-
Image
A 60 year old woman presented with the complaints of  Dyspnea at rest since 15 days Left lower limb swelling upto knee since 10 days Reduced urine output since 10 days A 60 year old woman who used to work as a farmer 3 years back, mother of 5 children (3 daughters and 2 sons - 1 son expired, patients attendant reluctant to discuss the cause) presented to the casualty with the complains of dyspnea on exertion since 1 year. 1 year back she visited Osmania hospital for these complaints after which she has been put on medications which she has been using on and off (not documented). Since the past 4 months she has been experiencing dyspnea at rest on and off, whenever she experiences dyspnea she visits a hospital, takes medication and then stops taking them. Since the past 15 days she has been experiencing dyspnea at rest and 10 days back she has had a trauma to her right 2nd toe after which she developed left lower limb swelling along with reduced urine output. She was taken to a local ho
Read more

Brain Stem Strokes

-
Image
BRAIN STEM STROKES: Here's a brief discussion regarding the Ventral Midbrain Syndromes which I've gone through on 9th & 10th of May. Will update regarding the other syndromes in my further posts. The posterior surface of midbrain has a Tectum portion & a Tegmental portion. The Tectum portion consists of Corpora Quadrigemina & 4th cranial nerve where as the Tegmental portion comprises of Floor of the 4th ventricle, Median Sulcus, Facial colliculus & Sulcus Limitans.  Three important Ventral Midbrain Syndromes are  : 1) Weber syndrome 2) Claude syndrome 3) Benedikt syndrome These occur due to the involvement of P1 segment of Posterior cerebral artery.  Posterior Cerebral Artery is divided into P1 & P2 segment ( proximal & distal to Posterior communication artery)  1) Weber Syndrome:   The lesion is at the level of crus cerebri, here you can see the location of the cortico spinal tract whi
Read more