Online ISSN: 2515-8260

Keywords : mortality


Prognostic Factors Associated with Mortality in Covid 19 Disease: A Retrospective Single Centre Institutional Study

Atul Kumar, Devendra Nargawe, Sanjay Kumar Dubey, Shivani Sinha, Neelam R. Charles

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4721-4728

Background:To evaluate the association of the demographic, clinical sign and symptoms
and laboratory biomarkers in predicting the mortality in COVID-19 infected patients.
Materials and Methods: This was a single centre retrospective observational study
carried out in atertiary care centre of a tribal region of central India, which was a
referral centre for COVID-19.Parameters taken into account were physiological
parameters,symptoms at admission,radiographic findings and laboratory findings.
Results: Out of 103 deaths included in this study 76 were male and 37 females (2:1).
Mean age of the deceased were 54.90 years (18-90 years). The most common symptom
on admission was breathlessness in 92 patients (89.32%). Abdominal symptoms like
diarrhoea and vomiting were associated in 7.7 % of the deceased patients only.Most of
the patients who died were older patients having age 60 years and above (65.04 %).
Most of the patients who died had Spo2 less than 90 % on admission (85.43
%).Lymphopenia (92.23 %) was the most commonly observed finding on blood
investigations done in deceased patients followed by increased CRP level (78.64 %).
Comorbidities were present in 77 patients out of 103 patients (74.75%) included in this
study. Diabetes and hypertension were being the most common comorbidities associated
in these patients.Death was not commonly observed in patients with COVID 19
associated with respiratory diseases.
Conclusion: Identified prognostic factors can help clinicians and policy makers in
tailoring management strategies for patients with COVID-19 infectious disease while
researchers can utilize our findings to develop multivariable prognostic models that
could eventually facilitate decision-making and improve patient important outcomes.

“COVID-19 AND LOW PLATELET COUNT-A RELATIONSHIP”

DR.SHAILZA, DR. AMARJEET SINGH VERMA, DR. JYOTI SINGH RAJPUT .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 766-771

BACKGROUND
Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship between mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width.
METHODS
In total, 100 COVID-19 patients were included in this study. The patients were divided into two groups. Patients with room air oxygen saturation < 90% were considered as severe COVID-19, and patients with ≥90% were considered moderate COVID-19. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Analyses were performed using the SPSS statistical software. A p-value <0.05 was considered significant.
RESULTS
The patients’ mean age was 64,32 ± 16,07 years. According to oxygen saturation, 38 patients had moderate and 62 had severe COVID-19. Our findings revealed that oxygen saturation at admission and the MPV difference between the first and third days of hospitalization were significant parameters in COVID-19 patients for predicting mortality. While mortality was 8.4 times higher in patients who had oxygen saturation under 90 % at hospital admission, 1 unit increase in MPV increased mortality 1.76 times.
CONCLUSION
In addition to the lung capacity of patients, the mean platelet volume may be used as an auxiliary test in predicting the mortality in COVID-19 patients.

A retrospective cohort study on laparoscopic cholecystectomy in cirrhosis patients

Dr. Faisal Mumtaz,Dr.Urooj Najami,Dr.Prabodh Bansal,Dr Gopal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2797-2803

Background:The advanced instruments like harmonic shears have made laparoscopic cholecystectomy (LC) a safe option. The present study determined twoyearsexperience of patients after laparoscopic cholecystectomy in cirrhosis patients.
Methods: A total of 50 cirrhotic patients underwent LC from August 2020 to February 2022. The type of surgery performed was laparoscopic cholecystectomy. The parameters recorded were,presence of adhesions,use ofharmonic devices, amount of bleeding during surgery,rate of conversion to open surgery and the reasons thereof, operative time in minutes, plasma and platelet transfusion postoperatively and duration of hospital stay .
Results:Majority of the patients were of Child-Pugh class A. The cause of cirrhosis was hepatitis C virus (HCV) in most of the patients. Biliary colic was found to be the most common presentation. Higher CTP, model for end-stage liver disease (MELD) scores, higher mean international normalization ratio (INR) value, lower mean platelet count, higher operative bleeding, higher blood, and plasma transfusion rates, longer mean operative time and postoperative hospital stays were found to be statistically significantand  correlated well with 30-day morbidities and mortalities.
Conclusion: LC could be a better surgery performed in patients with cirrhosis. However, higher CTP and MELD scores, greater operative bloodloss, largerno of  blood and plasma transfusion in units, longer operative time, lower platelet count, and higher INR values can be considered factors resulting in poor outcome. 

Neutrophilic lymphocyte ratio and lymphocyte monocyte ratio: prognostic significance in COVID 19

Dr Fayaz Ahmad Wani, Dr Aabhasha Parotra, Dr Aakriti Mahajan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2809-2818

Aim: To evaluate neutrophilic lymphocyte ratio and lymphocyte monocyte ratio as prognostic markers in COVID 19.
Material and method: The present retrospective observational studyconducted in the department of Medicine, Government Medical College, Jammu for a period of one year. The study comprised of 100 Covid 19 RT PCR positive cases admitted patient in ICU as well as Ward, in covid care centre of Government Medical College, Jammu. Patients characteristics were obtained from the hospital covid care centre satisfying inclusion criteria from electronic medical records and demographic, clinical, laboratory data were extracted included age, sex clinical features, signs and symptoms, comorbidities, exposure history, oxygen support during hospitalization, duration of oxygen support during hospitalization,imaging features of the chest (CT scoring), laboratory findings (Hemogram, Total leucocyte count, differential counts, NLR and LMR. Complete blood count including NLR and LMR collected at day of admission and day 3 of admission and documented on a standardized proforma. Two outcomes were evaluated: “discharge” or “died.”
Results:In majority (53%) of patients, ventilation given was high flow followed by bipap (21%), ventimask (19%) and ventilator (5%). Ventilation given was room air in only 2 out of 100 patients (2%). In present study, only 10 out of 100 patients (10.00%) died.Discriminatory power of neutrophil lymphocyte ratio (AUC 0.865; 95% CI: 0.781 to 0.925) was excellent and discriminatory power of lymphocyte monocyte ratio (AUC 0.791; 95% CI: 0.698 to 0.867) was acceptable. Among both the parameters, neutrophil lymphocyte ratio was the best predictor of CTSI severity at cut off point of >3.57 with 86.50% chances of correctly predicting CTSI severity.
Conclusion: It can be concluded from the results that NLR may be a rapid, widely available, useful prognostic factor in the early screening of critical illness in patients with confirmed COVID-19.

Assessment of incidence of CBD injury who underwentLaparoscopic cholecystectomypatients

Dr.Nayan Pancholi, Dr.Latif Bagwan,Dr.Sandipkumar Chaudhari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 584-587

Background:Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical
procedures worldwide is accepted as the gold standard in the treatment of symptomatic gallstones.
The present study was conducted to assess incidence of CBD injury who underwent LC.
Materials & Methods:180 patients who underwent laparoscopic cholecystectomy of both genders
were included. Predictors of CBD injury were assessed based on grading of degree of difficult LC and
visualization of critical view of safety (CVS). BDI was classified according to Strasberg
classification.
Results: Out of 180, males were 110 and females were 70. Diagnosis was acute cholecystitis in 90,
chronic cholecystitis in 40, empyema gall bladder in 30 and mucocele gall bladder in 20 cases. Degree
of difficulty was mild in 46, moderate in 84, severe in 28 and extreme in 22. CVS was seen in 160.
The difference was significant (P< 0.05). Type of bile duct injury was type A in 5, type B in 1, type D
in 2 and type E4 in 3 patients. The difference was significant (P< 0.05).
Conclusion: Majority of bile duct injuries, results mainly from the surgeon’s inexperience,
misinterpretation of anatomy and poor surgical technique.

Assessing risk factors of 1 year mortality in patients with hip fractures: A hospital-based retrospective cohort study from a developing level 1 trauma centre in Northern India

Dr. Chethan MH,Dr.Himanshu Agrahari,Dr. Arvind Kumar Yadav, Dr.Bhaskar Sarkar, Dr.Siddharth Dubey, Dr. MD Quamar Azam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 308-313

Purpose: Proximal femoral fracture is one of the major causes of morbidity and mortality in
elderly group patientswith 11-23% of mortality is reported to occur at 6 months and 22-29%
at 1 year. Despite the huge burden of osteoporosis, there is paucity of data regarding
epidemiology, risk factors and outcome of fragility hip fractures in Indian population. As
most of the published literature are from western world, we conducted the study to look for
risk factors for early-mortality in hip fracture in Indian sub-continent and compare the same
with published literature.
Methods: Total of 174 patients were available for final evaluation. Primary outcome was to
see the mortality in elderly patients undergoing operative treatment and the secondary
outcome measures were predictors of mortality in this age group with regard to age, sex,
Charlson comorbidity index, injury severity score, pre-operative ASA grading, injury-surgery
duration and length of hospital stay. Cox proportional regression hazards regression
modelling was performed to assess the effect of different variables on time of mortality.
Results: Mean age of the patients was 70.56 (± 8.05) years. Mean Charlson Comorbidity
Score was 1.68 (± 1.54; 2SD). Mean time from injury to operation time was 35.59 (±19.02; 2
SD) hours and the mean length of hospital stay was 4.78 (± 1.68; 2 SD) days. Mortality at
one-year after surgery was 18.4%.On univariate and multivariate regression analysis variables
significantly associated (p<0.05) with ‘Mortality’ are: Age, Charlson Index, Charlson Index
Category, Injury to operation time(Hours), Length of hospital stay and pre-operative ASA
grade.
Conclusion: We suggest that, without a dedicated hip-fracture protocol in a resource-poor
set-up, early aggressive management to optimize patients for surgery and surgical
intervention as soon as feasible lead to early return to pre-fracture status and reduces early
mortality.

The effect of body mass index (BMI) on the mortality among patients with stroke

Salah Elsayed, Muath Othman

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 181-186

Stroke is considered one of the leading causesof morbidity and mortality in many
countries. Many studies investigated the outcomes after the occurrence of stroke.
Some of those research studies indicated that obesity and the increasein the
bodymass index areestablished risk factors for mortality among stroke patients.
However, the results of these studies were inconsistent.The main aim of this review
article was to examine the association between bodymass index and mortality
among stroke patients. The majority of the studies had shown a possible effect of
overweight on mortality among stroke patients; the evidence regarding the
association's presence is limited.On the other hand, the majority of the studies had
shown a protective effect of obesity (mild obesity, bodymass index between 30-35)
onreducingthe risk of mortality among stroke patients. This means underweight
stroke patients have more risk of mortality. Thus, the argument regarding the effect
of high bodymass index on mortality has been explained by the obesity paradox.
However, most of those studies were observational, and results could be attributed
to the methodological flaw. There is a need to well-designed prospective studies that
to overcome the limitation of the previous studies.

Molecular Diagnostic Methods For Viral Infections

Dhakshinya M; Smiline Girija A.S; Ezhilarasan D

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 2595-2605

Viral diagnostic tests are categorized as direct diagnosis, indirect examination (virus isolation), and serology. Molecular testing is often done to detect potent viral markers resulting from any gene or chromosomal modifications during viral replication in the host. The clinical specimen is tested specifically in direct analysis for the presence of virus particles, virus antigens or viral nucleic acids. Molecular diagnosis of viruses can be achieved from clinical samples like blood, hair, skin, amniotic fluid, or other tissue. Molecular biology techniques are considered to be the standard and confirmatory protocols in the analysis of viral DNA, RNA and protein. Molecular viral diagnosis are considered to be more specific and sensitive in preliminary viral screening and can pave the way for rapid diagnosis. However, the procedures are costly and involve automated bio-instruments to perform the same. This review thus highlights the various molecular diagnostic methods used in diagnostic virology with their limitations and challenges.