Introduction and Aim: It is crucial to identify and start treating the COVID-19 patients who are most at risk of becoming seriously ill as soon as possible. There is some evidence that prognostic nutritional index (PNI) could predict the outcome of some diseases. The study objective was to determine whether PNI is a useful prognostic tool for predicting the outcome of COVID-19-positive patients. Patients and Methods: At Al-Shifaa Hospital in Baghdad Medical City, a total of 160 patients with COVID-19 participated in a study that was designed as a cross-sectional. At the time of admission, information was collected on the patient's history, including clinical, laboratory, and demographic details. The PNI score was determined by 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (/mm3). Patients were followed up for survival. Results: The mortality rate was 14.37%. Survived patients had a mean age of 55.85±16.03 years compared with 64.30 ±14.76 years for died patients with a significant difference. Diabetes was more common among died (39.13%) than survived patients (15.33%) with a significant difference. The median serum level of C-reactive protein (CRP), D-dimer and ferritin in deceased patients was 84 mg/L, 2208 ng/ml and 650 ng/ml, respectively compared with 48 mg/L, 858 ng/ml and 550 ng/ml in survived patients with highly significant differences. The mean PNI in survived and non-survived patients was 40.89±5.9 and 37.86±4.36, respectively with a significant difference. The area under the curve (AUC) for PNI was 0.888, 95%CI = 0.827 and 0.939, p = 0.002 At an ideal cutoff value of 39.08, the test's sensitivity and specificity are 80 % and 74 %, respectively. Conclusion: The PNI score is an easy-to-use, speedy, and cost-effective tool that has the potential to be utilized on a routine basis to predict mortality in patients with COVID-19.
Frequent relapse occurs in about 60% of children with steroid-sensitive nephrotic syndrome (SSNS) despite the tangible initial response. Several factors have been documented as triggers for frequent relapses (FR). However, the role of urinary tract infection (UTI) was not well-illustrated. Our aim was to evaluate the role of UTI as a trigger for FR among Iraqi children SSNS. This cross-sectional study was conducted on a total of 68 children with the first episode of SSNS who were followed up for 6 months after taking their treatment for the first episode. The patients were divided into two groups: frequent and infrequent relapse. Midstream urine samples were collected from each child and routine bacteriological culture and detection were achieved. Data regarding age at onset, sex, steroid therapy at the onset, the time between the onset and first relapse were collected from patients' records. The proportion of frequent relapses was 41.18%. UTI affected 22 (32.35%) patients with E. coli was the most common isolated bacteria accounting for 63.64% followed by Klebsiella pneumonia (18.18%), Proteus spp. and Pseudomonas aeruginosa (13.64% for each). In univariate analysis, each of age at onset, inadequate therapy for the first episode, and UTI were significantly associated with frequent relapse. However, in multivariate analysis, only adequate treated for first episode (OR= 0.26, 95%CI= 0.08-0.86, p= 0.028) and UTI (OR= 4.8, 95%CI= 1.22-18.87, p= 0.025) were significantly associated. In conclusion, UTI is an important cause of FR in children with SSNS. Therefore, affected children should be routinely investigated for such infection.
A ureteral stent is most broadly used to manage upper urinary tract disorders such as obstruction and prevent post-endoscopic complications. However, the stent may become a niche for bacterial colonization. This study aimed to determine the rate of bacterial colonization and type of bacteria in internal ureteral stents and the risk factors associated with bacterial colonization. This prospective cross-sectional study included 100 consecutive adult patients who had temporary ureteral stenting as preparation for a secondary ureterorenoscopy at Al-Yarmook Hospital/ Baghdad. All included patients were negative for bacterial culture before stenting. Stent and urine culture were performed at the time of stent removal. The colonization rate and bacteriuria in patients with internal ureteral stent were 19% and 9%, respectively. The most common bacteria in-stent and urine were E. coli accounting for 31.58% and 33.33%. Pseudomonas aeruginosa was common in stent culture, representing 21.05%. Positive bacterial culture was confirmed in 19 stents and 9 urine samples. All cases with positive urine samples were also positive for culture. Thus, the sensitivity and specificity of urine culture for detection of stent colonization were 47.37% and 100%, respectively. Diabetes mellitus, chronic renal failure, and prolonged stenting were significantly associated with increased stent colonization. The ureteral stent could be a source of urinary tract infection. The most pathogenic bacteria associated with the ureter stent are E. coli and Pseudomonas aeruginosa. Risk factors associated with stent colonization are diabetes mellitus, chronic renal failure, and prolonged indwelling time.
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