Objective: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains pandemic with considerable morbidity and mortality around the world. The aim of this study was to identify the predictors for clinical deterioration in patients with COVID-19 who did not show clinical deterioration upon hospital admission. Methods: Two hundred fifty-seven patients with confirmed COVID-19 pneumonia admitted to Guangzhou Eighth People's Hospital between 23 January and 21 March 2020 were retrospectively enrolled. Demographic data, symptoms, laboratory values, comorbidities and treatments were all collected. The study endpoint was clinical deterioration within 20 days from hospital admission. Univariate and multivariable logistic regression methods were used to explore the risk factors associated with clinical deterioration. Results: A total of 49 (19%) patients showed clinical deterioration after admission. Compared with patients that did not experience clinical deterioration, clinically deteriorated patients had more dyspnea, cough and myalgia (65.3% versus 29.3%) symptoms and more had comorbidities (89.8% versus 36.1%). Clinical and laboratory characteristics at admission that were associated with clinical deterioration included senior age, diabetes, hypertension, myalgia, higher temperature, systolic blood pressure, C-reactive protein (CRP), procalcitonin, activated partial thromboplastin time, aspartate aminotransferase, alanine transaminase, direct bilirubin, plasma creatinine, lymphocytopenia, thrombocytopenia, decreased albumin and bicarbonate concentration. Medical history of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, calcium channel blockers and metformin were also risk factors. Conclusion: The four best predictors for clinical deterioration were CRP, procalcitonin, age and albumin. A "best" multivariable prediction model, resulting from using a variable selection procedure, included senior age, presentation with myalgia, and higher level of CRP and serum creatinine (bias-corrected c-statistic ¼ 0.909). Sensitivity and specificity corresponding to a cut point of CRP !18.45 mg/L for predicting clinical deterioration were 85% and 74%, respectively.
ABSTRACT ABSTRACTEssential hypertension being a major public health problem with an atrocious toll. Furthermore resistant hypertension has increased morbidity and mortality in spite of using three or more antihypertensive medication, including one diuretic at their optimal doses to achieve the target blood pressure. Renal artery with its sympathetic afferent and efferent nerve signaling has substantial role in elevating and sustaining blood pressure. Blunting the overt sympathetic activity, catheter based renal sympathetic nerve denervation has become new treatment approach for the treatment of resistant hypertension. So in this review we address the current aspect and development of renal sympathetic denervation in the management of difficult to control hypertension.
Background: The clinical pathways have been developed to guide and standardize diagnosis, treatment of certain diseases, optimize smooth patient care, and its application has been proven to regulate the medical practice and to improve the quality of medical care in developed countries. Objective: To analyze and evaluate the diagnosis and treatment of acute coronary syndrome (ACS) after the implementation of clinical pathways and to identify the areas need to be improved in clinical practice in Xiangya Third Hospital of Central South University. Methods: 250 ACS patients, divided into five groups 50 in each, were collected from December 2009 to December 2011, the first group was considered as baseline and compared with other four group. All these data were compared and analyzed with other tertiary hospitals of china. Results: STEMI patients arriving within 12 hours of onset of symptoms was increased (P<0.05), and final diagnosis consistent with cardiac markers was also increased (P<0.05).Use of aspirin, clopidogrel, β-Blocker, ACEI /ARB, and statin was higher (P>0.05), but the use of clopidogrel and statin was significantly higher (P<0.05) than other hospitals; no significant difference (P>0.05) in Door-to-needle time or Door-to-balloon time, though longer than standard guidelines, but the door-to-needle time was shorter when compared with other hospitals. TIMI risk score of UA/NSTEMI patients and invasive therapy (PCI) was negatively correlated (r = -0.312, P<0.05), and results were similar when compared with other hospitals; high-risk patients increased, but no significant difference in mortality (P>0.05). Conclusion: Implementation of Clinical pathway may help to improve patient outcome with early invasive and medical therapy.
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