Background The assessment of clinical prognosis of pregnant COVID-19 patients at hospital presentation is challenging, due to physiological adaptations during pregnancy. Our aim was to assess the performance of the ABC2-SPH score to predict in-hospital mortality and mechanical ventilation support in pregnant patients with COVID-19, to assess the frequency of adverse pregnancy outcomes, and characteristics of pregnant women who died. Methods This multicenter cohort included consecutive pregnant patients with COVID-19 admitted to the participating hospitals, from April/2020 to March/2022. Primary outcomes were in-hospital mortality and the composite outcome of mechanical ventilation support and in-hospital mortality. Secondary endpoints were pregnancy outcomes. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC). Overall performance was assessed using the Brier score. Results From 350 pregnant patients (median age 30 [interquartile range (25.2, 35.0)] years-old]), 11.1% had hypertensive disorders, 19.7% required mechanical ventilation support and 6.0% died. The AUROC for in-hospital mortality and for the composite outcome were 0.809 (95% IC: 0.641–0.944) and 0.704 (95% IC: 0.617–0.792), respectively, with good overall performance (Brier = 0.0384 and 0.1610, respectively). Calibration was good for the prediction of in-hospital mortality, but poor for the composite outcome. Women who died had a median age 4 years-old higher, higher frequency of hypertensive disorders (38.1% vs. 9.4%, p < 0.001) and obesity (28.6% vs. 10.6%, p = 0.025) than those who were discharged alive, and their newborns had lower birth weight (2000 vs. 2813, p = 0.001) and five-minute Apgar score (3.0 vs. 8.0, p < 0.001). Conclusions The ABC2-SPH score had good overall performance for in-hospital mortality and the composite outcome mechanical ventilation and in-hospital mortality. Calibration was good for the prediction of in-hospital mortality, but it was poor for the composite outcome. Therefore, the score may be useful to predict in-hospital mortality in pregnant patients with COVID-19, in addition to clinical judgment. Newborns from women who died had lower birth weight and Apgar score than those who were discharged alive.
Background Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia. Methods This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events. Results Among 8,947 eligible patients, 405 (4.5%) had a diagnosis of dementia and were matched with 1,151 patients without dementia. Compared to a group of similar demographics and comorbidities, patients with dementia presented a lower duration of symptoms (5.0 vs. 7.0 days; p<0.001) and frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia. Fever and delirium were more frequent in patients with dementia than the control group. Patients with dementia also received more palliative care than the control group. Dementia was associated with lower admission (32.7% vs. 47.1%, p<0.001) and length of stay (7 vs. 9 days, p<0.026) in the ICU, frequency of sepsis (17% vs. 24%, p=0.005), KRT (6.4% vs. 13%, p<0.001), and IVM (4.6% vs. 9.8%, p=0.002). We did not find differences in hospital mortality among those with and without dementia. Conclusion Clinical manifestations of COVID-19 differ in older patients with and without dementia in the hospital, with delirium being highly prevalent among those with dementia. Our findings indicate that dementia alone might not explain higher short-term mortality after severe COVID-19. Clinicians should include other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of COVID-19 in the hospital.
No abstract
Introduction: Optic neuritis (ON) is characterized by a condition of the optic nerve´s demyelinating inflammation, unilateral or bilateral involvement, which can lead to painful visual loss, color blindness, and other neurological and systemic impairments. Because it has several etiologies, ON is underdiagnosed and the studies seek an integrative review to identify the causes and differential diagnoses for the proper management. Methods: An analysis of scientific publications in the Pubmed and ScienceDirect databases was realized using the descriptors Optic Neuritis and diagnosis. Results: The diagnosis of ON is made by clinical findings associating neuroimage tests. About 60% of diagnosed patients have an alternative diagnosis; as optic neuropathies of anterior ischemic causes, Leber’s hereditary neuropathy and compressive neuropathies; infiltrative; toxic-metabolic or vitamin B12 deficiency. ON has different etiologies, such as infectious, paraneoplastic, autoimmune and demyelinating, so a directed anamnesis and ophthalmological examination is essential for professional´s orientation. The investigation of infectious, parainfectious and inflammatory causes must include the research of diseases such as syphilis, ricketsiosis, toxoplasmosis, mycobacteriosis, HIV and herpes zoster, and the recent vaccination. It is necessary to investigate autoimmune diseases, due to the increased risk of the coexistence of autoantibodies that attack structures of the optic nerve. Within the spectrum of demyelinating lesions, Multiple Sclerosis is the most common etiology, although Neuromyelitis Optica, Schilder Disease and Encephalitis Periaxilis Concentric should be remembered. Conclusion: When considering the various causes, it is necessary for professionals to make the diagnosis with effective clinical evaluation, with complementary tests, essential for the proper patient´s management.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.