Objectives To characterise the clinical features of hospitalised COVID 19 patients in a single centre during the first epidemic wave and explore potential predictive variables associated with outcomes such as mortality and the need for mechanical ventilation, using baseline clinical parameters. Methodology We conducted a retrospective review of electronic records for demographic, clinical and laboratory data, imaging and outcomes for 500 hospitalised patients between February 20th and May 7th 2020 from Southend University Hospital, Essex, UK. Multivariate logistic regression models were used to identify risk factors relevant to outcome. Results The mean age of the cohort admitted to hospital with Covid-19, was 69.4 and 290 (58%) were over 70. The majority were Caucasians, 437 (87%) with less than 2 co-morbidities 280(56%). Most common were hypertension 186(37 %), Cardiovascular disease 178(36 %) and Diabetes 128 (26 %), represented in a larger proportion on the mortality group. Mean CFS was 4 with Non Survivors had significantly higher CFS 5 vs 3 in survivors, p<0.001. In addition, Mean CRP was significantly higher 150 vs 90, p<0.001 in Non Survivors. We observed the baseline predictors for mortality were age, CFS and CRP. Conclusions In this single centre study, older and frailer patients with more comorbidities and a higher baseline CRP and creatinine were risk factors for worse outcomes. Integrated frailty and age based risk stratification are essential, in addition to monitoring SFR (Sp02/Fi02) and inflammatory markers throughout the disease course to allow for early intervention to improve patient outcomes.
Aim To explore potential predictive variables associated with outcomes using baseline clinical parameters in 500 hospitalised COVID-19 patients. Findings Older age, clinical frailty score and C-reactive protein are independent predictors of mortality. Message Integrated frailty and age-based risk stratification are essential to allow for early intervention to improve patient outcomes.
Primary cardiac tumors are rare, and myxoma is a rare benign primary cardiac tumor in adults, commonly found within the left atrium. The presentation can vary from patients being asymptomatic to pulmonary embolism or stroke. Smaller atrial myxomas are usually asymptomatic, however, larger ones can cause symptoms such as dyspnea, orthopnea, cough, peripheral edema, palpitations, and fatigue. We present a case report of a 72-year-old patient presenting with right shoulder pain and chest pain on breathing to the accident and emergency department. The patient was complaining of right shoulder pain for five days and pleuritic chest pain for the last 48 hours. Initial electrocardiogram showed normal sinus rhythm, however, repeat electrocardiograms showed atrial fibrillation. An echocardiogram showed a homogeneous, relatively round mass seen in the left atrium, close to the inter-atrial septum, and close to the roof of the left atrium, and the patient underwent surgical removal of the benign tumor.
We describe the case of a 70-year-old lady who presented to a district general hospital during an evening with fevers, feeling generally unwell. She was found to have weakness in her left upper limb and went on to have tonic-clonic seizures whilst in the Accident and Emergency Department. CT scan of the brain showed subarachnoid haemorrhage, in absence of headache, in the right frontal, superior parietal and left occipital regions. Her C-reactive protein level was elevated at 426 mg/L and her urine dip was normal. Chest radiograph showed small bilateral pleural effusions. In addition to the above-mentioned findings on clinical examination, she also had pansystolic murmur although did not have any other feature of infective endocarditis (IE). In view of the above findings, normal chest examination and no urinary symptoms, the decision was made to treat this as a case of IE empirically. She subsequently went into fast atrial fibrillation requiring direct current (DC) cardioversion and intensive care unit admission due to hypotension. The next day, echocardiography confirmed vegetations and blood cultures were positive for Staphylococcus aureus. Her MRI scan of the brain confirmed parenchymal haemorrhages and haemorrhagic infarcts. She completed a 6week course of antibiotics and clinically improved. Despite being critically unwell, appropriate antibiotics were initiated within hours of her admission in view of clinical suspicion of underlying IE, which aided her recovery.
Clopidogrel is an antiplatelet drug used for secondary prevention of myocardial infarction, and it is also used in patients with cerebrovascular ischemia. Patients with acute myocardial infarction tend to be on dual antiplatelet therapy for 12 months followed by aspirin lifelong to prevent the risk of stent thrombosis. The most common side effects of clopidogrel are bleeding, neutropenia, and rash; however, arthritis is also one of the rare side effects. We present a case of a 53-year-old patient who had a recent myocardial infarction and was commenced on dual antiplatelet therapy in the form of aspirin and clopidogrel. He started to have severe joint pain, particularly in his knees and shoulders, and was not able to mobilize anymore only three weeks after starting the medications. His clopidogrel was stopped and the patient showed dramatic improvement within three to four days after discontinuation with complete resolution one week later.
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