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   Table of Contents - Current issue
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October 2021
Volume 10 | Issue 5
Page Nos. 179-220

Online since Tuesday, October 5, 2021

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META-ANALYSIS  

Chest CT features in COVID-19 patients: A systematic review and meta-analysis p. 179
Mohammadreza Taghavi, Azar Shokri, Parastoo Niloofar, Salar Poorbarat, Samaneh Mollazadeh, Hamed Milani
DOI:10.4103/2221-6189.326907  
Objective: To derive the pooled estimate of chest computed tomography (CT) findings in coronavirus disease 2019 (COVID-19) patients. Methods: A comprehensive systematic search was conducted according to the PRISMA checklist from January 2020 to September 2020 in electronic databases including PubMed, Google Scholar, and Scopus based on search terms in title and texts. Original descriptive studies with epidemiological parameters of interest were included into the systematic review and meta-analysis. Results: Totally 54 articles comprised of 4 879 patients with a mean age of 49.05 years were eligible for this study. The pooled prevalence for abnormal CT images was 86.0%. Pooled prevalence for ground-glass opacity was 68.0%, 71.0% for bilateral abnormalities, 47.0% for mixed ground-glass opacity and consolidation and 29.0% for consolidation. In addition, 64.0% of lesions were peripheral, and 12.0% were central while 28.0% were both central and peripheral. Furthermore, 61.0% of lower lungs were involved, and 7.0% and 5.0% of the cases presented with pleural effusion and pericardial effusion, respectively. Besides, 11% of the cases showed lymphadenopathy, and 37% had air broncho gram sign. The pooled prevalence of other chest CT findings ranged from 8.0% to 65.0%. Conclusions: Chest CT can be used as predictive tools for the detection of COVID-19 disease along with clinical manifestations and the RT-PCR method.
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ORIGINAL ARTICLES Top

Performance of HEART and TIMI scores in predicting major adverse cardiovascular events (MACEs) of chest pain patients in the emergency department: A prospective observational study p. 190
Sonal Kaushal Ginoya, Samira N Parikh
DOI:10.4103/2221-6189.326908  
Objective: To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events (MACEs) of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad, a city in western India. Methods: A prospective study was conducted on chest pain patients from January to December 2019. All adult patients with non-traumatic chest pain presenting to the emergency department were included, and their HEART and TIMI scores were evaluated. The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death. The receiver-operating characteristics (ROC) curve was used to determine the value of HEART and TIMI scores in predicting MACEs. Besides, the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of the two scores were assessed and compared. Results: A total of 350 patients were evaluated [mean age (55.03±16.6) years, 56.6% of males]. HEART score had the highest predictive value of MACEs with an area under the curve (AUC) of 0.98, followed by the TIMI score with an AUC of 0.92. HEART score had the highest specificity of 98.0% (95% CI: 96.4%-99.6%), the sensitivity of 75.0% (95% CI: 70.7%-79.3%), and PPV of 97.0% (95% CI: 94.1%-99.9%) and NPV of 82.5% (95% CI: 74.6%-90.4%) for low-risk patients. TIMI score had a specificity of 95.0% (95% CI: 92.4%-97.6%), sensitivity of 75.0% (95% CI: 69.4%-80.6%), PPV of 92.3% (95% CI: 88.1%-96.5%) and NPV of 82.3% (95% CI: 73.8%-90.8%) for low-risk patients. Conclusions: HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score. Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.
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Effect of pulsed corticosteroids and tocilizumab on hyperinflammation in COVID-19 patients with acute respiratory distress syndrome p. 195
Murat Aslan, Mehmet Süleyman Sabaz, Rabia Yilmaz, Sinan Aşar, Yasemin Tekdöş Şeker, Gülsüm Oya Hergünsel
DOI:10.4103/2221-6189.326909  
Objective: To compare the efficacy of pulsed-dose corticosteroids (≥250 mg methylprednisolone, 3 days) and tocilizumab in treating COVID-19-related hyperinflammation. Methods: This prospective observational study included RT-PCR positive COVID-19 patients with acute respiratory distress syndrome, who were admitted to the COVID-19 Adult Intensive Care Unit of Prof Dr. Murat Dilmener Emergency Hospital (Istanbul, Turkey) between December 1, 2020 and February 28, 2021. Clinical, laboratory and radiological examinations were used to diagnose COVID-19 associated hyperinflammation. Three cohort groups were formed: the pulsed-dose corticosteroids group (250 mg methylprednisolone for 3 days), the tocilizumab group (8 mg/day single dose or 400 mg/day for 2 days), and the combined group (pulsed-dose corticosteroid+tocilizumab). The difference in mortality rates among the groups was compared primarily. The most common cause(s) of death was determined. Furthermore, adverse events (secondary infection, acute kidney injury, arrhythmia, gastrointestinal system bleeding) for 28 days were recorded. Results: A total of 60 patients were included in this study, with 20 patients in each group. There was no statistically significant difference between the 3 groups in mortality rates (55% in the pulsed corticosteroid group, 60% in the tocilizumab group, 50% in the combined group, χ2=0.404, P=0.817). Infectious causes were found to be the most common cause of mortality in all the three groups, and no difference was found between them (χ2=0.404, P=0.817). There was also no difference in the development of adverse events such as secondary infection, acute kidney injury, arrhythmia, and gastrointestinal bleeding among the groups (P>0.05). Conclusions: Corticosteroids can be used instead of tocilizumab to treat hyperinflammation in COVID-19 patients with acute respiratory distress syndrome.
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Drug dependence and its risk factors in emergency department patients: A retrospective cross-sectional study p. 202
Erdal Yavuz, Kasim Turgut, Umut Gulacti, Ugur Lok, Erman Altunisik
DOI:10.4103/2221-6189.326910  
Objective: To determine the characteristics and risk factors of drug dependence among patients who were administered drugs with addictive potential (DAP) in an emergency department (ED). Methods: This retrospective cross-sectional study included patients who were administered DAP 3 or more times in the emergency room between September 1, 2019 and March 1, 2020. The demographic and baseline information were recorded. All the prescibed DAP, the reasons to use these drugs, secondary drug dependence, the department where DAP were first prescribed, types of doctors who preferred to prescribed DAP, and the risk factors for the development of drug dependence were determined. Results: A total of 3 000 patients were screened from medical records, and among them, 80 patients developed drug dependence. Drug dependence only developed for tramadol (n=57, 71.3%), diazepam (n=11, 13.8%), and biperiden (n=12, 15.0%). Tramadol was the most frequently prescribed drug (n=57, 71.3%). The most common reason for drug dependence was psychiatric disorders (n=29, 36.3%). Drug dependence developed in renal colic patients due to the administration of tramadol (n=7, 100%). On the contrary, dependence to biperiden were mainly developed in patients with psychiatric complaints (n=12, 41.4%). The rate of secondary drug dependence was 15% (n=12). Of the Biperiden users, 41.7% developed secondary drug dependence on diazepam. Most DAP were first prescribed in the ED (n=52, 65%), and the specialist preferred to prescribe DAP (n=43, 53.8%). For the development of dependence, the presence of renal colic (OR: 3.387, 95% confidence interval (CI): 1.473-7.788, P=0.004) and low back pain (OR: 5.778, 95% CI: 2.779-12.014, P<0.001) were the risk factors. Conclusions: Most DAP were first prescribed in the ED compared to other departments, and specialist are preferred to use DAP. Tramadol is the most commonly used drugs caused drug dependence. Psychiatric disorder patients are easier to develope drug dependence. Furthermore, renal colic and low back pain patients needs more attention to avert drug dependence.
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Early outcomes of limb salvage surgery with mega-prosthesis: A single center experience p. 208
Muhammad Bilal, Syed Rizwan-UL-Ahsan Jilani, Ilyas Rafi, Osama Shakeel, Wardah Jabeen
DOI:10.4103/2221-6189.326911  
Objective: To determine the early outcomes of limb salvage surgery with mega prosthesis. Methods: This retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) from 1st January 2017 till 31st January 2020. Data like demographics, histopathology, functional and survival outcomes were retrieved from the Hospital Information System. Musculoskeletal Tumor Society (MSTS) score was used to evaluate the functional outcomes after the surgery. For survival analyses, Kaplan-Meier curve was applied. Prosthesis joint infection, amputation rate, metastasis, mortality rate, and recurrence were also recorded. Results: This study included 43 patients who underwent limb salvage surgery with endoprosthesis reconstruction at SKMCH&RC. The mean age at the time of diagnosis was (26.5±15.8) years. Patients with distal femoral replacement had the highest MSTS scores (81.45±9.70) while those with proximal humerus replacement has the lowest MSTS scores (56.8±11.2). There was a strong association between site of tumor and MSTS (F=3.30, P=0.017). We also found a correlation between surgical site infection and MSTS scores (r=0.484, P=0.001). Patients with recurrence also had significantly lower MSTS scores (P<0.05). The cumulative survival rate at the end of two-year follow-up was (71.4±17.1)% in proximal femur tumor patients, (88.0±7.8)% in distal femur tumor patients, and (50.0±3.5)% in proximal humerus tumor patients. Besides, patients with Ewing sarcoma had the highest survival rate (97.5±11.0)% while patients with chondrosarcoma had the lowest survival rate (77.8±13.9)%. Conclusions: Limb salvage surgery with mega-prosthesis can be performed with satisfactory functional and survival outcomes, but further studies are needed to compare it with other limb salvage methods. This study can be used as a reference for future studies.
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Effect of traditional Chinese preparation Xuebijing on inflammatory markers in patients with ventilator-associated pneumonia p. 216
Hong-wei Zhang, Li-you Wei, Ji-xuan Wang, Shu-zheng Liu, Dan Xing, Rui Zhang, Hui Guo, Li-juan Chen, Jing Zhang
DOI:10.4103/2221-6189.326912  
Objective: To observe the effect of Xuebijing, a complex traditional Chinese preparation, on inflammation and prognosis of patients with pneumonia. Methods: The patients with ventilator-associated pneumonia in the intensive care unit (ICU) were randomly divided into the control group and the treatment group with 35 cases in each group. Both groups were given routine treatment such as anti-inflammatory drugs, rehydration, expectorant, and nutritional support, while the treatment group was additionally given Xuebijing injection. Serum C-reactive protein (CRP), clinical pulmonary infection score (CPIS), acute physiology, and chronic health score II (APACHE II) were recorded before treatment, the 3rd and 7th day after treatment. The duration of antibiotic use, mechanical ventilation, ICU stay, and mortality during 28 days was recorded. Results: There was no significant difference in CRP, CPIS, and APACHE II between the two groups before treatment (P>0.05). The improvement of CRP, CPIS, and APACHE II in the treatment group was better than those in the control group on the 3 and 7 days after treatment, and the differences were statistically significant (P<0.05). The duration of antibiotic use, mechanical ventilation, and ICU stay in the treatment group were less than those in the control group (P<0.05). The 28-day mortality of the treatment group was lower than that of the control group, but the difference was not statistically significant (P>0.05). Conclusions: Xuebijing injection can improve the inflammatory indexes of patients with ventilator-associated pneumonia, and can partly improve the prognosis.
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