OBJECTIVES

The study aimed to define the cycle threshold (Ct) value of reverse transcription polymerase reaction (RT PCR) as a potential marker in identifying the risk of COVID-19-confirmed patients in developing cerebrovascular disease (CVD) and to present the risk factors associated with such occurrence.

METHODS

The researcher employed a single center, retrospective, chart review, case-control study among adult RT-PCR confirmed, hospitalized COVID-19 patients at Las Piñas General Hospital and Satellite Trauma Center (LPGH STC) from January to December 2021. The study included 252 patients among 730 RT-PCR-confirmed adult COVID-19 patients who met the study population criteria.

RESULTS

Fifty patients had concomitant CVD, while 202 patients were non-CVD. The majority (n=143, 56.75%) were 19-59 years old male predominance (n=138, 54.76%). More than half of the study population suffered from either hypertension, diabetes, or both, with a high proportion of the subjects being non-compliant or no maintenance medications. Two hundred ten (83.3%) out of 252 patients were unvaccinated. Twenty (7.9%) patients were noted with a history of smoking, and 58 (23%) patients with a history of alcohol intake. The majority of the patients suffered moderate COVID-19 severity during their hospital stay, with a 30.16% (n=76) mortality rate. Ischemic stroke was the most common CVD, with 38 (76%) occurrences. Acute respiratory failure was the leading cause of death, followed by ARDS, brainstem failure, and ACS. The median cycle threshold among CVD patients was 32.84, significantly higher than the majority at 28.64. A higher mean Ct value was noted among patients with CVD infarct at 33.44 as compared to 26.83 among patients with Hemorrhagic Stroke. Utilizing the Point-Biserial Correlation Coefficient to analyze possible association between the Ct value and the occurrence of stroke, a 0.22 correlation coefficient implied a weak positive correlation between the Ct value and CVD occurrence.

CONCLUSION

The relationship between the cycle threshold (Ct) value and the occurrence of CVD exists weakly, and factors that might affect this relationship must be addressed and resolved. Interpreting Ct value results also requires clinical context; hence, careful utilization of such data must always be observed. Several factors, including old age, male gender, co existing comorbidities such as hypertension and diabetes mellitus, lack of maintenance medication and noncompliance, vaccination status, smoking, and alcohol intake history, contributed to the poorer outcome of the patients and the high probability of having a stroke.

Human ; Covid-19 ; Cerebrovascular Diseases ; Cerebrovascular Disorders

OBJECTIVE: To review cases of adult patients who develop Hungry Bone Syndrome (HBS) after parathyroidectomy for Primary Hyperparathyroidism (PHPT) in a tertiary care center in the Philippines and describe the clinical features, pre-operative preventive measures done and risk factors for HBS.
METHODS:
Design: Retrospective Case Note Review
Setting: Tertiary Private Hospital
Participants: Chart review of adult Filipino patients who underwent parathyroidectomy for PHPT at Makati Medical Center from January 2011 to December 2016 was conducted and evaluated according to the inclusion and exclusion criteria. Medical information obtained included clinical parameters, biochemical results, operation performed, pathology, length of hospital stay and complications if with any.
RESULTS: From among 20 adult Filipino patients (mean age 55 years; 13, 65% female) who underwent parathyroidectomy for PHPT, HBS was found in 7 (35%). Most common pre-operative symptoms of hypercalcemia were musculoskeletal complaints. To prevent HBS, all were hydrated prior to surgery while some were given bisphosphonates and diuretics. The most common parathyroid gland imaging used for pre-procedure localization was Tc 99m Sestamibi scan with single photon emission computed tomography (SPECT) and 19 (95%) had parathyroid adenoma on post-operative histopathologic report. Among biochemical and clinical factors that may be risk factors for HBS, those with HBS had significantly lower pre-operative 25-hydroxyvitamin D, higher BUN, phosphate and alkaline phosphatase (ALP) than those without HBS. Of these, only ALP showed significant association with HBS (OR = 107.17, p = <0.0001). Length of hospital stay was longer among those with HBS although not statistically significant.
CONCLUSION: Knowledge on post-parathyroidectomy HBS for PHPT may aid clinicians on preoperative prevention and post-operative monitoring. Thirty-five percent (7) of our patients presented with HBS post-parathyroidectomy for PHPT from 2011 to 2016. An abnormal ALP level pre-operatively may be a risk factor in developing HBS post-parathyroidectomy for PHPT

Human ; Male ; Female ; Middle Aged ; Adult ; Hyperparathyroidism, Primary ; Parathyroidectomy ; Parathyroid Neoplasms ; Alkaline Phosphatase ; Parathyroid Glands ; Hypercalcemia ; Diphosphonates ; Diuretics ; Blood Urea Nitrogen ; Calcifediol ; 25-hydroxyvitamin D ; Vitamin D