ObjectiveWe examined the demographic, clinical characteristics and indicators of poor outcomes among hospitalized adults with COVID-19 at the University Hospital of the West Indies, Jamaica.MethodsA retrospective medical record review between March 10 and December 31, 2020 analyzed data for 362 participants.ResultsThere were 218 males (mean age 59.5 years) and 144 females (mean age 55.7 years). Hypertension, diabetes mellitus, cardiovascular disease, obesity and chronic kidney disease were the most common comorbidities. Cough, shortness of breath, fever and malaise were the most common presenting complaints. Fifty-one percent of patients were moderately to severely ill on admission; 11% were critically ill; 18% were admitted to the Intensive Care Unit (ICU). Death occurred in 62 (17%) patients (95% CI 13.6-21.4%). Among obese participants, there were increased odds of developing respiratory failure (OR 5.2, p < 0.001), acute kidney injury (OR 4.7, p < 0.001), sepsis (OR 2.9, p =0.013) and the need for ICU care (OR 3.7, p < 0.001). Factors independently associated with increased odds of death were age (OR 1.03 per year, p = 0.013) and obesity (OR 2.26, p = 0.017). Mortality also correlated significantly with D-dimer > 1000 ng/ml (OR 2.78; p = 0.03), serum albumin < 40 g/L (OR 3.54; p = 0.03) and serum LDH > 485 U/L OR 1.92, p = 0.11).ConclusionsTargeted interventions among these high-risk patient subgroups may reduce in-patient morbidity and mortality.

Background Recent data on the prevalence of H. pylori infection in Jamaica are lacking. It is postulated that there has been a decline in the prevalence of H. pylori infection and its associated complications. We determined sociodemographic characteristics, prevalence of H. pylori infection and clinical outcomes among adults undergoing esophagogastroduodenoscopy (EGD) and histology at the University Hospital of the West Indies (UHWI) between May 2018 and December 2020. Materials and methods A cross‐sectional study of patients (≥18 years old), who underwent EGD and histological evaluation for H. pylori infection, was conducted. Associations of H. pylori positivity and gastric cancer with sociodemographic/clinical variables and endoscopic findings were determined by stepwise logistic regression using backward selection. Unadjusted and adjusted odds ratios with related 95% confidence intervals (Cis) were calculated for H. pylori positivity and gastric cancer status. Results There were 323 participants (mean age 58.6 ± 17.8 years, 54.2% females). H. pylori prevalence was 22.2% (n = 70 of 315), 5.6% had gastric neoplasia (GN), 15.5% gastric atrophy, 11.4% intestinal metaplasia and 3.7% dysplasia on histology. Mucositis (64.5%), gastric ulcer (14.9%), and duodenal ulcer (13.9%) were the most common endoscopic findings. Participants with peptic ulcer disease (PUD) (unOR = 4.0; p = .017), gastric cancer (unOR = 9.5; p = .003), gastric atrophy (unOR = 12.8; p < .001), and intestinal metaplasia (unOR = 5.0; p < .001) had a significantly higher odds of being H. pylori positive, but after multivariable analyses only gastric atrophy remained significant (aOR = 27.3; p < .001). Participants with mucositis had a significantly lower odds of gastric cancer (unOR 0.1; p = .035) while participants with dysplasia had significantly higher odds (unOR 8.0; p = .042), but these were no longer significant after multivariable analyses (aOR = 0.2; p = .156 and aOR = 18.9; p = .070, respectively). Conclusions Histology based prevalence of H. pylori infection is lower than previously reported in Jamaica. Gastric atrophy is a significant predictor of H. pylori positivity.

Introduction: Acute kidney disease (AKI) is preventable in certain situations. Long-term and/or high dose furosemide may lead to acute kidney injury. Objectives: We aimed to find the risk of AKI among hospitalised patients who were exposed to furosemide. Patients and Methods: This is a retrospective cohort study of hospitalised patients who received furosemide therapy during the admission between 2019 and 2021. Exposure to furosemide was grouped into low dose (≤ 40 mg/d) or high dose (>40 mg/d) and short-term use (≤ 72 hours) or long-term use (>72 hours). Risk of acute kidney injury was calculated as odds ratios with a 95% confidence interval (CI). A P value <0.05 was considered statistically significant. Results: Of 314 patients who received furosemide intravenously or orally, 197 patients (62.7%) had acute kidney injury. Of 197 patients with acute kidney injury, 110 patients (55.9%) received the dosage of >40 mg/d and 121 patients (61.4%) were on furosemide for >7 days (odds ratios [ORs]: 5.46, 95% CI: 3.17 to 9.39, P≤0.001 and ORs: 7.72, 95% CI: 4.4 to 13.52, P≤0.001). In comparison, the 87 (44.1%) patients who received ≤40 mg/d of furosemide had a lower incidence of AKI (ORs: 0.25, 95% CI: 0.13 to 0.48, P≤0.001) and only 21 of the patients (10.6%) who received furosemide for < 7 days were found to have acute kidney injury (ORs: 0.08, 95% CI: 0.04 to 0.14, P≤0.001). The combined effect of high dose and long-term furosemide therapy is more consequential as we found that 100 (31.8%) patients who received furosemide >40 mg for >72 hours, 96 patients (30.6%) developed AKI (ORs: 26.8, 95% CI: 9.53 to 75.63, P≤0.001). Conclusion: Among hospitalised patients, exposure to high dose furosemide or prolonged use of furosemide is associated with AKI. The risk is more when high dose furosemide is administered for longer than 72 hours. Presence of underlying diabetes, hypertension, cardiac failure and chronic kidney disease, are also associated with furosemide -induced hospital-acquired acute kidney injury.

Introduction: Potential nephrotoxic agents are not well recognized and are being used irrespective of patients’ vulnerability. Objectives: We aimed to evaluate the relationship between the prevalence of exposure to normal saline and the risk of hospital acquired acute kidney injury (HA-AKI). Patients and Methods: A retrospective case-control study of a total of 424 hospitalized patients was done. The frequency of exposure to the individual intravenous fluids and their risk of HA-AKI were calculated as odds ratios with 95% confidence interval (CI). Results: Of 424 total sampled hospitalized patients, post-admission normal saline exposure was found in 37.6% in which 22.6% had the development of HA-AKI and 15% did not develop AKI. The risk of HA-AKI was significantly higher in patients who received normal saline and lower in patients who received 5% dextrose water (ORs; 1.92, 95% CI; 1.28, 2.85; P=0.001 and ORs; 0.48, 95% CI; 0.24, 0.95, P=0.02, respectively). Conclusion: Exposure to normal saline was considerably high among hospitalized patients and was associated with a higher risk of AKI. Post-admission administration of high sodium and chloride containing intravenous fluid should be limited in patients who are vulnerable to develop AKI.