Clinical Effects of Pediatric Clonidine Exposure: A Retrospective Cohort Study at a Single Tertiary Care Center

AbstractObjectivesBirth tears are a common complication of vaginal childbirth. We aimed to evaluate the outcomes of birth tears first by comparing the mode of vaginal birth (VB) and then comparing different vacuum cups in instrumental VBs in order to better advise childbearing women and obstetrical professionals.MethodsIn a retrospective cohort study, we analyzed nulliparous and multiparous women with a singleton pregnancy in vertex presentation at ≥37 + 0 gestational weeks who gave birth vaginally at our tertiary care center between 06/2012 and 12/2016. We compared the distribution of tear types in spontaneous births (SBs) vs. vacuum-assisted VBs. We then compared the tear distribution in the vacuum group when using the Kiwi Omnicup or Bird’s anterior metal cup. Outcome parameters were the incidence and distribution of the different tear types dependent on the mode of delivery and type of vacuum cup.ResultsA total of 4549 SBs and 907 VBs were analyzed. Birth tear distribution differed significantly between the birth modes. In 15.2% of women with an SB an episiotomy was performed vs. 58.5% in women with a VB. Any kind of perineal tear was seen in 45.7% after SB and in 32.7% after VB. High-grade obstetric anal sphincter injuries (OASIS) appeared in 1.1% after SB and in 3.1% after VB. No significant changes in tear distribution were found between the two different VB modes.ConclusionsThere were more episiotomies, vaginal tears and OASIS after VB than after SB. In contrast, there were more low-grade perineal and labial tears after SB. No significant differences were found between different vacuum cup systems, just a slight trend toward different tear patterns.

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The relationship between obesity, hemoglobin A1c and the severity of COVID-19 at an urban tertiary care center in New York City: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-044526 ◽

2021 ◽

Vol 11 (1) ◽

pp. e044526

Author(s):

Gurchetan Randhawa ◽

Kunzah A Syed ◽

Kavish Singh ◽

Sanchit V Kundal ◽

Sharad Oli ◽

...

Keyword(s):

New York ◽

New York City ◽

Cohort Study ◽

Lactic Acidosis ◽

Retrospective Cohort ◽

Hemoglobin A1c ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Obesity And Diabetes

ObjectivesTo determine if obesity and diabetes are risk factors for severe outcomes in COVID-19 and to compare patient outcomes in those two conditions.DesignRetrospective cohort study.SettingUrban tertiary care center in New York City.Participants302 patients admitted in an inpatient setting, ≥18 years old, with a laboratory-confirmed diagnosis of COVID-19 via nasal PCR swab were randomly selected. Patients were separated into two cohorts based on their body mass index and hemoglobin A1c. 150 patients were placed in the non-obese, non-diabetic cohort and 152 patients were placed in the corresponding cohort (obesity alone, obesity and diabetes, and diabetes alone).MeasurementsPrimary outcomes were development of acute kidney injury, commencement of renal replacement therapy, aminotransferase elevation, troponin elevation, lactic acidosis, development of septic shock, use of vasopressors, presence of acute respiratory distress syndrome (ARDS) and intubation. The secondary outcomes were length of stay in days and mortality.ResultsPatients with obesity and/or diabetes were more likely to develop ARDS (79 patients vs 57 patients, p<0.0001) and to be intubated (71 patients vs 45 patients, p=0.0031). Patients with obesity and/or diabetes were more likely to require vasopressors (60 patients vs 41 patients, p=0.0284) and to develop lactic acidosis (median 3.15 mmol/L, IQR 1.8 to 5.2 mmol/L, p=0.0432). When comparing patients with diabetes with and without obesity against patients with obesity alone, they were more likely to develop ARDS (87.5%, p=0.0305). Despite these findings, there was no difference in mortality.ConclusionsIn patients hospitalised with COVID-19, those with obesity and/or diabetes were more likely to suffer severe complications, but had negligible differences in mortality. This highlights the importance of close monitoring of patients with these conditions and additional areas of research needed to explain the mortality findings.

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1496. Aspergillosis Complicating Severe Respiratory Syncytial Virus (RSV) in ICU Patients: A Retrospective Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1677 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S750-S750

Author(s):

Hannah Nam ◽

Michael G Ison

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Care Center ◽

Tertiary Care ◽

Invasive Pulmonary Aspergillosis ◽

Categorical Variables ◽

Cell Transplant ◽

Pulmonary Aspergillosis ◽

Icu Patients

Abstract Background There are recent reports that identify severe influenza pneumonia as an independent risk factor for the development of invasive pulmonary aspergillosis (IPA), even in patients without immunocompromise. We aimed to understand the incidence of IPA as well as other coinfections over multiple seasons in patients with RSV pneumonia in the intensive care unit (ICU). Methods A retrospective cohort study was conducted in a single center in Chicago. Data was collected over 9 seasons (January 2009-March 2018) from adult patients admitted to the ICU at a large urban tertiary care center with severe RSV pneumonia. Patients were included if they had a positive RSV PCR test, older than 18 years, admitted to the ICU with acute respiratory failure, and had pulmonary infiltrates on imaging. IPA was defined per both the EORTC/MSG criteria as well as the revised AspICU criteria (Schauwvlieghe et al). Descriptive statistics were calculated. In univariable analysis, we compared categorical variables by Fisher’s exact test and Chi-square test, continuous variables by Wilcoxon Rank Sum where appropriate. Results Of 224 patients admitted to the ICU with RSV (median ICU LoS 10.5 d), IPA was diagnosed in 8 (3.5%). Patients diagnosed with IPA had an increased LoS in the hospital (23.7 days vs. 11.6 days, p=0.01). Although the mortality was numerically higher (3, 37.5% vs 26, 17.9%) this was statistically not significant). History of hematological malignancy, stem cell transplant, and neutropenia were significant factors in the development of IPA. Those with lung disease had significantly lower rates of IPA. All patients with IPA were treated with voriconazole. Other coinfections among RSV-infected ICU patients included bacterial (21, 13.7%), viral (10, 6.5%), and non-IPA fungal (13, 8.5%) pathogens. Baseline Characteristics and Mortality/Morbidity Patient Characteristics in Invasive Pulmonary Aspergillosis Conclusion Although IPA is relatively uncommon in patients admitted to the ICU with severe RSV pneumonia, patients with IPA had significant increased LOS and tended to have underlying host factors. Other coinfections with bacterial, viral, and non-IPA fungal pathogens are common in those with severe RSV pneumonia. Disclosures Michael G. Ison, MD MS, AlloVir (Consultant)

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Transoral endoscopic approach versus transcervical with or without mandibular swing approach to parapharyngeal space- a retrospective cohort study in a tertiary care center in Tamil Nadu

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204625 ◽

2020 ◽

Vol 6 (11) ◽

pp. 2022

Author(s):

Sheetal Krishnappa ◽

Nikisha G. N.

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Tamil Nadu ◽

Parapharyngeal Space ◽

Care Center ◽

Tertiary Care ◽

Endoscopic Approach ◽

Transcervical Approach ◽

Mandibular Swing

Background: The objective of this study was to evaluate and compare patient outcomes and advantages of endoscopic transoral approach to parapharyngeal space with other approaches like transcervical with or without mandibular swing approach.Methods: In this retrospective cohort study, we have reviewed 13 cases of parapharyngeal space tumors resected with either trans oral endoscopic assisted approach or external approaches such as trans cervical and mandibular swing approach during the period of June 1, 2015 to May 31, 2020. Results: A total of 13 cases were included in the study. Among 13 cases, 9 were operated by transoral endoscopic approach, 2 by transcervical approach and 2 by transcervical with mandibular swing approach. Operative time (p=0.048), blood loss (p=0.028), hospital days (p=0.02) and postoperative patient satisfaction (p=0.008) were more in transoral route compared to transcervical route.Conclusions: Transoral endoscopic route is a safe route of surgery with less morbidity, less complications, less chance of neurovascular injury and cosmetically more acceptable for the patient when compared to open procedures for smaller size tumors without vascularization, present in the upper part of the parapharyngeal space and without attachment to any neurovascular structures.

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