Antibiotics during Intrauterine Balloon Tamponade Is Associated with a Reduction in Endometritis

Objective To determine if illness severity during the first days of life predicts adverse outcome in asphyxiated newborns treated with hypothermia. Study Design We conducted a retrospective cohort study of asphyxiated newborns treated with hypothermia. Illness severity was calculated daily during the first 4 days of life using the Score for Neonatal Acute Physiology II (SNAP-II score). Adverse outcome (death and/or brain injury) was recorded. Differences in SNAP-II scores between the newborns with and without adverse outcome were assessed. Result 214 newborns were treated with hypothermia. The average SNAP-II score over the first 4 days of life was significantly worse in newborns developing adverse outcome. The average SNAP-II score was an excellent predictor of death (area under the curve [AUC]: 0.93; p < 0.001) and a fair predictor of adverse outcome (AUC: 0.73; p < 0.001). The average SNAP-II score remained a significant predictor of adverse outcome (odds ratio [95% confidence interval]: 1.08 [1.04–1.12]; p < 0.001), after adjusting for baseline characteristics, degree of initial asphyxial event, and initial severity of encephalopathy. Conclusion In asphyxiated newborns treated with hypothermia, not only the initial asphyxial event but also the illness severity during the first days of life was a significant predictor of death or brain injury.

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Relationship between vaginal group B streptococcus colonization in the early stage of pregnancy and preterm birth: a retrospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03624-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sho Tano ◽

Takuji Ueno ◽

Michinori Mayama ◽

Takuma Yamada ◽

Takehiko Takeda ◽

...

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Early Stage ◽

Group B Streptococcus ◽

Multivariable Logistic Regression Analysis ◽

Simple Method ◽

Group B ◽

Singleton Pregnancies

Abstract Background Although infection and inflammation within the genital tract during pregnancy is considered a major risk factor for spontaneous preterm birth (PTB), there are few studies on association between vaginal microorganisms in the early stage of pregnancy and PTB. The aim of this study was to investigate relationship between vaginal Group B streptococcus (GBS) colonization, a leading cause of infection during pregnancy, in the early stage of pregnancy and PTB. Methods This single-center, retrospective cohort study utilized data from 2009 to 2017 obtained at TOYOTA Memorial Hospital. Women with singleton pregnancies who underwent vaginal culture around 14 weeks of gestation during their routine prenatal check-up were included. Vaginal sampling for Gram staining and culture was performed regardless of symptoms. GBS colonization was defined as positive for GBS latex agglutination assay. Statistical analysis was performed to determine the factors associated with PTB. Results Overall 1079 singleton pregnancies were included. GBS (5.7%) and Candida albicans (5.5%) were the most frequently observed microorganisms. The incidence of PTB (before 34 and before 37 weeks of gestation) were significantly higher in the GBS-positive group than in the GBS-negative group (6.6% vs 0.5%, p = 0.001 and 9.8% vs 4.3%, p = 0.047). Our multivariable logistic regression analysis revealed that GBS colonization was a factor associated with PTB before 34 and before 37 weeks of gestation (Odds ratio [OR] 15.17; 95% confidence interval [CI] 3.73–61.74), and OR 2.42; 95%CI 1.01–5.91, respectively). Conclusions The present study found that vaginal GBS colonization in the early stage of pregnancy was associated with PTB. Our study indicates that patients at a high risk for PTB can be extracted by a simple method using conventional culture method.

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Fetal CHD and perinatal outcomes

Cardiology in the Young ◽

10.1017/s1047951120000785 ◽

2020 ◽

Vol 30 (5) ◽

pp. 686-691

Author(s):

Christina J. Ge ◽

Amanda C. Mahle ◽

Irina Burd ◽

Eric B. Jelin ◽

Priya Sekar ◽

...

Keyword(s):

Cohort Study ◽

Preterm Delivery ◽

Odds Ratio ◽

Retrospective Cohort ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Fold Increase ◽

Cesarean Sections ◽

Increased Risk ◽

Gestational Age At Delivery

AbstractObjective:To evaluate delivery management and outcomes in fetuses prenatally diagnosed with CHD.Study design:A retrospective cohort study was conducted on 6194 fetuses (born between 2013 and 2016), comparing prenatally diagnosed with CHD (170) to those with non-cardiac (234) and no anomalies (5790). Primary outcomes included the incidence of preterm delivery and mode of delivery.Results:Gestational age at delivery was significantly lower between the CHD and non-anomalous cohorts (38.6 and 39.1 weeks, respectively). Neonates with CHD had a significantly lower birth weights (p < 0.001). There was an approximately 1.5-fold increase in the rate of primary cesarean sections associated with prenatally diagnosed CHD with an odds ratio of 1.49 (95% CI 1.06–2.10).Conclusions:Our study provides additional evidence that the prenatal diagnosis of CHD is associated with a lower birth weight, preterm delivery, and with an increased risk of delivery by primary cesarean section.

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Understanding patterns and factors associated with place of death in patients with end-stage kidney disease: A retrospective cohort study

Palliative Medicine ◽

10.1177/0269216316655747 ◽

2016 ◽

Vol 31 (3) ◽

pp. 283-288 ◽

Cited By ~ 9

Author(s):

Natasha Lovell ◽

Chris Jones ◽

Dawn Baynes ◽

Sarah Dinning ◽

Katie Vinen ◽

...

Keyword(s):

Cohort Study ◽

Kidney Disease ◽

Confidence Interval ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Place Of Death ◽

Renal Unit ◽

End Stage Kidney Disease ◽

End Stage

Background: Meeting place-of-death preferences is an important measure of the quality of end-of-life care. Systematic review shows that 42% of end-stage kidney disease patients prefer home death. Little research has been undertaken on place of death. Aim: To understand patterns of place of death in patients with end-stage kidney disease known in one UK renal unit. Design: A retrospective cohort study of all patients with chronic kidney disease stage 4–5, age ⩾75 and known to one UK renal unit, who died between 2006 and 2012. Patients were categorised into three management pathways: haemodialysis, conservative and pre-dialysis. Results: A total of 321 patients (mean age, 82.7; standard deviation, 5.21) died (61.7% male). In all, 62.9% died in hospital (95% confidence interval, 57.5%–68.1%), 21.8% died in their usual place of residence (95% confidence interval, 17.5%–26.6%) and 15.3% died in an inpatient palliative care unit (95% confidence interval, 11.6%–19.5%). Management pathway and living circumstances were most strongly associated with place of death. Patients on the conservative pathway had four times the odds of dying out of hospital (odds ratio, 4.0; 95% confidence interval, 2.1–7.5; p < 0.01). Patients living alone were less likely to die out of hospital (odds ratio, 0.3; 95% confidence interval, 0.1–0.6; p < 0.01). There were also changes in place of death over time, with more patients dying out of hospital in 2012 compared to 2006 (odds ratio, 3.1; 95% confidence interval, 1.0–9.7; p < 0.05). Conclusion: Most patients with end-stage kidney disease die in hospital, but patients managed without dialysis are significantly more likely to die outside of hospital. Planning ahead is key to be able to meet preference for place of death.

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Deep sedation using propofol target-controlled infusion for gastrointestinal endoscopic procedures: a retrospective cohort study*

10.21203/rs.3.rs-32195/v2 ◽

2020 ◽

Author(s):

María. E. García Guzzo ◽

María Sol Fernandez ◽

Delfina Sánchez Novas ◽

Sandra S. Salgado ◽

Sergio A. Terrasa ◽

...

Keyword(s):

Cohort Study ◽

Adverse Events ◽

Confidence Interval ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Gastrointestinal Endoscopy ◽

Oxygen Desaturation ◽

Endoscopic Procedures ◽

Target Controlled Infusion

Abstract Background: Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine its potentially improved safety over other anaesthetic strategies. Methods: This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age >18 years, American Society of Anesthesiologists physical status classification scores I–III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support. Results: The most frequently encountered adverse event was oxygen desaturation <95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation <90% followed, with incidences of 19.2%, 12.64%, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P=0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P=0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, confidence interval: 95% 2.83 to 36.99) more likely to experience oxygen desaturation <90% events. Conclusions: Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with low rates of adverse events and could be more widely adopted in clinical practice.

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The clinical implications of sinus tachycardia in mild COVID-19 infection: A retrospective cohort study

SAGE Open Medicine ◽

10.1177/20503121211054973 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110549

Author(s):

Jenny Yi Chen Hsieh ◽

Juliana Yin Li Kan ◽

Shaikh Abdul Matin Mattar ◽

Yan Qin

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Venous Thromboembolism ◽

Confidence Interval ◽

Odds Ratio ◽

Retrospective Cohort ◽

Sinus Tachycardia ◽

High Dependency ◽

General Wards

Objectives: This study aims to estimate the prevalence of sinus tachycardia in hospitalized patients with mild COVID-19 infection and to identify the clinical, radiological, and biological characteristics associated with sinus tachycardia. Methods: A retrospective cohort study was conducted on patients with mild COVID-19 infection and sinus tachycardia during hospitalization. Outcomes measured included incidences of venous thromboembolism, high-dependency/intensive care unit admission, laboratory parameters, and radiological findings. Results: A total of 236 COVID-19 positive patients admitted to Singapore General Hospital isolation general wards from 1 June 2020 to 30 June 2020 were included in this study. Ninety-seven (41.1%) patients had sinus tachycardia on or during their admission. All patients were monitored in general wards and discharged to community quarantine facilities. None required oxygen support or high-dependency/intensive care unit admission. Sinus tachycardia was associated with increased C-reactive protein level (odds ratio = 1.033, 95% confidence interval = 1.002–1.066), abnormal chest X-ray findings (odds ratio = 3.142, 95% confidence interval = 1.390–7.104), and longer hospitalization (odds ratio = 1.117, 95% confidence interval = 1.010–1.236). There was no significant statistical association between sinus tachycardia and incidences of venous thromboembolism. Conclusion: This study suggests that patients with mild COVID-19 infection and concurrent sinus tachycardia are more likely to have higher inflammatory marker levels, abnormal imaging, and prolonged hospitalization. However, no significant association between sinus tachycardia and thromboembolism is identified in mild COVID-19 infection.

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Smoking increases the risk of surgical site infection after hydrocelectomy in adults: a retrospective cohort study in Brazil

The Journal of Infection in Developing Countries ◽

10.3855/jidc.9450 ◽

2018 ◽

Vol 11 (12) ◽

pp. 950-956

Author(s):

Thiago Silva Da Costa ◽

Paulo José De Medeiros ◽

Mauro José Costa Salles

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Confidence Interval ◽

Surgical Site Infection ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Univariate Analysis ◽

Smoking Habits ◽

Site Infection

Introduction: Surgical site infection (SSI) following hydrocelectomy is relatively uncommon, but it is one of the main post-operative problems. We aimed to describe the prevalence of SSI following hydrocelectomy among adult patients, and to assess predisposing risk factors for infection. Methodology: This retrospective cohort study was carried out at a university hospital and included hydrocelectomies performed between January 2007 and December 2014. Diagnosis of SSI was performed according to the Center for Diseases Control (CDC) guidelines. Multivariable logistic regression analysis was used to identify independent risk factors. Results: A total of 196 patients were included in the analysis. Overall, 30 patients were diagnosed with SSI (15.3%) and of these, 63.3% (19/30) were classified as having superficial SSI, while 36.7% (11/30) had deep SSI. The main signs and symptoms of infection were the presence of surgical wound secretion (70%) and inflammatory superficial signs such as hyperemia, edema and pain (60%). Among the 53 patients presenting chronic smoking habits, 26.4% (14⁄53) developed SSI, which was associated with a higher risk for SSI (odds ratio [OR] = 2.84, 95% confidence interval [CI] = 1.27 to 6.35, p < 0.01) in the univariate analysis. In the adjusted multivariable analysis, smoking habits were also statistically associated with SSI after hydrocelectomy (odds ratio [OR] = 2.84, 95% confidence interval [CI] = 1.30 to 6.24, p = 0.01). No pre-, intra-, or post-operative variable analyzed showed an independent association to SSI following hydrocelectomy. Conclusions: Smoking was the only independent modifiable risk factor for SSI in the multivariate analysis.

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Deep Sedation using Propofol Target-Controlled Infusion for Gastrointestinal Endoscopic Procedures: A Retrospective Cohort Study*

10.21203/rs.3.rs-32195/v1 ◽

2020 ◽

Author(s):

MARIA EUGENIA GARCIA GUZZO ◽

María Sol Fernandez ◽

Delfina Sánchez Novas ◽

Sandra S. Salgado ◽

Sergio A. Terrasa ◽

...

Keyword(s):

Cohort Study ◽

Adverse Events ◽

Confidence Interval ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Gastrointestinal Endoscopy ◽

Oxygen Desaturation ◽

Endoscopic Procedures ◽

Target Controlled Infusion

Abstract Background: Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine its potentially improved safety over other anaesthetic strategies. Methods: This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age >18 years, American Society of Anesthesiologists physical status classification scores I–III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support. Results: The most frequently encountered adverse event was oxygen desaturation <95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation <90% followed, with incidences of 19.2%, 12.64%, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P=0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P=0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, confidence interval: 95% 2.83 to 36.99) more likely to experience oxygen desaturation <90% events. Conclusions: Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with low rates of adverse events and could be more widely adopted in clinical practice.

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Iron Packaging Regulations in the United States and Pediatric Morbidity: A Retrospective Cohort Study

Clinical Pediatrics ◽

10.1177/0009922819901010 ◽

2020 ◽

Vol 59 (4-5) ◽

pp. 375-379 ◽

Cited By ~ 1

Author(s):

James B. Leonard ◽

Elizabeth Quaal Hines ◽

Wendy Klein-Schwartz

Keyword(s):

United States ◽

Cohort Study ◽

Confidence Interval ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Early Time ◽

The United States ◽

Morbidity And Mortality ◽

Pediatric Morbidity

Iron poisoning was a leading cause of pediatric morbidity and mortality. We sought to assess whether the removal of strict iron packaging requirements in 2003 resulted in an increase in iron-related morbidity and mortality in pediatric exposures. We performed a retrospective cohort study utilizing the National Poison Data System from 2000 to 2017. A total of 4110 exposures met inclusion criteria: 847 from before (2000-2003) and 3263 after removal of unit-dose package regulations (2004-2017). The incidence of any marker of severity (7.2% vs 3.8%; odds ratio = 0.51, 95% confidence interval = 0.37-0.69) and frequency of deferoxamine use were both higher in the early time period (2.6% vs 1.0%; odds ratio = 0.38, 95% confidence interval = 0.22-0.66). There was no difference in the frequency of key serious effects (acidosis, elevated transaminases, hypotension). Despite removal of iron packaging regulations in the United States, there continues to be a decrease in the incidence of severe iron exposures in children.

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Association Between Use of Preoperative Antihypertensive Medication and 90-Day Mortality After Noncardiac Surgery: A Retrospective Cohort Study

American Journal of Hypertension ◽

10.1093/ajh/hpaa012 ◽

2020 ◽

Vol 33 (6) ◽

pp. 534-542

Author(s):

Chami Im ◽

Tak Kyu Oh ◽

In-Ae Song

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cohort Study ◽

Confidence Interval ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Antihypertensive Medication ◽

Noncardiac Surgery ◽

Hypertensive Patients

Abstract Background This study aimed to determine whether use of preoperative antihypertensive medication is associated with postoperative 90-day mortality in the hypertensive adult population that underwent elective noncardiac surgery. Methods In this retrospective cohort study, medical records of preoperative hypertensive patients who underwent noncardiac surgery at a single tertiary academic hospital from 2012 to 2018 were reviewed. Among the hypertensive patients, those prescribed to take antihypertensive medication continuously for more than 1 month before admission were defined as the HTN MED group; others were defined as the non-HTN MED group. Multiple imputation, propensity score (PS) matching, and logistic regression analysis were used for statistical analysis. Results Overall, 35,589 preoperative hypertensive adult patients (HTN MED group: 26,154 patients, non-HTN MED group: 9,435 patients) were included in the analysis. After PS matching, each group comprised 6,205 patients; thus, 12,410 patients were included in the final analysis. The odds for 90-day mortality of the HTN MED group in the PS-matched cohort were 41% lower (odds ratio: 0.59, 95% confidence interval: 0.41–0.85; P = 0.005) than those of the non-HTN MED group. Comparable results were obtained in the multivariable logistic regression analysis of the entire cohort (odds ratio: 0.54, 95% confidence interval: 0.41–0.72; P < 0.001). Conclusions This study showed that the use of preoperative antihypertensive medication was associated with lower 90-day mortality among hypertensive patients who underwent noncardiac surgery. Therefore, preoperative screening and treatment with appropriate antihypertensive medication are important for hypertensive patients.

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