scholarly journals Endoscopy in Pregnancy: A Systematic Review

2021 ◽  
Vol 12 (03) ◽  
pp. 138-150
Author(s):  
Partha Pal ◽  
D. Nageshwar Reddy ◽  
Manu Tandan
Keyword(s):  
Cohort Study ◽  
Prospective Study ◽  
Retrospective Studies ◽  
Case Control Study ◽  
Case Reports ◽  
Case Series ◽  
Case Control ◽  
Gi Endoscopy ◽  
Control Study ◽  
In Pregnancy

Abstract Background Fetomaternal outcomes are of primary concern for gastrointestinal (GI) endoscopy in pregnancy. We aimed to systematically review the safety and utility of endoscopic procedures in pregnancy. Methods A systematic literature search was performed using PubMed. All original research articles with sample size > 10 involving endoscopy in pregnancy were included for the review along with case report/series describing novel/rare techniques from 1948 to July 2021. Results After screening 12,197 references, 216 citations were found and finally 66 references were included. Esophagogastroduodenoscopy had favorable fetal outcome (>95%) based on two large retrospective studies and a review of case reports. Sclerotherapy and band ligation of varices were safe according to case series. A large nationwide cohort study established safety of endotherapy for nonvariceal bleed. Botulinum toxin and pneumatic dilation in achalasia are only supported by case reports. Percutaneous endoscopic gastrostomy can be useful to support nutrition based on case reports. A retrospective case–control and cohort study with systemic review justified flexible sigmoidoscopy if strongly indicated. Low birth weight was more common when sigmoidoscopy was done in inflammatory bowel disease based on a prospective study. Colonoscopy was considered safe in second trimester based on a case–control study whereas it can be performed otherwise only in presence of strong indication like malignancy. Capsule endoscopy is promising and can be useful in acute small bowel bleeding although risk of capsule retention is unknown. There are no reports of enteroscopy in pregnancy. Twelve retrospective studies and one prospective study showed high success rate of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) (> 90%) in all trimesters and can be performed if strongly indicated. Pregnancy was an independent risk factor for post-ERCP pancreatitis in a large nationwide case–control study. Radiation-free ERCP with wire-guided bile observation, stent-guided or precut sphincterotomy, endoscopic ultrasound (EUS) guidance, and spyscopy have been described. Safety of EUS is limited to case series and can be used in intermediate probability of choledocholithiasis to guide ERCP and endoscopic cystogastrostomy. Conclusion This review concludes that GI endoscopy during pregnancy can be done effectively if strongly indicated with good fetomaternal outcomes. Precautions are advocated during procedures where radiation exposure is expected.

scholarly journals Risk Factors Associated with Fatal Dengue Hemorrhagic Fever in Adults: A Case Control Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Arjuna Medagama ◽  
Chamara Dalugama ◽  
Gukes Meiyalakan ◽  
Darshani Lakmali
Keyword(s):  
Large Scale ◽  
Case Control Study ◽  
Case Reports ◽  
Case Series ◽  
Hemorrhagic Fever ◽  
Case Control ◽  
Clinical Parameters ◽  
Case Record ◽  
Predictors Of Mortality ◽  
Control Study

Background. Dengue is endemic in most parts of the tropics with a significant mortality of 1–5%. Although individual case reports and case series have been published, large-scale case controls studies are few. The objective of this study was to find clinical and laboratory predictors of mortality in dengue. Methods. Hospital case record based case control study was performed. Results. Twenty fatalities with 80 controls were analyzed. Clinical parameters of postural dizziness (OR 3.2; 95% CI 1.1–8.9), bleeding (OR 31.9; 95% CI 6.08–167.34), presence of plasma leakage (OR 64.6; 95% CI 7.45–560.5), abdominal tenderness (OR 2.24; 95% CI 0.79–6.38), and signs of cardiorespiratory instability at admission increased the risk of dying from dengue. Altered consciousness was exclusively seen in 20% of cases. Laboratory parameters of elevated CRP (OR 1.652; 95% CI 1.28–2.14), AST, or ALT > 500 IU/L (OR 52.5; 95% CI 12.52–220.1) and acute kidney injury (AKI) (OR 103.5; 95% CI 13.26–807.78) during hospital stay increased the odds of dying. Need for assisted ventilation and multiorgan dysfunction (MOD) were exclusively seen in the cases. Multivariate logistic regression revealed bleeding at admission, AKI, and elevated hepatic transaminase >500 IU/L to be independent predictors of mortality. Conclusions. This case control study revealed that mortality from dengue could be predicted using clinical parameters at admission and low cost routine laboratory investigations.

scholarly journals Risk factors associated with Fatal Dengue Hemorrhagic Fever in Adults; A case control study

2019 ◽  
Author(s):  
Arjuna Medagama ◽  
Chamara Dalugama ◽  
Gukes Meiyalakan ◽  
Darshani Lakmali
Keyword(s):  
Large Scale ◽  
Case Control Study ◽  
Case Reports ◽  
Case Series ◽  
Hemorrhagic Fever ◽  
Case Control ◽  
Clinical Parameters ◽  
Case Record ◽  
Predictors Of Mortality ◽  
Control Study

Abstract Background Dengue is endemic in most parts of the tropics with a significant mortality of 1-5%. Although individual case reports and case series have been published, large-scale case controls studies are few. The objective of this study was to find clinical and laboratory predictors of mortality in dengue. Methods Hospital case record based case control study was performed. Results Twenty fatalities with 80 controls were analyzed. Clinical parameters of postural dizziness (OR 3.2; 95% CI 1.1 - 8.9), bleeding (OR 31.9; 95% CI 6.08 - 167.34), presence of plasma leakage (OR 64.6; 95% CI 7.45 – 560.5), abdominal tenderness (OR 2.24; 95% CI 0.79 – 6.38) and signs of cardio-respiratory instability at admission increased the risk of dying from dengue. Altered consciousness was exclusively seen in 20% of cases. Laboratory parameters of elevated CRP (OR 1.652; 95% CI 1.28 – 2.14), AST or ALT> 500IU/L (OR 52.5; 95% CI 12.52 – 220.1) and acute kidney injury (AKI) (OR 103.5; 95% CI 13.26 – 807.78) during hospital stay increased the odds of dying. Need for assisted ventilation and multi organ dysfunction (MOD) were exclusively seen in the cases. Multivariate logistic regression revealed bleeding at admission, AKI and elevated hepatic transaminase >500IU/L to be independent predictors of mortality. Conclusions This case-control study revealed that mortality from dengue could be predicted using clinical parameters at admission and low cost routine laboratory investigations.

scholarly journals 530. COVID-19 in kidney transplant recipients: Single-center experience and case-control study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S332-S332
Author(s):  
Anna Hardesty ◽  
Aakriti Pandita ◽  
Yiyun Shi ◽  
Kendra Vieira ◽  
Ralph Rogers ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Case Control Study ◽  
Clinical Course ◽  
Case Series ◽  
Case Fatality ◽  
Case Control ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Transplant Patients ◽  
Control Study

Abstract Background Organ transplant recipients (OTR) are considered high-risk for morbidity and mortality from COVID-19. Case-fatality rates (CFR) vary significantly in different case series, and some patients were still hospitalized at the time of analyses. To our knowledge, no case-control study of COVID-19 in OTR has been published to-date. Methods We captured kidney transplant recipients (KTR) diagnosed with COVID-19 between 3/1 and 5/18/2020. After exclusion of KTR on hemodialysis and off immunosuppression (IS), we compared the clinical course of COVID-19 between hospitalized KTR and non-transplant patients, matched by sex and age (controls). All patients were discharged from the hospital or died. Results 16 KTR had COVID-19. All 3 KTR off IS, who were excluded from further analyses, survived. Median age was 54 (range: 34–65) years; 5/13 KTR (38.4%) were men. Median time from transplant was 41 (range: 1–203) months. Two KTR, both transplanted >10 years ago, were managed as outpatients. IS was reduced in 12/13 (92.3%), most often by discontinuation of the antimetabolite. IL6 levels were >1,000 (normal: < 5) pg/mL in 3 KTR. Tacrolimus or sirolimus levels were >10 ng/mL in 6/9 KTR (67%) (Table 1). Eleven KTR were hospitalized (84.6%) and matched with 44 controls. One KTR, the only one treated with hydroxychloroquine, died (CFR 5.8%; 7.6% in KTR on IS; 9% in hospitalized KTR on IS). Four controls died (CFR: 9%; state CFR: 5.2%; inpatient CFR: 16.6%). There were no significant differences in length of stay or worst oxygenation status between hospitalized KTR and controls. Four KTR (30.7%), received remdesivir, 4 convalescent plasma, 3 (23%) tocilizumab. KTR received more often broad-spectrum antibiotics, convalescent plasma or tocilizumab, compared to controls (Table 2). Table 1 Table 2 Conclusion Unlike early reports from the pandemic epicenters, the clinical course and outcomes of KTR with COVID-19 in our small case series were comparable to those of non-transplant patients. Calcineurin or mTOR inhibitor levels were high, likely due to diarrhea and COVID-19-related hepatic dysfunction. Extremely high IL6 levels were common. The role of IS and potential benefits from investigational treatments remain to be elucidated. A larger multi-institutional study is underway. Disclosures All Authors: No reported disclosures

scholarly journals An ADAM33 Polymorphism Associates with Progression of Preschool Wheeze into Childhood Asthma: A Prospective Case-Control Study with Replication in a Birth Cohort Study

PLoS ONE ◽  
2015 ◽  
Vol 10 (3) ◽  
pp. e0119349 ◽  
Author(s):  
Ester M. M. Klaassen ◽  
John Penders ◽  
Quirijn Jöbsis ◽  
Kim D. G. van de Kant ◽  
Carel Thijs ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Cohort ◽  
Childhood Asthma ◽  
Case Control Study ◽  
Case Control ◽  
Birth Cohort Study ◽  
Control Study ◽  
Prospective Case Control Study

First norovirus outbreaks associated with consumption of green seaweed (Enteromorpha spp.) in South Korea

2014 ◽  
Vol 143 (3) ◽  
pp. 515-521 ◽  
Author(s):  
J. H. PARK ◽  
H. S. JEONG ◽  
J. S. LEE ◽  
S. W. LEE ◽  
Y. H. CHOI ◽  
...  
Keyword(s):  
Cohort Study ◽  
Relative Risk ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Case Control Study ◽  
Case Control ◽  
Green Seaweed ◽  
Norovirus Gii ◽  
Control Study

SUMMARYIn February 2012, an outbreak of gastroenteritis was reported in school A; a successive outbreak was reported at school B. A retrospective cohort study conducted in school A showed that seasoned green seaweed with radishes (relative risk 7·9, 95% confidence interval 1·1–56·2) was significantly associated with illness. Similarly, a case-control study of students at school B showed that cases were 5·1 (95% confidence interval 1·1–24·8) times more likely to have eaten seasoned green seaweed with pears. Multiple norovirus genotypes were detected in samples from students in schools A and B. Norovirus GII.6 isolated from schools A and B were phylogenetically indistinguishable. Green seaweed was supplied by company X, and norovirus GII.4 was isolated from samples of green seaweed. Green seaweed was assumed to be linked to these outbreaks. To our knowledge, this is the first reported norovirus outbreak associated with green seaweed.

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