Appendicitis in Pregnancy: A Post-Hoc Analysis of an EAST Multicenter Study

Abstract Objectives Maternal vitD deficiency as defined by circulating 25(OH)D concentration is linked with certain adverse pregnancy outcomes (e.g., preterm birth) and childhood outcomes (e.g., asthma), with the effect seemingly more pronounced if deficiency occurs earlier in pregnancy. OBJ: Assess the long-term effect of maternal and neonatal vitD status on later risk of childhood allergy, wheezing and/or asthma to 4 yrs. It was hypothesized that deficiency earlier in pregnancy would have a significant effect on risk that would continue during pregnancy. Methods In this follow-up post hoc analysis of women and their offspring enrolled in 1 of 2 pregnancy vitD supplementation trials (NICHD, n = 348 and Kellogg Foundation, n = 298), women were randomized to either 400, 2000 or 4000 IU vitD/day (NICHD) at 12–16 wks’ or 400 or 4400 IU/day at 10–14 wks’ (Kellogg). Baseline then monthly 25(OH)D concentration as the primary outcome in both studies and as the indicator of vitD status was measured by RIA until delivery. Neonatal vitD status was measured in cord blood. Follow-up data on the offspring were available through 4 yrs using an EMR with ICD-9 and 10 codes for eczema, wheezing and/or asthma. Student's t-test was used to analyze differences in mean 25(OH)D and eczema, wheezing, and asthma. Chi-square analyses were used to test for differences in incidence of 25(OH)D below 20, 30, and 40 and eczema, wheezing, and asthma. Results In NICHD Pregnancy, 326/348 (93.7%) offspring had EMR data available: 48 (14.7%) had eczema; 32 (9.8%) had wheezing; and 48 (14.7%) had asthma. In Kellogg Pregnancy, 205/298 (68.8%) had EMR data available; 36 (17.6%) had eczema; 14 (6.8%) had wheezing; and 10 (4.9%) had asthma. Maternal baseline 25(OH)D < 30 ng/mL was associated with eczema (P = 0.024) and asthma (P = 0.035) by age 4 yrs. Neonatal 25(OH)D was inversely associated with eczema (P = 0.01) and asthma by age 4 (P = 0.0012). When dichotomized, neonates with 25(OH)D < 20 ng/mL had a significantly higher risk of eczema (P = 0.02) and asthma (P = 0.004) and those below 40 ng/mL had a higher risk of eczema (P = 0.03). Conclusions In this combined cohort of pregnant women and their offspring, both maternal and neonatal vitD status were associated with later allergy, wheezing and asthma risk. Efforts to improve maternal vitD status may have later significant consequences on childhood health outcomes. Funding Sources NIH/NICHD/NCATS.

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Impact of Delay in Appendectomy on the Outcome of Appendicitis: A Post Hoc Analysis of an EAST Multicenter Study

Surgical Infections ◽

10.1089/sur.2020.219 ◽

2020 ◽

Author(s):

Khaled Abdul Jawad ◽

Alessia Cioci ◽

Eva Urrechaga ◽

Hang Zhang ◽

Saskya Byerly ◽

...

Keyword(s):

Multicenter Study ◽

Post Hoc Analysis ◽

Post Hoc

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Optical diagnosis expanded to small polyps: post-hoc analysis of diagnostic performance in a prospective multicenter study

Endoscopy ◽

10.1055/a-0759-1605 ◽

2018 ◽

Vol 51 (03) ◽

pp. 244-252 ◽

Cited By ~ 2

Author(s):

Jasper Vleugels ◽

Yark Hazewinkel ◽

Marcel Dijkgraaf ◽

Lianne Koens ◽

Paul Fockens ◽

...

Keyword(s):

Multicenter Study ◽

Screening Program ◽

Narrow Band Imaging ◽

Optical Diagnosis ◽

Prospective Multicenter Study ◽

Post Hoc Analysis ◽

Confidence Levels ◽

Surveillance Interval ◽

Immunochemical Test ◽

Post Hoc

Abstract Background: Optical diagnosis can replace histopathology of diminutive (1 – 5 mm) polyps if surveillance intervals based on optical diagnosis of polyps have ≥ 90 % agreement with intervals based on polyp histology and if the negative predictive value (NPV) for predicting neoplastic histology in the rectosigmoid is ≥ 90 %. This study aims to assess whether small (6 – 9 mm) polyps can be included in optical diagnosis strategies. Method: This is a post-hoc analysis of a prospective multicenter study in which 27 endoscopists, all performing endoscopies for the Dutch screening program, were trained in optical diagnosis. For 1 year, endoscopists recorded the predicted histology for all lesions detected using narrow-band imaging during 3144 consecutive colonoscopies after a positive fecal immunochemical test, along with confidence levels. Surveillance interval agreement and NPV were calculated for high confidence predictions for polyps of 1 – 9 mm and compared with histopathology. Surveillance interval agreement was calculated using the European Society of Gastrointestinal Endoscopy surveillance guideline. Results: Surveillance interval agreement was 95.4 % (confidence interval [CI] 94.2 % – 96.4 %), and NPV for predicting neoplastic histology in the rectosigmoid 90.0 % (CI 87.3 % – 92.2 %). The reduction in histology (45.9 % vs. 30.5 %) and the proportion of patients who could have received direct surveillance advice (15.6 % vs. 7.3 %) was higher when small polyps were included (P < 0.001). T1 cancer was found in seven small polyps (0.33 %), five of which would have been discarded without histopathology. Conclusion: Including small polyps in the optical diagnosis strategy improves its efficacy while maintaining performance thresholds. However, there is a small risk of missing T1 cancers when small polyps are included in the optical diagnosis strategy.

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