scholarly journals The efficacy of Andrographis paniculata (Burm.f.) Wall. ex Nees crude extract in hospitalised mild COVID-19 patients: a retrospective cohort study

2022 ◽  
Author(s):  
Jeeranan Tanwettiyanont ◽  
Napacha Piriyachananusorn ◽  
Lilit Sangsoi ◽  
Benjawan Boonsong ◽  
Chamlong Sunpapoa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Crude Extract ◽  
Retrospective Cohort Study ◽  
Chest Radiography ◽  
Retrospective Cohort ◽  
Standard Of Care ◽  
Andrographis Paniculata ◽  
Sufficient Evidence ◽  
Care Group ◽  
X Rays

Background: Andrographis paniculata (AP) crude extract has been widely used in Thailand to treat mild COVID-19 infection since early 2020; however, supporting evidence was lacking. Purpose: To evaluate the efficacy of AP compared with standard treatment among hospitalised mild COVID-19 patients. Study design: Single-centre retrospective cohort study Methods: We collected data between March 2020 and August 2021 from COVID-19 patients admitted to one hospital in Thailand. Patients whose infection was confirmed by Real-Time Polymerase Chain Reaction (RT-PCR) and had normal chest radiography were included, whereas those receiving favipiravir or had unclear chest X-rays at admission were excluded. Participants were categorised as either AP or standard of care and followed for pneumonia confirmed by chest radiography. Multiple logistic regression was used to analyse the main results controlling for age, sex, history of having diabetes, hypertension, receiving statins, and antihypertensive drugs. Results: 605 out of 1,054 patients were included in the analysis. Of these, 59 patients (9.8%) developed pneumonia during the median follow-up of 7 days. The incidence rates of pneumonia were 13.93 (95%CI 10.09, 19.23) and 12.47 (95%CI 8.21, 18.94) per 1,000 person-days in AP and standard of care group, respectively. Compared to the standard of care group, the odds ratios of having pneumonia in the AP group were 1.24 (95%CI 0.71, 2.16; unadjusted model) and 1.42 (95%CI 0.79, 2.55; fully adjusted model). All sensitivity analyses produced consistent findings with the main results. Conclusion: We do not have sufficient evidence to show the efficacy of AP in mild COVID-19 infection. Interestingly, we observed the potentially harmful signal of using AP. While waiting for insights from ongoing trials, the use of AP in this condition should be done with caution.

scholarly journals Rapid corticosteroid taper versus standard of care for immune checkpoint inhibitor induced nephritis: a single-center retrospective cohort study

2021 ◽  
Vol 9 (4) ◽  
pp. e002292
Author(s):  
Meghan D Lee ◽  
Harish Seethapathy ◽  
Ian A Strohbehn ◽  
Sophia H Zhao ◽  
Genevieve M Boland ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Immune Checkpoint ◽  
Retrospective Cohort ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Standard Of Care ◽  
Renal Recovery ◽  
Care Group ◽  
Significant Difference

BackgroundCurrent guidelines for treatment of immune checkpoint inhibitor (ICI)-induced nephritis are not evidence based and may lead to excess corticosteroid exposure. We aimed to compare a rapid corticosteroid taper to standard of care.MethodsRetrospective cohort study in patients with ICI-induced nephritis comparing a rapid taper beginning with 60 mg/day prednisone and tapered to 10 mg within 3 weeks to a historical control group that began 60 mg/day tapered to 10 mg within 6 weeks (standard of care). Renal recovery was defined as creatinine returning to within 1.5-fold baseline. The log-rank test compared the differences in time to renal recovery between the groups. We report rates of renal recovery at 30, 60 and 90 days, and timing and outcomes of ICI rechallenge.ResultsThirteen patients received rapid corticosteroid taper and 14 patients received standard of care. Baseline characteristics were similar between groups. The median time to ≤10 mg/day prednisone was 20 days (IQR 15–25) in the rapid-taper group compared with 38 days (IQR 30–58) in the standard-of-care group. There was no significant difference in the time to renal recovery between the groups, though numerically higher numbers of patients recovered by 30 days, 11 (85%) in the rapid-taper arm versus 6 (46%) in the standard of care arm. Exposure to other nephritis-causing medications (proton pump inhibitor or trimethoprim-sulfamethoxazole) during the corticosteroid taper was more common in the standard of care group, 9 (64%) versus rapid-taper group, 2 (15%), and was associated with longer time to renal recovery, 20 days (IQR 14–101) versus 13 days (IQR 7–34) in those that discontinued nephritis-causing medications. Fifteen (56%) of patients were rechallenged with ICIs, and only two (13%) developed recurrent nephritis.ConclusionsPatients with ICI-induced nephritis have excellent kidney outcomes when treated with corticosteroids that are tapered over 3 weeks.

scholarly journals Surgical Treatment of Ossifications of the Cervical Anterior Longitudinal Ligament: A Retrospective Cohort Study

2020 ◽  
pp. 219256822092219
Author(s):  
Alexander von Glinski ◽  
Ariel Takayanagi ◽  
Christopher Elia ◽  
Basem Ishak ◽  
Mishan Listmann ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Intraoperative Complications ◽  
Deformity Correction ◽  
Kyphotic Deformity ◽  
X Rays ◽  
Anterior Longitudinal Ligament ◽  
Duration Of Symptoms ◽  
Instrumentation Failure

Study Design: Retrospective cohort study Objectives: The study aims to evaluate anterior cervical discectomy and fusion (ACDF) in the treatment of patients with ossification of the anterior longitudinal ligament (OALL). Methods: We retrospectively reviewed cases performed at our institution between January 2015 and December 2018; adult (age ≥18 years) patients who underwent anterior cervical decompression and fusion in the presence of dysphagia and OALL. Ten patients (9 male, 1 female, mean age 64.4 years) with OALL who underwent ACDF were included. Charts were reviewed for demographics and comorbidities. Primary outcomes assessed were intra- and postoperative complications. Secondary outcomes were fusion rates, instrumentation failure, postsurgical instability/deformity, and readmission rates. Results: The average duration of symptoms prior to surgery was 12.3 months. All patients presented with dysphagia (mean Bazaz score 2.0). The average number of levels with OALL was 4.7 (±1.67). All patients underwent ACDF and 3 patients underwent additional posterior cervical fusion for kyphotic deformity correction or when extensive laminectomy was required. We did not encounter any intraoperative complications. Eight patients (72%) had solid fusion demonstrated on the lateral x-rays and no evidence of progressive kyphotic deformity. We did not encounter any instrumentation failure or loosening. Two patients developed recurrence of dysphagia (Bazaz scores 2 and 3 respectively). Conclusion: ACDF for OALL with dysphagia and concomitant myelopathy in our small series of 10 patients demonstrate good fusion and clinical outcomes. Larger studies will be necessary to determine the optimal treatment for patients with dysphagia due to OALL.

scholarly journals Corticosteroids and mortality in patients with severe Covid-19 who have autoantibodies

2021 ◽  
Author(s):  
Zhu Cui ◽  
Maxwell Roth ◽  
Yelena Averbukh ◽  
Andrei Assa ◽  
Azal Al-ani ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Mortality Rate ◽  
Serum Sample ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Standard Of Care ◽  
Corticosteroid Treatment ◽  
Loss Of Self ◽  
Self Tolerance

Auto-reactivity in COVID-19 is increasingly being recognized and may identify a group of patients with inflammation severe enough to result in loss of self-tolerance. Corticosteroids are potent anti-inflammatory agents and now the standard of care for patients with severe Covid-19 requiring oxygen support/mechanical ventilation. We studied the outcomes of COVID-19 patients who demonstrated clinically identifiable auto-reactivity and received corticosteroid treatment. In this retrospective cohort study, we included 51 COVID-19 patients admitted between March 10, 2020 and May 2, 2020 who received corticosteroid treatment and also had serum sample in our institution bio-bank available for ANA and RF ELISA. Twelve patients (23.5%) had positive ANA or RF. Mortality rate among patients with positive autoantibodies was significantly higher than those without (9/12 or 75% versus 13/39 or 33.3%, p= 0.02). The high mortality rate in patients with auto-reactivity warrants further investigation and may be the subgroup where additional immunomodulation is effective.

scholarly journals Effectiveness and safety of biodegradable calcium sulfate antibiotic beads as adjuvant therapy in vascular graft infections

2021 ◽  
Author(s):  
James B Doub ◽  
Jacqueline T Bork ◽  
Emily Heil ◽  
Kristen Stafford ◽  
Mary Banoub ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Adjuvant Therapy ◽  
Retrospective Cohort Study ◽  
Vascular Graft ◽  
Retrospective Cohort ◽  
Calcium Sulfate ◽  
Kidney Injury ◽  
Standard Of Care

Abstract This is a retrospective cohort study evaluating the safety and effectiveness of biodegradable calcium sulfate antibiotic beads in vascular graft infections compared to standard of care. No differences in acute kidney injury or hypercalcemia were observed between the cohorts. Recurrence of infection did not occur in the 13 patient bead cohort compared to 14 patients that had recurrence in the 45 patient non-bead cohort with a NNT of 4.0.

scholarly journals ASSESSMENT OF TIME IN THERAPEUTIC RANGE WITH WARFARIN THERAPY IN PHARMACIST VERSUS USUAL CARE GROUP: A RETROSPECTIVE COHORT STUDY

2020 ◽  
pp. 68-71
Author(s):  
DANIEL MAJERCZYK ◽  
KIMBERLY RUSCHE ◽  
PRASHANT SAKHARKAR
Keyword(s):  
Cohort Study ◽  
Usual Care ◽  
Therapeutic Range ◽  
Retrospective Cohort Study ◽  
Usual Care Group ◽  
Retrospective Cohort ◽  
Warfarin Therapy ◽  
Care Group ◽  
Chads2 Score ◽  
Pharmacist Care

Objective: Anticoagulation management with warfarin is a familiar challenge seen in primary care settings. A greater time in the therapeutic range (TTR) has shown improved health benefits in patients treated with warfarin for atrial fibrillation. The aim of this study was to assess the level of anticoagulation control achieved with warfarin therapy measured by TTR. Methods: Patients attending anticoagulation service at a medical center were included in this retrospective cohort study. Patients with at least two international normalized ratio (INR) values not more than 4 weeks apart were included and placed in a usual care group or a pharmacist care group based on the care received. Anticoagulation control was measured by calculating TTR according to Roosendaal’s linear interpolation method. A TTR of >70% was considered high-quality and >60% was considered moderate coagulation control. The data were analyzed for descriptive statistics, associations, and for identifying predictors of TTR. A p value of <0.05 was considered statistically significant. Results: Mean age of patients was 58±9 years; 57% were male; 48% were White Caucasian, and 43% had a CHADS2 score of ≥3. Patients in the pharmacist group had a high TTR (67.6% vs. 43.4%, p<0.0001) and an INR in a significantly lower sub-therapeutic range than the usual care group (5.6% vs. 14.8%; p<0.0001). Half of the patients in the pharmacist group were able to achieve a TTR threshold of 60% and greater compared to less than one-third among the usual care group. Age and pharmacist care were found to be great predictors of TTR after adjusting for gender, ethnicity, and CHADS2 score (p<0.001). Conclusion: Our findings confirmed that pharmacist led anticoagulation care positively improved patients’ TTR with warfarin.

Obesity and Meniscal Transplant Failure: A Retrospective Cohort Study

2019 ◽  
Author(s):  
Carlos Jiménez-Garrido ◽  
Abel Gómez-Cáceres ◽  
María Josefa Espejo-Reina ◽  
Alejandro Espejo-Reina ◽  
Iskandar Tamimi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Smoking Status ◽  
Obese Patients ◽  
X Rays ◽  
Meniscal Allograft ◽  
Transplant Failure ◽  
Nonobese Patients

AbstractThe purpose of this study was to analyze the effect of obesity and other clinical factors on the outcome of meniscal allograft transplantation (MAT) with transosseous fixation. A retrospective cohort study was performed on patients who underwent a MAT between 2002 and 2017. All the participants had a minimum follow-up period of 24 months. The variables assessed were age at the time of the transplant, side, sex, transplanted meniscus (lateral/medial), body mass index (BMI), smoking status, and previous surgeries. Lysholm, Tegner, and International Knee Documentation Committee (IKDC) test outcomes, and patient satisfaction were recorded. Image assessment was performed using plain standing X-rays and a follow-up magnetic resonance imaging scan. Thirty-five patients fulfilled the inclusion criteria. The mean follow-up time was of 75.7 standard deviation (SD) 43.4 months. Patients with a BMI ≥ 30 underwent medial meniscal transplants (88.9 vs. 42.3%, p = 0.022, respectively) more frequently. Obese patients had a significantly lower IKDC (48.6 SD 19.9 vs. 61.7 SD 13.1, p = 0.038, power: 57.5%) and Lysholm (60.3 SD 19.2 vs. 79.4 SD 14.3, p = 0.004, power: 88.7%) scores compared with nonobese patients. The satisfaction and Tegner scores were also lower in obese patients (55.6 vs. 80.7%, p = 0.136, and 2.8 SD 1.0 vs. 4.0 SD 1.9, p = 0.104, respectively); however, these differences were not statistically significant. Obese patients had higher rates of meniscal transplant failure compared with nonobese patients (adjusted hazard ratio: 11.8 [95% confidence interval: 1.5–91.4]). No differences were observed between obese and nonobese patients regarding age, sex, side, smoking status, and follow-up time. In this study, a BMI ≥ 30 kg/m2 resulted in higher MAT failure rates. Nonobese patients had better knee functional results compared with obese individuals.

scholarly journals Impact of COVID-19 Lockdown on Preterm Births, Low Birthweights and Stillbirths: A Retrospective Cohort Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5649
Author(s):  
Charles Garabedian ◽  
Ninon Dupuis ◽  
Christophe Vayssière ◽  
Laurence Bussières ◽  
Yves Ville ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Pregnancy Outcomes ◽  
Retrospective Cohort ◽  
Low Birthweight ◽  
Perinatal Outcomes ◽  
Preterm Births ◽  
Sufficient Evidence ◽  
Multiple Pregnancies ◽  
Maternity Hospitals

Objective: The effect of lockdowns during the coronavirus (COVID-19) pandemic on pregnancy outcomes remains uncertain. We aimed to evaluate the association between the COVID-19-related lockdown and pregnancy outcomes in maternity hospitals in France. Study design: This was a retrospective cohort study from six tertiary referral hospitals in different regions of France. Three 55-day periods were compared: pre-lockdown from 22 January 2020, lockdown from 17 March 2020, and post-lockdown from 11 May 2020 to 4 July 2020. We included all women who delivered singleton or multiple pregnancies, who delivered at ≥24 weeks of gestation and with birthweights ≥500 g. We documented gestational ages at the delivery of liveborn and stillborn infants (‘stillbirths’). These were categorized as having a very low birthweight (VLBW, <1500 g), or a low birthweight (LBW, <2500 g). Adjustments were made for place of birth, maternal age, parity and diabetes, and hypertensive disorders, as well as for multiple pregnancies. Results: In total, 11,929 women delivered in the six selected centers. This figure is constituted of 4093, 3829, and 4007 deliveries in the pre-lockdown (1), peri-lockdown (2), and post-lockdown (3) periods, respectively. There were no differences in pregnancy outcomes between these three periods. Overall, birth rates <27+6 weeks, between weeks 28+0 and 31+6, and between 32+0 and weeks 36+6 were 1.0%, 1.9%, and 4.4%, respectively. After adjustment, these rates were stable between periods 1 and 2 (adjusted odds ratio, aOR 0.90; 95% confidence interval, CI 0.69–1.19) and between periods 2 and 3 (aOR 1.04; 95% CI 0.80–1.36). Although more VLBW neonates were born during lockdown (3.5% vs. 2.6%, p = 0.03), this difference did not persist after adjustment (aOR 0.84, CI 95% 0.64–1.10). The LBW rates were similar during the three periods at 12.5% overall. The stillbirth rate was unaffected by the lockdown. Conclusion: The pregnancy outcomes (preterm birth, LBW, VLBW, and stillbirth rates) were not modified by the COVID-19 lockdown in our cohort study in France. Considering the discrepancies in results and methodological issues in previous published studies, there is not sufficient evidence to conclude that such lockdowns have any impact on perinatal outcomes.

scholarly journals Characterizing inpatient care for adults with schizophrenia using the Health Quality Ontario indices: A single-centre retrospective cohort study

2019 ◽  
Vol 41 (4) ◽  
pp. E196-E203
Author(s):  
Anees Bahji ◽  
Jennifer L Pikard ◽  
Dane Mauer-Vakil ◽  
Tariq Munsh ◽  
Farooq Naeem
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Inpatient Care ◽  
Average Length ◽  
Medication Management ◽  
Standard Of Care ◽  
Quality Standard ◽  
Behavioural Therapy ◽  
Health Quality

Purpose: This single-center retrospective cohort study is one of the first reports to evaluate the inpatient care provided to persons diagnosed with schizophrenia in Canada. Methods: This study examined all admissions for adults diagnosed with schizophrenia over a 6-month period in 2017 to an inpatient psychiatric unit situated in a nonprofit general hospital in Kingston, Ontario, Canada. The Health Quality Ontario standards for the inpatient care of adults with schizophrenia were used to assess the quality of care provided in hospital. Standards were determined to have been met by doing a thorough chart review for each patient, reviewing all documentation in progress notes, admission notes, discharge notes and emergency room notes for quality standard completion. Results: The average length of stay per patient was 18.64 days. The treatment at this facility largely focused on medication management of schizophrenia; however, it was found that several areas of care did not meet the standard of care as set by the Health Quality Ontario Quality Standards for Schizophrenia Care for Adults in Hospitals, which was set in 2016. Problematic areas were promoting physical activity and healthy eating (4.9% compliance), treatment with clozapine (13.1% compliance) and cognitive behavioural therapy (9.8% compliance). The study site is fully accredited and attending physicians were all psychiatrists. How pervasive these deficiencies are in other settings is not known.

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