scholarly journals Prospective, observational, single-centre cohort study with an independent control group matched for age and sex aimed at investigating the significance of cholinergic activity in patients with schizophrenia: study protocol of the CLASH-study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050501
Author(s):  
Benedikt Schick ◽  
Eberhard Barth ◽  
Benjamin Mayer ◽  
Claire-Louise Weber ◽  
Theresa Hagemeyer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Symptoms ◽  
Point Of Care ◽  
Acetylcholinesterase Activity ◽  
Primary Objective ◽  
University Hospital ◽  
Control Group ◽  
Independent Control ◽  
Data Set ◽  
Butyrylcholinesterase Activity

IntroductionAlterations in the cholinergic metabolism may cause various clinical symptoms of schizophrenia. In addition to the ‘monoamine hypothesis,’ neuroinflammation is also discussed as a cause of schizophrenia. To date, there has been no evidence of alterations in the central cholinergic transmitter balance in patients with schizophrenia under clinical conditions. By contrast, studies in critically ill patients have established the measurement of acetylcholinesterase activity as a suitable surrogate parameter of central cholinergic transmitter balance/possible pathophysiological changes. Butyrylcholinesterase activity has been established as a parameter indicating possible (neuro)inflammatory processes. Both parameters can now be measured using a point-of-care approach. Therefore, the primary objective of this study is to investigate whether acetylcholinesterase and butyrylcholinesterase activity differs in patients with various forms of schizophrenia. Secondary objectives address the possible association between acetylcholinesterase and butyrylcholinesterase activity and (1) schizophrenic symptoms using the Positive and Negative Syndrome Scale, (2) the quantity of antipsychotics taken and (3) the duration of illness.Methods and analysisThe study is designed as a prospective, observational cohort study with one independent control group. It is being carried out at the Department of Psychiatry and Psychotherapy III, Ulm University Hospital, Germany. Patient enrolment started in October 2020, and the anticipated end of the study is in January 2022. The enrolment period was set from October 2020 to December 2021 (extension required due to SARS-CoV-2 pandemic). The sample size is calculated at 50 patients in each group. Esterase activity is measured on hospital admission (acute symptomatology) and after referral to a postacute ward over a period of three consecutive days. The matched control group will be created after reaching 50 patients with schizophrenia. This will be followed by a comprehensive statistical analysis of the data set.Ethics and disseminationThe study was registered prospectively in the German Clinical Trials Register (DRKS-ID: DRKS00023143,URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023143) after approval by the ethics committee of the University of Ulm, Germany Trial Code No. 280/20.Trial registration numberDRKS00023143; Pre-results.

Differentiation of acute pyelonephritis from other febrile states in children using urinary neutrophil gelatinase-associated lipocalin (uNGAL)

2016 ◽  
Vol 54 (1) ◽  
Author(s):  
Jadranka Arambašić ◽  
Sanja Mandić ◽  
Željko Debeljak ◽  
Dario Mandić ◽  
Vesna Horvat ◽  
...  
Keyword(s):  
Acute Pyelonephritis ◽  
Clinical Symptoms ◽  
Characteristic Curve ◽  
Severe Disease ◽  
White Blood Cells ◽  
Diagnostic Value ◽  
University Hospital ◽  
Control Group ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

AbstractAcute pyelonephritis is a severe disease which is sometimes difficult to recognize based on clinical symptoms and routinely available diagnostic tests, especially in young children. The aim of this study was to assess the diagnostic value of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a biomarker of acute pyelonephritis.In this case-control study we analyzed 134 children (median age 2.5 years) who were admitted to the Pediatric Clinic of University Hospital Centre Osijek, Croatia. Eighty of them had acute pyelonephritis, while 54 children had febrile state of different etiology including cystitis and they represented the control group. uNGAL, white blood cells, C-reactive protein, urinanalysis, urine culture, kidney ultrasound and a dimercaptosuccinic acid scintigraphic scan were done for each child. uNGAL was measured using chemiluminiscent microparticle immunoassay on ARHITECT i1000SR (Abbott Diagnostics, IL, USA).uNGAL values were significantly higher in children with acute pyelonephritis compared to the control groups (113.6 ng/mL vs. 10.2 ng/mL, p<0.001). A receiver operating characteristic curve comparison was done for tested parameters and encouraging results were obtained for uNGAL (AUC=0.952). A cut-off value of 29.4 ng/mL had 92.5% sensitivity and 90.7% specificity. We showed that uNGAL can also serve in differentiating acute pyelonephritis from cystitis (cut-off 38.5 ng/mL), and for differentiation of cystitis from febrile states with etiology other than urinary tract infection (UTI) (cut-off 20.4 ng/mL).uNGAL can be a useful diagnostic biomarker in acute pyelonephritis in children, but also in differentiating cystitis from febrile states other than UTI.

scholarly journals The Seasonality, Steroid and the Lower Ratio of Neutrophil to Lymphocyte Associated With Listeriosis in Japan

2021 ◽  
Author(s):  
Yusuke Watanabe ◽  
Itaru Nakamura ◽  
Yuri Miura ◽  
Hidehiro Watanabe
Keyword(s):  
Mortality Rate ◽  
Clinical Symptoms ◽  
Warm Season ◽  
Underlying Disease ◽  
University Hospital ◽  
Control Group ◽  
Case Group ◽  
Steroid Use ◽  
Lower Ratio ◽  
Tokyo Medical

Abstract Background: Although listeriosis is a foodborne infection with a high mortality rate, studies of listeriosis from Asia are limited. We aimed to compare the characteristics of listeriosis and non-listeriosis (defined as bacteremia without Listeria monocytegenes infection) in Japan.Methods: We conducted a case–control study of adults with listeriosis or with bacteremia without L. monocytegenes infection from January 1, 2010, to December 31, 2019, at Tokyo Medical University Hospital in Japan. We recorded the incidence of admissions and the clinical characteristics, including age and sex; underlying disease; clinical symptoms; onset month; whether listeriosis was community-associated or health care–associated; medicine; blood count; biochemical findings; antibiotics use; admission to the intensive care unit; and outcome.Results: A total of 12 patients were included in the case group and 28 patients were included in the control group. Most cases of listeriosis were present in patients of an advanced age, with underlying disease, and/or on immunosuppressant therapy. Two patients died within 30 days and one developed a brain abscess. Listeriosis onset was associated with the warm season (90.9% vs. 53.8%; P = 0.033), steroid use (54.5% vs. 19.2%; P = 0.042), and a lower ratio of neutrophils to lymphocytes (9.46 vs. 18.44; P = 0.015).Conclusion: The incidence of listeriosis in this study was similar to that in other Asian countries and the 30-day mortality rate was 18.2%. We observed that listeriosis onset was associated with the warm season, steroid use, and a lower ratio of neutrophils to lymphocytes.

scholarly journals Clinical, cytogenetic and toxicological studies in rural workers exposed to pesticides in Botucatu, São Paulo, Brazil

1998 ◽  
Vol 14 (suppl 3) ◽  
pp. S117-S123 ◽  
Author(s):  
Salete Marcia Bréga ◽  
Igor Vassilieff ◽  
Alaor Almeida ◽  
Amauri Mercadante ◽  
Denise Bissacot ◽  
...  
Keyword(s):  
Chromosomal Aberrations ◽  
Clinical Symptoms ◽  
Gene Mutations ◽  
Acetylcholinesterase Activity ◽  
Exposed Group ◽  
Control Group ◽  
Rural Workers ◽  
Toxicological Studies ◽  
Copper Zinc ◽  
Enzyme Dosage

Pesticides can cause gene mutations and chromosomal aberrations in exposed individuals. We have investigated 24 workers exposed to pesticides. Clinical examinations and cytogenetic and toxicological tests were performed. Ten non-exposed individuals were used as controls. Toxicological dosages of copper, zinc and manganese (metals found in some pesticides), hepatic enzyme dosage (GOT, GPT, AR) and acetylcholinesterase activity were performed in 16 workers and 8 controls. In the exposed workers, the most relevant clinical symptoms were poor digestion with fullness sensation after meals, irritated eyes, headache and fasciculations. The exposed group showed significantly lower manganese dosage and acetylcholinesterase activity, and significantly higher levels of alkaline phosphatase. Cytogenetic studies showed significantly higher chromosomal aberrations in the exposed group compared to the control group. Although the workers used protection against the pesticide's fog, the results revealed that the workers were contaminated with the pesticides. Therefore, the cytogenetic, toxicological studies with clinical examination are necessary for monitoring workers who are exposed to pesticides in any situation.

scholarly journals Effects of Point-Of-Care Testing in General Practice for Type 2 Diabetes Patients on Ambulatory Visits and Hospitalizations

2020 ◽  
Vol 17 (17) ◽  
pp. 6185
Author(s):  
Troels Kristensen ◽  
Kim Rose-Olsen ◽  
Christian Volmar Skovsgaard
Keyword(s):  
General Practice ◽  
Event Study ◽  
Diabetes Management ◽  
Hospital Admissions ◽  
Point Of Care ◽  
Control Group ◽  
Point Of Care Testing ◽  
Data Set ◽  
Capital Region ◽  
Diabetes Patients

Point-of-care testing (POCT) of HbA1c means instant test results and more coherent counseling that is expected to improve diabetes management and affect ambulatory visits and hospitalizations. From late 2008, POCT has been implemented and adopted by a segment of the general practices in the capital region of Denmark. The aim of this study is to assess whether the introduction of POCT of HbA1c in general practice (GP) has affected patient outcomes for T2 diabetes patients in terms of hospital activity. We apply difference-in-differences models at the GP clinic level to assess the casual effects of POCT on the following hospital outcomes: (1) admissions for diabetes, (2) admissions for ambulatory care sensitive diabetes conditions (ACSCs), (3) ambulatory visits for diabetes. The use of POCT is remunerated by a fee, and registration of this fee is used to measure the GP’s use of POCT. The control group includes clinics from the same region that did not use POCT. The sensitivity of our results is assessed by an event study approach and a range of robustness tests. The panel data set includes 553 GP clinics and approximately 30,000 diabetes patients from the capital region of Denmark, observed in the years 2004–2012. We find that voluntary adoption of POCT of HbA1c in GP has no effect on hospital admissions and diabetes-related hospital ambulatory visits. Event study analysis and different treatment definitions confirm the robustness of these results. If implementation of POCT of HbA1c improves other parts of diabetes management as indicated in the literature, it seems worthwhile to implement POCT of HbA1c in the capital region of Denmark. However, doubts around the quality of POCT of HbA1c testing and a desire to capture data at central labs may prevent implementation of more value based HbA1c testing.

scholarly journals Endometriosis and the risk of ectopic pregnancy: 10-year retrospective cohort study

2019 ◽  
Vol 12 (1) ◽  
pp. 10-15
Author(s):  
Ally Saetta ◽  
Michael Magro ◽  
Reeba Oliver ◽  
Funlayo Odejinmi
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Ectopic Pregnancy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Primary Objective ◽  
University Hospital ◽  
Chi Square Analysis

Objective: Our primary objective is to give weight to the unanswered and recently heavily debated question, as to whether endometriosis is a statistically significant risk factor for ectopic pregnancy. Our study also provides information on the ethnicity, age and parity of each woman. We report the clinical presentation, the presence of other risk factors as well as intraoperative findings. Design: A retrospective cohort study. Settings: Whipps Cross University Hospital, Bart’s Health NHS Trust which is a district general University hospital in East London. Population: All women, over 10-year period (2005–2014), who were surgically treated for an ectopic pregnancy. Methods: In total, 800 patients were surgically managed. A total of 100 had incomplete data and were, therefore, excluded from analysis. The clinical details, demographics and operation notes were retrospectively analysed for 700 patients. Data were analysed using the student’s t test or chi-square analysis as appropriate. Results: In total, 37 women (5.3%) had endometriosis and 663 women (94.7%) had no evidence of endometriosis. Of the 37 patients, 24 had stage 1, 11 had stage 2 and 2 patients had stage 3 endometriosis. Conclusion: Our data support the theory that endometriosis is not a statistically significant occurrence in women with surgically managed ectopic pregnancy and is not risk factor for ectopic pregnancy.

scholarly journals Bedside POCUS during ward emergencies is associated with improved diagnosis and outcome: an observational, prospective, controlled study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Laurent Zieleskiewicz ◽  
Alexandre Lopez ◽  
Sami Hraiech ◽  
Karine Baumstarck ◽  
Bruno Pastene ◽  
...  
Keyword(s):  
Point Of Care ◽  
Circulatory Failure ◽  
University Hospital ◽  
Controlled Study ◽  
Control Group ◽  
Point Of Care Ultrasound ◽  
Clinical Trial Registration ◽  
Ultrasound Device ◽  
Management Protocol ◽  
The Impact

Abstract Background Rapid response teams are intended to improve early diagnosis and intervention in ward patients who develop acute respiratory or circulatory failure. A management protocol including the use of a handheld ultrasound device for immediate point-of-care ultrasound (POCUS) examination at the bedside may improve team performance. The main objective of the study was to assess the impact of implementing such a POCUS-guided management on the proportion of adequate immediate diagnoses in two groups. Secondary endpoints included time to treatment and patient outcomes. Methods A prospective, observational, controlled study was conducted in a single university hospital. Two teams alternated every other day for managing in-hospital ward patients developing acute respiratory and/or circulatory failures. Only one of the team used an ultrasound device (POCUS group). Results We included 165 patients (POCUS group 83, control group 82). Proportion of adequate immediate diagnoses was 94% in the POCUS group and 80% in the control group (p = 0.009). Time to first treatment/intervention was shorter in the POCUS group (15 [10–25] min vs. 34 [15–40] min, p < 0.001). In-hospital mortality rates were 17% in the POCUS group and 35% in the control group (p = 0.007), but this difference was not confirmed in the propensity score sample (29% vs. 34%, p = 0.53). Conclusion Our study suggests that protocolized use of a handheld POCUS device at the bedside in the ward may improve the proportion of adequate diagnosis, the time to initial treatment and perhaps also survival of ward patients developing acute respiratory or circulatory failure. Clinical Trial Registration NCT02967809. Registered 18 November 2016, https://clinicaltrials.gov/ct2/show/NCT02967809.

The Epstein-Barr virus and osteosarcoma in Iranian children.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e23543-e23543
Author(s):  
Mahtab Rahbar ◽  
Keykhosro Mardanpour
Keyword(s):  
Tumor Cells ◽  
Clinical Symptoms ◽  
Disease Free Survival ◽  
University Hospital ◽  
Proliferation Index ◽  
Control Group ◽  
Free Survival ◽  
Ebv Infection ◽  
Epstein Barr ◽  
Iranian Children

e23543 Background: This study was conducted to describe the possible association between EBV infection and OS in Iranian children. Methods: This study carried out at Kermanshah university hospital on 48 OS tissue and ten non-cancerous bone tissue as a control group by three laboratory methods. The real-time polymerase chain reaction (RT-PCR) and Chromogenic in-situ hybridization (CISH) done to detect the Epstein Barr Encoded RNA (EBER1) expression as long as immunohistochemistry staining (IHC) to detect EBV latent membrane protein-1 (LMP-1) in tumor cells and controls. Overall-survival (O-S), prognosis free survival (PFS) and disease-free survival (DFS) provided based on the Kaplan-Meier method. Results: Specimen considered positive when EBER using PCR and CISH associated with LMP-1 using IHC stain were expressed separately in the same sample. Six out of eighty-four (12.5%) of OS cases were simultaneously EBV positive in all three methods within the tumor cells as compared to the control group. (P < 0.22) Association between EBV positivity and histologic characteristics of OS cases such as nodal involvement (P < 0.04), metastasis (P < 0.04), Ki67 reactivity (as proliferation index) (P < 0.03), and tumor stage (P < 0.05) were significant. EBV Positive patients show worse clinical symptoms in older age as well as the worse prognosis compared with negative patients. EBV positive patients presented shorter DFS, PFS, and OS. Conclusions: Our research could not find a statistical association between EBV infection and OS in Iranian children significantly. Meanwhile, we found, EBV infection could interfere in the invasive behavior of tumors. [Table: see text]

Recovery After Adenotonsillectomy—Do Steroids Help? Outcomes From a Randomized Controlled Trial

2020 ◽  
pp. 019459982097325
Author(s):  
Ariana G. Greenwell ◽  
Amal Isaiah ◽  
Kevin D. Pereira
Keyword(s):  
Randomized Controlled Trial ◽  
Pain Control ◽  
Controlled Trial ◽  
Tertiary Care ◽  
Primary Objective ◽  
University Hospital ◽  
Control Group ◽  
Randomized Controlled ◽  
Phone Calls ◽  
Ed Visits

Objectives The primary objective was to compare pain control following adenotonsillectomy (AT) in children with and without a single postoperative dose of oral dexamethasone in addition to standard analgesic medication. The secondary objective was to compare changes in caregiver-reported snoring, return to normal diet and baseline function, and the number of phone calls and emergency department (ED) visits. Study Design Prospective randomized controlled trial. Setting Tertiary care university hospital. Methods Children aged 3 to 10 years with sleep-disordered breathing who were scheduled to undergo AT were randomized to receive standard analgesia with or without dexamethasone (0.6 mg/kg) administered on the third postoperative day. Standard analgesia was defined as alternating weight-based doses of ibuprofen and acetaminophen. A nurse practitioner blinded to the study condition performed telephone surveys postoperatively, and the electronic medical record was reviewed. Results Enrollment comprised 149 children, of whom 119 were included. When compared with the control group (n = 61, 51%), children who received dexamethasone (n = 58, 49%) had a greater decrease in reported pain score on day 4 (mean ± SD, 2.5 ± 3.1 vs 1.1 ± 3.5, P < .001). Additionally, steroid use was associated with fewer caregiver phone calls (18 [29.5%] vs 6 [10%]) and ED visits (6 [10%] vs 1 [2%]). Conclusion A single dose of dexamethasone administered on day 3 after adenotonsillectomy significantly improved pain control. There were fewer phone calls and ED visits in the steroid arm. These results support the use of oral steroids as an adjunct for postoperative pain control in children undergoing AT.

Pregnancy Outcomes in A Group Egyptian Patients with Systemic Lupus Erythematosus: A Cohort Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
DF Mohammed ◽  
HE Mansour ◽  
AE El-Feky ◽  
SM Hosny ◽  
CS Morad ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Fetal Loss ◽  
University Hospital ◽  
Intrauterine Fetal Death ◽  
Control Group ◽  
Childbearing Age ◽  
Systemic Lupus

Abstract Background Systemic lupus erythematosus (SLE) predominantly affects women of childbearing age thus pregnancy in lupus patients is a common clinical scenario. SLE adversely affects pregnancy outcomes and pregnancy leads to SLE flares Aim of the work Determining the frequencies and predictors of maternal and fetal pregnancy outcomes in women with SLE by a prospective cohort study Patients and methods seventy-one pregnant lupus patients were followed prospectively, and their data compared to age-matched pregnant healthy controls attending Ain Shams University Hospital clinics Results Thirteen Patients had activity at conception. Sixty-six(93%) Where on treatment. Flares occurred in 51 patients (72%) during pregnancy with nephritis being the most common occurring in 78%. The prevalence of anemia, AKI and hypertension (HTN) during pregnancy were higher in SLE group than control group (P &lt; 0.01). The rate of delivery by Cesarean section (CS), PTL, postpartum hemorrhage, preeclampsia (PE), severe PE and HELLP were higher in SLE group then control group (P &lt; 0.01) as well as an increase in rate of postpartum infection (P &lt; 0.05). There was an increase in rate of fetal loss, prematurity, intrauterine growth restriction (IUGR), NICU admission, still birth/intrauterine fetal death and highly significant decrease in fetal weight in SLE group than control group (P &lt; 0.01). Pregestational HTN was independently associated with PE (OR 91.228; CI 6.791-1225.538). Proteinuria and HTN during pregnancy were independently associated with prematurity (OR 14.162 CI 1.029-194.958 & OR 10.596, CI 1.460-76.894). Conclusion Pregnancy in lupus patients carries a higher risk of pregnancy morbidity and worse fetal outcomes than the controls.

scholarly journals Effect of cryoprecipitate transfusion therapy in patients with postpartum hemorrhage: a retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryo Kamidani ◽  
Takahito Miyake ◽  
Hideshi Okada ◽  
Genki Yoshimura ◽  
Keigo Kusuzawa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Fluid Balance ◽  
Retrospective Cohort Study ◽  
Postpartum Hemorrhage ◽  
Retrospective Cohort ◽  
Active Bleeding ◽  
University Hospital ◽  
Control Group ◽  
Initial Examination ◽  
Transfusion Therapy

AbstractTo evaluate the effect of cryoprecipitate (CRYO) transfusion in women referred for postpartum hemorrhage (PPH). This retrospective cohort study included patients with primary PPH referred to Gifu University Hospital between April 2013 and March 2020. We analyzed the effect of CRYO transfusion on fluid balance 24 h after the initial examination using a multivariable linear regression model adjusted for several confounding variables. To evaluate whether outcomes were modified by active bleeding, an interaction term of CRYO*active bleeding was incorporated into the multivariable model. We identified 157 women: 38 in the CRYO group (cases) and 119 in the control group. Fluid balance in the aforementioned period tended to decrease in the CRYO group compared with that in the control group (coefficient − 398.91; 95% CI − 1298.08 to + 500.26; p = 0.382). Active bleeding on contrast-enhanced computed tomography affected the relationship between CRYO transfusion and fluid balance (p = 0.016). Other outcomes, except for the overall transfusion requirement, were not significantly different; however, the interaction effect of active bleeding was significant (p = 0.016). CRYO transfusion may decrease the fluid balance in the first 24 h in PPH patients, especially in those without active bleeding.

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