Risk Factors Associated with Fatal Dengue Hemorrhagic Fever in Adults: A Case 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.

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

10.21203/rs.2.11347/v1 ◽

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.

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Endoscopy in Pregnancy: A Systematic Review

Journal of Digestive Endoscopy ◽

10.1055/s-0041-1739567 ◽

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.

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COVID-19 and Its Symptoms’ Panoply: A Case-Control Study of 919 Suspected Cases in Locked-Down Ovar, Portugal

Portuguese Journal of Public Health ◽

10.1159/000514925 ◽

2021 ◽

pp. 1-8

Author(s):

Regina Sá ◽

Tiago Pinho-Bandeira ◽

Guilherme Queiroz ◽

Joana Matos ◽

João Duarte Ferreira ◽

...

Keyword(s):

Large Scale ◽

Case Control Study ◽

Statistical Significance ◽

Case Control ◽

Case Definition ◽

Suspected Case ◽

Risk Characteristics ◽

Increased Risk ◽

Wide Range ◽

Control Study

Background: Ovar was the first Portuguese municipality to declare active community transmission of SARS-CoV-2, with total lockdown decreed on March 17, 2020. This context provided conditions for a large-scale testing strategy, allowing a referral system considering other symptoms besides the ones that were part of the case definition (fever, cough, and dyspnea). This study aims to identify other symptoms associated with COVID-19 since it may clarify the pre-test probability of the occurrence of the disease. Methods: This case-control study uses primary care registers between March 29 and May 10, 2020 in Ovar municipality. Pre-test clinical and exposure-risk characteristics, reported by physicians, were collected through a form, and linked with their laboratory result. Results: The study population included a total of 919 patients, of whom 226 (24.6%) were COVID-19 cases and 693 were negative for SARS-CoV-2. Only 27.1% of the patients reporting contact with a confirmed or suspected case tested positive. In the multivariate analysis, statistical significance was obtained for headaches (OR 0.558), odynophagia (OR 0.273), anosmia (OR 2.360), and other symptoms (OR 2.157). The interaction of anosmia and odynophagia appeared as possibly relevant with a borderline statistically significant OR of 3.375. Conclusion: COVID-19 has a wide range of symptoms. Of the myriad described, the present study highlights anosmia itself and calls for additional studies on the interaction between anosmia and odynophagia. Headaches and odynophagia by themselves are not associated with an increased risk for the disease. These findings may help clinicians in deciding when to test, especially when other diseases with similar symptoms are more prevalent, namely in winter.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.724 ◽

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

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Tinnitus severity correlated with zinc, copper, risk factors: a large-scale case-control study

Authorea ◽

10.22541/au.158775642.22559247 ◽

2020 ◽

Author(s):

Jiangfeng Huang ◽

Jing He ◽

Qingping Zhu ◽

Zhiwei Zheng ◽

Peiji Zeng ◽

...

Keyword(s):

Risk Factors ◽

Large Scale ◽

Case Control Study ◽

Case Control ◽

Tinnitus Severity ◽

Control Study

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Association of Mesothelioma Deaths With Cumulated Neighborhood Exposures Due to a Large-Scale Asbestos Cement Plant in Amagasaki City, Japan: A Nested Case-control Study

10.21203/rs.3.rs-574038/v1 ◽

2021 ◽

Author(s):

Yuri Kitamura ◽

Ling Zha ◽

Rong Liu ◽

Masayuki Shima ◽

Tomoki Nakaya ◽

...

Keyword(s):

Occupational Exposure ◽

Large Scale ◽

Case Control Study ◽

Conditional Logistic Regression ◽

Asbestos Exposure ◽

Case Control ◽

Asbestos Cement ◽

Nested Case Control ◽

Dose Dependent ◽

Control Study

Abstract BackgroundAlthough a causal relationship between mesothelioma and asbestos exposure is well known, few studies have shown a relationship to non-occupational exposure, including neighborhood exposure, most likely because of the large effect size of occupational exposure. The aim of this study was to quantify the risk of malignant mesothelioma death associated with neighborhood asbestos exposure due to a large-scale asbestos-cement (AC) plant in Amagasaki, Japan, by properly adjusting for occupational exposure. MethodsThis was a nested case-control study in which a fixed population of 143,929 residents who had been living in Amagasaki City between 1975 and 2002 were followed from 2002 to 2015. All 133 cases and 403 matched controls were interviewed about their occupational, domestic, household, and neighborhood asbestos exposures. Odds ratios (ORs) for mesothelioma death associated with neighborhood exposure were estimated by a conditional logistic-regression model that adjusted for other asbestos exposures. We adopted cumulative indices that considered residence-specific asbestos (crocidolite) concentrations and durations during the potential exposure period of 1957-1975 to evaluate individual neighborhood exposures.ResultsThere was an increasing, dose-dependent risk of mesothelioma death associated with neighborhood exposure, demonstrated by ORs in the highest quintile category that were 21.4 (95%CI: 5.8 to 79.2) for all, 23.7 (95% CI: 3.8-147.2) for males and 26.0 (95% CI: 2.8-237.5) for females, compared to the lowest quintile, respectively. These results clearly demonstrated no substantial differences between males and females in relation to the magnitude of risk from neighborhood exposure.Our findings suggest that the risk of mesothelioma death associated with neighborhood exposure persists and will not be diminished for many years, even though it has been decades since the AC plant closed. ConclusionsBy adjusting for occupational and other asbestos exposures, a dose-dependent relationship was demonstrated between mesothelioma death and neighborhood asbestos exposure from a large-scale AC plant.

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