The Relationship Between Epidermal Mitotic Density, Atypical Mitotic Figure Density, Breslow Depth, Ulceration, and Dermal Mitotic Rate in Cutaneous Melanoma: A Retrospective Cohort Study

Prognostic factors for melanoma include Breslow depth (BD), ulceration, and dermal mitotic rate (DMR). No studies have queried the effect of epidermal mitotic density (EMD) or atypical mitotic figure density (AMD) in an outcome-based assessment. Our objective was to determine if there is a relationship between EMD, AMD, BD, DMR, and ulceration and patient outcomes. This was a retrospective cohort study of 185 cases of thick and thin melanomas. Univariate and multivariate cause-specific regression analysis was performed. There was a positive correlation between EMD and BD ( P = .0001). The difference between AMD in thick and thin melanomas was statistically significant. For every unit increase in EMD, patients had a 2.8-fold increase in the risk of distant metastasis; however, statistical significance was lost in the multivariate analysis. In adjusted analyses, ulceration, DMR, and BD were associated with outcomes. There were no statistically significant correlations between AMD and outcomes. This study is limited by its small sample size, diminution of the epidermis in some thick melanomas preventing EMD estimates, and reproducibility of mitotic figure counting. EMD and AMD do not seem to have any independent value in multivariate analyses for melanoma. Ulceration, BD, and DMR were significantly associated with outcomes and further solidify these known predictors of prognosis.

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435. Outcomes for E484K Mutation Negative COVID-19 Patients Cohorted with E484K Mutation Positive COVID-19 Patients: A Retrospective Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.634 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S319-S319

Author(s):

Fahad Buskandar ◽

Amber L Linkneheld-Struk ◽

Victoria R Williams ◽

Adrienne Chan ◽

Lorraine Maze Dit Mieusement ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Small Sample Size ◽

Acute Infection ◽

Admission Rate ◽

Small Sample ◽

Secondary Outcome ◽

Hospital Room ◽

Risk Of Death

Abstract Background The emergence of the E484K mutation of SARS-CoV-2 poses a risk of immune evasion but the risk of re-infection during acute infection is not well defined. Our aim was to assess the risk of re-infection among patients with existing acute E484K mutation negative COVID-19 infection who were exposed to an E484K mutation positive SARS-CoV-2 infected patient. Methods We performed a retrospective cohort study of patients admitted with acute E484K negative COVID-19 infection and shared a hospital room with a patient who was E484K mutation positive during their period of communicability. The primary outcome was laboratory confirmed and/or clinical evidence of re-infection within the E484K negative population within 30 days of exposure and the secondary outcome was the 30-day risk of death or re-admission to hospital due to COVID-19. Results We identified 41 patients who were E484K mutation negative who shared a hospital room with some of the identified 34 E484K positive patients. Six (14%) underwent repeat COVID-19 testing and remained E484K negative and none developed signs or symptoms of COVID-19 re-infection during the 30 days following exposure. The mortality rate was 7% (3/41) and re-admission rate was zero at 30 days from exposure. Conclusion Despite the small sample size, we did not observe any evidence of re-infection among patients with COVID-19 who shared a hospital room with E484K positive patients during their acute infection. If necessary due to high hospital occupancy, patients with discordant E484K results can be safely cohorted in a shared room. Disclosures All Authors: No reported disclosures

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General versus regional anaesthesia for caesarean section indicated for acute foetal distress: a retrospective cohort study

BMC Anesthesiology ◽

10.1186/s12871-021-01289-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Junette Arlette Mbengono Metogo ◽

Theophile Njamen Nana ◽

Brian Ajong Ngongheh ◽

Emelinda Berinyuy Nyuydzefon ◽

Christoph Akazong Adjahoung ◽

...

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Retrospective Cohort Study ◽

Medical Records ◽

Regional Anaesthesia ◽

Retrospective Cohort ◽

Statistical Significance ◽

Neonatal Resuscitation ◽

Maternal Outcomes ◽

Foetal Distress

Abstract Background Acute foetal distress (AFD) is a life-threatening foetal condition complicating 2% of all pregnancies and accounting for 8.9% of caesarean sections (CS) especially in developing nations. Despite the severity of the problem, no evidence exists as to the safest anaesthetic technique for the mother and foetus couple undergoing CS for AFD. We aimed to compare general anaesthesia (GA) versus regional (spinal and epidural) anaesthesia in terms of their perioperative maternal and foetal outcomes. Methods We carried out a retrospective cohort study by reviewing the medical records of all women who underwent CS indicated for AFD between 2015 to 2018 at the Douala General Hospital, Cameroon. Medical records of neonates were also reviewed. We sought to investigate the association between GA, and regional anaesthesia administered during CS for AFD and foetal and maternal outcomes. The threshold of statistical significance was set at 0.05. Results We enrolled the medical records of 117 pregnant women who underwent CS indicated for AFD. Their mean age and mean gestational age were 30.5 ± 4.8 years and 40 weeks respectively. Eighty-three (70.9%), 29 (24.8%) and 05 (4.3%) pregnant women underwent CS under SA, GA and EA respectively. Neonates delivered by CS under GA were more likely to have a significantly low APGAR score at both the 1st (RR = 1.93, p = 0.014) and third-minute (RR = 2.52, p = 0.012) and to be resuscitated at birth (RR = 2.15, p = 0.015). Past CS, FHR pattern on CTG didn’t affect these results in multivariate analysis. Adverse maternal outcomes are shown to be higher following SA when compared to GA. Conclusion The study infers an association between CS performed for AFD under GA and foetal morbidity. This, however, failed to translate into a difference in perinatal mortality when comparing GA vs RA. This finding does not discount the role of GA, but we emphasize the need for specific precautions like adequate anticipation for neonatal resuscitation to reduce neonatal complications associated with CS performed for AFD under GA.

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Separation and not residency permit restores function in resignation syndrome: a retrospective cohort study

European Child & Adolescent Psychiatry ◽

10.1007/s00787-021-01833-3 ◽

2021 ◽

Author(s):

Karl Sallin ◽

Kathinka Evers ◽

Håkan Jarbin ◽

Lars Joelsson ◽

Predrag Petrovic

Keyword(s):

Cohort Study ◽

Social Services ◽

Residential Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Care Home ◽

Essential Components ◽

Residential Care Home ◽

The Difference ◽

Oriented Approach

AbstractDespite poor treatment results, a family-oriented approach and the securing of residency have been deemed essential to recovery from resignation syndrome (RS). In a retrospective cohort study, we evaluated an alternative method involving environmental therapy, with patients separated from their parents, while actively abstaining from involving the asylum process in treatment. We examined medical records, social services acts, and residential care home acts from 13 individuals treated at Solsidan residential care home between 2005 and 2020. Severity and outcome were assessed with Clinical Global Impression, Severity and Improvement subscales. Thirteen participants were included and out of these nine (69%) recovered, i.e. they very much or much improved. Out of the eight that were separated, all recovered, also, one non-separated recovered. The difference in outcome between subjects separated and not was significant (p = 0.007). Moreover, out of the five which received a residency permit during treatment, one recovered whereas four did not. The difference in outcome between subjects granted residency and not was significant (p = 0.007). The data revealed three (23%) cases of simulation where parents were suspected to have instigated symptoms. Our evaluation suggests that separation from parents and abstaining from invoking residency permit could be essential components when treating RS. Relying on a family-oriented approach, and residency could even be detrimental to recovery. The examined intervention was successful also in cases of probable malingering by proxy.

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Does tonsillectomy reduce medical care visits for pharyngitis/tonsillitis in children and adults? Retrospective cohort study from Sweden

BMJ Open ◽

10.1136/bmjopen-2019-033817 ◽

2019 ◽

Vol 9 (11) ◽

pp. e033817 ◽

Cited By ~ 3

Author(s):

Eirik Østvoll ◽

Ola Sunnergren ◽

Joacim Stalfors

Keyword(s):

Cohort Study ◽

Surgical Treatment ◽

Medical Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Control Group ◽

Clinical Value ◽

Recurrent Tonsillitis ◽

Visit Rate ◽

The Difference

ObjectiveTo assess the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis or tonsillitis in children and adults with chronic/recurrent tonsillitis.DesignRetrospective cohort study.SettingData were retrieved from the VEGA register, a comprehensive regional cohort in Sweden.Participants1044 children (<15 years) and 2244 adults.InterventionTonsillectomy/adenotonsillectomy compared with no surgical treatment.Main outcome measuresChanges in yearly mean rates of medical care visits due to pharyngitis/tonsillitis.ResultsIn children, there was a significant decrease in the yearly mean medical care visits rate from 1.93 (1.82 to 2.04) before surgery to 0.129 (0.099 to 0.165) after surgery, with a mean change of −1.80 (−1.90 to −1.69), p<0.0001. In patients who did not undergo surgery, the corresponding mean change was −1.51 (−1.61 to −1.41), resulting in a mean difference in the change in visit rates between the intervention and control groups of −0.283 (−0.436 to −0.135), p=0.0002. In adults, a significant decrease in the yearly mean medical care visit rate was observed from 1.45 (1.39 to 1.51) before surgery to 0.152 (0.132 to 0.173) after surgery, with a mean change of −1.30 (−1.36 to −1.24), p<0.0001, compared with −1.18 (−1.24 to −1.13) in the control group. The difference in the change in yearly mean visit rate between the surgical and non-surgical groups was −0.111 (−0.195 to −0.028), p=0.0097. The subgroup analysis showed a greater effect of surgery in children, in patients with a higher number of medical care visits before surgery and in the first year of follow-up.ConclusionIn this cohort of patients moderately or less affected with chronic/recurrent tonsillitis, the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis and tonsillitis compared with no surgical treatment was low and of questionable clinical value.

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A Comparison of the Efficacy and Cost of Different Venous Leg Ulcer Dressings: A Retrospective Cohort Study

International Journal of Vascular Medicine ◽

10.1155/2015/187531 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Syed M. Asim Hussain

Keyword(s):

Cohort Study ◽

Standard Deviation ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Healing Rate ◽

Leg Ulcer ◽

University Hospital ◽

Venous Leg Ulcer ◽

Number Of Patients ◽

The Difference

Objective. To compare the efficacy and cost-effectiveness of simple nonadherent dressings with other more expensive dressing types in the treatment of venous leg ulcers.Study Design. Retrospective cohort study.Location. The leg ulcer clinic at the University Hospital of South Manchester.Subjects and Methods. The healing rates of twelve leg ulcer patients treated with simple nonadherent dressings (e.g., NA Ultra) were compared with an equal number of patients treated with modern dressings to determine differences in healing rates and cost.Main Outcome Measures. Rate of healing as determined by reduction in ulcer area over a specified period of time and total cost of dressing per patient.Results. Simple nonadherent dressings had a mean healing rate of 0.353 cm2/week (standard deviation ± 0.319) compared with a mean of 0.415 cm2/week (standard deviation ± 0.383) for more expensive dressings. This resulted in a one-tailedpvalue of 0.251 and a two-tailedpvalue of 0.508. Multiple regression analysis gave a significanceFof 0.8134.Conclusion. The results indicate that the difference in healing rate between simple and modern dressings is not statistically significant. Therefore, the cost of dressing type should be an important factor influencing dressing selection.

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A RETROSPECTIVE COHORT STUDY OF PATIENTS IN THE ICU FOR COVID-19: A LOOK INTO THE DIFFERENCE BETWEEN THE FIRST AND THE SECOND WAVE

CHEST Journal ◽

10.1016/j.chest.2021.07.1035 ◽

2021 ◽

Vol 160 (4) ◽

pp. A1129-A1130

Author(s):

Ruhma Ali ◽

Aditya Patel ◽

Divya Mounisha Thimmareddygari ◽

Kok Hoe Chan ◽

Chrystina Kiwan ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

The Difference ◽

Second Wave

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Secondary erythrocytosis following drugs used in rifampicin/multidrug-resistant tuberculosis: a retrospective cohort study

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2021-001064 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001064

Author(s):

Sirak Tesfamariam ◽

Amon Solomon Ghebrenegus ◽

Henok Woldu ◽

Ephrem Fisseha ◽

Gebremeskel Belai ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Statistical Significance ◽

Multidrug Resistant ◽

Hospital Data ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb ◽

Time To Onset

BackgroundMultidrug-resistant tuberculosis (MDR-TB) drugs have never been associated with erythrocytosis. In Eritrea, however, several cases of incident erythrocytosis had been observed in the MDR-TB hospital. This study was aimed at exploring the association between MDR-TB drugs and secondary erythrocytosis, characterising the cases, and identifying other possible risk factors.MethodsA retrospective cohort study was conducted in Merhano National Referral MDR-TB hospital. Data were extracted from physically available clinical cards and laboratory results collected longitudinally between 23 June 2011 and 17 January 2021. Initially, univariate descriptive statistics (frequency, mean (SD), median (IQR) and range) were used as appropriate. Then, χ2 or Fisher χ2 test, and bivariate and/or multivariate Cox proportional hazard model were used to identify the predictors of incident erythrocytosis. All statistical analyses were conducted using R, and a two-sided alpha 0.05 was used to determine the statistical significance.ResultsA total of 257 patients’ medical cards were screened, and 219 were eligible for further analysis. The median age of the patients was 38 years (range: 13–90 years) and 54.8% were males. During the follow-up time, 31 (14.2%) patients developed secondary erythrocytosis yielding an incidence rate of 7.8 cases per 1000 person-months. On average, the median time to onset of the event was found to be 5-months (range: 1–24 months). Males were more likely to develop the event than females (adjusted HR=7.13, 95% CI=1.66 to 30.53), and as body weight increases by 1 kg, the likelihood of developing secondary erythrocytosis was found to increase by 7% (adjusted HR=1.07, 95% CI=1.03 to 1.10). Moreover, all cases of secondary erythrocytosis were found to be possibly associated with the MDR-TB drugs.ConclusionThe authors hypothesised that the incident erythrocytosis is possibly be associated with MDR-TB drugs, and further studies are required to substantiate this finding.

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Clinical features of Anti-synthetase syndrome associated interstitial lung disease: a retrospective cohort in China

10.21203/rs.3.rs-23685/v1 ◽

2020 ◽

Author(s):

Xi Zhan ◽

YAN Wei ◽

WANG Ying ◽

LI Qing ◽

SHI Xuhua ◽

...

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Clinical Features ◽

Retrospective Cohort ◽

Small Sample Size ◽

Inflammatory Myopathy ◽

Small Sample ◽

Positive Group ◽

The Difference

Abstract Background Antisynthetase Syndrome (ASSD) is a chronic autoimmune condition characterized by antibodies directed against an aminoacycl transfer RNA synthetase (ARS) along with a group of clinical features including the classical clinical triad: inflammatory myopathy, arthritis, interstitial lung disease (ILD). ASSD is highly heterogenous due to the different organs involvement, and ILD is the main cause of mortality and function loss, which presents as different patterns when diagnosed. We designed this retrospective cohort to describe the clinical features and disease behavior of the ASSD) associated ILD. Methods Retrospectively collected the data of 108 cases of ASSD associated ILD in Beijing Chaoyang Hospital since 2017.12 to 2019.3. Data including age, gender, physical examination, laboratory test, pulmonary function and High Resolution Computer Tomography (HRCT), treatment, were obtained from the Electronic Medical Record (EMR) system. Patients were divided into 5 groups according to the distinct Aminoacyl tRNA synthetases (ARS) antibodies, and all patients had a multiple discussion team (MDT) to make a radiological and pathological diagnosis of the ILD pattern. Each patient had at least 1 follow up for no less than 6 months. Patients with missing data of MDT evaluation or follow up were excluded. Results: 108 consecutive patients were recruited in this retrospective cohort. 30 cases received bronchoscopy for a transbronchial lung biopsy. 3 had bronchoscopy for a transbronchial cryobiopsy. 33 were with JO-1 positive and 30 were with PL-7 positive. 23 with EJ positive, 13 with PL12 positive and 9 with OJ positive. JO-1 group had a significant higher rate of mechanic’s hand (57.6%) than other 4 groups, the skin involvement (Gottron Papules and/or Heliotrope Rash) was found in 38 (35%) and no difference was found among the 5 groups. Polymyositis/Dermatomyositis (PM/DM) was diagnosed in 25 (23.1%) patients and no difference was observed among the 5 groups. The anti-PL7 positive group had a higher frequency of UIP pattern (13.3%) than other 4 groups but the difference was not significant due to the small sample size, and EJ group had the most frequent OP pattern(78.2%), which was significantly higher than PL-7 group (P<0.001) and PL-12 group (P=0.025). The median follow-up time were 10.7 months. All received prednisone treatment, with or without immunosuppressants ,and at the 6-month-follow up, the JO-1 group and EJ group had the significantly higher improvement of forced vital capacity that the other 3 groups (P<0.05), and PL-7 group had the lowest FVC improvement (P<0.05). The anti-Jo1-positive group and anti-EJ-positive group had significantly higher anti-RO52-positive occurrence than other 3 groups (P<0.05).Conclusion Anti PL-7 antibody had the same frequency as anti-JO1 in ASSD-ILD, in which the ILD pattern was different with distinct anti-ARS antibodies. All ASSD-ILD responded to therapy of steroids, with or without immunosuppressants. PL-7 group had a highest occurrence of UIP pattern, and significantly lower respondence to therapy.

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Breastfeeding cessation in the era of Elimination of Mother to Child Transmission of HIV in Uganda: a retrospective cohort study

10.21203/rs.3.rs-19025/v2 ◽

2020 ◽

Author(s):

Jackslina Gaaniri Ngbapai ◽

Jonathan Izudi ◽

Stephen Okoboi

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Statistical Significance ◽

World Health ◽

Hiv Care ◽

Breastfeeding Initiation ◽

One Year ◽

Postpartum Mothers ◽

Mother To Child

Abstract Background: Among human immunodeficiency (HIV) infected mothers, the World Health Organization (WHO) recommends cessation of breastfeeding at one year to prevent HIV transmission but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at one year among HIV infected postpartum mothers at Ndejje Health Center IV, a large peri-urban health facility in Uganda. Methods: This retrospective cohort study involved all HIV infected postpartum mothers enrolled in HIV care for at least 12 months between June 2014 and June 2018. We abstracted data from registers, held focused group discussions with HIV infected postpartum mothers, and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of HIV infected postpartum mothers who had stopped breastfeeding at one year. We summarized quantitative data descriptively, tested differences in outcome with the Chi-square and t-tests, and established independently associated factors using the modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results. Results: Of 235 HIV infected postpartum mothers, 150 (63.8%) ceased breastfeeding at one year and this was independently associated with the HIV exposed infant (HEI) being female than male (Adjusted risk ratio (aRR): 1.25, 95% confidence interval (CI), 1.04, 1.50), the mother being multiparous than primparous (aRR, 1.26; 95% CI, 1.04-1.53), and breastfeeding initiation on same-day as birth (aRR, 0.06; 95% CI, 0.01-0.41). Qualitative results showed that partner reminders about breastfeeding adequacy of BF knowledge and maternal literacy facilitated continued breastfeeding until one year. Inadequate breastfeeding knowledge, casual and formal work demands, in addition to increased breastfeeding demand among boys led to cessation of breastfeeding before one year.Conclusion. Cessation of breastfeeding at one year among HIV infected postpartum mothers was suboptimal and this might increase risk of mother to child transmissions of HIV. Cessation of breastfeeding was more likely among female HEIs and multiparous mothers, and less likely when breastfeeding is initiated on same-day as birth. Interventions to enhance cessation of breastfeeding at one year should target groups of women with lower rates.

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