scholarly journals Predictors of the recurrence of surgically removed previous caesarean skin scars at caesarean section: A retrospective cohort study

2021 ◽  
Vol 7 ◽  
pp. 205951312110233 ◽  
Author(s):  
İhsan Bağlı ◽  
Rei Ogawa ◽  
Sait Bakır ◽  
Cuma Taşın ◽  
Ayhan Yıldırım ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Caesarean Section ◽  
Retrospective Cohort ◽  
Treatment Strategies ◽  
Surgical Excision ◽  
Hypertrophic Scars ◽  
Group 2 ◽  
Risk Factor For Recurrence ◽  
Group 1

Background: Caesarean skin scars (CSS; hypertrophic scars and keloids) are very stressful for women and treatment strategies vary. However, there is a lack of knowledge about the outcome of surgical excision of CSS during caesarean section (CS). The study aims to determine the rate of recurrence and risk factors of recurrence for surgically removed CSS. Method: This is a retrospective cohort study that used STROBE guidelines. Pfannenstiel incisions of 145 patients were evaluated. Patients were divided into two groups: recurred (group 1, n = 19) and non-recurred group (group 2, n = 126). The groups were compared. Results: The rate of recurrence of CSS was 13% in the total cohort (19/145), one of the main outcomes of the study. While emergency CS was performed for 12 patients in group 1 (63%), CS was carried out in 25 patients in group 2 (20%); this difference was significant ( P = 0.001). Before surgery, white blood cell and neutrophil counts were significantly higher in group 1 ( P = 0.014 and P = 0.023, respectively). There were 11 dark-skinned women (26%; Fitzpatrick type 4) in group 1 and 31 (74%) in group 2. This difference was statistically significant ( P = 0.031). As the other main outcome, emergency CS could be accepted as a risk factor for recurrence in the multivariate regression analysis ( P = 0.060; odds ratio = 5.07; 95% confidence interval = 0.93–17.51). Conclusion: The rate of recurrence of surgically removed previous CSS at CS is promising without adjunct therapy. Emergency CS was found to be a risk factor for recurrence. Lay Summary Background Caesarean skin scars (CSS; hypertrophic scars and keloids) are very stressful and are generally itchy and painful for women. Treatment strategies vary. However, there is a lack of knowledge about the outcome of only surgical excision of CSS scars during caesarean section (CS). The issue being explored There are few data in the literature for CSS in the lower abdomen. These scars can be removed during the second or third CS, but the results are not known exactly. How was the work conducted? In our clinic, 145 patients with CSS were given a CS and their scars were removed at the same time. While most of these scars were reported as hypertrophic by pathological examination, some were reported as keloid. At the earliest, one year after surgery, the rate of recurrence was found to be 13%. What we learned from the study Asymptomatic patients who are planning another pregnancy and do not want to receive any other radiotherapy or steroid injection therapy can wait to remove their CSS at the next CS, especially elective CS with or without adjunct therapy. Emergency CS was found to be a risk factor for the recurrence of these scars.

scholarly journals Pregnancy Outcomes Following the First Frozen Blastocyst Transfer Among Women Aged Less Than 35 Years Old: A Retrospective Cohort Study

2021 ◽  
pp. 1-7
Author(s):  
Le Hoang ◽  
Le Duc Thang ◽  
Nguyen Thi Lien Huong ◽  
Nguyen Minh Thuy ◽  
Vu Thi Mai Anh ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnancy Rate ◽  
Live Birth ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Group 2 ◽  
Group 1

Background: Many guidelines have been issued regarding the number of embryos to be transferred after in vitro fertilization (IVF), but patients and clinicians may be reluctant to accept or offer a single embryo transfer due to the expected lower chance of pregnancy or live birth. This study was aimed to provide additional information on cycle outcome according to the number and quality of thawed transferred blastocysts. Methods:A retrospective cohort study was designed to collect the data of 505 patients who performed the first frozen blastocysts transfer at Tam Anh General Hospital from June 2018 to September 2019. One good-quality embryo was transferred for 121 patients (Group 1), two good for 214 patients (Group 2), one good and one poor for 112 patients (Group 3), one good and two poor for 25 patients (Group 4), and one or two poor for 33 patients (Group 5). Results:The pregnancy rate was 71.9%, 74.8%, 69.4%, 84.0%, and 39.4% in Group 1–5, respectively. The multiple pregnancy rate was 36.9%, 16.9%, and 32.0% in Groups 2–4, respectively, higher than Group 1 (4.9%). The live birth rate was 55.6%, 50.9%, and 60.0% in Group 2–4, respectively, but not significantly different from the Group 1 (47.9%). Conclusions:Transferring an additional good or poor embryo, along with a good embryo, does not increase the live birth rate while the incidence of multiple pregnancies rises significantly.

scholarly journals The Effect of Early Rescue ICSI and Split IVF-ICSI in Preventing Low Fertilization Rate During the First ART Cycle: A Real-world Retrospective Cohort Study

2021 ◽  
Author(s):  
Dongzi Yang ◽  
Linlin Jiang ◽  
Yifan Qian ◽  
Xiaoli Chen ◽  
Xiaohui Ji ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Real World ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Fertilization Rate ◽  
Clinical Pregnancy ◽  
Fertilization Rates ◽  
Group 2 ◽  
Group 1

Abstract BackgroundShort gamete coincubation in in vitro fertilization (IVF-S) combined with early rescue intracytoplasmic sperm injection (R-ICSI) and split IVF-ICSI insemination, are two methods to prevent unpredicted low or failed fertilization. This study aimed to determine the utility of IVF-S combined with R-ICSI and split IVF-ICSI during the first assisted reproductive technology (ART) cycle.Patients and methodsA single-center retrospective cohort study based on real-world data. Couples with a high risk of low IVF fertilization during the first ART cycle underwent IVF-S with R-ICSI (n=191) or split IVF-ICSI (n=775). Fertilization rate, embryo quality, and clinical outcomes were measured.ResultsAfter propensity score matching, we included 188 couples in the IVF-S with R-ICSI group as Group 1 and 720 in the split IVF-ICSI group as Group 2, with low IVF fertilization rates of 4.79% and 9.03%, respectively. Normal fertilization rates were similar in the two groups; however, Group1 had a higher multiple pronuclei rate (10.42% vs. 4.50%, P <0.001). The groups were similar for rates of high-quality embryos, blastocyst formation rate, embryo implantation, clinical pregnancy, miscarriage, loss to follow-up, and live birth. Low fertilization following IVF occurred in nine couples in Group 1 with 47 MII oocytes performed R-ICSI and 65 in Group 2 with 331 MII oocytes performed ICSI. Similar fertilization rate, embryo development, and clinical outcomes were noted in two groups with low fertilization.ConclusionsIVF-S with early R-ICSI and split IVF-ICSI were effective strategies in preventing IVF fertilization failure or low fertilization rate in couples with high-risk factors. IVF-S with early R-ICSI could become the preferred approach because of its advantages-fewer ICSI procedures, similar clinical pregnancy rate and live birth rate.

Early Recognition and Treatment of Sepsis After the Addition of Lactate to the Laboratory’s Critical Result Call List

2016 ◽  
Vol 33 (2) ◽  
pp. 111-115 ◽  
Author(s):  
Hani I. Kuttab ◽  
Ethan Sterk ◽  
Megan A. Rech ◽  
Trac Nghiem ◽  
Burak Bahar ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Early Recognition ◽  
Intravenous Fluids ◽  
Time To Antibiotics ◽  
Group 2 ◽  
Group 1

Purpose: Screening of patients with sepsis is needed to increase recognition and allow for earlier interventions. There is no consensus on whether the addition of lactate to the critical result laboratory’s call list should be a standard practice. Materials and Methods: This was a retrospective cohort study that compared management and outcomes of patients with sepsis having lactate ≥4 mmol/L before (group 1) and after (group 2) the addition of a critical result threshold of lactate of ≥4 mmol/L to the critical result laboratory’s call list and its effects on time to antibiotics and intravenous fluids (IVFs). Results: One hundred twenty-one patients were included. Lactate was higher in group 1 (7.0 ± 4.3 vs 5.6 ± 2.0, P = 0.03). More patients in group 2 received hydrocortisone (1.9% vs 22.4%, P = .001). Hospital mortality, 30-day mortality, and 90-day mortality were significantly lower in group 2 (59.3% vs 32.8%, P = .003; 68.5% vs 37.3%, P ≤ .001; 68.5% vs 41.8%, P = .002). There were no significant differences in total volume of IVFs (2400.8 ± 1720.0 vs 2483.7 ± 2155.7, P = 0.83), time to start IVFs (184.0 ± 283.2 vs 115.6 ± 190.5, P = 0.27), or antibiotics (184.8 ± 187.1 vs 133.7 ± 137.4, P = 0.16). Conclusion: Addition of lactate to the critical result laboratory’s call list did not lead to a statistically significant improvement in time to IVFs or antibiotics, although the average time to antibiotics and IVFs decreased by 51.1 and 68.4 minutes, respectively. Hospital mortality, 30-day mortality, and 90-day mortality were lower in group 2, which may be, in part, due to increased recognition of severe sepsis by critical result notification and earlier intervention.

scholarly journals Does Postoperative Mechanical Axis Alignment Have an Effect on Clinical Outcome of Primary Total Knee Arthroplasty? A Retrospective Cohort Study

2017 ◽  
Vol 11 (1) ◽  
pp. 1330-1336 ◽  
Author(s):  
Mikhail Salzmann ◽  
Peter Fennema ◽  
Roland Becker ◽  
Hagen Hommel
Keyword(s):  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Clinical Outcome ◽  
Retrospective Cohort ◽  
Varus Alignment ◽  
Varus Malalignment ◽  
Group 4 ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Background: There is an ongoing debate whether patients with constitutional varus should be restored to neutral mechanical alignment following total knee arthroplasty (TKA). Objective: The aim of this retrospective cohort study is to determine whether mild unintentional postoperative varus alignment (3°–6°) influences TKA outcome in patients with and without preoperative varus alignment due to medial osteoarthritis of the knee. Methods: We analyzed 172 consecutive TKA cases between April 2011 and May 2014. Patients were divided into four groups based on their preoperative and postoperative hip-knee-ankle angles (HKA): preoperative varus ≤ 3° with postoperative varus position ≤ 3° (Group 1, n = 47); preoperative varus >3° with postoperative varus ≤ 3° (Group 2, n = 104); preoperative varus ≤ 3° with postoperative varus malalignment > 3° (Group 3, n = 3); and preoperative varus > 3° with postoperative varus malalignment > 3° (Group 4, n = 18). Patients were followed up until 2 years postoperatively. Results: Knee Society Score and Western Ontario and McMaster University Osteoarthritis Index scores for all study groups increased following TKA, with no postoperative differences at any time point. Group 4 performed significantly better on the Forgotten Joint Score than Group 2 (p = 0.019). Group 4 performed significantly better on the High Flexion Knee Score than Group 2 (p = 0.004) and Group 1 (p = 0.019). All other between-group differences were not statistically significant. Conclusion: Residual postoperative varus alignment of the lower limb does not appear to adversely affect clinical outcome following TKA for varus-type osteoarthritis.

Seven-Year Follow up of An Inception Cohort Study of Patients with Atrial Fibrillation Starting Oral Anticoagulation: Aging as An Independent Bleeding Risk

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4045-4045
Author(s):  
Patricia Casais
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Cohort Study ◽  
Independent Risk Factor ◽  
Inception Cohort ◽  
Exclusion Criteria ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Introduction: Our objectives were to investigate if aging is an independent risk factor for major bleeding during oral anticoagulant treatment (OAT) for atrial fibrillation (AF). Patients and Methods: An inception cohort study was designed to include patients (pts) referred to our Department to initiate OAT due to AF from July 2000 to July 2007. Inclusion criteria: no prior OAT, AF being the only reason to OAT, follow-up at our Institution, and signed informed consent. Exclusion criteria: concomitant reason for OAT, and pts refusal to participate. Pts were followed until OAT was stopped by the patient’s cardiologist or until July 2007. Patients who underwent a successful electric cardioversion and were followed up only for 4 weeks were not included unless they presented a bleeding episode. Epidemiological and clinical data were documented for all patients. Major bleeding episodes, age, time on OAT, and INR at the bleeding event were recorded. Deaths were registered and classified as “related” or “not related” to OAT. For the analysis, the inception cohort was divided into three groups according to the age of beginning and ending of OAT. Group 1 included patients younger than 77 at the end of OAT. Group 2 was constituted by the patients that initiated therapy before 80 and were followed after that age. Patients starting after 80 years of age were the group 3. Time in therapeutic range and INR variability were calculated. Incidence rate and relative risk (RR) of major hemorrhage (MH) was estimated. Results: During the study period, 2.971 patients were referred for initiation of OAT, 40% (1.172) had AF, and 671 met the exclusion criteria (138 patients had a prior OAT, 111 were not going to go on control OAT at the Institution, and 422 had a concomitant reason for OAT (mitral estenosis, heart valve prostheses, venous thrombosis, coronary artery by-pass, etc.) Five-hundred and one patients were included in the study, 68 (13.5%) were lost for follow-up after inclusion or had less than 4 weeks after initiation, and 433 had complete follow-up. Patients’ characteristics and MH are shown in Table 1. Time within therapeutic range was similar in all age-groups (65.0%, 62.8%, and 65.4% for group 1, 2 and 3, respectively). There were 28 MH in 23 pts during the study period. In group 3, the rate of MH was 3.39/100 patient-years while in group 1 it was 0.85/100 patient-years. The RR was 3.0 (1.2–7.6 95%CI) in group 3 compared to group 1(p= 0.02). Among patients in group 2, the RR of bleeding increased to 5.8 (2.27–14.95) after the age of 80. The likelihood ratio of MH with increasing age was 14.1 (p= 0.001). INR variability tended to be higher in Group 3 and in bleeding patients regardless their age. Aspirin, number of concomitant medications and CHADS2 score were not associated with the risk of MH. There were 10 deaths, all in pts older than 80. In 9/10 the cause of death was documented and was unrelated to OAT. One patient died after a non-characterized stroke, it was considered hemorrhagic. Rate of death related to bleeding after age of 80 (groups 2 and 3) was 0.54%. Conclusions: This long-term follow up cohort study shows that aging is an independent risk factor for MH; this observation might have clinical implications for the management of elderly pts. Table 1: Patients’ characteristics Group 1 Group 2 Group 3 N 249 55 129 * 8/9 events after the age of 80. Sex Female (%)&#x2028; Male (%) 55 (49.5)&#x2028; 56 (50.0) 29 (54)&#x2028; 25 (46) 69 (55)&#x2028; 57 (45) Age at beginning OAT mean± SD 63.9±8.4 74.9 ± 2.0 82.8 ± 2.7 Age at ending OAT mean± SD 68.7±7.9 81.3 ± 1.4 85.7 ± 3.1 Follow-up (years) mean± SD 5.2±0.2 4.5 ±0.3 2.5 ± 0.1 Prior ischemic stroke N (%) 15 (13.5) 9 (17) 28 (22) Deaths N (%) 0 1 (2) 9 (7%) Major hemorrhages Events (pts) 8 (7) 9 (8)* 11 (8) Mean age (years) 68.4 ± 2.6 79.7 ± 0.5 83.0 ± 0.8 Mean Time on OAT (weeks± SE) 32.1±8 142.2 ± 28.6 77.8 ± 22.5 Mean INR ±SE at 3.9 ± 0.7 3.5 ± 1.0 3.6 ± 0.5 1st event (range) (2.6–8.2) (2.0–10.8) (1.6–6.0)

scholarly journals Associations of coprescribed medications for chronic comorbid conditions in very old adults with clinical dementia: a retrospective cohort study using insurance claims data

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e043768
Author(s):  
Nobuhiro Handa ◽  
Seigo Mitsutake ◽  
Tatsuro Ishizaki ◽  
Tetsuo Nakabayashi ◽  
Masahiro Akishita ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Comorbid Conditions ◽  
Tokyo Metropolitan Area ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

ObjectiveTo assess the association of coprescribed medications for chronic comorbid conditions with clinical dementia in older adults, as indicated by the initiation of a new prescription of antidementia medication (NPADM).DesignRetrospective enumeration cohort study.SettingA Japanese city in Tokyo Metropolitan Area.ParticipantsA total of 42 024 adults aged ≥77 years residing in Kashiwa City, a suburban city of Tokyo Metropolitan Area, who did not have any prscription of antidementia medication from 1 April to 30 June 2012.Main outcome measureThe primary outcome was NPADM during follow-up period until 31 March 2015 (35 months). Subjects were categorised into four age groups: group 1 (77–81 years), group 2 (82–86 years), group 3 (87–91 years) and group 4 (≥92 years). In addition to age and sex, 14 sets of medications prescribed during the initial background period (from 1 April 2012 and 31 June 2012) were used as covariates in a Cox proportional hazard model.ResultsIn a follow-up period of 1 345 457 person-months (mean=32.0±7.5 months, median 35 months), NPADM occurred in 2365 subjects. NPADM incidence at 12 months was 1.9%±0.1% (group 1: 0.9%±0.1%, group 2: 2.1%±0.1%, group 3: 3.2%±0.2% and group 4: 3.6%±0.3%; p<0.0001). In addition to older age and female sex, use of the following medications was significantly associated with NPADM: statins (HR: 0.82, 95% CI 0.73 to 0.92; p=0.001), antihypertensives (HR: 0.80, 95% CI 0.71 to 0.85; p<0.0001), non-steroidal bronchodilators (HR: 0.72, 95% CI 0.58 to 0.88; p=0.002), antidepressants (HR: 1.79, 95% CI 1.47 to 2.18; p<0.0001), poststroke medications (HR: 1.45, 95% CI 1.16 to 1.82; p=0.002), insulin (HR: 1.34, 95% CI 1.01 to 1.78; p=0.046) and antineoplastics (HR: 1.12, 95% CI 1.01 to 1.24; p=0.035).ConclusionsThis retrospective cohort study identified the associations of coprescribed medications for chronic comorbid conditions with NPADM in older adults. These findings would be helpful in understanding the current clinical practice for dementia in real-world setting and potentially contribute to healthcare policymaking.Trial registration numberUMIN000039040.

Nonunion Rates in Hind- and Midfoot Arthrodesis in Current, Ex-, and Nonsmokers

2020 ◽  
pp. 107110072097126
Author(s):  
Jack Allport ◽  
Jayasree Ramaskandhan ◽  
Malik S. Siddique
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Relative Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Smoking Status ◽  
Time Frame ◽  
Modifiable Risk Factor ◽  
Level Of Evidence ◽  
Significant Difference

Background: Nonunion rates in hind or midfoot arthrodesis have been reported as high as 41%. The most notable and readily modifiable risk factor that has been identified is smoking. In 2018, 14.4% of the UK population were active smokers. We examined the effect of smoking status on union rates for a large cohort of patients undergoing hind- or midfoot arthrodesis. Methods: In total, 381 consecutive primary joint arthrodeses were identified from a single surgeon’s logbook (analysis performed on a per joint basis, with a triple fusion reported as 3 separate joints). Patients were divided based on self-reported smoking status. Primary outcome was clinical union. Delayed union, infection, and the need for ultrasound bone stimulation were secondary outcomes. Results: Smoking prevalence was 14.0%, and 32.2% were ex-smokers. Groups were comparable for sex, diabetes, and body mass index. Smokers were younger and had fewer comorbidities. Nonunion rates were higher in smokers (relative risk, 5.81; 95% CI, 2.54-13.29; P < .001) with no statistically significant difference between ex-smokers and nonsmokers. Smokers had higher rates of infection ( P = .05) and bone stimulator use ( P < .001). Among smokers, there was a trend toward slower union with heavier smoking ( P = .004). Conclusion: This large retrospective cohort study confirmed previous evidence that smoking has a considerable negative effect on union in arthrodesis. The 5.81 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in smokers. Our study shows that after cessation of smoking, the risk returns to normal, but we were unable to quantify the time frame. Level of Evidence: Level III, retrospective cohort study.

Sign in / Sign up

Export Citation Format

Share Document