scholarly journals Plasmodium falciparum clearance time in Malawian children with cerebral malaria: a retrospective cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Alexuse M. Saidi ◽  
Geoffrey Guenther ◽  
Rima Izem ◽  
Xiaojun Chen ◽  
Karl Seydel ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Cohort Study ◽  
Cerebral Malaria ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Artemisinin Resistance ◽  
Parasite Clearance ◽  
First Year ◽  
Clearance Time ◽  
Parasite Clearance Time

Abstract Background Standard treatment for both uncomplicated and severe malaria is artemisinin derivatives. Delayed parasite clearance times preceded the appearance of artemisinin treatment failures in Southeast Asia. Most worldwide malaria cases are in sub-Saharan Africa (SSA), where clinically significant artemisinin resistance or treatment failure has not yet been detected. The recent emergence of a resistance-conferring genetic mutation in the Plasmodium falciparum parasite in Africa warrants continued monitoring throughout the continent. Methods An analysis was performed on data from a retrospective cohort study of Malawian children with cerebral malaria admitted between 2010 and 2019 to a public referral hospital, ascertaining parasite clearance times across years. Data were collected from patients treated for severe malaria with quinine or artesunate, an artemisinin derivative. Parasite density was determined at admission and every subsequent 6 h until parasitaemia was below 1000 parasites/µl.The mean parasite clearance time in all children admitted in any one year was compared to the parasite clearance time in 2014, the first year of artesunate use in Malawi. Results The median population parasite clearance time was slower from 2010 to 2013 (quinine-treated patients) compared to 2014, the first year of artesunate use in Malawi (30 h (95% CI: 30–30) vs 18 h (95% CI: 18–24)). After adjustment for admission parasite count, there was no statistically significant difference in the median population parasite clearance time when comparing 2014 with any subsequent year. Conclusion Malaria parasite clearance times in Malawian children with cerebral malaria remained constant between 2014 and 2019, arguing against evolving artemisinin resistance in parasites in this region.

scholarly journals Delayed Parasite Clearance after Treatment with Dihydroartemisinin-Piperaquine in Plasmodium falciparum Malaria Patients in Central Vietnam

2014 ◽  
Vol 58 (12) ◽  
pp. 7049-7055 ◽  
Author(s):  
Kamala Thriemer ◽  
Nguyen Van Hong ◽  
Anna Rosanas-Urgell ◽  
Bui Quang Phuc ◽  
Do Manh Ha ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Clearance Rate ◽  
Artemisinin Resistance ◽  
Parasite Clearance ◽  
Clearance Time ◽  
Sensitivity Testing ◽  
Content Type ◽  
Parasite Clearance Time ◽  
Central Vietnam

ABSTRACTReduced susceptibility ofPlasmodium falciparumtoward artemisinin derivatives has been reported from the Thai-Cambodian and Thai-Myanmar borders. Following increasing reports from central Vietnam of delayed parasite clearance after treatment with dihydroartemisinin-piperaquine (DHA-PPQ), the current first-line treatment, we carried out a study on the efficacy of this treatment. Between September 2012 and February 2013, we conducted a 42-dayin vivoandin vitroefficacy study in Quang Nam Province. Treatment was directly observed, and blood samples were collected twice daily until parasite clearance. In addition, genotyping, quantitative PCR (qPCR), andin vitrosensitivity testing of isolates was performed. The primary endpoints were parasite clearance rate and time. The secondary endpoints included PCR-corrected and uncorrected cure rates, qPCR clearance profiles,in vitrosensitivity results (for chloroquine, dihydroartemisinin, and piperaquine), and genotyping for mutations in the Kelch 13 propeller domain. Out of 672 screened patients, 95 were recruited and 89 available for primary endpoint analyses. The median parasite clearance time (PCT) was 61.7 h (interquartile range [IQR], 47.6 to 83.2 h), and the median parasite clearance rate had a slope half-life of 6.2 h (IQR, 4.4 to 7.5 h). The PCR-corrected efficacy rates were estimated at 100% at day 28 and 97.7% (95% confidence interval, 91.2% to 99.4%) at day 42. At day 3, theP. falciparumprevalence by qPCR was 2.5 times higher than that by microscopy. The 50% inhibitory concentrations (IC50s) of isolates with delayed clearance times (≥72 h) were significantly higher than those with normal clearance times for all three drugs. Delayed parasite clearance (PCT, ≥72 h) was significantly higher among day 0 samples carrying the 543 mutant allele (47.8%) than those carrying the wild-type allele (1.8%;P= 0.048). In central Vietnam, the efficacy of DHA-PPQ is still satisfactory, but the parasite clearance time and rate are indicative of emerging artemisinin resistance. (This study has been registered at ClinicalTrials.gov under registration no. NCT01775592.)

scholarly journals High thrombotic risk increases adverse clinical events up to 5 years after acute myocardial infarction. A nationwide retrospective cohort study

2019 ◽  
Vol 89 (3) ◽  
Author(s):  
Gian Francesco Mureddu ◽  
Cesare Greco ◽  
Stefano Rosato ◽  
Paola D'Errigo ◽  
Leonardo De Luca ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Recurrent Events ◽  
First Year ◽  
Thrombotic Risk ◽  
Clinical Events ◽  
Cerebrovascular Events

The risk of recurrent events among survivors of acute myocardial infarction (AMI) is understudied. The aim of this analysis was to investigate the role of residual high thrombotic risk (HTR) as a predictor of recurrent in-hospital events after AMI. This retrospective cohort study included 186,646 patients admitted with AMI from 2009 to 2010 in all Italian hospitals who were alive 30 days after the index event. HTR was defined as at least one of the following in the 5 years preceding AMI: previous myocardial infarction, ischemic stroke/other vascular disease, type 2 diabetes mellitus, renal failure. Risk adjustment was performed in all multivariate survival analyses. Rates of major cardiac and cerebrovascular events (MACCE) within the following 5 years were calculated in both patients without fatal readmissions at 30 days and in those free from in-hospital MACCE at 1 year from the index hospitalization. The overall 5-year risk of MACCE was higher in patients with HTR than in those without HTR, in both survivors at 30 days [hazard ratio (HR), 1.49; 95% confidence interval (CI), 1.45-1.52; p<0.0001] and in those free from MACCE at 1 year (HR, 1.46; 95% CI, 1.41-1.51; p<0.0001). The risk of recurrent MACCE increased in the first 18 months after AMI (HR, 1.49) and then remained stable over 5 years. The risk of MACCE after an AMI endures over 5 years in patients with HTR. This is also true for patients who did not have any new cardiovascular event in the first year after an AMI. All patients with HTR should be identified and addressed to intensive preventive care strategies.

Patient and Physician Predictors of Peritoneal Dialysis Technique Failure: A Population Based, Retrospective Cohort Study

2011 ◽  
Vol 31 (5) ◽  
pp. 565-573 ◽  
Author(s):  
Mala Chidambaram ◽  
Joanne M. Bargman ◽  
Robert R. Quinn ◽  
Peter C. Austin ◽  
Janet E. Hux ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Peritoneal Dialysis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Proportional Hazards Model ◽  
First Year ◽  
Patient Death ◽  
Technique Failure ◽  
Late Referral

BackgroundThe use of peritoneal dialysis (PD) has been declining over the past decade in Canada, and high technique failure rates have been implicated. Studies have examined clinical risk factors for PD technique failure, but few studies have addressed sociodemographic factors driving technique failure. There are no studies examining the effect of physician factors on technique failure.MethodsWe conducted a retrospective cohort study using Ontario healthcare databases from 1 April 1995 to 31 March 2005 to examine the effects of patient sociodemographic and physician characteristics on PD technique failure. The primary outcome was time to technique failure. Secondary outcomes included the proportion of patients experiencing technique failure during the first year and the proportion of patients experiencing death during the study period. A competing risks analysis was applied to the Cox proportional hazards model to determine the predictors of technique failure, death, and kidney transplantation.ResultsIn 5162 incident PD patients, the probability of technique success and patient survival at 5 years was 58.2% and 46.9% respectively. Of patients failing PD, 43.5% failed during the first year of treatment. Statistically significant predictors of technique failure included increasing age [hazard ratio (HR) 1.02], diabetes mellitus (HR 1.32), lower neighborhood education level (HR 2.93), and receiving transient (≤ 3 months) hemodialysis before starting PD (HR 1.24). Predictors of patient death included increasing age (HR 1.05), diabetes mellitus (HR 1.44), coronary artery disease (HR 1.26), congestive heart failure (HR 1.58), and late referral to the nephrologist (HR 1.27). Distance from treating dialysis center and residing in a rural area did not impact the risk of technique failure or death. Male physician gender increased the risk of technique failure (HR 1.31). Increased PD patient volume decreased the risk of technique failure (HR 0.98). None of the physician factors were predictors of patient death.ConclusionThese findings support the need for implementing strategies to reduce technique failure, which could include increasing educational resources for patients initiating PD, aggressive risk factor modification in patients with multiple comorbidities, and increasing physician awareness regarding the detrimental outcomes associated with late referral and late PD start.

scholarly journals Biologic Cost per Effectively Treated Rheumatoid Arthritis Patient in a Large Managed Care Population: A Retrospective Cohort Study

10.36469/9830 ◽  
2015 ◽  
Vol 3 (2) ◽  
pp. 122-131
Author(s):  
Tao Gu ◽  
Neel Shah ◽  
Gaurav Deshpande ◽  
Derek H. Tang ◽  
Debra F. Eisenberg ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Managed Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Treated Patient ◽  
Certolizumab Pegol ◽  
First Year ◽  
Administrative Claims ◽  
First Line

Background: Until recently, the lack of clinical outcomes information for rheumatoid arthritis (RA) in administrative claims databases limited their use in comparative effectiveness research. A validated claims-based algorithm has been developed to estimate the effectiveness of biologics for RA, allowing for estimation of cost and effectiveness in the same database. Objectives: To implement a validated claims-based effectiveness algorithm in a US managed care claims database to compute the 1-year biologic cost per effectively treated patient among first-line biologics approved for moderate-to-severe RA (abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab). Methods: This retrospective cohort study used administrative claims data for individuals in the HealthCore Integrated Research Database (HIRDSM). The first claim for a first-line biologic between July 1, 2009, and January 31, 2013, after 6 months of continuous enrollment, was defined as the index event and date. Patients were aged 18-63 years on the index date and had at least one claim for RA in the 6-month pre- index period. Biologic costs included plan and patient paid amounts on claims for the biologic drug and administration. The algorithm defined effectiveness during the 12-month post-index period as achieving all six of the following: high adherence (medication possession ratio ≥80% or infusions consistent with the product label); no increase in biologic dose or decrease in dosing interval; no new biologic; no new nonbiologic disease-modifying antirheumatic drug; no new or increased oral glucocorticoid use; and ≤1 glucocorticoid injection. Cost per effectively treated patient was calculated as the total biologic cost (drug and administration) divided by the number of patients categorized by the algorithm as effectively treated. Results: The cohort comprised 4844 patients (mean age 48.6 years, 76.4% female). Average first-year biologic cost ranged from $14 795 (golimumab) to $19 520 (abatacept). Average first-year biologic cost per effectively treated patient was significantly lower for etanercept ($50 217) than for golimumab ($56 427, p&lt;0.001) adalimumab ($56 879, p&lt;0.001), abatacept ($68 062, p&lt;0.001), certolizumab pegol ($76 427, p&lt;0.001), and infliximab ($95 126, p&lt;0.001). Conclusions: In this application of a validated claims-based algorithm to a large managed care population, etanercept had the lowest 1-year biologic cost per effectively treated patient among first-line biologics.

scholarly journals The outcome of endometrial ablation at Queen Elizabeth the Queen Mother Hospital between 2001-2016

2018 ◽  
Vol 17 (2) ◽  
pp. 31-34
Author(s):  
Ahmed El Gohari
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Endometrial Ablation ◽  
First Year ◽  
Age Group ◽  
Pathology Laboratory ◽  
Queen Mother ◽  
Study Setting

Objective: to determine the long term risk of hysterectomy following balloon endometrial ablation. Design: retrospective cohort study. Setting: A teaching university NHS hospital(Queen Elizabeth The Queen Mother Hospital. Methods: Patients having balloon endometrial ablation were prospectively recorded in an operating room log-book between 2001 to 2016. This logbook was used to search the pathology laboratory database (Dart and Apex) to identify patients who required a hysterectomy. Results: 796 patients underwent BEA at QEQM Hospital in Margate. The patients’ age was between 25 to 60 years. A hysterectomy was subsequently performed in 166 women (20.85%). The risk of hysterectomy was higher among the 40-50 age group. The shortest time to hysterectomy was 1 year and the longest was 10 years. Conclusion: The risk of having a hysterectomy after endometrial ablation in this study was 8.7% in the first year after the ablation and this risks drop to 3.5% in 2 years after the ablation. There was 20.85% failure rate of endometrial ablation using thermachoice, and this raise the question about the effectiveness of other devices which use ballon ablation like thermablate, cavaterm and librata.

scholarly journals Long-term outcomes among Medicare patients readmitted in the first year of hemodialysis: a retrospective cohort study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Katherine H. Ross ◽  
Bernard G. Jaar ◽  
Janice P. Lea ◽  
Tahsin Masud ◽  
Rachel E. Patzer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
First Year ◽  
Long Term Outcomes ◽  
Medicare Patients

scholarly journals Ten-year trends in traumatic brain injury: a retrospective cohort study of California emergency department and hospital revisits and readmissions

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022297 ◽  
Author(s):  
Renee Y Hsia ◽  
Amy J Markowitz ◽  
Feng Lin ◽  
Joanna Guo ◽  
Debbie Y Madhok ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Retrospective Cohort Study ◽  
Hospital Readmission ◽  
Retrospective Cohort ◽  
Secondary Outcome ◽  
Common Mechanism ◽  
First Year ◽  
Severity Of Injury

ObjectiveTo describe visits and visit rates of adults presenting to emergency departments (EDs) with a diagnosis of traumatic brain injury (TBI). TBI is a major cause of death and disability in the USA; yet, current literature is limited because few studies examine longer-term ED revisits and hospital readmission patterns of TBI patients across a broad spectrum of injury severity, which can help inform potential unmet healthcare needs.DesignWe performed a retrospective cohort study.SettingWe analysed non-public patient-level data from California’s Office of Statewide Health Planning and Development for years 2005 to 2014.ParticipantsWe identified 1.2 million adult patients aged ≥18 years presenting to California EDs and hospitals with an index diagnosis of TBI.Primary and secondary outcome measuresOur main outcomes included revisits, readmissions and mortality over time. We also examined demographics, mechanism and severity of injury and disposition at discharge.ResultsWe found a 57.7% increase in the number of TBI ED visits, representing a 40.5% increase in TBI visit rates over the 10-year period (346–487 per 100 000 residents). During this time, there was also a 33.8% decrease in the proportion of patients admitted to the hospital. Older, publicly insured and black populations had the highest visit rates, and falls were the most common mechanism of injury (45.5% of visits). Of all patients with an index TBI visit, 40.5% of them had a revisit during the first year, with 46.7% of them seeking care at a different hospital from their initial hospital or ED visit. Additionally, of revisits within the first year, 13.4% of them resulted in hospital readmission.ConclusionsThe large proportion of patients with TBI who are discharged directly from the ED, along with the high rates of revisits and readmissions, suggest a role for an established system for follow-up, treatment and care of TBI.

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