scholarly journals Diabetes increases severe COVID-19 outcomes primarily in younger adults Age and diabetes in COVID-19 severity

2021 ◽  
Author(s):  
Marc Diedisheim ◽  
Etienne Dancoisne ◽  
Jean-François Gautier ◽  
Etienne Larger ◽  
Emmanuel Cosson ◽  
...  
Keyword(s):  
Risk Factor ◽  
Outcome Measure ◽  
Orotracheal Intubation ◽  
Composite Outcome ◽  
Younger Adults ◽  
Confounding Variables ◽  
Patients With Diabetes ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Abstract Context Diabetes is reported as a risk factor for severe COVID-19, but whether this risk is similar in all categories of age remains unclear. Objective To investigate the risk of severe COVID-19 outcomes in hospitalized patients with and without diabetes according to age categories. Design Setting and Participants We conducted a retrospective observational cohort study of 6,314 consecutive patients hospitalized for COVID-19 between February and June 30 2020, and follow-up recorded until 30 September 2020, in the Paris metropolitan area, France. Main Outcome Measure(s) The main outcome was a composite outcome of mortality and orotracheal intubation in subjects with diabetes compared with subjects without diabetes, after adjustment for confounding variables and according to age categories. Results Diabetes was recorded in 39% of subjects. Main outcome was higher in patients with diabetes, independently of confounding variables (HR 1.13 [1.03-1.24]) and increased with age in individuals without diabetes, from 23% for those <50 to 35% for those >80 years but reached a plateau after 70 in those with diabetes. In direct comparison between patients with and without diabetes, diabetes-associated risk was inversely proportional to age, highest in <50 and similar after 70 years. Similarly, mortality was higher in patients with diabetes (26%) than in those without diabetes (22%, p<0.001), but adjusted HR for diabetes was significant only in patients under 50 (HR 1.81 [1.14-2.87]). Conclusions Diabetes should be considered as an independent risk factor for the severity of COVID-19 in young adults more so than in older adults, especially for individuals younger than 70 years.

scholarly journals Substitution of Oral for Intravenous Cyclophosphamide in Membranous Nephropathy

Kidney360 ◽  
2020 ◽  
Vol 1 (9) ◽  
pp. 943-949
Author(s):  
Leonella Luzardo ◽  
Gabriela Ottati ◽  
Jimena Cabrera ◽  
Hernando Trujillo ◽  
Mariela Garau ◽  
...  
Keyword(s):  
Complete Remission ◽  
Membranous Nephropathy ◽  
Immunosuppressive Treatment ◽  
Clinical Relapse ◽  
Oral Cyclophosphamide ◽  
Intravenous Cyclophosphamide ◽  
Safe Alternative ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

BackgroundOptimal immunosuppressive treatment for membranous nephropathy is still a matter of controversy. Current recommendations include oral cyclophosphamide combined with steroids (modified Ponticelli regimen) as first-line treatment in patients who are high risk. However, concerns about the cumulative toxicity of oral cyclophosphamide persist. In the last 30 years, a protocol based on low-dose intravenous cyclophosphamide plus steroids has been used to treat membranous nephropathy in Uruguay. We aimed to assess the efficacy of this regimen to induce clinical remission in patients with membranous nephropathy.MethodsIn this retrospective, observational cohort study, we analyzed the outcome of 55 patients with membranous nephropathy treated between 1990 and 2017 with a 6-month course of alternating steroids (months 1, 3, and 5) plus intravenous cyclophosphamide (single dose of 15 mg/kg on the first day of months 2, 4, and 6).ResultsAt 24 months, 39 (71%) patients achieved clinical response with complete remission observed in 23 patients (42%) and partial remission in 16 (29%). Median time to achieve partial and complete remission was 5.9 and 11.5 months, respectively. Absence of response was observed in 16 patients (29%), five of whom started chronic RRT after a median follow-up of 3.5 years. Clinical relapse occurred in nine of 33 (27%) patients at a median of 34 months after treatment discontinuation.ConclusionsReplacement of oral cyclophosphamide with a single intravenous pulse on months 2, 4, and 6 of the modified Ponticelli regimen can be an effective and safe alternative for treatment of membranous nephropathy.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_09_24_KID0002802020.mp3

scholarly journals The Relationship between AKI and CKD in Patients with Type 2 Diabetes: An Observational Cohort Study

2020 ◽  
Vol 32 (1) ◽  
pp. 138-150 ◽  
Author(s):  
Simona Hapca ◽  
Moneeza K. Siddiqui ◽  
Ryan S.Y. Kwan ◽  
Michelle Lim ◽  
Shona Matthew ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Observational Studies ◽  
Observational Cohort Study ◽  
Patients With Diabetes ◽  
Observational Cohort ◽  
The Relationship ◽  
Egfr Slope

BackgroundThere are few observational studies evaluating the risk of AKI in people with type 2 diabetes, and even fewer simultaneously investigating AKI and CKD in this population. This limits understanding of the interplay between AKI and CKD in people with type 2 diabetes compared with the nondiabetic population.MethodsIn this retrospective, cohort study of participants with or without type 2 diabetes, we used electronic healthcare records to evaluate rates of AKI and various statistical methods to determine their relationship to CKD status and further renal function decline.ResultsWe followed the cohort of 16,700 participants (9417 with type 2 diabetes and 7283 controls without diabetes) for a median of 8.2 years. Those with diabetes were more likely than controls to develop AKI (48.6% versus 17.2%, respectively) and have preexisting CKD or CKD that developed during follow-up (46.3% versus 17.2%, respectively). In the absence of CKD, the AKI rate among people with diabetes was nearly five times that of controls (121.5 versus 24.6 per 1000 person-years). Among participants with CKD, AKI rate in people with diabetes was more than twice that of controls (384.8 versus 180.0 per 1000 person-years after CKD diagnostic date, and 109.3 versus 47.4 per 1000 person-years before CKD onset in those developing CKD after recruitment). Decline in eGFR slope before AKI episodes was steeper in people with diabetes versus controls. After AKI episodes, decline in eGFR slope became steeper in people without diabetes, but not among those with diabetes and preexisting CKD.ConclusionsPatients with diabetes have significantly higher rates of AKI compared with patients without diabetes, and this remains true for individuals with preexisting CKD.

FP2-4 Paediatric posterior fossa tumour resection rates in a small volume centre: the past decade’s experience

2019 ◽  
Vol 90 (3) ◽  
pp. e26.2-e26
Author(s):  
H Bhatt ◽  
MI Bhatti ◽  
C Patel ◽  
P Leach
Keyword(s):  
Posterior Fossa ◽  
Extent Of Resection ◽  
Primary Outcome Measure ◽  
Tumour Resection ◽  
Clinical Notes ◽  
Observational Cohort ◽  
Csf Diversion ◽  
Paediatric Brain Tumours ◽  
Retrospective Observational Cohort Study

ObjectivesResection rates for paediatric brain tumours correlate with outcome. At the 2018 BPNG meeting a commitment to prospectively collect resection data was made. Here we review our posterior fossa resection rates for the last decade.DesignRetrospective observational cohort study of paediatric posterior fossa astrocytomas, medulloblastomas and ependymomas from 2008–2018. Primary outcome measure was extent of resection on post-op MRI, with secondary outcomes including post-op complications and need for temporary/permanent CSF diversion.Subjects57 patients had 62 operations for: 26 astrocytomas, 28 medulloblastomas and 8 ependymomas. Ages ranged from 7 months-16 years, with a median of 9, 7 and 6 years, respectively, and an even male: female split. Follow-up ranged from 2 months to >10 years.MethodsPatients were identified from a prospectively collected paediatric neuro-oncology database, with clinical notes and peri-operative imaging used for analysis. Our results were compared to the published literature.ResultsComplete resection (CR) rates after 1 st surgery for patients with astrocytomas, medulloblastomas and ependymomas were 77%, 79% and 63%, respectively. 5/57 patients had a 2nd operation later, 3 of whom had primary CR followed by recurrence.ConclusionsOur resection rates, complications and need for CSF diversion are comparable to the literature. Factors enabling this in a low-volume centre may include a robust paediatric neuro-oncology framework, fellowship-trained subspecialty surgeons and joint operating.

scholarly journals P522 Effectiveness of tofacitinib in a real-world Israeli cohort of patients with moderate-severe ulcerative colitis

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S498-S499
Author(s):  
I Avni Biron ◽  
A Bar-Gil Shitrit ◽  
B Koslowsky ◽  
U Kopylov ◽  
A Levartovsky ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Real World ◽  
Disease Duration ◽  
Activity Index ◽  
Albumin Level ◽  
Severe Ulcerative Colitis ◽  
Mayo Score ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Abstract Background We sought to define the effectiveness of tofacitinib in a real-world (RW) cohort of patients with moderate to severe ulcerative colitis (UC). Methods This was a multi-center retrospective observational cohort study (2017–2020). Clinical response and remission were defined as a reduction in Simple Clinical Colitis Activity Index (SCCAI) or partial Mayo score (PMS) of ≥3, and SCCAI ≤2 or a PMS ≤1, respectively. Results We included 73 patients (47% male; median age 26 years [IQR 19.5–39.5], disease duration 7 years [IQR 2.5–14.5], follow-up 7.1 months [IQR 3–12]), 91% biologics-experienced, and 74% ≥ 2-biologics. Half of patients used concomitant steroids. Overall, 56.1% discontinued therapy due to either lack of response and/or adverse events (AEs), median time to discontinuation - 9.7 months (IQR 3.4–16). Based on per-protocol analysis, after induction (week-8–16), 33.3% achieved response, 23.3% remission, and 19% corticosteroid free remission. At early maintenance (week 26), 50% achieved response, 26.8% remission, and 24.4% corticosteroid free remission. There were no differences between biologics-experienced and naïve patients. Seventeen patients (23.2%) had an AE: herpes zoster- 2.7%, hospitalization- 12.3%, and colectomy- 2.7%. Remitters had higher albumin level compared with non-remitters (4.2±0.35 Vs. 3.8±0.35, P=0.023, respectively). Conclusion In this multicenter RW cohort of highly biologics - experienced patients with UC, those who continued tofacitinib throughout induction achieved 50% response and 27% remission. Tofacitinib was well-tolerated.

scholarly journals Sentinel Node Biopsy for Conjunctival Melanoma; Single Centre Experience and Review of Current Literature

2021 ◽  
Vol 28 ◽  
pp. 107327482110421
Author(s):  
Barbara Peric ◽  
Spela Leiler ◽  
Gregor Hawlina ◽  
Boris Jancar ◽  
Marko Snoj ◽  
...  
Keyword(s):  
Overall Survival ◽  
Single Centre ◽  
Node Biopsy ◽  
Single Centre Experience ◽  
Observational Cohort ◽  
The Mean ◽  
The Moment ◽  
Retrospective Observational Cohort Study

Purpose To evaluate the role of sentinel lymph node (SLN) biopsy in patients with conjuctival melanoma (CjM). Study design Retrospective observational cohort study and literature review. Subjects Slovenian patients with CjM are included in the study. Methods Prospectively collected data of CjM patients treated from June 2005 to December 2016 were retrospectively analyzed. Main outcome measures The numbers of SLN biopsy procedures, positive and false positive SLN, and local and regional relapses have been described together with overall survival. Results From June 2005 until December 2016, 24 patients with CjM were treated. The median follow-up time was 65.3 months. The mean Breslow thickness was 1.5 mm (sd = 1.8 mm), and ulceration was present in 29% of cases. Altogether, 14/24 (58%) SLN biopsy procedures were performed. SLN was positive in 2/14 (14%) cases. The estimated 5-year overall survival (OS) of the group was 72.5%, with a median survival of 151 months (95% CI 77–224). From January 2013 to January 2020, five (5/140, 3%) authors reported results comparable to our study. Conclusion Our results confirm that CjM is a rare disease with approximately 14% of positive SLN. At the moment, there are no firm conclusions regarding who would benefit most from SLN biopsy or whether or not CLND should be offered. Data from literature emphasize the need for consistent and uniform staging and future multicentric studies.

scholarly journals Efficacy of tacrolimus as long-term immunotherapy for neuronal surface antibody-mediated autoimmune encephalitis

2022 ◽  
Vol 13 ◽  
pp. 204062232110630
Author(s):  
Chenchen Liu ◽  
Suqiong Ji ◽  
Huajie Gao ◽  
Zhuajin Bi ◽  
Qin Zhang ◽  
...  
Keyword(s):  
Nmda Receptor ◽  
Autoimmune Encephalitis ◽  
Efficacy And Safety ◽  
Nmda Receptor Encephalitis ◽  
Significant Difference ◽  
Observational Cohort ◽  
Surface Antibody ◽  
Retrospective Observational Cohort Study

Aims: We aimed to verify the efficacy and safety of tacrolimus as long-term immunotherapy for the treatment of neuronal surface antibody-mediated autoimmune encephalitis (AE) during the first attack. Methods: In this retrospective observational cohort study, patients with neuronal surface antibody-mediated AE who experienced the first attack were enrolled. We compared the outcomes of 17 patients who received tacrolimus with those of 47 patients treated without tacrolimus. Patients were assessed at onset and 3, 6, and 12 months, as well as at the last follow-up, by using the modified Rankin scale (mRS) and the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The efficacy of tacrolimus was also compared in a subgroup of patients with anti-NMDA receptor encephalitis. Results: Among all patients with neuronal surface antibody-mediated AE, those receiving tacrolimus had lower median mRS scores [1 (IQR = 0–1) versus 2 (IQR = 1–3) in controls, p = 0.001)], CASE scores [2 (IQR = 1–3) versus 3 (IQR = 2–7), p = 0.006], and more favorable mRS scores (94.1% versus 68.1%, p = 0.03) at the 3-month follow-up. No difference was found at the last follow-up. There was no significant difference in the occurrence of relapse and adverse events between the two groups (11.8% versus 14.9%, p = 0.75). In the subgroup of patients with anti-NMDA receptor encephalitis, patients treated with tacrolimus had a lower median mRS score at the 3-month follow-up [1 (IQR = 0–2) versus 2 (IQR = 1–3), p = 0.03]; however, no difference in the outcome was detected at the last follow-up. Conclusion: Tacrolimus can be used as long-term immunotherapy in patients with neuronal surface antibody-mediated AE during the first attack. Treatment with tacrolimus appears to accelerate the clinical improvement of neuronal surface antibody-mediated AE.

Mortality and significant neurosensory impairment in preterm infants: an international comparison

2021 ◽  
pp. fetalneonatal-2021-322288
Author(s):  
Marie Chevallier ◽  
Thierry Debillon ◽  
Brian A Darlow ◽  
Anne R Synnes ◽  
Véronique Pierrat ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Population Based ◽  
Preterm Neonates ◽  
Composite Outcome ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Observational Cohort ◽  
Baseline Characteristics ◽  
French Cohort

ObjectiveTo compare mortality and rates of significant neurosensory impairment (sNSI) at 18–36 months’ corrected age in infants born extremely preterm across three international cohorts.DesignRetrospective analysis of prospectively collected neonatal and follow-up data.SettingThree population-based observational cohort studies: the Australian and New Zealand Neonatal Network (ANZNN), the Canadian Neonatal and Follow-up Networks (CNN/CNFUN) and the French cohort Etude (Epidémiologique sur les Petits Ages Gestationnels: EPIPAGE-2).PatientsExtremely preterm neonates of <28 weeks’ gestation in year 2011.Main outcome measuresPrimary outcome was composite of mortality or sNSI defined by cerebral palsy with no independent walking, disabling hearing loss and bilateral blindness.ResultsOverall, 3055 infants (ANZNN n=960, CNN/CNFUN n=1019, EPIPAGE-2 n=1076) were included in the study. Primary composite outcome rates were 21.3%, 20.6% and 28.4%; mortality rates were 18.7%, 17.4% and 26.3%; and rates of sNSI among survivors were 4.3%, 5.3% and 3.3% for ANZNN, CNN/CNFUN and EPIPAGE-2, respectively. Adjusted for gestational age and multiple births, EPIPAGE-2 had higher odds of composite outcome compared with ANZNN (OR 1.71, 95% CI 1.38 to 2.13) and CNN/CNFUN (OR 1.72, 95% CI 1.39 to 2.12). EPIPAGE-2 did have a trend of lower odds of sNDI but far short of compensating for the significant increase in mortality odds. These differences may be related to variations in perinatal approach and practices (and not to differences in infants’ baseline characteristics).ConclusionsComposite outcome of mortality or sNSI for extremely preterm infants differed across high-income countries with similar baseline characteristics and access to healthcare.

Comparative Effectiveness of Second Vasoactive Agents in Septic Shock Refractory to Norepinephrine

2016 ◽  
Vol 32 (7) ◽  
pp. 451-459 ◽  
Author(s):  
H. Bryant Nguyen ◽  
Samantha Lu ◽  
Isabella Possagnoli ◽  
Phillip Stokes
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Observational Cohort Study ◽  
Vasoactive Agents ◽  
Vasoactive Agent ◽  
Mechanically Ventilated ◽  
Confounding Variables ◽  
Significant Difference ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Objective: We aim to identify the appropriate vasoactive agent in patients with septic shock who are refractory to optimal doses of norepinephrine. Methods: In this retrospective observational cohort study over a 4-year period, patients who received norepinephrine within 24 hours of ICU admission and a second agent within 48 hours were enrolled. Results: Among 2640 patients screened, 234 patients were enrolled, aged 60.8 ± 17.8 years, Acute Physiology and Chronic Health Evaluation IV 98.3 ± 27.5, 81.6% mechanically ventilated, and 65.8% in-hospital mortality. Within 96 hours, 2.8 ± 1.0 vasoactive agents were administered. Fifty, 50, 66, and 68 patients received dobutamine, dopamine, phenylephrine, and vasopressin as the second agent, with crude in-hospital mortality 40.0%, 66.0%, 74.2%, and 76.5%, respectively, P < .001. Survival analysis showed a statistically significant difference in survival time by second vasoactive agent, P < .001. After adjusting for confounding variables, dobutamine showed significant decreased odds ratio (OR) for mortality compared to vasopressin: OR 0.34 (95% confidence interval 0.14-0.84, P = .04). The relative risk of dying was 55.8% lower in patients receiving dobutamine versus vasopressin, P < .01. Conclusion: Dobutamine is associated with decreased mortality compared to other second vasoactive agents in septic shock when norepinephrine is not sufficient. A prospective randomized trial examining the outcome impact of the second vasoactive agent is needed.

scholarly journals Recurrent acute interstitial nephritis: what lies beneath

2020 ◽  
Author(s):  
Fernando Caravaca-Fontán ◽  
Amir Shabaka ◽  
Beatriz Sánchez-Álamo ◽  
Alberto de Lorenzo ◽  
Martha Díaz ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Interstitial Nephritis ◽  
Acute Interstitial Nephritis ◽  
Multivariable Logistic Regression Analysis ◽  
Drug Induced ◽  
Glomerular Diseases ◽  
Acute Kidney Disease ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Abstract Background Acute interstitial nephritis (AIN) is an emerging cause of acute kidney disease. While this disease usually follows an acute course, it may occasionally recur, representing a major challenge for the clinician. Methods We performed a retrospective, observational cohort study in 13 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. Patients with biopsy-proven AIN between 1996 and 2018 were included. Results The study group consisted of 205 patients with AIN, 22 of which developed recurrent AIN (RAIN) after a median of 111 days from diagnosis. RAIN was due to a surreptitious reintroduction of a previously known implicated drug or toxic in six patients (27%), sarcoidosis in two (9%), Sjögren’s syndrome in three (14%), light-chain-mediated AIN in two (9%) and tubulointerstitial nephritis and uveitis syndrome in two (9%), while in the rest of cases (32%), no precise cause could be identified. Microscopic haematuria was more frequent in patients with underlying systemic diseases. The first RAIN episode was treated with a repeated course of corticosteroids in 21 patients (95%). In six cases (27%), azathioprine and mycophenolate mofetil were added as corticosteroid-sparing agents. During a median follow-up of 30 months, 50 patients (27%) with no recurrences and 12 patients (55%) with RAIN reached Stages 4 and 5 chronic kidney disease (CKD). By multivariable logistic regression analysis, RAIN was independently associated with the risk of reaching Stages 4 and 5 CKD, even after adjusting for potential covariables. Conclusions RAIN is infrequent but is associated with poor kidney survival. RAIN should prompt clinicians to search for an underlying aetiology other than drug induced. However, in a large percentage of cases, no precise cause can be identified.

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