scholarly journals Clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 infection in a Latin American country: Results from the ECCOVID multicenter prospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258260
Author(s):  
Ezequiel Cordova ◽  
Analia Mykietiuk ◽  
Omar Sued ◽  
Lautaro De Vedia ◽  
Natalia Pacifico ◽  
...  

Background Clinical features and outcomes of SARS-CoV-2 infections diverge in different countries. The aim of this study was to describe clinical characteristics and outcomes in a cohort of patients hospitalized with SARS-CoV-2 in Argentina. Methods Multicenter prospective cohort study of ≥18 years-old patients with confirmed SARS-CoV-2 infection consecutively admitted to 19 hospitals in Argentina. Multivariable logistic regression models were used to identify variables associated with 30-day mortality and admission to intensive care unit (ICU). Results A total of 809 patients were analyzed. Median age was 53 years, 56% were males and 71% had at least one comorbidity. The most common comorbidities were hypertension (32%), obesity (23%) and diabetes (17%). Disease severity at admission was classified as mild 25%, moderate 51%, severe 17%, and critical 7%. Almost half of patients (49%) required supplemental oxygen, 18% ICU, and 12% invasive ventilation. Overall, 30-day mortality was 11%. Factors independently associated with ICU admission were male gender (OR 1.81; 95%CI 1.16–2.81), hypertension (OR 3.21; 95%CI 2.08–4.95), obesity (OR 2.38; 95%CI 1.51–3.7), oxygen saturation ≤93% (OR 6.45; 95%CI 4.20–9.92) and lymphopenia (OR 3.21; 95%CI 2.08–4.95). Factors independently associated with 30-day mortality included age ≥60 years-old (OR 2.68; 95% CI 1.63–4.43), oxygen saturation ≤93% (OR 3.19; 95%CI 1.97–5.16) and lymphopenia (OR 2.65; 95%CI 1.64–4.27). Conclusions This cohort validates crucial clinical data on patients hospitalized with SARS-CoV-2 in Argentina.

2018 ◽  
Vol 33 (3) ◽  
pp. 216-224 ◽  
Author(s):  
Jelske W. van der Burg ◽  
T. Michael O’Shea ◽  
Karl Kuban ◽  
Elizabeth N. Allred ◽  
Nigel Paneth ◽  
...  

The authors hypothesized that the risk of cerebral palsy at 2 years in children born extremely preterm to overweight and obese women is increased relative to the risk among children born to neither overweight nor obese women. In a multicenter prospective cohort study, the authors created multinomial logistic regression models of the risk of diparetic, quadriparetic, and hemiparetic cerebral palsy that included the prepregnancy body mass index of mothers of 1014 children born extremely preterm, cerebral palsy diagnoses of children at 2 years, as well as information about potential confounders. Overweight and obese women were not at increased risk of giving birth to a child who had cerebral palsy. The risk ratios associated with overweight varied between 1.1 for quadriparesis (95% CI = 0.5, 2.1) to 2.0 for hemiparesis (95% CI = 0.4, 9.8). The risk ratios associated with obesity varied between 0.7 for diparesis (95% CI = 0.2, 2.5) to 2.5 for hemiparesis (95% CI = 0.4, 13).


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Teddy Wu ◽  
Nawaf Yassi ◽  
Darshan Shah ◽  
Minmin Ma ◽  
Gagan Sharma ◽  
...  

Background and Purpose: Simultaneous multiple intracerebral hemorrhages (SMICH) are uncommon. Few single center studies have analyzed characteristics and outcome of SMICH. We analyzed clinical characteristics and outcome of SMICH patients from two comprehensive stroke centers. Methods: Baseline imaging from consecutive intracerebral hemorrhage (ICH) patients (n=1552) from Helsinki ICH study and Royal Melbourne Hospital ICH study were screened for SMICH. ICH etiology was classified according to the SMASH-U classification system. ICH due to trauma, tumor and aneurysmal rupture were excluded. Baseline clinical and radiological characteristics and 90-day mortality were compared between SMICH and single ICH patients. Association of SMICH with 90-day mortality was assessed in multivariable logistic regression models adjusted for predictors of ICH outcome. Results: 1452 patients were included in the analysis and 85 (5.9%) were classified as SMICH. SMICH were more often female (58% vs 42%;p=0.004), had lower baseline Glasgow Coma Scale (12 vs 14;p=0.008), and more frequent lobar location (59% v 34%;p<0.001) compared to single ICH. The SMASH-U etiology of SMICH patients was less often hypertensive (20% vs 37%;p=0.001), more other systemic coagulopathy (12% vs 3%;p<0.001) and trended towards more cerebral amyloid angiopathy (32% vs 23%;p=0.071). SMICH was not associated with 90-day mortality on univariate (37% vs 35%;p=0.635), multivariable (OR 0.783 95%CI 0.401-1.529;p=0.473), or propensity score matched analyses (OR 0.817 95% CI 0.400-1.668,p=0.578). Conclusion: SMICH occurs in approximately 1 in 20 ICH with more often lobar located hematomas, less often hypertensive and associated with more systemic coagulopathy. The mortality is similar to single ICH. Given varied etiologies, SMICH management should target the underlying pathology.


2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 314-314 ◽  
Author(s):  
Jorge Ramos ◽  
Sarah Holt ◽  
George Schade ◽  
Matt D. Galsky ◽  
Jonathan L. Wright ◽  
...  

314 Background: Cisplatin chemotherapy (CTX) is associated with increased risk of venous thromboembolism (VTE); however, other agents have also been hypothesized to increase risk. We assessed the association of VTE with different CTX regimens in urothelial tract cancer patients. Methods: We identified > 66 year-old patients diagnosed with urothelial tract cancers (excluding renal pelvis) from the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database from 1998 to 2011. CTX regimens included gemcitabine/cisplatin (GC), methotrexate/vinblastine/doxorubicin/cisplatin (MVAC), or gemcitabine/carboplatin (GCarbo). We calculated VTE rates within 120 days of CTX initiation and compared VTE by CTX regimen with multivariable logistic regression models adjusted for patient and cancer characteristics. Results: Of 5050 identified patients, VTE occurred in 13.1% (660/5050). VTE rates were 15.3% (265/1737) and highest for GC; 8.8% (23/262) and 12.2% (372/3051) of MVAC and GCarbo patients experienced VTE, respectively. Adjusted for patient demographic and cancer-specific variables, MVAC and GCarbo were associated with lower odds of VTE compared with GC (see Table). Conclusions: Compared with GC, MVAC and GCarbo are associated with a decreased rate of VTE. This finding suggests that gemcitabine may add to the increased thrombosis risk from cisplatin. Patients treated with GC should be counseled about this association. Sensitivity analyses to assess VTE risk of different CTX regimens in the perioperative setting will be presented. [Table: see text]


Crisis ◽  
2018 ◽  
Vol 39 (6) ◽  
pp. 469-478 ◽  
Author(s):  
Prianka Padmanathan ◽  
Lucy Biddle ◽  
Robert Carroll ◽  
Jane Derges ◽  
John Potokar ◽  
...  

Abstract. Background: The rise in Internet use adds a new dimension to suicide prevention. We investigated suicide/self-harm (S/Sh)-related Internet use among patients presenting to hospital with self-harm. Method: We asked 1,198 adult and 315 child and adolescent patients presenting to hospital following self-harm in a city in South West England about Internet use associated with their hospital presentation. Associations between Internet use and sociodemographic and clinical characteristics were investigated using multivariable logistic regression models. Focus groups with clinicians explored the acceptability and utility of asking about Internet use. Results: The prevalence of S/Sh-related Internet use was 8.4% (95% CI: 6.8–10.1%) among adult hospital presentations and 26.0% (95% CI = 21.3–31.2%) among children's hospital presentations. In both samples, S/Sh-related Internet use was associated with higher levels of suicidal intent. Mostly, clinicians found it acceptable to ask about Internet use during psychosocial assessments and believed this could inform perceptions of risk and decision-making. Limitations: It is unclear whether the findings in this study are applicable to the general self-harm patient population because only those who had psychosocial assessments were included. Conclusion: S/Sh-related Internet use is likely to become increasingly relevant as the Internet-native generation matures. Furthermore, Internet use may be a proxy marker for intent.


2020 ◽  
Vol 64 (9) ◽  
pp. 1242-1270
Author(s):  
Matias López

Popular models portray that high inequality induces elites to sponsor coups and reverse democratization as a means for repressing redistributive demands. Challenging this prediction, Latin America shifted from a historical pattern of systematic democratic breakdowns to one characterized by the resilience of democracy despite extreme levels of inequality. This article argues that the reminiscence of state-led repression under democracy explains why elites more regularly waive coups as solutions to distributive conflict in Latin American democracies. I call this state segmentation, a concept that describes the asymmetries between the enforcement of citizenship rights for those in privileged positions and for the poor. Wherever state segmentation is high, the odds of democratic breakdown should be lower. I test the argument using logistic regression models to predict the probability of coups and mandate interruptions considering different levels of state segmentation in Latin America using V-Dem data. Results show that asymmetries in access to citizenship rights indeed prevent democratic breakdowns.


2010 ◽  
Vol 31 (9) ◽  
pp. 926-933 ◽  
Author(s):  
Cinzia Auriti ◽  
Maria Paola Ronchetti ◽  
Patrizio Pezzotti ◽  
Gabriella Marrocco ◽  
Anna Quondamcarlo ◽  
...  

Background.Nosocomial infections are still a major cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs).Objective.To describe the epidemiology of nosocomial infections in NICUs and to assess the risk of nosocomial infection related to the therapeutic procedures performed and to the clinical characteristics of the neonates at birth and at admission to the NICU, taking into account the time between the exposure and the onset of infection.Design.A multicenter, prospective cohort study.Patients and Setting.A total of 1,692 neonates admitted to 6 NICUs in Italy were observed and monitored for the development of nosocomial infection during their hospital stay.Methods.Data were collected on the clinical characteristics of the neonates admitted to the NICUs, their therapeutic interventions and treatments, their infections, and their mortality rate. The cumulative probability of having at least 1 infection and the cumulative probability of having at least 1 infection or dying were estimated. The hazard ratio (HR) for the first infection and the HR for the first infection or death were also estimated.Results.A total of 255 episodes of nosocomial infection were diagnosed in 217 neonates, yielding an incidence density of 6.9 episodes per 1,000 patient-days. The risk factors related to nosocomial infection in very-low-birth-weight neonates were receipt of continuous positive airway pressure (HR, 3.8 [95% confidence interval {CI}, 1.7-8.1]), a Clinical Risk Index for Babies score of 4 or greater (HR, 2.2 [95% CI, 1.4-3.4]), and a gestational age of less than 28 weeks (HR, 2.1 [95% CI, 1.2-3.8]). Among heavier neonates, the risk factors for nosocomial infection were receipt of parenteral nutrition (HR, 8.1 [95% CI, 3.2-20.5]) and presence of malformations (HR, 2.3 [95% CI, 1.5-3.5]).Conclusions.Patterns of risk factors for nosocomial infection differ between very-low-birth-weight neonates and heavier neonates. Therapeutic procedures appear to be strong determinants of nosocomial infection in both groups of neonates, after controlling for clinical characteristics.


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