scholarly journals An Investigation Into the Beneficial Effects of High-Dose Interferon beta 1-a, Compared to Low-Dose Interferon Beta 1-a (the base therapeutic regimen) in moderate to severe COVID-19

2021 ◽  
Author(s):  
Ilad Alavi Darazam ◽  
Firouze Hatami ◽  
Mohammad Mahdi Rabiei ◽  
Mohamad Amin Pourhoseingholi ◽  
Minoosh Shabani ◽  
...  
Keyword(s):  
Regression Model ◽  
Low Dose ◽  
Interferon Beta ◽  
Cox Regression ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
High Dose ◽  
Cox Regression Model ◽  
Subcutaneous Injections

Abstract Introduction: Coronavirus disease 2019 (COVID-19) has been a serious obstacle in front of public health. Interferon-beta 1a (IFN-β 1a) has been used to treat patients with COVID-19. We aimed to compare the effectiveness of high dose IFN-β 1a compared to low dose IFN-β 1a (the base therapeutic regimen) in moderate to severe COVID-19 cases.Methods: In this randomized, controlled, and clinical trial, eligible patients with confirmed SARS-CoV-2 infections were randomly assigned to receive one of the two following therapeutic regimens: The intervention group was treated with high dose IFN-β 1a (Recigen) (Subcutaneous injections of 88μg (24,000 IU) on days 1, 3, 6) + lopinavir /ritonavir (Kaletra) and the control group was treated with low dose IFN-β 1a (Recigen) (Subcutaneous injections of 44μg (12,000 IU) on days 1, 3, 6) + lopinavir /ritonavir (Kaletra) (400mg/100 mg twice a day for 10 days, orally, in all two groups). Result:A total of 168 COVID- 19 confirmed patients underwent randomization; 83 were assigned to the intervention group and 85 were assigned to the control group. Median Time To Clinical Improvement (TTIC) for cases treated with low dose of IFN-β1a was shorter than that for cases treated with high dose of IFN-β1a (6 vs10 days; P=0.018). Hazard Ratio for TTCI in the Cox regression model was 1.56 (95% CI: 1.05-2.30, P-value=0.026). Due to differences between some baseline clinical factors between intervention and control group, we; therefore, performed an adjusted analysis by including spo2, D-dimer and CRP in Cox regression model. The model failed to reach a significant difference between two groups. The adjusted HR was 1.37 (95% CI: 0.88-2.12, P-value=0.16). No difference was observed in terms of mortality between two groups. ConclusionThe use of high-dose IFN-β 1a did not improve TTCI in hospitalized patients with moderate to severe COVID-19. Also, it has not any significant effect in mortality reduction compared with treating with low-dose IFN-β 1a.Trial registration: The trial was confirmed by the Ethics in Medical Research Committee of the Shahid Beheshti University of Medical Sciences. signed informed consents were obtained from all the participants or their legally authorized representatives. This trial has been registered as ClinicalTrials.gov, NCT04521400.

scholarly journals An Investigation Into the Beneficial Effects of High-Dose Interferon beta 1-a, Compared to Low-Dose Interferon Beta 1-a (the base therapeutic regimen) in moderate to severe COVID-19

2021 ◽  
Author(s):  
Ilad Alavi Darazam ◽  
Firouze Hatami ◽  
Mohammad Mahdi Rabiei ◽  
Mohamad Amin Pourhoseingholi ◽  
Minoosh Shabani ◽  
...  
Keyword(s):  
Low Dose ◽  
Interferon Beta ◽  
Intervention Group ◽  
Control Group ◽  
High Dose ◽  
Research Committee ◽  
Subcutaneous Injections ◽  
Beneficial Effects ◽  
Significant Difference ◽  
And Control

Abstract Introduction: Coronavirus disease 2019 (COVID-19) has been a serious obstacle in front of public health. Interferon-beta 1a (IFN-β 1a) has been used to treat patients with COVID-19. We aimed to compare the effectiveness of high-dose IFN-β 1a compared to low dose IFN-β 1a in moderate to severe COVID-19 cases.Methods: In this randomized, controlled, and clinical trial, eligible patients with confirmed SARS-CoV-2 infections were randomly assigned to receive one of the two following therapeutic regimens: The intervention group was treated with high-dose IFN-β 1a (Recigen) (Subcutaneous injections of 88μg (24,000 IU) on days 1, 3, 6) + lopinavir /ritonavir (Kaletra) and the control group was treated with low-dose IFN-β 1a (Recigen) (Subcutaneous injections of 44μg (12,000 IU) on days 1, 3, 6) + lopinavir /ritonavir (Kaletra) (400mg/100 mg twice a day for 10 days, orally, in two groups). Result: A total of 168 COVID- 19 confirmed patients underwent randomization; 83 were assigned to the intervention group and 85 were assigned to the control group. Median Time To Clinical Improvement (TTIC) for cases treated with low-dose IFN-β1a was shorter than that for cases treated with high-dose IFN-β1a (6 vs10 days). Due to differences between some baseline clinical factors between intervention and control group, we performed an adjusted analysis. The model failed to reach a significant difference between two groups. Conclusion: The use of high-dose IFN-β 1a did not improve TTCI in hospitalized patients with moderate to severe COVID-19. Also, it did not have any significant effect on mortality reduction compared with treating with low-dose IFN-β 1a.Trial registration: The trial was confirmed by the Ethics in Medical Research Committee of the Shahid Beheshti University of Medical Sciences. Signed informed consents were obtained from all the participants or their legally authorized representatives. This trial has been registered as ClinicalTrials.gov, NCT04521400.

scholarly journals 813. The Reduction of the acquisition rate of carbapenem resistant Acinetobacter baumannii after room privatization in the intensive care unit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S448-S449
Author(s):  
Jongtak Jung ◽  
Pyoeng Gyun Choe ◽  
Chang Kyung Kang ◽  
Kyung Ho Song ◽  
Wan Beom Park ◽  
...  
Keyword(s):  
Regression Model ◽  
Acinetobacter Baumannii ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Intervention Group ◽  
Feeding Tube ◽  
Control Group ◽  
Cox Regression Model ◽  
Carbapenem Resistant ◽  
Hospital Acquired

Abstract Background Acinetobacter baumannii is one of the major pathogens of hospital-acquired infection recently and hospital outbreaks have been reported worldwide. On September 2017, New intensive care unit(ICU) with only single rooms, remodeling from old ICU with multibed bay rooms, was opened in an acute-care tertiary hospital in Seoul, Korea. We investigated the effect of room privatization in the ICU on the acquisition of carbapenem-resistant Acinetobacter baumannii(CRAB). Methods We retrospectively reviewed medical records of patients who admitted to the medical ICU in a tertiary care university-affiliated 1,800-bed hospital from 1 January 2015 to 1 January 2019. Patients admitted to the medical ICU before the remodeling of the ICU were designated as the control group, and those who admitted to the medical ICU after the remodeling were designated as the intervention group. Then we compared the acquisition rate of CRAB between the control and intervention groups. Patients colonized with CRAB or patients with CRAB identified in screening tests were excluded from the study population. The multivariable Cox regression model was performed using variables with p-values of less than 0.1 in the univariate analysis. Results A total of 1,105 cases admitted to the ICU during the study period were analyzed. CRAB was isolated from 110 cases in the control group(n=687), and 16 cases in the intervention group(n=418). In univariate analysis, room privatization, prior exposure to antibiotics (carbapenem, vancomycin, fluoroquinolone), mechanical ventilation, central venous catheter, tracheostomy, the presence of feeding tube(Levin tube or percutaneous gastrostomy) and the length of ICU stay were significant risk factors for the acquisition of CRAB (p< 0.05). In the multivariable Cox regression model, the presence of feeding tube(Hazard ratio(HR) 4.815, 95% Confidence interval(CI) 1.94-11.96, p=0.001) and room privatization(HR 0.024, 95% CI 0.127-0.396, p=0.000) were independent risk factors. Table 1. Univariate analysis of Carbapenem-resistant Acinetobacter baumannii Table 2. Multivariable Cox regression model of the acquisition of Carbapenem-resistant Acinetobacter baumannii Conclusion In the present study, room privatization of the ICU was correlated with the reduction of CRAB acquisition independently. Remodeling of the ICU to the single room would be an efficient strategy for preventing the spreading of multidrug-resistant organisms and hospital-acquired infection. Disclosures All Authors: No reported disclosures

scholarly journals Evaluation of the BDNF, NGF, NT3 and NT4 Genes Expressions in the Brains of Neonatal Mice with Hypothyroidism

2017 ◽  
Vol 7 (1) ◽  
pp. 171
Author(s):  
Hamid Reza Adeli Bhroz ◽  
Kazem Parivar ◽  
Iraj Amiri ◽  
Nasim Hayati Roodbari
Keyword(s):  
Dose Group ◽  
Low Dose ◽  
Pure Water ◽  
Intervention Group ◽  
Control Group ◽  
High Dose ◽  
Endocrine Glands ◽  
Blood Samples ◽  
High Doses ◽  
The Brain

Background and Aim: Thyroid is one of the endocrine glands, (T3 and T4) play a significant role in the development of prenatal brain and the following stages. The study aimed to evaluate the effect of hypothyroidism on the amount of expression of NT4, NT3, nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) in brain of one-day rat neonates with hypothyroidism.Materials and Methods: In total, 25 mature mice of Albino NMRI race were selected after mating, divided into three group, control, as well as low-dose and high-dose intervention groups. Samples of the control group received pure water during pregnancy, whereas subjects of the intervention group with low and high doses of the medication were administered with 20 mg and 100 mg methimazole powder (dissolved in 100 cc water), respectively. After child delivery, blood samples were obtained from mother mice to determine the level of T3 and T4 in blood serum. Following that, the brain of one-day mice were removed by surgery and assessed to determine the amount of expression of NT4, NT3, NGF and BDNF using the complete kit of RT-PCR.Results: Levels of T4 and T3 in the control group were 28 ug/dl and 1.59 ug/dl, respectively. In the low-dose intervention group, the amounts of the mentioned hormones were 8 ug/dl and 0.85 ug/dl, significantly, indicating a significant reduction in the expression of NT4, NT3, NGF and BDNF genes, compared to the control group. Moreover, T4 and T3 were 6 ug/dl and 0.79 ug/dl in the high-dose group, respectively, conveying a significant decrease in the expression of NT4, NT3, NGF and BDNF genes, compared to the control group (P<0.05).

scholarly journals 551. Remdesivir and Tocilizumab for the Treatment of Severe COVID-19 in a Community Hospital: A Retrospective Cohort Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S378-S379
Author(s):  
Guillermo Rodriguez-Nava ◽  
Goar Egoryan ◽  
Daniela Patricia Trelles-Garcia ◽  
Maria Adriana Yanez-Bello ◽  
Qishuo Zhang ◽  
...  
Keyword(s):  
Regression Model ◽  
Community Hospital ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Rank Test ◽  
Hospital Death ◽  
P Value ◽  
Survival Curves ◽  
Cox Regression Model ◽  
Kaplan Meier

Abstract Background Growing evidence supports the use of remdesivir and tocilizumab for the treatment of hospitalized patients with severe COVID-19. The purpose of this study was to evaluate the use of remdesivir and tocilizumab for the treatment of severe COVID-19 in a community hospital setting. Methods We used a de-identified dataset of hospitalized adults with severe COVID-19 according to the National Institutes of Health definition (SpO2 &lt; 94% on room air, a PaO2/FiO2 &lt; 300 mm Hg, respiratory frequency &gt; 30/min, or lung infiltrates &gt; 50%) admitted to our community hospital located in Evanston Illinois, between March 1, 2020, and March 1, 2021. We performed a Cox proportional hazards regression model to examine the relationship between the use of remdesivir and tocilizumab and inpatient mortality. To minimize confounders, we adjusted for age, qSOFA score, noninvasive positive-pressure ventilation, invasive mechanical ventilation, and steroids, forcing these variables into the model. We implemented a sensitivity analysis calculating the E-value (with the lower confidence limit) for the obtained point estimates to assess the potential effect of unmeasured confounding. Figure 1. Kaplan–Meier survival curves for in-hospital death among patients treated with and without steroids The hazard ratio was derived from a bivariable Cox regression model. The survival curves were compared with a log-rank test, where a two-sided P value of less than 0.05 was considered statistically significant. Figure 2. Kaplan–Meier survival curves for in-hospital death among patients treated with and without remdesivir The hazard ratio was derived from a bivariable Cox regression model. The survival curves were compared with a log-rank test, where a two-sided P value of less than 0.05 was considered statistically significant. Results A total of 549 patients were included. The median age was 69 years (interquartile range, 59 – 80 years), 333 (59.6%) were male, 231 were White (41.3%), and 235 (42%) were admitted from long-term care facilities. 394 (70.5%) received steroids, 192 (34.3%) received remdesivir, and 49 (8.8%) received tocilizumab. By the cutoff date for data analysis, 389 (69.6%) patients survived, and 170 (30.4%) had died. The bivariable Cox regression models showed decreased hazard of in-hospital death associated with the administration of steroids (Figure 1), remdesivir (Figure 2), and tocilizumab (Figure 3). This association persisted in the multivariable Cox regression controlling for other predictors (Figure 4). The E value for the multivariable Cox regression point estimates and the lower confidence intervals are shown in Table 1. Figure 3. Kaplan–Meier survival curves for in-hospital death among patients treated with and without tocilizumab The hazard ratio was derived from a bivariable Cox regression model. The survival curves were compared with a log-rank test, where a two-sided P value of less than 0.05 was considered statistically significant. Figure 4. Forest plot on effect estimates and confidence intervals for treatments The hazard ratios were derived from a multivariable Cox regression model adjusting for age as a continuous variable, qSOFA score, noninvasive positive-pressure ventilation, and invasive mechanical ventilation. Table 1. Sensitivity analysis of unmeasured confounding using E-values CI, confidence interval. Point estimate from multivariable Cox regression model. The E value is defined as the minimum strength of association on the risk ratio scale that an unmeasured confounder would need to have with both the exposure and the outcome, conditional on the measured covariates, to explain away a specific exposure-outcome association fully: i.e., a confounder not included in the multivariable Cox regression model associated with remdesivir or tocilizumab use and in-hospital death in patients with severe COVID-19 by a hazard ratio of 1.64-fold or 1.54-fold each, respectively, could explain away the lower confidence limit, but weaker confounding could not. Conclusion For patients with severe COVID-19 admitted to our community hospital, the use of steroids, remdesivir, and tocilizumab were significantly associated with a slower progression to in-hospital death while controlling for other predictors included in the models. Disclosures All Authors: No reported disclosures

scholarly journals Serum miRNAs, a potential prognosis marker of loco-regionally advanced nasopharyngeal carcinoma patients treated with CCRT

2019 ◽  
Author(s):  
Zhimin Zhang ◽  
Ge Wang ◽  
Feng Jin ◽  
Jijun Zheng ◽  
He Xiao ◽  
...  
Keyword(s):  
Regression Model ◽  
Distant Metastasis ◽  
Clinical Remission ◽  
Cox Regression ◽  
Rank Test ◽  
Control Group ◽  
Cox Regression Model ◽  
Serum Mirnas ◽  
Significant Difference ◽  
Before And After

Abstract Background: Serum miRNA was once found as potential disease survival index,thus we investigated the role of miRNA in predicting prognosis in loco-regionally advanced NPC patients treated with CCRT. Methods: This study included two phases: (i) We enrolled 3 NPC patients with recurrence or distant metastasis (experimental group, EG) and 3 NPC patients in clinical remission (control group, CG) , who were treated with CCRT within 5 years.The paired serum was collected before and after treatment and biomarkers were discovered by TaqMan Human MicroRNA Arrays. (ii) we used the bioinformatic analysis, marker selection and an independent validation by qRT-PCR to analyse the serums of 29 NPC patients with recurrent disease or distant metastasis and 19 NPC patients in clinical remission treated with CCRT. We used the Kaplan-Meier method, log-rank test and Cox regression model to estimate the accuracy of the miRNAs to predict PFS and OS, and identified factors significantly associated with prognosis, respectively. Results: Using fold change≥2.0 or ≤0.5 and p≤0.05 as cutoff levels, we identified 1 up-regulated and 9 down-regulated miRNAs, 1 up-regulated and 6 down-regulated miRNAs in EG versus CG before and after CCRT, respectively. After significantly down-regulated miRNAs from EG versus CG were removed, only 9 different miRNAs were significantly reduced. In the serum samples of 48 NPC patients, there were no significant difference in the expression of miRNA-26b, miRNA-29a and miRNA-125b before CCRT, and the expression of miRNA-143 and miRNA-29b after CCRT. We calculated a risk score with the expression of miRNA-26b、miRNA-29a、miRNA-125b、miRNA-29b、miRNA-143 and then classified patients as high or low risk group. Cox regression model suggested that combining miRNA-29a and miRNA-125b before CCRT with miRNA-26b after CCRT was independent prognostic factors for PFS (HR=3.149, 95%CI:1.018-9.115, p=0.034), whereas combining the former two is independent for OS (HR=5.146, 95%CI:1.674-15.817, p=004）. Conclusions: For loco-regionally advanced NPC patients treated with CCRT, especially high-risk patients- serum miRNAs such as miRNA-29a, miRNA-125b and miRNA-26b etc, play an important role in predicting prognosis factors for PFS and OS, which will contribute to the strategic direction of future research.

Gene-Expression for Prediction of Disease Progression Following Initial Management of Follicular Lymphoma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4804-4804
Author(s):  
Etienne Mahe ◽  
Ariz Akhter ◽  
Danielle H. Oh ◽  
Fahad Farooq ◽  
Meer-Taher Shabani-Rad ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Regression Model ◽  
Disease Progression ◽  
Cox Regression ◽  
Tumor Grade ◽  
Age At Diagnosis ◽  
P Value ◽  
Cox Regression Model ◽  
Cox Regression Analysis

Abstract Introduction Patients with advanced staged Follicular Lymphoma (FL) are initially managed with either immediate chemoimmunotherapy (CI) or "watchful waiting" (WW) depending on clinical symptoms, tumor burden, and organ compromise. Clinicians currently predict time to progression (TTP) using the Follicular Lymphoma International Prognostic Index (FLIPI) score. Well-defined & validated molecular techniques capable of additional predictive power are lacking, however. We hypothesized that gene-expression (GE) data, employing an evidence-based feature set, might assist in the upfront stratification of FL patients. Objectives 1 Identify genes whose GE has previously been identified as relevant to FL 2 Perform GE testing on an series of FL cases, classified by upfront intervention, using this custom gene feature set 3 Identify the gene(s) most strongly predictive of disease progression in each of the clinical classes (i.e. CI vs. WW) 4 Compare the performance of GE data to other prognostic parameters Methods We performed a search of MEDLINE-indexed studies reporting FL GE results. We input all available appertaining data into NVIVO (v10), in which a computer-assisted search for GE features was performed. This list, after refinement, formed the basis of a custom NanoString codeset. We used the MD Anderson Microarray Sample Size Calculator for sample size estimation and retrieved FL cases from our regional archives; those cases with sufficient tissue were organized by upfront treatment approach and available clinical data recorded (age at diagnosis, sex, stage, grade, FLIPI scores & TTP). TTP was defined as time in months either to diagnosed disease progression or, in the WW group, first CI-based treatment. After pathology review, RNA was isolated using standard protocols. GE data was analyzed using gene-specific receiver-operating characteristic analysis, ranking performed according to the area-under-the-curve (MATLAB v 8.3.0.532). Validation against TTP using Cox-regression was then performed (SPSS v22); p < 0.05 was considered significant. Results Our MEDLINE search yielded 713 publications; after refinement, our NVIVO analysis suggested 282 valid gene features. Review of local FL cases accessioned between 2004 & 2012 was performed; this period ensured uniform follow-up and CI treatment strategies for all FL patients. Patients were classified as WW (68 patients) & CI (98 patients), and then sub-classified as WW1 (WW without need for CI over the follow-up interval; 23 patients) and WW2 (WW requiring CI in the follow-up interval; 45 patients) and CI1 (CI without disease progression over the follow-up interval; 61 patients) and CI2 (CI with disease progression; 37 patients). Median follow-up time was 60 months in the WW group and 56 months in the CI group (Mann-Whitney p = 0.177). With the exception of FLIPI score in the WW class (higher on average in the WW2 sub-class), no other clinical factor differed significantly between the sub-classes. GE analyses suggested that ACTB in the WW group and MEK1 in the CI group might be most predictive of TTP. Table 1. TTP results by Cox-regression analysis for the WW group WW Variable Cox-Regression Model Co-efficient p-value Cox-Regression Model Linear Co-efficient 95% CI Age at diagnosis 0.56 0.98-1.04 Sex 0.34 0.67-3.19 Tumor Grade 0.41 0.40-9.48 Tumor Stage 0.54 0.69-2.04 FLIPI Score 0.06 0.97-3.6 ACTB Expression 0.006 1.4-7.74 Table 2. TTP results by cox-regression analysis for the CI group CI Variable Cox-Regression Model Co-efficient p-value Cox-Regression Model Linear Co-efficient 95% CI Age at diagnosis 0.34 0.99-1.04 Sex 0.96 0.48-2.16 Tumor Grade 0.92 0.43-2.13 Tumor Stage 0.17 0.874-2.11 FLIPI Score 0.4 0.47-1.35 MEK1 Expression 0.011 0.19-0.81 Conclusions To our knowledge, we have performed the first GE analysis of FL cases classified by intervention, and have identified GE features predictive of disease progression or requirement of intervention (as in the WW group). In the CI group, identification of MEK1 as a major prognostic player echoes previous work studying the MAP-kinase pathway in FL. In the WW group, however, identification of ACTB as a potential prognostic player is a novel observation requiring validation, especially since this gene is ubiquitously expressed across multiple cell types. Figure 1. WW TTP, stratified by ACTB expression Figure 1. WW TTP, stratified by ACTB expression Figure 2. CI TTP, stratified by MEK1 expression Figure 2. CI TTP, stratified by MEK1 expression Disclosures No relevant conflicts of interest to declare.

Effectiveness of a Student Pharmacist–Led Telephone Follow-Up Intervention to Improve Hemoglobin A1Cin Diabetic Patients

2019 ◽  
Vol 33 (6) ◽  
pp. 832-837 ◽  
Author(s):  
Samuel K. Peasah ◽  
Kathryn Granitz ◽  
Michelle Vu ◽  
Bobby Jacob
Keyword(s):  
Regression Model ◽  
Clinical Care ◽  
Intervention Group ◽  
Standard Of Care ◽  
Multiple Regression Model ◽  
Control Group ◽  
P Value ◽  
Diabetic Patients ◽  
Phone Calls

Objective:To evaluate the effectiveness of a student pharmacist–led telephone follow-up intervention to improve hemoglobin A1c(HbA1c) in diabetic patients.Methods:This was a prospective, randomized, pilot study to implement a telephone follow-up intervention for diabetic patients with HbA1c≥7%. Patients were recruited and randomized into intervention and control groups. All patients received standard of care. Patients in the intervention group additionally received weekly phone calls from a student pharmacist for 12 weeks to encourage medication adherence. HbA1cat baseline and end of study were measured and the data were analyzed using SAS version 9.4. Analysis included descriptive statistics and a multiple regression model to assess the association between the end of study and baseline HbA1cwhile controlling for demographics.Results:Seventy-eight patients participated and the average age was 62 (±11) years. Baseline HbA1cwas 8.2% (±1.4%) in the intervention group and 7.9% (±1.3%) in the control group. HbA1cdecreased by 0.35% in the intervention group ( P = .027) and increased by 0.338% in the control group ( P = .013). The end of study HbA1cwere higher in the control group even after controlling for baseline HbA1cs (0.5547, P value .002) in the regression model.Conclusion:Incorporating student pharmacists in physician offices to provide clinical care services could lead to improved patient outcomes and students’ clinical and research skills.

scholarly journals First and second waves among hospitalised patients with COVID-19 with severe pneumonia: a comparison of 28-day mortality over the 1-year pandemic in a tertiary university hospital in Italy

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e054069
Author(s):  
Marianna Meschiari ◽  
Alessandro Cozzi-Lepri ◽  
Roberto Tonelli ◽  
Erica Bacca ◽  
Marianna Menozzi ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Regression Model ◽  
Cox Regression ◽  
Severe Pneumonia ◽  
University Hospital ◽  
P Value ◽  
Cox Regression Model ◽  
Hospitalised Patients ◽  
The Impact ◽  
Second Wave

ObjectiveThe first COVID-19–19 epidemic wave was over the period of February–May 2020. Since 1 October 2020, Italy, as many other European countries, faced a second wave. The aim of this analysis was to compare the 28-day mortality between the two waves among COVID-19 hospitalised patients.DesignObservational cohort study. Standard survival analysis was performed to compare all-cause mortality within 28 days after hospital admission in the two waves. Kaplan-Meier curves as well as Cox regression model analysis were used. The effect of wave on risk of death was shown by means of HRs with 95% CIs. A sensitivity analysis around the impact of the circulating variant as a potential unmeasured confounder was performed.SettingUniversity Hospital of Modena, Italy. Patients admitted to the hospital for severe COVID-19 pneumonia during the first (22 February–31 May 2020) and second (1 October–31 December 2020) waves were included.ResultsDuring the two study periods, a total of 1472 patients with severe COVID-19 pneumonia were admitted to our hospital, 449 during the first wave and 1023 during the second. Median age was 70 years (IQR 56–80), 37% women, 49% with PaO2/FiO2 <250 mm Hg, 82% with ≥1 comorbidity, median duration of symptoms was 6 days. 28-day mortality rate was 20.0% (95% CI 16.3 to 23.7) during the first wave vs 14.2% (95% CI 12.0 to 16.3) in the second (log-rank test p value=0.03). After including key predictors of death in the multivariable Cox regression model, the data still strongly suggested a lower 28-day mortality rate in the second wave (aHR=0.64, 95% CI 0.45 to 0.90, p value=0.01).ConclusionsIn our hospitalised patients with COVID-19 with severe pneumonia, the 28-day mortality appeared to be reduced by 36% during the second as compared with the first wave. Further studies are needed to identify factors that may have contributed to this improved survival.

scholarly journals Impact of Non-synchronous Diagnostic Ureteroscopy on Intravesical Recurrence in Patients Underwent Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Propensity-Score Matched Analysis

2019 ◽  
Author(s):  
Huamao Ye ◽  
Xiang Feng ◽  
Yang Wang ◽  
Rui Chen ◽  
Meimian Hua ◽  
...  
Keyword(s):  
Propensity Score ◽  
Regression Model ◽  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Upper Tract Urothelial Carcinoma ◽  
Control Group ◽  
Radical Nephroureterectomy ◽  
Cox Regression Model ◽  
Upper Tract ◽  
The Impact

Abstract Background: The effect of diagnostic ureteroscopy (DURS) on intravesical recurrence (IVR) after radical nephroureterectomy (RNU) were controversial. To investigate the impact of DURS, we carried out this single-center retrospective study by applying propensity-score matching (PSM) and Cox regression model. Patients and Methods: The data of 160 patients with pTa-pT3 upper tract urothelial carcinoma (UTUC) were analyzed. Eighty-six patients underwent DURS (DURS group) and 74 patients without DURS (control group). The DURS group was further sub-grouped into synchronous DURS group (DURS followed by immediate RNU, n=45) and non-synchronous DURS group (DURS followed by delayed RNU, n=41). Baseline confounders were corrected by PSM. The impact of DURS on IVR was assessed by Kaplan-Meier analysis in PSM cohort and by Cox regression model in the full data set. Results: The median follow-up time was 40.4 months. No difference of the 3-year IVRFS between DURS group and control group (72.6% vs. 65.3%, p=0.263). In subgroup analysis, the 3-year IVR-free survival of non-synchronous DURS group (51.4%) was significantly lower than that of synchronous DURS (78.3%) or control group (72.6%) (p=0.027). Further Cox regression analysis showed that non-synchronous DURS (HR 1.481, 95% CI 1.031-2.127, p=0.034) was independent risk factors for postoperative IVR. Conclusions: Non-synchronous DURS was not recommended for the diagnosis and preoperative evaluation of UTUC, because it could raise the risk of IVR after RNU. For UTUC patients in need of DURS, synchronous DURS could be a safer choice than the non-synchronous DURS in terms of lowering the IVR risk.

scholarly journals The Effect Of Erythropoietin Administration In Experimental Burns Wound Healing: An Animal Study

2016 ◽  
Vol 3 (1) ◽  
pp. 1-8
Author(s):  
Afriyanti Sandhi ◽  
Aditya Wardhana
Keyword(s):  
Wound Healing ◽  
Animal Study ◽  
Low Dose ◽  
Healing Process ◽  
Control Group ◽  
Wound Healing Process ◽  
P Value ◽  
High Dose ◽  
Sprague Dawley ◽  
Surface Areas

Background: The hematopoietic growth factor erythropoietin (EPO) attracts attention due to its all-tissue-protective pleiotropic properties. The purpose of this study is to investigate the effect of EPO in experimental burn wounds healing. Methods: Fifteen healthy Sprague-Dawley, strain of Rattus Novergicus weighing 300-350 grams, were prepared to achieve deep dermal burns. Animals were randomized to receive either low-dose EPO injection (600 IU/mL), high-dose EPO injection (3000 IU/mL) or nothing (control group). After 14 days of observations, quantitative and qualitative assessments of wound healing was determined. Results: The size of the wound area and re-epithelialization rate percentage was determined on Day-0, Day-5, Day-10, and Day-14. The average of raw surface areas measurement (p value: 0.012 in day-5; 0.009 in day-10 and 0.000 in day-14) and healing percentage of the lesions (p value: 0.011 in day-5; 0.016 in day-10 and 0.010 in day-14) were significantly best in the low-dose EPO grup compared to the control group and high-dose EPO grup. The histopathology evaluation revealed that the highest score for for re-epithelialization, granulation tissue and neo-angiogenesis were achieved by the low-dose EPO injection group than in both control and high-dose EPO injection groups. Conclusion: In this animal study using Sprague-Dawley rats, Recombinant Human EPO (rHuEPO) injection administration prompted the evidences of improved re-epithelialization and wound healing process of the skin caused by deep dermal burns. These findings may lead to a new therapeutic approach to improve the clinical outcomes for the management of burns wound healing.

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