scholarly journals Assessing Predictive Factors of COVID-19 Outcomes: A Retrospective Cohort Study in the Metropolitan Region of São Paulo (Brazil)

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1068
Author(s):  
Juliana Neide Amato ◽  
Paula Midori Castelo ◽  
Ferla Maria Simas Bastos Cirino ◽  
Guilherme Meyer ◽  
Luciano José Pereira ◽  
...  
Keyword(s):  
Cohort Study ◽  
Regression Model ◽  
Health System ◽  
Symptom Onset ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Environmental Data ◽  
Metropolitan Region ◽  
Primary Data ◽  
Convenience Sample

Background and Objectives: The aim of this retrospective cohort study was to search individual, sociodemographic and environmental predictors of COVID-19 outcomes. Materials and Methods: A convenience sample of 1036 COVID-19 confirmed patients (3–99 years, mean 59 years; 482 females) who sought treatment at the emergency units of the public health system of Diadema (Brazil; March–October 2020) was included. Primary data were collected from medical records: sex, age, occupation/education, onset of symptoms, presence of chronic diseases/treatment and outcome (death and non-death). Secondary socioeconomic and environmental data were provided by the Department of Health. Results: The mean time spent between COVID-19 symptom onset and admission to the health system was 7.4 days. Principal component analysis summarized secondary sociodemographic data, and a Poisson regression model showed that the time between symptom onset and health system admission was higher for younger people and those from the least advantaged regions (availability of electricity, a sewage network, a water supply and garbage collection). A multiple logistic regression model showed an association of age (OR = 1.08; 1.05–1.1), diabetes (OR = 1.9; 1.1–3.4) and obesity (OR = 2.9; 1.1–7.6) with death outcome, while hypertension and sex showed no significant association. Conclusion: The identification of vulnerable groups may help the development of health strategies for the prevention and treatment of COVID-19.

scholarly journals Lasting s-ketamine block of spreading depolarizations in subarachnoid hemorrhage: a retrospective cohort study

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Edgar Santos ◽  
Arturo Olivares-Rivera ◽  
Sebastian Major ◽  
Renán Sánchez-Porras ◽  
Lorenz Uhlmann ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Subarachnoid Hemorrhage ◽  
Regression Model ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Logistic Regression Model ◽  
Poisson Model ◽  
High Dose ◽  
First Line

Abstract Objective Spreading depolarizations (SD) are characterized by breakdown of transmembrane ion gradients and excitotoxicity. Experimentally, N-methyl-d-aspartate receptor (NMDAR) antagonists block a majority of SDs. In many hospitals, the NMDAR antagonist s-ketamine and the GABAA agonist midazolam represent the current second-line combination treatment to sedate patients with devastating cerebral injuries. A pressing clinical question is whether this option should become first-line in sedation-requiring individuals in whom SDs are detected, yet the s-ketamine dose necessary to adequately inhibit SDs is unknown. Moreover, use-dependent tolerance could be a problem for SD inhibition in the clinic. Methods We performed a retrospective cohort study of 66 patients with aneurysmal subarachnoid hemorrhage (aSAH) from a prospectively collected database. Thirty-three of 66 patients received s-ketamine during electrocorticographic neuromonitoring of SDs in neurointensive care. The decision to give s-ketamine was dependent on the need for stronger sedation, so it was expected that patients receiving s-ketamine would have a worse clinical outcome. Results S-ketamine application started 4.2 ± 3.5 days after aSAH. The mean dose was 2.8 ± 1.4 mg/kg body weight (BW)/h and thus higher than the dose recommended for sedation. First, patients were divided according to whether they received s-ketamine at any time or not. No significant difference in SD counts was found between groups (negative binomial model using the SD count per patient as outcome variable, p = 0.288). This most likely resulted from the fact that 368 SDs had already occurred in the s-ketamine group before s-ketamine was given. However, in patients receiving s-ketamine, we found a significant decrease in SD incidence when s-ketamine was started (Poisson model with a random intercept for patient, coefficient − 1.83 (95% confidence intervals − 2.17; − 1.50), p < 0.001; logistic regression model, odds ratio (OR) 0.13 (0.08; 0.19), p < 0.001). Thereafter, data was further divided into low-dose (0.1–2.0 mg/kg BW/h) and high-dose (2.1–7.0 mg/kg/h) segments. High-dose s-ketamine resulted in further significant decrease in SD incidence (Poisson model, − 1.10 (− 1.71; − 0.49), p < 0.001; logistic regression model, OR 0.33 (0.17; 0.63), p < 0.001). There was little evidence of SD tolerance to long-term s-ketamine sedation through 5 days. Conclusions These results provide a foundation for a multicenter, neuromonitoring-guided, proof-of-concept trial of ketamine and midazolam as a first-line sedative regime.

Therapeutic Plasma Exchange in Neonatal Septic Shock: A Retrospective Cohort Study

2019 ◽  
Vol 37 (09) ◽  
pp. 962-969
Author(s):  
Taylor Sawyer ◽  
Zeenia Billimoria ◽  
Sarah Handley ◽  
Kendra Smith ◽  
Larissa Yalon ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cohort Study ◽  
Plasma Exchange ◽  
Retrospective Cohort Study ◽  
Adjunctive Therapy ◽  
Retrospective Cohort ◽  
Life Support ◽  
Therapeutic Plasma Exchange ◽  
Convenience Sample ◽  
Icu Discharge

Objective This study aimed to examine the use of therapeutic plasma exchange (TPE) as adjunctive therapy in neonatal septic shock. Study Design This retrospective cohort study was performed on a convenience sample of neonates in a quaternary children's hospital between January 2018 and February 2019. Results We identified three neonates with septic shock who received TPE. Two neonates had adenovirus sepsis, and one had group B streptococcal sepsis. All neonates were on extracorporeal life support (ECLS) when TPE was started. The median duration of TPE was 6 days (interquartile range [IQR]: 3–15), with a median of four cycles (IQR: 3–5). Lactate levels decreased significantly after TPE (median before TPE: 5.4 mmol/L [IQR: 2.4–6.1] vs. median after TPE: 1.2 mmol/L [IQR: 1.0–5.8]; p < 0.001). Platelet levels did not change (median before TPE: 73,000/mm3 [IQR: 49,000–100,000] vs. median after TPE: 80,000/mm3 (IQR: 62,000–108,000); p = 0.2). Organ failure indices improved after TPE in two of the three neonates. Hypocalcemia was seen in all cases despite prophylactic calcium infusions. One neonate died, and two survived to ICU discharge. Conclusion TPE can be safely performed in neonates with septic shock. TPE may have a role as an adjunctive therapy in neonates with septic shock requiring ECLS.

scholarly journals Cognitive Impairment Is a Common Comorbidity in Deceased COVID-19 Patients: A Hospital-Based Retrospective Cohort Study

2020 ◽  
Vol 78 (4) ◽  
pp. 1367-1372
Author(s):  
Paloma Martín-Jiménez ◽  
Mariana I. Muñoz-García ◽  
David Seoane ◽  
Lucas Roca-Rodríguez ◽  
Ana García-Reyne ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Nursing Homes ◽  
Symptom Onset ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Tertiary Hospital

We analyzed the frequency of cognitive impairment (CI) in deceased COVID-19 patients at a tertiary hospital in Spain. Among the 477 adult cases who died after admission from March 1 to March 31, 2020, 281 had confirmed COVID-19. CI (21.1% dementia and 8.9% mild cognitive impairment) was a common comorbidity. Subjects with CI were older, tended to live in nursing homes, had shorter time from symptom onset to death, and were rarely admitted to the ICU, receiving palliative care more often. CI is a frequent comorbidity in deceased COVID-19 subjects and is associated with differences in care.

scholarly journals Age at symptom onset and death and disease duration in genetic frontotemporal dementia: an international retrospective cohort study

2020 ◽  
Vol 19 (2) ◽  
pp. 145-156 ◽  
Author(s):  
Katrina M Moore ◽  
Jennifer Nicholas ◽  
Murray Grossman ◽  
Corey T McMillan ◽  
David J Irwin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Frontotemporal Dementia ◽  
Symptom Onset ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Disease Duration

scholarly journals Underuse and Overuse of Osteoporosis Screening in a Regional Health System: a Retrospective Cohort Study

2015 ◽  
Vol 30 (12) ◽  
pp. 1733-1740 ◽  
Author(s):  
Anna Lee D. Amarnath ◽  
Peter Franks ◽  
John A. Robbins ◽  
Guibo Xing ◽  
Joshua J. Fenton
Keyword(s):  
Cohort Study ◽  
Health System ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Regional Health ◽  
Osteoporosis Screening ◽  
System A

scholarly journals Cognitive impairment is a common comorbidity in COVID-19 deceased patients. A hospital-based retrospective cohort study

2020 ◽  
Author(s):  
Paloma Martín-Jiménez ◽  
Mariana I. Muñoz-García ◽  
David Seoane ◽  
Lucas Roca-Rodríguez ◽  
Ana García-Reyne ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Palliative Care ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Symptom Onset ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Invasive Mechanical Ventilation ◽  
Non Invasive

ABSTRACTIntroductionLittle is known about the relation of cognitive impairment (CI) to COVID-19 mortality. Here, we analyse the frequency of CI in deceased COVID-19 patients.MethodsWe included 477 adult cases that died after admission from March 1 to March 31, 2020: 281 with confirmed COVID-19, 58 probable COVID-19, and 138 who died of other causes.ResultsThe number of comorbidities was high in the confirmed COVID-19, and CI was common (30%: 21.1% dementia; 8.9% mild cognitive impairment). Subjects with CI were older, more lived in nursing homes and had shorter times from symptom onset to death than those without CI. COVID-19 patients with CI were rarely admitted to the ICU and fewer received non-invasive mechanical ventilation, but palliative care was provided more often.ConclusionsDementia is a frequent comorbidity in COVID-19 deceased patients. The burden of COVID-19 in the dementia community will be high.

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