scholarly journals Postpartum Follow-Up of Women Who Developed Subclinical Hypothyroidism during Pregnancy

2020 ◽  
Vol 8 (3) ◽  
pp. 29
Author(s):  
Anastasia Linardi ◽  
Ioannis Kakoulidis ◽  
Ioannis Ilias ◽  
Aikaterini Michou ◽  
Athina Pappa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Subclinical Hypothyroidism ◽  
Retrospective Cohort Study ◽  
Postpartum Period ◽  
Retrospective Cohort ◽  
Treatment Initiation ◽  
One Year ◽  
Tsh Levels ◽  
New Onset

There is inconsistency in the literature regarding the management of women diagnosed with subclinical hypothyroidism (SCH) during pregnancy in the postpartum period. The purpose of our study was to assess the need for continuation of levothyroxine (LT4) treatment after delivery. We conducted a retrospective cohort study of 114 women with new-onset SCH during pregnancy and at 1-year follow-up postpartum. Criteria for continuation of LT4 after delivery were breastfeeding, thyrotropin (TSH) levels at diagnosis >5 mIU/L, positive antithyroid antibodies and LT4 dose before delivery >50 μg/day. On treatment initiation, mean TSH ± SD was 5.24 ± 2.55 mIU/L. One year after delivery, most patients (86/114) were still on LT4. This was related to TSH levels at the initiation of treatment in gestation (p = 0.004) and inversely related to primiparity (p = 0.019). In the group of patients who stopped LT4 postpartum, treatment was reinstated in 11 out of 39 (28.2%) due to SCH relapse (mean TSH ± SD = 9.09 ± 5.81 mIU/L). Most women in our study continued treatment after delivery, and a considerable number of women who had discontinued LT4 restarted treatment postpartum. These results stress the need to reassess thyroid function at 6 to 12 months postpartum.

One-Year Outcome Study of Anatomic Reconstruction of Lesser Metatarsophalangeal Joints

2019 ◽  
Vol 13 (4) ◽  
pp. 286-296 ◽  
Author(s):  
Jeremy J. Cook ◽  
Emily A. Cook ◽  
Daniel D. Hansen ◽  
Michael Matthews ◽  
Timothy Karthas ◽  
...  
Keyword(s):  
Cohort Study ◽  
Visual Analogue Scale ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Analogue Scale ◽  
Anatomic Repair ◽  
Plantar Plate ◽  
One Year ◽  
Radiographic Alignment

Background: Lesser metatarsophalangeal joint (MTPJ) and plantar plate pathologies are commonly seen forefoot conditions. Traditional rebalancing techniques are commonly used but can have concerning adverse effects. The purpose of this study was to analyze the 1-year outcomes of a new technique consisting of anatomic repair of the plantar plate and collateral ligaments involving lesser MTPJs. Methodology: A retrospective cohort study of 50 consecutive patients treated with anatomic plantar plate and collateral ligament reconstruction were evaluated for lesser MTPJ imbalances between 2013 and 2016. The primary outcome was postoperative digital stability defined as a normal dorsal drawer test and normal paper pull-out test. Secondary outcomes included pre- and postoperative visual analogue scale pain measurements, MTPJ radiographic alignment, and ACFAS Forefoot module scores. Results: All patients had digital instability prior to the surgical intervention. Final follow-up revealed that 92% of patients showed improved digital stability, P = .0005. Multivariate regression found statistically significant improvement in pain reduction via the visual analogue scale of 51.2 mm ( P < .0001) and ACFAS Forefoot module scores improved to 92 ( P < .0001). The 45 joints with preoperative abnormal transverse plane deformity, had either complete (n = 29) or partial (n = 16) radiographic MTPJ correction. Conclusion: These results suggest that anatomic repair of lesser MTPJ improved digital stability, pain, function and radiographic alignment with greater than one year of follow-up. Levels of Evidence: Level IV: Retrospective cohort study

scholarly journals Clinical Outcomes of Bariatric Surgery Among Military Retirees and Beneficiaries: A Retrospective Cohort Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1677-1677
Author(s):  
Joshua Roe ◽  
Brenda Bustillos ◽  
Adam Kieffer
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Cohort Study ◽  
Clinical Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Military Retirees ◽  
Student’S T ◽  
One Year

Abstract Objectives Obesity prevalence is estimated at 34% in U.S. military retirees and 28% in beneficiaries of military healthcare, with common comorbidities being type 2 diabetes (T2D), hypertension, and hyperlipidemia. Stressors experienced during active duty service result in higher risk for disabling musculoskeletal injuries, psychological trauma, and alcohol abuse; all of which debilitate healthy weight loss efforts. No literature exists on the demographics and clinical outcomes of military retirees who elect bariatric surgery. The purpose of this study was to assess demographics and determine clinical outcomes of retirees and beneficiaries following bariatric surgery. It was hypothesized that pre-operative weights and comorbidity remission would be higher in the military retiree group. Methods A retrospective cohort study assessed military retirees and beneficiaries who underwent sleeve gastrectomy or gastric bypass surgery at a military treatment facility in 2014. Percent total weight loss (%TWL) and remission of pre-existing comorbidities (T2D, hypertension, and hyperlipidemia) at one year follow-up were primary outcomes and compared using Student's T tests and chi-squared contingency analysis. Additional statistical analyses included a Wilcoxon-Mann-Whitney test and backwards stepwise regression. Results Ninety-eight patients (64 beneficiaries and 34 retirees) were included with mean ages of 48 and 52 years, respectively. Student's T test and Wilcoxon-Mann-Whitney test confirmed that beneficiaries achieved greater %TWL at one year follow-up, 30.2% vs. 25.8% (p &lt; 0.05) and 55.5 vs. 38.2 mean rank (p &lt; 0.01), respectively. Beneficiaries and retirees achieved similar remission of T2D, hypertension, and hyperlipidemia. Patient's sex and surgery type were significant predictors of %TWL variation between groups at one year follow-up. These variables accounted for 9% of the %TWL variance. Conclusions Retirees who elect bariatric surgery lose less weight than their beneficiary counterparts. Etiology of this poorer outcome remains unclear, but further research may demonstrate need for improving healthcare resources provided to military retirees. Funding Sources No funding was received to support this study.

scholarly journals Tuberculous meningitis in adult patients of a Mexican neurological referral center: A-six-year retrospective cohort study

2020 ◽  
Author(s):  
Maldonado-Diaz Ellis Daniela ◽  
Soto-Hernández José Luis ◽  
Salinas-Lara Citlaltepetl ◽  
Kammar-Garcia Ashuin ◽  
Cárdenas Graciela
Keyword(s):  
Cohort Study ◽  
Tuberculous Meningitis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Laboratory ◽  
Hiv Positive ◽  
Important Concern ◽  
Lowenstein Jensen ◽  
One Year

AbstractIntroductionTuberculosis (TB) remains as an important concern of public health worldwide because the high prevalence and severe sequelae. Tuberculous meningitis (TBM) is the most lethal and disabling form.AimTo describe the clinical, laboratory, and neuroimaging characteristics of TBM on admission at neurological center in Mexico City.MethodsRetrospective cohort study at the third level neurological center from 2010 to 2016. Clinical follow-up was evaluated at hospital discharge, three months, and one-year either due to lack of follow-up or mortality, during the follow-up the adverse events were registered.ResultsOne-hundred and six patients were included, 74 (69.8%) males and 32 (30.2%) females. From these 31 (29.2%) were HIV-positive. The median age was 35.5 (IQR:28-51). Pulmonary TB was found in 25% of the population. Alcoholism was observed in a half of the patients while diabetes in 15%, the latter being significant (p=0.04). Abnormalities in neuroimaging were significant among our population (p=0.003). Only one-third of the population had a positive Lowenstein-Jensen culture. There were no differences in clinical outcomes between HIV positive and non-HIV patients.ConclusionOur study shows data to those described in the literature. The initiation of empirical treatment in all patients with a high clinical suspicion of tuberculosis mandatory to try to avoid severe neurological sequels.

scholarly journals P370 Concomitant azathioprine prevents new-onset arthralgia after initiation of vedolizumab: A retrospective cohort study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S387-S387
Author(s):  
G Kokkotis ◽  
E Zampeli ◽  
M Tzouvala ◽  
I Giotis ◽  
P Orfanos ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Cohort Study ◽  
Median Duration ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Concomitant Treatment ◽  
Exact Test ◽  
History Of ◽  
New Onset

Abstract Background Vedolizumab is a monoclonal antibody against the gut-homing integrin α4β7 that is being used for the treatment of moderate to severe Ulcerative Colitis (UC) and Crohn’s Disease (CD). An increasing number of studies have reported new onset or reactivation of extra-intestinal manifestations (EIMs), among which arthralgia is the most prominent. Methods We aimed to study the incidence, characteristics and possible predictors of arthralgia development in patients under treatment with Vedolizumab, in a retrospective cohort study in 3 IBD centers in Athens, Greece. UC and CD patients treated with Vedolizumab (n=115, men=50.4%, UC=70.4%, median duration of follow-up=9 months) or Infliximab (n=93, men=69.9%, UC=29%, median duration of follow-up=29.1 months) were recruited. For each participant the entry point for the study was the first day of drug administration while the endpoint was either the day of arthralgia occurrence, the day of drug discontinuation or the day of the last interview if the patient was still receiving the drug. The SPSS-23 statistical program was used for analysis. Results Patients under Vedolizumab were at higher risk for new-onset (HR=4.76, P=0.001) and recurrent (HR=5.41, P=0.003) arthralgia compared to patients under Infliximab. New-onset arthralgia occurred in 20.9% while recurrent in 37.8% of 45 patients with a history of articular EIM. New-onset and recurrent arthralgias differed in certain characteristics. New-onset arthralgia involved peripheral joints in 91.7%, was milder, occurred shortly after Vedolizumab initiation (median drug exposure= 3 months, IQR=5 months) in patients in remission and remitted in 50% of cases. In multivariate Cox’s proportional-hazards model new-onset arthralgia was significantly associated with extensive colitis (HR=2.91, 95%CI=1.04-8.12). Of 15 patients with concomitant treatment of azathioprine no one manifested new-onset arthralgia (X2 P= 0.03, Fisher’s exact test P=0.038). Similarly, no patient with a history of appendectomy manifested new-onset arthralgia (n=12, X2 P= 0.067, Fisher’s exact test P=0.12). No predictors were identified for recurrent arthralgia. No patients discontinued vedolizumab due to arthralgia. Conclusion Vedolizumab treatment may be associated with the temporal manifestation of arthralgias. Patients under Vedolizumab with extensive ulcerative colitis have a higher risk of developing new-onset arthralgia, whereas, concomitant treatment with azathioprine and a history of appendectomy appears to have a prophylactic effect. This effect could be indicative of a distinct pathophysiological lymphocyte-mediated mechanism.

scholarly journals 3283 Comparative Effectiveness of Levetiracetam versus Phenobarbital for Infants Aged One Month to One Year, using US Medicaid Claims

2019 ◽  
Vol 3 (s1) ◽  
pp. 141-141
Author(s):  
Michelle Yun ◽  
Manyao Zhang ◽  
Alan Wu ◽  
Natasha Basma ◽  
Zachary Grinspan
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Comparative Effectiveness ◽  
Retrospective Cohort ◽  
Total Cost ◽  
Epilepsy Diagnosis ◽  
Ed Visits ◽  
One Year

OBJECTIVES/SPECIFIC AIMS: Using national Medicaid claims, this retrospective cohort study aims to compare the outcomes of levetiracetam (LEV) versus phenobarbital (PHB) as initial monotherapy in infants with epilepsy aged one month to one year. We primarily analyzed health services outcomes, as follows: (1) Emergency Department (ED) visits: proportion of those with at least 1 ED visit, time to first ED visit, total number of ED visits, proportion leading to inpatient admission (2) Inpatient Admissions: proportion of those with at least 1 admission, time to first admission, total number of inpatient admissions, total length of stay (3) Treatment discontinuation: proportion of those who discontinued medication, time to discontinuation, proportion of those with prescription of second antiepileptic drug (AED) (4) Cost: total cost at 1 year from first prescription. METHODS/STUDY POPULATION: The project is a retrospective cohort study utilizing Medicaid claims from 2009-2012 from all states and DC. Inclusion criteria were: (1) Epilepsy diagnosis (ICD9 345.x) at age 1 month to 1 year (2) 1 year of continuous Medicaid enrollment Exclusion criteria were: (1) Neither LEV nor PHB monotherapy as initial treatment (2) Neither LEV nor PHB prescription within 45 days of epilepsy diagnosis (3) Less than 1 year of follow-up after first LEV or PHB prescription (4) Infantile Spasms diagnosis (5) Brain Surgery (6) Death within 1 year of follow-up Using R for statistical analysis, we analyzed outcomes including ED visits, inpatient admissions, treatment discontinuation, and total cost. In this abstract, we present our preliminary bivariate analysis. RESULTS/ANTICIPATED RESULTS: Demographics and Etiology: Compared to infants prescribed PHB (n = 1954), infants prescribed LEV (n = 1248) were older (median 6 months [IQR 3-9] vs 3[2-6]; p < 0.001), more likely to be white (44.2% vs 38.9%; p < 0.05) and not Hispanic (63.5% vs 58.9%; p<0.05). There were also important differences in epilepsy etiologies (p < 0.05). For example, infants prescribed LEV were more likely to have a diagnosis of tuberous sclerosis (1% vs 0.15%) or traumatic brain injury (12.8% vs 0.56%). Health Services Outcomes: After 1 year, infants prescribed LEV had more ED visits (2 [0-4] vs 1 [0-3]; p < 0.001) but shorter inpatient length of stay when admitted (3 days [2-5] vs 3 [2-6]; p < 0.001). They were less likely to discontinue the medication (46.6% vs 64.3%; p<0.001) but more likely to have a second AED prescription (53.3% vs 43.4%; p < 0.001). Other outcomes, including total cost, were similar. DISCUSSION/SIGNIFICANCE OF IMPACT: This preliminary analysis suggests that the healthcare trajectory of infants treated with LEV and PHB differ in complex ways. In ongoing work, we are conducting a multivariable comparative effectiveness analysis of LEV versus PHB using propensity score weighting to account for observable selection bias and multiple imputation to account for missing data.

scholarly journals Clinical Observation of Therapeutic Keratoplasties for Infectious Keratitis: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Yue Ma ◽  
Yue Zeng ◽  
Xiao-Rong Zhang ◽  
Jia Yao ◽  
Li-Ying Huang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Graft Rejection ◽  
Retrospective Cohort ◽  
Lamellar Keratoplasty ◽  
Infectious Keratitis ◽  
Therapeutic Success ◽  
One Year ◽  
The One

Abstract Background: To investigate the therapeutic outcomes of two types of keratoplasties in patients with infectious keratitis.Methods: This retrospective cohort study enrolled 52 consecutive patients (52 eyes) with medically uncontrolled infectious keratitis who underwent deep lamellar keratoplasty (DLKP) (n=16 eyes) or penetrating keratoplasty (PKP) (n=36 eyes; 24 nonperforated ulcers; 12 perforated ulcers) with a follow-up of 12 to 36 months (mean follow-up duration: DLKP, 24.6 months; PKP: 25.7 months) between June 2014 and 2019 at the Department of Ophthalmology, The Third Hospital of Hebei Medical University. The clinical characteristics, preoperative, and postoperative best-corrected visual acuity (BCVA) outcomes, therapeutic success rate, graft rejection, management, and complications were assessed.Results: The postoperative BCVA increased by 93.8% (15/16 eyes) and 77.2% (27/36 eyes) at the one-year follow-up in the DLKP and PKP groups, respectively: the differences were not statistically significant (p=0.149). The therapeutic success rates did not differ (statistically) significantly between the DLKP (81.2%) and PKP (80.6%) groups (p=0.953). The incidence of secondary glaucoma was 6.25% and 33.33% in the DLKP and PKP groups, respectively, and the difference between them was statistically significant (p=0.037). The graft survival rates at the one-year follow-up differed significantly between the DLKP (12.5%) and PKP (42.9%) groups (p=0.033).Conclusion: Infectious keratitis is common in male farmers in northern China. Therapeutic keratoplasty is the most commonly performed vision-saving procedure for patients with severe serious infectious keratitis, which can improve the quality of life significantly. Bandage contact lenses were commonly used to protect the cornea and ameliorate pain. DLKP and PKP elicited good clinical outcomes with respect to visual recovery and therapeutic success. The frequencies of graft rejection and complications were lower with DLKP compared to PKP. Surgery should be considered at the early stage in patients with refractory infectious keratitis to improve the therapeutic success.

scholarly journals Evaluation of management strategies in patients with coronary ectasia: a retrospective cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Sierra Gonzalez De Cossio ◽  
F Solis-Jimenez ◽  
J A Viana Rojas ◽  
M Villalobos Pedroza ◽  
E Terrazas Cervantes ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cohort Study ◽  
Coronary Artery ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Management Strategies ◽  
Coronary Ectasia ◽  
Significant Difference ◽  
One Year

Abstract Background/Introduction Since patients with coronary ectasia have an increased risk of developing myocardial infarction and cardiovascular death, these patients could benefit from a more intensive treatment. Unfortunately, the evidence regarding outcomes with different management strategies is limited, especially with direct oral anticoagulants (DOAC). Purpose To compare clinical outcomes in patients with coronary ectasia based on the selected/chosen treatment strategy. Methods We conducted a retrospective cohort study in patients diagnosed with coronary artery ectasia. They were divided into 3 different groups based on the treatment they received at discharge and we evaluated the main cardiovascular outcomes at one-year follow-up. Results Between 2016 and 2019, 7,579 angiographies were performed, in which 510 patients with coronary ectasia were found (prevalence of 6.72%). Of these patients, 43.9% (n=224) had the diagnosis of STEMI, 21% NSTEMI (n=107), 5.1% unstable angina (n=26), 18.6% chronic stable angina (n=95) and other 11.4% (n=58). The angiographic distribution of the lesions was as follows: left main coronary artery 25.1%, Left descending coronary artery 62.7%, circumflex artery 52.1%, right coronary artery 79.2%. It was possible to obtain the follow-up of 363 patients (71.2%) because 25 died during their hospitalization and data of 122 were not available at the time of analysis. Three groups were formed based on the treatment: (1) Dual Antiplatelet Therapy (DAPT) in 47% (n=174); (2) DAPT + Vitamin K Antagonist (VKA) in 8.5% (n=31); (3) DAPT + DOAC in 6.6% (n=24). The overall MACE rate at 1-year of follow-up was 6.6% (n=15): 11 patients in the DAPT group (6.3%), 1 patient in the DAPT + VKA group (3.2%), and 3 patients in the DAPT + DOAC group (12.5%). During this period, 3 patients died from cardiovascular causes, all of them in the DAPT group. Myocardial infarction occurred in 12 patients, 8 in the DAPT group (4.2%), 1 in the DAPT + VKA group (3.2%) and 3 in the DAPT + DOAC group (12.5%). Stroke occurred in 2 patients: 1 patient in the DAPT group (0.5%) and 1 patient in the DAPT + DOAC group, 4.1% None of these findings were statistically significant. One-year occurrence of bleeding events was also evaluated: 23 patients presented a bleeding event, 14 in the DAPT group (8%), 7 in the DAPT + VKA group (22.5%) and 2 in the DAPT + DOAC group (8.3%); p=0.010. Conclusion(s) Our findings suggest that there is no statistically significant difference in the incidence of thrombotic complications, when comparing the treatment options. Patients using the combination of DAPT+VKA have a higher incidence of bleeding. FUNDunding Acknowledgement Type of funding sources: None.

Status and Determinants of Treatment Outcomes Among New Tuberculosis Patients in South Korea: A Retrospective Cohort Study

2021 ◽  
pp. 101053952110005
Author(s):  
Hyunjin Son ◽  
Jeongha Mok ◽  
Miyoung Lee ◽  
Wonseo Park ◽  
Seungjin Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
South Korea ◽  
Success Rate ◽  
Treatment Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Care Facilities ◽  
Tuberculosis Patients ◽  
Lost To Follow Up

This is a retrospective cohort study using notification data in South Korea. We evaluated the nationwide status, regional differences, and the determinants of treatment outcomes among tuberculosis patients. Treatment success rate improved from 77.0% in 2012 to 86.0% in 2015. The lost to follow-up rate was higher among older people, males, and foreign nationals. Health care facilities designated for the Public-Private Mix (PPM) project showed higher success rate and lower rate of lost to follow-up. Moreover, municipalities with low regional deprivation index had higher PPM project coverage. Since there is a large regional difference in the coverage of the PPM project, an additional community-based support program should be implemented, especially for tuberculosis patients residing in region with low PPM project coverage.

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