Comorbidity Adjusted Odds Ratio Research Articles

Symptom Burden and Immune Dynamics 6 to 18 Months Following Mild Severe Acute Respiratory Syndrome Coronavirus 2 Infection (SARS-CoV-2): A Case-control Study.

BackgroundThe burden and duration of persistent symptoms after non-severe COVID-19 remains uncertain. This study aimed to assess post-infection symptom trajectories in home-isolated COVID-19 cases compared to age- and time-period matched seronegative controls, and investigate immunological correlates of long COVID.MethodsA prospective case-control study conducted between February 28th and April 4th 2020 included home-isolated COVID-19 cases followed for 12 (n = 233) to 18 (n = 149) months, and 189 age-matched SARS-CoV-2 naive controls. We collected clinical data at baseline, 6, 12 and 18 months post-infection, and blood samples at 2, 4, 6 and 12 months for analysis of SARS-CoV-2 specific humoral and cellular responses.ResultsOverall, 46% (108/233) had persisting symptoms 12 months after COVID-19. Compared to controls, adult cases had a high risk of fatigue (27% excess risk, gender and comorbidity adjusted odds ratio [aOR] 5.86, 95% confidence interval [CI]3.27-10.5), memory problems (21% excess risk, aOR 7.42, CI 3.51-15.67), concentration problems (20% excess risk, aOR 8.88, CI 3.88-20.35), and dyspnea (10% excess risk, aOR 2.66, CI 1.22-5.79). The prevalence of memory problems increased overall from 6 to 18 months (excess risk 11.5%, CI 1.5, 21.5, p = 0.024) and among women (excess risk 18.7%, CI 4.4, 32.9, p = 0.010). Longitudinal spike IgG was significantly associated with dyspnea at 12 months. The spike-specific clonal CD4 + TCRβ depth was significantly associated with both dyspnea and number of symptoms at 12 months.ConclusionsThis study documents a high burden of persisting symptoms after mild COVID-19, and suggest that infection induced SARS-CoV-2 specific immune responses may influence long-term symptoms.

Guillain-Barré syndrome following influenza vaccination: A 15-year nationwide population-based case-control study.

Influenza vaccination may increase the risk of developing Guillain-Barré syndrome (GBS) due to an elicited immune response, but the exact magnitude and duration of risk is unclear and hence the aim of this study. We conducted a retrospective nationwide population-based case-control study of prospectively collected data on all patients with first-time hospital-diagnosed GBS in Denmark between 2002 and 2016 and 10 age-, sex- and index date-matched population controls per case. The primary exposure was incident influenza vaccination 1 month prior to admission with GBS. We used medical registries to ascertain a complete hospital contact history of pre-existing morbidities. To examine duration of GBS risk, we repeated the analysis for five consecutive 1-month risk periods following vaccination. Of the 1295 GBS cases and 12,814 controls, 20 cases (1.5%) and 119 controls (0.9%) had received an influenza vaccination within the last month, yielding a comorbidity-adjusted odds ratio of 1.9 (95% confidence interval 1.1-3.2) for GBS. Stratified analyses by calendar time, gender and age showed similar results. The increased risk of GBS was largely confined to 1 month following influenza vaccination. The population-attributable fraction of GBS from influenza vaccination in Denmark was 0.4%. Influenza vaccination was associated with a slightly elevated risk of GBS occurrence within 1 month after vaccination. However, only 1.5% of GBS cases in Denmark are associated with recent influenza vaccination. Thus, the benefit of influenza vaccines in preventing influenza infections and associated morbidity and mortality needs to be weighed against the small absolute risk of GBS.

Mapping of epidemiological determinants of confirmed COVID-19 cases among health-care workers of municipal corporation of Delhi: A roadmap to risk reduction.

BACKGROUND:Coronavirus disease (COVID-19) is a respiratory illness caused by a novel coronavirus which can spread from person to person. Health-care workers of any medical college and hospital are at more risk to the coronavirus disease (COVID-19) than the general population. The aim of this study was to assess the epidemiological profile of confirmed COVID-19 cases among health-care workers of Municipal Corporation of Delhi.METHODOLOGY:A cross-sectional study was planned among 422 health-care workers of Municipal Corporation of Delhi. The questionnaire consisted of questions about sociodemographic data, personal history, and clinical profile such as signs and symptoms and their duration. Data were analyzed by SPSS software version 21.0, and, Chi-square test and logistic regression were used.RESULTS:Mean age of study subjects was 41.1 ± 9.8 years, and males (57.6%) were more as compared to (42.4%) females. Out of total participants, about one-third (36.4%) of study participants were asymptomatic. Study participants with higher education status adjusted odds ratio (AOR) 2.43 (1.25–4.70), living in overcrowding AOR 3.74 (1.86–7.54), and having some comorbidity AOR 2.78 (1.57–4.92) were at higher risk of being symptomatic.CONCLUSION:This study concludes that about one-third of study participants were asymptomatic. Factors such as higher education status, living in overcrowding, presence of some comorbidity, and smokeless tobacco consumption were significantly associated with symptomatic COVID-19 cases. Hence, there is a need to identify these risk factors at an early stage in order to design prevention strategies for better control of such pandemics in future.

The impact of socioeconomic factors on the early postoperative complication rate after laparoscopic gastric bypass surgery: A register-based cohort study

BackgroundSocioeconomic factors may influence the outcome of certain surgical procedures, but it is not known whether such factors influence the risk for postoperative complication after bariatric surgery. ObjectivesDetermining whether different socioeconomic factors influence the risk for postoperative complication after laparoscopic gastric bypass surgery. SettingNationwide in Sweden. MethodsRetrospective register-based cohort study that includes all primary laparoscopic gastric bypass procedures in Sweden between 2010 and 2016, using data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, and the Swedish Population Register. Main outcome measures were occurrence and severity of early postoperative complications. ResultsIncluded in this study were 41,537 patients with 30-day follow-up percentage of 96.7%. Study groups with increased risk for postoperative complication (age, sex, body mass index, and co-morbidity adjusted–odds ratio with 95% confidence intervals) were as follows: being divorced, a widow, or a widower (1.14 [1.03–1.23]); receiving disability pension (1.37 [1.23–1.53]) or social assistance (1.22 [1.07–1.40]); and being first- (1.22 [1.04–1.44]) or second-generation (1.20 [1.09–1.32]) immigrant. In contrast, being single (.90 [.83–.99]), having higher disposable income (50th–80th percentile: .84 [.76–.93]; >80th percentile: .84 [.72–.98]), and living in a medium (.90 [.83–.98]) or small (.84 [.76–.92]) town were associated with lower risk. Increased risk for severe postoperative complication was seen for divorced, widowm, or widower (1.30 [1.12–1.52]) and those receiving disability pension (1.37 [1.16–1.61]) or social assistance (1.32 [1.08–1.62]), while higher disposable income (50th–80th percentile: .79 [.68–.92]; >80th percentile .57 [.46–.72]) was associated with lower risk. ConclusionSocioeconomic factors influence the risk for early postoperative complication after laparoscopic gastric bypass surgery. The impact is not enough to exclude patients from surgery, but they must be taken into account in preoperative risk assessment.

The Rise of Prevalence and the Fall of Mortality of Patients with Acute Renal Failure

Acute renal failure (ARF) remains one of the most enigmatic syndromes in nephrology, with reported incidence rates varying from 0.9 to 20% and mortality rates between 25 to 80% ([1][1]). There is little doubt that these discrepancies are caused by large differences in the definition of ARF ([2][2