Hospital-based Prospective Cohort Study Research Articles

Etiology, clinical characteristics, and risk factors associated with severe influenza-like illnesses in Mexican adults

ObjectiveThe aim of this study was to determine the risk factors associated with severe influenza-like illness (ILI) in Mexican adults that could be useful to clinicians when assessing patients with ILI. MethodsData from adult patients enrolled from 2010 through 2014 in ILI002 – a prospective hospital-based observational cohort study – were analyzed. Etiology and clinical characteristics were compared between cases of severe ILI (defined as hospitalization and/or death) and cases of non-severe ILI. ResultsOverall, 1428 (39.0%) out of a total 3664 cases of ILI were classified as severe. Adjusted analyses showed a higher risk of severe ILI associated with signs and symptoms related to lower tract infection, i.e. cough with sputum (odds ratio (OR) 2.037, 95% confidence interval (CI) 1.206–3.477; P = 0.008), dyspnea (OR 5.044, 95% CI 2.99–8.631; and shortness of breath (OR 5.24, 95% CI 3.0839.124; P < 0.001), and with increases in lactate dehydrogenase (OR 4.426, 95% CI 2.321–8.881; P < 0.001) and C-reactive protein (OR 3.618, 95% CI 2.5955.196; P < 0.001). Further, there was an increased risk of severe ILI with a longer time between symptom onset and inclusion (OR 1.108, 95% CI 1.049–1.172; P < 0.001) and with chronic steroid use (OR 14.324, 95% CI 8.059-26.216; P < 0.001). ConclusionsRespiratory viruses can cause severe ILI. The results of this study highlight the importance of evaluating data compatible with lower tract involvement and previous use of immunosuppressants at baseline, because patients meeting these conditions may develop severe illness.

Effect of one-to-one versus group counseling on uptake of postpartum contraception in selected hospitals in Ghana: A prospective cohort study.

To compare the effect of one provider to one client counseling and one provider to a group client counseling on the uptake of postpartum contraception. This was a hospital-based prospective cohort study among women attending a postpartum clinic at Korle-Bu Teaching Hospital and Greater Accra Regional Hospital. Postpartum mothers were recruited daily from April 1, 2017 to November 28, 2017. Mothers from this cohort that used a contraceptive method within a year postpartum were determined at 3, 6, 9, and 12 months after recruitment. A P value of less than 0.05 was considered statistically significant for all analyses. Of 982 women surveyed, contraceptive uptake among women who received one-to-one counseling was 306/600 (51.0%) and that for women who received group counseling was 48/382 (12.6%) (P< 0.001). Factors associated with contraceptive uptake during postpartum period were: one-to-one counseling (adjusted odds ratio [aOR] 7.05, 95% confidence interval [CI] 4.94-10.07), mothers' age (aOR 0.95, 95% CI 0.91-0.98), being single (aOR 0.54, 95% CI 0.35-0.85), cohabiting (aOR 0.39, 95% CI 0.22-0.69), and previous use of contraception (aOR 1.55, 95% CI 1.12-2.15). One-to-one counseling was associated with a significantly greater uptake of contraception during the postpartum period compared with group counseling. Other factors associated with uptake were age, marital status, and history of contraceptive use.

Prevalence of Deep Vein Thrombosis among COVID-19 Patients using Colour Doppler Ultrasound in a Tertiary Care Centre of Central India: A Prospective Cohort Study

Introduction: Acute respiratory disease, Coronavirus Disease 2019 (COVID-19) is an infectious and potentially fatal respiratory disease. Increase in the inflammatory response, hypoxia, immobilisation are suggested mechanisms of procoagulant state. Deep Vein Thrombosis (DVT) and pulmonary emboli are common and often silent. Venous duplex ultrasound help in determination of the presence, extent, age of the thrombus and its attachment to venous wall. Aim: To evaluate the prevalence of DVT by colour doppler ultrasound in lower limbs of mild to severe clinical categories of COVID-19 patients. Materials and Methods: A time-bound, hospital-based prospective cohort study was conducted in the Department of Radiodiagnosis, MY Hospital, Indore, Madhya Pradesh, India, between March 2021 and February 2022. Study comprised 2200 cases of COVID-19 positive patients with elevated D-dimer levels i.e., &gt;0.5 ng/mL and colour doppler imaging for lower limb. The clinical (co-morbidities, clinical severity) and radiological data (compressibility, colour flow) were studied and analysed using Statistical Package for the Social Sciences (SPSS) software version 25.0. Results: In the present study, there were 1144 (53%) males and 1056 (47%) females. Out of 2200 patients, 792 (36%) patients showed presence of DVT. The most prevalent age group was 36- 55 years having 506 (63.9%) patients. Majority of DVT positive patients were suffering with hypertension and diabetes i.e., 261 (33%) and 372 (47%) patients, respectively. Most commonly affected vein in DVT was Common Femoral Vein (CFV) in 704 (88.9%) patients. Superficial veins thrombosis was also associated with DVT affecting Short Saphenous Vein (SSV) in 439 (55.4%) patients and Great Saphenous Vein (GSV) in 221 (27.9%) patients. Conclusion: There was a high prevalence of DVT among COVID19 positive patients. Colour doppler ultrasound has provided an excellent aid in the diagnosis of DVT.

Acceptability, Safety and Compliance of Copper T 380A as a Postpartum Intrauterine Contraceptive Device Inserted via Vaginal or Intracaesarean Route: A Cohort Study

Introduction: Considering the high unmet need for family planning in India, especially in postpartum mothers, there is a necessity for reliable, long-term, highly efficacious, safe and reversible contraception like Intrauterine Device (IUD) in these women. Copper T 380A (CuT 380A) as a Postpartum Intrauterine Contraceptive Device (PPIUCD) can reduce maternal and perinatal mortality by decreasing unintended and closely spaced pregnancies in the postpartum period. Despite many advantages, the acceptability and utilisation of PPIUCD still remain very low due to lack of information about it. Aim: To determine the acceptance, safety, and efficacy of Copper T 380A; its association with socio-demographic factors and to compare the clinical outcomes between vaginal and intracaesarean insertions of this device. Materials and Methods: A hospital-based prospective cohort study was conducted in the Department of Obstetrics and Gynaecology, RG Kar Medical College and Hospital, Kolkata, India, from February 2021 to July 2021 among the cohort of 210 consecutive eligible postpartum mothers delivered either vaginally or by caesarean section. Primarily, acceptance rate was assessed. Postinsertion follow-up was done till six months after delivery to note various clinical outcomes and complications measuring safety of the device in terms of cramping pain abdomen, irregular vaginal bleeding, abnormal vaginal discharge, string problems, and perforation; compliance in terms of pregnancy and expulsion; and continuation of the device. All the follow-up results were compared between two modes of insertions. Comparison between categorical variables was done by Chi-square test. Results: Out of 210 counselled mothers, Copper T 380A insertions were done in 178 (84.8%) postpartum mothers. The acceptance rate was slightly higher in intracaesarean group (n=87, 85.3%). The mean±Standard Deviation (SD) age of acceptance of IUCD in partcipants was 25.59±4.06 years with the highest rate observed in the age group of 21-25 years (n=82, 46.1%). Acceptance of the device was significantly associated with multipara and the clients completed primary education (p-value &lt;0.05). On follow-up, overall complications are low. No case of perforation was reported. Significantly higher incidences of abnormal vaginal bleeding, foul smelling vaginal discharge, string problems, and expulsions were observed in the vaginal group (p-value &lt;0.05). Pregnancy was recorded in five (5.5%) clients and all of them were in the vaginal group. Out of 178 acceptors, compliance-continuation of the device was shown by 151 (84.8%), with significantly higher in the caesarean group (p-value &lt;0.000051). A significantly higher continuation rate was observed among the clients of low socio-economic status (p-value &lt;0.000207). Abdominal pain (33.33%) was reported to be the most common reason for discontinuation of Copper T 380A. Conclusion: Regardless of the mode of delivery, Copper T 380A is quite an acceptable, safe, effective, and convenient contraceptive method with a good continuation rate in the immediate postpartum period.

Assessment of 28-day survival of patients with sepsis based on vitamin D status: a hospital-based prospective cohort study in Indonesia.

sepsis is a potentially life-threatening condition caused by the body´s response to an infection. Recent studies have demonstrated a correlation between low vitamin D status and high mortality in septic patients. This study aims to evaluate the vitamin D status of septic patients at Dr. Sardjito Hospital and describe 28-day survival with very low vitamin D levels (< 8.1 ng/mL). this prospective cohort study was conducted in the intensive care unit and internal medicine ward at Dr. Sardjito Hospital in septic patients admitted between December 2018 and October 2019. Vitamin D [25(OH)D] was prospectively measured within 24 hours of admission. Data collection used SPSS software for statistical analysis. In addition, the sample size was calculated using the sample size formula used in a comparative survival study intended to find the incidence rate in septic patients. The minimum sample for each group is 23 samples. sepsis-related mortality was higher in patients with low vitamin D. The analysis included 88 septic patients during the study period. The mean age was 56.09 ± 16.82 years and the proportion of males was 46.6%. 26 of 28 patients with vitamin D levels < 8.1 ng/mL died (92.6%), whereas 39 of 60 patients with vitamin D levels ≥ 8.1 ng/mL (65%) died. Multivariate Cox regression analysis showed that vitamin D concentrations < 8.1 ng/mL at admission (p=0.01) and sepsis shock (p=0.02) were associated with increased sepsis mortality. The hazard ratio of 28-day mortality was 1.95 (95% CI 1.15-3.29, p=0.01) for vitamin D levels < 8.1 ng/mL. The average survival was 9 days for patients with vitamin D levels < 8.1 ng/mL (median: 6 days) compared with 14 days for those with vitamin D levels ≥ 8.1 ng/mL (median: 10 days). low serum vitamin D levels (< 8.1ng/mL) at admission were associated with increased 28-day mortality in septic patients.

Effect of Phototherapy on Transcutaneous vs Total Serum Bilirubin Level in Preterm Neonates- A Prospective Cohort Study

Introduction: Neonatal jaundice is one of the most common problems encountered in the first week after birth. Neonates who develop significant hyperbilirubinemia require phototherapy. Delay in the diagnosis and management of jaundice may lead to neonatal morbidity and mortality. Total Serum Bilirubin (TSB) estimation is considered the gold standard method. However, this invasive procedure causes pain, anxiety, and may lead to infection and iatrogenic anaemia, especially in preterm neonates. Transcutaneous Bilirubin (TcB) estimation, which measures bilirubin through the skin, has been proposed as an alternative screening method for hyperbilirubinemia in term and near-term neonates. Aim: To compare TcB to TSB in preterm neonates of 30-34 6/7 weeks gestational age before, during, and after phototherapy. Materials and Methods: This hospital-based prospective cohort study was conducted at SDMCMS&amp;H, Dharwad, Karnataka, India, between December 2019 and November 2020. A total of 100 preterm neonates between 30 to 34 6/7 weeks of gestation with clinically suspected jaundice were enrolled in the study. TSB was measured in the laboratory using the Diazo Method, while TcB was measured using the Drager jaundice meter JM 103. TcB and TSB were measured and compared in preterm neonates with clinically suspected jaundice before phototherapy, during phototherapy (8 to 12 hours after initiation), and after 12- 18 hours of discontinuation of phototherapy. The collected data was analysed statistically using the mean, standard deviation, dependent t-test, Karl Pearson’s correlation coefficient, and scatter plots. Results: This study enrolled 100 neonates diagnosed with neonatal jaundice, of which 57 were males and 43 were females, resulting in a male-to-female ratio of 1:1.3. Phototherapy was administered to neonates with TSB values, with 79% of the babies between 30-32 weeks and 21% between 32-34 weeks. In the present study, TcB and TSB were compared before, during, and after phototherapy, and the results were analysed, showing statistical significance. The mean TcB levels were 12.05, 9.66, and 7.23 before, during, and after phototherapy, respectively. The mean TSB levels were 11.28, 10.16, and 7.65 before, during, and after phototherapy, respectively. Based on Karl Pearson’s correlation coefficient, a positive correlation was found between TcB and TSB before (r=0.8319, p-value &lt;0.001), during (r=0.6069, p &lt;0.001), and after phototherapy (r=0.8154, p&lt;0.001). Conclusion: TcB values are comparable to TSB values and can be adopted as the standard method to measure bilirubin levels in preterm babies in a clinical setting.

Effect of Bilateral Salpingectomy versus Bilateral Tubal Ligation on Ovarian Reserve for Patients Seeking Permanent Sterilisation: A Prospective Cohort Study

Introduction: Ovarian cancer is a common malignancy in women with a high mortality rate, necessitating effective preventive measures. The American Cancer Society and the American College of Obstetricians and Gynaecologists, in their newer guidelines, suggest that patients undergoing tubectomy have an opportunity for the prevention of ovarian carcinoma by undergoing Prophylactic Bilateral Salpingectomy (PBS) instead of tubectomy in average-risk women. However, salpingectomy is not widely accepted as a method of sterilisation over tubectomy during caesarean section due to concerns about its potentially detrimental effect on ovarian reserve. Aim: To determine the effect of Bilateral Salpingectomy (BLS) and Bilateral Tubectomy (BLT) on ovarian reserve over a period of six months from surgery and to compare salpingectomy and tubectomy for their intraoperative and postoperative complications. Materials and Methods: The study is a hospital-based prospective cohort study conducted in the Department of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta, Assam, India, from Sept 2020 to Aug 2021, over a period of one year, involving women between 32-35 years undergoing sterilisation during caesarean section. Mean Antimullerian Hormone estimation was done preoperatively, at the 3rd month, and at the 6th month to assess changes in ovarian reserve following salpingectomy and tubectomy. Intraoperative blood loss, surgery time, surgical complications, postoperative complications, recovery period, histopathological study of the fallopian tube, etc., were analysed and compared between the two groups. All data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0. A p-value &lt;0.05 was considered statistically significant at a 5% confidence level. Results: A total of 114 patients were enrolled in the study, of which 9.64% dropped out midway, while the remaining 103 (90.36%) patients were part of the study until its completion. The mean age of the participants was 33 years and six months. There was no significant intergroup variation in preoperative, 3rd month, and 6th month mean Antimullerian Hormone (AMH) values (p&gt;0.05). However, in each group, the preoperative mean AMH was lower than its 3rd month and 6th month values, which were in the normal range. This was attributed to ovarian suppression during pregnancy, which normalised following delivery and showed an increasing trend thereafter. However, on average, salpingectomy required approximately 10 minutes more than tubectomy. Conclusion: Salpingectomy does not affect ovarian reserve in the short-term of six months. Other than being more timeconsuming compared to tubectomy, salpingectomy is on par with traditional tubectomy. Therefore, it may be adopted as a routine sterilisation method considering its role in the prevention of ovarian cancers.

Using Weibull model of survival analysis workflow and its relevant factors: A prospective cohort study

Objective: One of the most important indicators used in the evaluation of emergency centers is the chronometric analysis of patients’ workflow. The aim of this study was to provide a chronometric analysis of patients’ workflow (patients’ waiting time in the emergency department) and related factors. Methods: This hospital-based prospective cohort study was carried out in Khatam al-Anbia hospital in Shoushtar in 2020. Random sampling was used and patients referred to the emergency ward in three shifts based on the ESI 5-level triage system. The research tools were the emergency workflow chronometry form and a questionnaire of determining the factors related to the speed of emergency services and using a stopwatch. In order to analyse the data, Stata software version 16 and Weibull model of survival analysis were used. Results: Of 468 participants, the most common cause of referral was trauma with 21.7%. The median±interquartile range duration of giving the final result was 6.06±4.48 hours, which was more than 0.54 times shorter in clients with level 3. There was a statistically significant difference in the duration of making the final decision based on the request for testing, manner of referring and the type of initial diagnosis (P&lt;0.05). Conclusion: The duration of service provision in the studied hospital is appropriate for an Iranian hospital, but it should be closer to international standards. At level 2 triage, patients stayed longer. This can be reduced by lessening the time of consultations which can help the emergency ward.

A hospital-based prospective cohort study to assess the factors associated with transmission dynamics of SARS CoV-2 among healthcare workers in Delhi

Background: Healthcare personnel providing COVID-19 care are at increased risk of acquiring infection. Understanding the factors associated with the transmission of infection among healthcare workers provides input for the development of prevention strategies. The objectives of this study were to study the adherence to Infection Prevention and Control (IPC) measures followed between different categories of healthcare workers, to estimate seroconversion rate based on the type of exposure with COVID-19 patients, and to study the association between seroconversion and IPC practices. Methods: A prospective cohort study was conducted from December 2020 to June 2021 among the healthcare workers in two tertiary healthcare institutes selected by purposive sampling. All Healthcare workers (HCWs) participating in the clinical management or having any exposure to a laboratory-confirmed COVID-19 case were included. A total of 817 subjects were enrolled in the study. At baseline, details on IPC training and adherence along with details of the type of exposure with the COVID-19 patient were collected. The end-line visit was scheduled at 22-31 (preferably 28 days) days from the first visit for the collection of the symptom diary and end-line form. Results: Hand hygiene practices were found to be best among paramedics (98.0%), followed by doctors (84.5%) and nurses (90.1%). Maximum HCWs (99.5%; 99.8%; 97.1%) reported using Personal Protective Equipment (PPE) appropriately and regular availability of PPE in the hospital setting. Among the various categories of HCWs, nurses had the highest proportion (28.7%) of untrained personnel. Conclusion: The HCWs who had contact with the surroundings of an infected patient showed higher odds of seroconversion although not statistically significant. Further, analyzing the types of PPE used, we found that the use of masks and gloves was protective in preventing infection. Strengthening IPC training through refresher training and demonstrating the correct use of PPE can enhance adherence to IPC measures.

Association of triglyceride-glucose index with ischemic stroke recurrence in nondiabetic patients with small vessel occlusion: a multicenter hospital-based prospective cohort study

BackgroundTriglyceride-glucose (TyG) index is a simple and reliable surrogate marker of insulin resistance. Elevated TyG index was related to stroke recurrence. This study aimed to explore the associations between TyG index with ischemic stroke recurrence in nondiabetic patients with small vessel occlusion.MethodsFrom November 1, 2016 to February 28, 2021, consecutive acute ischemic stroke patients admitted within 1 week after onset were screened. The stroke mechanism was determined based on medical history, laboratory examinations, cardiac examinations, vascular examinations and neuroimaging. Nondiabetic patients with small vessel occlusion were enrolled and followed up for 1 year. The primary outcome was ischemic stroke recurrence. Logistic regression and Kaplan–Meier survival curve were used to analyze the association of the TyG index and stroke recurrence.ResultsA total of 6100 acute ischemic stroke patients were screened, with 1970 nondiabetic patients with small vessel occlusion included and divided into 4 groups according to the TyG index quartiles (Q1: < 8.20; Q2: 8.20–8.53; Q3: 8.54–8.92; Q4: > 8.92). There were significant differences in age, body mass index, systolic blood pression, diastolic blood pressure, lipid-lowering agents, infarct location, fasting blood glucose, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, uric acid, and stroke recurrence among the 4 groups. In the multi-adjusted models, compared to Q1 of the TyG index, the odds ratio for Q4 of the TyG index for stroke recurrence was 3.100 (1.366–8.019). The Kaplan–Meier survival (ischemic stroke-free) curves by quartiles of the TyG index also showed statistically significant differences (log-rank test, P = 0.004).ConclusionsOur findings suggested that the TyG index was associated with ischemic stroke recurrence in nondiabetic patients with small vessel occlusion, and it could be a valuable biomarker for assessing the risk of ischemic stroke recurrence in these patients.

Maternal diabetes and the role of neonatal reticulocyte hemoglobin content as a biomarker of iron status in the perinatal period.

We aimed to evaluate the effects of maternal diabetes on neonatal iron status, measuring erythrocyte indices including hemoglobin, hematocrit, reticulocytes, mean corpuscular volume (MCV), percent (%) hypochromia, ferritin, and additionally mean reticulocyte hemoglobin content (MCHr) as an early marker of iron deficiency, and examine the association between neonatal MCHr, red cell indices, and ferritin. We conducted a hospital-based prospective cohort study in a tertiary neonatal unit of a University Hospital from 2018 to 2020. We enrolled 126 maternal-infant pairs of mothers whose pregnancy was associated with diabetes and 74 maternal-infant pairs from uncomplicated pregnancies. Erythrocyte indices were analyzed within the first twelve hours after birth. Erythrocyte parameters were compared between infants of the diabetes and the non-diabetic group. We examined the correlation of the neonatal MCHr with perinatal characteristics, including gestation, birth weight, maternal body mass index, the erythrocytic indices, maternal diabetes, maternal obesity, prematurity, small-for-gestational-age status, maternal preeclampsia, and maternal anemia. Finally, we evaluated the discordance between neonatal MCHr and neonatal ferritin. Infants of the diabetes group had a significantly lower MCHr (32.6 pg vs. 34.2 pg, p=0.003) compared with infants of uncomplicated pregnancies. Neonatal MCHr was significantly correlated with maternal hypochromia (r=-0.237, p=0.004) and neonatal MCV (r=0.674, p<0.001). Neonatal MCHr was significantly associated with maternal diabetes [standardized coefficients 0.21, 95% confidence interval (CI) 0.05-0.58, p=0.003) and maternal preeclampsia (standardized coefficients 0.17, 95% CI 0.02-0.92, p=0.019), after adjusting for maternal anemia, maternal obesity, prematurity, and small-for-gestational-age status. Those results were consistent also when analyzing maternal-infant pairs with pre-existing diabetes, and maternal-infant pairs with gestational diabetes. There was significant discordance between neonatal MCHr and neonatal ferritin (p=0.001). MCHr was significantly lower in infants of mothers whose pregnancy was associated with diabetes compared with infants of non-diabetic mothers and correlated with neonatal and maternal red cell indices of iron deficiency. Since there was significant discordance between neonatal MCHr and ferritin during the first postnatal day, it is possible that MCHr could be used as a screening test for iron deficiency, especially in infants.

Relationship trajectories of pregnant women with their parents and postpartum depression: A hospital-based prospective cohort study in Japan.

A history of childhood abuse and subsequent poor relationship with parents in adulthood among pregnant women is a known risk factor for postpartum depression (PPD). Although parent-daughter relationship can change during pregnancy, little is known whether the trajectories have an impact on PPD. The aim of this study is to examine whether trajectories of parent-daughter relationship during pregnancy are associated with PPD in Japanese mothers. In a hospital-based prospective cohort study conducted in Japan, 4,772 women were followed from their first visit to their 1-month postpartum check-up (follow-up rate: 77.4%). Parent-daughter relationship was assessed whether participants were satisfied with their parents at first visit and after delivery. We defined four parent-daughter relationship trajectory categories: consistently satisfied, improving, deteriorating, and consistently unsatisfied. PPD was assessed by the Edinburgh Postnatal Depression Scale. Logistic regression model was applied to adjust covariates. There were 129 (2.7%), 122 (2.6%), and 181 (3.8%) cases of improving, deteriorating, and consistently unsatisfied relationship, respectively. Compared to the group that was consistently satisfied, pregnant women of the deteriorating and consistently unsatisfied group showed 2.81 (95% CI: 1.73-4.55) and 2.39 (95% CI: 1.58-3.62) times, respectively, more likely to show PPD after adjustment for confounders. Women who felt that their relationship with parents "deteriorated" or was "consistently unsatisfactory" during pregnancy showed significant risk of PPD. Paying attention to the pregnant women's feelings about the relationship with their parents and promoting positive change may help predict and prevent PPD.

Incidence and predictors of acute kidney injury among women with severe pre-eclampsia at Mbarara Regional Referral Hospital

BackgroundThe presence of acute kidney injury (AKI) in pre-eclampsia complicates treatment including; increasing length of hospital stay and a need to access services like dialysis which are largely expensive in resource-limited settings. We aimed to determine incidence and predictors of acute kidney injury among women with severe pre-eclampsia at Mbarara Regional Referral Hospital in southwestern Uganda.MethodsWe carried out a hospital-based prospective cohort study from 16 November 2018 to 18 April 2019, among pregnant women with severe pre-eclampsia followed up in the hospital. We enrolled 70 mothers with severe pre-eclampsia and eclampsia; we excluded patients with a history of chronic kidney disease, chronic hypertension, and gestational hypertension. Data on socio-demographics, laboratory parameters, health system, obstetric and medical factors were collected. Baseline serum creatinine, complete blood count, and CD4 T-cell count were all done at admission (0-hour). A second serum creatinine was done at 48-hours to determine the presence of AKI and AKI was defined as a relative change of serum creatinine value at least 1.5 times the baseline (i.e., at admission) within 48 h. The proportion of women diagnosed with acute kidney injury among the total number of women with severe pre-eclampsia was reported as incidence proportion. Univariate and multivariate logistic regression was used to establish the association between acute kidney injury and severe pre-eclampsia.ResultsIncidence of acute kidney injury was high (42.86%) among women with severe pre-eclampsia. Antenatal care attendance was protective with an odds ratio of 0.14 (0.03, 0.73), p-value 0.020 at bivariate analysis but had no statistical significance at multivariate analysis. Eclampsia was an independent risk factor for acute kidney injury. (aOR 5.89 (1.51, 38.88), p-value 0.014.ConclusionThe incidence of acute kidney injury in patients with severe pre-eclampsia is high. Eclampsia is an independent risk factor of acute kidney injury. The findings of this study highlight the urgent need for more research and better perinatal care for these women.

Risk factors and clinical features in young patients with myocardial infarction: A cross-sectional study

Background: Changes in lifestyle with increased sedentary lifestyle are associated with its consequences such as obesity, metabolic syndrome, hypertension, diabetes, and eventually myocardial infarction (MI). Coronary artery diseases (CADs) although have been commonly seen in elderly individuals it’s now being increasingly recognized in a relatively younger age group (&lt;45 years). The present study was aimed at analyzing risk factors and clinical presentation of MI in young (&lt;45 years). Aims and Objectives: The aims of this study were to study risk factors and clinical profile of young patients with MI. Materials and Methods: This was a hospital-based prospective cohort study, in which 60 young patients (age &lt;45 years) of age were included on the basis of a predefined inclusion and exclusion criteria. A thorough history was obtained and detailed general and cardiovascular examination was done. Electrocardiogram, basic hematological profile, and 2 D echo were done in all cases. Clinical profile, site of infarction, and severity of systolic dysfunction were studied. P&lt;0.05 was taken as statistically significant. Results: A total of 60 patients were studied. Out of these 60 cases, there were 48 (80%) males and 12 (20%) females with a M: F ratio being 1:0.25. Although the mean age of female patients (40.25±3.44 years) was more than male patients (38.62±4.43 years), the difference was not found to be statistically significant (P&gt;0.05). Obesity, family history of CADs, smoking, dyslipidemia, hypertension, and diabetes were common risk factors in studied cases. Majority of the patients (81.67%) presented with typical chest pain radiating to left arm. The atypical clinical features were seen in 11 (18.33%) patients. In m ost of the patients (63.33%) there was anterior wall infarction. Inferior wall infarction and anteroseptal MI were seen in 12 (20%) and 10 (16.67%) patients, respectively. Conclusion: MI in young patients is increasing. Majority of the risk factors associated with MI in young patients are modifiable risk factors. A high index of suspicion is necessary in diagnosing these patients in time particularly in cases, where there is atypical presentation.

Aetiologies and clinical presentation of central nervous system infections in Vietnamese patients: a prospective study

Knowledge of the clinical presentation of central nervous system (CNS) infections and the causative pathogens is crucial for appropriate diagnosis and rapid initiation of appropriate treatment to prevent severe neurological sequelae. The aim of this study is to understand the aetiology of CNS infections based on the clinical presentation of Vietnamese patients. A prospective hospital-based cohort study was conducted between May 2014 and May 2017. We screened 137 patients with clinically suspected CNS infection for fungal, bacterial and viral pathogens using their cerebrospinal fluid (CSF) and blood cultures. In addition, DNA or RNA extracted from CSF samples were subjected to nucleic acid testing (NAT) with a selective panel of bacterial, viral and fungal pathogens. At least one pathogen could be detected in 41% (n = 56) of the patients. The main pathogens causing CNS infections were Streptococcus suis (n = 16; 12%) and Neisseria meningitidis (n = 9; 7%), followed by Herpes simplex virus 1/2 (n = 4; 3%) and Klebsiella pneumoniae (n = 4; 3%). Other pathogens were only identified in a few cases. Patients with bacterial CNS infections were significantly older, had a worse outcome, a lower Glasgow Coma Scale (GCS), a higher rate of speech impairment and neck stiffness than patients with viral or tuberculous CNS infections. In northern Vietnam, adults are mostly affected by bacterial CNS infections, which have a severe clinical course and worse outcomes compared to viral or tuberculous CNS infections. Clinicians should be aware of the regional occurrence of pathogens to initiate rapid and appropriate diagnosis and treatment.

Effect of prior Zika and dengue virus exposure on the severity of a subsequent dengue infection in adults

Given the structural similarity between Zika and dengue viruses, prior infection from one virus is hypothesized to modulate the severity of a subsequent infection from the other virus. A previous paediatric cohort study observed that a prior Zika infection may increase the risk of a subsequent symptomatic or severe dengue infection. The Colombo Dengue study is a prospective hospital-based cohort study in Sri Lanka that recruits symptomatic adult dengue patients within the first three days of fever. Anti-Dengue Envelope and anti-Zika NS1 IgG antibodies were tested by ELISA (Euroimmun, Lubeck, Germany) in all recruited patients. Associations between pre-morbid seroprevalence for either or both infections and adverse clinical outcomes of the current dengue infection were explored. A total of 507 dengue infected patients were assessed of whom 342 (68%) and 132 (26%) patients had anti-dengue IgG and anti-Zika IgG respectively. People with combined prior dengue and zika exposure as well as prior dengue exposure alone, were at increased risk of plasma leakage, compensated and uncompensated shock, and severe dengue (p < 0·05), compared to people without prior exposure to either infection. The effect of prior Zika exposure alone could not be established due to the small the number of primary dengue infections with prior Zika exposure.

Case fatality rate and its determinants among admitted stroke patients in public referral hospitals, Northwest, Ethiopia: A prospective cohort study.

According to the global burden of disease 5.5 million deaths were attributable to stroke. The stroke mortality rate is estimated to be seven times higher in low-income countries compared to high-income countries. The main aim of the study was to assess the 28 days case fatality rate and its determinants among admitted stroke patients in public referral hospitals, in Northwest Ethiopia. A hospital-based prospective cohort study was conducted from December 2020 to June 2021. The study population was 554 stroke patients. Based on Akakian Information Criteria, the Gompertz model was fitted to predict the hazard of death. The study included admitted stroke patients who were treated in the general medical ward and neurology ward. The mean age of the participants was 61 ± 12.85 years and 53.25% of the patients were female. The 28-days case fatality rate of stroke was 27.08%. The results from Gompertz parametric baseline hazard distribution revealed that female sex adjusted hazard rate (AHR = 0.27, 95% CI:0.18-0.42), absence of a family history of chronic disease (AHR = 0.50, 95%CI:0.29-0.87), good GCS score (AHR = 0.21, 95% CI:0.09-0.50) and the absence of complication during hospital admission (AHR = 0.16, 95% CI:0.08-0.29) were factors which decrease hazard of 28 days case fatality rate. While, hemorrhagic stroke sub-type (AHR = 1.38, 95% CI:1.04-3.19), time from symptom onset to hospital arrival (AHR = 1.49, 95% CI:1.57-2 .71), time from confirmation of the diagnosis to initiation of treatment (AHR = 1.03, 95% CI:1.01-1.04), a respiratory rate greater than 20 (AHR = 7.21, 95% CI:3.48-14.9), and increase in NIHSS score (AHR = 1.16, 95% CI:1.10-1.23) were factors increasing hazard of 28 days case fatality rate of stroke. At 28-days follow-up, more than one-fourth of the patients have died. The establishment of separate stroke centers and a network of local and regional stroke centers with expertise in early stroke evaluation and management may address challenges.

Predictors of recurrence of chronic subdural haematoma in a cohort study of patients presenting in a sub-Saharan African teaching hospital

BackgroundChronic subdural haematoma (CSDH) is a common neurological condition affecting the elderly with decreased quality of life. Recurrence leads to increase in number of hospital admissions and surgical interventions. Several factors contribute to recurrence of chronic subdural haematoma, and determination of these factors will help institute measures to reduce recurrence of CSDH, cost of care and improved quality of life. The aim of this study was to determine the predictors of recurrence of chronic subdural haematoma in a cohort of patients presenting in a Sub-Saharan African Teaching Hospital.MethodsA prospective hospital-based cohort study of 62 participants who presented with CSDH and underwent burr-hole and drainage at the Neuroscience unit of the Korle-bu Teaching Hospital. The primary outcome of this study was the recurrence of CSDH within 3 months after the surgery. Data was entered into Microsoft Excel 2016 and exported to International Business Machine (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0 for analysis. Predictors of recurrence of CSDH were determined using logistic regression with odds ratio calculated at the 95% confidence level and a p-value less than 0.05 accepted as statistically significant.ResultsThere was a male preponderance of 45 (72.6%), over females of 17 (27.4%). The mean age was 63.1 ± 13.6 years. The recurrence rate of CSDH was 21.0% whilst the mortality rate was 4.8%. Facial palsy and dysphasia were associated with the recurrence of CSDH (p = 0.045, 0.029). Hypertension and bilaterality were associated with recurrence of CSDH from a univariate analysis (p = 0.039, OR = 4.865, CI = 0.975–24.285; p = 0.005, OR = 5.979, CI = 1.585–22.557). In a multivariate logistic regression analysis, bilaterality was the only independent predictor of recurrence of CSDH (p = 0.030, AOR = 5.47, CI = 1.18–25.34).ConclusionsBoth hypertension and bilaterality showed statistically significant association with recurrence of CSDH. However, only bilaterality proved to be an independent predictor of recurrence of CSDH in patient who underwent burr-hole and drainage.

Perinatal outcomes and maternal complications at a county referral hospital in Kenya

Introduction/Aims Maternal complications during pregnancy and labour are a leading cause of global maternal and neonatal mortality. Despite efforts by the Kenyan Government, the mortality rate in the country is now 22 neonatal deaths per 1000 live births. This study's aims were to observe and compare perinatal outcomes of newborns from women with and without maternal complications. Methods This was a prospective hospital-based paired cohort study of 510 pregnant women, 102 of whom presented with complications. Follow up took place up to 28 days after birth, at which point 132 women with complications and 364 women without complications completed the study (some women developed complications after initial recruitment and crossed over to the complications group). Data were gathered on obstetric characteristics and perinatal outcomes using a structured, researcher-administered questionnaire. Differences between the two groups (with and without complications) in terms of obstetric data were compared using Pearson's Chi-squared test. Associations between complications and obstetric characteristics were tested using relative risk. Results Almost all obstetric characteristics showed significant differences between groups, with the exception of a history of poor obstetric outcomes and known contracted pelvis. A mother with complications was more likely to have a newborn with a low Apgar score (relative risk 8.000, P&lt;0.001), low birth weight (relative risk: 1.838, P&lt;0.001), prematurity (relative risk 9.652, P&lt;0.001), admission to the newborn unit (relative risk 8.000, P&lt;0.001), complications after 28 days (relative risk: 2.186, P=0.017) and admission after 28 days (relative risk: 4.892, P=0.006). Mothers with complications were also more likely to have given birth by caesarean section (relative risk: 13.893, P&lt;0.001). Conclusions The newborns born to women who experienced maternal complications were at a higher risk of poor perinatal outcomes compared to those born to women without maternal complications at the Kitui County Referral Hospital. Newborn care should be scaled up to deal with the most difficult cases brought about by maternal complications. Rural facilities should be well equipped to be able to deal with poor outcomes in newborns.

A hospital-based prospective cohort study to assess the factors associated with transmission dynamics of SARS CoV-2 among healthcare workers in Delhi

Background: Healthcare personnel providing COVID-19 care are at increased risk of acquiring infection. Understanding the factors associated with the transmission of infection amongst healthcare workers provides input for the development of prevention strategies. The objectives of this study were to study the adherence to Infection Prevention and Control (IPC) measures followed between different categories of healthcare workers, to estimate seroconversion rate based on the type of exposure with COVID-19 patients and to study the association between seroconversion and IPC practices. Methods: A prospective cohort study was conducted from December 2020 to June 2021 among the healthcare workers in two tertiary healthcare institutes selected by purposive sampling. All Healthcare workers (HCW) participating in the clinical management or having any exposure to a laboratory-confirmed COVID-19 case were included. A total of 817 subjects were enrolled in the study. At baseline, details on IPC training and adherence along with details of the type of exposure with the COVID-19 patient were collected. The end-line visit was scheduled at 22-31 (preferably 28 days) days from the first visit for the collection of the symptom diary and end-line form. Results: Hand hygiene practices were found to be best among paramedics (98.0%), followed by doctors (84.5%) and nurses (90.1%). Maximum HCWs (99.5%; 99.8%; 97.1%) reported using Personal Protective Equipment (PPE) appropriately and regular availability of PPE in the hospital setting. Among the various categories of HCWs, nurses had the highest proportion (28.7%) of untrained personnel. Conclusion: The HCWs who had contact with the surroundings of an infected patient showed higher odds of seroconversion although not statistically significant. Further, analyzing the types of PPE used, we found that the use of masks and gloves were protective in preventing infection. Strengthening IPC training through refresher training and demonstrating the correct use of PPE can enhance adherence to IPC measures.