Prevalent Cohort Study Research Articles

Severe hypocalcemia in the emergency department: a retrospective cohort study of prevalence, etiology, treatment and outcome.

The aim of this study was to evaluate the prevalence of severe hypocalcemia in patients attending the emergency department. Symptoms, causes, treatment, and outcome of severe hypocalcemia as well as course of calcium concentrations were assessed. This retrospective case series included all adult patients with measurements of serum calcium concentrations presenting to the emergency department of the Bürgerspital Solothurn between January 01 in 2017 and December 31 in 2020. Medical record reviews were performed of all patients with severe hypocalcemia, defined by a serum calcium concentration < 1.9mmol/L, to assess clinical presentation and management. 1265 (3.95%) patients had a serum calcium concentration of < 2.1mmol/L of which 139 (11%) had severe hypocalcemia of < 1.9mmol/L. 113 patients had at least one measurement of albumin. Of these, 43 (3.4%) had an albumin-corrected serum calcium < 1.9mmol/L defining true, severe hypocalcemia. Hypocalcemia was identified and documented in 35% of all cases. The mean serum calcium concentration was 1.74 ± 0.14mmol/L. Calcium concentrations in malignancy-related hypocalcemia were similar to non-malignancy-related hypocalcemia. The main symptoms attributed to hypocalcemia were cardiac and neurologic. 12% of patients with severe hypocalcemia received intravenous and 23% oral calcium replacement. Active malignancy was the main cause of severe hypocalcemia in 28%, while in most cases, the main cause remained unclear. 41.9% of severely hypocalcemic patients reattended the emergency department for another episode of hypocalcemia within 1 year. Hypocalcemia is common in patients attending the emergency department, however, appears to be neglected frequently. The disorder is often a manifestation of severe disease, triggered by multiple causes. Calcium replacement was administered in less than half of the patients with severe hypocalcemia in this study. Due to frequent readmissions to the emergency department and a high mortality, increased awareness of the disorder and careful follow-up are desirable.

Informal judgement of delirium status underestimates delirium prevalence: World Delirium Awareness Day point prevalence results from Ireland

Introduction Delirium is an encephalopathy characterized by acute onset, fluctuation, and prominent deficits in attention and alertness, due to one or more physical disorders, interventions or medications. It is associated with increased mortality and morbidity, and with incidence and worsening of dementia; thus, delirium prevention and timely detection and appropriate management are crucial. Objective This study aimed to determine delirium prevalence in Irish clinical sites. Methods The overall study was an observational, cohort study of the point prevalence of delirium (and current delirium practice) in multiple clinical sites on a single day (i.e. World Delirium Awareness Day, March 2023). In this study, the point prevalence of delirium is reported in Irish sites. Results In total, 132 wards from 15 hospitals across Ireland participated in this study, including general medical, surgical and specialised wards, and some long-term care and rehabilitation wards. Overall, 27% of patients on wards which reported using a formal tool had not been assessed for delirium. Delirium prevalence, using a formal assessment tool, was 15.9% overall, with the highest rate in geriatric wards (20.5%). However, on wards where ‘personal judgment’ to detect delirium was utilized, the prevalence rate was 11.5%, implying that delirium may have been under-detected on these wards. Conclusions Delirium screening can quickly rule out delirium or lead to more formal assessment where screening is positive or equivocal. Delirium is prevalent in Irish hospitals and appears to be under-detected unless a formal screening tool is used; equally, delirium screening is not universally applied on wards reporting that they use a formal tool. Together, this indicates that delirium is still under-diagnosed in Irish hospitals.

Comparative Effectiveness of Long-Acting Injectable Versus Oral Antipsychotics in Patients With Schizophrenia Using the Prevalent New User Design and Subgroup Analyses.

We compared the effectiveness of long-acting injectable antipsychotics (LAIs) and oral antipsychotics (OAs) in treating schizophrenia, focusing on whether the benefits of LAIs over OAs are evident even in the prevalent new user design and on effect heterogeneity. We conducted a prevalent new user cohort study using 2 administrative claims databases in Japan. We included patients with schizophrenia initiated on LAIs and propensity score-matched patients on OA. We compared the risks of psychiatric hospitalization and treatment discontinuation based on hazard ratios (HRs) using the Cox proportional hazards model. Effect heterogeneity was evaluated using subgroup analyses. In total, 2520 patients using LAI and OA were identified as matched cohorts. Long-acting injectable antipsychotics were associated with a higher psychiatric hospitalization risk than OAs (HR, 1.41; 95% confidence interval [CI], 1.06-1.88) in the entire population; however, LAIs were associated with lower risk in the group with a low proportion of days covered and psychiatric hospitalization history (HR, 0.51; 95% CI, 0.30-0.89). Long-acting injectable antipsychotics were associated with a lower risk of treatment discontinuation than OAs (HR, 0.76; 95% CI, 0.66-0.87) in the entire population; in the subgroup analyses, a consistent trend was observed in all strata (LAIs had a lower risk). Using a prevalent new user design, this study confirmed that LAIs have an advantage regarding treatment continuity. Long-acting injectable antipsychotics had higher psychiatric hospitalization risk than OAs in the entire population; however, this study suggested the presence of effect heterogeneity due to psychiatric hospitalization history.

Determining sample sizes for combined incident and prevalent cohort studies with and without follow-up

Determining sample sizes for combined incident and prevalent cohort studies with and without follow-up

Doubly robust estimation under covariate-induced dependent left truncation

Summary In prevalent cohort studies with follow-up, the time-to-event outcome is subject to left truncation leading to selection bias. For estimation of the distribution of the time to event, conventional methods adjusting for left truncation tend to rely on the quasi-independence assumption that the truncation time and the event time are independent on the observed region. This assumption is violated when there is dependence between the truncation time and the event time, possibly induced by measured covariates. Inverse probability of truncation weighting can be used in this case, but it is sensitive to misspecification of the truncation model. In this work, we apply semiparametric theory to find the efficient influence curve of the expectation of an arbitrarily transformed survival time in the presence of covariate-induced dependent left truncation. We then use it to construct estimators that are shown to enjoy double-robustness properties. Our work represents the first attempt to construct doubly robust estimators in the presence of left truncation, which does not fall under the established framework of coarsened data where doubly robust approaches were developed. We provide technical conditions for the asymptotic properties that appear to not have been carefully examined in the literature for time-to-event data, and study the estimators via extensive simulation. We apply the estimators to two datasets from practice, with different right-censoring patterns.

Association between proton pump inhibitors use and risk of asthma in Korea: A prevalent new-user cohort study.

There have been conflicting mechanisms that proton pump inhibitors (PPIs) may promote or prevent asthma development. However, the evidence on the association of PPI use with the risk of asthma and its exposure-response relationship has been limited. We aim to identify the association between the use of PPIs and the incidence of asthma, compared with use of histamine 2 receptor antagonists (H2RAs). A nationwide, prevalent new-user cohort study was conducted using Korea's National Sample Cohort database. Patients were defined as PPI or H2RA users between 2003 and 2019. PPI users matched to H2RA users based on time-conditional propensity score. Cox proportional hazards model was used to estimate adjusted hazard ratios with 95% confidence intervals of incident asthma associated with PPI use by duration of use, cumulative dose, and average dose per duration. Among the 250,041 pairs, PPI users (51.3% male; mean [SD] age, 42.6 [16.5]; mean follow-up, 6.7 years) showed a higher incidence rate of asthma (7.94 events per 1000 person-year) compared to H2RA users (3.70 events per 1000 person-year) with adjusted hazard ratio of 2.15 (95% confidence interval = 2.08-2.21). The risk of asthma was significantly increased across all observed groups of duration of use, cumulative dose, and average dose per duration. This study suggested that PPI use is associated with an increased risk of developing asthma compared to H2RA use.

A retrospective cohort study of myocarditis prevalence and diagnosis in Al‐Baha region, Saudi Arabia

Background: Carditis describes heart inflammation with a variety of symptoms ranging from mild chest pain to cardiac shock or even sudden death. Myocarditis will result in heart failure (HF) in around 12%–17% of adults, with a death rate of approximately 8.4/100,000. The causatives of myocarditis include viral, bacterial, fungal, and protozoan infections. Aims: This retrospective cohort study aimed to statistically analyze the prevalence and diagnosis of myocarditis and other cardiovascular diseases (CVDs) among admitted patients to Al-Baha Hospitals in Saudi Arabia. Setting and Design: The study involved 384 patients diagnosed with CVDs at Al-Baha Hospital between January 2017 and December 2022. Statistical Analysis and Results: Overall, patients’ ages ranged from 25 to 94 years, averaging 59 ± 14. The majority of patients with different CVDs were aged between 41 and 70 years (69% myocardial infarction (MI), 48% HF, and 56% heart block). Most of the patients were male (80%), and 90% of the participants were Saudis. The incidence of CVDs showed a gradual increase between 2017 and 2019 and a dramatic increase in 2020 and 2022 compared to other years. The analysis included the most common laboratory markers aimed for the diagnosis. The result of the study showed an increase in lactate dehydrogenase (91%), creatine kinase (CK) (95%), CK-myocardial band (93%), aspartate aminotransferase (94%), and white blood cells (89%) of the patients who were diagnosed with MI compared to the other CVDs. Conclusions: It is important to note that while electrocardiogram, complete blood count, and cardiac profile form the core of the diagnostic protocol, additional diagnostic measures may be considered depending on the specific circumstances.

IDENTIFYING AND PREVENTING RESIDENT-TO-RESIDENT AGGRESSION IN LONG-TERM CARE: EMERGING GLOBAL PERSPECTIVES

Abstract Resident-to-resident aggression (RRA) is a widespread form of mistreatment in long-term care facilities, affecting 1 in 5 residents every month. Despite its high frequency and adverse consequences for residents, staff, and family members, RRA remains under-recognized and insufficiently studied. Several reasons exist for this, including challenges in obtaining high-quality data to inform evidence-based prevention and intervention strategies. Improved understanding of RRA aligns with recent national policy imperatives to increase nursing home safety and quality of care. To accelerate knowledge-to-practice translation, this symposium highlights expertise from North America and Asia to review the latest evidence and experiences that characterize and improve RRA. Dr. E-Shien Chang will identify the role of racial and ethnic conflicts in RRA using data from the largest RRA prevalence cohort study of U.S. nursing home residents. Dr. Elsie Yan will examine resident and environment risk factors of RRA in Hong Kong, illustrating the needs for improved dementia care training among direct care workers. Dr. David Burnes will discuss barriers, successes, and lessons learned in replicating and adapting a gold standard U.S. based RRA prevalence study in the unique context of Canada. Dr. Karl Pillemer will describe a novel dissemination model to expand program reach of Improving Resident Relationships in Long Term Care (IRRL), an evidence-based RRA intervention program. Finally, Dr. Laura Mosqueda, as policy expert of long-term care services and discussant, will moderate a discussion on translating RRA research to practice and policy changes within the global contexts of long-term care. This is a collaborative symposium between the Abuse, Neglect and Exploitation of Older Persons and Research in Quality of Care Interest Groups.

JAK-inhibitors and risk on serious viral infection, venous thromboembolism and cardiac events in patients with rheumatoid arthritis: A protocol for a prevalent new-user cohort study using the Danish nationwide DANBIO register.

Janus Kinase inhibitors (JAKis) are targeted synthetic disease-modifying antirheumatic drugs and represent an important alternative to treat patients with moderate to high rheumatoid arthritis (RA) disease activity. Safety concerns associated with increased risk for venous thromboembolism (VTE), serious viral infection, and, more recently, major adverse cardiovascular events (MACE) in JAKi users have emerged worldwide. However, as the exact mechanisms to explain these safety concerns remain unclear, the increased risk of VTE, MACE, and serious viral infection in JAKi users is heavily debated. In light of the need to enrich the safety profile of JAKis in real-world data, we aim to quantify the incidence and risk of MACE, VTE, and serious viral infections in RA patients registered in the Danish DANBIO registry, a nationwide registry of biological therapies used in rheumatology. Therefore, we will conduct a population-based cohort study using a prevalent new-user design. We will identify all RA patients in the DANBIO, ≥ 18 years old, receiving a JAKi or a tumor necrosis factor α inhibitor (TNF-αi) from January 2017 to December 2022. Prevalent and new users of JAKis will be matched to TNF-αi comparators with similar exposure history using time-conditional propensity scores (TCPS). We will describe the cumulative incidence of the outcomes (VTE, MACE, serious viral infection) in each exposure group (JAKi users; TNF-αi users), stratified by outcome type. Additionally, the Aalen-Johansen method will be used to estimate the time-to-event survival function stratified by outcome type. We will also estimate the hazard ratio (HR) with 95% confidence interval (CI) of each outcome in both exposure groups using the time-dependent Cox proportional hazards model. Results will enrich the safety profile of JAKis in real-world data.

P105 Mode of hospital rheumatology appointments in people with rheumatoid arthritis: the impact of the pandemic in England

Abstract Background/Aims During the COVID-19 pandemic rheumatology services were advised to limit face to face contact, with remote telemedicine used instead. Although suitable for some people, issues have been highlighted with telemedicine. The frequency and proportion of remote appointments during the pandemic has not been described, or the socio-demographic characteristics of those accessing remote or in-person rheumatology care. This study aims to describe rheumatology healthcare utilisation and mode of appointment (remote/in-person) in people with rheumatoid arthritis (RA), prior to, and during the pandemic in England. Methods A retrospective prevalent cohort study of people with RA, identified using a validated algorithm, as of 1st April 2019 using electronic health record data (OpenSAFELY). Outpatient rheumatology appointments between 1st April 2019 and 31st March 2022 were identified. For each year, the number of outpatient appointments, mode of appointment (remote/in-person) and patient socio-demographic characteristics were described. Results 130,884 people with RA were identified. Since the start of the pandemic, the proportion of people without any appointments in a 12-month period increased from 28.5% in 2019/20 to 33.3% in 2020/21 and has not recovered. Older people were most frequently not seen (51% of people &amp;gt;80 years in 2020/21 and 2021/22). Of appointments where mode was known, 54.4% of people with appointments in the year from April 2020 were only seen remotely, reducing to 35.1% in the year from April 2021 (Table 1). The proportion with all remote appointments increased with increasing age, comprising 62% of people &amp;gt;80 years in 2020. This age gradient persisted in 2021, though proportions of those &amp;gt;80 years with all-remote appointments was lower (44%). Compared to urban dwellers, a higher proportion of those living in rural areas had all remote appointments in 2020 (58% vs 53%) and 2021 (38% vs 34%). Conclusion During the pandemic, one third of people with RA were not seen at all over a 12-month period and these were more frequently older people. Over half of people were only seen remotely in 2020, decreasing to one-third in 2021. Given the limitations of remote appointments it is unknown whether this increased frequency of remote appointments will impact long-term outcomes. Disclosure R.E. Costello: Shareholder/stock ownership; AstraZeneca. R.J. Hollick: None. M. Parker: None. J. Kennedy: None. B. Mackenna: None. S. Brophy: None. L. Tomlinson: None. J.H. Humphreys: None.

Long COVID in Cancer: A Matched Cohort Study of 1-year Mortality and Long COVID Prevalence Among Patients With Cancer Who Survived an Initial Severe SARS-CoV-2 Infection.

The long-term effects of severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) infection in patients with cancer are unknown. We examined 1-year mortality and prevalence of long COVID in patients with and without cancer after initial hospitalization for acute COVID-19 infection. We previously studied 585 patients hospitalized from March to May 2020 with acute COVID-19 infection at Weill Cornell Medicine (117 patients with cancer and 468 age, sex, and comorbidity-matched non-cancer controls). Of the 456 patients who were discharged, we followed 359 patients (75 cancer and 284 non-cancer controls) for COVID-related symptoms and death, at 3, 6, and 12 months after initial symptom onset. Pearson χ 2 and Fisher exact tests were used to determine associations between cancer, postdischarge mortality, and long COVID symptoms. Multivariable Cox proportional hazards models adjusting for potential confounders were used to quantify the risk of death between patients with and without cancer. The cancer cohort had higher mortality after hospitalization (23% vs 5%, P < 0.001), a hazard ratio of 4.7 (95% CI: 2.34-9.46) for all-cause mortality, after adjusting for smoking and oxygen requirement. Long COVID symptoms were observed in 33% of patients regardless of cancer status. Constitutional, respiratory, and cardiac complaints were the most prevalent symptoms in the first 6 months, whereas respiratory and neurological complaints (eg, "brain fog" and memory deficits) were most prevalent at 12 months. Patients with cancer have higher mortality after hospitalization for acute severe acute respiratory syndrome coronavirus 2 infections. The risk of death was highest in the first 3 months after discharge. About one-third of all patients experienced long COVID.

Mean residual life cure models for right-censored data with and without length-biased sampling.

We propose a semiparametric mean residual life mixture cure model for right-censored survival data with a cured fraction. The model employs the proportional mean residual life model to describe the effects of covariates on the mean residual time of uncured subjects and the logistic regression model to describe the effects of covariates on the cure rate. We develop estimating equationsto estimate the proposed cure model for the right-censored data with and without length-biased sampling, the latter is often found in prevalent cohort studies. In particular, we propose two estimating equationsto estimate the effects of covariates in the cure rate and a method to combine them to improve the estimation efficiency. The consistency and asymptotic normality of the proposed estimates are established. The finite sample performance of the estimates is confirmed with simulations. The proposed estimation methods are applied to a clinical trial study on melanoma and a prevalent cohort study on early-onset type 2 diabetesmellitus.

A Prospective Cohort Study of Psoriatic Arthritis Prevalence in a Serbian Patients with Psoriasis

Objective: The aim of this study was to determine the incidence and prevalence of psoriatic arthropathy and to point out the problem of their occurrence in a sample of patients diagnosed with psoriasis. Methods: 109 patients with diagnosed psoriasis and psoriatic arthropathy, took part in the survey. The average age of patients was 48,85±10,11. We analyzed the incidence and prevalence of the psoriatic arthropathy occurrence for the patients with psoriasis. Results: Psoriatic arthropathy registered with patients were those with arthritic changes on: sacroiliac joints with 24 (22,02%) patients, 19 (79,17%) male and 5 (20,83%) female (p&lt;0,001); spine with 11 (10,09%) patients, 6 (54,56%) male and 5 (45,45%) female (p=0,578); peripheral joints with 74 (67,89%) patients, 33 (44,59%) male and 41 (55,41%) female (p&lt;0,01). When comparing the symptoms, most of the patients (63,30%) skin changes were represented before arthritis, for 27,52% patients arthritis preceded the skin changes, and for 9,17% patients the changes were simultaneous, Conclusion: Psoriatic arthropathy occurs more often in median age (31 to 50 years old) and it is more common for men than women. For most patient’s psoriatic skin changes preceded joints affection, with the most common ones being polyarthritis.

Mitigation behavior prior to COVID-19 vaccination availability is associated with COVID-19 infection and time to vaccination.

Mitigation behaviors reduce the incidence of COVID-19 infection. Determining characteristics of groups defined by mitigation behaviors compliance may be useful to inform targeted public health policies and interventions. This study aimed to identify groups of individuals according to self-reported compliance with COVID-19 mitigation behaviors, define compliance class characteristics, and explore associations between compliance classes and important study and public health outcomes. We studied 1,410 participants in the Cabarrus County COVID-19 Prevalence and Immunity longitudinal cohort study (June 2020 to December 2021) who were asked 10 questions regarding compliance with recommended COVID-19 mitigation behaviors. By Latent Class Analysis, 1,381 participants were categorized into 3 classes (most [49.4%], moderately [45.0%], and least [5.6%] compliant). Compared with the most compliant class, the least and moderately compliant classes were younger (mean = 61.9 v. 59.0 v. 53.8 years), had fewer medical conditions per individual (1.37 v. 1.08 v. 0.77), and differed in Hispanic ethnicity (6.2% v. 2.8% v. 9.1%) and COVID-19 vaccine intention (65.8% v. 59.8% v. 35.1%). Compared to the most compliant class, the least compliant class had fewer women (54.6% v. 76.3%), fewer insured individuals (92.2% v. 97.4%), and more withdrew from study participation early (28.6% v. 16.0%). Relative to the most compliant class, the least compliant class had a higher likelihood of COVID-19 infection (OR = 2.08 [95% CI 1.13, 3.85]), lower rate of COVID-19 vaccination (72.6% v. 95.1%), and longer time to 50% COVID-19 vaccination following eligibility (8-9 vs 16 days). Classes defined by mitigation behaviors compliance had distinct characteristics, including age, sex, medical history, and ethnicity, and were associated with important study and public health outcomes. Targeted public health policies and interventions according to the compliance group characteristics may be of value in current and future pandemic responses to increase compliance.

Estimation of reinforced urn processes under left-truncation and right-censoring

We propose a non-parametric estimator for bivariate left-truncated and right-censored observations that combines the expectation-maximization algorithm and the reinforced urn process. The resulting expectation-reinforcement algorithm allows for the inclusion of experts' knowledge in the form of a prior distribution, thus belonging to the class of Bayesian models. This can be relevant in applications where the data is incomplete, due to biases in the sampling process, as in the case of left-truncation and right-censoring. With this new approach, the distribution of the truncation variables is also recovered, granting further insight into those biases, and playing an important role in applications like prevalent cohort studies. The estimators are tested numerically using artificial and empirical datasets, and compared with other methodologies such as copula models and the Kaplan-Meier estimator.

Managing cold intolerance after hand injury: A systematic review

ObjectivesThis systematic review seeks to understand whether cold intolerance (CI) improves with time and if there is any role for management strategies such as behavioural therapy, surgery, or pharmacotherapy. MethodsTwo independent reviewers used a predefined search strategy to query MEDLINE, PubMed, Embase, CINAHL, Cochrane Library, Web of Science and Google Scholar databases. Articles written in English, Studies of interventions (such as pharmacotherapy or behavioural therapy) for cold intolerance in adult patients with a history of hand injury along with prevalence over time were included for review. ResultsSeventeen studies were included, with twelve prognostic studies of the effect of time on CI, four studies of self management/behavioural therapies, and a single study of surgical treatment of neuromas. No studies of pharmacotherapies were identified for inclusion in the hand injury literature. Most studies (76.4%) were either prevalence or prospective cohort studies; no level I or II evidence studies were included. ConclusionsCold intolerance does not resolve over time for the vast majority of patients. Behavioral and self-management studies have low efficacy and studies presented had a high risk of bias. There is a lack of evidence for the use of pharmacotherapy in CI and this could be considered for future studies.

Postoperative infections after non-elective cesarean section – a retrospective cohort study of prevalence and risk factors at a single center in Denmark administering prophylactic antibiotics after cord clamping

BackgroundMothers giving birth by non-elective cesarean section have considerably higher risk of developing postoperative infection, than mothers giving birth by elective cesarean section. Meta-analyses have shown that the risk of infection is reduced when administering antibiotics at least 30 min prior to skin incision rather than after cord clamping. If given prior to incision, antibiotics are present in the neonatal bloodstream for up to 24 h after delivery, with early exposure to antibiotics potentially disturbing development of the gut microbiome. We aimed to retrospectively assess the prevalence of postoperative infection after non-elective cesarean section at a single labor ward administering antibiotics after cord clamping, additionally investigating risk factors for developing postoperative infections.MethodsIn this retrospective cohort study, we included a total of 2,725 women giving birth by non-elective cesarean section in 2010–2017 with a review of records for prenatal risk factors, labor management, and perinatal outcomes. The primary outcomes were a main composite infection of development of either endometritis, surgical-site infection, or sepsis in conjunction with a relevant antibiotic prescription. Secondary outcomes included infection of unknown focus, mastitis, urinary tract infection, and pneumonia.ResultsA total of 88 patients developed a main composite infection (3.2%). These infections subdivide into endometritis (n = 37/2725, 1.4%), surgical-site infection (n = 35/2725, 1.3%) and sepsis (n = 15/2725, 0.6%). We found a high body mass index (aOR = 3.38, 95%CI 1.93–5.92) and intrapartum fever (aOR = 2.26, 95%CI 1.22–4.59) to be independent risk-factors for developing postoperative infection after non-elective cesarean section. Furthermore, we found delivery by a more expedient emergency grade 2 cesarean section (aOR = 0.61 95%CI 0.37–0.998) compared to grade 3 to be a protective factor for developing postoperative infection after non-elective cesarean section.ConclusionIn a labor ward administering antibiotics after cord clamping at non-elective cesarean births, we find a low prevalence of main composite infections when compared to estimates from meta-analyses on the topic. We conclude that administration of prophylactic antibiotics after cord clamping appears to result in acceptable rates of postoperative infection and avoids transplacental-transmission of antibiotics to the infant.

Registry-based cohort study of alpha-1 antitrypsin deficiency prevalence, incidence and mortality in Denmark 2000–2018

ObjectiveTo estimate the prevalence of diagnosed alpha-1 antitrypsin deficiency (dAATD) in Denmark as of 31 December 2018, and dAATD incidence and mortality from 1 January 2000 to 31 December 2018.Study...

An update on oral clinical courses among patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: A clinical follow-up (a prospective prevalent cohort) study.

Contemporary literature has revealed that Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes acute sialadenitis and related symptoms, such as discomfort, pain, swelling, and secretory dysfunction in salivary glands. The secretory dysfunction is due to SARS-CoV-2 infection-induced xerostomia and other associated clinical courses such as sore tongue, mucosal ulcer, and gingivitis in the oral cavity. Furthermore, it has been reported that COVID-19 causes the development of other oral manifestations. A prospective clinical follow-up (a prevalent cohort) study was conducted to identify the possible oral manifestations of SARS-CoV-2 infection among patients admitted toat the Eka General Hospital COVID-19 treatment center. Furthermore, the study aimed to calculate the prevalence rate of oral clinical courses in the cohorts. The study consisted of two follow-up phases: Hospital and patient-home-based. A total of 55 patients (36 males and 19 females) met the inclusion criteria and were followed for 7.5 weeks. The 3.5 weeks hospital-based prospective follow-up study documented an 18% (n = 10) prevalence rate of oral clinical courses among the cohorts. Twelve oral symptoms appeared in these ten patients. The manifested oral symptoms were oral mucosal lesions (n = 6), xerostomia (n = 5), and thickening of saliva (n = 1). The oral mucosal lesions per se consisted of aphthous lesions (n = 3), candidiasis (n = 1), geographic tongue (n = 1), and localized gingivitis (n = 1). The four weeks' home-based follow-up study disclosed four newly manifested oral symptoms: hemorrhagic crust, bulla, buccal mucositis, and petechiae. These manifestations appeared among six patients (four males and two females) who had not manifested any oral symptoms during the hospital-based follow-up. Accordingly, the overall prevalence of oral clinical courses among patients presented with SARS-CoV-2 is raised from 18% (n = 10) to 29% (n = 16). Similarly, the number of clinical courses increased from 12 to 16 after four additional weeks of follow-up. The study's findings suggest the importance of initiating oral health care for patients with COVID-19. Therefore, multidisciplinary healthcare approaches should be delivered to assure optimal health outcomes. Accordingly, oral health professionals must be a substantial part of the interdisciplinary approach in caring for patients with COVID-19.

A nonparametric test for equality of survival medians using right-censored prevalent cohort survival data.

The median is a robust summary commonly used for comparison between populations. The existing literature falls short in testing for equality of survival medians when the collected data do not form representative samples from their respective target populations and are subject to right censoring. Such data commonly occur in prevalent cohort studies with follow-up. We consider a particular case where the disease under study is stable, that is, the incidence rate of the disease is stable. It is known that survival data collected on diseased cases, when the disease under study is stable, form a length-biased sample from the target population. We fill the gap for the particular case of length-biased right-censored survival data by proposing a large-sample test using the nonparametric maximum likelihood estimator of the survivor function in the target population. The small sample performance of the proposed test statistic is studied via simulation. We apply the proposed method to test for differences in survival medians of Alzheimer's disease and dementia groups using the survival data collected as part of the Canadian Study of Health and Aging.