Hospital-based Prospective Cohort Study Research Articles

Effect of apremilast on cardiovascular risk in psoriasis patients in comparison with methotrexate

Background: Psoriasis is a common chronically relapsing inflammatory disorder with cutaneous and rheumatologic manifestations characterized by an increase in risk of cardiovascular diseases. Chronic inflammation in psoriatic patients predisposes them to cardiovascular morbidity. This study was done to compare the change in cardiovascular risk factors who are taking apremilast and methotrexate. Aims and objectives: The aims of this study were as follows: (1) To evaluate the effect on biochemical parameters pertaining to cardiovascular risk in psoriasis patients after 12 weeks of treatment with apremilast in comparison with methotrexate. (2) To compare the efficacy of methotrexate with apremilast in treating chronic plaque psoriasis. Materials and Methods: This hospital-based prospective cohort study included 40 newly diagnosed cases of psoriasis who were divided into two groups – group A (receiving methotrexate) and group B (receiving apremilast) and were assessed at baseline and after 12 weeks. The outcome was assessed on the basis of psoriasis area and severity index score and the biochemical parameters. Results: We found a significant decrease in triglycerides, high sensitivity C-reactive protein, and low-density lipoprotein levels in psoriasis patients taking methotrexate and high-density lipoprotein in the apremilast group. Conclusion: On comparing the two drugs, methotrexate is considered to have more cardioprotective action.

Cataract Surgery and Chronic Kidney Disease: A Hospital-based Prospective Cohort Study.

Objective Cataract and chronic kidney disease (CKD) occur with increasing frequency with age and share common risk factors including smoking, diabetes, and hypertension. We evaluated the risk of incident cataract surgery in patients with non-dialysis-dependent CKD and dialysis-dependent CKD compared to non-CKD patients, while taking into account the competing risk of death. Methods The participants included 1,839 patients from Sado General Hospital enrolled in the Project in Sado for Total Health (PROST) between June 2008 and December 2016 (54% men; mean age, 69 years). Among these patients, 50%, 44%, and 6% had non-CKD, non-dialysis-dependent CKD, and dialysis-dependent CKD, respectively. Results During a median follow-up of 5.6 years (interquartile range, 4.7-7.1), 193 participants underwent cataract surgery [18.7 (95% confidence interval (CI), 16.2-21.5)/1,000 person-years] and 425 participants died without undergoing cataract surgery [41.0 (95% CI, 37.4-45.2)/1,000 person-years]. The cumulative incidence of cataract surgery was the highest in the dialysis-dependent CKD group, followed by the non-dialysis-dependent CKD and non-CKD groups (log-rank p=0.002). After adjusting for potential confounding factors, the dialysis-dependent CKD group [hazard ratio (HR) 2.48; 95% CI 1.43-4.31], but not the non-dialysis-dependent CKD group (HR, 1.01; 95% CI 0.74-1.38), had a higher risk of cataract surgery than the non-CKD group. However, this association was no longer significant according to a competing risk analysis (sub-hazard ratio, 1.67; 95% CI 0.93-3.03). Conclusion Dialysis-dependent CKD patients were found to have an increased risk of cataract surgery; however, the association was attenuated and no longer significant when death was considered a competing risk.

Neuroimaging Changes and Treatment Outcome of Tubercular Meningitis- Experiences 22 Cases in a Tertiary Care Center

Background: Tuberculous meningitis (TBM) is caused by Mycobacterium tuberculosis (M. tuberculosis) and is the most common form of central nervous system (CNS) tuberculosis (TB).The prevalence of TB meningitis remains largely underestimated because clinical manifestations are nonspecific in early stages of the disease. Prompt diagnosis is critical for initiating appropriate therapy, facilitating measures to prevent dissemination of this highly contagious disease and to combat fatal complication in children Aims: To evaluate the role of neuroimaging changes and treatment outcome of tubercular meningitis. Methods: This prospective hospital-based cohort study was conducted in Department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during January 2022 to December 2022. Children age belonged to 1 month to 10 year diagnosed as TBM during study period were enrolled in this study. Detailed history, clinical examination, CSF analysis and other relevant investigations were done. Data were recorded in standard questionnaire. Statistical analyses of the results were obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: Total 22 diagnosed case of TBM was enrolled and evaluated. Among them two third (63.63%) children were in 5-10 year age group. Male (59%) were outnumbered than female (36.36 %).Male female ratio was 1.6:1. More than half (59%) of patients came from urban area. All of the patients were vaccinated. Cent percent (100%) patients were presented with fever followed by headache (77.27%), sign of meningeal irritation (54.54%), vomiting (54.54%) and seizures (50%). Most common complication was hemiparesis (45.45%) followed by cranial nerve palsy (40.90%), visual problem (9.09%) and hydrocephalus (4.54%). Abnormal neuroimaging changes were found in 100% cases. Common findings were hydrocephalus (40.90%), tubercloma (36.36%), basilar enhancement (18.18%), Benign enlargement of subdural space & cerebellar hyperintensity (9%) and thalamic infract was present in 4.54% cases. Anti TB and steroid treatment were given in 100% cases and among them18.18% cases were required shunt procedure. More than one-third cases (40.90%) were completely normal without any no sequelae. Among abnormal sequelae found in two third (59%) cases. Speech impairment (36.36%) was most common followed by GDD (18.18%), hemiparesis (13.63%), quadriparesis (9.09%) and epilepsy in 9.09% cases. Conclusion: In our study all children of TBM were presented with fever followed by other predominant clinical features headache, vomiting, seizures and sign of meningeal irritation. Abnormal neuroimaging changes were found in all cases. Common findings were basilar enhancement, hydrocephalus, tubercloma, benign enlargement of subdural space & cerebellar hyper intensity and thalamic infract. After treatment more than one-third cases were completely normal without any no sequelae. J Bangladesh Coll Phys Surg 2024; 42: 214-218

Infection-related severe maternal outcomes and case fatality rates in 43 low and middle-income countries across the WHO regions: Results from the Global Maternal Sepsis Study (GLOSS).

The highest toll of maternal mortality due to infections is reported in low and middle-income countries (LMICs). However, more evidence is needed to understand the differences in infection-related severe maternal outcomes (SMO) and fatality rates across the WHO regions. This study aimed to compare the burden of infection-related SMO and case fatality rates across the WHO regions using the Global Maternal Sepsis Study (GLOSS) data. GLOSS was a hospital-based one-week inception prospective cohort study of pregnant or recently pregnant women admitted with suspected or confirmed infection in 2017. Four hundred and eight (408) hospitals from 43 LMICs in the six WHO regions were considered in this analysis. We used a logistic regression model to compare the odds of infection-related SMOs by region. We then calculated the fatality rate as the proportion of deaths over the total number of SMOs, defined as maternal deaths and near-misses. The proportion of SMO was 19.6% (n = 141) in Africa, compared to 18%(n = 22), 15.9%(n = 50), 14.7%(n = 48), 12.1%(n = 95), and 10.8%(n = 21) in the Western Pacific, European, Eastern Meditteranean, Americas, and South-Eastern Asian regions, respectively. Women in Africa were more likely to experience SMO than those in the Americas (aOR = 2.41, 95%CI: [1.78 to 2.83]), in South-East Asia (aOR = 2.60, 95%CI: [1.57 to 4.32]), and the Eastern Mediterranean region (aOR = 1.58, 95%CI: [1.08 to 2.32]). The case fatality rate was 14.3%[3.05% to 36.34%] (n/N = 3/21) and 11.4%[6.63% to 17.77%] (n/N = 16/141) in the South-East Asia and Africa, respectively. Infection-related SMOs and case fatality rates were highest in Africa and Southeast Asia. Specific attention and actions are needed to prevent infection-related maternal deaths and severe morbidity in these two regions.

Cardiac Troponin I as an Early Prognostic Indicator in Asphyxiated Neonates

Background: Myocardial damage, estimated to occur in 28%–73% of asphyxiated neonates, 1 is a major cause of mortality in perinatal asphyxia, and survivors can show significant myocardial morbidity as well. 2 Study Setting and Design: This study is a hospital-based prospective cohort study, done at the pediatrics department of a tertiary care hospital in northern India, from December 2020 to June 2022. Materials and Methods: 40 asphyxiated neonates with an APGAR score of <7 at 1 minute of life, as per the WHO–Neonatal Perinatal Database, were included in the study. They were graded as hypoxic ischemic encephalopathy (HIE) I (mild), II (moderate), and III (severe) based on Sarnat and Sarnat staging. The blood samples at 0 and 6 hours of life were taken for studying successive changes in the values of high-sensitivity cardiac troponin I (hs-cTnI) and creatinine phospho-kinase-myocardium-bound (CPK-MB). These were compared with various parameters such as electrocardiograph (ECG) findings, 2D-ECHO abnormalities, HIE severity, and outcome. Results: Among the two biomarkers that were assessed, hs-cTnI had the highest diagnostic value for detecting myocardial injury and was corelated with the severity of HIE and higher chances of death. Conclusion: The troponin I levels, in contrast to CPK-MB levels, were significantly associated with the outcome of the patient, implying that asphyxiated babies with elevated troponin I levels have a poorer prognosis and a higher mortality rate.

Persistent facial pain in post-stroke patients, a hospital-based cohort study; experience from North India

BackgroundPost-stroke pain is common after a stroke and might be underreported. We describe Persistent Facial Pain (PFP) developed in post-stroke patients. Methodology: This was a prospective hospital-based cohort study of stroke patients, and patients were followed up. Out of 415 stroke patients, 26 developed PFP. ResultOut of all PFP patients, six patients had an ischemic stroke, and 20 had a hemorrhagic stroke. 57.7% of patients had hypertension, while 34.6 patients had diabetes. The stroke location was left-sided in 12 patients and right-sided in 14 patients. 46.15% of patients responded to venlafaxine, 30.77% responded to amitriptyline, and 23.08% responded to pregabalin. ConclusionPersistent facial pain is a pain syndrome that might be missed in patients post-stroke. It might be more common in hemorrhagic stroke patients than in ischemic stroke patients. It responds adequately to antidepressants. A high index of suspicion is required to diagnose and appropriately manage these patients.

Association of the medication protocols and longitudinal change of COVID-19 symptoms: a hospital-based mixed-statistical methods study

ABSTRACT The objective of this study was to identify the relationship between hospitalization treatment strategies leading to change in symptoms during 12-week follow-up among hospitalized patients during the COVID-19 outbreak. In this article, data from a prospective cohort study on COVID-19 patients admitted to Khorshid Hospital, Isfahan, Iran, from February 2020 to February 2021, were analyzed and reported. Patient characteristics, including socio-demographics, comorbidities, signs and symptoms, and treatments during hospitalization, were investigated. Also, to investigate the treatment effects adjusted by other confounding factors that lead to symptom change during follow-up, the binary classification trees, generalized linear mixed model, machine learning, and joint generalized estimating equation methods were applied. This research scrutinized the effects of various medications on COVID-19 patients in a prospective hospital-based cohort study, and found that heparin, methylprednisolone, ceftriaxone, and hydroxychloroquine were the most frequently prescribed medications. The results indicate that of patients under 65 years of age, 76% had a cough at the time of admission, while of patients with Cr levels of 1.1 or more, 80% had not lost weight at the time of admission. The results of fitted models showed that, during the follow-up, women are more likely to have shortness of breath (OR = 1.25; P-value: 0.039), fatigue (OR = 1.31; P-value: 0.013) and cough (OR = 1.29; P-value: 0.019) compared to men. Additionally, patients with symptoms of chest pain, fatigue and decreased appetite during admission are at a higher risk of experiencing fatigue during follow-up. Each day increase in the duration of ceftriaxone multiplies the odds of shortness of breath by 1.15 (P-value: 0.012). With each passing week, the odds of losing weight increase by 1.41 (P-value: 0.038), while the odds of shortness of breath and cough decrease by 0.84 (P-value: 0.005) and 0.56 (P-value: 0.000), respectively. In addition, each day increase in the duration of meropenem or methylprednisolone decreased the odds of weight loss at follow-up by 0.88 (P-value: 0.026) and 0.91 (P-value: 0.023), respectively (among those who took these medications). Identified prognostic factors can help clinicians and policymakers adapt management strategies for patients in any pandemic like COVID-19, which ultimately leads to better hospital decision-making and improved patient quality of life outcomes.

Mortality and associated factors among children admitted to an intensive care unit in muhimbili national hospital, from the time of admission to three months after discharge: a prospective cohort study

BackgroundMortality of children admitted to Intensive Care Units (ICU) is higher in low-to-middle-income countries (LMICs) as compared to high-income countries (HICs). There is paucity of information on outcomes following discharge from ICU, especially from sub-Saharan Africa region. This study was conducted to determine mortality and its associated factors among children admitted to Pediatric ICU (PICU) at Muhimbili National Hospital, from admission to three months after discharge.MethodologyThis was a hospital-based prospective cohort study conducted between July 2021 and May 2022, among children admitted to PICU who were followed up for 3-month after discharge. Structured questionnaires were used to collect data from their medical charts. Telephone interviews were made after discharge. Medical records and verbal autopsy were used to determine the cause of death after discharge. Cox regression analysis was performed to assess the association between variables. A p-value of < 0.05 was considered statistically significant. Survival after PICU discharge was estimated by Kaplan - Meier curve.ResultsOf 323 children recruited, 177(54.8%) were male, with a median age of 17 months (1-168). The leading cause of PICU admission was severe sepsis 90/323(27.9%). A total of 161/323 children died, yielding an overall mortality of 49.8%. Of 173 children discharged from PICU, 33(19.1%) died. The leading cause of death among children who died in the general ward or as readmission into PICU was sepsis 4/17(23.5%). Respiratory diseases 4/16(25.0%) were the commonest cause of death among those who died after hospital discharge. Independent predictors of overall mortality included single organ dysfunction with hazard ratio(HR):5.97, 95% confidence interval (CI)(3.05–12.26)] and multiple organ dysfunction [HR:2.77,95%CI(1.03–2.21)]. Chronic illness[HR:8.13,95%CI(2.45–27.02)], thrombocytosis [HR:3.39,95%CI(1.32–8.73)], single[HR:3.57,95%CI(1.42–9.03)] and multiple organ dysfunction[HR:3.11,95%CI(1.01–9.61)] independently predicted post-PICU discharge mortality.ConclusionOverall mortality and post- PICU discharge mortality were high and more likely to affect children with organ dysfunction, chronic illness, and thrombocytosis. The leading causes of mortality post- PICU discharge were sepsis and respiratory diseases. There is a need for a focused follow up plan of children post- PICU discharge, further research on the long term survival and strategies to improve it.

Survival Status and Predictors of Mortality Among Low-birth-weight Neonates in Southern Ethiopia: A Prospective Follow-up Study

Background: Due to anatomical and physiological immaturity low-birth-weight (LBW) neonates are at risk for different complications which may lead to death at a specified period after birth. Therefore, this study aimed to assess the survival rate and predictors of mortality among LBW neonates. Methods: A hospital-based prospective cohort study design was conducted among 768 LBW neonates. The Cox proportional hazard model was used to identify predictors of mortality among LBW neonates. Result: The mortality rate of low birth weight was 38.8 (95% CI: 33.9–44.3) per 1,000 child-day observations. Parity (AHR = 1.47 [95% CI: 1.06–2.05]), Birth weight &lt;1000 gram (AHR = 4.70 [95% CI: 2.36–9.35]), Birth weight &lt;1500 gram (AHR = 1.62 [95% CI: 1.16–2.27]), Neonatal sepsis (AHR = 2.41 [95% CI: 2.25–2.91]), Birth asphyxia (AHR = 1.46 [95% CI = 1.02–2.08]), Kangaroo mother care (KMC) (AHR = 0.35 [95% CI: 0.24–0.49]), were statistically significantly associated with mortality. Conclusions: The findings of this study revealed that the incidence rate of mortality among LBW neonates was high. Practising KMC for all LBW neonates and appropriate treatment of neonatal sepsis and birth asphyxia were strongly recommended to reduce mortality among LBW neonates.

Correlation of Serum Galactose-Deficient IgA1 and Oxford Class in Cases of IgA Nephropathy.

Galactose-deficient immunoglobulin A1 (Gd-IgA1) deposition in the renal mesangium plays a role in the pathogenesis of IgA nephropathy. To assess the serum Gd-IgA1 level in biopsy-proven IgA nephropathy cases on diagnosis and 3 months post treatment and its relation with histologic Oxford classification. In this hospital-based prospective cohort study, 40 cases and 20 controls were enrolled. Serum samples of biopsy-proven IgA nephropathy cases collected on the day of biopsy and 3 months post treatment were evaluated. Solid-phase ELISA (enzyme-linked immunosorbent assay) was performed for assessment of Gd-IgA1 level. All renal biopsies were scored by using Oxford Classification (C-MEST score). The association of serum Gd-IgA1 levels with other established prognostic parameters was assessed. To estimate the prognostic value of markers, logistic regression analysis and Kruskal-Wallis ANOVA (analysis of variance) were used. Significant difference was observed in the serum Gd-IgA1 level values in the IgA nephropathy cases and healthy controls (P = .001) at baseline. However, no significant correlation between serum Gd-IgA1 levels at baseline and 3 months of follow-up (P = .31) or between baseline levels and age, proteinuria, hematuria, or estimated glomerular filtration rate was noted. There was no significant correlation between C-MEST score and serum Gd-IgA1 levels at baseline (P > .05); however, the distribution of Gd-IgA1 at 3 months was found to differ significantly between different grades of S score (P = .008). Serum Gd-IgA1 levels may be of utility in predicting disease progression in IgA nephropathy cases. Measurement of serum Gd-IgA1 levels for the diagnosis and prognosis of IgA nephropathy may preclude the need for invasive renal biopsies.

Geriatric nutritional risk index and adverse medical outcomes among Egyptian patients admitted to a geriatric hospital: a prospective cohort study

BackgroundElderly are one of the most heterogeneous and vulnerable groups who have a higher risk of nutritional problems. Malnutrition is prevalent among hospitalized elderly but underdiagnosed and almost undistinguishable from the changes in the aging process. The Geriatric Nutritional Risk Index (GNRI) is a tool created to predict nutrition-related complications in hospitalized patients. This study aims to measure the prevalence of nutritional risk using the GNRI among hospitalized elderly Egyptian inpatients and to determine the association between the GNRI and selected adverse clinical outcomes.MethodsA hospital-based prospective cohort study was conducted among 334 elderly patients admitted to a tertiary specialized geriatric university hospital in Cairo, Egypt from August 2021 to June 2022. Within 48 hours after hospital admission, socio-demographic characteristics, blood biomarkers, anthropometric measurements, and nutritional risk assessment by the GNRI score were obtained. Patients were divided into three groups based on their GNRI: high, low, and no nutritional risk (GNRI<92, 92-98, and >98) respectively. Patients were followed up for the occurrence of adverse outcomes during hospital stay (bed sores, Healthcare-Associated Infections (HAIs), hospital Length of Stay (LOS), and hospital mortality) and three months after discharge (non-improvement medical status, appearance of new medical conditions, hospital readmission and 90-day mortality). Multivariable regression and survival analysis were conducted.ResultsThe prevalence of high-nutritional risk was 45.5% (95% CI, 40%–51%). Patients with high risk had significantly longer LOS than those with no risk. The high-nutritional risk was significantly associated with the development of bed sores (Adjusted Odds Ratio (AOR) 4.89; 95% CI, 1.37–17.45), HAIs (AOR: 3.18; 95% CI, 1.48–6.83), and hospital mortality (AOR: 4.41; 95% CI, 1.04–18.59). The overall survival rate was significantly lower among patients with high-nutritional risk compared to those with no risk.ConclusionGNRI is a simple and easily applicable objective nutritional screening tool with high prognostic value in this Egyptian sample of patients. The findings of this study signal the initiation of the application of this tool to all geriatric hospitals in Egypt.

Effect of Corneal Collagen Crosslinking with Riboflavin in Patients of Progressive Keratoconus: A Prospective Cohort Study

Introduction: Keratoconus is a non inflammatory disease characterised by progressive corneal thinning that results in a cone-like ectasia, irregular astigmatism, and decreased vision. Advanced disease can result in corneal scarring and blindness, necessitating penetrating keratoplasty. The only treatment believed to have the ability to stop or decrease the progression of keratoconus is Collagen Cross-Linking (CXL). Aim: To evaluate the efficacy of corneal collagen cross-linking with riboflavin (C3R) in patients with keratoconus by studying the outcomes in terms of Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), manifest refraction, and corneal topography. Materials and Methods: A hospital-based prospective cohort study was conducted at the Regional Institute of Ophthalmology, Government Medical College, Thiruvananthapuram, Kerala, India from June 2017 to June 2018. Fifteen eyes of 12 patients who underwent corneal collagen cross-linking for progressive keratoconus were included. Routine ophthalmological examinations was done for all patients. Patients under the age of 35 years with progressive keratoconus, an average K value not exceeding 60 D, and who had not undergone any other surgical modalities of treatment were included in the study. Patients with scarred cornea or hydrops, active ocular infection, or pachymetry &lt;400 µm were excluded. Detailed informed consent was obtained from all patients before surgery. Preoperative UCVA, BCVA cylinder, Spherical Equivalent (SE), and topography values were obtained. All patients were followed-up at three and six months postoperative period to look for changes in UCVA, BCVA, manifest refraction, and corneal topography. Data were expressed as the mean±Standard Deviation (SD) pre- and postoperatively and analysed statistically using the paired t-test, with p&lt;0.05 considered statistically significant. Analysis was conducted using Statistical Package for Social Sciences (SPSS) version 16.0. Results: On follow-up at six months post-treatment, UCVA (log MAR) improved from 0.87±0.40 to 0.65±0.35 (p-value=0.001), and BCVA (log MAR) changed from 0.37±0.21 to 0.17±0.22 (p-value=0.001). K max decreased from 54.90±6.05 to 52.67±5.02 (p-value=0.001), and K min decreased from 48.14±4.24 to 45.93±4.07 (p-value=0.001). Astigmatism and SE also showed statistically significant improvement post-procedure (p-value 0.001 and 0.002, respectively). Astigmatism reduced from -3.50±1.58 to -2.90±1.37. SE reduced from -4.93±3.92 to -4.28±3.48. No significant complications were noted in any of the patients. Conclusion: The CXL is an effective procedure for stabilising the progression of keratoconus, thus reducing the burden of preventable blindness and the need for keratoplasty.

Clinico-Microbiological Correlates of Hospital-Acquired Pneumonia: A Hospital-Based Prospective Cohort Study.

Hospital-acquired pneumonia (HAP) is a life-threatening hospital-acquired infection contributing to poor outcomes and mortality. Though the prevalence is comparable,the burden of comorbidities and malnutrition further worsens the scenario in developing countries. Infective agents responsible for these infections vary between regions due to the variables involved. There is a dearth of data on clinico-microbiological correlates of HAP from Northern India. With this study, we aim to explore the same and add more evidence to fill the gap. A hospital-based cohort study was done on ICU patients of the tertiary care center in Northern India including the cohort of patients obeying a strict inclusion criterion. The clinical and microbiological correlates were estimated following an appraisal of quality of study samples. We found that the most common clinical feature in patients with HAP was fever (82%) followed by purulent respiratory secretions (72%), tachycardia (52%), and crepitations on auscultation (38%). Approximately 86% of cases were found to be culture-positive while others were bacteriologically sterile. Gram-negative bacilli were more commonly isolated (83% Gram-negative vs 17% Gram-positive). The most common organisms isolated were Klebsiella pneumoniae, Citrobacter freundii, Escherichia coli, Acinetobacter, and Pseudomonas aeruginosa. Staphylococcus aureus was isolated from eight specimens and all isolates were susceptible to vancomycin, linezolid, teicoplanin, and tigecycline. Seven isolates were resistant to clindamycin and all 8 were resistant to macrolides and quinolones. Five strains had methicillin resistance indicating a rising burden of 'superbugs'. The most common side involved was the right side and the right middle zone was the most common zone involved. Forty-four percent of cases had a poor outcome and succumbed to the infection. HAPplaces patients at a heightened risk of mortality and manifests a distinctive clinical-microbiological profile. It is advisable to adopt a proactive stance in averting HAI by adhering to robust prophylaxis and management protocols in alignment with regional data and hospital guidelines. Despite the study's constrained sample size, it contributes significant insights specific to the region. This underscores the necessity for further exploration through analogous studies and audits in the northern part of India. Such endeavors have the potential to tailor treatment approaches for patients, ultimately enhancing overall outcomes.

Arterial Hypertension and Its Consequences Are the Main Predictors of Embolic Stroke of Undetermined Source.

We performed a hospital-based prospective cohort study with 1,317 enrolled participants. We compared patients and healthy volunteers according to the main demographic, anthropometric parameters, stroke risk factors, comorbidities, and data of clinical and instrumental examination. In order to balance the study and the control groups for age and sex, the propensity score matching was performed. In order to generate the overall predictive model, a multivariate analysis was performed using the binary logistic regression method. The following predictors of ESUS were identified in current study: arterial hypertension (AH); increased heart rate and pulmonary arterial systolic pressure (PASP); the presence of conduction disturbance; the enlargement of left, right atrium, and left ventricle end-systolic length; increased intima-media thickness (IMT) in right and left common carotid artery (CCA); lowered Montreal Cognitive Assessment (MoСA) cognitive scale score; the presence of subcortical microbleeds; central brain atrophy; the larger size of third ventricle; and the higher medial temporal lobe atrophy (MTA) score. The following risk factors were included in the final predictive model: the presence of AH (p < 0.0005; OR = 12.98 (95% CI: 4.53-37.21)) and PASP (p=0.018; OR = 1.13 (95% CI: 1.02-1.25)) and male sex (p=0.046; OR = 2.771 (95% CI: 1.017-7.555)). The Nagelkerke's pseudo-R-squared value was 0.404 and the significance of the Hosmer-Lemeshow test was 0.733, which indicate the goodness of the final logistic regression model. We propose that AH and its consequences are the main predictors of ESUS. The results of this study emphasize the importance of AH control for primary and secondary prevention of ESUS.

Comparison between different radiological scoring systems in predicting post-PCNL outcome

Background: Various scoring systems, including Guy's stone score (GSS), S.T.O.N.E. score, and Clinical Research Office of the Endourological Society (CROES) nomogram, have been assessed for predicting post-percutaneous nephrolithotomy (PCNL) success in terms of stone-free status (SFS) and complications. Our study aims to determine the optimal predictor of SFS among these systems and assess their efficacy in predicting perioperative factors and complications, using modified Clavien grade. Methods: This prospective hospital-based cohort study involved 107 patients aged ≥18 years who underwent standard PCNL (tract size &gt;24 Fr) within a year. GSS, S.T.O.N.E. score, and CROES nomogram were calculated using preoperative computed tomography (CT) scans. Comparisons between 'stone-free' and 'residual-stone' groups were statistically analyzed. Results: All parameters effectively predicted SFS. S.T.O.N.E. score exhibited excellent discriminatory power (AUC 0.844; 95% CI: 0.762-0.907), followed by GSS (AUC 0.756; 95% CI: 0.663-0.834) and CROES nomogram (AUC 0.749; 95% CI: 0.656-0.828). S.T.O.N.E. score, with an AUC of 0.844, proved the most accurate predictor at ≤7 cut-off. GUY's score correlated positively with operative time and hospital stay (correlation coefficient 0.403, 0.34). S.T.O.N.E. score also positively correlated with these factors (correlation coefficient 0.443, 0.37). CROES nomogram negatively correlated with operative time and hospital stay (correlation coefficient -0.374, -0.314). Conclusions: All scoring systems effectively predict post-PCNL SFS, with S.T.O.N.E. score being the most predictive. GSS and S.T.O.N.E. score associate significantly with operative time and hospital stay. Both GSS and S.T.O.N.E. score show significant associations with perioperative complications assessed by modified Clavien grade.

Survival benefit of a third dose of the COVID-19 vaccine among hemodialysis patients: A prospective cohort study

BackgroundHemodialysis (HD) patients are particularly vulnerable to severe coronavirus disease 2019 (COVID-19) due to their immunocompromised state and comorbid conditions. Timely vaccination could be the most effective strategy to reduce morbidity and mortality. However, data on the survival benefit of the COVID-19 vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and death among HD patients are limited, especially during the Omicron-dominant period. MethodsIn this prospective hospital-based cohort study, we identified HD patients from July 1, 2021, to April 29, 2022. The patients were divided into fully vaccinated and partially vaccinated groups. We compared the humoral response, risk of developing SARS-CoV-2 infection, and all-cause mortality between the two groups. ResultsAmong the 440 HD patients included, 152 patients were fully vaccinated, and 288 patients were partially vaccinated. Patients in the fully vaccinated group exhibited higher anti-spike protein receptor-binding domain (S protein RBD) antibody levels and lower risks of all-cause mortality (adjusted hazard ratio, 0.35; 95% confidence interval, 0.17–0.73; p = 0.005) than the partially vaccinated group. However, the risk for SARS-CoV-2 infection did not significantly differ between the two groups. Irrespective of the number of vaccinations, the risk of all-cause mortality was lower in patients with anti-S protein RBD antibody levels in the higher tertile. ConclusionA third dose of the COVID-19 vaccine was associated with a decreased risk of all-cause mortality among HD patients during the Omicron-dominant period. A higher post-vaccination anti-S protein RBD antibody level was also associated with a lower risk of mortality.

Associations of renal function with cerebral small vessel disease and functional outcome in acute intracerebral haemorrhage: A hospital-based prospective cohort study

BackgroundIntracerebral haemorrhage (ICH) is a severe clinical consequence of cerebral small vessel disease (SVD), but associations between renal impairment and SVD in patients with ICH have not been fully characterised. MethodsUsing data from the CROMIS-2 ICH observational study, we compared SVD neuroimaging markers and total burden (score 0–3) identified using CT brain imaging in patients with and without renal impairment (estimated glomerular filtration rate, eGFR<60). We assessed functional outcome at 6-month follow-up using the modified Rankin scale. Results1027 participants were included (mean age 72.8, 57.1% male); 274 with and 753 without renal impairment. 18.7% of the eGFR<60 group had moderate-to-severe SVD burden (score 2–3), compared with 14.0% of those with eGFR>60 (p = 0.039). SVD burden was associated with renal impairment after adjusting for hypertension (OR 1.36, 95% CI 1.04–1.77, p = 0.023), but not after adjusting for age. Cerebral atrophy was more prevalent in patients with eGFR<60 (81.2% vs. 72.0%, p = 0.002), as were WMH (45.6% vs. 36.6%, p = 0.026). Neither was associated with renal function after adjusting for age and vascular risk factors. Renal impairment was associated with functional outcome (OR 0.65, 95% CI 0.47–0.89, p = 0.007), but not after adjusting for age, pre-morbid function and comorbidities (OR 0.95, 95% CI 0.65–1.38, p = 0.774). ConclusionIn acute ICH, renal impairment is associated with a higher cerebral SVD burden independent of hypertension, but not age. Reduced eGFR is associated with worse functional outcome, but not independent of age and comorbidities. Since CT has limited sensitivity to detect SVD severity and distribution, further studies including MRI are needed.

Need for Neonatal Resuscitation: Does Maternal COVID-19 Affect It?

Background Maternal COVID-19 infection acquired during late pregnancy carries a potential risk for adverse neonatal outcomes. There is still a paucity of data on its effect on the transition from intrauterine to extrauterine life. Objectives The objectives of this study were to determine the impact of maternal COVID-19 infection on neonates for the risk and need for resuscitation at birth, Apgar scores at 1- and 5-minutes, and the need of NICU admission during early neonatal period. Materials and method In this hospital-based prospective matched cohort study, 100 COVID-positive pregnant women presenting for delivery were enrolled. We also included 100 non-COVID pregnant women after the best possible matching of their major baseline parameters with the study group. Neonates of both groups were followed-up till 7 days of life. Results The two groups were comparable for all baseline variables except for the mode of delivery. The requirement of neonatal resuscitation was 30% and 21% in the study and control groups (RR = 1.429; 95% CI 0.88–2.32; p = 0.149). Apgar scores at 1- and 5- minutes were also unaffected by maternal COVID-19 infection with mean scores of 8.8 ± 0.651 vs. 8.87 ± 0.562 (p = 0.42) in the study and control groups, respectively. COVID-exposed neonates had a higher incidence of NICU admission when compared with the unexposed group (RR =1.616; 95% CI 1.002–2.606; p = 0.047). Among neonates born to COVID-positive mothers, 11% demonstrated evidence of SARS-CoV-2 positivity within first 5 days of life. The risk for need of resuscitation and mean Apgar scores were comparable among SARS-CoV-2 positive and negative neonates (p &gt; 0.05). Conclusion COVID-19 infection in pregnant women is not associated with an increased risk of neonatal resuscitation.

Using time-course as an essential factor to accurately predict sepsis-associated mortality among patients with suspected sepsis

BackgroundBiomarker dynamics in different time-courses might be the primary reason why a static measurement of a single biomarker cannot accurately predict sepsis outcomes. Therefore, we conducted this prospective hospital-based cohort study to simultaneously evaluate the performance of several conventional and novel biomarkers of sepsis in predicting sepsis-associated mortality on different days of illness among patients with suspected sepsis. MethodsWe evaluated the performance of 15 novel biomarkers including angiopoietin-2, pentraxin 3, sTREM-1, ICAM-1, VCAM-1, sCD14 and 163, E-selectin, P-selectin, TNF-alpha, interferon-gamma, CD64, IL-6, 8, and 10, along with few conventional markers for predicting sepsis-associated mortality. Patients were grouped into quartiles according to the number of days since symptom onset. Receiver operating characteristic curve (ROC) analysis was used to evaluate the biomarker performance. ResultsFrom 2014 to 2017, 1483 patients were enrolled, of which 78% fulfilled the systemic inflammatory response syndrome criteria, 62% fulfilled the sepsis-3 criteria, 32% had septic shock, and 3.3% developed sepsis-associated mortality. IL-6, pentraxin 3, sCD163, and the blood gas profile demonstrated better performance in the early days of illness, both before and after adjusting for potential confounders (adjusted area under ROC curve [AUROC]:0.81–0.88). Notably, the Sequential Organ Failure Assessment (SOFA) score was relatively consistent throughout the course of illness (adjusted AUROC:0.70–0.91). ConclusionIL-6, pentraxin 3, sCD163, and the blood gas profile showed excellent predictive accuracy in the early days of illness. The SOFA score was consistently predictive of sepsis-associated mortality throughout the course of illness, with an acceptable performance.

Comparison of Causes of Maternal Near Miss and Maternal Mortality in a Tertiary Care Hospital: A Prospective Study

The Maternal Near miss (MNM) concept has led to a more comprehensive and better assessment of the effect of care on maternal health. Investigating severe life-threatening pregnancy complications that women encounter and maternal morbidities (near misses) may help evaluate the quality of care in health facilities and recommend ways to improve maternal survival, especially in poor resource settings. Aim This study aimed to identify causes, classify, and determine the nature of complications in maternal near misses and in maternal death. Material and Methods The hospital-based prospective cohort study was conducted in the Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Aligarh Muslim University of Aligarh from 2020 to 2022. The study was approved by the Institutional Ethics Committee and informed written consent was obtained from the study participants. The outcome measures included causes, organ dysfunction, complications, maternal morbidities, and neonatal outcome. Results: Higher rate of unbooked referrals was observed in our study. Hemorrhage was 42.9%, followed by 39.1% hypertensive disorders, 8.6% sepsis in the maternal near miss group while in the maternal mortality group, 26.1% had hypertensive disorders followed by 23.8% women had hemorrhagic disorders, and 20.4% had sepsis. There was a significant difference in HDU, ICU Hospital stay and IUDs in the maternal mortality group compared to the maternal near-miss group. Conclusion The WHO near-miss approach was found to represent a feasible strategy in low-resource settings each Near Miss should be evaluated in detail to diagnose underlying pathology, correct and timely detection of complications, prompt referral and early institution of essential and comprehensive obstetrics care are important for maternal and infant survival.