Hospital-based Prospective Cohort Research Articles

Umbilical cord albumin and serum bilirubin as predictive factors for hyperbilirubinemia in term neonates

Background: Hyperbilirubinemia is one of the common causes of neonatal admission. As clinical evaluation may cause a delay in identification and subsequent initiation of medical therapy, there is a need for the sensitive and inexpensive predictive marker for hyperbilirubinemia in neonates. Measurement of cord albumin and its correlation with the serum bilirubin is one of the noninvasive predictive markers for Hyperbilirubinemia. The present study carried out to know the significance of umbilical cord albumin level as a predictor of neonatal hyperbilirubinemia.Methods: It is a hospital-based prospective cohort study, total 100 healthy term new-borns admitted in the Neonatal Intensive Care Unit, were included in the study as per study protocol over a period of one year. The blood sample was collected from umbilical cord blood for the analysis of bilirubin and albumin, and post 72 hours of life venous blood obtained for estimation of serum bilirubin and albumin along with direct and indirect Coombs test.Results: In this study most of the patients were in the gestational age of 37-38 weeks (71%) followed by 38-40 weeks (27%) and only 1% are >40 weeks. A positive correlation was observed between cord blood bilirubin, serum bilirubin, serum albumin, and cord blood albumin levels. Cord blood albumin was a better marker for neonatal hyperbilirubinemia with a sensitivity of 83%, and a specificity of 48%; as compared to cord blood bilirubin with a sensitivity and specificity of 73% and 39% respectively.Conclusions: From this study, cord blood albumin level was demonstrated as a good predictive marker for neonatal hyperbilirubinemia with a sensitivity of 83.1%. and specificity 48.8%. Hence, cord blood albumin may be used as a non-invasive predictor for neonatal hyperbilirubinemia.

P316 Hepatobiliary manifestations measured by vibration-controlled transient elastography in inflammatory bowel disease: A prospective hospital-based cohort study

Abstract Background Intestinal mucosal injury is supposed to cause liver disease and inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) is a typical chronic injury of intestinal mucosa. Therefore, we investigated the hepatobiliary manifestation with liver ultrasonography (LUS) and vibration-controlled transient elastography (VCTE) in IBD. Methods IBD patients newly diagnosed in Kosin University Gospel Hospital were enrolled consecutively. Gross hepatobiliary abnormality was evaluated with LUS and simultaneous liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were assessed to evaluate hepatic injury and steatosis with VCTE. Laboratory tests including hepatic biochemistries, anti-nuclear antibody (ANA), and faecal calprotectin level (FC) were taken. Results Eighty-two (37 patients of CD and 45 UC) patients were enrolled. Gallbladder abnormality was noted in 39 patients (47.5%) including stone in 7, sludge in 11, polyp in 10, wall thickening in 9 and collapsed in 2. CAP >233 dB/m was in 33 patients (40.2%) and LSM >5.5 kPa in 10 (12.2%). Nineteen patients (23.2%) were diagnosed fatty liver. FC was 382 ± 785 (mean ± SD). CAP >233 dB/m was significantly associated with lower FC (209.6 vs. 352.1, p = 0.038). The correlation coefficient was −0.316 between CAP and FC (p = 0.006). LSM >5.5 kPa tended to be lower FC but was not statistically significant (199.8 vs. 306.2, p = 0.283). ANA was positive in 14 patients (17.1%). In ANA positive patients, FC was significantly higher than ANA negative patients (609.5 vs. 319.4, p = 0.015). Conclusion In this prospective analysis, the major hepatobiliary manifestations in IBD patients were gallbladder abnormality and fatty liver and there could be an association between low hepatic fat amount and intestinal disease activity.

CLINICAL SYNDROMES OF THE THALAMIC STROKE IN THE CLASSICAL VASCULAR TERRITORIES: A PROSPECTIVE HOSPITAL-BASED COHORT STUDY

The aim: We aimed to determine, describe, and analyze the clinical and neuroimaging features of vascular syndromes of acute thalamic stroke in the classical vascular territories in a prospective hospital-based cohort study. Materials and methods: We have prospectively recruited 319 acute stroke patients, admitted to the Neurological Center at an academic hospital (Oleksandrivska Clinical Hospital) in Kyiv, Ukraine. Complex neurological, clinical, laboratory, ultrasound, and neuroimaging examinations were performed to all study patients within 24 hours since the symptoms onset. Results: MRI/CT-proven thalamic stroke was diagnosed in 34 (10.6%) out of 319 patients, forming a study group. Twenty-two out of 34 patients (average age 61.9 ± 10.2 years) were diagnosed with an acute isolated ischemic thalamic stroke, and 12 patients (average age 59.0 ± 9.6 years) were diagnosed with an acute thalamic hemorrhage. Conclusions: Specific neurological features of clinical vascular syndromes of acute thalamic stroke in the classical vascular territories were analyzed, compared, and described.

Antithrombotic prescription and clinical outcomes among patients with atrial fibrillation

Patients with atrial fibrillation (AF) are at risk of developing heart failure and stroke, which contribute to its high morbidity and mortality. Optimal anticoagulation therapy significantly reduces stroke risk, though it predisposes patients to bleeding. There is little information on the outcomes of patients with AF receiving antithrombotic therapy in our setting. This study aimed at determining the heart failure, ischemic stroke, major bleeding, hospitalisation and mortality rates, to compare the outcomes according to antithrombotic treatment, and to determine the predictors of adverse outcomes in patients with AF. It was a hospital-based prospective cohort study, using a retrospective atrial fibrillation registry. Baseline characteristics were obtained from the registry and follow-up was done 12 months after inclusion in the registry. We enrolled 113 participants, and follow-up was completed for 107 of them (94.7%). The mean age was 70 ± 12 years with a marked female predominance (F:M= 2.1:1). Antiplatelets, Vitamin K Antagonists and Non Vitamin K oral anticoagulants were the prescribed antithrombotic treatment in 24.8%, 52.2% and 23% of the population respectively. Hospitalisation was the most frequent event (35.1%), followed by heart failure (18.6%) and death (16.8%). Ischemic stroke occurred in 5 (5.2%) participants and major bleeding in 3 (3.1%). Overall, 47.7% of the participants experienced an outcome. There was no difference in the outcomes of patients according to their antithrombotic treatment. Previous heart failure and sedentary lifestyle were independently associated with mortality ( P = 0.019 and 0.025 respectively). Age > 60 years was associated with hospitalisation ( P = 0.031) and male gender with ischemic stroke ( P = 0.043). AF related morbidity and mortality remains high due to sub-optimal anticoagulation. More strategies are needed to improve the outcomes of those patients.

The effects of isobaric and hyperbaric bupivacaine on maternal hemodynamic changes post spinal anesthesia for elective cesarean delivery: A prospective cohort study.

BackgroundSpinal anesthesia is a form of regional anesthesia frequently used in various lower abdominal, orthopedic, obstetric operations such as a cesarean delivery. The most common local anesthetic used for spinal anesthesia in obstetric and non-obstetric surgery is bupivacaine which can be utilized as an isobaric or hyperbaric solution, producing differences in maternal hemodynamic changes. Against this backdrop, the study aims to compare the effects of isobaric and hyperbaric bupivacaine on maternal hemodynamic alterations after administering spinal anesthesia for elective cesarean delivery at Gandhi Memorial Hospital, Addis Ababa, Ethiopia.MethodsA hospital-based prospective cohort study design was employed for the period December 1, 2017 to January 30, 2018. A total of 100 parturient were involved, with one group exposed to isobaric bupivacaine and the other to hyperbaric bupivacaine to observe their effects on maternal hemodynamic changes post spinal anesthesia. The participants were selected through systematic random sampling. Data analysis was performed using SPSS (version 20) through descriptive statistic, independent sample t-test, Mann-Whitney U-test, Fisher’s exact test, and Chi-square test were used. P values of <0.05 was assumed as statistically significant for all tests.ResultsThe incidence of hypotension was found to be greater in isobaric than hyperbaric groups (82% vs. 60% respectively; p = 0.015). No statistical significant differences were found in mean arterial pressure value at baseline, but, statistically significant changes were observed among the groups (p <0.05) at all study timing after spinal anesthesia, except at 30thmin. No statistically significant differences were seen in the mean heart rate variability after spinal anesthesia at all periods, except the 15th minute (p = 0.033). A greater rate of vasopressor was used in the isobaric group as compared to the hyperbaric group (36% vs. 14% respectively; p = 0.011).ConclusionBaricity is a significant factor in maternal hemodynamic changes in the parturient for elective cesarean section. Isobaric bupivacaine produces greater change in blood pressure and incidence of hypotension and entails a greater vasopressor requirement than hyperbaric bupivacaine after spinal anesthesia for elective cesarean section.

Flow cytometric significance of cellular alkaline phosphatase activity in acute myeloid leukemia.

In this prospective hospital-based cohort study that included 43 newly diagnosed patients with acute myeloid leukemia, flow cytometric cellular alkaline phosphatase (ALP) activity within primitive leukemic cells allowed us to identify two groups of patients at diagnosis according to the numbers of leukemic blasts expressing ≥ 12% of ALP+ cells (27 patients, Group A) and less than 12% of ALP+ cells (16 patients, Group B). Differences in outcome for complete response, relapse or treatment resistance, and exitus were statistically analyzed and were significant, when comparing the two groups. The overall survival (OS) and event-free survival (EFS) differences between Group A and B were statistically significant. The survival of Group A patients was significantly shorter than those for Group B. No significant relationship was detected in outcome when comparing ELN prognostic-risk group based on cytogenetic and molecular profile (patients in the favorable, intermediate, and adverse risk groups). Flow cytometric cellular ALP activity at diagnosis may be used to estimate relapses and disease persistence more accurately. The limitations of our study include the small number of patients enrolled and a short follow-up, due to its prospective nature.

Etiology, Clinical Features, And Short-Term Outcome Of Seizures In Newborns Admitted To The University Of Gondar Hospital, Ethiopia.

BackgroundNeonatal seizures are the most common neurological dysfunction in the neonatal period. Neonatal seizure patterns and short-term neurologic outcomes, particularly in the Ethiopian context, have not been adequately studied.ObjectiveThe main aim of this study is to assess the pattern, probable etiology, short-term outcomes, and determinants of neonatal seizures in the neonatal intensive care unit of Gondar University Specialized Comprehensive Hospital.MethodsA hospital-based prospective observational cohort study was conducted from October 1, 2016, to September 30, 2018.ResultsAmong the 117 neonates enrolled, the most common type of neonatal seizure was subtle (60.6%), followed by tonic (15.4%), and clonic (12.8%) seizures. The most common etiology for the seizure was perinatal asphyxia (PNA) with hypoxic-ischemic encephalopathy (HIE; 74.4%) followed by electrolyte disturbances (12.8%). In the follow-up, 23 (19.7%) died during the acute neonatal illness. The most common cause of death was PNA with HIE, accounting for 73.9% of the deaths. Among the surviving newborns, 10 (10.6%) had neurodevelopmental deficits at discharge. Being a multiparous mother (OR= 0.172; 95% CI: 0.033, 0.880), being female (OR= 0.171; 95% CI: 0.055, 0.538), and having tonic (OR= 0.164; 95% CI: 0.030, 0.885) and myoclonic seizures (OR= 0.040; 95% CI: 0.055, 0.538) were significantly associated with mortality poor short-term outcome.ConclusionSubtle seizures were the most common seizure semiology. The most common etiology for seizure was PNA with HIE. Parity, gestational age, neonatal sex, and seizure type were determinants of short-term outcomes.

The Effectiveness of a Timely Discharge Plan in Older Adults: A Prospective Hospital-Based Cohort Study in Southern Taiwan

The Effectiveness of a Timely Discharge Plan in Older Adults: A Prospective Hospital-Based Cohort Study in Southern Taiwan

Extracellular fluid volume is associated with incident end-stage kidney disease and mortality in patients with chronic kidney disease

Volume overload has been shown to be an independent risk factor for mortality in patients receiving chronic dialysis, but data in non-dialysis patients are scarce. Therefore we evaluated the prognostic value of extracellular fluid (ECF) volume for chronic kidney disease (CKD) progression and mortality in a prospective hospital-based cohort with CKD stage 1-4 (NephroTest Study). ECF (scaled to body surface area) and the measured glomerular filtration rate (mGFR) were determined using the distribution volume and clearance of 51Cr-EDTA, respectively. Cause-specific Cox and linear mixed-effect regression models were used to analyze the association of ECF with end-stage kidney disease (ESKD) and mortality, and with mGFR decline, respectively. The 1593 patients were mean age 58.8 years, 67% were men, mean mGFR of 43.6 mL/min/1.73m2 and mean ECF 15.1 L/1.73m2. After a median follow-up of 5.3 years, ESKD occurred in 324 patients and 185 patients died before ESKD. In multivariable analysis, ECF was significantly associated with the risk of ESKD (hazard ratio per 1L/1.73m2 increase: 1.14; 95% confidence interval [1.07; 1.21]) and with a faster GFR decline (adjusted mean difference in mGFR slope per 1L/1.73m2 increase -0.14 [-0.23; -0.05] mL/min/year). The relationship of ECF with mortality was non-linear and not significant (per 1L/1.73m2 increase 0.92, [0.73; 1.16]), below 15L/1.73m2, but significant (1.28; [1.14-1.45]) above 15L/1.73m2. Thus, in this large cohort of carefully phenotyped patients with CKD, ECF was an independent risk factor of CKD progression and mortality. Hence, close monitoring and treatment of fluid overload are important for the clinical management of patients with non-dialysis CKD.

Surgical Evaluation of Flame Burn Injuries in Syrian Civilians.

The aim of the current study was to evaluate the severity and location of flame burns and the mortality rate of civilians affected by these in the Syrian Civil War and to present the surgical treatment outcomes of the injured civilians to be able to provide recommendations. This was a prospective hospital-based observational cohort study involving 573 patients with data collected from 2011 to 2018. All of these patients were Syrian civilians, and their flame burn injuries were related to the Syrian conflict. All burns were divided into four subgroups according to TBSA and compared. The groups of TBSA were compared as 0 to 25% (n = 97), 25 to 50% (n = 257), 50 to 75% (n = 135), and >75% (n = 84) (P = .413). Almost all had a second (n = 331; 57.7%) and third (n = 189; 32.9%) degree deep burns. The median burn size was 47% TBSA in the patients. The burn mechanism was mostly the flame type of burn (n = 467; 81.5%) as a result of fuel oil explosions, followed by bomb-related burns (n = 106; 18.5%) (P < .001). Mortality was seen in 223 (39%) due to the high surface area and reaching hospital too late at 1 to 8 days (P = .187). The findings of this study indicate that war-related flame burns result in an extremely high mortality rate and time is lost, which could protect against life-threatening outcomes.

Quantile regression for survival data in modern cancer research: expanding statistical tools for precision medicine.

Quantile regression links the whole distribution of an outcome to the covariates of interest and has become an important alternative to commonly used regression models. However, the presence of censored data such as survival time, often the main endpoint in cancer studies, has hampered the use of quantile regression techniques because of the incompleteness of data. With the advent of the precision medicine era and availability of high throughput data, quantile regression with high-dimensional predictors has attracted much attention and provided added insight compared to traditional regression approaches. This paper provides a practical guide for using quantile regression for right censored outcome data with covariates of low- or high-dimensionality. We frame our discussion using a dataset from the Boston Lung Cancer Survivor Cohort, a hospital-based prospective cohort study, with the goals of broadening the scope of cancer research, maximizing the utility of collected data, and offering useful statistical alternatives. We use quantile regression to identify clinical and molecular predictors, for example CpG methylation sites, associated with high-risk lung cancer patients, for example those with short survival.

Effect of serum albumin level on hospital outcomes in out-of-hospital cardiac arrest

Background: Background: Serum albumin has been known as a strong predictive value of mortality in various disease conditions, severe burns, major surgeries, stroke, myocardial infarction, etc. But little is known for the effect of serum albumin level on out-of-hospital cardiac arrest patients. Objectives: This study aimed to investigate the effect of serum albumin level on the outcome of out of hospital cardiac arrest. Methods: This study was a prospective hospital-based patient cohort study, conducted during January to December 2014 at 27 emergency departments in Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance project. The albumin was measured immediately after arrival to the emergency department during cardiopulmonary resuscitation, and albumin was categorized into two groups, group &lt; 3.5 g/dL group and ⩾ 3.5 g/dL group. The primary outcome was a good neurological recovery at discharge (cerebral performance category scale 1 or 2). Multivariable logistic regression was used for adjusting for confounders. Results: During the study period, 1616 out-of-hospital cardiac arrest patients with presumed cardiac etiology were enrolled, and the total of 1013 patients were analyzed in this study. A total 452 (44.6%) patients had serum albumin level less than 3.5 g/dL. The serum albumin ⩾ 3.5 g/dL group showed better neurological outcomes than the serum albumin &lt; 3.5 g/dL group: 18.5% versus 4.0%, and ⩾ 3.5 g/dL group had higher survival discharge rates than the &lt; 3.5 g/dL group: 23.9% versus 9.1% (p &lt; 0.01). After adjusting for potential covariates, patients with serum albumin ⩾ 3.5 g/dL had a higher odds of good neurological recovery (adjusted odds ratio: 2.94 (95% confidence interval: [1.57, 5.49])), and higher survival to discharge (adjusted odds ratio: 1.74 (95% confidence interval: [1.10, 2.76])). Conclusion: Low serum albumin levels are associated with a worse neurologic outcome in patients with out-of-hospital cardiac arrest.

Maternal HBsAg carriers and adverse pregnancy outcomes: A hospital-based prospective cohort analysis.

It is not clear whether chronic hepatitis B virus (HBV) infection during pregnancy can increase the risk of adverse pregnancy outcomes for both mothers and neonates. We conducted a hospital-based prospective cohort study on pregnant women (PW) and used an analysis strategy that was guided by directed acyclic graphs (DAGs). Maternal characteristics and major adverse pregnancy outcomes were collected both from questionnaires and hospital-based electronic medical records. Serum hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) status were determined. In total, 3329 of the 3416 pregnant women who received routine antenatal care in a hospital setting at baseline, including 346 HBsAg carriers, were available for analysis. Maternal HBsAg carrier status was associated with an increased risk of intrahepatic cholestasis pregnancy [aOR (adjusting odds ratio)=1.70; 95% CI (confidence interval)=1.16-2.49], premature rupture of the membranes (aOR=1.38; 95% CI=1.00-1.89) and large for gestational age birth aOR=1.67; 95% CI=1.17-2.39). The risk of intrahepatic cholestasis remained in pregnant women with either HBeAg-positive (aOR=2.96; 95% CI=1.33-6.62) or HBeAg-negative (aOR=1.52; 95% CI =1.00-2.32)] status; notably, only maternal HBeAg-negative status was associated with a higher risk of large for gestational age birth (aOR=1.91; 95% CI=1.33-2.76). Our results implied that chronic HBV infection during pregnancy may increase the risk of intrahepatic cholestasis of pregnancy, premature rupture of membranes and large for gestational age pregnancies.

Fixation Characteristics in Highly Myopic Eyes: the Shanghai High Myopia Study

We enrolled 500 highly myopic eyes and 50 controls in this hospital-based prospective cohort study. The fixation ellipse angle and area in terms of the bivariate contour ellipse area (BCEA) were measured with Macular Integrity Assessment microperimetry. Optic disc tilt and rotation were evaluated with retinal images. The associations between fixation and optic disc changes were assessed. Both 63% and 95% BCEA correlated positively with axial length (AL) (both r = 0.230, P = 0.001) in highly myopic group, and were significantly higher than the control group (both P < 0.001). The direction of fixation ellipse presented clockwise rotation in the right eyes and anti-clockwise rotation in the left eyes with the increase of AL in highly myopic group (AL ≥30 vs <30 mm: OD 76.12 ± 51.17°: vs 90.60° ± 51.28°, P = 0.029; OS 94.73 ± 57.45° vs 87.82 ± 55.15°, P = 0.371). The angle between the long axis of the fixation ellipse and the long axis of the optic disc (AngleF−D) distributed in various directions: 0–30° (34.6% almost parallel) ≈60–90° (34.4% almost vertical) >30–60° (31% oblique). AngleF−D increased slightly with the AL (r = 0.105, P = 0.024). In highly myopic eyes, fixation stability decreased with the AL, and superior rotation of the fixation ellipse increased with AL. The long axis of fixation ellipse and the long axis of optic disc became less parallel to each other with increasing AL. Our data may provide clues for improvement of fixation evaluation designs of biometric instruments.

Incidence and recurrence risk of low birth weight in Northern Tanzania: A registry based study.

BackgroundLow birth weight (LBW) is an important indicator of newborn survival. It is associated with higher risk of morbidity, mortality and long-term health consequences. Little has been done on incidence and recurrence risk of LBW in developing countries including Tanzania. This study aimed to determine the incidence and recurrence risk of LBW among women who delivered at Kilimanjaro Christian Medical Center (KCMC), Tanzania.MethodsA hospital-based prospective cohort study was conducted using maternally-linked data from KCMC birth registry between 2000 and 2010. A total of 26,191 women delivered singleton live babies during the study period. Of these, 4,603 (17.6%) had subsequent pregnancies. The recurrence risk of LBW was estimated using a multivariable log-binomial regression model. A robust variance estimator was used to account for correlation between births of the same mother.ResultsThe incidence of LBW was 7.1%. The absolute recurrence risk of LBW was 28.1%. This corresponds to a relative risk (RR) of 5.08-fold, 95% CI 4.01–6.45). Antenatal care visits (<4) (RR: 5.00; 95% CI 3.58–6.98), preterm birth (RR: 4.55; 95% CI 3.21–6.43), positive HIV status (RR: 7.49: 95% CI 3.91–14.36) and preeclampsia (RR: 4.37; 2.60–7.35) in the first pregnancy were important predictors of LBW recurrence.ConclusionThe incidence of LBW and its recurrence was high in the study population. Women with previous history of LBW had higher risk of recurrent LBW in subsequent pregnancies. Identification of factors associated with LBW recurrence, proper post-partum care management to ensure Healthy Timing and Spacing of Pregnancy, Pre-conception care and close clinical follow-up during subsequent pregnancy may help reduce LBW recurrence.

Plasma cell-free DNA: a potential biomarker for early prediction of severe dengue

BackgroundConsiderable progress has been made in dengue management, however the lack of appropriate predictors of severity has led to huge number of unwanted admissions mostly decided on the grounds of warning signs. Apoptosis related mediators, among others, are known to correlate with severe dengue (SD) although no predictive validity is established. The objective of this study was to investigate the association of plasma cell-free DNA (cfDNA) with SD, and evaluate its prognostic value in SD prediction at acute phase.MethodsThis was a hospital-based prospective cohort study conducted in Vietnam. All the recruited patients were required to be admitted to the hospital and were strictly monitored for various laboratory and clinical parameters (including progression to SD) until discharged. Plasma samples collected during acute phase (6–48 h before defervescence) were used to estimate the level of cfDNA.ResultsOf the 61 dengue patients, SD patients (n = 8) developed shock syndrome in 4.8 days (95% CI 3.7–5.4) after the fever onset. Plasma cfDNA levels before the defervescence of SD patients were significantly higher than the non-SD group (p = 0.0493). From the receiver operating characteristic (ROC) curve analysis, a cut-off of > 36.9 ng/mL was able to predict SD with a good sensitivity (87.5%), specificity (54.7%), and area under the curve (AUC) (0.72, 95% CI 0.55–0.88; p = 0.0493).ConclusionsTaken together, these findings suggest that cfDNA could serve as a potential prognostic biomarker of SD. Studies with cfDNA kinetics and its combination with other biomarkers and clinical parameters would further improve the diagnostic ability for SD.

Long-Term Exposure to Air Pollution and Survival After Ischemic Stroke.

Background and Purpose- China bears a heavy burden of stroke because of its large population of elderly people and the propensity for stroke. Previous studies have examined the association between air pollution and stroke mortality or hospital admission. However, the global evidence for adverse effects of air pollution on survival after stroke is scarce. Methods- We used the first national hospital-based prospective registry cohort of stroke in China, which included 12 291 ischemic stroke patients who visited hospitals during 2007 to 2008. All patients were followed for 1-year poststroke. Deaths during the follow-up period were recorded. Participants' 3-year prestroke exposures to ambient PM1, PM2.5, PM10 (particulate matter with aerodynamic diameters ≤1, ≤2.5, and ≤10 μm, respectively) and NO2 (nitrogen dioxide) were estimated by machine learning algorithms with satellite remote sensing, land use information, and meteorological data. Cox proportional hazards models were used to examine the association between air pollution and survival after ischemic stroke. Results- In total, 1649 deaths were identified during the 1-year follow-up period. After controlling for potential confounders, significant associations were observed between exposure to PM1 and PM2.5 and incident fatal ischemic stroke. The corresponding hazard ratios and 95% CIs associated with 10 µg/m3 increase in PM1 and PM2.5 were 1.05 (1.02-1.09) and 1.03 (1.00-1.06), respectively. No significant association was observed for PM10 or NO2 (hazard ratios and 95% CIs, 1.01 [1.00-1.03] and 1.03 [0.99-1.06], respectively). Higher hazard ratios (and 95% CIs) were observed for male, elderly and obese individuals. Conclusions- Prestroke exposure to PM1 and PM2.5 was associated with increased incident fatal ischemic stroke in the year following an ischemic stroke in China. Improved air quality may be beneficial for people to recover from stroke.

Increased incidence of obstetric and perinatal complications in pregnancies achieved using donor oocytes and single embryo transfer in young and healthy women. A prospective hospital-based matched cohort study

In this single-center matched-cohort study, women who underwent IVF/ICSI with donor oocytes between 2007 and 2014 (n = 259) were compared to women undergoing autologous cycles during the same time period (n = 515). The matching (1:2) took into consideration the women’s age, type of treatment (IVF/ICSI), and year of embryo transfer. All women were healthy and below 40 years of age at the time of IVF/ICSI, and the treatments were performed using a strict policy of single embryo transfer. Multiple logistic regression analysis, adjusted for body mass index (BMI), smoking, and parity, showed a four times increased risk of gestational hypertensive disorders (adjusted odds ratio, AOR 4.25; 95% confidence interval (CI), 2.61–6.92) and pre-eclampsia (AOR 3.99; 95% CI 2.27–7.00) in pregnancies achieved with donor oocytes. There was also a higher rate of cesarean section in women who gave birth after oocyte donation (AOR 1.69; 95% CI 1.22–2.35) and a higher risk of postpartum hemorrhage >1000 mL (AOR 1.59; 95% CI, 1.11–2.27). After further adjustment for preeclampsia in the logistic regression analysis, no additional increased perinatal risks were found. The incidence of preterm delivery, low weight at birth, need of neonatal intensive care, Apgar scores, and incidence of perinatal death were also similar between the groups.

Comparison of Vitamin D status in obese and nonobese children: A hospital-based prospective cohort study

Objectives: The objective of this study is to compare the Vitamin D3 level in obese children in a tertiary care center in Jammu (Jammu and Kashmir), India, and to find the association between Vitamin D3 levels and the comorbidities of obesity. Materials and Methods: Twenty obese children and 20 controls were included in the study group. Obesity defined by international obesity task force (criteria) Questionnaires Form and anthropomorphic data were collected on patients, and fasting blood glucose, lipids, liver function tests, renal function test and 25-hydroxyvitamin D (25-OHD) were measured. Results: The levels of 25-OHD in the obese group were significantly lower than those of the control group (χ = 0.000). About 80% of obese children and 10% of controls were Vitamin D deficient; similarly, 20% of obese children and 35% of controls had Vitamin D insufficiency. There was no statistical significant difference of mean serum Vitamin D level between male and female children in both cases and controls. Calorie intake (P = 0.11), serum cholesterol, and triglycerides were significantly raised among the obese group with the mean (152.70 ± 18.85) than in the control group (134.65 ± 15.27) (P = 0.002). There was no significant association of 25 (OH) Vitamin D3 level with the other comorbidities of obesity such as deranged blood sugar, liver function tests, and lipid profile. Conclusion: Vitamin D deficiency is significantly more prevalent in obese children and showed a linear relationship, but we were unable to find any significant statistical association between 25 (OH) Vitamin D3 levels with the comorbidities of obesity.

Impact of in vitro fertilization-embryo transfer on adverse pregnancy outcomes: A prospective cohort study

To evaluate whether the in vitro fertilization-embryo transfer (IVF-ET) procedures could increases the risks of adverse pregnancy outcomes (APOs) in offspring. Methods: A hospital-based prospective cohort design was conducted, which contained a control group of singleton pregnancies with indicators of subfertility who were still conceived naturally after using simple medical treatment (e.g. minimal medical intervention or ovulation induction), and an exposure group consisted of singleton pregnancies who had a history of infertility and IVF-ET treatment. All factors different between two groups in the univariate analysis were included in the multivariable logistic regression to evaluate the independent effect of IVF-ET procedures themselves on APOs. Results: After controlling for confounding factors by using multivariate logistic regression analysis, our results showed that pregnancies after IVF-ET experienced a higher risk of preterm birth (OR=1.28, 95% CI 1.05 to 1.56), low birth weight (OR=1.69, 95% CI 1.27 to 2.31), perinatal mortality (OR=5.33, 95% CI 2.44 to 11.81), and congenital malformations (OR=1.83, 95% CI 1.12 to 2.94). Conclusion: The IVF-ET operational factors may increase the risk of APOs.