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1.
N Engl J Med ; 386(13): 1221-1229, 2022 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-35172072

RESUMO

BACKGROUND: The risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) decreases substantially among patients who have recovered from coronavirus disease 2019 (Covid-19). However, it is unknown how long protective immunity lasts. Current guidelines recommend vaccination of recovered patients even though data regarding vaccine effectiveness in such cases are still limited. METHODS: In this retrospective cohort study, we reviewed electronic medical records from a large health care organization in Israel to assess reinfection rates in patients who had recovered from SARS-CoV-2 infection before any vaccination against Covid-19. We compared reinfection rates among patients who had subsequently received the BNT162b2 vaccine (Pfizer-BioNTech) and those who had not been vaccinated between March 1 and November 26, 2021. We used a Cox proportional-hazards regression model with time-dependent covariates to estimate the association between vaccination and reinfection after adjustment for demographic factors and coexisting illnesses. Vaccine effectiveness was estimated as 1 minus the hazard ratio. In a secondary analysis, we evaluated the vaccine effectiveness of one dose as compared with two doses. RESULTS: A total of 149,032 patients who had recovered from SARS-CoV-2 infection met the eligibility criteria. Of these patients, 83,356 (56%) received subsequent vaccination during the 270-day study period. Reinfection occurred in 354 of the vaccinated patients (2.46 cases per 100,000 persons per day) and in 2168 of 65,676 unvaccinated patients (10.21 cases per 100,000 persons per day). Vaccine effectiveness was estimated at 82% (95% confidence interval [CI], 80 to 84) among patients who were 16 to 64 years of age and 60% (95% CI, 36 to 76) among those 65 years of age or older. No significant difference in vaccine effectiveness was found for one dose as compared with two doses. CONCLUSIONS: Among patients who had recovered from Covid-19, the receipt of at least one dose of the BNT162b2 vaccine was associated with a significantly lower risk of recurrent infection.


Assuntos
Vacina BNT162 , COVID-19 , Reinfecção , Adolescente , Adulto , Idoso , Vacina BNT162/uso terapêutico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Humanos , Pessoa de Meia-Idade , Reinfecção/prevenção & controle , Estudos Retrospectivos , SARS-CoV-2 , Eficácia de Vacinas , Vacinas/uso terapêutico , Adulto Jovem
2.
N Engl J Med ; 387(9): 790-798, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-36001529

RESUMO

BACKGROUND: The oral protease inhibitor nirmatrelvir has shown substantial efficacy in high-risk, unvaccinated patients infected with the B.1.617.2 (delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data regarding the effectiveness of nirmatrelvir in preventing severe coronavirus disease 2019 (Covid-19) outcomes from the B.1.1.529 (omicron) variant are limited. METHODS: We obtained data for all members of Clalit Health Services who were 40 years of age or older at the start of the study period and were assessed as being eligible to receive nirmatrelvir therapy during the omicron surge. A Cox proportional-hazards regression model with time-dependent covariates was used to estimate the association of nirmatrelvir treatment with hospitalization and death due to Covid-19, with adjustment for sociodemographic factors, coexisting conditions, and previous SARS-CoV-2 immunity status. RESULTS: A total of 109,254 patients met the eligibility criteria, of whom 3902 (4%) received nirmatrelvir during the study period. Among patients 65 years of age or older, the rate of hospitalization due to Covid-19 was 14.7 cases per 100,000 person-days among treated patients as compared with 58.9 cases per 100,000 person-days among untreated patients (adjusted hazard ratio, 0.27; 95% confidence interval [CI], 0.15 to 0.49). The adjusted hazard ratio for death due to Covid-19 was 0.21 (95% CI, 0.05 to 0.82). Among patients 40 to 64 years of age, the rate of hospitalization due to Covid-19 was 15.2 cases per 100,000 person-days among treated patients and 15.8 cases per 100,000 person-days among untreated patients (adjusted hazard ratio, 0.74; 95% CI, 0.35 to 1.58). The adjusted hazard ratio for death due to Covid-19 was 1.32 (95% CI, 0.16 to 10.75). CONCLUSIONS: Among patients 65 years of age or older, the rates of hospitalization and death due to Covid-19 were significantly lower among those who received nirmatrelvir than among those who did not. No evidence of benefit was found in younger adults.


Assuntos
Antivirais , Tratamento Farmacológico da COVID-19 , COVID-19 , Lactamas , Leucina , Nitrilas , Prolina , Adulto , Idoso , Antivirais/uso terapêutico , COVID-19/virologia , Hospitalização , Humanos , Lactamas/uso terapêutico , Leucina/uso terapêutico , Pessoa de Meia-Idade , Nitrilas/uso terapêutico , Prolina/uso terapêutico , SARS-CoV-2 , Resultado do Tratamento
3.
N Engl J Med ; 385(26): 2413-2420, 2021 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-34879190

RESUMO

BACKGROUND: The emergence of the B.1.617.2 (delta) variant of severe acute respiratory syndrome coronavirus 2 and the reduced effectiveness over time of the BNT162b2 vaccine (Pfizer-BioNTech) led to a resurgence of coronavirus disease 2019 (Covid-19) cases in populations that had been vaccinated early. On July 30, 2021, the Israeli Ministry of Health approved the use of a third dose of BNT162b2 (booster) to cope with this resurgence. Evidence regarding the effectiveness of the booster in lowering mortality due to Covid-19 is still needed. METHODS: We obtained data for all members of Clalit Health Services who were 50 years of age or older at the start of the study and had received two doses of BNT162b2 at least 5 months earlier. The mortality due to Covid-19 among participants who received the booster during the study period (booster group) was compared with that among participants who did not receive the booster (nonbooster group). A Cox proportional-hazards regression model with time-dependent covariates was used to estimate the association of booster status with death due to Covid-19, with adjustment for sociodemographic factors and coexisting conditions. RESULTS: A total of 843,208 participants met the eligibility criteria, of whom 758,118 (90%) received the booster during the 54-day study period. Death due to Covid-19 occurred in 65 participants in the booster group (0.16 per 100,000 persons per day) and in 137 participants in the nonbooster group (2.98 per 100,000 persons per day). The adjusted hazard ratio for death due to Covid-19 in the booster group, as compared with the nonbooster group, was 0.10 (95% confidence interval, 0.07 to 0.14; P<0.001). CONCLUSIONS: Participants who received a booster at least 5 months after a second dose of BNT162b2 had 90% lower mortality due to Covid-19 than participants who did not receive a booster.


Assuntos
Vacina BNT162 , COVID-19/mortalidade , Imunização Secundária , Eficácia de Vacinas/estatística & dados numéricos , Idoso , Vacina BNT162/imunologia , COVID-19/prevenção & controle , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais
4.
Inj Prev ; 2024 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-38050046

RESUMO

BACKGROUND: Research shows violence against women likely increases during emergencies. COVID-19's emergence exacerbated intimate partner violence (IPV), suggesting that healthcare services (HCS) should have increased IPV screening efforts and referrals of victims to support services. However, little is known about the prevalence of IPV screening and information provision during COVID-19 lockdowns. METHODS: We examined prevalence of 'ever been screened' (ES) for IPV and 'receiving information about support services' (RI) in HCS during COVID-19 lockdowns and compared these among non-immigrant Jewish women, immigrant Jewish and other women, and Palestinian women citizens in Israel. We collected data during Israel's second and third COVID-19 lockdowns (October 2020-February 2021) using a structured, online, self-administrated Arabic-language and Hebrew-language questionnaire. Eligibility criteria included women ≥18 years old, citizens of Israel, in a current intimate relationship (permanent or occasional) who used social media or smartphones. In total, 519 women completed the survey: 73 Palestinian, 127 Jewish immigrants and others, and 319 non-immigrant Jewish. RESULTS: Overall, 37.2% of women reported any IPV, of whom just 26.9% reported ES, 39.4% reported RI and 13.5% reported both (ES&RI). Palestinian women reported higher IPV rates (49.3%) compared with non-immigrant Jewish (34.2%) and immigrant Jewish and other (37.8%) women; however, they reported lower ES (OR 0.64, 90% CI (0.34 to 1.86) and RI 0.29 (0.17 to 0.50). CONCLUSIONS: In a survey during COVID-19 lockdowns, only about one-quarter of women who reported IPV were ES for IPV, or RI about support services, suggesting strengthened IPV screening is needed in HCS during emergencies, particularly targeting minority women, who report higher IPV but receive fewer services.

5.
Gastroenterology ; 162(2): 482-494, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34757139

RESUMO

BACKGROUND AND AIMS: Starting biologic treatment early in the course of inflammatory bowel disease (IBD) may be associated with higher efficacy, especially in Crohn's disease (CD). METHODS: This was a systematic review and individual-patient data meta-analysis of all placebo-controlled trials of biologics approved for IBD at study inception (October 2015), using Vivli data-sharing platform. The primary outcome was the proportional biologic/placebo treatment effect on induction of remission in patients with short-duration (≤18 months) vs long-duration disease (>18 months) analyzed separately for CD and ulcerative colitis (UC). We used meta-regression to examine the impact of patients' characteristics on the primary outcome. RESULTS: We included 25 trials, testing infliximab, adalimumab, certolizumab, golimumab, natalizumab, or vedolizumab (6168 patients with CD and 3227 patients with UC). In CD, remission induction rates were higher in pooled placebo and patients in active arms with short-duration disease of ≤18 months (41.4% [244 of 589]) compared with disease duration of >18 months (29.8% [852 of 2857], meta-analytically estimated odds ratio, 1.33; 95% confidence interval, 1.09-1.64). The primary outcome, proportional biologic/placebo treatment effect on induction of remission, was not different in short-duration disease of ≤18 months (n = 589, odds ratio, 1.47; 95% confidence interval, 1.01-2.15) compared with longer disease duration (n = 2857, odds ratio, 1.43; 95% confidence interval, 1.19-1.72). In UC trials, both the proportional biologic/placebo remission-induction effect and the pooled biologic-placebo effect were stable, regardless of disease duration. Primary outcome results remained unchanged when tested using alternative temporal cutoffs and when modeled for individual patient's covariates, including prior anti-tumor necrosis factor exposure. CONCLUSIONS: There are higher rates of induction of remission with biologics and with placebo in early CD, resulting in a treatment to placebo effect ratio that is similar across disease durations. No such relationships between disease duration and outcomes was found in UC. PROSPERO registration: CRD42018041961.


Assuntos
Produtos Biológicos/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Adalimumab/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Certolizumab Pegol/uso terapêutico , Colite Ulcerativa/fisiopatologia , Doença de Crohn/fisiopatologia , Fármacos Gastrointestinais/uso terapêutico , Humanos , Fatores Imunológicos/uso terapêutico , Infliximab/uso terapêutico , Natalizumab/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Pediatr Allergy Immunol ; 34(12): e14061, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38146117

RESUMO

BACKGROUND: Accumulating evidence suggests that food-induced anaphylaxis (FIA) may induce different psychological disorders (PDs). In this study, we aimed to further evaluate the effect of FIA, specifically when occurring in early life, on subsequent PDs development. METHODS: We conducted a population-based, retrospective, matched-cohort study of pediatric patients (age ≤ 18 years) treated at the "Clalit" healthcare organization during the period 2001-2021. Children diagnosed with FIA were propensity score-matched with patients without any allergies (controls) of similar demographic parameters. Associations between FIA and different PDs were examined by multivariable regression models. RESULTS: The cohorts comprised 545 FIA patients and 4514 controls. Most patients were <3 years old [87.6% of controls (N = 3955) and 87.3% of the FIA cohort (N = 476)]. In this age group, the major food allergens were cow's milk (N = 258; 54.2%), eggs (N = 60; 12.6%), and peanuts (N = 20; 4.2%). The multivariable regression model identified an association between FIA and any PDs (p < .001), sleeping disorders (p < .001), and eating disorders (p = .050). Kaplan-Meier curves revealed that patients who experienced FIA before 3 years of age had an increased cumulative risk over the follow-up time of developing any PDs, sleeping disorders, and eating disorders. CONCLUSION: FIA during the first 3 years of life increases the risk of later developing eating and sleeping disorders, which can last into adulthood. Further attention should be focused on accurately diagnosing these children.


Assuntos
Anafilaxia , Transtornos da Alimentação e da Ingestão de Alimentos , Hipersensibilidade Alimentar , Hipersensibilidade a Leite , Feminino , Animais , Bovinos , Humanos , Criança , Adolescente , Pré-Escolar , Anafilaxia/epidemiologia , Anafilaxia/etiologia , Estudos Retrospectivos , Estudos de Coortes , Alérgenos , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Hipersensibilidade a Leite/diagnóstico
7.
Acta Obstet Gynecol Scand ; 102(8): 1000-1006, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37186304

RESUMO

INTRODUCTION: Multiple gestations are a risk factor for most pregnancy complications. The current study aimed to study whether offspring born after twin pregnancies are at increased risk for long-term health complications. MATERIAL AND METHODS: A retrospective cohort study was conducted in a large medical center, including all offspring born between the years 1991-2021, which were followed-up until 18 years of age. Hospital-based diagnoses of the offspring were categorized into main groups of morbidities: cardiac, respiratory, infectious, neurological, malignancy, and metabolic. Incidence of hospitalization with diagnoses from each main group was compared between twins and singletons, as well as time to first hospitalization. Cox proportional hazard models were used to study the association between twins vs singletons and hospitalizations by grouped morbidities, while adjusting for maternal age, ethnicity and gender, besides maternal recurrence in the cohort. RESULTS: A total of 369 478 offspring were included in the analysis; of these 11 986 (3.2%) were twins and 357 492 (96.8%) were singletons. Twins were more likely to be delivered preterm (odds ratio = 17.65, 95% CI: 16.74-18.60), by cesarean delivery and following infertility treatments. Incidence of hospitalizations with all morbidity groups was slightly, some significantly, higher among twins, including cardiac: 1.9% vs 1.5%, respiratory; 8.4% vs 7.1%, neurological: 7.7% vs 7.4%, infectious: 26.0% vs 24.1%, and malignancies: 0.7% vs 0.4%. The risk remained higher in the multivariable analyses (adjusted hazard ratios ranging between 1.09-1.75). When stratifying by gestational age at delivery, the risk for most morbidities was lower among twins vs singletons born in similar gestational ages. CONCLUSIONS: Twins as compared to singletons are at increased risk for most morbidities due to their risk of being born earlier.


Assuntos
Gravidez de Gêmeos , Gêmeos , Gravidez , Recém-Nascido , Feminino , Humanos , Estudos Retrospectivos , Idade Materna , Idade Gestacional , Avaliação de Resultados em Cuidados de Saúde , Resultado da Gravidez/epidemiologia
8.
J Pediatr ; 245: 111-116, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35120988

RESUMO

OBJECTIVE: To study the association between phototherapy for the treatment of neonatal jaundice and the risk of childhood neoplasms. STUDY DESIGN: This population-based retrospective cohort study included all infants born at ≥32 weeks of gestation at a single medical center between 1988 and 2018. The incidence of neoplastic diseases was compared between infants exposed to phototherapy and those unexposed. Kaplan-Meier curves and log-rank tests were used for cumulative incidence comparison, and multivariable Cox and Weibull survival analysis were used to adjust for confounding or clinically significant variables. RESULTS: The study population included 342 172 infants, of whom 18 797 (5.5%) were exposed to phototherapy. The median duration of follow-up was 9.5 years (range, birth to 18 years). Phototherapy was associated with a significantly increased risk for childhood malignancies and benign tumors (preterm birth and maternal age-adjusted hazard ratio, 1.89 [95% CI, 1.35-2.67] for malignancies and 1.27 [95% CI, 1.02-1.57] for benign tumors) Specifically, phototherapy was associated with hematopoietic cancers and leukemia (hazard ratio, 2.29 [95% CI, 1.48-3.54; P < .01] for hematopoietic cancers and 2.51 [95% CI, 1.52-4.14; P < .001] for leukemia), but not with solid tumors and lymphoma. CONCLUSIONS: Phototherapy may be associated with a slightly increased childhood risk of neoplasm. It is important to strictly follow phototherapy treatment guidelines to minimize unnecessary exposure.


Assuntos
Hiperbilirrubinemia Neonatal , Icterícia Neonatal , Leucemia , Neoplasias , Nascimento Prematuro , Feminino , Humanos , Hiperbilirrubinemia Neonatal/terapia , Lactente , Recém-Nascido , Icterícia Neonatal/epidemiologia , Icterícia Neonatal/etiologia , Icterícia Neonatal/terapia , Leucemia/etiologia , Neoplasias/epidemiologia , Neoplasias/etiologia , Neoplasias/terapia , Fototerapia/efeitos adversos , Nascimento Prematuro/etiologia , Estudos Retrospectivos
10.
Am J Obstet Gynecol ; 225(5): 546.e1-546.e11, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34363782

RESUMO

BACKGROUND: Failure to progress is one of the leading indications for cesarean delivery in trials of labor in twin gestations. However, assessment of labor progression in twin labors is managed according to singleton labor curves. OBJECTIVE: This study aimed to establish a partogram for twin deliveries that reflects normal and abnormal labor progression and customized labor curves for different subgroups of twin labors. STUDY DESIGN: This was a multicenter, retrospective cohort analysis of twin deliveries that were recorded in 3 tertiary medical centers between 2003 and 2017. Eligible parturients were those with twin gestations at ≥34 weeks' gestation with cephalic presentation of the presenting twin and ≥2 cervical examinations during labor. Exclusion criteria were elective cesarean delivery without a trial of labor, major fetal anomalies, and fetal demise. The study group comprised twin gestations, whereas singleton gestations comprised the control group. Statistical analysis was performed using Python 3.7.3 and SPSS, version 27. Categorical variables were analyzed using chi-square tests. Student t test and Mann-Whitney U test were applied to analyze the differences in continuous variables, as appropriate. RESULTS: A total of 1375 twin deliveries and 142,659 singleton deliveries met the inclusion criteria. Duration of the active phase of labor was significantly longer in twin labors than in singleton labors in both nulliparous and multiparous parturients; the 95th percentile duration was 2 hours longer in nulliparous twin labors and >3.5 hours longer in multiparous twin labors than in singleton labors. The cervical dilation progression rate was significantly slower in twin deliveries than in singleton deliveries with a mean rate in twin deliveries of 1.89 cm/h (95th percentile, 0.51 cm/h) and a mean rate of 2.48 cm/h (95th percentile, 0.73 cm/h) in singleton deliveries (P<.001). In addition, epidural use further slowed labor progression in twin deliveries. The second stage of labor was also markedly longer in twin deliveries, both in nulliparous and multiparous women (95th percentile, 3.04 vs 2.83 hours, P=.002). CONCLUSION: Twin labors are characterized by a slower progression of the active phase and second stage of labor compared with singleton labors in nulliparous and multiparous parturients. Epidural analgesia further slows labor progression in twin labors. Implementation of these findings in clinical management might lower cesarean delivery rates among cases with protracted labor in twin gestations.


Assuntos
Trabalho de Parto/fisiologia , Gravidez de Gêmeos , Adulto , Analgesia Epidural , Analgesia Obstétrica , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Paridade , Gravidez , Estudos Retrospectivos , Fatores de Tempo
11.
J Med Internet Res ; 23(12): e28120, 2021 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-34890352

RESUMO

Research using artificial intelligence (AI) in medicine is expected to significantly influence the practice of medicine and the delivery of health care in the near future. However, for successful deployment, the results must be transported across health care facilities. We present a cross-facilities application of an AI model that predicts the need for an emergency caesarean during birth. The transported model showed benefit; however, there can be challenges associated with interfacility variation in reporting practices.


Assuntos
Inteligência Artificial , Atenção à Saúde , Cesárea , Feminino , Humanos , Parto , Gravidez
12.
Arch Gynecol Obstet ; 303(3): 703-708, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32935142

RESUMO

PURPOSE: The purpose of our study was to evaluate the effect of IPI on long-term neurological morbidity of the offspring. METHODS: In this retrospective cohort study, 144,397 singleton infants born to multiparous mothers, between the years 1991 and 2014 in a tertiary medical center, were evaluated for different perinatal outcomes and were followed until 18 years of age for long-term neurological morbidity according to three IPI groups: Short IPI (< 6 months), long IPI (> 60 months) and intermediate IPI (6-60 months). We used a Kaplan-Meier survival curve to compare cumulative incidence of long-term neurological morbidity, and a Cox regression analysis to control for confounders such as gestational age, birth weight and maternal age. RESULTS: Offspring born to mothers with long IPI had higher rates of neurological morbidity (3.62% among offspring born after long IPI vs. 3.18% and 3.19% among offspring born after short and intermediate IPI, respectively, p = 0.041). The cumulative incidence of long-term neurological morbidity was significantly higher in the long IPI group (Kaplan-Meier log-rank test p < 0.001). Being born after a long IPI was found to be an independent risk factor for long-term neurological morbidity of the offspring (adjusted hazard ratio 1.2; 95% confidence interval 1.1-1.4; p < 0.001). CONCLUSION: Long IPI is independently associated with an increased risk of long-term neurological morbidity of the offspring.


Assuntos
Intervalo entre Nascimentos , Mães/estatística & dados numéricos , Doenças do Sistema Nervoso/epidemiologia , Adulto , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido , Israel/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Idade Materna , Parto , Gravidez , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
14.
J Viral Hepat ; 27(8): 794-799, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32274882

RESUMO

The objective of the study was to investigate the long-term effects of maternal hepatitis B virus (HBV) or hepatitis C virus (HCV) carrier status on the long-term infectious morbidity of their offspring. A population-based cohort study was conducted, including all singleton deliveries between the years 1991 and 2014 at a tertiary medical centre. The mothers were subdivided into three groups: HBV carriers, HCV carriers and non-carriers. Data on demographics, maternal, perinatal and long-term hospitalization for infectious morbidity were compared between the groups. During the study period, 242 905 (99.7%) non-carrier mothers, 591 (0.2%) HBV carriers and 186 (0.1%) HCV carriers were observed. Hospitalizations related to infectious morbidity was significantly higher in the offspring of HBV carriers compared with HCV and non-carriers (15.6% vs 11.3% vs 11.0%; P = .002, respectively; Kaplan-Meier, log-rank P < .001). Specifically, a significantly higher rate of hospitalizations gastrointestinal infectious morbidity was noted among the offspring of HBV carrier mothers (3.6% in the HBV carrier group, 1.6% in the HCV carrier group and 1.6% in the non-carrier group [P = .001]). There was a respiratory infectious morbidity of 8.1% among the offspring of HBV carriers, 8.6% among HCV carriers and 5.5% in non-carriers (P = .005). Using a Cox multivariable model, controlling for confounding variables, maternal HBV carrier status was associated with a significantly increased long-term infectious morbidity of the offspring, with an adjusted HR of 1.7 (95% CI, 1.388-2.077, P < .001). Maternal HBV carrier status is an independent risk factor for long-term infectious morbidity of the offspring, particularly for gastrointestinal and respiratory infections.


Assuntos
Hepatite B , Hepatite C , Complicações Infecciosas na Gravidez/virologia , Efeitos Tardios da Exposição Pré-Natal/virologia , Portador Sadio/virologia , Estudos de Coortes , Feminino , Hepacivirus , Hepatite B/epidemiologia , Vírus da Hepatite B , Hepatite C/epidemiologia , Humanos , Incidência , Morbidade , Gravidez , Fatores de Risco
15.
Eur J Clin Microbiol Infect Dis ; 39(12): 2415-2426, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32720090

RESUMO

We compared the etiologic, microbiologic, clinical, and outcome picture among febrile and non-febrile immunocompetent children hospitalized during 2013-2015 with acute neutropenia (absolute neutrophil count < 1.5 × 109/L). Serious bacterial infections (SBI) were defined as culture-positive blood, urine, cerebrospinal fluid, articular fluid or stool infections, pneumonia, brucellosis, and rickettsiosis. Overall, 664 children < 18 years of age were enrolled; 407 (62.2%) had fever > 38.0 °C and 247 (37.8%) were non-febrile at admission. There were 425 (64.0%), 125 (18.8%), 48 (7.2%), and 66 (9.9%) patients aged 0-24 months, 2-6, 7-12, and > 12 years, respectively. No differences were recorded in the distribution of febrile vs. non-febrile patients among the age groups nor among the 3 neutropenia severity groups (< 0.5, 0.5-1.0 and 1.0-1.5 × 109/L). SBI infections were diagnosed in 98 (14.8%) patients, with higher rates among febrile patients vs. non-febrile patients (16.8% vs. 11.5%, P = 0.06). Brucellosis and rickettsiosis were diagnosed in 15.4% and 23.1% tests performed, respectively. 295/688 (42.9%) virologic examinations returned positive. Among patients < 24 months, more febrile ones had viral infectious compared with afebrile patients (P = 0.025). Acute leukemia was diagnosed in 6 patients. Neutropenia resolved in 163/323 (50.5%) patients during a 1-month follow-up. No differences were recorded in neutropenia resolution between febrile and non-febrile children among all 3 severity groups. Severe neutropenia was rare and occurred mainly in very young patients. SBIs were more common among febrile patients compared with non-febrile patients, but there was no association between severity of neutropenia or its resolution and the presence or absence of fever at diagnosis.


Assuntos
Infecções Bacterianas/diagnóstico , Hospitalização/estatística & dados numéricos , Imunocompetência , Neutropenia/etiologia , Viroses/diagnóstico , Adolescente , Infecções Bacterianas/complicações , Brucelose/diagnóstico , Criança , Pré-Escolar , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Febre/etiologia , Humanos , Lactente , Recém-Nascido , Contagem de Leucócitos , Masculino , Análise Multivariada , Neutropenia/complicações , Neutropenia/microbiologia , Pneumonia/complicações , Modelos de Riscos Proporcionais , Infecções por Rickettsia/diagnóstico , Viroses/complicações
16.
Eur J Pediatr ; 179(6): 959-971, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32016603

RESUMO

Since introduced, the Apgar score has remained the most widespread predictor for neonatal morbidity and mortality. We aimed to investigate the association between low 5-min Apgar score and long-term infectious pediatric morbidity. A population-based cohort analysis was performed comparing total and specific subtypes of infectious morbidity leading to hospitalization among term newborns with normal (≥ 7) and low (< 7) 5-min Apgar scores, born between 1999 and 2014 at a single tertiary regional hospital. Infectious morbidity included hospitalizations involving a pre-defined set of infection-related ICD-9 codes. A Kaplan-Meier survival curve was constructed to compare cumulative infectious morbidity incidence and a Cox proportional hazards model to adjust for confounders. The long-term analysis of 223,335 children (excluding perinatal death cases) yielded 585 (0.3%) infants with low 5-min Apgar scores. The rate of infection-related hospitalizations was 9.8% and 12.4% among newborns with normal and low 5-min Apgar scores, respectively (p = 0.06). Adjusting for maternal age, gestational age, hypertension, diabetes, cesarean delivery, and fertility treatments, the association proved to be statistically significant (adjusted HR = 1.28; 95% CI 1.01-1.61).Conclusion: Term infants with low 5-min Apgar scores may be at an increased risk for long-term pediatric infectious morbidity.What is Known:• Though not meant to be a prognostic tool for long-term morbidity, studies assessing the correlation between low Apgar score and long-term outcomes were and are being performed, reporting significant associations with many outcomes-such as cerebral palsy (CP), ophthalmic disorders, GI disorders, and several types of malignancies.• Yet, an association between low Apgar scores and future health remains a matter of controversy.What is New:• Our work shows that a low 5-min Apgar score is independently associated with long-term pediatric infection-related hospitalizations among term singleton newborns.


Assuntos
Índice de Apgar , Hospitalização/estatística & dados numéricos , Infecções/etiologia , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Infecções/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
17.
Int Urogynecol J ; 31(3): 505-511, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31813040

RESUMO

INTRODUCTION AND HYPOTHESIS: Identifying protective factors against pelvic floor disorders (PFDs) is important. We investigated whether cesarean delivery (CD) at the indication of abnormal second stage of labor (ASSL) has the same protective effect against future PFDs. METHODS: This population-based cohort study included deliveries occurring from 1991-2017 in a tertiary medical center. Women were grouped by their delivery mode: patients with vaginal deliveries (VD) only; those with CD only, excluding second-stage indications; and those with CD due to ASSL. The outcome measure, PFDs and related repair diagnoses, included any recorded hospitalization involving a pre-defined set of ICD-9 codes. A Kaplan-Meier survival curve compared cumulative PFD morbidity in the different groups, and a Cox proportional hazards model controlled for confounders. RESULTS: A total of 106,003 patients met the inclusion criteria; 86.7% (n = 91,856) experienced VD only, 11.7% (n = 12,359) underwent CD only and 1.7% (n = 1788) had at least one CD due to ASSL. PFD-related hospitalization incidence was 0.7% (n = 719) for the entire cohort. While a significantly higher PFD-related hospitalization rate was recorded in the VD group (0.7%) compared with the ASSL CD group (0.3%) and the non-ASSL CD group (0.5%, p < 0.001), after controlling for potential confounders, an independent and protective association was noted between CD and later PFDs only in parturients who did not experience ASSL (aHR 0.679, 95% CI 0.51-0.90, p = 0.006). CONCLUSIONS: CDs may be protective against later PFD development only if performed prior to the second stage of labor.


Assuntos
Distúrbios do Assoalho Pélvico , Cesárea , Estudos de Coortes , Parto Obstétrico , Feminino , Humanos , Segunda Fase do Trabalho de Parto , Distúrbios do Assoalho Pélvico/epidemiologia , Distúrbios do Assoalho Pélvico/etiologia , Gravidez
18.
Arch Gynecol Obstet ; 301(6): 1473-1477, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32322983

RESUMO

OBJECTIVE: Data regarding the effect of post-partum bilateral tubal ligation (BTL) on future risk for ovarian cancer (OC) is lacking. In the current study, we aimed to evaluate the effect of BTL during cesarean delivery (CD) on the long-term risk for OC. STUDY DESIGN: A population-based cohort analysis of women above the age of 35 that underwent CD in their last delivery, comparing the long-term risk for OC between patients that had a Pomeroy excisional BTL and those that did not. OC diagnosis was pre-defined based on ICD-9 codes. Procedures occurred between the years 1991-2017. Kaplan-Meier survival curve was used to compare the cumulative incidence of OC over time and Cox proportional hazards model was constructed to control for confounders. RESULTS: During the study period 13,124 women met the inclusion criteria; 9438 (71.9%) of which had only CD and 3686 (28.1%) underwent CD with BTL. Despite the significantly higher incidence of maternal factors that might increase the long-term risk for OC in the BTL group (advanced maternal age, obesity, hypertensive diseases during pregnancy and diabetes mellitus), the cumulative incidence of OC cases was not significantly different between the two groups (Log-rank test p = 0.199). Likewise, when performing a Cox regression model controlling for maternal age, obesity, hypertensive diseases and diabetes, OC risk was not significantly different between the groups (adjusted HR 2.36, 95% CI 0.73-7.62; p = 0.149). CONCLUSION: Despite an increased incidence of known risk factors for OC, patients that underwent BTL during CD did not have increased long-term risk for OC.


Assuntos
Cesárea/métodos , Neoplasias Ovarianas/etiologia , Esterilização Tubária/métodos , Adulto , Estudos de Coortes , Feminino , Humanos , Incidência , Neoplasias Ovarianas/patologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
19.
Arch Gynecol Obstet ; 301(1): 101-106, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31784813

RESUMO

OBJECTIVE: Group B Streptococcus (GBS) early onset disease is a major cause for neonatal morbidity and mortality. We aimed to determine whether maternal GBS and the associated intrapartum antibiotic prophylaxis impacts pediatric long-term respiratory infectious morbidity. STUDY DESIGN: A population-based cohort study was conducted, during the years 1991-2013, comparing the incidence of hospitalizations due to common respiratory infections (RI) in offspring of mothers with and without GBS. Univariate analysis and a Cox proportional hazard model were used to estimate un-adjusted and adjusted hazard ratios for pediatric RI risk. RESULTS: During the study period, 173,757 term vaginal deliveries took place, of which 2.4% (4252) were diagnosed as GBS + gravidas. In univariate and multivariate analyses for the entire study period, RI risk was increased in exposed offspring. In a sensitivity analysis investigating study periods with different health policies, both GBS diagnosis rates and pediatric infectious respiratory morbidity rates increased over time, but with no independent association between the two. CONCLUSION: When analyzing large data sets spanning over long time periods, a special attention must be paid to account for healthcare trends, to avoid erroneous conclusions, as demonstrated here.


Assuntos
Complicações Infecciosas na Gravidez/fisiopatologia , Infecções Respiratórias/etiologia , Infecções Estreptocócicas/complicações , Vagina/virologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Infecções Respiratórias/patologia , Estudos Retrospectivos , Fatores de Tempo
20.
Arch Gynecol Obstet ; 302(4): 873-878, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32602001

RESUMO

BACKGROUND: Amniotic fluid abnormalities may be associated with adverse perinatal outcomes, some of which are endocrine related. OBJECTIVE: To evaluate whether in utero exposure to amniotic fluid abnormalities is associated with long-term endocrine morbidity in the offspring. STUDY DESIGN: In this cohort study, the incidence of long-term endocrine disorders was compared between singletons exposed and non-exposed to oligohydramnios or polyhydramnios. RESULTS: During the study period, 195 943 newborns were included in the study, of them 2.0% (n = 4072) and 2.9% (n = 5684) were exposed to oligohydramnios and polyhydramnios, respectively. Long-term endocrine morbidity was higher among children exposed to isolated amniotic fluid disorders, as was also noted in the Kaplan-Meier survival curve (log-rank test p < 0.001). Abnormal amniotic fluid volume was found to be independently associated with long-term endocrine morbidity of the offspring according to a Cox regression model controlled for clinically related confounders. CONCLUSION: In utero exposure to isolated amniotic fluid abnormalities is independently associated with long-term endocrine morbidity in the offspring.


Assuntos
Complicações do Diabetes/etiologia , Diabetes Gestacional/fisiopatologia , Feto/fisiologia , Oligo-Hidrâmnio/fisiopatologia , Obesidade Infantil/etiologia , Poli-Hidrâmnios/fisiopatologia , Gravidez/fisiologia , Efeitos Tardios da Exposição Pré-Natal , Líquido Amniótico , Criança , Estudos de Coortes , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , Morbidade , Oligo-Hidrâmnio/epidemiologia , Obesidade Infantil/epidemiologia , Poli-Hidrâmnios/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez
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