Malaria Lethality in Children under 5 Years of Age and Study of Risk Factors in MbujiMayi Paediatric Environment, a Neglected Deadly Epidemic in the Democratic of Republic of Congo

2021 ◽  
Author(s):  
Félicien Ilunga-Ilunga ◽  
Alain Levêque ◽  
Vévé Mbuyi Kanyinda ◽  
Jean Paul Mbikayi Muya ◽  
Michèle Dramaix
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Severe Malaria ◽  
Risk Model ◽  
Institutional Care ◽  
Case Fatality ◽  
Deep Coma ◽  
Information Campaigns ◽  
Case Rate ◽  
Children Under 5

The objective of this study was to determine the risk factors for malaria lethality in the MbujiMayi paediatric environment, a follow-up study of hospitalised cases over 5 years was conducted between January 2016 and December 2020 in the four hospitals. The case rate was 6.9% for the total (139 cases of death for 2017 cases of severe malaria for 5 years,) and varied from year to year (10.7% in 2016 to 4.6% in 2020). Cox Proportional Risk Model results including significant covariates in multivariate analysis [HR (IC95%)]. In multivariate analysis, two models were considered. The case-fatality rate was independently associated with late arrival after 48 hours [3.1 (1.9–5.1); p < 0.001], types of pre-hospital recourse such as recourse to the church [1.4 (1.1–2.1),; p = 0.042) and tradipractor [3.2 (1.8–6.1); p < 0.001] for severe malaria, children under 12 months of age [1.8 (1.2–2.8); p < 0.001], those with circulatory collapse [2.6 (1.1–6.1); p < 0.001] and those in deep coma [1.9 (1.1–3.4); p = 0.016]. The second model with the number of associated syndromes, showed that the risk was 1.7 plus for children with a complex clinical picture, made up of the combination of several signs [1.7 (1.1–2.6); p < 0.001]. These results highlight the need for more information campaigns to encourage people to seek institutional care for malaria. Our results also suggest that prophylactic treatment may be advisable for children under 5 years of age.

scholarly journals Presentation and Treatment Outcomes of Liberian Children Age 5 Years and Under Diagnosed With Severe Malaria

2019 ◽  
Vol 6 ◽  
pp. 2333794X1988481
Author(s):  
Benetta Collins-Andrews ◽  
Patricia McQuilkin ◽  
Kanagasabai Udhayashankar ◽  
Eric Adu ◽  
Ann Moormann
Keyword(s):  
Treatment Outcomes ◽  
Severe Malaria ◽  
Medical Center ◽  
Laboratory Data ◽  
Case Fatality ◽  
Febrile Illness ◽  
Salmonella Typhi ◽  
Presenting Symptoms ◽  
National Referral Hospital ◽  
Children Under 5

Malaria is endemic in Liberia with a prevalence rate of up to 60% in some regions, and it has been a major cause of death in children under 5 years of age. Prior to the recent Ebola epidemic, we undertook a prospective, hospital-based pilot study at the National Referral Hospital in Monrovia, to characterize the presentation, accuracy of diagnosis, and treatment outcomes of children presenting for treatment of malaria. From June 2013 to May 2014, we recruited children 5 years and under who presented to the JFK Medical Center with suspected malaria. We collected both clinical and laboratory data on admission and on discharge. We enrolled 477 patients with an average age of 1.6 years. Demographic factors associated with testing negative for malaria included regular bed net use and prior treatment for malaria. The most common presenting symptoms of severe malaria in this population were headache and seizures. Of 246 patients admitted and treated for severe malaria, 33% tested negative by rapid diagnostic test and blood smear for malaria. The case fatality rate was higher for the patients who tested negative for malaria (4.9%) versus those who tested positive (0.6%). Three children who tested negative for malaria showed evidence of undiagnosed Salmonella typhi infection. These results suggest that malaria may be overdiagnosed and that the diagnoses of other infectious diseases, which present in a similar fashion, may be neglected. These findings underscore the need to develop rapid diagnostic tests to screen for alternative causes of febrile illness.

scholarly journals The Study of Thrombosis in JAK2V617F Mutated Myeloproliferative Neoplasms

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1149-1149
Author(s):  
Jie Bai ◽  
Yuhui Zhang ◽  
Yingshao Wang ◽  
Guangshuai Teng ◽  
Yan Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Risk Model ◽  
Conflicts Of Interest ◽  
Myeloproliferative Neoplasms ◽  
Chinese Patients ◽  
Continuous Variables ◽  
History Of

Introduction: Thrombosis is the most important risk factor affecting event-free survival and overall survival (OS) of patients with myeloproliferative neoplasms (MPNs). To explore the risk factors of thrombosis in patients with JAK2V617F-mutated MPN, a cohort of 1537 Chinese patients with JAK2V617F-mutated MPN was retrospectively analyzed for clinical characteristics, laboratory characteristics, cytogenetics, thromboembolism, disease progression and OS. Methods: The qualitative data were compared by the Chi-square test or Fisher's test, and continuous variables were compared with the Mann-Whitney U test or Kruskal-Wallis test. The Kaplan-Meier method and multivariate Cox analysis were used to study the risk factors of thrombosis in patients with JAK2V617F-mutated MPN. Results: Among the 1537 MPN patients, 931, 468 and 138 had polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), respectively. The median follow-up time was 7 years (range 1-47), and 12.8% of patients (197/1537) died during this period. A total of 16.8% (259/1399) of PV and ET patients had secondary myelofibrosis, and 2.5% (38/1537) of patients developed acute myeloid leukemia (AML). Thrombosis events occurred in 43.9% (675/1537) of patients, among which 91.4%(617/675) were arterial thrombosis and 16.6% (112/675) were venous thrombosis. The number of thrombosis events in PV, ET and PMF patients was 439 (47.2%), 197 (42.1%) and 39 (28.2%), respectively. The multivariate analysis indicated that age≥60 years old (P=0.003, HR=1.76, 95% CI[1.214, 2.552]), HCT≥48% (P=0.022, HR=1.635, 95% CI[1.073, 2.492]), at least one cardiovascular risk factor (P=0.024, HR=1.559, 95% CI[1.061,2.291]), a history of thrombosis (P<0.0001, HR=2.313, 95% CI[1.573,3.401]), and JAK2V617Fallele burden (V617F%) ≥50% (P=0.003, HR=1.804, 95% CI [1.221, 2.665]) are risk factors for thrombosis in JAK2V617F-mutated MPN. According to the results of the multivariate analysis, a risk model of thrombosis was established and comprised low-risk (0 points), intermediate-risk (1 points) and high-risk (≥2 points) groups, among which the incidence of thrombosis was 9.1%, 33.7% and 72.9%, respectively. Conclusions: The Chinese thrombosis risk model of JAK2V617F-mutated MPN established in this study suggests that elderly patients with a history of thrombosis should reduce V617F%, control HCT to less than 48% and mitigate cardiovascular risk factors, all of which are necessary measures to prevent thrombosis in patients with JAK2V617F-mutated MPN. Disclosures No relevant conflicts of interest to declare.

Measles case fatality among the under-fives: A multivariate analysis of risk factors in a rural area of Bangladesh

1987 ◽  
Vol 24 (5) ◽  
pp. 439-443 ◽  
Author(s):  
Abbas Bhuiya ◽  
Bogdan Wojtyniak ◽  
Stan D'Souza ◽  
Lutfun Nahar ◽  
Kashem Shaikh
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Rural Area ◽  
Case Fatality

Improved Risk Adjustment in Public Reporting: Coronary Artery Bypass Graft Surgical Site Infections

2012 ◽  
Vol 33 (5) ◽  
pp. 463-469 ◽  
Author(s):  
Sandra I. Berríos-Torres ◽  
Yi Mu ◽  
Jonathan R. Edwards ◽  
Teresa C. Horan ◽  
Scott K. Fridkin
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Model ◽  
Artery Bypass ◽  
Risk Index ◽  
Bypass Graft ◽  
Surgical Site Infections ◽  
Predictive Performance ◽  
Public Reporting ◽  
Artery Bypass Graft

Objective.The objective was to develop a new National Healthcare Safety Network (NHSN) risk model for sternal, deep incisional, and organ/space (complex) surgical site infections (SSIs) following coronary artery bypass graft (CABG) procedures, detected on admission and readmission, consistent with public reporting requirements.Patients and Setting.A total of 133,503 CABG procedures with 4,008 associated complex SSIs reported by 293 NHSN hospitals in the United States.Methods.CABG procedures performed from January 1, 2006, through December 31, 2008, were analyzed. Potential SSI risk factors were identified by univariate analysis. Multivariate analysis with forward stepwise logistic regression modeling was used to develop the new model. The c-index was used to compare the predictive power of the new and NHSN risk index models.Results.Multivariate analysis independent risk factors included ASA score, procedure duration, female gender, age, and medical school affiliation. The new risk model has significantly improved predictive performance over the NHSN risk index (c-index, 0.62 and 0.56, respectively).Conclusions.Traditionally, the NHSN surveillance system has used a risk index to provide procedure-specific risk-stratified SSI rates to hospitals. A new CABG sternal, complex SSI risk model developed by multivariate analysis has improved predictive performance over the traditional NHSN risk index and is being considered for endorsement as a measure for public reporting.

scholarly journals Risk Factors for Neutropenia after the First Cycle of Chemotherapy for Non-Hodgkin Lymphoma

2021 ◽  
Vol 3 (6) ◽  
pp. 73-77
Author(s):  
M. S. Hardianti ◽  
S. A. Setiawan ◽  
M. R. Bagaskoro ◽  
N. Anggorowati ◽  
I. Purwanto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Model ◽  
Severe Neutropenia ◽  
Poor Prognostic Factor ◽  
Non Hodgkin Lymphoma ◽  
Treatment Naïve ◽  
Potential Risk Factors ◽  
Pre Treatment ◽  
Clinical Conditions

Background and Objective: Neutropenia that occurs after the first cycle of chemotherapy for non-Hodgkin’s Lymphoma (NHL) may predict its recurrence in the subsequent cycles. Moreover, it has also been reported to be a poor prognostic factor for the treatment outcome. Therefore, we aimed to observe the incidence of first cycle neutropenia and identify the potential risk factors for its occurrence among patients with NHL underwent chemotherapy. Methods: A retrospective cohort was conducted in Sardjito General Hospital, Yogyakarta, Indonesia to analyze 466 subjects during 2012-2018, confirmed NHL, age 17 or older, treatment-naïve, underwent first-line chemotherapy without any previous primary GCSF prophylaxis. Relevant clinical conditions, pre-treatment laboratory parameters and treatment factors were obtained from medical records. Univariate and multivariate analysis were done using logistic regression to determine the significant factors. Results: Among 466 NHL subjects, 241 (51.7%) received rituximab-containing regiment, with DLBCL as predominant subtype in 196 subjects (41.8%). Neutropenia occurred in 119 (25.5%; 95% CI 21.7-29.6%) of the cases, with 87 (73.2%) of them had moderate-severe neutropenia. Age older than 50 years old, use of rituximab-containing regiment, ANC ≤ 4.83×103 cells/mm3, and WBC ≤ 7.26×103 cells/mm3 were significant predisposing factors for first cycle neutropenia. A multivariate analysis showed two significant prognostic factors i.e., rituximab-containing regiment and ANC level ≤ 4.83×103 cells/mm3 with OR 2.18 (95% CI 1.38–3.43) and 2.30 (95%CI 1.49–3.57), respectively. Conclusion: The administration of rituximab-based regimen and pre-treatment ANC ≤ 4.83×103 cells/mm3 in NHL require more attention to anticipate the occurrence of neutropenia after the first chemotherapy cycle. Further investigation is required to validate risk model and identify subgroup who benefits from early use of growth factor.

scholarly journals Severe malaria and death risk factors among children under 5 years at Jason Sendwe Hospital in Democratic Republic of Congo

2018 ◽  
Vol 29 ◽  
Author(s):  
Augustin Mulangu Mutombo ◽  
Olivier Mukuku ◽  
Kristel Nzeba Tshibanda ◽  
Edouard Kawawa Swana ◽  
Eric Mukomena ◽  
...  
Keyword(s):  
Risk Factors ◽  
Severe Malaria ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Republic Of Congo ◽  
Death Risk ◽  
Children Under 5

scholarly journals A novel simple risk model to predict the prognosis of patients with paraquat poisoning

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yanxia Gao ◽  
Liwen Liu ◽  
Tiegang Li ◽  
Ding Yuan ◽  
Yibo Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Latent Class ◽  
Risk Model ◽  
Risk Groups ◽  
Training Sample ◽  
Risk Indicators ◽  
Hospital Death ◽  
Gamma Glutamyl Transferase ◽  
Creatine Kinase Mb ◽  
Glutamyl Transferase

AbstractTo identify risk factors and develop a simple model to predict early prognosis of acute paraquat (PQ) poisoning patients, we performed a retrospective cohort study of acute PQ poisoning patients (n = 1199). Patients (n = 913) with PQ poisoning from 2011 to 2018 were randomly divided into training (n = 609) and test (n = 304) samples. Another two independent cohorts were used as validation samples for a different time (n = 207) and site (n = 79). Risk factors were identified using a logistic model with Markov Chain Monte Carlo (MCMC) simulation and further evaluated using a latent class analysis. The prediction score was developed based on the training sample and was evaluated using the testing and validation samples. Eight factors, including age, ingestion volume, creatine kinase-MB [CK-MB], platelet [PLT], white blood cell [WBC], neutrophil counts [N], gamma-glutamyl transferase [GGT], and serum creatinine [Cr] were identified as independent risk indicators of in-hospital death events. The risk model had C statistics of 0.895 (95% CI 0.855–0.928), 0.891 (95% CI 0.848–0.932), and 0.829 (95% CI 0.455–1.000), and predictive ranges of 4.6–98.2%, 2.3–94.9%, and 0–12.5% for the test, validation_time, and validation_site samples, respectively. In the training sample, the risk model classified 18.4%, 59.9%, and 21.7% of patients into the high-, average-, and low-risk groups, with corresponding probabilities of 0.985, 0.365, and 0.03 for in-hospital death events. We developed and evaluated a simple risk model to predict the prognosis of patients with acute PQ poisoning. This risk scoring system could be helpful for identifying high-risk patients and reducing mortality due to PQ poisoning.

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