Clinical Profile and Two-Year Outcome of Patients with MDS-5q

The inter-relationships of voxels can be captured by the radiomics texture features across multiple spatial scales. Prediction models of brain texture changes captured by the contrast texture feature in recent-onset psychosis (ROP) and recent-onset depression (ROD) have recently been proposed, although the validation of these models transdiagnostically at the individual level and the investigation of the variability in clinical profiles are lacking. Established prevention and treatment approaches focus on specific diagnoses and do not address the heterogeneity and manifold potential outcomes of patients. Here we aimed to investigate the cross-sectional utility of brain texture changes for (1) identification of the psychopathological state (ROP and ROD) and (2) the association of individualized brain texture maps with clinical symptom severity and outcome profiles. We developed transdiagnostic models based on structural magnetic resonance imaging data for 116 patients with ROD, 122 patients with ROP and 197 healthy control participants from the PRONIA (Personalized pROgNostic tools for early psychosIs mAnagement) study by applying a set of tools and frameworks to explain the classification decisions of the deep-learning algorithm (named explainable artificial intelligence) and clustering analysis. We investigated the contrast texture feature as the key feature for the identification of a general psychopathological state. The discrimination power of the trained prediction model was >72% and was validated in a second independent age- and sex-matched sample of 137 ROP, 94 ROD and 159 healthy control participants. Clustering analysis was implemented to map the changes in texture brain produced from an explainable artificial intelligence algorithm, in a group fashion. The explained individualized brain contrast map grouped into eight homogeneous clusters. In the clinical group, we investigated the association between the explained brain contrast texture map and clinical symptom severity as well as outcome profiles. Different patterns in the explained brain contrast texture map showed unique associations of brain alterations with clinical symptom severity and clinical outcomes, that is, age, positive, negative and depressive symptoms, and functionality. In some clusters, the mean explained brain contrast texture map values and/or brain contrast texture voxels that contributed significantly to the classification decision predicted accurately the PANSS (positive and negative symptom scale) scores, functionality and change in functionality over time. In conclusion, we created homogeneous clusters which predict the clinical severity and outcome profile in ROP and ROD patients.

Studies on microorganisms in a large cohort of patients with congenital heart disease (CHD) and infective endocarditis (IE) are rare. Using a nationwide survey, the relationship between causative microorganisms and clinical profiles in patients with CHD and IE was investigated. Data from 188 patients with CHD (pediatric patients (n=113), mean age, 6.2+/-4.9 years; adult patients (n=75), mean age 28.4+/-13.4 years) and IE from 60 institutions were analyzed. Causative microorganisms were Streptococcus species (94:50.0%), Staphylococcus species (68:36.2%), Haemophilus species (9:4.8%), Candida (5:2.7%), Pseudomonas species (4:2.1%) and other unclassified microorganisms (8:4.3%). Staphylococcal IE was observed significantly higher in perioperative IE (11/16), in cyanotic patients (32/73) and patients younger than 1 year old (11/16). Streptococcal IE was observed significantly higher in acyanotic patients (64/109) and patients aged 16 years or older (48/75). Total mortality was 20/188 (10.6%) and was high for candidial (2/5; 40%) and pseudomonal IE (2/4; 50%). Mortality was highly associated with younger age, especially infants (5/16), and methicillin-resistant staphylococcal IE (6/15). The causative microorganisms are significantly related to the clinical profile and outcome in patients with IE and CHD. These results form the basis for selecting appropriate antibiotics for prevention and management.

Neurocognitive and clinical profile of male patients with substance use disorder in early remission phase with and without comorbid depression

Background/aims Stroke early supported discharge services were introduced to provide a comprehensive stroke specialist therapy input, while reducing cost of acute care. Early supported discharge services resulted in better health-related outcomes. A consensus has not yet been established regarding specific early supported discharge patient characteristics and clinical profile. The main aim of this study was to establish evidence to support the development of an early supported discharge patient profile (demographics and clinical) and eligibility criteria to enable early supported discharge services achieve their purposes of reducing post-stroke disability and institutionalisation rates. This article outlines the relationship between early supported discharge patients' clinical profiles and clinical outcomes, in terms of disability, goal attainment and institutionalisation rates. Methods A retrospective review of data was implemented to determine whether specific early supported discharge patients' clinical profiles and characteristics correlate with clinical outcomes. Data were collected for patients admitted to the Suffolk Stroke Early Supported Discharge Service between August and October 2016, comprising patients' demographics and clinical profiles, including stroke type, Barthel Index and Modified Rankin Scale. Performance data were collected at the end of the early supported discharge service including therapy frequency and intensity, as well as clinical outcomes including the Goal Attainment Scale. Results Data were collected for 53 patients. Data were analysed for all patients in three groups: goals not achieved; goals achieved; and goals achieved to a higher level), according to the Goal Attainment Scale. A Chi-square test showed no significant difference with regard to sex and stroke side (P=0.27). Analysis of variance revealed no significant difference in age. Conversely, results showed a significant association between goal attainment and the stroke subtype, severity and length of hospital stay. Conclusions Specific clinical characteristics and disease profiles correlate with functional outcomes and could influence goal attainment and functional status. A specific patient cohort seems to benefit the most from early supported discharge services in terms of optimised functional outcomes and recovery.

INTRODUCTION The burden of type 2 diabetes is increasing in world and same is scenario in Nepal.The prevalence of T2DM in Nepal has increased from 2014 to 2020. T2DM is still a major cause of worldwide morbidity and mortality, due to its complications. A strong correlation between cardiovascular diseases and diabetes mellitus type 2 (DM) has been found. This study aimed to investigate echocardiographic features and clinical profile in patients with newly diagnosed T2DM. MATERIAL AND METHODS Our study included 100 patients with newly diagnosed type 2 diabetes, presented to Medicine Department of Universal College of Medical Sciences Teaching Hospital, Bhairahawa from 1st May, 2019 AD to 30th April 2020. We included type 2 diabetes diagnosed as per American diabetes association 2018 criteria. RESULTS Males (52%) were more compared to females (44%). 28% were in age group 61-70 years, 26% in age group 41-50 years and 25% in age group 51-60 years. Abnormal thirst 42%, polyuria 38% and weight loss 32% were most common presenting symptoms with 23% having all 3 symptoms. Fifty two percent were smokers, 22% consumed alcohol, 48% had HTN and 23% cases had CAD. Fourty two cases (42%) had Left ventricular diastolic dysfunction, 25 cases (25%) had Left ventricular hypertrophy (LVH), 16 cases (16%) had RWMA others had RA/RV dilated and dilated LV/LA. CONCLUSION LVDD was most common echocardiographic finding in newly diagnosed type 2 diabetes.

Chronic urticaria is a condition characterized by recurrent wheals associated with itching lasting longer than six weeks. The condition tends to run a chronic course with significant morbidity. Several factors have been explored in the cause, yet the aetiology is still uncertain. We documented the clinical profile and assessed the possible aetiologic factors in patients with chronic urticaria. Clinical profile of sixty consecutive patients with chronic spontaneous urticaria was assessed with possible precipitants identified using a structured questionnaire. The complete blood count with erythrocyte sedimentation rate, antithyroid peroxidase (antiTPO), hepatitis B surface antigen (HBsAg), antihepatitis C virus screening (AntiHCV), stool for ova and parasites and helicobacter pylori were carried out. Controls without a history of urticaria were recruited in a 1: 1 ratio for stool for parasites and H. pylori because of the high prevalence rates reported in this environment. Data analysis was carried out with Statistical Packages for Social Sciences (SPSS) version 22. Sixty patients with chronic urticaria and sixty age and sex matched controls were enrolled in the study. Females presented more often with urticaria with a M: F ratio of 1: 2.5. The mean age of onset of urticaria was in the third decade of life. Precipitants were identified in close to a third of patients. The investigated antigenic aetiology was not found to play a role. The presentation and clinical profile of patients in this environment is similar to previously documented studies. History still remains the cornerstone of management as precipitants and triggers may be identified. Management of patients should therefore be individualized.

BackgroundChile has one of the highest incidences of COVID-19 infection in the world. Primary care can play a key role in early detection and containment of the disease. There is a lack of information on the clinical profile of patients with suspected COVID-19 in primary care, and controversy on the effectiveness of rapid serologic tests in the diagnosis and surveillance of the disease.AimTo assess the effectiveness of rapid serologic testing in detection and surveillance of COVID-19 cases in primary care.Design & settingA longitudinal study was undertaken, which was based on a non-random sample of 522 participants, including 304 symptomatic patients and 218 high-risk asymptomatic individuals. They were receiving care at four primary health clinics in an underserved area in Santiago, Chile.MethodThe participants were systematically assessed and tested for COVID-19 with reverse transcriptase-polymerase chain reaction (RT-PCR) and serology at baseline, and were followed clinically and serologically for 3 weeks.ResultsThe prevalence rate of RT-PCR confirmed COVID-19 cases were 3.5 times higher in symptomatic patients (27.5%; 95% confidence interval [CI] = 22.1 to 32.8) compared with asymptomatic participants (7.9%; 95% CI = 4.3 to 11.6). Similarly, the immune response was significantly different between both groups. Sensitivity of serologic testing was 57.8% (95% CI = 44.8 to 70.1) during the third week of follow-up and specificity was 98.4% (95% CI = 95.5 to 99.7).ConclusionRapid serologic testing is ineffective for detecting asymptomatic or non-severe cases of COVID-19 at early stages of the disease, but can be of value for surveillance of immunity response in primary care. The clinical profile and immune response of patients with COVID-19 in primary care differs from those in hospital-based populations.

Objective: The prevalence of pediatric onset multiple sclerosis (POMS) is 0.69–26.92 per 100,000 individuals. Here we describe the clinical profile and follow-up of patients with POMS from India where the data are scarce. Materials and Methods: This is a retrospective observational study; the data were collected from the ongoing MS registry from 2007. The clinical and demographic profile was studied and therapy response was documented. Results: There were nine patients with POMS with a mean age of 16.8 years (13–19). The lag in the diagnosis ranged from 0 to 8 years (mean of 2.5 years). Six had relapsing remitting variant of MS (RRMS). Optic neuritis was the most common presentation (44%). Oligoclonal bands were positive in 5 (55%). Conclusion: Optic neuritis was the common symptom followed by ataxia due to brainstem or spinal cord involvement. The lag period was long and the impairment in academic performance and social functioning was a concern.

OBJECTIVE: To assess the clinical profile, biochemical and haematological parameters of patients with Dengue fever and evaluate the prognostic value of the platelet parameters in the recovery of the patients. METHODS: Data of IPD patients with an established diagnosis of Dengue fever were collected. Seventy-two patients underwent a clinical and haematological evaluation, and values were analysed according to the study’s objectives. RESULTS: The total sample of Dengue fever patients ( n=72 ) included 46 males and 26 females, with the majority of patients above 30 years of age ( males=31, females=15 ). The clinical profile of all patients was taken, viz., age distribution, residence status, duration of fever ( < 3 days & > 3 days ). Majority of patients had chills and rigor (M=40,F=26), myalgia ( M=36, F=21 ), nausea and vomiting ( M=31, F=15 ), joint pain ( M=43, F=25 ) and headache ( M=45, F=26 ). Bleeding manifestations and other systemic involvements were less likely to be seen. Laboratory investigations were conducted to detect Dengue virus infection and other relevant infections. Requirement for transfusion,viz.,blood ( M=6, F=5 ), platelet ( M=21, F=14 ) with more number of platelet units requirement seen in males ( n=21 ). Haematological parameters profile revealed substantial improvement in platelet-related parameters and platelet indices (increase in TPC ( p<0.001 ), PCT ( p<0.001 ), PLCR, and MPV ( p<0.001 ). CONCLUSION: The study’s findings on the increased platelet indices ( MPV, IPF, PLCR, plateletcrit ) during the recovery phase of Dengue provide valuable insights. These parameters can serve as essential tools for prognosticating Dengue, empowering healthcare professionals with practical knowledge for better disease management.

Objective: This study aimed to describe the sociodemographic and clinical profile of pediatric patients who consulted at the Out-Patient Department of a psychiatric facility in Davao City, ie. Southern Philippines Medical Center Institute of Psychiatry and Behavioral Medicine and provide baseline data for future research and program development. Methodology: This is a descriptive chart review that used a purposive sampling method to determine the sociodemographic and clinical profile of patients below nineteen (19) years old, seen at the Out-Patient Department of a psychiatric facility from January 2015 to December 2019. Results: A total of 427 charts were reviewed in this study. Majority (30.2%) of the study population had their first consult in 2019, female (56%), belonged to the 12-18 age group (64%), and had high school education (43%). Most came from Davao Region (89%) with class D social classification (64%). The clinical profile showed that majority consulted due to forensic reasons (54%), with referrals coming from WCPU, courts, or police stations (54%). Sexual abuse (43.9%) was the most common cause for forensic consult. The most common diagnosis was clustered under Adverse Childhood Experiences (30%). Most were advised referral to the psychology unit (59%) and were discharged as Out-patient (97%). Conclusion: The number of child and adolescent consults in the Out-Patient Department of a psychiatric facility steadily increased within the span of five years. Majority of the patients came in for forensic reasons, with sexual abuse as the highest. A third of the consults were diagnosed to have Adverse Childhood Experience.

Objective: This study aimed to describe the sociodemographic and clinical profile of pediatric patients who consulted at the Out-Patient Department of a psychiatric facility in Davao City, ie. Southern Philippines Medical Center Institute of Psychiatry and Behavioral Medicine and provide baseline data for future research and program development. Methodology: This is a descriptive chart review that used a purposive sampling method to determine the sociodemographic and clinical profile of patients below nineteen (19) years old, seen at the Out-Patient Department of a psychiatric facility from January 2015 to December 2019. Results: A total of 427 charts were reviewed in this study. Majority (30.2%) of the study population had their first consult in 2019, female (56%), belonged to the 12-18 age group (64%), and had high school education (43%). Most came from Davao Region (89%) with class D social classification (64%). The clinical profile showed that majority consulted due to forensic reasons (54%), with referrals coming from WCPU, courts, or police stations (54%). Sexual abuse (43.9%) was the most common cause for forensic consult. The most common diagnosis was clustered under Adverse Childhood Experiences (30%). Most were advised referral to the psychology unit (59%) and were discharged as Out-patient (97%). Conclusion: The number of child and adolescent consults in the Out-Patient Department of a psychiatric facility steadily increased within the span of five years. Majority of the patients came in for forensic reasons, with sexual abuse as the highest. A third of the consults were diagnosed to have Adverse Childhood Experience

Amyotrophic Lateral Sclerosis (ALS) is a severe neurodegenerative disease with highly heterogeneous disease presentation and progression patterns. This hampers effective treatments targeting all patients and finding a cure is still a challenge. In this scenario, patient stratification is believed to be a key tool to deal with the heterogeneous nature of the disease, promoting the discovery of more homogeneous groups of patients, that can then be used to improve patient prognosis and care. In this work, we propose to use clustering to stratify patient observations in accordance with clinically defined subsets of features (Clinical Profiles). The groups obtained by clustering patients using the Clinical Profiles are called Patient Profiles. Each patient profile is then used to learn specialized prognostic models to predict the need for Non-Invasive Ventilation (NIV) within a time window of 90 days. Each patient profile specific prognostic model is then used in ensemble learning. We used three clinical profiles (prognostic, respiratory and functional) based on complementary clinically relevant views of disease presentation and progression. These clinical profiles yielded two, four, and two patient profiles, respectively. The specialized prognostic models learned from these clinical and patient profiles show overall improvements when compared to the baseline models, where patients are not stratified. These promising results highlight the need for patient stratification for prognostic prediction in ALS. Furthermore, this innovative approach for prognostic prediction, where clinical profiles and patient profiles are integrated to enhance patient stratification, can be used to improve predictions for other disease outcomes in ALS or applied to other diseases.

BackgroundThere is limited information on clinical profile and outcomes of patients on mechanical ventilation (MV) who developed pulmonary barotrauma (PBT) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Patients and methodsIn a retrospective observational study, all SARS-CoV-2 pneumonia patients admitted from March 28, 2020, to August 31, 2020, at Sir HN Reliance Foundation Hospital and Research Center and Seven Hills Hospital (Reliance Facility), Mumbai, India, of 18 years and above on MV and developed PBT, were included.ResultsA total of 14 SARS-CoV-2 patients of 45 on MV (31.0%) developed PBT of 1,029 hospitalized. All patients were male and divided as per admission into PaO2/FiO2 (P/F) ≤100 (median 80) and P/F >100 (median 222) group. Pneumothorax developed in seven and six cases of P/F ≤100 and P/F >100 groups, respectively. Three patients in each group developed subcutaneous emphysema, while four developed pneumomediastinum in P/F >100 group. Twelve patients (7, P/F ≤100, and 5, P/F >100) were on invasive, while two (P/F >100) were on noninvasive MV. The mean P/F on the day of PBT was reduced by 27.5 and 65.3%, while peak inspiratory pressure was elevated with a median of 36 and 28 cm H2O in P/F ≤100 and P/F >100 groups, respectively. The median highest tidal volume (420 mL), positive-end expiratory pressure (8 vs 6 cm H2O) on the day of PBT, and length of hospital stay (11 vs 25 days) did not differ between two groups. Survival was 28.6% (4/14).ConclusionSARS-CoV-2 patients requiring MV with PBT had poor outcomes. Clinicians should be vigilant about the diagnosis of PBT.How to cite this articleKargirwar KV, Rathod D, Kumar V, Patel M, Shah M, Choudhury H, et al. Clinical Profile of Patients with Severe Acute Respiratory Syndrome Coronavirus 2 Infection Developing Pulmonary Barotrauma on Mechanical Ventilation. Indian J Crit Care Med 2022;26(5):613–618.

IntroductionThe objective of the study was to evaluate the clinical profile and outcome of patients with secondary hemophagocytic lymphohistiocytosis (HLH) in critically ill patients.Materials and methodsA prospective observational study was conducted where critically ill adult patients presenting with fever and bicytopenia were evaluated according to the HLH-2004 diagnostic criteria for the presence of secondary HLH. The underlying trigger, clinical profile, treatment, and outcome of patients with HLH were analyzed.ResultsOf the 76 critically ill patients with fever and bicytopenia, 33 (43%) patients were diagnosed with HLH. The following triggers for HLH were identified: bacterial infections (23%), fungal infections (10%), viral infections (10%), parasitic infections (10%), autoimmune diseases (13%), and malignancy (8%). A total of 78% of the HLH cases received steroids, but the use of steroids was not associated with improvement in mortality.ConclusionThere is a high prevalence of HLH in patients presenting with fever and bicytopenia in critically ill adult patients. Infections were identified as the most common trigger of HLH.How to cite this articleFazal F, Gupta N, Soneja M, Mitra DK, Satpathy G, Panda SK, et al. Clinical Profile, Treatment, and Outcome of Patients with Secondary Hemophagocytic Lymphohistiocytosis in Critically Ill Patients: A Prospective Observational Study. Indian J Crit Care Med 2022;26(5):564–567.

Context:Cancer of the cervix is the most common genital tract malignancy in the female and is a major public health problem in the developing countries. Study of the sociodemographic and clinical profile of patients is the first step in planning control measures and treatment facilities.Aims:The aims of the study were to determine the sociodemographic and clinical profile of cervical cancer patients and study their association with other tumor-related factors.Settings and Design:This is a record-based retrospective study from a single institution.Subjects and Methods:The data on sociodemographic and clinical factors of 765 cervical cancer patients visited and treated at tertiary care cancer hospital in Mumbai in 1 year period were analyzed.Statistical Analysis:Data were analyzed using descriptive statistics. Kruskal–Wallis and Chi-square test were used to assess relationship between variables.Results:The median age of the cohort was 54 years and interquartile range was 16 years. Nearly 53.6% of patients were illiterate. About 88.10% of patient's had squamous cell carcinoma. Only 13% of cases had early stage disease and 77% of patient's had not taken any treatment before coming to the hospital. Of the total, about 26% patients also had concomitant comorbidities, of which hypertension was found to be the leading comorbid condition. Stage of disease was found to be significantly (P < 0.05) associated with age and educational status.Conclusion:This study highlights certain important baseline characteristics of cervical cancer patients. This basic information on profile of patients can help plan and optimum utilization of hospital services, especially in resource-poor countries like India.