Higher Risk Of Unfavorable Outcome Research Articles

Impact of isoniazid monoresistance on overall and vulnerable patient populations in Taiwan

ABSTRACT Isoniazid is an early bactericidal anti-tuberculosis (TB) agent and isoniazid mono-resistance TB is the most prevalent drug-resistant TB worldwide. Concerns exist regarding whether resistance to isoniazid would lead to delayed culture conversion and worst outcomes. From January 2008 to November 2017, adult culture-positive pulmonary TB patients receiving isoniazid, rifampicin, pyrazinamide, and ethambutol were identified through Taiwan Center for Disease Control database and were followed until the end of 2017. Primary outcomes included time to sputum culture conversion (SCC) within two months. Secondary outcomes included death and unfavourable outcomes at the end of 2nd month. A total of 37,193 drug-susceptible and 2,832 isoniazid monoresistant pulmonary TB patients were identified. Compared with no resistance, isoniazid monoresistance was not associated with a delayed SCC (HR: 0.99, 95% CI: 0.94─1.05, p = 0.8145), a higher risk of 2-month mortality (HR: 1.19, 95% CI: 0.92─1.53, p = 0.1884), and unfavourable outcomes at 2nd month (OR: 1.05, 95% CI: 0.97─1.14, p = 0.2427). Isoniazid monoresistance was associated with delayed SCC (HR: 0.90, 95% CI: 0.83─0.98, p = 0.0099) and a higher risk of unfavourable outcomes (OR:1.18, 95% CI: 1.05─1.32, p = 0.0053) in patients aged between 20 and 65, and delayed SCC in patients without underlying comorbidities (HR: 0.90, 95% CI: 0.81─0.98, p = 0.0237). Isoniazid mono-resistant TB had a comparable outcome with drug-susceptible TB at the end of the intensive phase. Healthy, and non-elderly patients were more likely to had culture persistence, raising concerns about disease transmission in these subgroups and warranting early molecular testing for isoniazid resistance.

Sociodemographics and clinical factors associated with depression treatment outcomes in 65,741 first-time users of selective serotonin reuptake inhibitors: A Danish cohort study in older adults

ObjectiveTo investigate a wide range of sociodemographic and clinical factors associated with treatment outcomes in older adults who initiated an SSRI for depression treatment in a real-world setting. MethodsThis cohort study used Danish registry data covering all older adults (aged ≥65) who initiated SSRIs for depression from 2006 to 2017, first-time (since 1995). We followed the individuals for one year after their SSRI prescription. Six different outcomes were analyzed, including treatment discontinuation, switching, augmentation, psychiatric hospital contacts for depression, psychiatric hospital admission, and suicide attempt/self-harm. Association analyses employed Poisson regression, estimating incidence rate ratios with 95 % confidence intervals. ResultsThe study included 65,741 individuals with a mean age of 78.23 years, and 55.6 % were females. During follow-up, 40.1 % discontinued, 4.8 % switched, 20.3 % received augmentation, 3.0 % had psychiatric hospital contacts for depression, 3.2 % had psychiatric admission, and 0.1 % had suicide attempt/self-harm records. Differential treatment outcomes were observed based on sociodemographic and clinical factors. For example, being female, residing predominantly in rural areas, having psychiatric or somatic diagnoses, and using medications acting on blood/blood-forming organs, the cardiovascular system, or musculo-skeletal systems were linked to fewer unfavorable clinical outcomes. Conversely, marital status as being single or separated and the use of nervous system drugs were associated with a higher risk of unfavorable outcomes. LimitationsConfounding by indication might remain a problem, and depression severity data was not unavailable. ConclusionsOur findings emphasize considering patient characteristics in clinical decisions, as they can influence the clinical course of those undergoing depression treatment.

Geriatric nutrition risk index in the prediction of all-cause and cardiovascular mortality in older adults with hyperlipidemia: NHANES 1999–2018

BackgroundMalnutrition is linked to a higher risk of unfavorable outcomes in various illnesses. The present investigation explored the correlation between inadequate nutritional condition and outcomes in older individuals diagnosed with hyperlipidemia.MethodsThe geriatric nutritional risk index (GNRI) was used to evaluate the nutritional status. All patients were divided into two groups according to GNRI. A Kaplan-Meier analysis was used to assess the survival rates of different groups at risk of malnutrition. In addition, GNRI was used in COX proportional risk regression models to evaluate its predictive effect on both overall mortality and cardiovascular mortality among patients with hyperlipidemia. Furthermore, the study employed restricted cubic splines (RCS) to examine the nonlinear correlation between GNRI and mortality.ResultsThe study included 4,532 elderly individuals diagnosed with hyperlipidemia. During a median follow-up duration of 139 months, a total of 1498 deaths from all causes and 410 deaths from cardiovascular causes occurred. The Kaplan-Meier analysis demonstrated significantly poorer survival among individuals at risk of malnutrition, as indicated by the GNRI. In the malnutrition risk group, the modified COX proportional hazards model revealed that a decrease in GNRI was associated with a higher risk of all-cause mortality (HR=1.686, 95% CI 1.212-2.347) and cardiovascular mortality (HR=3.041, 95% CI 1.797-5.147). Furthermore, the restricted cubic splines revealed a non-linear association between GNRI and both all-cause mortality and cardiovascular mortality (p-value for non-linearity = 0.0039, p-value for non-linearity=0.0386).ConclusionsIn older patients with hyperlipidemia, lower levels of GNRI are associated with mortality. The GNRI could potentially be used to predict all-cause mortality and cardiovascular mortality.

Incidence of mortality in vulnerable and non-vulnerable older patients with cancer.

e13775 Background: Cancer most often affects older adults; 56% of all newly diagnosed cancer patients and 71% of deaths belong to this age group. Frail patients are at increased risk of unfavorable outcomes after Treatment. Methods: This cross-sectional study included adults older than ≥ 65 years who attended the Oncology department were included, with a diagnosis of a solid malignant neoplasm during March 2022-May 2023. Sociodemographic characteristics and characteristics of the disease were evaluated, and the G8 test was applied, a tool that identifies patients at risk of frailty (nutritional status, mobility, age, general health status, neuropsychological status, drugs used); a score ≤14 indicates that they are vulnerable. They were classified into two groups: group 1 (vulnerable) and group 2 (non-vulnerable). Telephone follow-up was performed at 12 and 24 weeks. We evaluated the incidence of mortality in both groups after oncological medical management. Results: Eighty-eight older adults were recruited, the majority were men (77.3%), and the mean age was 74.2 ± 6.71. Forty-seven patients (53.4%) were vulnerable (group 1), and 41 patients (46.6%) were non-vulnerable (group 2). Mortality at 12 weeks was evaluated: vulnerable (29.8%) vs. non-vulnerable (0%), and mortality at 24 weeks: vulnerable (46%) vs. non-vulnerable (4.9%). In both follow-ups, statistically significant results were obtained (<0.001). Conclusions: Vulnerable patients have a higher risk of unfavorable outcomes; their detection is essential to perform a comprehensive geriatric assessment and provide multidisciplinary treatment, improving the prognosis of their disease. [Table: see text]

Clinical predictive value of the CRP-albumin-lymphocyte index for prognosis of critically ill patients with sepsis in intensive care unit: a retrospective single-center observational study.

Sepsis is a complex syndrome characterized by physiological, pathological, and biochemical abnormalities caused by infection. Its development is influenced by factors such as inflammation, nutrition, and immune status. Therefore, we combined C-reactive protein (CRP), albumin, and lymphocyte, which could reflect above status, to be the CRP-albumin-lymphocyte (CALLY) index, and investigated its association with clinical prognosis of critically ill patients with sepsis. This retrospective observational study enrolled critically ill patients with sepsis who had an initial CRP, albumin, and lymphocyte data on the first day of ICU admission. All data were obtained from the Affiliated Hospital of Jiangsu University. The patients were divided into quartiles (Q1-Q4) based on their CALLY index. The outcomes included 30-/60-day mortality and acute kidney injury (AKI) occurrence. The association between the CALLY index and these clinical outcomes in critically ill patients with sepsis was evaluated using Cox proportional hazards and logistic regression analysis. A total of 1,123 patients (63.0% male) were included in the study. The 30-day and 60-day mortality rates were found to be 28.1 and 33.4%, respectively, while the incidence of AKI was 45.6%. Kaplan-Meier analysis revealed a significant association between higher CALLY index and lower risk of 30-day and 60-day mortality (log-rank p < 0.001). Multivariate Cox proportional hazards analysis indicated that the CALLY index was independently associated with 30-day mortality [HR (95%CI): 0.965 (0.935-0.997); p = 0.030] and 60-day mortality [HR (95%CI): 0.969 (0.941-0.997); p = 0.032]. Additionally, the multivariate logistic regression model showed that the CALLY index served as an independent risk predictor for AKI occurrence [OR (95%CI): 0.982 (0.962-0.998); p = 0.033]. The findings of this study indicated a significant association between the CALLY index and both 30-day and 60-day mortality, as well as the occurrence of AKI, in critically ill patients with sepsis. These findings suggested that the CALLY index may be a valuable tool in identifying sepsis patients who were at high risk for unfavorable outcomes.

Towards a Remote Patient Monitoring Platform for Comprehensive Risk Evaluations for People with Diabetic Foot Ulcers.

Diabetic foot ulcers (DFUs) significantly affect the lives of patients and increase the risk of hospital stays and amputation. We suggest a remote monitoring platform for better DFU care. This system uses digital health metrics (scaled from 0 to 10, where higher scores indicate a greater risk of slow healing) to provide a comprehensive overview through a visual interface. The platform features smart offloading devices that capture behavioral metrics such as offloading adherence, daily steps, and cadence. Coupled with remotely measurable frailty and phenotypic metrics, it offers an in-depth patient profile. Additional demographic data, characteristics of the wound, and clinical parameters, such as cognitive function, were integrated, contributing to a comprehensive risk factor profile. We evaluated the feasibility of this platform with 124 DFU patients over 12 weeks; 39% experienced unfavorable outcomes such as dropout, adverse events, or non-healing. Digital biomarkers were benchmarked (0-10); categorized as low, medium, and high risk for unfavorable outcomes; and visually represented using color-coded radar plots. The initial results of the case reports illustrate the value of this holistic visualization to pinpoint the underlying risk factors for unfavorable outcomes, including a high number of steps, poor adherence, and cognitive impairment. Although future studies are needed to validate the effectiveness of this visualization in personalizing care and improving wound outcomes, early results in identifying risk factors for unfavorable outcomes are promising.

Chronic meningitis in adults: a comparison between neurotuberculosis and neurobrucellosis

BackgroundIn regions endemic for tuberculosis and brucellosis, distinguishing between tuberculous meningitis (TBM) and brucella meningitis (BM) poses a substantial challenge. This study investigates the clinical and paraclinical characteristics of patients with TBM and BM.MethodsAdult patients diagnosed with either TBM or BM who were admitted to two referral hospitals between March 2015 and October 2022, were included, and the characteristics of the patients were analyzed.ResultsSeventy patients formed the study group, 28 with TBM and 42 with BM, were included. TBM patients had a 2.06-fold (95% CI: 1.26 to 3.37, P-value: 0.003) higher risk of altered consciousness and a 4.80-fold (95% CI: 1.98 to 11.61, P-value: < 0.001) higher risk of extra-neural involvement as compared to BM patients. Cerebrospinal fluid (CSF) analysis revealed a significantly higher percentage of polymorphonuclear leukocytes (PMN) in TBM compared to BM (Standardized mean difference: 0.69, 95% CI: 0.18 to 1.20, P-value: 0.008). Neuroimaging findings indicated higher risks of hydrocephalus (P-value: 0.002), infarction (P-value: 0.029), and meningeal enhancement (P-value: 0.012) in TBM compared to BM. Moreover, TBM patients had a 67% (95% CI: 21% to 131%, P-value:0.002) longer median length of hospital stay and a significantly higher risk of unfavorable outcomes (Risk ratio: 6.96, 95% CI: 2.65 to 18.26, p < 0.001).ConclusionsOur study emphasizes that TBM patients displayed increased frequencies of altered consciousness, PMN dominance in CSF, extra-neural involvement, hydrocephalus, meningeal enhancement, and brain infarction. The findings emphasize the diagnostic difficulties and underscore the importance of cautious differentiation between these two conditions to guide appropriate treatment strategies.

Sex differences in the correlation between white matter hyperintensity and 3-month outcome in acute stroke patients

BackgroundThe severity of white matter hyperintensities (WMH) has been shown to be an independent predictor of poor stroke outcome, but the effect of sex on this correlation has not been investigated further. Therefore, the purpose of our study was to assess whether there was a sex difference between the severity of WMH and poor stroke outcome. MethodsThis retrospective study included 449 patients with acute ischemic stroke (AIS) who received intravenous thrombolysis. WMH severity was graded based on the Fazekas scale. The association between WMH severity and stroke outcome was explored through multivariable regression analyses in men and women. ResultsAmong women, when dividing WMH severity into tertiles, T3 (Fazekas scale >3) had a 5.334 times higher risk for unfavorable outcomes than T1 (Fazekas scale <2) (p-trend = 0.026) in the adjusted model. In addition, moderate-severe WMH (Fazekas scale 3–6) had a 3.391 (1.151–9.991) times higher risk than none-mild WMH (Fazekas scale 0–2) (p = 0.027). ConclusionsThe risk of unfavorable outcomes increased proportionally with the enlargement of the WMH severity in females, suggesting the sex-specific value of the WMH severity in optimizing the risk stratification of stroke.

Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot study

BackgroundSubarachnoid hemorrhage (SAH) patients with cerebral autoregulation (CA) impairment at an early post-SAH period are at high risk of unfavorable outcomes due to delayed cerebral ischemia (DCI) or other complications. Limited evidence exists for an association between early-stage CA impairments and SAH patient outcomes. The objective of this prospective study was to explore associations between CA impairments detected in early post-SAH snapshot examinations and patient outcomes.MethodsThe pilot observational study included 29 SAH patients whose CA status was estimated 2–3 days after spontaneous aneurysm rupture and a control group of 15 healthy volunteers for comparison. Inflatable leg recovery boots (reboots.com, Germany) were used for the safe controlled generation of arterial blood pressure (ABP) changes necessary for reliable CA examination. At least 5 inflation‒deflation cycles of leg recovery boots with a 2–3 min period were used during examinations. CA status was assessed according to the delay time (∆TCBFV) measured between ABP(t) and cerebral blood flow velocity (CBFV(t)) signals during artificially induced ABP changes at boot deflation cycle. CBFV was measured in middle cerebral artery by using transcranial Doppler device.ResultsStatistically significant differences in ∆TCBFV were found between SAH patients with unfavorable outcomes (∆TCBFV = 1.37 ± 1.23 s) and those with favorable outcomes (∆TCBFV = 2.86 ± 0.99 s) (p < 0.001). Early assessment of baroreflex sensitivity (BRS) during the deflation cycle showed statistically significant differences between the DCI and non-DCI patient groups (p = 0.039).ConclusionsA relatively small delay of ∆TCBFV <1.6 s between CBFV(t) and ABP(t) waves could be an early warning sign associated with unfavorable outcomes in SAH patients. The BRS during boot deflation can be used as a biomarker for the prediction of DCI.Trial registrationClinicalTrials.gov Identifier: NCT06028906. Registered 31 August 2023 - Retrospectively registered, https://www.clinicaltrials.gov/study/NCT06028906.

Sex Differences in Epidemiological Distribution and Outcomes of Surgical Mitral Valve Disease.

Mitral valve (MV) disease is the most common form of valvular heart disease. Findings that indicate women have a higher risk for unfavorable outcomes than men remain controversial. This study aimed to determine the sex-based differences in epidemiological distributions and outcomes of surgery for MV disease.Methods and Results: Overall, 18,572 patients (45.3% women) who underwent MV surgery between 2001 and 2018 were included. Outcomes included in-hospital death and all-cause mortality during follow up. Subgroup analysis was conducted across different etiologies, including infective endocarditis (IE), degenerative, ischemic, and rheumatic mitral pathology. The overall MV repair rate was lower in women than in men (20.5% vs. 30.6%). After matching, 6,362 pairs (woman : man=1 : 1) of patients were analyzed. Women had a slightly higher risk for in-hospital death than men (10.8% vs. 9.8%; odds ratio [OR]: 1.11, 95% confidence interval [CI]: 0.99-1.24; P=0.075). Women tended to have a higher incidence of de novo dialysis (9.8% vs. 8.6%; P=0.022) and longer intensive care unit stay (8 days vs. 7.1 days; P<0.001). Women with IE had poorer in-hospital outcomes than men; however, there were no sex differences in terms of all-cause mortality. Sex-based differences of MV intervention still persist. Although long-term outcomes were comparable between sexes, women, especially those with IE, had worse perioperative outcomes than men.

Abstract 5205: Beyond boundaries: ADRB3, a novel prognostic marker in pediatric neuroblastoma

Abstract Introduction: Neuroblastoma (NB) is a pediatric tumor arising from immature nerve cells originating from neural crest cells. This malignancy is characterized by a remarkably early onset, with only 10% of cases occurring beyond 5 years of age. According to the INRG classification, ~50% of patients are classified as low risk (L1/L2). Despite advances in treatment, around 20% of these experienced a relapse within 5 years with a mere 10% survival rate. Methods: We investigated the role of the adrenoceptor beta-3 (ADRB3) as a prognostic factor for NB. The samples provided by IRCCS Meyer Children’s Hospital allowed us to measure cytofluorimetric level expression of ADRB3 in tissue biopsies from 43 NBs, in the circulating tumor cells (CTCs) and in the bone marrow cells (BMCs) at onset and at the end of treatment. Further, to study the role of ADRB3 in NB, we used CRISPR-Cas9 to knock down ADRB3 expression in mice model. Results: Results indicate that ADRB3 levels in biopsy at the onset are significantly higher (Wilcoxon test, p = 0.026) in patients with negative outcome than those who achieved complete remission. The R package survival was used to perform Survival curve analysis to further assess the impact of ADRB3 at the onset in biopsy tissues. Results confirmed a significant separation (p = 0.031) between survival curves of patients with high levels and those with low levels, reinforcing its importance as a prognostic factor. Moreover, the same results were found in survival curves (p = 0.038) in low-risk patients, corroborating the importance of ADRB3 levels to discriminate between unfavorable or favorable prognosis. Moreover, post-chemotherapeutic treatment analysis, in both residual CTCs and BMCs, indicated statistically differences in ADRB3 levels between fully recovered patients and deceased. Survival curves, stratified by ADRB3 levels in CTCs post-chemotherapy, a favorable prognosis for patients with low levels (p = 0.0001). Finally, the expression analysis showed that ADRB3 levels in NB cells led to increment of processes associated with the cellular migration and metastasization and in metabolism. Conclusion: Our findings suggest that ADRB3 is a significant prognostic factor for NB. Patients with high ADRB3 expression in biopsy at the onset and after the treatment have a higher risk of unfavorable outcome, even for low-risk patients. In conclusion, our results challenge current classification and prognostic paradigms, highlighting ADRB3's crucial role in NB, contributing to refine risk stratification and unveil a new potential target for liquid biopsy of detecting, analyzing and monitoring CTCs. Citation Format: Gianluca Mattei, Cristina Banella, Francesco Carrozzo, Amada Pasha, Annalisa Tondo, Claudio Favre, Maura Calvani. Beyond boundaries: ADRB3, a novel prognostic marker in pediatric neuroblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5205.

Predicting COVID-19 outcomes in patients at advanced stages of HIV infection: a model-based approach

BACKGROUND: Today, clinicians and their decisions extensively rely on specific treatment algorithms. These algorithms include prognostic models to identify high risk patients requiring hospital admission and clinical monitoring. This study suggests a prognostic model for forecasting COVID-19 outcomes in patients with advanced HIV infection, considering the high risk of unfavorable outcomes and the need for a specialized approach.&#x0D; AIM: To develop a prognostic model that combines predictors of unfavorable COVID-19 outcomes in patients with advanced HIV infection.&#x0D; MATERIALS AND METHODS: The study was based on 500 medical records of patients with advanced HIV infection admitted for confirmed COVID-19 between March 1, 2020, and December 31, 2022, and inpatient treatment at the Infectious Diseases Hospital in Moscow.&#x0D; RESULTS: All 500 patients were evaluated for 167 predictive markers for unfavorable COVID-19 outcomes, outlining 50 indicators that significantly varied across the subgroups of patients with both advanced HIV infection and COVID-19 depending on the presence of favorable or poor outcomes. Oxygen therapy was the most significant factor showing a strong correlation with poor outcomes in patients with advanced HIV infection and COVID-19. Subsequently, predictors were selected stepwise to enhance the predictive accuracy of the resulting model by adding more factors.&#x0D; The resulting model included seven factors: oxygen therapy requirements, CD4+ count under 50 cells/μL; manifested CMV infection with lung damage; elevated levels of lactate dehydrogenase, urea, and fibrinogen; and the presence of unspecified encephalitis. Using the available data in the calculations, a prognostic scenario and a receiver operating characteristic (ROC) curve were created to assess the practical significance of the proposed prognostic model. The area under the ROC curve was 90.9%, confirming the prediction accuracy and overall practical significance of the model.&#x0D; CONCLUSIONS: The proposed prognostic model enables the assessment of potential outcomes and planning of adequate therapies in patients with HIV and COVID-19 co-infection admitted to hospitals at advanced stages of the disease.

The Impact of the Neutrophil-to-Lymphocyte Ratio on In-Hospital Outcomes in Patients With Acute ST-Segment Elevation Myocardial Infarction.

Introduction The neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of cardiovascular diseases, influencing their progression and prognosis. The exact role of the NLR in acute ST-segment elevation myocardial infarction (STEMI) is unclear. We investigated the possible association between peak NLR values within the first three days after STEMI onset and in-hospital outcomes in patients undergoing primary percutaneous coronary intervention (PCI). Methods This retrospective study included 641 patients who were diagnosed with acute STEMI and treated with primary PCI for 18 months at Dr. Siyami Ersek Hospital. The NLR was calculated using the maximum values obtained during the first three days after admission. The patients were divided into quartiles according to their NLR values for further analysis of potential complications during and after hospitalization, up to a follow-up period of three months. Results Significant differences were found in factors such as age, body mass index (BMI), and length of hospital stay among these groups. Specifically, we found that in-hospital mortality rates were significantly higher in the Q4 group, and there were variations in target vessel revascularization (TVR) rates, major adverse cardiac events (MACE) rates, and other clinical outcomes. Some parameters, such as reinfarction rates and certain procedural outcomes, did not show significant differences among the groups. However, despite the differences, most of the patients achieved successful outcomes after PCI, with the best results in the low NLR group and the worst results in the high NLR group. Conclusion Higher NLR values were associated with a higher risk of unfavorable outcomes during hospitalization.

СУЧАСНИЙ ПОГЛЯД НА ХОЗЛ: НА ЩО ЗВЕРНУТИ УВАГУ?

Last decade has been marked by the worsening of COPD epidemiology, particularly due to increase of its prevalence and mortality. According to recent data COPD is a cause of more than 3 million or 6 % of all deaths annually. Among the causes of high mortality rate the experts mention the exacerbations of the disease. An exacerbation of COPD is defined as an event, characterized by dyspnea and/or cough and sputum, that worsen over last 14 days. Exacerbations are frequently associated with the increased local and systemic inflammation caused of respiratory tract infection, air pollution or other insults to the lungs. Prevention of exacerbations as a major factor of COPD progression is one of the prerogatives of respiratory medicine. Patients with COPD and cardio-vascular comorbidity is the most vulnerable cohort due to high risk of mortality. Timely initiation of triple inhalation therapy with LAMA/LABA/ICS combination for patients with high risk of unfavorable outcomes is one of effective tools to reduce mortality. Clinical trials proved its statistically significant efficacy. Current understanding of the problem requires individualized approach to management of COPD, based on close contact with the patients, monitoring of availability and accessibility of medications, control of inhalation technique and treatment compliance, psychological and information support of the patients. Key words: chronic obstructive pulmonary disease, GOLD-2024, changes and additions.

Neuron-specific enolase as a prognostic biomarker in acute ischemic stroke patients treated with reperfusion therapies.

Ischemic stroke is a significant global health concern, with reperfusion therapies playing a vital role in patient management. Neuron-specific enolase (NSE) has been suggested as a potential biomarker for assessing stroke severity and prognosis, however, the role of NSE in predicting long-term outcomes in patients undergoing reperfusion therapies is still scarce. To investigate the association between serum NSE levels at admission and 48 h after reperfusion therapies, and functional outcomes at 90 days in ischemic stroke patients. This study conducted a prospective cross-sectional analysis on consecutive acute ischemic stroke patients undergoing intravenous fibrinolysis and/or endovascular thrombectomy. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days post-stroke and two groups were defined according to having unfavorable (mRS3-6) or favorable (mRS0-2) outcome. Demographic, clinical, radiological, and laboratory data were collected, including NSE levels at admission and 48 h. Spearman's coefficient evaluated the correlation between analyzed variables. Logistic regression analysis was performed to verify which variables were independently associated with unfavorable outcome. Two ROC curves determined the cut-off points for NSE at admission and 48 h, being compared by Delong test. Analysis of 79 patients undergoing reperfusion treatment following acute stroke revealed that patients with mRS 3-6 had higher NIHSS at admission (p < 0.0001), higher NIHSS at 24 h (p < 0.0001), and higher NSE levels at 48 h (p = 0.008) when compared to those with mRS 0-2. Optimal cut-off values for NSE0 (>14.2 ng/mL) and NSE48h (>26.3 ng/mL) were identified, showing associations with worse clinical outcomes. Adjusted analyses demonstrated that patients with NSE48h > 26.3 ng/mL had a 13.5 times higher risk of unfavorable outcome, while each unit increase in NIHSS24h score was associated with a 22% increase in unfavorable outcome. Receiver operating characteristic analysis indicated similar predictive abilities of NSE levels at admission and 48 h (p = 0.298). Additionally, a strong positive correlation was observed between NSE48h levels and mRS at 90 days (r = 0.400 and p < 0.0001), suggesting that higher NSE levels indicate worse neurological disability post-stroke. Serum NSE levels at 48 h post-reperfusion therapies are associated with functional outcomes in ischemic stroke patients, serving as potential tool for patient long-term prognosis.

Fluid management strategy in dengue acute respiratory distress syndrome with chronic kidney disease: A case report

Abstract Pulmonary manifestation in dengue is due to the involvement of both the upper and lower airways. Severe forms of dengue infection (pleural effusion, dengue hemorrhagic shock syndrome, and acute respiratory distress syndrome [ARDS]) are mainly due to the involvement of the lower respiratory tract. ARDS is a well-known respiratory complication following dengue infection. Patients with chronic kidney disease (CKD) diagnosed with dengue had a higher risk of unfavorable outcomes. Pulmonary involvement is one of the life-threatening complications in patients having CKD that contributes to increasing the mortality rate. Dysregulation of cytokines and apoptotic signaling pathway is a nonclassical mechanism of the kidney–lung crosstalk that results in the development of acute kidney injury in patients having ARDS. Severe worsening of renal function is common in CKD patients with dengue. Here, we discuss fluid management strategy in a patient having CKD who developed ARDS following dengue infection. The difficulty in the therapeutic dilemma is attributable to ambiguity in liberal versus conservative fluid therapy, contributing to a high risk of mortality. The narrow window of fluid tolerance in CKD patients further complicates the resuscitation strategy in patients with dengue ARDS.

The impact of time to evacuation on outcomes in endoscopic surgery for supratentorial spontaneous intracerebral hemorrhage: a single-center retrospective study.

Supratentorial spontaneous intracerebral hemorrhage (SICH) can be treated with endoscopic surgery, but the optimal timing remains uncertain. We retrospectively analyzed data from 46 patients who underwent endoscopic surgery for supratentorial SICH. We examined the relationship between time to evacuation and functional outcome at 3months, adjusting for prognostic factors. Surgical outcomes and complications were compared between patients with early (≤ 12h) or late (> 12h) evacuation. Median time to evacuation was 12h, and the rate of unfavorable outcome (modified Rankin Scale > 3 at 3months) was 32.6%. Longer time to evacuation was independently associated with unfavorable outcome (odds ratio per hour delay: 1.26). Late evacuation carried a 7.25-fold higher risk of unfavorable outcome compared to early evacuation. This association held across subgroups based on hematoma volume, location, and intraventricular extension (P for interaction > 0.05). Patients with late evacuation had fewer spot signs (24% vs. 4.8%, P = 0.035) and markers of hemorrhagic expansion (36% vs. 9.5%, P = 0.018), longer neurosurgical intensive care unit (NSICU) stay (3.2 vs. 1.9days, P = 0.011) and hospital stay (15.7 vs. 11.9days, P = 0.014), and higher 30-day mortality (28.6 vs. 4%, P = 0.036) and complication rates (57.1% vs. 28.0%, P = 0.023). This study suggests a potential association between early endoscopic evacuation of supratentorial SICH and improved functional outcomes, lower 30-day mortality and reduced complications. The need for timely intervention in managing supratentorial SICH is highlighted, yet further validation through multi-center prospective studies is essential to substantiate these findings and provide a higher level of evidence.

Comparative Effectiveness of Mechanical Circulatory Support Devices in Cardiogenic Shock

In patients with cardiogenic shock, this review compares the efficacy of percutaneous microaxial left ventricular assist devices (pLVADs) to intra-aortic balloon pumps (IABPs) or no mechanical circulatory support (MCS). End-organ hypoperfusion brought on by insufficient cardiac output characterizes the potentially fatal disease known as cardiogenic shock. Relevant papers were found by a thorough search of internet resources and were incorporated into the study. The main outcomes evaluated were: (1) Short-term mortality, (2) hemodynamic indices, (3) organ function, and (4) Length of hospital stay. Considered secondary outcomes were: (1) Adverse events, (2) quality of life, and (3) long-term survival. As shown by increased cardiac output and mean arterial pressure, the findings of this research imply that pLVADs may provide superior hemodynamic support versus IABPs or no MCS. In addition, pLVADs may have better organ function and lower short-term mortality rates than IABPs or no MCS. However, using pLVADs was also linked to a higher risk of unfavorable outcomes, such as bleeding and vascular issues. Data on long-term survival and quality-of-life outcomes were sparse and ambiguous. In conclusion, as compared to IABPs or no MCS, pLVADs may offer more effective hemodynamic support and better short-term outcomes in patients with cardiogenic shock. More investigation is required to fully comprehend the long-term advantages, hazards, and effects of pLVADs on the quality of life in this patient population.

Elevated Calcium after Acute Ischemic Stroke Predicts Severity and Prognosis.

The aim of this study is to investigate whether there is a correlation between serum calcium levels and clinical severity or functional outcome at discharge in Chinese patients with acute ischemic stroke. Data from 339 patients admitted to our hospital between July 2020 and July 2021 were analyzed. Baseline demographic and clinical information was collected within 24h of admission, including serum calcium levels, stroke severity (measured by the National Institutes of Health Stroke Scale [NIHSS] score), and lesion volumes. The modified Rankin Scale [mRS] assessed functional outcomes at discharge. Our analysis showed that the median age of patients included in the study was 65 years (interquartile range [IQR], 60-70), and 60.8% were men. We found a positive correlation between serum calcium levels and stroke severity (r[spearman] = 0.266, P < 0.001), with calcium levels increasing as stroke severity increased. In a subgroup of 188 patients with available MRI data, serum calcium concentrations positively correlated with infarct size. Furthermore, in multivariate analysis, a calcium serum level in the highest quartile was associated with a higher risk of unfavorable outcome (odds ratios [OR] = 3.27; 95% confidence intervals [CI] = 1.91-5.59; P < 0.001). In conclusion, our study indicates that higher calcium serum levels are associated with stroke severity and early neurologic outcome after acute ischemic stroke, indicating that calcium may serve as a prognostic biomarker for stroke in Chinese patients.

Clinicopathological Risk Factors of Unfavorable Outcomes in Vietnamese Women with Primary Invasive Breast Cancer: A Retrospective Cohort Study.

The rate of unfavorable outcomes, such as recurrence and death, in women with invasive breast cancer varies widely across countries and populations. Identifying those with high-risk profiles is critical so that early detection, prediction, and intervention can be made to improve their survival rate. Therefore, our study evaluated the rate of unfavorable outcomes and its association with clinicopathological characteristics in Vietnamese women with primary invasive breast cancer. A retrospective open cohort study was conducted on Vietnamese women with invasive breast cancer who underwent a mastectomy and were regularly followed up by the hospitals. Kaplan-Meier method was used to estimate the rate of unfavorable outcomes to take into account the follow-up time of each patient. Univariate and multiple Cox regression analyses were conducted to examine the associations between unfavorable outcomes and clinicopathological characteristics. Among 204 women included in the data analysis, the mean age was 54.4 ± 10.9 years. The majority of patients were diagnosed with early-stage (76.5%) or locally advanced (22.5%) breast cancer. The 5-year rate of unfavorable outcomes was 12.8%, and the 8-year rate was 31.7%. Patients with advanced stages had a higher risk of unfavorable outcomes compared to those with early stages (IA, IIA, T2N1). Patients with lymph node metastases and those with triple-negative molecular classification had significantly higher rates of unfavorable outcomes. Although Vietnamese women with breast cancer have a relatively low rate of unfavorable outcomes compared to other countries, findings from this study emphasize the importance of early detection and underscore the need for targeted interventions for patients with advanced stages, lymph node metastases, and triple-negative breast cancer to optimize their treatment, outcomes, and overall prognosis.