Initial Prognosis Research Articles

Lenalidomide in Multiple Myeloma: Review of Resistance Mechanisms, Current Treatment Strategies and Future Perspectives.

Multiple myeloma (MM) is the second most common hematologic malignancy, accounting for approximately 1% of all cancers. Despite the initial poor prognosis for MM patients, their life expectancy has improved significantly with the development of novel agents. Immunomodulatory drugs (IMiDs) are widely used in MM therapy. Their implementation has been a milestone in improving the clinical outcomes of patients. The first molecule belonging to the IMiDs was thalidomide. Subsequently, its novel derivatives, lenalidomide (LEN) and pomalidomide (POM), were implemented. Almost all MM patients are exposed to LEN, which is the most commonly used IMiD. Despite the potent anti-MM activity of LEN, some patients eventually relapse and become LEN-resistant. Drug resistance is one of the greatest challenges of modern oncology and has become the main cause of cancer treatment failures. The number of patients receiving LEN is increasing, hence the problem of LEN resistance has become a great obstacle for hematologists worldwide. In this review, we intended to shed more light on the pathophysiology of LEN resistance in MM, with particular emphasis on the molecular background. Moreover, we have briefly summarized strategies to overcome LEN resistance and we have outlined future directions.

Abnormal posterior semicircular canal function may predict poor prognosis in patients with severe and profound ISSNHL.

Severe and profound idiopathic sudden sensorineural hearing loss (ISSNHL) generally leads to unfavorable prognosis, and has a considerable impact on patient quality of life. However, related prognostic factors remain controversial. To elaborate the relationship between vestibular function impairment and the prognosis of patients with severe and profound ISSNHL, and investigated the relevant factors affecting prognosis. Forty-nine patients with severe and profound ISSNHL were divided into good outcome group [GO group, pure tone average (PTA) improvement > 30 dB] and poor outcome group (PO group, PTA improvement ≤ 30 dB) according to hearing outcomes. The clinical characteristics and the proportion of abnormal vestibular function tests in these two groups were analyzed by univariate analysis, and multivariable logistic regression analysis was performed for parameters with significant differences. Forty-six patients had abnormal vestibular function test results (46/49, 93.88%). The number of vestibular organ injuries was 1.82 ± 1.29 in all patients, with higher mean numbers in PO group (2.22 ± 1.37) than in GO group (1.32 ± 0.99). Univariate analysis revealed no statistical differences between the GO and PO groups in terms of gender, age, side of the affected ear, vestibular symptoms, delayed treatment, instantaneous gain value of horizontal semicircular canal, regression gain value of vertical semicircular canal, abnormal rates of oVEMP, cVEMP, caloric test and vHIT in anterior and horizontal semicircular canal, however, significant differences were found in the initial hearing loss and abnormal vHIT of posterior semicircular canal (PSC). Multivariable analysis revealed that only PSC injury was an independent risk factor for predicting the prognosis of patients with severe and profound ISSNHL. Patients with abnormal PSC function had worse initial hearing impairment and prognosis than patients with normal PSC function. The sensitivity of abnormal PSC function in predicting poor prognosis in patients with severe and profound ISSNHL was 66.67%, specificity was 95.45%, and positive and negative likelihood ratios were 14.65 and 0.35, respectively. Abnormal PSC function is an independent risk factor for poor prognosis in patients with severe and profound ISSNHL. Ischemia in the branches of the internal auditory artery supplying the cochlea and PSC may be the underlying mechanism.

A retrospective analysis of tumor infiltrating lymphocytes in head and neck squamous cell carcinoma patients treated with nivolumab

Nivolumab, an immune checkpoint inhibitor is the first-line therapy for platinum-resistant recurrent/metastatic head and neck cancer, and highly effective for some patients. However, no factors have been identified that could predict response or prognosis after nivolumab administration. We retrospectively investigated the association between tumor infiltrating lymphocytes (TILs) of initial pathology and prognosis in patients treated with nivolumab. Twenty-eight patients with human papilloma virus and Epstein–Barr virus unrelated head and neck squamous cell carcinoma were enrolled. CD8+cells, FoxP3+cells and FoxP3−CD4+cells in the tumoral and peritumoral stromal area and PD-L1 were measured. In result, FoxP3−CD4+TIL, FoxP3+TIL, and CD8+TIL were not correlated with survival in either intratumoral and stromal area. In univariate analysis, objective response was significant prognostic factor both in progression-free survival and overall survival (p = 0.01, 0.006, respectively). PD-L1 was also significant prognostic factor both in progression-free survival and overall survival (p = 0.01, 0.01, respectively). ECOG Performance status was a significant prognostic factor in overall survival (p = 0.0009). In the combined analysis of stromal CD8+TIL and PD-L1, PD-L1 positive with high stromal CD8+TIL subgroups had a better prognosis than PD-L1 negative with low stromal CD8+TIL subgroups in progression-free survival (p = 0.006). Although these results require a further investigation, PD-L1 and ECOG Performance status and the combination of stromal CD8+TIL and PD-L1 positivity have potential as useful prognostic markers in patients of virus unrelated head and neck squamous cell carcinoma treated with nivolumab.

Guidelines on lung adenocarcinoma prognosis based on immuno-glycolysis-related genes

ObjectivesThis study developed a new model for risk assessment of immuno-glycolysis-related genes for lung adenocarcinoma (LUAD) patients to predict prognosis and immunotherapy efficacy.MethodsLUAD samples and data obtained from the Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases are used as training and test columns, respectively. Twenty-two (22) immuno-glycolysis-related genes were screened, the patients diagnosed with LUAD were divided into two molecular subtypes by consensus clustering of these genes. The initial prognosis model was developed using the multiple regression analysis method and Receiver Operating characteristic (ROC) analysis was used to verify its predictive potential. Gene set enrichment analysis (GSEA) showed the immune activities and pathways in different risk populations, we calculated immune checkpoints, immune escape, immune phenomena (IPS), and tumor mutation burden (TMB) based on TCGA datasets. Finally, the relationship between the model and drug sensitivity was analyzed.ResultsFifteen (15) key differentially expressed genes (DEGs) with prognostic value were screened and a new prognostic model was constructed. Four hundred and forty-three (443) samples were grouped into two different risk cohorts based on median model risk values. It was observed that survival rates in high-risk groups were significantly low. ROC curves were used to evaluate the model’s accuracy in determining the survival time and clinical outcome of LUAD patients. Cox analysis of various clinical factors proved that the risk score has great potential as an independent prognostic factor. The results of immunological analysis can reveal the immune infiltration and the activity of related functions in different pathways in the two risk groups, and immunotherapy was more effective in low-risk patients. Most chemotherapeutic agents are more sensitive to low-risk patients, making them more likely to benefit.ConclusionA novel prognostic model for LUAD patients was established based on IGRG, which could more accurately predict the prognosis and an effective immunotherapy approach for patients.

Ruxolitinib on acute graft-versus-host disease prophylaxis after modified donor lymphocyte infusion

ObjectiveTo evaluate the effectiveness of ruxolitinib on acute graft-versus-host disease (aGVHD) prophylaxis and its impact on graft-versus-leukemia (GVL) effect in patients after modified donor lymphocyte infusion (mDLI). MethodsWe retrospectively included patients with relapsed leukemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT) who received ruxolitinib prophylaxis between October 2018 and April 2020. The incidence of aGVHD, disease-free survival (DFS), overall survival (OS), and treatment safety were evaluated. ResultsSeventeen patients were followed up for a median time of 8 months (range: 1–26 months). The incidence of aGVHD on Day 30 after mDLI was 41.2% and ranged from Grade 1 to 4; ten of 17 patients (58.8%) achieved a complete response (CR), and two (11.8%) had a partial response (PR). Cytomegalovirus (CMV) reactivation rate was 23.5%, and the median time from mDLI to CMV reactivation was 48.5 days. The mean DFS and OS after mDLI were 1.0 (95% CI 0.0–3.5) and 9.0 (95% CI 1.2–16.8) months, respectively. The causes of death for 10 patients were leukemia relapse (n = 5), aGVHD and septic shock (n = 3), intracranial lesion (n = 1), and COVID-19 (n = 1). ConclusionsWe reported encouraging results of ruxolitinib monotherapy in the prevention of aGVHD and maintenance of GVL for post-transplantation relapsed patients, even though being at high risk with poor initial prognosis.

Response to growth hormone treatment in patients with sufficient secretion

BackgroundThere are situations of short stature, with a normal stimulus test for GH, but decreased nocturnal secretion in which there could be a benefit with GH treatment. ObjetivesTo assess adult height and height gain in patients with neurosecretory dysfunction diagnosis treated with growth hormone. Material y methodsLongitudinal, retrospective and observational study including 61 patients treated with growth hormone after diagnosis of neurosecretory dysfunction who have already reached adult height. Variables such as adult height gain, growth rate, growth prognosis variation and IGF-I and IGFBP-3 were evaluated. Variables related to a good response in the first year have also been calculated, using the Index of responsiveness (IoR). ResultsGH treatment produces an improvement in growth rate and height, observing an increase in adult height with respect to initial height of 1.15±0.60 SD, height with respect to genetic height of -0.015±0.62 SD and adult height with respect to the initial growth prognosis 0,74±1,13 DE. The IoR in the first year is associated with a greater increase in height in the first year (p=0.000), with a greater adult height (p=0.000) and with a greater gain in adult height compared to its initial height (p=0.039). ConclusionsPatients with growth delay due to neurosecretory dysfunction of GH show a good response to treatment with rhGH, observing a significant height gain in their genetic size and improving their initial growth prognosis.

Development and validation of a pyradiomics signature to predict initial treatment response and prognosis during transarterial chemoembolization in hepatocellular carcinoma.

We aimed to develop and validate a pyradiomics model for preoperative prediction of initial treatment response to transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). To this end, computed tomography (CT) images were acquired from multi-centers. Numerous pyradiomics features were extracted and machine learning approach was used to build a model for predicting initial response of TACE treatment. The predictive accuracy, overall survival (OS), and progression-free survival (PFS) were analyzed. Gene Set Enrichment Analysis (GSEA) was further used to explore signaling pathways in The Cancer Genome Atlas (TCGA)-HCC cohort. Overall, 24 of the 1,209 pyradiomic features were selected using the least absolute shrinkage and selection operator (LASSO) algorithm. The pyradiomics signature showed high predictive accuracy across the discovery set (AUC: 0.917, 95% confidence interval [CI]: 86.93-96.39), validation set 1 (AUC: 0.902, 95% CI: 84.81-95.59), and validation set 2 (AUC: 0.911; 95% CI: 83.26-98.98). Based on the classification of pyradiomics model, we found that a group with high values base on pyramidomics score showed good PFS and OS (both P<0.001) and was negatively correlated with glycolysis pathway. The proposed pyradiomics signature could accurately predict initial treatment response and prognosis, which may be helpful for clinicians to better screen patients who are likely to benefit from TACE.

Encounters at the Mound in Old Norse Literature: Dialogues between Landscape and Narrative

Encounters at the Mound in Old Norse Literature: Dialogues between Landscape and Narrative

Hepcidin discriminates sepsis from other critical illness at admission to intensive care

Initial differential diagnosis and prognosis for patients admitted to intensive care with suspected sepsis remain arduous. Hepcidin has emerged as a potential biomarker for sepsis. Here we report data on the relevance of levels of hepcidin versus other biomarkers as a diagnostic and prognostic tool for sepsis. 164 adult patients admitted to the intensive care unit (ICU) within 24 h upon arrival to the hospital were included. Blood samples collected daily for seven consecutive days and hepcidin levels, heparin binding protein (HBP) levels and standard biomarkers were determined. Blood cultures were initiated at inclusion. Clinical scores were evaluated daily and mortality after 28- and 180-days was recorded. One hundred of the patients were found to fulfil the criteria for sepsis whereas 64 did not. Hepcidin levels at admission were significantly higher in the septic than in the non-septic patients. In septic patients hepcidin levels declined significantly already at 24 h followed by a steady decline. A significant negative correlation was observed between hepcidin levels and SAPS 3 in patients with sepsis. Hepcidin levels at inclusion were significantly higher among septic patients that survived 180-days and predicted mortality. Our data show that hepcidin levels are indicative of sepsis in patients admitted to the ICU and has a prognostic value for mortality.

Age at initial diagnosis and prognosis of breast cancer: a nationwide multicenter retrospective study in China.

BackgroundSeveral studies have indicated possible associations between age and the prognosis of breast cancer (BC), but limited data are available from hospital-based multicenter studies in China. This study aimed to explore the associations between age at initial diagnosis of BC and the risk of recurrence or metastasis among Chinese women with newly diagnosed advanced breast cancer (ABC) and provide treatment decision support for BC patients of different ages to medical workers.MethodsThe medical records of patients newly diagnosed with ABC were obtained from 21 hospitals in seven geographic regions in China from 2012 to 2014. Patients’ general information, clinicopathological features at first diagnosis, treatment information, and prognosis were retrospectively collected based on the self-designed case report form (CRF). Cox proportional hazards regression models were used to determine hazard ratios (HR) and 95% confidence intervals (CI) for the associations between age groups and the risk of recurrence and metastasis.ResultsA total of 1,852 cases were included in the final analysis. Age at initial diagnosis was shown to be significantly related to hormone receptor status, human epidermal growth factor receptor 2 (HER2) status, molecular subtypes, and the number of lymph node metastasis (all P<0.05). Patients aged <35 years were more likely to have bone metastasis (45.6%). Patients aged ≥65 years had a lower percentage of receiving surgery (87.1%), adjuvant chemotherapy (61.3%), adjuvant radiotherapy (35.5%), and adjuvant endocrine therapy (30.6%) than the other groups (all P<0.05). Compared with patients aged <35 years, the risk of recurrence or metastasis in those aged 55–64 years was significantly higher (HRage 55–64 =1.24, 95% CI: 1.04–1.47), and the risk of bone metastasis and lung metastasis in those aged 35–44 years was lower (HRbone metastasis =0.74, 95% CI: 0.59–0.93; HRlung metastasis =0.70, 95% CI: 0.53–0.93). After adjusting for stage, grade, and molecular subtype, surgery, neoadjuvant chemotherapy, adjuvant chemotherapy, adjuvant radiotherapy, adjuvant endocrine therapy, and family history of BC, patients aged 35–44 years still had a significantly reduced risk of bone metastasis and lung metastasis by 31% and 52%, respectively (HRbone metastasis =0.69, 95% CI: 0.48–0.98; HRlung metastasis =0.48, 95% CI: 0.31–0.74).ConclusionsAge at initial diagnosis is related to the clinicopathological characteristics and treatment pattern. Although the risk of site-specific metastasis varies by age, age is not an independent factor influencing the risk of total recurrence and metastasis. In accordance with current clinical practice guidelines for BC, however, precise treatment shall be chosen personally for patients whose ages at initial diagnosis are different.

Respuesta al tratamiento con hormona del crecimiento en pacientes con secreción suficiente

BackgroundThere are situations of short stature, with a normal stimulus test for GH, but decreased nocturnal secretion in which there could be a benefit with GH treatment. ObjetivesTo assess adult height and height gain in patients with neurosecretory dysfunction diagnosis treated with growth hormone. Material y methodsLongitudinal, retrospective and observational study including 61 patients treated with growth hormone after diagnosis of neurosecretory dysfunction who have already reached adult height. Variables such as adult height gain, growth rate, growth prognosis variation and IGF-1 and IGFBP-3 were evaluated. Variables related to a good response in the first year have also been calculated, using the index of responsiveness. ResultsGH treatment produces an improvement in growth rate and height, observing an increase in adult height with respect to initial height of 1.15±0.60 SD, height with respect to genetic height of −0.015±0.62 SD and adult height with respect to the initial growth prognosis 0,74±1,13 DE. The index of responsiveness in the first year is associated with a greater increase in height in the first year (P<0.001), with a greater adult height (P<0.001) and with a greater gain in adult height compared to its initial height (P=0.039). ConclusionsPatients with growth delay due to neurosecretory dysfunction of GH show a good response to treatment with rhGH, observing a significant height gain in their genetic size and improving their initial growth prognosis.

Coronavirus disease 2019 (COVID-19) update: From metabolic reprogramming to immunometabolism.

The field of immunometabolism investigates and describes the effects of metabolic rewiring in immune cells throughout activation and the fates of these cells. Recently, it has been appreciated that immunometabolism plays an essential role in the progression of viral infections, cancer, and autoimmune diseases. Regarding COVID‐19, the aberrant immune response underlying the progression of diseases establishes two major respiratory pathologies, including acute respiratory distress syndrome (ARDS) or pneumonia‐induced acute lung injury (ALI). Both innate and adaptive immunity (T cell‐based) were impaired in the course of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Current findings have deciphered that macrophages (innate immune cells) are involved in the inflammatory response seen in COVID‐19. It has been demonstrated that immune system cells can change metabolic reprogramming in some conditions, including autoimmune diseases, cancer, and infectious disease, including COVID‐19. The growing findings on metabolic reprogramming in COVID‐19 allow an exploration of metabolites with immunomodulatory properties as future therapies to combat this hyperinflammatory response. The elucidation of the exact role and mechanism underlying this metabolic reprograming in immune cells could help apply more precise approaches to initial diagnosis, prognosis, and in‐hospital therapy. This report discusses the latest findings from COVID‐19 on host metabolic reprogramming and immunometabolic responses.

Analysis of survival and prognostic factors of thymic neuroendocrine tumors.

e20622 Background: To investigate the clinical characteristics of thymic neuroendocrine tumors and the relationship between treatment and survival prognosis. Methods: 69 patients, including 54 males and 15 females, who were diagnosed with NETT by puncture or surgical pathology in the First Affiliated Hospital of Zhengzhou University from September 2011 to October 2021 were retrospectively analyzed for initial symptoms, Pathological type, lesion size, treatment and prognosis of survival. Results: The median age of the 69 patients was 53 years old (28-83 years old), the median maximum diameter of the primary lesion was 6.85 cm (1.1-14.9 cm), and the clinical manifestations were not specific. The most common initial symptom was chest tightness and chest pain for 20 cases, 19 cases with hidden disease, found during physical examination. The manifestations of local invasion and metastasis included cough (6 cases), neck and face swelling (9 cases), retrosternal discomfort (3 cases), and low back pain (4 cases). There were 6 cases with systemic manifestations (anorexia, fatigue and fever). Only one case showed ectopic ACTH syndrome. The pathological types included 46 cases of well-differentiated neuroendocrine tumors (5 cases of typical carcinoid tumors, 41 cases of atypical carcinoid tumors), 23 cases of poorly differentiated neuroendocrine tumors (13 cases of small cell carcinomas, 3 cases of large cell neuroendocrine carcinomas, and high-grade neuroendocrine carcinomas). 7 cases of endocrine carcinoma). Masaoka-Koga staging: 2 cases of stage I, 10 cases of stage II, 20 cases of stage III, and 37 cases of stage IV. Thirty patients received surgical treatment, and 19 received postoperative adjuvant therapy. Long-term follow-up results showed a median overall survival time of 49.5 months. Univariate analysis showed that surgery could improve PFS (P = 0.009), while postoperative comprehensive treatment had no effect on PFS (P = 0.724). Pathological grade (P &lt; 0.001), Masaoka-Koga stage (P = 0.004), and surgery (P = 0.014) were associated with OS. Multivariate analysis showed that pathological grade was an independent factor affecting OS (HR: 7.133; 95%CI: 2.183-23.306; P = 0.001). Conclusions: Thymic neuroendocrine tumor is a rare malignant tumor, and pathological grade is an independent risk factor for prognosis. Surgery can improve the patient's PFS.

Myasthenia gravis coexisting with HINT1-related motor axonal neuropathy without neuromyotonia: a case report

BackgroundHINT1 mutations cause an autosomal recessive axonal neuropathy with neuromyotonia. This is a first case report of coexistence of myasthenia gravis (MG) and HINT1-related motor axonal neuropathy without neuromyotonia.Case presentationA 32-year-old woman presented with recurrent ptosis for 8 years, diplopia for 2 years and limb weakness for 1 year and a half. Neostigmine test, elevated AChR antibody level and positive repetitive nerve stimulation supported the diagnosis of MG. Electroneurography (ENG) and electromyography (EMG) examinations revealed a motor axonal neuropathy without neuromyotonic or myokymic discharges. Next-generation sequencing and Sanger sequencing were performed to identify the gene responsible for suspected hereditary neuropathy. Genetic testing for a HINT1 mutation was performed and revealed a homozygous mutation at c.278G>T (p. G93V). The patient was treated with pyridostigmine, oral prednisolone and azathioprine. Her ptosis and diplopia have significantly improved at 6-month follow-up.ConclusionsConcurrence of MG and hereditary motor axonal neuropathy without neuromyotonia is quite rare. Detection of ptosis with or without ophthalmoplegia, distribution of limb weakness, and reflex can help in recognizing the combination of MG and peripheral neuropathy. Early diagnosis is important for initial treatment and prognosis. The novel homozygous variant c.278G>T(p.G93V) contributes to the pathogenic variants spectrum of the HINT1 gene.

HBV Infection Status Does Not Influence the Initial Metastatic Pattern and the Prognosis of Breast Cancer Patients with de novo and Relapsed Metastatic Disease.

PurposeThis study aimed to evaluate the influence of hepatitis B virus (HBV) infection status on the initial metastatic pattern and prognosis in metastatic breast cancer (MBC).MethodsMBC patients admitted to Chongqing University Cancer Hospital between January 2011 and December 2019 were enrolled. The association of HBV infection status with clinicopathological features was analyzed. The impact of HBV infection status on initial metastatic pattern and survival was evaluated.ResultsA total of 1124 patients with MBC, including 310 with de novo (cohort A) and 814 with relapsed metastatic disease (cohort B), were eligible for this study. Seropositive HBsAg was identified in 28 (9.0%) and 68 (8.4%) patients in cohort A and B, respectively. The clinicopathological features are similar between HBsAg-positive and HBsAg-negative patients. There was no significant association of HBV infection status with the rate of metastasis at each site in de novo and relapsed MBC. HBsAg-positive patients tended to have longer metastasis-free survival (MFS) and/or overall survival (OS) time, but it was not the independent prognostic factor.ConclusionIn conclusion, HBV infection status does not influence the initial metastatic pattern and the prognosis of MBC patients.

789 Role of Speech Therapy (SLP) in the rehabilitation of a complicated case of glossoparesis (GP)

IntroductionGlossoparesis is defined as a neurodegenerative process resulting in progressive dysphagia and dysarthria. The deinervation of the tongue and related structures results in flaccid muscle function unilaterally and bilaterally, this process is difficult to treat and rehabilitate and prognosis is considered poor. We encountered this in a patient that had a complicated case of necrotizing fasciitis (NF) that arose from an abscessed tooth.The purpose of this case report is to summarize the overall approach to a rehabilitation plan which resulted in successful return to speech and partial swallow.MethodsThe patient was diagnosed with an abscessed tooth which resulted in Necrotizing fasciitis of the face, neck and chest. Multiple surgical interventions resulted in removal of necrotic tissue and reconstructive interventions were implemented. Initial prognosis of return of function was noted as “poor” per ENT services. Ear, Nose and Throat (ENT) specialist noted that prognosis for recovery of function is unknown but was low.Speech Therapy was also consulted and an individualized plan of care to address the deficits assessed was developed. Initial prognosis of return of functional speech / swallow was guarded. It was felt to be highly appropriate to provide the patient with therapeutic options.Speech Therapy sessions included use of Neuromuscular Electrical Stimulation, Thermal Stimulation, Tactile Stimulation, Therapeutic Massage to affected regions, Deep Pharyngeal Neuromuscular Stimulation, finger occlusion trials for speech production attempts to ready patient for use of Passy Muir Valve, Oral Motor Exercises, Laryngeal Elevation Tasks, Vocal Stretching / Relaxation tasks and oral trials of ice chips as musculature function improved.ResultsThrough the use of these multiple modalities of skilled speech therapy intervention, the patient had return of functional verbal communication prior to discharge to a skilled rehabilitation program.ConclusionsUpon initial evaluation, the true potential for return of function was questioned. It is paramount that patient be given an opportunity to succeed - to be included in the plan of care - to be provided with opportunities to return to their prior level of function or as close as possible. There is little to no research regarding return of function for patients affected by glossoparesis.

Primary vs. Secondary Heart Failure Diagnosis: Differences in Clinical Outcomes, Healthcare Resource Utilization and Cost.

BackgroundThere is scarce information on patients with secondary heart failure diagnosis (sHF). We aimed to compare the characteristics, burden, and outcomes of sHF with those with primary HF diagnosis (pHF).MethodsRetrospective, observational study on patients ≥18 years with emergency department (ED) visits during 2018 with pHF and sHF in ED or hospital (ICD-10-CM) diagnostic codes. Baseline characteristics, 30-day and 1-year mortality, readmission and re-ED visit rates, and costs were compared between sHF and pHF.ResultsOut of the 797 patients discharged home from the ED, 45.5% had sHF, and these presented lower 1-year hospitalization, re-ED visit rates, and costs. In contrast, out of the 2,286 hospitalized patients, 55% had sHF and 45% pHF. Hospitalized sHF patients had significantly (p < 0.01) greater comorbidity, lower use of recommended HF therapies, longer length of stay (10.8 ± 10.1 vs. 9.7 ± 7.9 days), and higher in-hospital and 1-year mortality (32 vs. 25.8%) with no significant differences in readmission rates and lower 1-year re-ED visit rate. Hospitalized sHF patients had higher total costs (€12,262,422 vs. €9,144,952, p < 0.001), mean cost per patient-year (€9,755 ± 13,395 vs. €8,887 ± 12,059), and average daily cost per patient.ConclusionHospitalized sHF patients have a worse initial prognosis, greater use of healthcare resources, and higher costs.

Diagnosis and Follow Up of Non Hodgkin Lymphoma in Dakar, Senegal

Introduction: The management of Non-Hodgkin Lymphoma (NHL) in Senegal is challenging due to the lack of exploration tools and the inaccessibility of anticancer drugs. This study aimed to identify the prognostic factors at diagnosis and to assess their outcome under treatment. Methodology: We conducted a descriptive and analytical prospective study range from 1st January 2018 to 3rd July 2020 covering NHL cases. Initial prognostic factors were assessed according to the International Prognostic Index for diffuse large cell B lymphoma and T-cell lymphoma, the Mantle Cell Lymphoma International Prognostic Index and the Follicular Lymphoma International Index for mantle cell lymphoma and small cell lymphoma respectively. B-cell lymphomas were treated with polychemotherapy with or without rituximab, T-cell lymphomas were treated with polychemotherapy alone. Progression was assessed on the basis of response to treatment, toxicity and survival. Results: We included 40 patients, 30 males and 10 females with a sex ratio of 3. The mean age was 43.38 years +15.87. The mean time from symptom onset to diagnostic confirmation was 7.4 months. The total follow-up time of the cohort was 30.5 patient-years. B-cell lymphomas accounted for 57.5% of cases, T-cell lymphomas for 27.5% of cases. Twenty-five patients (67.6% of cases) were at an advanced stage at diagnosis. The initial prognosis was unfavourable in 29.7% of cases, all histological types combined. The overall survival at 30 months was 70%. Conclusion: Our patients were diagnosed with advanced disease stage. The overall survival at 30 months was short. Early diagnosis and better access to immunochemotherapy could improve these results.

The Correlation Between the Types of Initial Bacterial Infection and Clinical Prognosis in Patients With Septic AKI.

BackgroundAcute kidney injury (AKI) is a common complication of sepsis and is an independent risk factor for mortality. It is unclear whether different bacteria play different roles in the occurrence and development of sepsis-associated AKI (S-AKI). We observed the clinical characteristics and outcomes of patients that have types of bacterial infection, and different infections sites before the occurrence of AKI, respectively.MethodsData of patients who were diagnosed with sepsis and later developed AKI from 2008 to 2019 were retrieved from the MIMIC-IV 1.0 database. Patients were first divided into the two groups according to the bacterial culture results obtained prior to AKI occurrence: bacterial cultured positive (N = 1,785) and bacterial cultured negative (N = 8,777). Patients with bacteria culture positive were divided into culture bacteria Gram-positive (CGP, N = 1248) and Gram-negative (CGN, N = 537) groups.ResultsOverall, 1,785 patients were included in the present analysis. The patients in CGN group were older (70 vs. 66, p < 0.001), had lower body mass index (BMI) (27.0 vs. 28.4, p < 0.001), higher acute physiology III (APS III) score (63.0 vs. 58, p = 0.001), shorter time from positive microbial culture to diagnosis of AKI (2.94 vs. 3.16 days, p = 0.013) and longer intensive care unit (ICU) stay time (5.94 vs. 4.77 days, p < 0.001) compared with those in the CGP group (n = 1,248). In the culture gram-negative bacteria in patients with positive blood cultures (CGNb) group, the rate of vasopressors using (73.1 vs. 56.4%, P = 0.007), the Sequential Organ Failure Assessment (SOFA) score (10 vs. 9, p = 0.005), and the level of lactate (3.7 vs. 2.5, p = 0.001) were higher than those in the culture gram-positive bacteria in patients with positive blood cultures (CGPb) group. The time from positive microbial culture to the diagnosis of AKI was shorter (2.23 vs. 3 days, p = 0.001) in the CGNb group. However, there was no significant difference in the continuous renal replacement treatment (CRRT) application or short-term mortality rates between CGN and CGP groups.ConclusionThe Gram types of bacteria cultured prior to S-AKI occurrence was not related to AKI stage, CRRT application, and short-term mortality. Compared with the Gram-positive bacterial infections, Gram-negative bacterial infections take a shorter time to develop into AKI, and had a higher disease severity score.

Severe Forms of Acalculous Acute Pancreatitis in Young Female Patients. A Preliminary Study.

Acute pancreatitis (AP) is a severe disease that usually involves hospitalization and a customized therapy. To date, remarkable progress has been made in establishing the etiology, diagnosis and therapy of this condition. For example, it is well documented that the AP course consists of two distinct pathophysiological phases. The first phase lasts about 1-2 weeks, involving only local inflammatory changes and possibly a transient SIRS syndrome, which require conservative therapy. The second phase is represented either by disease remission in patients with mild forms of AP, or by the persistence of SIRS syndrome and the occurrence of local complications in patients with moderate forms. Local complications therefore often occur in the second phase, when therapy must be customized according to the complications of the pancreatic area, as well as to provide adequate systemic support. Methods/ Results: Severe forms are less common and generally associate MSOF, which can develop at any time in the evolution of AP. MSOF worsens preexisting SIRS syndrome and local complications, making treatment more difficult and significantly increasing morbidity and mortality. This study presents the evolution of a group of patients with acalculous AP, who did not present in the first phase any systemic determinant of SIRS syndrome. Consequently, our initial prognosis was favorable, but the evolution of some patients was unexpectedly severe. Conclusions: Such surprising cases in terms of the evolution may suggest that increased caution is required in all AP patients, even if preliminary data suggest a mild form of the disease. Additional studies are necessary in the near future on this topic, both to improve therapy and to establish a better prognostic score by using new diagnostic tools.