Early Poor Outcome Research Articles

Prognostic significance of predischarge echocardiography in acute decompensated heart failure

Abstract Introduction Current guidelines do not specify the timing of echocardiography during acute decompensation of heart failure (HF). In particular, the question of the usefulness of an echocardiographic imaging immediately before discharge from the hospital, i.e. after achieving hemodynamic stabilization, remains unresolved. Aim To compare the prognostic value of echocardiography performed on admission and discharge in patients hospitalized due to acute HF decompensation, and to identify which echocardiographic markers may predict a poor early outcome after discharge. Methods A complete echocardiogram, comprising assessment of myocardial deformation and myocardial work: global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) was performed twice- upon admission and upon discharge from the hospital in 130 patients (67±15 years of age, mean EF 35±15%) with decompensated HF (NYHA class III or IV). HFpEF was diagnosed in 26, HFmrEF in 19, and HFrEF in 85 enrollees. Participants were followed over 6 weeks after discharge for death and HF hospitalization (composite end-point). Results HF hospitalization or death occurred in 18 patients (13 and 5, respectively). Among echocardiographic parameters of left ventricular (LV), left atrial and right ventricular (RV) function, only E/e’ and GWW measured at pre-discharge were associated with the composite end-point, and the significance of these associations was retained when both predictors were included in the bivariable model. (Table). No associations with the study endpoint were found for any of the echo parameters measured at admission. Conclusions In patients with acute decompensated HF: 1) predischarge echocardiography after achieving hemodynamic stabilization can provide more short-term prognostic information than admission echocardiography during hemodynamic worsening; 2) in addition to LV filling pressure estimation (E/e’), measurement of LV myocardial work may improve the prediction of early mortality and HF readmission after hospital discharge. Table

A novel nomogram based on the patient's clinical data and CT signs to predict poor outcomes in AIS patients.

The 2019 American Heart Association/American Stroke Association (AHA/ASA) guidelines strongly advise using non-contrast CT (NCCT) of the head as a mandatory test for all patients with suspected acute ischemic stroke (AIS) due to CT's advantages of affordability and speed of imaging. Therefore, our objective was to combine patient clinical data with head CT signs to create a nomogram to predict poor outcomes in AIS patients. A retrospective analysis was conducted on 161 patients with acute ischemic stroke who underwent mechanical thrombectomy at the Guangzhou Hospital of Integrated Traditional and Western Medicine from January 2019 to June 2023. All patients were randomly assigned to either the training cohort (n = 113) or the validation cohort (n = 48) at a 7:3 ratio. According to the National Institute of Health Stroke Scale (NIHSS) score 7 days after mechanical thrombectomy, the patients were divided into the good outcome group (<15) and the poor outcome group (≥15). Predictive factors were selected through univariate analyses, LASSO regression analysis, and multivariate logistic regression analysis, followed by the construction of a nomogram predictive model. The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of the model, and bootstrapped ROC area under the curve (AUC) estimates were calculated to provide a more stable evaluation of the model's accuracy. The model's calibration performance was evaluated through the Hosmer-Lemeshow goodness-of-fit test and calibration plot, and the clinical effectiveness of the model was analyzed through decision curve analysis (DCA). Multivariate logistic regression analysis showed that hyperdense middle cerebral artery sign (HMCAS) (OR 9.113; 95% CI [1.945-42.708]; P = 0.005), the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) > 6 (OR 7.707; 95% CI [2.201-26.991]; P = 0.001), NIHSS score (OR 1.085; 95% CI [1.009-1.166]; P = 0.027), age (OR 1.077; 95% CI [1.020-1.138]; P = 0.008) and white blood cell count (WBC) (OR 1.200; 95% CI [1.008-1.428]; P = 0.040) were independent risk factors for early poor outcomes after mechanical thrombectomy. The nomogram model was constructed based on the above factors. The training set achieved an AUC of 0.894, while the validation set had an AUC of 0.848. The bootstrapped ROC AUC estimates were 0.905 (95% CI [0.842-0.960]) for the training set and 0.848 (95% CI [0.689-0.972]) for the validation set. Results from the Hosmer-Lemeshow goodness-of-fit test and calibration plot indicated consistent performance of the prediction model across both training and validation cohorts. Furthermore, the DCA curve demonstrated the model's favorable clinical practicality. This study introduces a novel practical nomogram based on HMCAS, ASPECTS > 6, NIHSS score, age, and WBC that can well predict the probability of poor outcomes after MT in patients with AIS.

Predicting early mortality and severe intraventricular hemorrhage in very-low birth weight preterm infants: a nationwide, multicenter study using machine learning

Our aim was to develop a machine learning-based predictor for early mortality and severe intraventricular hemorrhage (IVH) in very-low birth weight (VLBW) preterm infants in Taiwan. We collected retrospective data from VLBW infants, dividing them into two cohorts: one for model development and internal validation (Cohort 1, 2016–2021), and another for external validation (Cohort 2, 2022). Primary outcomes included early mortality, severe IVH, and early poor outcomes (a combination of both). Data preprocessing involved 23 variables, with the top four predictors identified as gestational age, birth body weight, 5-min Apgar score, and endotracheal tube ventilation. Six machine learning algorithms were employed. Among 7471 infants analyzed, the selected predictors consistently performed well across all outcomes. Logistic regression and neural network models showed the highest predictive performance (AUC 0.81–0.90 in both internal and external validation) and were well-calibrated, confirmed by calibration plots and the lowest two mean Brier scores (0.0685 and 0.0691). We developed a robust machine learning-based outcome predictor using only four accessible variables, offering valuable prognostic information for parents and aiding healthcare providers in decision-making.

Surgical repair of left ventricular free-wall rupture complicating acute myocardial infarction: a single-center 30 years of experience.

Left ventricular free-wall rupture (LVFWR) is a catastrophic complication of acute myocardial infarction (AMI). Historically, cardiac surgery is considered the treatment of choice. However, because of the rarity of this entity, little is known regarding the efficacy and safety of surgical treatment for post-infarction LVFWR. The aim of this study was to report a single-center experience in this field over a period of 30 years. Patients who developed LVFWR following AMI and underwent surgical repair at our Institution from January 1990 to December 2019 were considered. The primary end-point was in-hospital morality rate; secondary outcomes were long-term survival and postoperative complications. Multivariate analysis was carried out by constructing a logistic regression model to identify risk factors for early mortality. A total of 35 patients were enrolled in this study. The mean age was 68.9 years; 65.7% were male. The oozing type of LVFWR was encountered in 29 individuals, and the blowout type in 6 subjects. Sutured repair was used in 77.1% of patients, and sutureless repair in the remaining cases. The in-hospital mortality rate was 28.6%. Low cardiac output syndrome was the main cause of postoperative death. Multivariable analysis identified age >75 years at operation, preoperative cardiac arrest, concurrent ventricular septal rupture (VSR) as independent predictors of in-hospital death. Follow-up was complete in 100% of patients who survived surgery (mean follow-up: 9.3 ± 7.8 years); among the survivors, 16 patients died during the follow-up with a 3-year and 12-year overall survival rate of 82.5% and 55.2%, respectively. Surgical treatment of LVFWR following AMI is possible with acceptable in-hospital mortality and excellent long-term results. Advanced age, concurrent VSR and cardiac arrest at presentation are independent risk factors of poor early outcome.

Predictors of Early Hospice or Death in Patients With Inoperable Lung Cancer Treated With Curative Intent

IntroductionTreatment for inoperable stage II to III non-small cell lung cancer (NSCLC) involves chemo-radiotherapy (CRT). However, some patients transition to hospice or die early during their treatment course. We present a model to prognosticate early poor outcomes in NSCLC patients treated with curative-intent CRT. Methods and MaterialsAcross a statewide consortium, data was prospectively collected on stage II to III NSCLC patients who received CRT between 2012 and 2019. Early poor outcomes included hospice enrollment or death within 3 months of completing CRT. Logistic regression models were used to assess predictors in prognostic models. LASSO regression with multiple imputation were used to build a final multivariate model, accounting for missing covariates. ResultsOf the 2267 included patients, 128 experienced early poor outcomes. Mean age was 71 years and 59% received concurrent chemotherapy. The best predictive model, created parsimoniously from statistically significant univariate predictors, included age, ECOG, planning target volume (PTV), mean heart dose, pretreatment lack of energy, and cough. The estimated area under the ROC curve for this multivariable model was 0.71, with a negative predictive value of 95%, specificity of 97%, positive predictive value of 23%, and sensitivity of 16% at a predicted risk threshold of 20%. ConclusionsThis multivariate model identified a combination of clinical variables and patient reported factors that may identify individuals with inoperable NSCLC undergoing curative intent chemo-radiotherapy who are at higher risk for early poor outcomes.

Comparative analysis of models predicting the risks of early poor outcome of deceased-donor liver transplantation: a retrospective single-center study

Rationale. The risk of early graft loss determines the specifics and plan of anesthesiological assistance, intensive therapy, and overall the feasibility of liver transplantation. Various prognostic models and criteria have become widespread abroad; however, Russian transplant centers have not yet validated them.Objective. To evaluate the applicability and accuracy of the most common models predicting the risks of early adverse outcomes in liver transplantation from deceased donors.Material and methods. A retrospective single-center study included data on 131 liver transplantations from deceased donors performed between May 2012 and January 2023. For each observation, DRI, SOFT, D-MELD, BAR, MEAF, L-GrAFT, and EASE indices were calculated, and compliance with an early allograft dysfunction criteria was verified. Depending on the possibility of calculating the indicators and their values relative to known cutoff points, the study groups were formed, and 1-, 3-, 6-, and 12-month graft survival rates were calculated. The forecast was compared with the actual outcomes, and sensitivity, specificity, F1-score, and C-index were calculated.Results. When assessing the risk of 1- and 3-month graft loss, models using only preoperative parameters demonstrated relatively low prognostic significance: DRI (F1-score: 0.16; C-index: 0.54), SOFT (F1-score: 0.42; C-index: 0.64), D-MELD (F1-score: 0.30; C-index: 0.58), and BAR (F1-score: 0.23; C-index: 0.57). Postoperative indices of MEAF (F1- score: 0.44; C-index: 0.74) and L-GrAFT (F1-score: 0.32; C-index: 0.65) were applicable in 96%, those of ABC (F1-score: 0.29; C-index: 0.71) in 91%, and EASE (F1-score: 0.26; C-index: 0.80) in 89% of cases. The relative risk of 30-days graft loss in case of EAD was 5.2 (95% CI: 3.4-8.1; p&lt;0.0001), F1-score: 0.64, and C-index: 0.84. Using locally established cutoff values for SOFT (11 points) and L-GrAFT (-0.87) scores increased their prognostic significance: F1-score: 0.46 and 0.63, C-index: 0.69 and 0.87, respectively.Conclusion. The analyzed models can be used to assess the risks of early liver graft loss; however, their prognostic significance is not high. Developing a new model in a multicenter Russian study, as well as searching for new objective methods to assess the state of the donor liver are promising directions for future work.

Functional Outcomes of Brolucizumab-Induced Intraocular Inflammation Involving the Posterior Segment-A Meta-Analysis and Systematic Review.

Early poor outcomes of intraocular inflammation (IOI) after intravitreal brolucizumab (IVB) have negatively affected the use of brolucizumab in clinical routine. We wished to identify factors related to the treatment details of IOI involving the posterior segment resulting from IVB for neovascular AMD (nAMD), if these were reported in detail. Articles were retrieved from PubMed, Scopus, ClinicalTrials, and CENTRAL using the following search terms: <Brolucizumab> AND <AMD> AND <intraocular inflammation>. The risk of bias was rated using the JBI Critical Appraisal Tool. We included 31 reports (41 patients and 46 eyes). Patients were 75.9 ± 8.5 years, and 58.5% were female. IOI occurred 41.7 ± 37.5 (median 37.0) days after treatment initiation with 2.0 ± 1.3 (1-6) IVB injections. A mean change in visual acuity of -14.6 ± 21.0 (median -6.5) letters was reported. The mean time from first IOI signs to the initiation of any anti-inflammatory treatment was 3.3 ± 6.2 days, with 63% of the patients receiving systemic corticosteroids as standard treatment. Finally, a period effect was observed, with a change in visual acuity of -25.3 ± 27.1 and -2.6 ± 7.3 letters in the chronologically first and last third, respectively, of treated eyes (effect size: r = 0.71; p = 0.006). Functional outcomes markedly improved with increasing experience in managing IOI.

Quality indicators and patients' characteristics in relation to early outcome of Kasr-al-ainy stroke unit

BackgroundA wide variety of factors have been reported to influence stroke prognosis. Quality indicators serve as standards of care. The aim of this study is to assess the clinical and demographic characteristics of patients with stroke and to measure quality indicators in relation to stroke early outcome. We analyzed a prospective hospital-based data. All patients with acute stroke admitted to Kasr-al-ainy stroke unit over a 1-year period were included. Clinical variables and quality indicators were studied in relation to early outcome which was measured by both disability at discharge assessed by modified Rankin score (mRS) and in-hospital death.ResultsWe studied 242 patients with acute stroke, 145 patients (59.9%) had poor outcome at discharge [mRS 3–6]. There were 36 (14.9%) in-hospital deaths. High mRS and National institute of health stroke scale (NIHSS) at stroke onset, low Gugging swallowing scale (GUSS) score and hypertension (HTN) were independent predictors for more disability on discharge. Chest infection, bed sores, high mRS at stroke onset and hemorrhagic transformation were independent predictors for in-hospital mortality. Receiving recombinant tissue plasminogen activator (rtPA) showed significant association with good outcome. Mean door to needle time (DNT) was 50.6 min. Low GUSS score was associated with increased risk of chest infection.ConclusionsStroke severity, potentially modifiable risk factors and complications are associated with an increased risk of poor early outcome. Dysphagia screening using GUSS scale can predict patients with higher risk of aspiration pneumonia after stroke. DNT needs to be improved.

Stroke-associated infection in patients with co-morbid diabetes mellitus is associated with in-hospital mortality.

The association between infection and acute ischemic stroke (AIS) with diabetes mellitus (DM) remains unknown. Therefore, this study aimed to explore the effect of infection on AIS with DM. The data of patients with AIS and DM were extracted from the Chinese Stroke Center Alliance (CSCA) database from August 2015 to July 2019. The association between infections [pneumonia or urinary tract infection (UTI)] and in-hospital mortality was analyzed. Logistic regression models were used to identify the risk factors for in-hospital mortality of patients with infection. In total, 1,77,923 AIS patients with DM were included in the study. The infection rate during hospitalization was 10.5%, and the mortality rate of infected patients was 3.4%. Stroke-associated infection was an independent risk factor for an early poor functional outcome [odds ratio (OR) = 2.26, 95% confidence interval (CI): 1.97-2.34, P < 0.0001] and in-hospital mortality in AIS patients with DM. The in-hospital mortality after infection was associated with age (OR = 1.02, 95% CI: 1.01-1.03, P < 0.0001), male (OR = 1.39, 95% CI: 1.13-1.71, P = 0.0018), reperfusion therapy (OR = 2.00, 95% CI: 1.56-2.56, P < 0.0001), and fasting plasma glucose at admission (OR = 1.05, 95% CI: 1.03-1.08, P < 0.0001). In contrast, antiplatelet drug therapy (OR = 0.63, 95% CI: 0.50-0.78, P < 0.0001) and hospital stay (OR = 0.96, 95% CI: 0.94-0.97, P < 0.0001) were independent protecting factors against in-hospital mortality of patients with infection. Infection is an independent risk factor of in-hospital mortality for patients with AIS and DM, and those patients require strengthening nursing management to prevent infection.

Clinical Presentation of Myocarditis in the Pediatric Age Group and Predictors of Poor Early and Late Outcomes: Academic Hospital Experience.

Myocarditis is a leading cause of morbidity and mortality in the pediatric age group and contributes to a wide range of complications, including dilated cardiomyopathy, congestive heart failure, and even death, so early identification and comprehensive management are essential for a favorable outcome. Summarize the presenting clinical signs and symptoms of pediatric patients with a diagnosis of myocarditis and a poor outcome and correlate the clinical presentation and laboratory and radiographic findings to identify possible predictors of a poor outcome. This retrospective cohort study included all patients who were diagnosed with myocarditis and followed up at King Abdulaziz University Hospital, Jeddah, Saudi Arabia over the 13 years between January 01, 2007, and December 31, 2019. Information on patient demographics, clinical presentation, and non-invasive investigations was obtained. Poor outcomes were defined as death or evidence of left ventricular dysfunction on echocardiography which was evaluated at two points in time as an early outcome and a late outcome. Seventeen patients (male 52.9%, female 47.1%) with a median age of 4 ± 4.31 years are included. The most frequent initial complaints were exercise or feeding intolerance, respiratory symptoms, and shortness of breath. On the other hand, hepatomegaly and respiratory distress were the most common clinical signs. All the patients were admitted to the pediatric intensive care unit but only 41% required mechanical ventilation. The presence of a murmur at presentation was significantly correlated with a poor early outcome. Ischemic changes on the electrocardiogram and moderate left ventricular dysfunction on the echocardiogram were significantly correlated with a poor late outcome. Diagnosis of myocarditis can be established by a combination of clinical presentation and investigative tools. A murmur, ischemic changes on the electrocardiogram, and left ventricular dysfunction are important predictors of myocarditis in children.

Blood pressure variability related to early outcome of acute ischemia stroke in a prospective observational study.

Hypertension is a well-known risk factor for stroke, but the relationship between blood pressure variation (BPV) and prognosis remains unclear. This prospective observational study assessed the association between BPV and early functional outcomes in acute ischemic stroke patients. A total of 871 patients with acute ischemic stroke within 24 h of symptom onset were recruited from the Third Affiliated Hospital of Qiqihar Medical University between 2013 and 2016. Within 6 days of hospitalization, blood pressure was continuously measured from 8:00 to 9:00 every day, and the coefficient of variation (CV) of blood pressure was calculated (including systolic blood pressure [SBP] and diastolic blood pressure [DBP]). The modified Rankin scale was used to evaluate early functional outcomes at discharge. The coefficients of variation of SBP, DBP, and functional outcomes were included as primary outcome variables. Demographic characteristics and medical history were recorded as secondary outcome variables. We found that a greater CV level of SBP and DBP were associated with the poor early functional outcome at hospital discharge, and the odds ratio (OR) and 95% confidence interval (95%CI) of them were 1.56 (1.04–2.35) and 1.99 (1.31–3.03) respectively. A higher standard deviation (SD) of SBP and DBP significantly increased risk of poor early prognosis, OR (95%CI) was 1.78 (1.17–2.71) and 2.25 (1.47–3.45) respectively. Similar results were observed for SBP and DBP. The larger the range of SBP and DBP, the worse is the prognosis. In conclusion, the present study suggests that high BPV is a risk factor for poor early prognosis in acute ischemic stroke.

Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study

ObjectivePatients who are over 65 years old represent up to 24% of emergency department (ED) admissions. They are at increased risk of under-triage due to impaired physiological responses. The primary objective of this study was to assess the prevalence of elevated lactate by point of care testing (POCT) in this population. The secondary objective was to assess the additional value of lactate level in predicting an early poor outcome, as compared to and combined with common clinical scores and triage scales.MethodsThis monocentric prospective study recruited ED patients who were over 65 years old between July 19th 2019 and June 17th 2020. Patients consulting for seizures or needing immediate assessment were excluded. POCT lactates were considered elevated if ≥ 2.5 mmol/L. A poor outcome was defined based on certain complications or therapeutic decisions.ResultsIn total, 602 patients were included; 163 (27.1%) had elevated lactate and 44 (7.3%) had a poor outcome. There was no association between poor outcome and lactate level. Modified Early Warning Score (MEWS) was significantly associated with poor outcome, alongside National Early Warning Score (NEWS). Logistic regression also associated lactate level combined with MEWS and poor outcome.ConclusionThe prevalence of elevated lactate was 27.1%. Lactate level alone or combined with different triage scales or clinical scores such as MEWS, NEWS and qSOFA was not associated with prediction of a poor outcome. MEWS alone performed best in predicting poor outcome. The usefulness of POCT lactate measurement at triage is questionable in the population of 65 and above.

Оpen globe injury in children: epidemiology and predictors of an adverse outcome

Here we aimed to analyse the prevalence, clinical course, and current approaches to the prevention and treatment of open globe injury in children as well as its complications: hyphema, retinal detachment, traumatic uveitis, and endophthalmitis. Currently, children are responsible for the 10-15% of open globe injuries. In developed countries, open globe injury is the leading cause of monocular blindness in children. Open globe injury mainly affects boys (60−70% cases), yet severe injuries are rare, and closed globe injury is the most common type of eye injury. Most injuries are accidental and occur at home in daily life (50−60%), outdoors (20−35%), at school (1−5%), or while playing sports (1−3%). Open globe injury most often affects cornea and is associated with a high risk of early and late complications and poor outcomes. Wearing of protective glasses during sports and active recreation is recognised as an efficient tool for primary prevention of open globe injury in children. The main problems in prevention of complications of open globe injury are the lack of specialised care in low-income countries and the limited awareness of parents.

The performance of qSOFA as a prognostic tool for early prediction of high-risk infective endocarditis

According to the VIRSTA study, about sixty percent of infectious endocarditis (IE) are complicated by sepsis. The qSOFA score is used to identify patients with a high-risk of adverse outcome following their infection. Thus, our study aims to evaluate the predictive performance of qSOFA as a prognostic tool to identify those with IE at high-risk for early poor outcome. This is a 4-years monocentric retrospective cohort study, included patients admitted for IE between 2014 and 2018 according DUKE criteria, with initiation of anti-bacterial therapy. The qSOFA score was calculated for each patient and a score of ≥ 2 points was used as the prognostic cutoff value in predicting clinical deterioration and death within 30 days. Overall, on a total of 115 patients, demographics showed the mean age of 46 years, sex ratio 1.5. Twenty-five percent had qSOFA ≥ 2 and were considered the high qSOFA group. A higher proportion of low qSOFA patients (10% vs. 2%, P = 0.023) had no preexisting comorbid condition. The high qSOFA group was more likely to be infected with Staphylococcus aureus . The high qSOFA group had higher rate of persistently clinical and biologic infectious syndrome despite receipt of ≥ 4 days of effective therapy (34% vs. 20%, P = 0.0039), higher rate of 30-day mortality (19% vs. 3%, P < 0.0001), and a longer length of hospitalization compared to the low qSOFA group ( P = 0.001). Our findings are consistent with those from prior studies involving other infectious syndrome. The qSOFA score could be used as prognostic factor in IE and patients identified with high score should receive aggressive management in particular in S. aureus etiology.

The association between preoperative plasma D-dimer levels and early postoperative outcomes in patients with esophageal cancer

Background: The present study aimed to evaluate the efficacy of plasma D-dimer levels in predicting early morbidity and mortality in patients with esophageal cancer. Methods: for this purpose, 60 patients who did surgery for middle- (n=35) and lower-thoracic esophageal cancer (n=25) were recruited. Then, preoperative plasma D-dimer levels were measured in a quantitative and qualitative manner and their relation with postoperative outcomes in each type of cancer was assessed for six months. Results: With regard to the middle-thoracic esophageal cancer, complications were observed in 14 cases and deaths were reported in six individuals. Considering the lower type, morbidity was found in 11 cases and mortality was seen in five patients. In both types of cancer, plasma D-dimer levels were significantly higher in patients with complications or deaths compared with those who were not. Sensitivity, specificity, as well as positive and negative predictive value (P/NPV) of plasma D-dimer levels were 90.91%, 78.57%, 76.92%, and 91.67% for diagnosing morbidity of the lower-thoracic esophageal cancer and 80%, 85%, 57.14, 94.44% for predicting mortality in this type of cancer. Moreover, the given values were equal to 71.43%, 76.19%, 66.67%, and 80% for diagnosing complications of the middle-thoracic esophageal cancer and 83.3%, 72.41%, 38.46%, 95.45% in predicting deaths induced by this type of cancer. Conclusion: It was concluded that elevated plasma D-dimer levels could be accompanied by adverse events and early poor postoperative outcomes for esophageal cancer.

Choice of Antenatal Steroids for Prevention of Complications of Prematurity: Betamethasone Versus Dexamethasone

Antenatal steroids (ANS) are proven strategies to maximize outcomes of premature neonates without any major maternal side effects. Their use results in decreased incidence of neonatal mortality and major morbidities (respiratory distress syndrome, early onset sepsis, necrotizing enterocolitis, and intraventricular hemorrhage). However, due to concerns of long-term adverse effect (early onset hypertension and poor neurological outcome), a close follow-up is required. Similarly, due to lack of long-term follow-up data and potential risk of hypoglycemia, a cautious use is recommended in late preterms and elective cesareans. There is currently no consensus regarding preferential use of one ANS over the other. The current review therefore tried to address these issues for use of ANS in Indian prospective in light of recent emerging evidence. Due to better safety profile, lesser side effects, lower cost, and easy storage, we recommend dexamethasone as a steroid of choice for antenatal prophylaxis.

Atypical genomic cortical patterning in autism with poor early language outcome.

Cortical regionalization develops via genomic patterning along anterior-posterior (A-P) and dorsal-ventral (D-V) gradients. Here, we find that normative A-P and D-V genomic patterning of cortical surface area (SA) and thickness (CT), present in typically developing and autistic toddlers with good early language outcome, is absent in autistic toddlers with poor early language outcome. Autistic toddlers with poor early language outcome are instead specifically characterized by a secondary and independent genomic patterning effect on CT. Genes involved in these effects can be traced back to midgestational A-P and D-V gene expression gradients and different prenatal cell types (e.g., progenitor cells and excitatory neurons), are functionally important for vocal learning and human-specific evolution, and are prominent in prenatal coexpression networks enriched for high-penetrance autism risk genes. Autism with poor early language outcome may be explained by atypical genomic cortical patterning starting in prenatal development, which may detrimentally affect later regional functional specialization and circuit formation.

Poster: MPN-244: Comorbid Conditions Occur Frequently and Correlate with Early Disease Progression and Poor Outcomes in Young Patients with Myelofibrosis

Poster: MPN-244: Comorbid Conditions Occur Frequently and Correlate with Early Disease Progression and Poor Outcomes in Young Patients with Myelofibrosis

Visual outcome of endogenous endophthalmitis in Thailand

To evaluate a 10-year visual outcome of endogenous endophthalmitis (EE) patients. A 10-year retrospective chart review of EE patients. Thirty-eight patients (40 eyes) were diagnosed with EE at the mean age of 42. Among the identifiable pathogens (71.1% culture positive), the causative agents were predominantly gram-negative bacteria (48.1%). The most common specie was Klebsiella pneumoniae (25.9%). About a quarter of the patients required surgical eye removal, and the remaining 45.7% had visual acuity (VA) worse than hand motion at one month after the infectious episode. The most common complication was ocular hypertension (52.5%). Poor initial VA was significantly associated with a worse visual outcome in the early post-treatment period (p 0.12, adjusted OR 10.20, 95% CI 1.65–62.96). Five patients continued to visit the clinic for at least ten years. One patient had gained his vision from hand motion to 6/7.5. Two patients had visual deterioration, one from corneal decompensation, and the other from chronic retinal re-detachment. Two patients developed phthisis bulbi, with either some VA perception of light or no light perception. Poor initial VA is the only prognostic factor of a poor early post-treatment visual outcome of EE.

Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study.

Introduction: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcomes. Methods: Fifty consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and non-invasive monitoring of ICC. Subjects were included upon ICU admission; CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI), and estimated cerebral perfusion pressure (eCPP), while ICC was assessed by using the P2/P1 ratio of the non-invasive ICP curve. A CVH/ICC score was computed using all these variables. The primary composite outcome was unsuccessful in weaning from respiratory support or death on day 7 (defined as UO). Results: At the first assessment (n = 50), only the P2/P1 ratio (median 1.20 [IQRs 1.00–1.28] vs. 1.00 [0.88–1.16]; p = 0.03) and eICP (14 [11–25] vs. 11 [7–15] mmHg; p = 0.01) were significantly higher among patients with an unfavorable outcome (UO) than others. Patients with UO had a significantly higher CVH/ICC score (9 [8–12] vs. 6 [5–7]; p < 0.001) than those with a favorable outcome; the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75–0.97); a score > 8.5 had 63 (46–77)% sensitivity and 87 (62–97)% specificity to predict UO. For those patients undergoing a second assessment (n = 29), after a median of 11 (5–31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (n = 30) and survivors were observed. Conclusions: ICC impairment and CVH disturbances are often present in COVID-19 severe illness and could accurately predict an early poor outcome.