Criteria For Poor Prognosis Research Articles

Resuscitation outcomes in patients with cancer: experience in a large urban cancer centre.

Hospitalized patients with cancer who experience cardiopulmonary arrest have historically low survival rates. This retrospective cohort study describes outcomes of patients at a large Canadian cancer centre who had a "code medical emergency" activated, and the use of pragmatic criteria to identify patients with poor survival following resuscitation. We included hospitalized patients with cancer who had a "code blue" activated between January 2007 and December 2018. Our primary outcome was intensive care unit (ICU) mortality. We developed pragmatic criteria to identify patients with "poor prognosis" for survival from cardiopulmonary resuscitation (CPR) based on disease status and candidacy for further cancer treatment. We used descriptive statistics to analyze the outcomes of poor prognosis patients. Two hundred and twenty-five patients had a code blue activated. The median age was 61 yr, 52% were male, and 48% had a solid tumour. Overall, 173/225 (77%) patients survived the code blue; 164 were admitted to the ICU, where 49% (81/164) died; 31% survived to hospital discharge; and 16% (n=27) were alive at one year. One hundred and twenty out of 225 (53%) required chest compressions; spontaneous circulation returned in 61% (73/120), and 12% (14/120) survived to hospital discharge. Patients meeting "poor prognosis" criteria (114, 51%) were more likely to die in the ICU (64% vs 35%; P<0.001) or in hospital (86% vs 59%; P<0.001), and more often had goals-of-care discussions prior to the code blue (46% vs 7%; P<0.001). At one year, only 2% of poor prognosis patients were alive, compared with 24% of patients who did not meet any poor prognosis criteria. Hospitalized patients with cancer requiring CPR have poor hospital and long-term outcomes. The proposed set of pragmatic criteria may be useful to identify patients unlikely to benefit from CPR and life support, to trigger early goals of care discussions, and to avoid potentially goal-discordant interventions.

Selection Liver Transplantation and Bridge Therapeutic Modalities in Acute Liver Failure

Introduction: Acute liver failure (ALF) is a condition that can rapidly progress to multiorgan failure. Therefore, different extracorporeal liver support systems have been developed to function as a bridge to transplantation or spontaneous survival. Conversely, the shortage of organs demands a rigorous selection process to determine whom should receive transplantation and several prognostic models have been proposed to identify the patients who would benefit the most from liver transplantation (LT). Objectives: A review of the main selection criteria used for LT in ALF is carried out, focusing mostly on the new proposed prognostic markers, and aiming to identify poor prognosis criteria associated with futility in LT. Extracorporeal liver support systems (ECLS) were also reviewed, including an analysis of their impact on the survival of patients with ALF. Methods: MEDLINE and PubMed databases were searched between 16th October 2021 and 5th December 2021. The inclusion criteria were: adult patients; patients with acute liver injury (ALI) or ALF; observational studies; clinical studies; case series; case-control studies; systematic reviews; meta-analysis. Discussion: King’s College criteria (KCC) have been widely used and despite good specificity, have low sensitivity. Several markers have been used to improve prognostic accuracy, but the results are not sufficiently clear. Patient age, ABO incompatibility, and poor-quality grafting were potential factors that could indicate potential futility in LT. ECLS have a positive influence in clinical and laboratory parameters; however, there is no clear evidence of improvement in survival. Conclusion: ALF is a heterogeneous syndrome, which brings into question of the studies carried out to evaluate prognostic criteria to select patients for LT. It also narrows down the studies performed to evaluate the impact of ECLS on survival.

Endometrial cancer of the very elderly: Management and survival in the Francogyn population

IntroductionWe aimed to describe management and survival of patients with endometrial cancer (EC) ≥80 years to identify poor prognosis criteria. MethodsWe collected clinical, histologic, surgical and follow-up data for patients with EC ≥ 80 years included in a multicenter French cohort (FRANCOGYN) who underwent primary surgical treatment from 1999 to 2019. The outcomes were overall survival (OS) and disease-free survival (DFS). We performed a descriptive analysis then a survival time analysis and comparison using the Kaplan Meier method and log-rank test. ResultsOf the 1647 patients with EC who received treatment during the study period, 184 (11.17%) were ≥80 years. The mean age was 84 years (±3.34). Thirty-three patients (25.4%) died during the follow-up period and 26 relapsed (18.4%). Forty-nine patients were lost to follow-up (27.37%). The median follow-up time was 15.3 months (4.9–28.8). The median OS and DFS was 16.4 months (6.3–24.9) and 13.6 months (4.5–26.6), respectively. Eighty-three patients received adjuvant therapy (45.11%), out of 95 who had a formal or relative indication. Four patients received adjuvant chemotherapy (2.6%), out of 61 who had a formal or relative indication. Inappropriate or underuse of chemotherapy was significantly associated with a lower median OS of 12.6 months [3.73–24] versus 17.3 months [7.93–41.77] when performed appropriately (HR = 4.14, CI 95% [1.62–10.56]), and a lower median DFS of 10.83 months [3.73–24] versus 17.3 months [7.93–28.5] (HR = 9.04, CI 95% [2.04–40.12]). ConclusionOur results suggest that very elderly patients with EC should receive adjuvant chemotherapy according to the standard care guidelines.

76 A Report on 83 Patients with Suspected Methanol Poisoning from Philippine Coconut Wine (Lambanog) Seen at East Avenue Medical Center: A Case Series

Lambanog or Philippine Coconut wine is locally made distilled alcohol made from coconut sap and is well known for its strong alcohol content (40-45%). Severe methanol intoxication from Lambanog wine is rare but frequently lethal. Poor prognosis criteria include coma and seizure and severe metabolic acidosis. We present epidemiological and clinical data from a recent toxicologic mass casual incident involving suspected methanol poisoning. The management of methanol poisoning includes standard supportive care, correction of metabolic acidosis, administration of folinic acid, provision of an antidote to inhibit the metabolism of methanol to formate, and selective hemodialysis to correct severe metabolic abnormalities and enhance methanol and formate elimination.

Paclitaxel, ifosfamide, cisplatin (TIP) for the treatment of intermediateand poor-risk nonseminomatous germ cell tumors with an inadequate decrease in tumor markers: a phase II study

Purpose: To evaluate efficacy of TIP (paclitaxel, ifosfamid, cisplatin) in the 1st line treatment of germ cell tumors patients with unfavorable decline of serum tumor markers after 1 cycle of the standard regimen of chemotherapy. Patients and methods: In this phase II multicenter, nonrandomized trial, patients were enrolled from 4 centers of the Russian Federation. Patients were included if they were older than 18 years, had evidence of testicular, retroperitoneal, or mediastinal nonseminoma based on histologic findings or clinical evidence (high serum human chorionic gonadotropin or alpha-fetoprotein levels) that matched International Germ Cell Cancer Consensus Group (IGCCCG) intermediate and poor prognosis criteria. All patients got one cycle of BEP regimen (bleomycin 30 mg on days 1, 3, 5, etoposide 100 mg / m 2 on days 1–5, cisplatin 20 mg / m 2 on days 1–5). Patients with unfavorable serum tumor markers decline after the first cycle of chemotherapy at day 18–21 received four cycles of TIP regimen (paclitaxel 120 mg / m 2 on days 1–2, ifosfamide 1500 mg / m 2 on days 2–5, and cisplatin 25 mg / m 2 om days 2–5, granulocyte-colony stimulating factor 5 mg / kg on days 6–15). In the presence of a residual tumor larger than 1 cm and the technical possibility of its removal, surgical treatment was performed. The primary endpoint was 1-year progression-free survival. Results: Between 2017 and 2021, 28 patients were included in our study: seven patients with an intermediate prognosis according to IGCCCG classification and twenty-one with poor risk. Median follow-up was 15,5 months (range, 4,4–38,3 months). The 1-year progression-free survival and overall survival in intention-to-treat population were 76,6 % and 81,0 %, respectively. One-year progression-free survival and overall survival according IGCCCG classification were 100 % and 100 % for an intermediate risk patients and 68 % and 73,8 % for a poor risk, respectively. The favorable response rate (complete response + partial response with normalization STM) was observed in 19 (68 %) patients. During the follow-up period, disease progression was noted in 9 (32 %) patients, 7 (25 %) patients died, including one from an aggressive growing mature teratoma syndrome. Eleven (39 %) patients underwent surgical treatment: retroperitoneal lymph node dissection (55 %), mediastinal lymph node dissection (36 %), pulmonary resection (9 %). Pathological complete response was achieved in 6 (55 %) patients, mature teratoma — 2 (18 %), viable tumour — 3 (27 %). TIP showed acceptable safety profile and only in one case tumor lysis syndrome was observed. Conclusions: The TIP regimen may improve the results of treatment in the first line with unfavorable decrease of serum tumor markers after the first cycle of chemotherapy, which requires further study in a randomized trial.

Transient Myeloproliferative Syndrome associated with Down syndrome and Fetal Hydrops: Case Report

BACKGROUND: Transient myeloproliferative Syndrome can be defined as an abnormal proliferation of immature leukemic cells. It presents in newborns with Down syndrome or trisomy 21 mosaicism, as an uncontrolled proliferation of blasts in the megakaryocytic lineage; it resolves spontaneously during the first three months of life. One of the characteristic manifestations is Non-Immune Fetal Hydrops. CASE REPORT: Premature newborn patient adequate for gestational age, born by C-Section due to ultrasound diagnosis of NIHF. At birth, we evidenced phenotypic characteristics of Down syndrome; in addition, the clinical picture and physical examination (respiratory distress, bradycardia, hypotension, prolonged capillary refill, hypotonia, and thrombocytopenia) supported the diagnostic suspicion of neonatal sepsis. The initial management of the patient in the intensive care unit included: mechanical ventilation, vasopressor support, surfactant administration, intravenous antibiotic therapy, furosemide, fentanyl and midazolam, albumin, and vitamin k. EVOLUTION: During his hospital stay, the patient developed acute kidney injury. In addition, we detected leukocytosis and presence of immature cells, anemia and thrombocytopenia, with diagnostic suspicion of congenital leukemia versus MTS, confirmed by flow cytometry. Subsequently, the patient presented elevated bilirubin, with jaundice and subsequent multifactorial cholestasis. The patient was hospitalized for 48 days and after the resolution of the mentioned pathologies, he was discharged. At the follow up, 15 days after discharge, normalization of leucocyte, red blood cell and platelet values confirmed the TMS diagnosis. CONCLUSION: In this case report, the patient developed MTS in relation to Down syndrome and had a complicated clinical course due to all the complications derived from his prematurity, his congenital disease, and the presence of hydrops fetalis and other manifestations of MTS. In the present case, there were criteria of severity, poor prognosis and high risk of mortality, which advantageously do not affect his current clinical condition, but require continuous and strict clinical surveillance. Multidisciplinary management, a high index of suspicion, timely attention to the multiple manifestations and complications, and proper follow-up allowed for a favorable evolution and greater survival in this patient.

Harmless Acute Pancreatitis Score

Introduction: Acute Pancreatitis is a common disease in our region. It can range from mild to severe disease with high mortality rate. It is critical to identify patients who are at high risk for a severe disease course, since they require close monitoring and immediate aggressive treatment.&#x0D; Aims: To compare the effectiveness of Harmless Acute Pancreatitis Score with Ranson’s scoring system in predicting the severity of Acute Pancreatitis.&#x0D; Methods: A prospective cross sectional study was done among 45 patients who were admitted in surgery department over a period of one year with diagnosis of acute pancreatitis. If haematocrit was less than39% in female and less than43% in male, serum creatinine less than two miligram /deciliter and no sign of peritonitis, it was assigned as Harmless Acute Pancreatitis Score Zero. If at least one parameter was abnormal it was assigned as Harmless Acute Pancreatitis Score +. Severe pancreatitis (poor prognosis) was considered in those who required Intensive Care Unit care, who had in hospital mortality and who had hospitalization of more than five days. Patients with on admission Ranson’s score of more than three were suspected to have severe Pancreatitis.&#x0D; Results: There were total 45 patients, 18 females and 27 males. Twenty four patients were assigned as Harmless Acute Pancreatitis Score zero and 21 patients were assigned as Harmless Acute Pancreatitis Score +. Harmless Acute Pancreatitis Score was able to predict correctly in 18 out of 26 patients who fulfilled the criteria of poor prognosis (p&lt;0.001).&#x0D; Conclusion: Harmless Acute Pancreatitis Score proved to be a better screening tool compared to on admission Ranson’s scoring system to predict the severity of Acute Pancreatitis, which may help predict the prognosis of the patient.

Selection Criteria for Heart Transplantation in Patients with End-Stage Heart Failure

Today, heart transplantation remains the gold standard of treatment for patients with end-stage heart failure (HF). As the number of donors is limited and the risk of intervention is quite high, the key to achieving optimal outcomes and reducing the incidence of complications is the proper selection of patients who meet clearly defined criteria for inclusion in the waiting list for heart transplantation. This review presents the latest knowledge on indications and contraindications for inclusion recipients in the waiting list for heart transplantation, including the latest clinical guidelines of The International Society for Heart and Lung Transplantation (ISHLT) published in 2016.&#x0D; Thus, the absolute indications are dependence on intravenous inotropic and mechanical circulatory support; inoperable heart diseases or a history of volume reducing operations; refractory angina or life-threatening refractory arrhythmias despite maximal drug therapy and/or surgical correction; reduction of maximum oxygen consumption up to &lt;12-14 ml/kg/min when performing the maximum cardiopulmonary exercise test. While including patients in the waiting list for heart transplantation, it should be noted that the low left ventricular ejection fraction &lt;30%, a history of documented NYHA class III-IV HF, low maximum oxygen consumption as the only criterion of terminal HF and poor prognosis for annual survival in HF calculated on prognostic scales are not sufficient indications. Absolute contraindications include a systemic disease with a life expectancy of less than 2 years and irreversible pulmonary hypertension.&#x0D; The current procedure for the distribution of recipients by urgency status for heart transplantation is presented according to the updated recommendations of the United Network for Organ Sharing (UNOS) published in 2018 which consists of 6 degrees, compared with the 1999 edition which contained 3 degrees.

Early use of tocilizumab in patients with severe pneumonia secondary to severe acute respiratory syndrome coronavirus 2 infection and poor prognostic criteria: Impact on mortality rate and intensive care unit admission.

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, keeps spreading globally. Evidence suggests that a subgroup of patients with severe symptomatology might have cytokine storms, which increases mortality. The use of interleukin-6 (IL-6) inhibitors may help in controlling the pathological immune response to the virus. Tocilizumab, a monoclonal antibody against IL-6, stands as an optional treatment for COVID-19 patients presenting this inflammatory hyper-response.We conducted a retrospective, observational, cohort study including 50 patients affected by COVID-19 with severe pneumonia and poor prognosis criteria, who have also undergone standard treatment; 36 of these patients additionally received tocilizumab in an early stage. The need for intensive care unit (ICU) admission, mortality, recovery of respiratory function, and improvement of biochemical and hematological parameters were compared between cohorts.Most patients were men, non-smokers and the most frequently reported comorbidities were hypertension and diabetes. Recurrent symptoms were fever, cough, and dyspnoea. 54.8% of patients from the tocilizumab group needed intubation, while in the control group 85.7% needed it. Treatment with tocilizumab significatively increased IL-6 levels, (554.45; CI 95% 186.69, 1032.93; P < .05) while C-reactive protein mean levels were reduced (–108.19; CI 95% –140.15, –75.33; P < .05), but no significant difference was found between cohorts. In comparison with the controls, tocilizumab reduced mortality (25.0% vs 42.9%, P = .021) and the number of ICU admissions (63.9% vs 100.0%, P = .021). 44.1% of patients treated with tocilizumab showed favorable radiological evolution, when compared with 15.4% of patients from the control group.Tocilizumab may improve clinical symptoms and mitigate deterioration observed in severe COVID-19 patients, and could be considered as an effective therapeutic option in subjects experiencing a significant inflammatory response to the disease.

Hematolojik kanser tanısıyla yoğun bakım ünitesinde takip edilen hastaların klinik özelliklerinin ve sonuçlarının değerlendirilmesi: tek merkez deneyimi

Introduction: Patients diagnosed with hematological cancer (HC) often need intensive care during their follow-up and treatment. In this study, it was aimed to evaluate the clinical characteristics and follow-up results of patients diagnosed with HC who were followed up in the intensive care unit (ICU). Materials and methods: This is a retrospective study enrolling 77 adult HC patients requiring intensive care between February 2019 and March, 2020. Results: Thirty-eight (50.6%) patients included in the study were neutropenic and 67 patients (87%) had infection during admission to the ICU. Acute myeloid leukemia was diagnosed in 35 (45.5%) patients. Mechanical ventilation was applied to 56 (72.7%) patients on admission. In the follow-up, 32 (41.6%) patients developed ICU infection, 24 (31.2%) patients developed bacteremia. The most common pathogens were; Klebsiella pneumonia (n = 11, 14.3%) and non-fermentation bacteria (n = 13, 16.6%) were gram-negative bacilli. Overall ICU survival rate was 32.5% (n: 25). Variables predicted to affect mortality in univariate analysis; APACHE II score ≥ 25 (p <0.001), resistance to cancer treatment or relapse (p = 0.015), septic shock at hospitalization (p <0.001), need for invasive mechanical ventilation (p <0.001) and presence of hospital infection (p = 0.006) were statistically were found to be significant risk factors. As a result of the multivariate model established with these variables, it was seen that the APACHE II score was a significant predictor for mortality (ROC: 0.884). Conclusion: APACHE II score 25 and septic shock are important poor prognosis criteria. Successful treatment and long survival can be achieved by the protocols to be determined in the follow-up and treatment of HC patients in need of intensive care, supportive treatments and prevention of nosocomial infections.

The prognostic impact of BIA-derived fat-free mass index in patients with cancer

Reduced muscle mass represents one of the top ranked phenotypic criteria for malnutrition proposed by the Global Leadership Initiative on Malnutrition. Although height-indexed fat-free mass (FFMI) thresholds have been proposed as useful surrogate measures of reduced muscle mass, the independent prognostic value of BIA-derived FFMI by bioelectric impedance analysis (BIA) in patients with cancer still needs to be fully explored. Data on body mass index (BMI), 6-month percentage of weight loss (%WL), FFMI by BIA and quality of life (QoL by EORTC Quality of Life Questionnaire [EORTC QLQ-C30]) of Italian and German patients observed prospectively until death or censoring were used (N=1217). Patients were stratified in 5 risk categories according to a robustly validated scoring system based on BMI and %WL. Low FFMI was defined as follows: men, <17kg/m2; women, <15kg/m2. Reduced FFMI was found in 234 patients (19.2%). After a median follow-up of 57 months [25th-75th, 31-60], 620 patients (50.9%) had died. The study detected differences in survival between patients presenting with and without reduced FFMI (14.0 months vs. 45.1 months; P<0.001). The fully-adjusted hazard ratio of mortality for low FFMI was 1.46 [95%CI, 1.18-1.81] (P<0.001). Low FFMI was also independently associated with reduced QoL: fully-adjusted odds ratio, 1.50 [95%CI, 1.00-2.25] (P=0.050). Reduced FFMI by BIA independently predicted survival and was associated with impaired QoL. Altered body composition should always be considered in all patients with cancer as additional phenotypic criterion of poor prognosis and BIA offers the possibility of multiple, noninvasive bedside assessments.

Anatomical evolution of residual type B aortic dissections and associated prognostic factors: One year results of the prospective follow-up in an expert center

The risk of reintervention after a type A aortic dissection, directly related to the evolution of the type B residual dissection (TBD), is estimated between 10 and 25%. The follow-up of these patients is difficult, with a significant number of lost to follow up in observational studies. The aim of this study was to evaluate the one-year rates of aneurysmal evolution and reintervention on the distal aorta and the associated criteria of poor prognosis in patients presenting a residual TBD.

Early Use of Tocilizumab in Patients with Severe Pneumonia Secondary to SARS-CoV-2 Infection and Poor Prognostic Criteria: Impact on Mortality Rate and Intensive Care Unit Admission

Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, keeps spreading globally. Evidence suggests that a subgroup of patients with severe symptomatology might have cytokine storms, which increases mortality. The use of interleukin-6 inhibitors may help in controlling the pathological immune response to the virus. Tocilizumab, a monoclonal antibody against interleukin-6, stands as an option treatment for COVID-19 patients presenting this inflammatory hyper-response. Methods: We conducted a retrospective, observational, cohort study including 50 patients affected by COVID-19 with severe pneumonia and poor prognosis criteria, who have undergone standard treatment; 36 of these patients additionally received tocilizumab in an early stage. The need for intensive care unit (ICU) admission, mortality, recovery of respiratory function and improvement of biochemical and haematological parameters were compared between cohorts. Findings: Most patients were male, non-smokers and the most frequently reported comorbidities were hypertension and diabetes. Recurrent symptoms were fever, cough and dyspnoea. 54·8% of patients from the tocilizumab group needed intubation, while in the control group 85·7% needed it. Treatment with tocilizumab significatively increased interleukin-6 levels, (554·45; CI 95% 186·69, 1032·93; p<0·05) while C-reactive protein mean levels were reduced (-108·19; CI 95% -140·15, -75·33; p<0·05), but no significant difference was found between cohorts. In comparison with the controls, tocilizumab reduced mortality (25·0% vs. 42·9%, p=0·021) and the number of ICU admissions (63·9% vs. 100·0%, p=0·021). 44·1% of patients treated with tocilizumab showed a favourable radiological evolution, when compared to 15·4% of patients from the control group. Interpretation: Tocilizumab may improve clinical symptoms and mitigate deterioration observed in severe COVID-19 patients, and could be considered as an effective therapeutic option in subjects experiencing a significant inflammatory response to the disease. Funding Statement: Andalusian Public Foundation for Biosanitary Research in Eastern Andalusia - Alejandro Otero (FIBAO). Declaration of Interests: FMP has assisted to conferences and participated as speaker for Roche, Astra Zeneca, Incyte, and Celgene. MIST reports personal fees from Boehringer Ingelheim International Gmbh. All other authors declare no competing interests. Ethics Approval Statement: The study was classified as EPA-OD by the Spanish Agency of Medicines and Medical Devices (AEMPS) on May 8th 2020 and was approved by the Ethic Committee for Research with medicinal products of the province of Jaen on May 18th 2020.

Malignant Leakage After Sleeve Gastrectomy: Endoscopic and Surgical Approach.

Gastric leak occurs after sleeve gastrectomy (SG) in 2% of cases. Most staple-line disruptions (SLD) can be successfully treated with first-line endoscopic procedures. Less favorable situations may lead to more complex therapeutic strategies, like conversion to Roux-en-Y gastric bypass (RYGBP). The aim of our study is to predict the factors of endoscopic treatment failure and to assess the safety of conversion to RYGBP. We included all patients treated in two centers of academic excellence (n = 100) between 2013 and 2017 who had a malignant SLD after SG. A "malignant" leakage met one of the following poor prognosis criteria suggested in the literature: unsuccessfully treated by the first-line endoscopic treatment; generalized peritonitis; anatomical anomalies; gastro-cutaneous or gastro-pleural fistula (GCF/GPF); or chronic leaks (> 4weeks). No deaths occurred during the follow-up (20 ± 12months). The endoscopy reported an anatomically abnormal gastric tube in 35 (35%) patients (stenosis [n = 21 (21%)], twist [n = 9 (9%)], or both [n = 5 (5%)]). We could maintain the SG in place in 92% of cases without stenosis, twist, or GCF/GPF. Conversion to RYGBP due to leakage was necessary in 37 (37%) patients. Stenosis, twist, or GCF/GPF significantly prevented healing in multivariate analysis (respectively: p = 0.020, OR = 0.17, and p < 0.001, OR = 0.07-logistic regression). Endoscopy is the treatment of choice for the management of chronic leaks after SG. The association of anatomical anomalies and GCF/GPF should lead to consideration of conversion to RYGBP.

P0490IS THE SEVERITY OF GLOMERULAR IGG STAINING IN PATIENT WITH IGA NEPHROPATHY USEFUL FOR PREDICTING POOR RENAL PROGNOSIS? THE DATA FROM TSN-GOLD WORKING GROUP

Abstract Background and Aims In IgA nephropathy (IgAN), which is characterized by mesangial IgA accumulation, there is the formation of circulating autoantibodies against galactose deficient IgA1s (Gd-IgA1). IgG / Gd-IgA1 immunocomplexes accumulate in the glomerular mesangium and play a role in the pathogenesis of IgAN. Recent studies have suggested a relationship between glomerular IgG deposition and the severity of glomerular inflammation. However, detection of the presence and severity of IgG in routine immunofluorescence microscopy (IFM) may fail. This study aims to investigate whether IgG positivity detected by IFM is associated with poor renal prognostic indicators and whether renal prognosis can be predicted according to IgG positivity. Method 4399 patients who were enrolled between May 2009-June 2019 in database of Turkish Society of Nephrology, Glomerular Diseases Working Group (TSN-GOLD) including 44 centers were evaluated. After exclusion criteria, 994 primary IgAN patients were included in the study. Glomerular IgG negative and positive patients were compared by means of Oxford classification scores, histopathological evaluations, proteinuria, creatinine, albumin, blood pressures. IgG positive patients were divided into subgroups according to the grade of the IFM positivity. The relationship between IgG positivity and poor prognosis criteria were evaluated. Results Demographic and biochemical findings of glomerular IgG positive and negative patients at the time of biopsy are shown in Table 1. No difference was found between the groups. There was no difference in the demographic and biochemical findings at the time of biopsy in IgG subgroup analyses (Table 2). There was no difference between the histopathological and Oxford MEST scores of the subgroups. Glomerular IgG positivity was not associated with diastolic blood pressure, systolic blood pressure, urea, uric acid, age, eGFR, albumin, proteinuria (p&amp;gt; 0.05 for all, r= -0.084, r= -0.102, r= -0.006, r=0.062, r= 0.014, r= -0.044, r= -0.061, r= -0.066, r= 0.150, respectively). Conclusion Glomerular IgG positivity detected by routine IFM in IgAN is not associated with poor renal prognostic indicators. It is difficult to predict renal prognosis by looking at the severity of IgG positivity at the baseline evaluation.

Criteria for adverse prognosis for mitral valve prolapse.

On the basis of a survey of 151 patients, diagnostic criteria for an unfavorable prognosis of mitral valve prolapse were revealed according to echocardiography. Transthoracic and transesophageal echocardiography, daily Holter ECG monitoring were performed. Repeated echocardiography was performed in 12-18 months. Statistical analysis of the material allowed us to identify criteria for poor prognosis of mitral valve prolapse according to echocardiography: severe mitral regurgitation, mitral valve leaflet thickness in diastole 6 mm or more, dilatation of the left ventricular cavity, dilatation of the left atrial cavity, dilatation of the mitral ring.

Contemporary North-American population-based validation of the International Germ Cell Consensus Classification for metastatic germ cell tumors of the testis

The International Germ Cell Consensus Classification (IGCCC) is the recommended stratification scheme for newly diagnosed metastatic seminoma (mSGCT) and non-seminoma germ cell tumor (mNSGCT) patients. However, a contemporary North-American population-based validation has never been completed and represented our focus. We identified mSGCT and mNSGCT patients within the SEER database (2004-2015). The IGCCC criteria were used for stratification into prognostic groups. Kaplan-Meier (KM) derived actuarial 5-year overall survival (OS) rates were calculated. In addition, cumulative incidence plots tested cancer-specific (CSM) and other-cause mortality (OCM) rates. Of 321 mSGCT patients, 190 (59.2%) and 131 (40.8%), respectively, fulfilled good and intermediate prognosis criteria. Of 803 mNSGCT patients, 209 (26.1%), 100 (12.4%), and 494 (61.5%), respectively, fulfilled good, intermediate, and poor prognosis criteria. In mSGCT patients, actuarial KM derived 5-year OS was 87% and 78% for, respectively, good and intermediate prognosis groups (p = 0.02). In cumulative incidence analyses, statistically significant differences were recorded for CSM but not for OCM between good versus intermediate prognosis groups. In mNSGCT patients, actuarial KM derived 5-year OS was 89%, 75% and 60% for, respectively, good, intermediate, and poor prognosis groups (p < 0.001). In cumulative incidence analyses, statistically significant differences were recorded for both CSM and OCM between good, intermediate, and poor prognosis groups. Our findings represent the first population-based validation of the IGCCC in contemporary North-American mSGCT and mNSGCT patients. The recorded OM rates closely replicate those of the original publication, except for better survival of poor prognosis mNSGCT patients.

Functional state of the myocardium and criteria for poor prognosis in mitral valve prolapse

Aim. Study of the fnctional state of left ventricular myocardium and determination of diagnostic criteria of poor prognosis of mitral valve prolapse. Methods. 151 patients (116 males and 35 females) with mitral valve prolapse (MVP) were examined. The average age was 34.8 ± 0.79 years. Division by the groups was performed depending on the severity of structural changes of the valve and width of the cusps: group 1 included 54 patients with classic form of MVP (cusp width ≥5 mm), group 2 included 55 patients with cusp width ≥3 mm, group 3 included 42 patients with MV cusp width less than 3 mm. All patients underwent complex clinical functional examination of cardiovascular system. The state of systolic and diastolic cardiac function was assessed using stationary high-tech ultrasound scanner «Philips iE-33» (Philips, Holland) according to conventional technique with determination of standard heart parameters and calculation of intracardiac hemodynamic parameters. Echocardiography was performed on admission and 12 to 18 month later. Results. The study revealed that the most prominent changes of cardiohemodynamics and unfavorable disease course were observed in 72.2 % of patients with classic form of MVP (group 1). Patients with non-classic form of MVP (group 2) also had poor prognosis in 27.8 % of cases. Diagnostic criteria of poor prognosis of MVP according to echocardiography were determined: severe mitral regurgitation (degree ≥III), mitral valve cusp thickness during diastole over 6 mm, left ventricle dilation (EDS ≥ 60 mm; ESS ≥ 36 mm), left atrial dilation (anterior posterior size of LA ≥ 40 mm, LA volume ≥ 80 ml), mitral annulus dilation (diameter of MA ≥ 35 mm). Conclusion. Differences of functional state of the myocardium of left ventricle were revealed depending on the type of mitral valve prolapse caused by the severity of connective tissue dysplasia. In classic form of MVP more severe disorders of intracardiac hemodynamics were observed as well as more severe mitral insufficiency.

Case management program for complex chronic patients with mental health disorders

Introduction: Chronic Complex Patients have been a priority for National Health Systems recently. A care program for Complex Chronic Patients with Mental Health Disorders (CCP-MHD) was developed in MutuaTerrassa in 2013. The goal of this program was to take care of patients with specific diagnosis and a particular social and clinical setting, giving them an integrated, coordinated, proactive, efficient and adapted attention. Goals: Assess the impact of this care program for CCP- MHD in preventing unplanned hospital admissions. Description: In 2013 a care program for the CCP-MH was designed and carried out a year later throughout the territory depending on the Community Hospital. The goal was to treat patients with at least one of the following criteria of complexity: a) 2 or more hospital admissions in the last year b) Individual Support Program discharge (ISP) c) one clinical criteria of poor prognosis according to the medical team (poor compliance of medication, absenteeism from scheduled appointments, insufficient family support or being under multiple medications). The multidisciplinary team chooses the patients, defines their Individualized Therapeutic Plan (ITP) and labels their medical record to be seen by all professionals. A nurse case manager follows up all patients and is in charge of coordinating their multidisciplinary attention with defined care routes and performing patients and family visits follow-ups, home visits and multiple phone calls to patients. Results: In June 2014, the CCP-MHD program was launched. 45 patients have been included so far: 20 male and 25 female, mean age 44.7 and 48.5 respectively. Patients were classified according to their diagnosis: schizophrenic disorders (n = 29), borderline personality (n = 7), bipolar (n = 7), schizotypal (n = 1) and recurrent depressive (n = 1). Poor compliment of treatment was the first cause to be included (n=18), poor family support (n=11), emergency hospital admissions in the last months (n=8, mean: 2.6), absenteeism to scheduled appointments (n=5) and clinical instability after hospital discharge (n=3). From June 2014 to December 2015, 14 out of 45 patients were discharged from the program; mean time of assistance was 301 days. Among the causes of discharge are clinical improvement (n=7), being accepted in a different care unit (n=5), prison admission (n=1) and death (n=1). Eight patients were included for having 2 or more emergency admissions, with a total of 21 hospital admissions. Four of they were discharged after 211 days and there were only 2 admissions during follow-up. Ten patients who had had 1 emergency admission along the previous year, with a total of 10 hospital admissions, presented 2 re-admissions and 27 patients admitted in the program for other reasons had no urgent hospital admission during follow-up. Conclusion and impact: The care program for Complex Chronic Patients with Mental Health Disorders in this Community Hospital has fostered better control and management of the most fragile patients. This program has reduced significantly the number of readmissions. The nurse case manager has optimized the resources and the possibilities of each patient.

Integration of palliative and supportive care in the management of advanced liver disease: development and evaluation of a prognostic screening tool and supportive care intervention

Background and objectivesPatients with decompensated cirrhosis rarely receive palliative and supportive care interventions, which are routine in other life-limiting diseases. We aimed to design and evaluate a prognostic screening tool...