Rate Of Persistent Symptoms Research Articles

Tecovirimat Treatment of People With HIV During the 2022 Mpox Outbreak : A Retrospective Cohort Study.

The recent mpox outbreak has disproportionately affected people with HIV (PWH) and resulted in the first widespread use of the novel antiviral tecovirimat. Whether treatment outcomes differ between PWH and those without HIV is unknown. To compare the clinical presentation and treatment outcomes of PWH and HIV-negative persons with mpox virus (MPXV) infection treated with tecovirimat. Retrospective cohort study of patients treated with tecovirimat for confirmed MPXV infection from June to August 2022. Two academic medical centers in New York City. The study included 196 persons treated with tecovirimat from 20 June to 29 August 2022. Of 154 testing positive for MPXV, 72 were PWH and 4 had a CD4 count lower than 0.20×109 cells/L. Patient demographic characteristics, clinical presentation, treatment outcomes, and safety data for tecovirimat. Indications for tecovirimat treatment were similar between the PWH and HIV-negative groups. Four participants had serious adverse events; none were attributed to tecovirimat. Three of these 4 participants had HIV infection, and 2 had CD4 counts less than 0.20×109 cells/L. Twenty-two percent of participants had nonsevere adverse effects. Groups had similar rates of hospitalization, indications for treatment, and co-occurring infections, but PWH had fewer days from symptom onset to treatment (7.5 vs. 10). There was no difference in treatment outcomes, including days to improvement or rate of persistent symptoms. Patients with mpox who were not treated with tecovirimat were not followed routinely and therefore lacked comparable outcome data, limiting evaluation of efficacy. In our cohort of patients treated with tecovirimat for severe mpox, HIV status did not seem to affect treatment outcomes. National Institutes of Health.

Post-operative Outcomes for Vascular Rings: A Systematic Review and Meta-analysis

Vascular rings may cause tracheal and/or oesophageal compression. For many patients, symptoms/signs have been present for a long period before diagnosis. However, in the era of prenatal diagnosis, some units advocate universal early surgery. The risks and efficacy of surgery must be known to adequately counsel for the operation. This meta-analysis sought to define the morbidity and mortality associated with surgical correction, and persistent post-operative symptoms. PubMed, Cochrane Library and CINAHL databases were searched for studies that described the outcome of patients undergoing surgery for a double or right aortic arch (DAA or RAA). Non-comparative and random effects model-based meta-analyses were conducted to calculate the pooled rates of mortality, surgical complications, reintervention, and persistent follow-up symptoms. Nineteen eligible studies were included comprising 18 studies describing outcomes for DAA surgery and 15 for RAA surgery. For DAA surgery, overall mortality rate was 0% [95% confidence interval (CI) 0.0-1.0], post-surgical complication rate 18% [95% CI: 12.0-23.0], prevalence of reintervention 3% [95% CI: 1.0-5.0] and prevalence of symptoms at last follow-up was 33% [95% CI: 17.0-52.0]. For RAA surgery, overall pooled mortality was 0% [95% CI: 0.0-0.0], prevalence of post-surgical complications was 15% [95% CI: 8.0-23.0], reintervention rate was 2% [95% CI: 0.0-4.0], prevalence of symptoms at last follow-up was 40% [95% CI: 26.0-55.0]. While surgery to correct a vascular ring is safe, the rate of persistent symptoms is high and further strategies must be sought to reduce this burden.

Effectiveness of pediatric Crawford tube implants when endoscopically assisted by ENT surgeons

ObjectifL’épiphora chez l'enfant est souvent traité par l'insertion d'endoprothèses naso-lacrymales en silicone. La durée du traitement est le plus souvent de 3 mois, mais il peut arriver que les endoprothèses tombent d'elles-mêmes plus tôt sans nuire à l'efficacité du traitement. Il n'existe aucun consensus quant à la durée idéale du maintien en place des endoprothèses ni aux facteurs qui influent sur la réussite du traitement. MéthodesOn a procédé à un examen rétrospectif des dossiers médicaux de patients qui ont reçu des endoprothèses de Crawford entre 2009 et 2019. Les patients, qui étaient âgés de < 18 ans, ont reçu des endoprothèses de Crawford dans le cadre d'une intervention pendant laquelle un oto-rhino-laryngologue a réalisé une endoscopie nasale afin de visualiser directement les endoprothèses au moment de leur insertion et de réaliser la fracture des cornets inférieurs du nez. Dans tous les cas, on a tenté de réaliser une intubation bicanaliculaire; dans les cas où ce n’était pas possible, on a plutôt réalisé une intubation monocanaliculaire. RésultatsL’étude a porté sur 42 patients (50 yeux). L'extrusion spontanée des endoprothèses s'est produite dans 54 % des yeux. En moyenne, les endoprothèses sont demeurées in situ pendant 17,1 semaines (0–113 semaines). Les symptômes ont disparu chez 86 % des patients, ce qui correspond au taux de réussite des interventions sans endoscopie. On n'a recensé aucune complication peropératoire ni noté de lien entre le taux de persistance des symptômes et la durée du traitement. ConclusionL'insertion d'endoprothèses naso-lacrymales en silicone de type Crawford réalisée sous endoscopie afin d'obtenir une visualisation directe permet de traiter avec succès l’épiphora. Bien que l’épiphora puisse disparaître de lui-même, la persistance des symptômes au-delà de la première année de vie justifie le traitement. Il arrive souvent que les endoprothèses de Crawford subissent une extrusion spontanée avant la fin prévue du traitement. Or, la réussite du traitement n’était pas liée à la durée pendant laquelle les endoprothèses demeuraient en place. Par ailleurs, la visualisation sous endoscopie peut contribuer à réduire les complications peropératoires.

Prevalence and factors associated with symptom persistence: A prospective study of 429 mild COVID-19 outpatients

IntroductionPersistent symptoms have recently emerged as a clinical issue in COVID-19. We aimed to assess the prevalence and risk factors in symptomatic non-hospitalized individuals with mild COVID-19. MethodsWe performed a prospective cohort study of symptomatic COVID-19 outpatients, from March to May 2020, with weekly phone calls from clinical onset until day 30 and up to day 60 in case of persistent symptoms. The main outcomes were the proportion of patients with complete recovery at day 30 and day 60 and factors associated with persistent symptoms. ResultsWe enrolled 429 individuals mostly women (72.5%) and healthcare workers (72.5%), with a median age of 41.6 years [IQR 30–51.5]. Symptoms included: cough (69.7%), asthenia (68.8%), anosmia (64.8%), headaches (64.6%), myalgia (62.7%), gastrointestinal symptoms (61.8%), fever (61.5%), and ageusia (60.8%). Mean duration of disease was 27 days (95%CI: 25–29). The rate of persistent symptoms was 46.8% at day 30 and 6.5% at day 60 consisting in asthenia (32.6%), anosmia (32.6%), and ageusia (30.4%). The probability of complete recovery was 56.3% (95%CI: 51.7–61.1) at day 30 and 85.6% (95%CI: 81.2–89.4) at day 60. Factors associated with persistent symptoms were age>40 (HR 0.61), female sex (HR 0.70), low cycle threshold (HR 0.78), and ageusia (HR 0.59). ConclusionsCOVID-19 – even in its mild presentation – led to persistent symptoms (up to one month) in nearly half of individuals. Identification of risk factors such as age, gender, ageusia and viral load is crucial for clinical management and argues for the development of antiviral agents.

Abstract P30: Long-term outcomes of cancer patients infected with COVID-19

Abstract Background Patients with cancer appear to have poor outcomes with COVID-19 infection. Cohort analyses of short-term outcomes of COVID-19 (C19)-infected cancer patients (pts) have reported mortality rates ranging from 10 to 30%. Little is known about the long-term outcomes of cancer pts infected with C19. Here, we present an analysis of long-term outcomes of a cohort of active cancer pts with C19 infection. Methods This was a single center retrospective analysis of active cancer pts who tested positive for SARS-CoV-2 virus between 3/1/20- 9/30/20. Key inclusion criteria included a positive SARS-CoV-2 PCR test and an active cancer diagnosis within 90 days of a positive C19 test. We examined the rates of hospitalization for C19 infection, readmission, and C19-related mortality at 30-, 60-, 90-, and 120-day follow-up. Rates of persistent symptoms and systemic complications of C19 infection were described. Results We identified 81 active cancer pts with PCR-confirmed SARS-CoV-2 infection. Among this cohort, the median age was 55 years (range: 19- 89). 77% (N=62) had solid tumors and 23% (N=19) had a hematologic malignancy. 75% (N=61) were receiving an anti-cancer therapy at the time of C19 diagnosis. Median follow-up time from C19 diagnosis to last follow-up was 4.8 months (range: 0.1-9.0 mos). 32% (N=26) of the cohort required hospitalization for C19-related complications within 30 days of C19 diagnosis. Among those hospitalized, 35% (N=9/26) died from C19-related complications. Of the 17 pts who were discharged, 2 pts required readmission with a median time to readmission of 37 days. For these 2 pts, readmission was due to persistent dyspnea and hypoxia and both were treated for pneumonia with presumed bacterial superinfection. There were no additional hospitalizations for C19-related complications at 60-, 90-, and 120-day follow-up. At 90-day follow-up, 6 pts (7.4%) had been diagnosed with PE/DVT. No long-term cardiac, neurologic, or renal complications were observed. With regards to C19-related mortality, 30-day mortality was 8.6% (N=7) and 90-day mortality was 11.1% (N=9). No further C19-related deaths were observed after 90 days. All pts who died were hospitalized within 30 days of initial C19 diagnosis and remained hospitalized at the time of death. Persistent C19-related symptoms were noted in 8.2% (N=6/73) of the cohort at 60-days and 2.8% (N=2/71) at 90-day follow-up. Dyspnea was the most common symptom. Conclusions Among a cohort of active cancer pts with C19 infection, these data suggest that much of the morbidity and mortality associated with C19 infection appears to occur early, with decreased incidence of late complications beyond 30 days. Cancer pts who do not require hospitalization early in their infection course appear to have a decreased rate of late complications. Readmissions for C19-related complications were low, but this analysis was limited by a low number of pts. Achieving a better understanding of long-term outcomes of C19 pts with cancer will help us to better approach oncologic care as the pandemic continues. Citation Format: Justin Shaya, Angelo Cabal, Pedram Razavi, Rana R. McKay. Long-term outcomes of cancer patients infected with COVID-19 [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P30.

Modified Mitchell Osteotomy Alone Did Not Have Higher Rate Of Residual Metatarsalgia Than Combined First And Lesser Metatarsal Osteotomy

Category: Bunion Introduction/Purpose: Transfer metatarsalgia (TM) is a common forefoot disorder secondary to hallux valgus (HV), and the best treatment for HV related TM remains controversy. Some authors suggested a combined lesser metarsal osteotomy while undergoing HV surgery, but some authors didn’t agree with it and concluded that isolated HV corrective osteotomy can improve symptomatic metatarsalgia. The main purpose of the retrospective study was to compare clinical outcomes in the patients with and without combined lesser metatarsal osteotomy while they received HV correction surgery. Methods: We retrospectively reviewed the patients who underwent osteotomy for HV correction between January 2000 and December 2010. All the patients underwent HV correction with Modified Mitchell osteotomy. Clinical evaluations including the American Orthopaedic Foot and Ankle Society (AOFAS) score and residual metatarsalgia were assessed, and hallux valgus angle, 1st-2nd intermetatarsal angle, metatarsal shortening, and plantar shifting of metatarsal head were measured. Results: Sixty-five patients ( 83 feet ) meeting the selection criteria were enrolled. Thirty feet receiving a combined lesser metatarsal osteotomy were grouped as combined surgery group, and the others were grouped as control group ( 53 feet ). The overall rate of persistent symptomatic metatarsalgia was 19.28 % after operative treatment. There were 6 feet with residual metatarsalgia in combined surgery group, and 10 feet in control group. There was no significant difference in the rate of persistent symptoms between groups ( p=0.9). Conclusion: According to this result, modified Mitchell osteotomy alone didn’t have higher rate of residual metatarsalgia than combined surgery. Besides, we also found that the average recovery rate of transfer metatarsalgia was about 80.7% and the patients, whose preoperative hallux valgus angle was more than 30 degrees, had the higher risk of residual metatarsalgia after surgery.

Modified Mitchell osteotomy alone does not have higher rate of residual metatarsalgia than combined first and lesser metatarsal osteotomy

Transfer metatarsalgia (TM) is a common forefoot disorder secondary to hallux valgus (HV). Some authors suggest that a combined lesser metatarsal osteotomy while undergoing HV surgery improves metatarsalgia, whereas others concluded that isolated HV corrective osteotomy can improve symptomatic metatarsalgia. The main purpose of this retrospective study was to compare clinical outcomes in patients with and without combined lesser metatarsal osteotomy while receiving HV correction surgery. We retrospectively reviewed the patients who underwent osteotomy for HV correction between January 2000 and December 2010. All patients underwent HV correction with modified Mitchell osteotomy. Clinical evaluations including the American Orthopaedic Foot and Ankle Society score and residual metatarsalgia were assessed, and radiographic measurements were carried out. Sixty-five patients (83 feet) meeting the selection criteria were enrolled. Thirty feet receiving a combined lesser metatarsal osteotomy were classified as the combined surgery (CS) group, and the others were classified as the control (CN) group (53 feet). The overall rate of persistent symptomatic metatarsalgia was 19.28% after operative treatment. There were six feet with residual metatarsalgia in the CS group, and 10 feet in the CN group. There was no significant difference in the rate of persistent symptoms between the two groups (p = 0.9). According to this result, modified Mitchell osteotomy alone did not have a higher rate of residual metatarsalgia than CS. We also found that the average recovery rate of TM was about 80.7% and those patients whose preoperative HV angle was > 30° had the higher risk of residual metatarsalgia after surgery.

Parameters Influencing AIS 1 Neck Injury Outcome in Frontal Impacts

In order to gain more knowledge of the neck injury scenario in frontal impacts, a statistical study of parameters influencing incidences of AIS 1 neck injuries was performed. The data set consisted of 616 occupants in Volvo cars. Information regarding the crash, the safety systems, occupant characteristics (including prior neck problems), behavior and sitting posture at the time of impact, and neck symptoms (including duration) was collected and analyzed. Occupant characteristics (mainly gender, weight, and age), kinematics (head impacts) and behavior at the time of impact were identified as the most prominent parameter areas with regard to AIS 1 neck injury outcome. Specifically, women had a significantly higher AIS 1 neck injury rate as compared to men, occupants under the age of 50 had a significantly higher AIS 1 neck injury rate as compared to those above 50 and occupants weighing less than 65 kg have a significantly higher AIS 1 neck injury rate than heavier occupants. Drivers stating that they impacted their head against a frontal interior structure had a significantly higher AIS 1 neck injury rate than those without head impact. Also, occupants who stated they had tensed their neck muscles at the time of impact, had a significantly higher AIS 1 neck injury rate as compared to occupants who did not. Occupant activities, such as tightly gripping the steering wheel or straightening their arms showed a significantly increased AIS 1 neck injury rate, indicating that occupant behavior at time of impact could be influential with respect to AIS 1 neck injury outcome. Also, occupants reporting prior neck problems had a higher rate of persistent symptoms (> 1 year) but no difference with respect to passing symptoms (< 3 months) as compared to those without prior neck problems. Additionally, there was no distinct pattern for the duration of neck symptoms.