Significance Of Clinical Features Research Articles

Diagnosis of preeclampsia in women with diabetic kidney disease

ABSTRACT Objective: assessing the incidence of preeclampisa (PE) in women with diabetic kidney disease (DKD) and analyzing the significance of clinical characteristics and changes in laboratory findings throughout the pregnancy on the onset of PE. Methods: the study included 79 patients with DKD. All patients had elevated urinary protein loss (30–299 mg/24 h) or proteinuria (≥300 mg/24 h) in the first trimester of pregnancy. PE was diagnosed in 22,8% patients with DKD. Results: women with proteinuria and/or proliferative retinopathy at the admission developed preeclampsia significantly more frequently than those without these findings. The degree of proteinuria was significantly associated with the risk of PE development in each trimester of pregnancy. Patients with chronic hypertension developed PE significantly more frequently than those who had no chronic hypertension. Conclusion: chronic hypertension and the degree of primary kidney injury and dysfunction are crucial determinants of PE development in women with DKD. Proteinuria seems to be the best renal predictive factors of PE.

Successful remission of type B insulin resistance syndrome without rituximab in an elderly male.

SummaryType B insulin resistance syndrome (TBIR) is a rare autoimmune disease caused by antibodies against the insulin receptor. It should be considered in patients with dysglycaemia and severe insulin resistance when other more common causes have been ruled out. We report a case of a 72-year-old male with a 4-year history of type 2 diabetes who presented with hypercatabolism, vitiligo, acanthosis nigricans, and hyperglycaemia resistant to massive doses of insulin (up to 1000 U/day). Detection of anti-insulin receptor antibodies confirmed TBIR. The patient received six pulses of methylprednisolone and daily treatment with cyclophosphamide for 6 months. Response to treatment was evident after the fourth pulse of methylprednisolone, as indicated by weight gain, decreased glycosylated haemoglobin and decreased requirement of exogenous insulin that was later discontinued due to episodes of hypoglycaemia. Remission was eventually achieved and the patient is currently asymptomatic, does not require insulin therapy, has normal glycaemia and is awaiting initiation of maintenance therapy with azathioprine. Thus, TBIR remitted without the use of rituximab. This case highlights the importance of diagnosis and treatment in a timely fashion, as well as the significance of clinical features, available laboratory findings and medication. Large controlled studies are required to standardise a therapeutic protocol, particularly in resource-constrained settings where access to rituximab is limited.Learning points:Type B insulin resistance syndrome is a rare autoimmune disorder that should be considered in patients with dysglycaemia, severe insulin resistance and a concomitant autoimmune disease. Serological confirmation of antibodies against the insulin receptor is not necessary in all cases due to the high associated mortality without timely treatment.Although there is no standardised immunosuppressive treatment, a protocol containing rituximab, cyclophosphamide and steroids has shown a significant reduction in previously reported mortality rates.The present case, reports successful remission in an atypical patient using cyclophosphamide and methylprednisolone, which is an effective therapy in countries in which rituximab is not covered by health insurance.When there is improvement in the hypercatabolic phase, the insulin dose should be reduced and/or discontinued to prevent hypoglycaemia; a mild postprandial hyperglycaemic state should be acceptable.

Epidemiological Study of Hand, Foot and Mouth Disease in Al-Kindy Teaching Hospital/ Baghdad

Background: Hand, foot, and mouth disease is viral disease caused commonly by coxsackie virus A16 virus. It is a mild disease and children usually recover with no specific treatment within 7 to 10 days. Rarely, this illness may be associated with aseptic meningitis were patient may need hospitalization.
 Objective: To determine significance of clinical features of hand, foot and mouth disease.
 Methods: A cross sectional study of cases with clinical features of hand, foot and mouth disease visiting the dermatological consultation unit of Al Kindy teaching hospital. Sampling was for Zyona and Edressi Quarter patients over the period of 1st December 2017 to 30th of November 2017.
 Aim: To determine significance of clinical features of hand, foot and mouth disease
 Results: The mean age of patients (100 patients) was 29.99 months. Males were 65 (65%) and females were 35 (35%), (P 0.23). Tenderness of skin lesions, Malaise and decreased Appetite were the most frequent symptoms. Winter months illness was common .Cases were diagnosed two days before seeking medical help, while home contact of patients was most common place for infection transmission .Involvement of palms and soles was universal and indifferent (100%). Groin was more commonly affected (67%), (P 0.015). Fever was present in 81%.

The significance of clinical features in the prognosis of acute renal infarction: single center experience

Acute renal infarct (ARI) is a common renovascular disease caused by the abrupt interruption of renal blood flow. Since the presenting symptoms are often non-specific, a major concern in ARI has been prompt diagnosis, and its long-term outcome has never been studied. From January 2000 through to December 2009, adult patients with ARI were enrolled in this study. We retrospectively reviewed their clinical data, and followed them up until July 2011. Renal outcome and all-cause mortality were measured. A total of 67 patients were finally enrolled in this study. Their mean age was 56.1±16.4 years, and 52.2% of them were male. Over 76% of patients were identified to have more than one comorbidity and concurrent thromboembolic events occurred in 16.4% of the patients. Although, acute kidney injury (AKI) was present in 40.7% of the patients, long-term renal outcome was relatively good. In all cases, AKI was resolved within a month, and renal loss was found in only one patient. In-hospital mortality was 8.9% and during the median follow-up period of 40.6months, long-term mortality was 19.7%. Independent risk factors for mortality were age, atrial fibrillation, myocardial infarction and hematuria [hazard ratio (HR) 1.051, 95% confidence interval (CI) 1.008-1.096; HR 3.322, 95% CI 1.119-9.860; HR 9.315, 95% CI 1.555-55.796 and HR 7.745, 95% CI 1.606-37.353, respectively]. Our study suggested that in-hospital and long-term outcomes of ARI were closely related to the comorbidities or underlying disease of ARI, rather than the disease itself.

Outcome of Infective Endocarditis: Improved Results over 18 Years (1990-2007)

Background: High morbidity and mortality characterize patients suffering infective endocarditis (IE). The treatment of IE has undergone significant changes within ten years but it is not known whether mortality has decreased and which factors are determinant of the outcome. Objectives: Our aim was to evaluate the prognostic significance of clinical characteristics and outcomes of IE. Methods and Results: 312 definite cases of IE diagnosed using the Duke criteria were evaluated. Overall in-hospital mortality was 28%. Independent predictors of death, determined by a Weibull regression model, in medically-treated patients were (1) treatment era 1990–1995 vs. 2005–2007 (hazard ratio 3.14; 95% CI 1.37−7.21); (2) aging for each year (hazard ratio 1.02; 95% CI 1.004−1.03); (3) cardiac complications (hazard ratio 1.91; 95% CI 1.06−3.43); and (4) heart failure (hazard ratio 2.27; 95% CI 1.34−3.85). Independent predictors of the death in surgically-treated patients were (1) treatment era 2001–2004 vs. 2005–2007 (hazard ratio: 0.31; 95% CI 0.10−0.97), (2) aging for each year (hazard ratio: 0.96; 95% CI 0.94−0.99), and (3) cardiac complications (hazard ratio: 1.91; 95% CI 1.01−3.63). Conclusions: Some of the predictive factors for a poor prognosis were the same as those observed in previous studies. These factors could be used to identify those patients for more aggressive treatment. A new finding was the hazard function for mortality being highest at enrollment and declining rapidly in both medically and surgically treated patients, especially during the first 12 months.

Select high risk genetic features predict earlier progression following chemotherapy in chronic lymphocytic leukemia: Prospective randomized trial (Intergroup E2997) to evaluate justification for risk-adapted therapy

6521 Background: Genomic features including lack of IgVH mutations, del(11q), del(17p), and p53 mutations have been reported to predict clinical course and overall survival in CLL patients (pts). Bcl-2 family proteins and ZAP-70 have also been explored as predictors in CLL. Methods: We prospectively evaluated the prognostic significance of clinical features and laboratory variables on response and progression-free survival (PFS) following treatment with fludarabine (F, n=132) or fludarabine plus cyclophosphamide (FC, n=137) as part of the US Intergroup Trial E2997 for previously untreated CLL. Results: FC therapy had higher complete response (CR) (23.4% versus 4.6%), overall response (OR) (74.3% versus 59%), and median PFS (31.6 mos versus 19.2 mos) compared to F. CR and OR were not significantly different based on interphase cytogenetics, IgVH status, or p53 mutation. IgVH status or levels of ZAP-70, Bcl-2, Bax, Mcl-1, XIAP, Caspase-3, and Traf-1 proteins were not associated with clinical response or PFS. IgVH status and ZAP-70 levels were associated with time from diagnosis to treatment. Using a model including treatment arm, pts with del(17p) or (11q) had significantly shorter PFS (hazard ratios 3.54 and 2.05 respectively). In pts with a p53 mutation without del(17p) there was no enhancement of the model predicting poorer outcome, nor did IgVH status enter the model for predicting PFS. Conclusions: Combination chemotherapy is associated with a higher CR, OR, and PFS. Also, initiation of therapy for pts with Rai stages 0/1 resulted in a higher response rate. Del(17p) and del(11q) are highly predictive of shortened PFS with fludarabine-based chemotherapy. IgVH and p53 mutational status, as well as expression of ZAP-70, Bcl-2 family proteins, and CD38, did not predict response or PFS. ZAP-70 expression is associated with cytogenetic subsets predicted to have a worse overall prognosis, but did not identify pts who will do poorly with therapy. A combination of clinical staging and cytogenetics provide support for future risk-stratified treatment of CLL. Pts with a projected short response duration can be identified for future investigational strategies. No significant financial relationships to disclose.

Prognostic significance of clinical features and Akt activation in the survival of patients with bronchioloalveolar carcinoma (BAC)

7217 Background: Lung cancer is the leading cause of cancer related mortality in the world. BAC is a subset of NSCLC that has recently gained attention because of enhanced efficacy of epidermal growth factor receptor (EGFR) inhibitors in this population. Prognostic features for BAC have not been well defined. Because activation of Akt is a poor prognostic factor for other types of NSCLC, and because changes in Akt may predict outcome for EGFR inhibitors, we assessed the prognostic significance of clinical features and Akt activation in patients with BAC. Methods: 46 cases of BAC were classified according to WHO 2001 criteria. Akt activation was assessed using immunohistochemistry. Associations between ordered Akt levels and other dichotomous parameters were evaluated using an exact Cochran-Armitage test for trend. Survival was analyzed by the Kaplan-Meier method, and hazard ratios (HR) were determined based on Cox proportional hazard models. Results: Tissues from 45 patients were analyzed. Age and histology (mucinous vs. non-mucinous) were not associated with survival. Akt activation was observed in 63% of cases, but was not associated with differences in survival. Complete clinical data (except smoking) were available for 43 patients, and smoking history was available for 31 patients (8 never-smokers, 23 smokers). Cox model analysis revealed that male gender (HR 2.24, 95% CI 1.07–4.71, p = 0.032) and advanced stage (III or IV) (HR 2.17, 95% CI 1.004–4.71, p = 0.049) were associated with a worse prognosis. A model limited only to the 31 patients with smoking data demonstrated that smoking alone (HR 6.89, 95% CI 1.49–31.88, p = 0.013) was associated with a worse prognosis. Conclusions: These studies identify gender, stage, and especially smoking status as potentially important prognostic features for BAC. Akt was not prognostic. Given that the recent NSCLC clinical trials with erlotinib and gefitinib that showed varying survival benefit did not stratify by smoking status and BAC, it is possible that these characteristics could have affected the clinical outcomes. Investigators studying EGFR inhibitors should consider stratifying by smoking status and BAC to determine if there are subsets of patients who could benefit most from these therapies. No significant financial relationships to disclose.

0405 Non-traumatic coma: Prognostic significance of clinical features and investigations

0405 Non-traumatic coma: Prognostic significance of clinical features and investigations

1156 A study of prognostic significance of clinical features and CT scan head in cases of cerebral venous thrombosis in pregnancy and puerperium

1156 A study of prognostic significance of clinical features and CT scan head in cases of cerebral venous thrombosis in pregnancy and puerperium

Five cases of acute poststreptococcal glomerulonephritis with acute renal failure and nephrotic syndrome

During the period of 27 years from 1974 to 2000, acute episodes were studied retrospectively in 130 patients under 14 years of age with poststreptococcal acute glomerulonephritis(PSAGN). PSAGN cases have a variable clinical presentation from asymptomatic to severe oliguric acute renal failure(ARF). Proteinuria is nearly always present, but is less than 3.5 g/day. Nephrotic syndrome(NS) is not commonly observed in PSAGN. Among 130 patients, 5 cases had NS with ARF. The present study investigated a spectrum of NS with ARF and the significance of clinical features in PSAGN.

Primary reticulum cell sarcoma of bone. Significance of clinical features upon the prognosis.

Primary reticulum cell sarcoma of bone was found to have a relatively good prognosis in a review of 47 cases. It was also found that age, sex, or duration of symptoms had nothing to do with the prognosis. Although any statistical validity was not obtained, a large amount of radiation therapy during short periods on the whole bone seems the treatment of choice, and Coley's toxin may be combined with it for better results, at least for symptomatic improvement. Radiation therapy on the local area should be abandoned. The most important factor influencing the prognosis is the extent of the disease, an aspect of which may be reflected in the roentgenographic appearance in the long tubular bone involvement. Pelvic girdle involvement has a poor prognosis regardless of roentgenographic appearance. Surgery is indicated for the failure of control of local recurrence or complications due to radiation therapy.

Reticulum Cell Sarcoma Treated by Radiotherapy: Significance of clinical features upon the prognosis

(1969). Reticulum Cell Sarcoma Treated by Radiotherapy: Significance of clinical features upon the prognosis. Acta Radiologica: Therapy, Physics, Biology: Vol. 8, No. 6, pp. 439-458.