Two-year Follow-up Of Patients Research Articles

Two-year outcomes in patients after hospitalization for COVID-19: data from the TARGET-VIP registry

Aim. To evaluate 24-month outcomes after hospital treatment of patients with coronavirus disease 2019 (COVID-19) in a prospective registry.Material and methods. Two-year outcomes (2,2±0,5) after hospital treatment for COVID-19 were analyzed in 802 patients (mean age, 59,8±14,5 years, men, 51,0%). We assessed cases of death, non-fatal myocardial infarction (MI) and stroke, revascularization operations, hospitalizations, recurrent COVID-19, vaccination for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Results. During the follow-up period, 49 (5,9%) patients died, while 7 (0,8%) patients had MI, 7 (0,8%) — stroke. In addition, 222 (26,7%) patients were hospitalized, of which 26 (3,1%) for COVID-19. Recurrent COVID-19 were revealed in 146 (17,6%) patients, while 414 (49,6%) patients were vaccinated for SARS-CoV-2. The factors of age and stay in the intensive care unit were significantly associated (p<0,001) with the risk of all-cause death (hazard ratio (HR)=1,083 per 1 year of life and HR=6,28, respectively) and composite endpoint (death, non-fatal myocardial infarction, stroke, revascularization surgery): HR=1,057 and HR=3,28, respectively. Male sex was associated with the death risk (HR=2,50, p=0,003). Of the 49 deaths, 19 (38,8%) occurred in the first 3 months, and 35 (71,4%) in the first year of follow-up. A lower (1,8 times) incidence of new cases of cardiovascular (CVD) diseases and non- CVDs were associated with initial cardiovascular pathology. Hospitalization was associated with age (odds ratio (OR)=1,027; p<0,001) and CVDs (OR=1,66; p=0,01). The risk of recurrent COVID-19 was higher with CVDs (OR=1,55; p=0,03), lower — among those vaccinated for SARS-CoV-2 (OR=0,49; p<0,001).Conclusion. Over two-year follow-up of patients after hospital treatment for COVID-19, the proportion of deaths was 5,9%: >1/3 of deaths recorded in the first 3 months and >2/3 during the first year. Factors associated with death were age, male sex, and intensive care unit treatment during the hospitalization. The readmission rate was associated with older age and CVDs. The risk of repeated cases of COVID-19 was one and a half times higher in the presence of CVDs, but 2 times lower in those vaccinated for SARS-CoV-2 in the post- COVID-19 period.

Two-year follow-up of patients with post-COVID-19 condition in Sweden: a prospective cohort study.

Few studies have reported the long-term health effects of COVID-19. The regional population-based Linköping COVID-19 study (LinCoS) included all patients hospitalised due to COVID-19 during the first pandemic wave. Four months post-discharge, over 40% (185/433) experienced persisting symptoms and activity/participation limitations, indicating post-COVID-19 condition (PCC). The present follow-up study aimed to determine the long-term recovery among these patients 24 months post-admission. This prospective cohort study included all patients from LinCoS with PCC at four months post-discharge. We repeated the same structured interview at a 24-month follow-up to identify persisting symptoms and their impact on daily life. Intercurrent health issues were identified by reviewing medical records. Of 185 patients with PCC at 4 months post-discharge, 181 were alive at the 24-month assessment and 165 agreed to participate. Of those, 21% (35/165) had been readmitted to hospital for various causes in the interim period. The majority of patients (139/165, 84%) reported persisting problems affecting everyday life at 24 months. Significant improvements were seen in the prevalence and magnitude of some symptoms/limitations compared with four months post-discharge. Cognitive, sensorimotor, and fatigue symptoms were the most common persisting symptoms at 24 months. No clear difference was evident between individuals treated in the intensive care unit (ICU) and non-ICU-treated individuals. Approximately half of those who were on sick leave related to PCC at four months after infection were on sick leave at 24 months. This is one of the first studies to report 2-year outcomes in patients with PCC following COVID-19 hospitalisation. Despite some improvements over time, we found a high prevalence of persisting symptoms and a need for long-term follow-up and rehabilitation post COVID-19 infection. The study was funded by Region Östergötland.

ОДНОФОТОННАЯ ЭМИССИОННАЯ КОМПЬЮТЕРНАЯ ТОМОГРАФИЯ С 99mTс-1-ТИО-D-ГЛЮКОЗОЙ В ОЦЕНКЕ ЭФФЕКТИВНОСТИ И ПРОГНОЗЕ РЕЗУЛЬТАТОВ ЛЕЧЕНИЯ ЛИМФОПРОЛИФЕРАТИВНЫХ ЗАБОЛЕВАНИЙ

Purpose: Study of 99mTc-1-thio-D-glucose (99mTc-TG) SPECT using fore possibility to assess the effectiveness of therapy and predict the results of lymphomas treatment. Material and methods: We analyzed 99mTc-TG SPECT data of 30 people with malignant lymphomas: before treatment (SPECT1), after two courses (SPECT2) and after completion of chemotherapy (SPECT3). Results: By the results of SPECT2 analyzing, a complete metabolic response after two courses of chemotherapy (SPECT2–) was observed in 15 patients (50 %). In 15 patients, after 2 cycles of chemotherapy, a partial metabolic response (12 people) or no metabolic response (3 people) was established. These patients constituted the SPECT2+ group. After completion of chemotherapy, a complete metabolic response (SPECT3–) was diagnosed in 21 (70 %) patients. This effect was obtained in 15 (100 %) patients with SPECT2– and in 6 patients (40 %) with SPECT2+. Of the 15 patients in the SPECT2+ group, 9 (60 %) patients after completion of chemotherapy were diagnosed with a partial metabolic response (6 people) or metabolic progression (3 people). By two-year follow-up of patients, show that remission was observed in 23 (77 %) patients (complete remission in 15 people, uncertain complete remission in 8 patients). The relapse group consisted of 7 (23 %) cases, while 4 patients had a relapse of the disease, and 3 had progression. In SPECT2+ group, relapse of the disease was observed in 6 (40 %) cases, and remission in 9 (60 %) patients. While in SPECT2– group 1 (7 %) person relapse was diagnosed and 14 (93 %) were in remission (p<0.05). Conclusion: 99mTc-TG SPECT makes it possible to evaluate the results of lymphomas treatment with high efficiency. The presence of a complete metabolic response of the tumor after two courses of therapy indicates a high level of disease-free survival.

Two-year follow-up of patients with a first episode of psychosis for cannabis-induced psychotic disorder

Two-year follow-up of patients with a first episode of psychosis for cannabis-induced psychotic disorder

Abstract 10839: Two-year Follow-up Of Patients With Chronic Ischemic Heart Disease In A Specialized Center In Brazil

Introduction: Incidence of cardiovascular events in patients with chronic ischemic heart disease (CIHD) may vary significantly between regions. Although populous, Brazil is often underrepresented in international registries. Objective: This study aimed to describe the quality of care and 2-year incidence of cardiovascular events and prognostic factors in CIHD patients in a tertiary public health care center in Brazil. Methods: Patients with CIHD, denoted as previous revascularization, myocardial infarction (MI) or stenosis > 50% in at least one epicardial coronary artery, were enrolled and followed for at least 2 years. Main endpoint was the composite of MI, stroke or death. We also evaluated prescription, symptoms and laboratory records. Results: 625 patients with mean age 65 (±9.6) years, 33.3% women, were included. Previous MI was present in 59.8%, CABG in 26.8%, and percutaneous coronary intervention in 40.6%. Diabetes was prevalent in 48.6%, high blood pressure in 83.1%, and chronic kidney disease (creatinine clearance < 60 mL/min) in 34.7%. Residual coronary anatomy was known in 266 patients, of whom 29.3% had multivessel disease, and 11.7% had lesion in the left main artery. At a median follow-up (FU) of 881 days, we recorded 37 events of primary composite endpoint, with 2-year estimate event incidence of 7.05%. Age (HR per 10 years 1.61, 95%CI 1.32-1.97), stroke (3.65, 1.48-9.00) and LDL-cholesterol (1.23, 1.14-1.33) were the main prognostic factors in multivariate analysis. The participants experienced relief of angina symptoms based on Canadian Cardiovascular Society (CCS) scale (baseline vs. FU respectively): 65.7% vs. 81.7% were asymptomatic, 13 vs. 7.2% CCS1, 17.1 vs. 8.3% CCS2, 4.2 vs. 2.9% CCS3 or 4 (p < 0.001). Analysis of therapeutic goals identified better quality of medication prescription, defined as the use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker plus statin and any antithrombotic agent: 65.8% vs. 73.6% (p<0.001) comparing baseline with FU. On the other hand, there was no improvement in LDL or blood pressure control. Conclusion: This study shows that CIHD patients had a 2-year incidence of the primary composite endpoint of 7.05%, LDL was the main modifiable risk factor of worse prognosis.

Two-year follow-up of patients with heart failure with reduced ejection fraction receiving cardiac contractility modulation

Aim. To assess the 2-year prognosis of patients with heart failure with reduced ejection fraction (HFrEF) receiving cardiac contractility modulation (CCM).Material and methods. This single-center observational study included 55 patients (46 men, mean age 53±11 years) with NYHA class II-III HFrEF receiving optimal medical therapy, with sinus rhythm, QRS <130 ms or QRS<150 ms with nonspecific intraventricular conduction delay. NYHA class II and III were established in 76% and 24% of patients, respectively. All patients were implanted with CCM devices between October 2016 and September 2017. Follow-up visits were carried out every 3 months during the 1styear and every 6 months during the 2ndyear of observation. The primary composite endpoint was mortality and heart transplantation. Secondary composite endpoints included death, heart transplantation, paroxysmal ventricular tachycardia/ ventricular fibrillation, hospitalizations due decompensated HFResults.The one-year and two-year survival rate was 95% and 80%, respectively. Primary endpoint was observed in 20% of patients. NYHA class III and higher levels of N-terminal pro-brain natriuretic peptide (NTproBNP) were associated with unfavorable prognosis (p=0,014 and p=0,026, respectively). NTproBNP was an independent predictor of survival (p=0,018). CCM contributed to a significant decrease in hospitalizations due to decompensated HF (p<0,0001). The secondary endpoint was observed in 18 (33%) of patients during the 1styear. The predictor for the secondary composite endpoint was NTproBNP (p=0,047).Conclusion. CCM is associated with a significant decrease in hospitalization rate due to decompensated HF. The 2-year survival rate of patients with NYHA class II-III HF receiving CCM was 80%. The NTproBNP level was an independent predictor of survival in patients receiving CMM for 2 years. Further longer-term studies of the CCM efficacy are required.

Kliničke karakteristike i dvogodišnji ishod bolesnika sa anginom pektoris bez opstruktivne koronarne bolesti - dijabetičari vs. nedijabetičari

Introduction: Myocardial ischemia, without significant stenosis on epicardial coronary arteries is still not fully explained entity, however coronary microcirculatory dysfunction is certainly important. This heterogeneous syndrome is referred to as INOCA (Ischemia with No Obstructive Coronary Artery Disease) and carries a significant risk of major cardiovascular events (Major Adverse Cardiovascular Events - MACE). Diabetes mellitus (DM) is a risk factor for coronary microcirculatory dysfunction, but its role in INOCA is not completely evaluated. Aim: To compare the clinical characteristics and outcomes during two-year follow-up in patients with INOCA with vs. without diabetes, referred to coronary angiography due to chest pain or angina pectoris. Material and methods: A number of 328 patients with angina and/or documented inducible ischemia referred for angiography to Cardiology department of Clinical Center of Serbia between June 2015 and June 2017 were included in study. All of data (clinical parameters, echocardiographic and angiographic results) are obtained from standard medical history and through a telephone survey. Mortality was defined as the primary endpoint and MACE (mortality, myocardial infarction and hospitalization because of heart failure) as the secondary endpoint. Results: Patients are divided into two groups: DM (n = 93; 28.4%) and nonDM. The follow-up was done in 124 patients. The median of follow-up was two years and mortality was 3%. All patients who died had DM. The incidence of hospitalization in the whole group was 47%, and the development of heart failure was 69%. Patients with DM were older (p = 0.001), had higher BMI (p = 0.028), higher incidence of valvular diseases and higher incidence of MACE (p < 0.05). Groups didn't significantly differ according to results of the exercise test, coronarographic findings, nor according to the clinical presentation and other risk factors. Conclusion: Patients with INOCA might have severe clinical outcomes (mortality, hospitalization, heart failure development). Diabetes mellitus is a significant predictor of an adverse clinical event among INOCA patients.

The effect of coronary stent type on the long-term results of coronary artery bypass surgery after stenting clinically related artery in acute coronary syndrome in patients with multivessel coronary artery disease

Justification. The results of endovascular revascularization are largely determined by the type of stents used. The use of baremetal coronary stents significantly worsens the long-term results of endovascular treatment of coronary artery disease. Given the widespread use of bare-metal coronary stents in the Russian Federation for the treatment of coronary artery disease and acute coronary syndrome, in particular, the issue of the impact of the above-mentioned endovascular interventions on the long-term results of coronary artery bypass grafting (CABG) performed after endovascular revascularization of the clinically related artery in patients with acute coronary syndrome and multivessel lesions does not lose relevance.Aim. To compare the long-term results of the staged strategies of revascularization of the coronary bed: CABG performed after stenting the clinically related artery with third-generation biodegradable polymer-based sirolimus-eluting stents for acute coronary syndrome and CABG performed after stenting the clinically related artery with bare-metal coronary stents for acute coronary syndrome.Material and Methods. The analysis used the data of two-year follow-up of patients who underwent two-stage revascularization: at the first stage, patients received stenting of the clinically related artery for acute coronary syndrome and, at the second stage, they received coronary artery bypass grafting no later than 90 days from the date of stenting. The study included 218 patients with multivessel lesions of the coronary bed, admitted with clinical manifestation of acute coronary syndrome. The long-term follow-up period was 24 months. The following end points were analyzed: cardiovascular mortality, myocardial infarction, re-revascularization, and combined MACCE end point (cardiovascular mortality, myocardial infarction, acute cerebrovascular accident, and re-revascularization). The observation was carried out at the hospital stage and, then, on an outpatient basis once every three months.Results. There were no significant differences between the groups. The frequency of repeated revascularization, including repeated revascularization of the stented artery, and recurrence of angina were significantly higher in the group with baremetal coronary stents. There were no significant differences between the groups in regard to cardiovascular mortality, nonfatal myocardial infarction and acute cerebrovascular accidents. The frequency of MACCE events was significantly higher in the group of bare-metal coronary stents, mainly due to the frequency of repeated revascularizations.Conclusion. Coronary artery bypass grafting performed in the early period after stenting of the clinically related artery using bare-metal coronary stents in patients with acute coronary syndrome and multivessel lesions was associated with a significantly larger number of repeated coronary revascularizations and higher rate of recurrent angina compared to a similar strategy, but with the use of modern third-generation biodegradable polymer-based sirolimus-eluting stents.

Hedinger syndrome: first experience and two-year follow-up in patients with carcinoid heart disease.

Carcinoid heart disease (CHD) (Hedinger syndrome) is a rare manifestation, it has been described in up to 60% of patients with both neuroendocrine tumors (NETs) and carcinoid syndrome (CS) which, typically inducing right heart-sided abnormalities. Between 07/15 and 10/18, six patients (mean age 63±12 years; 3 females) presented with manifested (NYHA III-IV) Hedinger syndrome's related valvular(s) lesion and were operated at our center. Clinical data, adverse events and patient outcomes were recorded. The tricuspid valve was involved in all patients. Tricuspid valve repair was possible in four patients and two needed replacement. In two patients, operation was performed on beating heart without cross-clamping. Concomitant pulmonary valve replacement in two patients and aortic valve replacement in another two patients. A mean cross-clamp time of 61±50 minutes was observed. One patient with severely impaired right ventricular function needed ECMO support, and died 3 days later due to neuroendocrine enzyme storm. At 13 months, one patient developed severe tricuspid stenosis and underwent re-operation with replacement. Another patient died 18 months after surgery related to the underlying tumour. At mean of 30 months follow-up, four patients were alive and asymptotic. Hedinger syndrome is a challenging entity in cardiac surgery characterized by aggressive valve lesions combined with metastatic neuroendocrine neoplasia affecting the systemic circulation. We advise a multidisciplinary collaboration to early diagnose cardiac involvement to offer an early and proper treatment regime.

Open ventral hernia repair with a composite ventral patch - final results of a multicenter prospective study

BackgroundThis study assessed clinical outcomes, including safety and recurrence, from the two-year follow-up of patients who underwent open ventral primary hernia repair with the use of the Parietex™ Composite Ventral Patch (PCO-VP).MethodsA prospective single-arm, multicenter study of 126 patients undergoing open ventral hernia repair for umbilical and epigastric hernias with the PCO-VP was performed.ResultsOne hundred twenty-six subjects (110 with umbilical hernia and 16 with epigastric hernia) with a mean hernia diameter of 1.8 cm (0.4–4.0) were treated with PCO-VP. One hundred subjects completed the two-year study. Cumulative hernia recurrence was 3.0% (3/101; 95%CI: 0.0–6.3%) within 24 months. Median Numeric Rating Scale pain scores improved from 2 [0–10] at baseline to 0 [0–3] at 1 month (P < 0.001) and remained low at 24 months 0 [0–6] (P < 0.001). 99% (102/103) of the patients were satisfied with their repair at 24 months postoperative.ConclusionsThe use of PCO-VP to repair primary umbilical and epigastric defects yielded a low recurrence rate, low postoperative and chronic pain, and high satisfaction ratings, confirming that PCO-VP is effective for small ventral hernia repair in the two-year term after implantation.Trial registrationThe study was registered publically at clinicaltrials.gov (NCT01848184 registered May 7, 2013).

Incidence rate and risk factors of early repolarization in patients with growth hormone-secreting pituitary adenoma: a cohort study.

PurposeTo investigate the incidence and risk factors for early repolarization (ER) in patients with growth hormone (GH)-secreting pituitary adenomas.MethodsFrom August 2014 to August 2016, patients with GH-secreting pituitary adenomas and non-functioning pituitary adenomas admitted to the First Affiliated Hospital, Sun Yat-sen University, were prospectively enrolled. Logistic regression analysis was used to investigate risk factors for ER development.ResultsA total of 118 patients with GH-secreting pituitary adenomas (41 with concomitant ER) and 103 patients with non-functioning pituitary adenomas were included. Compared with the non-functioning adenoma group GH and IGF-1 levels, left ventricular mass index (LVMI), and incidence of ER were significantly higher in the GH-secreting pituitary adenoma group (all P<0.05). LVMI was an independent risk factor for ER. Bivariate correlation analysis showed that course of disease, GH, IGF-1, and diabetes were correlated with LVMI. Course of disease and IGF-1 were directly correlated with LVMI. Two-year follow-up of patients who underwent transsphenoidal resection showed that incidence of ER was significantly decreased in patients with normal GH and IGF-1 levels.ConclusionCompared with non-functioning pituitary adenoma patients, patients with GH-secreting pituitary adenomas have a significantly higher incidence of ER. Elevation of serum GH and IGF-1 had positive correlations with cardiac muscle cell hypertrophy and increased LVMI.

Two-year Follow-up of Patients With Unstable Angina/Non-ST Segment Elevation Myocardial Infarction Undergoing Early Invasive Strategy: Predictors of Normal or Near-Normal Coronary Angiography and Mortality.

Predictors of normal or near-normal coronary angiography (NONCAG) in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) and their importance regarding the prognosis are not understood. Accordingly, we determined these predictors as well as mortality risk factors at 2-year follow-up of UA/NSTEMI patients managed by the early invasive strategy. We prospectively studied consecutive patients with UA/NSTEMI managed with the early invasive strategy at Tehran Heart Center, in 1-year period. Echocardiography was performed before coronary angiography (CAG) for all the patients. Baseline characteristics, laboratory parameters, echocardiographic findings, invasive treatment modalities, and survival status after 2 years of follow-up were collected. We identified the predictors of NONCAG in the first phase of the study and then the risk factors of mortality in the second phase. In the study period, 298 patients including 211 (71%) males, with the age of 59.31 ± 10.72 years were enrolled. The following factors were predictors of NONCAG: the female sex (P < 0.001); negative family history of CAD (P = 0.028); Thrombolysis in Myocardial Infarction (TIMI) risk score (P < 0.001); and early transmitral flow velocity/mean mitral annular velocity (E/E'mean) (P = 0.003). The following items were significant protective factors against mortality: percutaneous coronary intervention (PCI) (P = 0.012), age (P = 0.001), and E/E'mean (P = 0.020). Patients' baseline characteristics as well as echocardiographic data could help in predicting those with NONCAG and PCI can be considered as the treatment of strategy with the most protection against mortality.

P.3.b.043 - Two-year follow-up of patients with a first psychotic episode: comparison between affective and non-affective psychoses and predictors of functioning

Dense registration of different impressions of the same finger is beneficial to various fingerprint matching methods. This is a challenging problem due to elastic distortion of finger skin and sparsity of distinctive features (namely minutiae) in fingerprints. Most existing fingerprint registration algorithms produce only correspondences between minutiae, which are not sufficient for dense registration of fingerprints. In this paper, we proposed a novel dense fingerprint registration algorithm, which consists of a composite initial registration step and a dual-resolution block-based registration step. The dual-resolution block-based registration is approached in an energy minimization framework which consists of local search, energy function construction and global optimization. In local search step, a candidate set of transformations of every input image block are found using image correlation w.r.t. the corresponding reference image block. In energy function construction, two factors are considered: (1) the similarity between the transformed input block and the corresponding reference block, and (2) the compatibility between transformations of neighboring input blocks. In global optimization, a region growing style algorithm is proposed to minimize the energy function. Experimental results on three databases containing many distorted fingerprints, namely FVC2004 DB1, Tsinghua Distorted Fingerprint database and NIST SD27 latent fingerprint database, show that the proposed algorithm not only produces more accurate registration results but also improves the matching performance by fusion of minutiae matching and image correlation.

Two-year clinical follow-up of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN): design and statistical analysis plan of the extended follow-up study.

BackgroundMR CLEAN was the first randomized trial to demonstrate the short-term clinical effectiveness of endovascular treatment in patients with acute ischemic stroke caused by large vessel occlusion in the anterior circulation. Several other trials confirmed that endovascular treatment improves clinical outcome at three months. However, limited data are available on long-term clinical outcome. We aimed to estimate the effect of endovascular treatment on functional outcome at two-year follow-up in patients with acute ischemic stroke. Secondly, we aimed to assess the effect of endovascular treatment on major vascular events and mortality during two years of follow-up.MethodsMR CLEAN is a multicenter clinical trial with randomized treatment allocation, open-label treatment, and blinded endpoint evaluation. Patients included were 18 years or older with acute ischemic stroke caused by a proven anterior proximal artery occlusion who could be treated within six hours after stroke onset. The intervention contrast was endovascular treatment and usual care versus no endovascular treatment and usual care. The current study extended the follow-up duration from three months to two years.The primary outcome is the score on the modified Rankin scale at two years. Secondary outcomes include all-cause mortality and the occurrence of major vascular events within two years of follow-up.DiscussionThe results of our study provide information on the long-term clinical effectiveness of endovascular treatment, which may have implications for individual treatment decisions and estimates of cost-effectiveness.Trial registration NTR1804. Registered on 7 May 2009; ISRCTN10888758. Registered on 24 July 2012 (main MR CLEAN trial); NTR5073. Registered on 26 February 2015 (extended follow-up study).

Two-Year Follow-up of Patients on Anti-TNFa Therapy Substituted to Certolizumab: SAVANT 2

Two-Year Follow-up of Patients on Anti-TNFa Therapy Substituted to Certolizumab: SAVANT 2

Two-Year Follow-up in Patients Treated With Emphysematous Lung Sealant for Advanced Emphysema

Endoscopic lung volume-reduction therapy for emphysema has been associated with therapeutic responses smaller in magnitude and less durable than surgical volume reduction (LVRS). Bronchoscopic emphysematous lung sealant (ELS) therapy has been shown to produce improvements in pulmonary function similar to surgery at 1 year. This case series summarizes safety and efficacy data of all patients from the initial ELS study out to 2 years. Between 1 and 2 years, there were three all-cause adverse events requiring hospitalization. One patient went on to successful lung transplant. Improvements relative to baseline in spirometry (change in FEV1: + 14.3 ± 33.1%; change in FVC: + 5.8 ± 23.2%) and diffusing capacity (change in diffusing capacity of the lung for carbon monoxide: + 10.6 ± 20.6%) were observed at 2 years. An exponential model fit to FEV₁ data at 6, 12, 18, and 24 months predicted improvements from a baseline of > 5% out to 4.1 years, similar to what has been reported following surgery. This report confirms long-term safety and efficacy following ELS therapy in advanced emphysema. Studies in a larger cohort are needed to define the role of ELS therapy in the treatment algorithm of patients with this condition.

Left ventricular dysfunction and outcome at two-year follow-up in patients with type 2 diabetes: The DYDA study

AimsLeft ventricular dysfunction (LVD) in type 2 diabetes mellitus (DM) (DYDA) study is a prospective investigation enrolling 960 with DM without overt cardiac disease. At baseline, a high prevalence of LVD was detected by analysing midwall shortening. We report here the incidence of clinical events in DYDA patients after 2-year follow-up and the frequency of LVD detected at baseline and 2-year evaluation. MethodsSystolic LVD was defined as midwall shortening ≤15%, diastolic LVD as any condition different from “normal diastolic function” identified as E/A ratio on Doppler mitral flow between 0.75 and 1.5 and deceleration time of E wave >140ms. Major outcome was a composite of major events, including all-causes death and hospital admissions. ResultsDuring the study period, any systolic/diastolic LVD was found in 616 of 699 patients (88.1%) in whom LVD function could be measured at baseline or at 2 years. Older age and high HbA1c predicted the occurrence of LVD. During the follow-up 15 patients died (1.6%), 3 for cardiovascular causes, 139 were hospitalized (14.5%, 43 of them for cardiovascular causes, 20 for a new cancer). ConclusionsDuring a 2-year follow-up any LVD is detectable in a large majority of patients with DM without overt cardiac disease. Older age and higher HbA1c predict LVD. All-cause death or hospitalization occurred in 15% of patients, cardiovascular cause was uncommon. Independent predictors of events were older age, pathologic lipid profile, high HbA1c, claudicatio and repaglinide therapy. Echo-assessed LVD at baseline was not prognosticator of events.

2 year followup of patients with diabetes mellitus nephropathy showing albuminuria reversal following angiotensin converting enzyme inhibitors

Introduction:Two-year follow-up of patients with diabetes mellitus (DM) nephropathy shows albuminuria reversal following angiotensin converting enzyme (ACE) inhibitors.Aim:To study about a clinical profile of 2-year follow-up of patients with DM nephropathy showing albuminuria reversal following ACE inhibitors.Materials and Methods:Twenty patients were taken up for study with duly informed consent and suggested for glycemic profile with HbA1C. Baseline renal function, urine microscopy, albuminuria, and other microvascular complications such as neuropathy and retinopathy. These patients were followed up for a period of 2 years with every month follow-up and monthly dose titration of ACE inhibitors, enalapril (Quote: Dr. M. K. Mani), to a maximum tolerable dose and checked after 1 week for raise in creatinine and potassium.Inclusion Criteria:Twenty patients, who have attended a secondary level diabetic clinic with diabetic nephropathy and are on regular follow-up for 2 years, were selected.Exclusion Criteria:Sick patients requiring parenteral feeds, IV antibiotics, co-morbid conditions such as autonomic gastroparesis and diabetic foot infections, type 1 diabetes and other known kidney disease, chronic kidney disease on dialysis are excluded from the study.Expected Result:Reversal of albuminuria.Conclusion:Enalapril is a safe, cheaper ACE inhibitors and the good dose titration coupled with early screening for DM nephropathy really help in halting the progression of chronic kidney disease from DM nephropathy.

Stationäre psychosomatische Rehabilitation bei Patienten mit somatoformen Störungen sowie Patienten mit sozialmedizinisch relevanten Problemen: Ergebnisse einer Zweijahreskatamnese

The success of psychosomatic rehabilitation based on psychoanalytical therapy was analyzed within the framework of a two-year follow-up in patients with somatoform disorders and in patients with social-medically relevant problems, who had been on sick leave for more than six months. Both groups of patients are often considered to be difficult. They were compared with patients of other diagnostic categories and with patients with shorter periods of sick leave. All in all, the physical and mental state of health showed lasting improvement, and demands on the health service and frequency of days off sick decreased. Patients with somatoform disorders partly proved to be more seriously affected at the time of admission, treatment outcomes, however, were to a great extent comparable to patients of other diagnostic categories. Patients who had been on sick leave for more than six months were found to have been more seriously affected at the time of admission and also to have been unable to benefit from rehabilitation to the same degree as those with shorter periods of sick leave. The success of rehabilitation does not seem to depend so much on diagnostic categories but rather on the duration of disablement. In cases of inability to work a specific treatment that pays greater attention to the somatic concept of illness as well as the low level of motivation for psychotherapy in this patient group could lead to better treatment outcomes.

Effect of elevated bilirubin levels on the long-term outcome in patients with chronic heart failure due to hypertension

The aim of the study was to evaluate the occurence of death and major adverse cardiac events (MACE) in patients with normal (group A) and elevated (group B) plasma bilirubin levels. We evaluated 124 patients (83% males, mean age 50.1 +/- 7.7 yrs) in New York Heart Association class II and III with hypertension-related chronic heart failure. We assessed the occurence of death and MACE (death, urgent heart transplantation and readmission to hospital). Groups A and B comprised 77 and 47 patients respectively. The independent predictors of death in group B were: N-terminal pro-brain natriuretic peptide (NT-proBNP) level (per 100 pg/ml difference; 95% CI: 1.29-4.76; p = 0.005) and physical component summary score (per 10 point difference; 95% CI: 0.66-0.99; p = 0.03). The independent predictors of MACE in group B were: age (per 10 yrs; 95% CI: 0.1-1.8; p = 0.04), NT-proBNP level (per 100 pg/ml difference; 95% CI: 1.02-3.69; p = 0.04) and the symptoms of depression (95% CI: 1.02-2.5; p = 0.01). The independent predictors of MACE in group A were: NT-proBNP level (per 100 pg/ml difference; 95% CI: 1.31-5.32; p = 0.006) and mental component summary (per 10 point difference; 95% CI: 0.85-0.98; p = 0.01). In a two-year follow-up the death rate was 5.2% in group A, and 23.4% in group B (p = 0.002) and frequency of MACE 18.2% and 42.6% in group A and B (p = 0.003), respectively. Elevated bilirubin levels are associated with higher incidence of death and MACE during a two-year follow-up in patients with hypertension-related chronic heart failure. Thus, it may be used as a simple prognostic factor in such of patients.