Impact of patient age on clinical features, serologic test reactivity and long-term outcome of culture-confirmed early Lyme disease

2017 ◽  
Vol 89 (4) ◽  
pp. 300-302 ◽  
Author(s):  
Erica Weitzner ◽  
Paul Visintainer ◽  
Gary P. Wormser
Keyword(s):  
Lyme Disease ◽  
Clinical Features ◽  
Serologic Test ◽  
Patient Age ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Patient Âgé

scholarly journals Clinical Course, Serologic Response, and Long-Term Outcome in Elderly Patients with Early Lyme Borreliosis

2018 ◽  
Vol 7 (12) ◽  
pp. 506 ◽  
Author(s):  
Katarina Boršič ◽  
Rok Blagus ◽  
Tjaša Cerar ◽  
Franc Strle ◽  
Daša Stupica
Keyword(s):  
Lyme Borreliosis ◽  
Older Patients ◽  
Erythema Migrans ◽  
Middle Aged ◽  
Patient Age ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Incomplete Response ◽  
Patient Âgé

Infected elderly people often present with signs and symptoms that differ from those in younger adults, but data on the association between patient age and presentation of early Lyme borreliosis (LB) are limited. In this study, the association between patient age (18–44 years, young vs. 45–64 years, middle-aged vs. ≥ 65 years, elderly) and disease course, microbiologic characteristics, and the long-term outcome of treatment was investigated prospectively in 1220 adult patients with early LB manifesting as erythema migrans (EM) at a single-center university hospital. Patients were assessed at enrolment and followed-up for 12 months. Age was associated with comorbidities, previous LB, presenting with multiple EM, and seropositivity to borreliae at enrolment. The time to resolution of EM after starting antibiotic treatment was longer in older patients. At 12 months, 59/989 (6.0%) patients showed incomplete response. The odds for incomplete response decreased with time from enrolment (odds ratio (OR) of 0.49, 0.50, and 0.48 for 2-month vs. 14-days, 6-month vs. 2-month, and 12-month vs. 6-month follow-up visits, respectively), but were higher with advancing age (OR 1.57 for middle-aged vs. young, and 1.95 for elderly vs. young), in women (OR 1.41, 95% confidence interval (CI) 1.01–1.96), in patients who reported LB-associated constitutional symptoms at enrolment (OR 7.69, 95% CI 5.39–10.97), and in those who presented with disseminated disease (OR 1.65, 95% CI 1.09–2.51). The long-term outcome of EM was excellent in patients of all age groups. However, older patients had slower resolution of EM and higher odds for an unfavorable outcome of treatment (OR 1.57, 95% CI 1.05–2.34 for middle-aged vs. young; and OR 1.95, 95% CI 1.14–3.32 for elderly vs. young), manifested predominantly as post-LB symptoms. The presence of LB-associated constitutional symptoms at enrolment was the strongest predictor of incomplete response.

scholarly journals Long-term outcome of closed reduction in late-detected hip dislocation: 60 patients aged six to 36 months at diagnosis followed to a mean age of 58 years

2018 ◽  
Vol 12 (4) ◽  
pp. 369-374 ◽  
Author(s):  
T. Terjesen
Keyword(s):  
Risk Factors ◽  
Closed Reduction ◽  
Hip Dislocation ◽  
Harris Hip Score ◽  
Patient Age ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Patient Âgé

PurposeThe aims of this study on late-detected developmental dislocation of the hip (DDH) were to assess the outcome in patients aged 55 to 60 years and to define prognostic factors.MethodsThe study included 60 patients (74 hips). Primary treatment was skin traction to obtain closed reduction, followed by hip spica plaster cast. There were 52 girls and eight boys with a mean age at reduction of 19.6 months (8 to 37). Criteria for good long-term outcome were no osteoarthritis (OA) or total hip arthroplasty (THA) and modified Harris Hip Score ≥ 80 points.ResultsThe mean patient age at follow-up was 57.7 years (55 to 60). Good long-term clinical and radiographic outcome occurred in 39 of 73 hips (53%). In all, 24 hips (32%) had undergone THA at a mean patient age of 48.1 years (31 to 58). Survival analysis with conversion to THA as endpoint showed a reduction in survival from 100% at patient age 30 years to 62% at 58 years. Risk factors for poor outcome were age at reduction ≥ 1.5 years and residual dysplasia (Severin grades III/IV) at skeletal maturity.ConclusionWith a mean follow-up of patient age 58 years, the outcome of late-detected DDH, treated with traction and closed reduction, was satisfactory in more than half the hips. This indicates that the hip will probably last more than 50 years if risk factors like age at reduction ≥ 1.5 years, residual dysplasia and avascular necrosis are avoided.

Clinical features and long-term outcome of ipsilateral delayed endolymphatic hydrops

2019 ◽  
Vol 69 (3) ◽  
Author(s):  
Andrea Albera ◽  
Claudia Cassandro ◽  
Carmine F. Gervasio ◽  
Sergio Lucisano ◽  
Marco Boldreghini ◽  
...  
Keyword(s):  
Clinical Features ◽  
Endolymphatic Hydrops ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Delayed Endolymphatic Hydrops

Orofacial granulomatosis: Clinical features and long-term outcome of therapy

2010 ◽  
Vol 62 (4) ◽  
pp. 611-620 ◽  
Author(s):  
Khalid A. Al Johani ◽  
David R. Moles ◽  
Tim A. Hodgson ◽  
Stephen R. Porter ◽  
Stefano Fedele
Keyword(s):  
Clinical Features ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Orofacial Granulomatosis

scholarly journals The clinical features and long-term prognosis of asymmetry childhood Guillain-Barré syndrome: a 5-year follow-up.

2020 ◽  
Author(s):  
Rui-Di Sun ◽  
jun Jiang
Keyword(s):  
Infectious Disease ◽  
Clinical Features ◽  
Guillain Barre Syndrome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Guillain Barré Syndrome ◽  
Motor Nerves ◽  
Long Term Prognosis ◽  
Guillain Barré

Abstract Backgroud: The aim was to investigate clinical features and long-term prognosis of asymmetric childhood Guillain-Barré syndrome (GBS). Methods: In a retrospective cohort study, standardized data from all children with GBS seen at the Wuhan Children’s Hospital were collected regarding clinical presentation, auxiliary examinations and long-term outcome. We compared asymmetry GBS with symmetry GBS. Asymmetry GBS was defined by Medical Research Council (MRC) grade and motor nerves conduction in bilateral limbs. Recovery was defined as a return to normal life with a DSS of 0. Results: GBS was diagnosed in 72 children. 12（16.67%）were asymmetry GBS compared to 60 symmetry GBS . In asymmetry GBS, six children were transient asymmetry weakness and six children were persistent asymmetry weakness. Compared to symmetry weakness GBS, asymmetry weakness GBS had more preschool children (75% vs 25%, P=0.005), longer days on hospital(26.5(15-37) days vs 11(9-15) days, p =0.000), more mechanical ventilation(MV) (50% vs 8.33%, p=0.000), higher Disease severity score(DSS)at nadir of disease(4(3-5) vs 3(1-4), p=0.010), more axonal subtypes(50% vs 15%, p=0.013) and more complications(58.33% vs 8.33%, p=0.000). Eight children had sequelae and sixty-four children had recovery. Compared to recovery group, sequelae group had more axonal subtypes(62.5% vs 15.63%, p=0.002) and more persistent asymmetry weakness(62.5% vs 4.69%, p=0.000). In six persistent asymmetry GBS, 5(83.33%) had abnormal EEG (electroencephalogram) results, 3(50%) children had mild to marked pleocytosis in CSF and 5(83.33%) had sequelae. Conclusions: In conclusion, asymmetry GBS had two types, namely transient and persistent asymmetry weakness. Asymmetry GBS indicated a more complex condition during disease. Most of persistent asymmetry GBS had clinical or subclinical infectious disease and poor prognosis. Inflammatory in anterior horn cells or nerve root by infectious disease may be the possible function in persistent asymmetry GBS.

Age-Dependent Frequencies of NPM-1/FLT3-ITD Mutations in Patients with Normal Karyotype AML

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2531-2531 ◽  
Author(s):  
Friederike Schneider ◽  
Eva Hoster ◽  
Michael Unterhalt ◽  
Stephanie Schneider ◽  
Annika Dufour ◽  
...  
Keyword(s):  
Molecular Markers ◽  
Negative Impact ◽  
Age Groups ◽  
Prognostic Impact ◽  
Patient Age ◽  
Term Survival ◽  
Long Term Outcome ◽  
Patient Âgé ◽  
Group 1

Abstract Background: Long-term survival in NK-AML is influenced by different clinical and molecular markers. Whereas the presence of a NPM-1 mutation is associated with a positive prognostic effect on long-term outcome, the presence of a FLT3-ITD mutation has a negative impact on survival. Interestingly, a significant interaction between NPM-1 and FLT3-ITD mutations has been shown. The positive prognostic impact on clinical outcome was evident predominantly in patients with NK-AML carrying NPM1 gene mutations when FLT3-internal tandem duplications (ITD) were absent. In contrast, the survival in all other groups of NPM-1 and FLT3-ITD combinations was not different so far. A clinical parameter with negative impact on all outcome parameters (OS, EFS, RFS, CR) is patient age at diagnosis. Certainly the worse prognosis in elderly patients is due to adverse patient characteristics and comorbidities. Nevertheless also disease-associated parameters reveal differences between older and younger patients with AML. Therefore we investigated the frequencies of NPM-1/FLT3-ITD mutations in different age groups. Patients and methods: Analyses were based on 803 patients with NK-AML included in the AMLCG (German AML Cooperative Group) 2000 trial until 01/2006. Patient age ranged from 17 to 85 years (median: 60 yrs). Information about the mutation status of NPM-1 and FLT3-ITD mutations at diagnosis was available in 689 patients. Patients were divided into six age groups (1: 17–30yrs; 2: 31–40yrs; 3: 41–50yrs; 4: 51–60yrs; 5: 61–70yrs; 6: 71–85yrs). The incidence of the molecular markers NPM-1 and FLT3-ITD as well as the four NPM-1 and FLT3-ITD combinations were calculated in cross tables (Pearson’s Chi Square test) in the different age groups. Results: In 689 patients with available mutations status we found a significant decrease in the frequency of the two molecular markers with higher age. Whereas the incidence of NPM-1 mutation decreased abruptly in patients >60 yrs [Group 1: 18/28 (64.3%), 2: 35/59 (59.3%), 3: 70/114 (61.4%), 4: 84/143 (58.7%), 5: 98/234 (41.9%), 6: 46/111 (41.4%); p<0.0001], the incidence of a FLT3-ITD decreased continuously with increasing age [Group 1: 14/28 (50.0%), 2: 21/59 (35.6%), 3: 36/114 (31.6%), 4: 47/143 (32.9%), 5: 60/234 (25.6%), 6: 22/111 (19.8%); p=0.013)]. Combining both markers we found a significant relative increase of NPM-1−/FLT3-ITD− patients (p<0.0001) with a sharp cut at 60 years whereas the NPM-1+/FLT3-ITD+ group diminished continuously (p=0.020). The proportion of the positive prognostic group of NPM-1+/FLT3-ITD− patients showed an increase between 40–60 years and a decrease afterwards (p=0.024) (see table 1 and figure 1). Conclusions: Our data show in a large cohort of 689 patients with NK-AML that the presence of mutations of the molecular markers NPM-1 and FLT3-ITD significantly decreases with age. Consequently the proportion of NPM-1−/FLT3-ITD− patients increases over time. This observation sheds light on the disease biology in older patients with AML. Table 1: Distribution of the NPM-1, FLT3-ITD and the 4 NPM-1/FLT3-ITD subgroups in different age groups age groups NPM-1 + % FLT3-ITD+ (%) NPM-1−/FLT3-ITD−(%) NPM-1+/FLT3-ITD+ (%) NPM-1−/FLT3-ITD+ (%) NPM-1+/FLT3-ITD− (%) 17–30 64.3 50.0 25.0 39.3 10.7 25.0 31–40 59.3 35.6 30.5 25.4 10.2 33.9 41–50 61.4 31.6 28.9 21.9 9.6 39.5 51–60 58.7 32.9 31.5 23.1 9.8 35.7 61–70 41.9 25.6 51.3 18.8 6.8 23.1 71–85 41 4 19.8 50.5 11.7 8.1 29.7 all age groups (%) 50.9 29.0 40.5 20.5 8.5 30.5 p-value < 0.0001*** 0.013* < 0.0001*** 0.020* 0.886 0.024* Figure 1: Proportions of the four NPM-1/FLT3-ITD subgroups in different age groups Figure 1:. Proportions of the four NPM-1/FLT3-ITD subgroups in different age groups

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