scholarly journals A 9-month retrospective evaluation of the aetiology and management of patients presenting with encephalitis/meningoencephalitis at a South London hospital

2020 ◽  
Vol 148 ◽  
Author(s):  
Tehmina Bharucha ◽  
Lina Nashef ◽  
Nick Moran ◽  
Sue Watkins ◽  
David Brown ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Early Stage ◽  
Response To Treatment ◽  
High Morbidity ◽  
Retrospective Evaluation ◽  
Clinical Algorithm ◽  
Radiological Data ◽  
Computed Topography ◽  
The Uk ◽  
Abnormal Eegs

Abstract Encephalitis causes high morbidity and mortality. An incidence of 4.3 cases of encephalitis/100 000 population has been reported in the UK. We performed a retrospective evaluation of the diagnosis and management of adults admitted to hospital with a clinical diagnosis of encephalitis/meningoencephalitis. Clinical, laboratory and radiological data were collated from electronic records. Thirty-six patients, median age 55 years and 24 (67%) male were included. The aetiology was confirmed over nine months in 25 (69%) of whom 16 were infections (six viral, seven bacterial, two parasitic and one viral and parasitic co-infection); 7 autoimmune; 1 metabolic and 1 neoplastic. Of 24 patients with fever, 15 (63%) had an infection. The median time to computed topography, magnetic resonance imaging and electroencephalography (EEG) was 1, 8 and 3 days respectively. Neuroimaging was abnormal in 25 (69%) and 17 (89%) had abnormal EEGs. Only 19 (53%) received aciclovir treatment. Six (17%) made good recoveries, 16 (44%) had moderate disability, 8 (22%) severe disability and 6 (17%) died. Outcomes were worse for those with an infectious cause. In summary, a diagnosis was made in 69.4% of patients admitted with encephalitis/meningoencephalitis. Autoimmune causes are important to consider at an early stage due to a successful response to treatment. Only 53% of patients received aciclovir on admission. Neuroimaging and EEG studies were delayed. The results of this work resulted in further developing the clinical algorithm for managing these patients.

scholarly journals Dynamic Clinical Features During the Para-Exacerbation Period of Critical COVID-19 Patients

2020 ◽  
Author(s):  
Aihua Bao ◽  
Yan Zhou ◽  
Lu Yunfei ◽  
Lihua Qiao ◽  
Fengming Ding ◽  
...  
Keyword(s):  
Lactic Acid ◽  
Hospital Admissions ◽  
Clinical Laboratory ◽  
Early Stage ◽  
Critical Parameters ◽  
Severe Illness ◽  
Clinical Parameters ◽  
Clinical Trial Registry ◽  
Neutrophil Lymphocyte Ratio ◽  
Radiological Data

Abstract Background COVID-19 has been currently spread all over the world with high mortality reported in severe COVID-19 patients. Many severe COVID-19 patients exacerbated from mild illness several days after hospital admissions. Pathophysiological evolution within this para-exacerbation period remain unclear.Methods Twenty-two confirmed COVID-19 patients who underwent at least one exacerbation were included. Epidemiological, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between the records of hospital admission day and the exacerbation day. Dynamic profiles of critical parameters were explored during the para-exacerbation period.Results Most of the patients were elder (67, IQR63-79), male (81.8%), coexisted with comorbidities (72.7%), multi-segments radiologically involved and exacerbated from mild to severe illness with anoxia at a median interval of 4 days (IQR, 2-7) from hospital admissions. On exacerbations, various clinical parameters were worsened, including respiratory rate, PaO2/FiO2 rate (PFR), alveolar-arterial PO2 difference (A-aDO2), hematological cellularities, biochemical parameters and radiological abnormalities. Dynamic profiles showed that neutrophil/lymphocyte ratio (NLR), and serum level of lactic acid, lactate dehydrogenase and coagulation parameters started to increase even at four days before the exacerbation. Conclusions Anoxia due to impaired gas exchange progress pathophysiologically characterized the exacerbation of COVID-19 patients. Continuously monitoring crucial clinical parameters, such as NLR, serum albumin, LDH, lactic acid, and CT involvement scale will be helpful to improve the recognition of the disease progression in patients with COVID-19 at early stage.Trial registration This retrospective study has been registered in Chinese Clinical Trial Registry (ChiCTR2000030580, www.chictr.org.cn)

scholarly journals Dynamic Clinical Features During the Para-Exacerbation Period of Critical COVID-19 Patients

2020 ◽  
Author(s):  
Aihua Bao ◽  
Yan Zhou ◽  
Lu Yunfei ◽  
Lihua Qiao ◽  
Fengming Ding ◽  
...  
Keyword(s):  
Lactic Acid ◽  
Hospital Admissions ◽  
Clinical Laboratory ◽  
Early Stage ◽  
Critical Parameters ◽  
Severe Illness ◽  
Clinical Parameters ◽  
Clinical Trial Registry ◽  
Neutrophil Lymphocyte Ratio ◽  
Radiological Data

Abstract Background COVID-19 has been currently spread all over the world with high mortality reported in severe COVID-19 patients. Many severe COVID-19 patients exacerbated from mild illness several days after hospital admissions. Pathophysiological evolution within this para-exacerbation period remain unclear.Methods Twenty-two confirmed COVID-19 patients who underwent at least one exacerbation were included. Epidemiological, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between the records of hospital admission day and the exacerbation day. Dynamic profiles of critical parameters were explored during the para-exacerbation period.Results Most of the patients were elder (67, IQR63-79), male (81.8%), coexisted with comorbidities (72.7%), multi-segments radiologically involved and exacerbated from mild to severe illness with anoxia at a median interval of 4 days (IQR, 2-7) from hospital admissions. On exacerbations, various clinical parameters were worsened, including respiratory rate, PaO2/FiO2 rate (PFR), alveolar-arterial PO2 difference (A-aDO2), hematological cellularities, biochemical parameters and radiological abnormalities. Dynamic profiles showed that neutrophil/lymphocyte ratio (NLR), and serum level of lactic acid, lactate dehydrogenase and coagulation parameters started to increase even at four days before the exacerbation.Conclusions Anoxia due to impaired gas exchange progress pathophysiologically characterized the exacerbation of COVID-19 patients. Continuously monitoring crucial clinical parameters, such as NLR, serum albumin, LDH, lactic acid, and CT involvement scale will be helpful to improve the recognition of the disease progression in patients with COVID-19 at early stage.Trial registration: This retrospective study has been registered in Chinese Clinical Trial Registry (ChiCTR2000030580, www.chictr.org.cn)

scholarly journals Predictive Factors of the Responses to Treatment of Mycoplasma pneumoniae Pneumonia

2021 ◽  
Vol 10 (6) ◽  
pp. 1154
Author(s):  
Eun Lee ◽  
Yun Young Lee
Keyword(s):  
Pleural Effusion ◽  
Mycoplasma Pneumoniae ◽  
Predictive Factors ◽  
Respiratory Virus ◽  
Clinical Laboratory ◽  
Poor Response ◽  
Response To Treatment ◽  
Slow Response ◽  
Response Group ◽  
Time Of Admission

The prevalence of refractory Mycoplasma pneumoniae (MP) pneumonia is increasing. The present study aimed to identify the predictive factors of responses to treatment of MP pneumonia in children. A total of 149 children were diagnosed with MP pneumonia, of whom 56 were included in the good response group, 75 children in the slow response group, and 18 children in no response or progression group. Data on the clinical, laboratory, and radiologic features were retrospectively obtained through medical chart reviews. The severity of pneumonia, based on the extent of pneumonic lesions on chest x-ray (adjusted odds ratio (aOR), 10.573; 95% confidence intervals (CIs), 2.303−48.543), and lactate dehydrogenase (LDH) levels (aOR, 1.002; 95% CIs, 1.000–1.004) at the time of admission were associated with slow response to treatment of MP pneumonia. Pleural effusion (aOR, 5.127; 95% CIs, 1.404–18.727), respiratory virus co-infection (aOR, 4.354; 95% CIs, 1.374–13.800), and higher LDH levels (aOR, 1.005; 95% CIs, 1.002–1.007) as well as MP-specific IgM titer (aOR, 1.309; 95% CIs, 1.095–1.564) were associated with no response or progression of MP pneumonia. The area under the curve for the prediction of no or poor response in MP pneumonia using pleural effusion, respiratory virus co-infection, LDH levels, and MP-specific IgM titer at the time of admission was 0.8547. This study identified the predictive factors of responses to treatment of MP pneumonia in children, which would be helpful in establishing a therapeutic plan and predicting the clinical course of MP pneumonia in children.

scholarly journals AB1119 U9: A NOVEL CLINICALLY ORIENTED ULTRASONOGRAPHIC SCALE AS A USEFUL MARKER FOR MONITORING THERAPEUTIC RESPONSE IN RHEUMATOID ARTHRITIS (MULTI CENTERS STUDY)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1848.2-1849
Author(s):  
M. A. Mortada ◽  
H. Eitta ◽  
R. Elmallah ◽  
A. Radwan ◽  
A. Elsaman
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Clinical Laboratory ◽  
Pearson Correlation ◽  
Response To Treatment ◽  
P Value ◽  
Clinical Parameters ◽  
Biologic Dmards ◽  
Das 28 ◽  
Significant Difference

Background:Musculoskeletal Ultrasonography (MSUS) is now a widely used tool for monitoring of rheumatoid arthritis (RA). Although there are many proposed sets of composite scores, a fixed set of joints may not be an ideal tool to assess a disease like RA, which affects many joints and tendons in different presentations. In previous study (1) U9 score was proven to be correlated with disease activity parameters.Objectives:To determine whether US assessment using U9 score is useful for monitoring response to treatment for RA or not?Methods:A prospective, multicenter study were conducted in period from July 2019 to December 2019. All recruited RA patients were subjected to: Disease activity assessment by clinical disease activity indices (CDAI and DAS28 ESR). Functional status assessment by (HAQ) and ultrasonographic assessment using U9 score which include 8 joints (bilateral wrists,2ndMCP,3RDMCP and knees) plus most clinically affected joint or tendon (one joint or one tendon). Most clinically affected joints from 48 joints. Any affected tendons could be choosing. All targeted joints were evaluated according to EULAR guidlines and by EULAR/ OMERACT combined score (0-3). Targeted tendons were scored (0-3).All patients received their treatment (biologic and non biologic DMARDs) according to the decision of the treating physicians. No specific therapy is needed. CDAI and DAS28 ESR, HAQ and U9 score were repeated after 3 months to detect the response to change after receiving the therapy.Results:One hundred and forty patients (23.6% were male) with mean age 39.26±11.30 were recruited from 4 tertiary referral university hospitals.There was a significant difference (<0.001) between the first and second visits as regards clinical, laboratory and ultrasonographic parameters. DAS 28 decreased form (5.29±1.21) to (3.95±0.99), ESR decreased from (42.12±15.24) to (26.84±12.32), HAQ2 improved from (0.652±0.350) to (0.510±0.237) and U9 total US score decreased from (13.56±5.18) to (8.02±4.28).There was significant correlation between U9 ultrasonographic score and clinical parameters at both visits (table 1).Table 1.correlation between U9 ultrasonographic score and clinical parameters.U9 at 1stvisitU9 at 2ndvisitDAS-28Pearson Correlation(P value)0.806<0.0010.790<0.001CDAIPearson Correlation(P value)0.787<0.0010.773<0.001HAQPearson Correlation(P value)0.431<0.0010.317<0.001We found that the most suitable cut-off value of U9 score to predict high disease activity was 11.5 (sensitivity 85.7% and specificity 80.6%), cut off value for moderate disease activity was 5.5(sensitivity 83.2% and specificity 88%) and cut off value for low disease activity was 3.5 (sensitivity of 83.3% and specificity 57.1%). These results are summarized in the following table:Conclusion:U9 ultrasonographic score is very useful method for evaluating the monitoring the response of treatment.References:[1]Mortada, et al. Annals of the Rheumatic Diseases 2019;78:1009.Disclosure of Interests:None declared

scholarly journals AGILE: a seamless phase I/IIa platform for the rapid evaluation of candidates for COVID-19 treatment: an update to the structured summary of a study protocol for a randomised platform trial letter

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Gareth O. Griffiths ◽  
Richard FitzGerald ◽  
Thomas Jaki ◽  
Andrea Corkhill ◽  
Helen Reynolds ◽  
...  
Keyword(s):  
Phase I ◽  
Early Stage ◽  
Late Phase ◽  
Optimum Dose ◽  
Open Label ◽  
Link Type ◽  
Hospitalised Patients ◽  
Volunteer Study ◽  
The Uk ◽  
Phase Trial

Abstract Background There is an urgent unmet clinical need for the identification of novel therapeutics for the treatment of COVID-19. A number of COVID-19 late phase trial platforms have been developed to investigate (often repurposed) drugs both in the UK and globally (e.g. RECOVERY led by the University of Oxford and SOLIDARITY led by WHO). There is a pressing need to investigate novel candidates within early phase trial platforms, from which promising candidates can feed into established later phase platforms. AGILE grew from a UK-wide collaboration to undertake early stage clinical evaluation of candidates for SARS-CoV-2 infection to accelerate national and global healthcare interventions. Methods/design AGILE is a seamless phase I/IIa platform study to establish the optimum dose, determine the activity and safety of each candidate and recommend whether it should be evaluated further. Each candidate is evaluated in its own trial, either as an open label single arm healthy volunteer study or in patients, randomising between candidate and control usually in a 2:1 allocation in favour of the candidate. Each dose is assessed sequentially for safety usually in cohorts of 6 patients. Once a phase II dose has been identified, efficacy is assessed by seamlessly expanding into a larger cohort. AGILE is completely flexible in that the core design in the master protocol can be adapted for each candidate based on prior knowledge of the candidate (i.e. population, primary endpoint and sample size can be amended). This information is detailed in each candidate specific trial protocol of the master protocol. Discussion Few approved treatments for COVID-19 are available such as dexamethasone, remdesivir and tocilizumab in hospitalised patients. The AGILE platform aims to rapidly identify new efficacious and safe treatments to help end the current global COVID-19 pandemic. We currently have three candidate specific trials within this platform study that are open to recruitment. Trial registration EudraCT Number: 2020-001860-27 14 March 2020 ClinicalTrials.gov Identifier: NCT04746183 19 February 2021 ISRCTN reference: 27106947

scholarly journals Identification of Novel Biomarker for Early Detection of Diabetic Nephropathy

Biomedicines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 457
Author(s):  
Kyeong-Seok Kim ◽  
Jin-Sol Lee ◽  
Jae-Hyeon Park ◽  
Eun-Young Lee ◽  
Jong-Seok Moon ◽  
...  
Keyword(s):  
Diabetic Nephropathy ◽  
Early Stage ◽  
Kidney Injury ◽  
Diabetic Patients ◽  
High Morbidity ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Zucker Diabetic Fatty Rats ◽  
Kidney Injury Molecule 1 ◽  
Stage Renal Disease ◽  
End Stage

Diabetic nephropathy (DN) is one of the most common complications of diabetes mellitus. After development of DN, patients will progress to end-stage renal disease, which is associated with high morbidity and mortality. Here, we developed early-stage diagnostic biomarkers to detect DN as a strategy for DN intervention. For the DN model, Zucker diabetic fatty rats were used for DN phenotyping. The results revealed that DN rats showed significantly increased blood glucose, blood urea nitrogen (BUN), and serum creatinine levels, accompanied by severe kidney injury, fibrosis and microstructural changes. In addition, DN rats showed significantly increased urinary excretion of kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL). Transcriptome analysis revealed that new DN biomarkers, such as complementary component 4b (C4b), complementary factor D (CFD), C-X-C motif chemokine receptor 6 (CXCR6), and leukemia inhibitory factor (LIF) were identified. Furthermore, they were found in the urine of patients with DN. Since these biomarkers were detected in the urine and kidney of DN rats and urine of diabetic patients, the selected markers could be used as early diagnosis biomarkers for chronic diabetic nephropathy.

scholarly journals Effective Early Treatment of AChR Antibody-Positive Myasthenia Gravis with Rituximab; the Experience from a Neuroimmunology Clinic in a Developing Country

2021 ◽  
Vol 13 ◽  
pp. 117957352110160
Author(s):  
Thomas Mathew ◽  
Kurian Thomas ◽  
Saji K John ◽  
Shruthi Venkatesh ◽  
Raghunandan Nadig ◽  
...  
Keyword(s):  
Observational Study ◽  
Myasthenia Gravis ◽  
Treatment Option ◽  
Early Treatment ◽  
Early Stage ◽  
Tertiary Care ◽  
Response To Treatment ◽  
Myasthenic Crisis ◽  
Achr Antibody ◽  
Significant Difference

Background: Rituximab is reserved for treating refractory myasthenia gravis (MG) patients. Here we report our experience with rituximab in AChR antibody positive generalized MG (gMG) and impending myasthenic crisis (IMC). Methods: This retrospective, observational study, conducted at a tertiary care, neuroimmunology clinic, analyzed the data of patients with AChR antibody positive gMG, treated with rituximab between 1st January 2016 and 30th October 2018. Results: Eleven patients with AChR antibody positive gMG received rituximab. Mean age of the cohort was 50.54 ± 18.71 years with 9 males. Seven out of 11 patients received rituximab in the early stage (<2 years from onset) and had good response to treatment. Four of the 5 patients with IMC improved with rituximab alone. In the 10 patients who regularly followed up, there was a significant difference between the QMG scores at baseline and at 1, 2, 6, 12, and 18 months ( P < .0001). Conclusion: Rituximab appears to be a potentially effective early treatment option for AChR antibody positive generalized MG and impending myasthenic crisis.

scholarly journals P.039 mTOR inhibitors as a new therapeutic strategy in treatment resistant epilepsy in hemimegalencephaly: a case report

2017 ◽  
Vol 44 (S2) ◽  
pp. S23-S23
Author(s):  
Q Xu ◽  
H Sarnat ◽  
S Uliel-Sibony ◽  
C Boelman ◽  
M Connolly ◽  
...  
Keyword(s):  
Therapeutic Strategy ◽  
Refractory Epilepsy ◽  
Focal Cortical Dysplasia ◽  
Mtor Inhibitors ◽  
Response To Treatment ◽  
Definitive Treatment ◽  
High Morbidity ◽  
Treatment Resistant ◽  
Integral Role ◽  
First Time

Background: Hemimegalencephaly (HME) is a hamartomatous malformation of one cerebral hemisphere, resulting in refractory epilepsy, intellectual disability, and autistic features. Hemispherectomy is the definitive treatment, but there is risk of high morbidity and mortality, especially when done in early infancy. Various preclinical studies have shown that dysregulation of the mTOR pathway has an integral role in the development of various epilepsy syndromes, including tuberous sclerosis complex (TSC), focal cortical dysplasia and HME. Recently, mTOR inhibitors were proven to be effective in treating seizures in TSC. Methods: We present a case of a 6 day old female with refractory epilepsy despite the trial of 9 anti-seizure medications and the ketogenic diet. As the patient was awaiting epilepsy surgery, an mTOR inhibitor, rapamycin was initiated. Results: After 1 week of the initiation, she had over a 50% reduction in seizures. At two weeks, the parents felt that for the first time, she was making developmental gains. She also appeared brighter and more interactive. Due to her response to treatment, her hemispherectomy was deferred to when she is older, so there will be a decreased risk of complications from the surgery. Conclusions: This case exemplifies how mTOR inhibitors should be considered as a treatment option for patients with HME and refractory epilepsy.

scholarly journals Lyme disease in the UK: clinical and laboratory features and response to treatment

2010 ◽  
Vol 10 (5) ◽  
pp. 454-457 ◽  
Author(s):  
Richard Dillon ◽  
Susan O'Connell ◽  
Stephen Wright
Keyword(s):  
Lyme Disease ◽  
Response To Treatment ◽  
Laboratory Features ◽  
The Uk
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