scholarly journals Predicting conversion to multiple sclerosis in patients with radiologically isolated syndrome: a retrospective study

2021 ◽  
Vol 14 ◽  
pp. 175628642110306
Author(s):  
Panagiotis Chaloulos-Iakovidis ◽  
Franca Wagner ◽  
Lea Weber ◽  
Lara Diem ◽  
Andrew Chan ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cell Count ◽  
Immune Cell ◽  
Univariate Analysis ◽  
Prediction Score ◽  
University Hospital ◽  
Cerebellar Hemisphere ◽  
Albumin Concentration ◽  
Radiologically Isolated Syndrome

Aims: To retrospectively analyse the Bernese radiologically isolated syndrome (RIS) cohort with the goal of developing a prediction score for conversion to multiple sclerosis (MS). Methods: A total of 31 patients with RIS were identified by screening medical records of neurological patients seen at the University Hospital of Bern between 2004 and 2017 for the diagnoses ‘radiologically isolated syndrome’ and ‘RIS’ adhering to 2009 Okuda recommendations. We analysed clinical, paraclinical and magnetic resonance imaging data during a maximum follow-up period of 3 years and identified significant predictors of conversion to MS. Results: Data were available for 31 patients meeting 2009 Okuda RIS criteria. During the 3 years of follow up, 5/31 RIS patients converted to relapsing-remitting (RR) MS. In our univariate analysis, gadolinium (Gd) enhancement, brainstem and cerebellar hemisphere lesions, immune cell count and albumin concentration in cerebrospinal fluid (CSF), and anti-nuclear antibody (ANA) positivity in serum were identified as significant predictors of conversion to MS. Integrating these factors into our ‘RIS–MS prediction score’ enabled us to calculate a cut-off for prediction of conversion to MS within 3 years with high specificity [1.0, 95% confidence interval (CI) 0.84–1.00) and acceptable sensitivity (0.6, 95% CI 0.17–0.93)]. Conclusion: Our RIS–MS prediction score, if validated in an independent cohort, integrating radiological (Gd enhancement, brainstem and cerebellar hemisphere lesions) and paraclinical factors (ANA in serum, cell count and albumin in CSF) could be a useful prognostic tool for early recognition of RIS patients with a high risk of clinical progression to MS.

scholarly journals Importance of Follow-Up Cerebrospinal Fluid Analysis in Cryptococcal Meningoencephalitis

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Thomas Skripuletz ◽  
Philipp Schwenkenbecher ◽  
Kaweh Pars ◽  
Matthias Stoll ◽  
Josef Conzen ◽  
...  
Keyword(s):  
Cell Count ◽  
Antifungal Therapy ◽  
Fatal Outcome ◽  
University Hospital ◽  
Cerebrospinal Fluid Analysis ◽  
Cryptococcal Meningoencephalitis ◽  
Fluid Analysis ◽  
Serious Infection ◽  
The Central Nervous System

Cryptococcal meningoencephalitis represents a serious infection of the central nervous system, where reliable prognostic factors during the disease course are needed. Twenty-one patients diagnosed with cryptococcal meningoencephalitis in a German university hospital from 1999 to 2013 were analysed retrospectively. CSF parameters were analysed prior to therapy and during antifungal treatment and were compared between patients who survived or deceased. Fifteen patients clinically improved after antifungal therapy, while six patients died. No differences were observed between the outcome groups for the CSF parameters cell count, lactate, total protein, and CSF-serum albumin quotients (QAlb). Follow-up examinations of serum cryptococcal antigen titer and CSF cell count have shown that these parameters cannot be used to monitor the efficacy of antifungal therapy as well. In contrast, the course of QAlb during therapy was indicative for the outcome as a possible prognostic marker. In patients with clinical improvement QAlb values were falling under therapy, while rising QAlb values were found in patients with fatal outcome indicating a continuing dysfunction of the blood-CSF barrier. In conclusion, our results indicate that, among the various CSF parameters, the course of QAlb presents a promising marker that might be used to monitor the efficacy of antifungal therapy.

scholarly journals Multilevel model on longitudinal data analysis in determinants of cd4 cell count among antiretroviral therapy attendant of hiv infected adults follow up in gondar teaching referral hospital, Gonder, Ethiopia.

2020 ◽  
Author(s):  
Kindu Kebede
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Count ◽  
Multilevel Model ◽  
Immune Cell ◽  
Hemoglobin Level ◽  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Cd4 Cell Count ◽  
Cd4 Cell

Abstract Background: Human immunodeficiency virus attacked an immune cell and the CD4 cell which is responsible for the body’s immune to infectious agents. Acquired immunodeficiency syndrome is one of the major public health problems in Sub-Saharan Africa including Ethiopia. The main objective of this study to identify the determinants of CD4 cell count among antiretroviral therapy attendants of infected adults follow up in Gonder teaching referral hospital, Gonder, Ethiopia implemented by SAS version 94. Methods: A retrospective cohort study was conducted on 216 regular follow up patients whose age greater than 14 years from December 1, 2012, to December 30, 2017. A multilevel model was used to identify the factors of CD4 cell count of patients and it considered variability between and within patients. Results: The mean with a standard deviation of weight, and a hemoglobin level of patients were 55.48(10.21), and 18.25(33.028) respectively. This study concluded that the variation for CD4 cell count existed between patients was 63 % and the remaining 37 % of variation existing within patients. In this study, the random coefficient time-varying covariate model was well fitted which shows weight and hemoglobin level were statistically significant predictors at a 5% level of significance for the log of CD4 cell count of patients. Conclusion: This study shows the hemoglobin level and weight of patients were statistically significant for the log of CD4 cell count of patients follow up in Gonder teaching referral hospital, Gonder, Ethiopia. Moreover, the result of the study shows that the log of CD4 count of patients increased when hemoglobin level and weight of patients increased. Hence, intervention should be given the ways to increase weight and hemoglobin levels of patients during follow up antiretroviral therapy.

Outcome and treatment of 62 Patients Aged Over 75 Years with Low Grade Non Hodgkin Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4854-4854
Author(s):  
Anne Parcelier ◽  
Isabelle Leduc ◽  
Lavinia Merlusca ◽  
Gandhi Damaj ◽  
Amandine Charbonnier ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
Low Grade ◽  
Albumin Concentration ◽  
Charlson Score ◽  
Non Hodgkin Lymphoma ◽  
Number Of Patients

Abstract Abstract 4854 The incidence of B cell Non Hodgkin Lymphoma (NHL) is steadily increasing with age and about 40% of cases occur in patients aged over 70 years. Some series have reported that low grade NHL lymphomas represent about 35% of all B NHL in elderly patients. However few data are available on the outcome of patients aged over 75 years. Methods We report in a retrospective study the outcome and management of 62 patients aged over 75 years and followed between Jan, 2006, and Jan, 2012 from 2 french centers (Amiens, Abbeville). The primary endpoint was overall survival (OS); secondary endpoints were response rates, progression free survival (PFS), and toxicity. Results 62 patients were registered with median age of 80,4 years (75–92): 31 patients with follicular lymphomas (FL) and 31 other low grade LNH: 15 Marginal Zone Lymphomas (MZL) of witch 11/31 splenic MZL, 1 gastric MALT, 5 lymphoplasmocytic and 10 lymphocytic lymphomas. At diagnostic, evaluation included: computed tomography scan for 46/62 patients (76%), bone marrow biopsy: 17/62 (27%), abdominal echography for 13/62 (24%) patients, echocardiography 24/62 (39%) and positron emission tomography for 11/62 (17%) patients. Charlson score (0–27) was evaluable for all of them with a median score of 2(0–4). At analysis, the median follow up was 23 months (range 0–79). Median FLIPI was 3 (0–5) for FL and median IPI 3(0–5) for other NHL. 21/31 (68%) FL patients and 27/31 (87%) other NHL had stage III or IV in the Ann Arbor classification. 47/62 (76%) patients received chemotherapy: 27/31 (89%) FL patients and 20/31 (65%) with other NHL. 12/62 (19%) patients were undergoing watchfull waiting (11 patients with other NHL, 1 FL); 1 patient refused chemotherapy; 1 FL patient died before any treatment. 29/47 (61%) treated patients received Rituximab (R). In the FL group, 12/31 (39%) received RCVP (C=Cyclophosphamide, V=Etoposide, P=Prednisone), 12/31 (39%) RCHOP-like regimen, 2/31 (6%) chlorambucil, 1/31 (3%) corticotherapy alone, 1/31 (3%) radiotherapy alone and 2/31 (6%) chemotherapy plus radiotherapy. For other low grade NHL, 2/31 (6%) received RCVP, 3/31 (9%) RCHOP-like regimen, 10/31 (32%) Chlorambucil, 1/31(1%) Fludarabine, 4/31(13%) orally cyclophosphamide and corticosteroid. 17 on 47 treated patients (36%) were in complete remission: 10/27 (37%) FL and 7/20 (35%) other NHL. The 2-years OS was 67%: 61% in the FL group and 74% other NHL (difference not significative); the 2-years PFS was 68%: 60% for FL and 77% for other low grade NHL. In univariate analysis, OS was affected by IPI (p=0,02) and FLIPI (p=0,008) (figure), but not by serum albumin concentration ≤ 35g/L, lymphopenia ≤1G/L, or Charlson score. 25 deaths were reported (14 FL and 11 other NHL): 9 lymphoma progressions, 6 sepsis, 3 attributed to cardiac failure and 1 to pulmonary embolism. The most frequent side-effects were hematological: febrile neutropenia (15 patients) and cardiac: acute failure (4 patients). Conclusion Our results in older patients with low grade lymphoma compare favorably with results in younger population. IPI and FLIPI only affect OS whereas geriatric evaluation with Charlson score is not relevant, possibly due to the small number of patients and short follow-up. These results prompt us to realize prospective studies in this population, reducing toxicity and improving efficacy with novel approach. Disclosures: No relevant conflicts of interest to declare.

Incidence and Risk Factors for Urolithiasis Recurrence After Endourological Management of Kidney Stones: A Retrospective Single-Centre Study

2021 ◽  
Author(s):  
Faris Baowaidan ◽  
Ahmed S. Zugail ◽  
Youssef Lyoubi ◽  
Thibaut Culty ◽  
Souhil Lebdai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factors ◽  
Univariate Analysis ◽  
Imaging Study ◽  
The Body ◽  
University Hospital ◽  
Urinary Stones ◽  
Stone Recurrence ◽  
Risk Factors For Recurrence

Abstract Purpose: Almost half of the patients have had recurrent nephrolithiasis despite undergoing effective treatment. Our objective is to determine the recurrence rate of lithiasis after endourological management of nephrolithiasis and identify the risk factors for these recurrences.Methods: Data were gathered retrospectively from all patients who were treated for nephrolithiasis by endourological management from May 2014 to January 2017 in our university hospital. All patients who had postoperative renal colic and/or stone upon an imaging study were considered to have recurrent disease. The patients were devised into two groups: with and without recurrence. Many variables were also compared between these two groups.Results: A total of 190 patients were included in our study. At the end of a median follow-up of 32 months (range, 13–61 months), 25.8% of patients had a recurrent stone. In the multivariate analysis, the risk factors for recurrence were diabetes (HR: 7.9; p <0.001) and smoking (HR: 3.5; p <0.029). While the body mass index greater than 25 kg/m2 (HR: 2; p <0.05) appears as a risk factor for recurrence only in the univariate analysis. However, age (HR: 0.96; p <0.003) and blood hypertension (HR: 0.37; p <0.027) were protective factors. The stone characteristics, urological history, and alcoholism had no apparent effect on stone recurrence.Conclusion: Stone recurrence is common after the management of urinary stones. In this study 25.8% of patients had recurred stone disease after endourological management with a median follow-up of 32 months. Our study findings showed that diabetes and smoking are risk factors for recurrence, while age and blood hypertension are protective factors that decreased the risk of recurrence.

scholarly journals P.070 Characteristics of patients presenting to a multiple sclerosis clinic in Hamilton, Ontario

2017 ◽  
Vol 44 (S2) ◽  
pp. S31-S31
Author(s):  
CB Tomkinson ◽  
JE Paulseth
Keyword(s):  
Multiple Sclerosis ◽  
Transverse Myelitis ◽  
Retrospective Chart Review ◽  
Initial Symptom ◽  
Limited Data ◽  
Mri Findings ◽  
Radiologically Isolated Syndrome ◽  
The Mean ◽  
First Time

Background: Multiple sclerosis (MS) is a neurological disease which is highly prevalent in Canada. To date limited data exists on the characteristics of this population in Ontario. Methods: A retrospective chart review was conducted of initial patient presentations to a MS clinic in 2011. Initial and follow-up consult notes were reviewed. Patients with a previous MS diagnosis were excluded. Results: 81 patients presented to the clinic for the first time in 2011. 41 were given alternative diagnoses (non-MS). Of the remaining 40 patients (MS group), 9 had clinically or radiologically isolated syndrome and 8 were in a progressive phase of MS. The mean age of presentation was 22 (MS group) and 47 (non-MS group). The most common initial symptom in both groups was a sensory disturbance. The mean initial EDSS in the MS group was 1.75 (0-6.5). In the MS group only 35% were put on disease modifying treatments. The most common reasons for exclusion of treatment were progressive disease phase, clinically or radiologically isolated syndrome, and unclear diagnosis. In the non-MS group, the most common diagnoses were non-specific MRI findings, transverse myelitis and peripheral nerve or muscular diagnoses. Conclusions: This retrospective review has outlined the characteristics of a MS population in Ontario.

Radiologically isolated syndrome: targeting miRNAs as prognostic biomarkers

Epigenomics ◽  
2020 ◽  
Vol 12 (23) ◽  
pp. 2065-2076
Author(s):  
María Muñoz-San Martín ◽  
Sandra Torras ◽  
René Robles-Cedeño ◽  
Maria Buxó ◽  
Imma Gomez ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Prognostic Factors ◽  
Prognostic Biomarkers ◽  
Circulating Mirnas ◽  
Radiologically Isolated Syndrome ◽  
Definite Multiple Sclerosis ◽  
Clinically Definite Multiple Sclerosis ◽  
Specific Profile

Aim: Some clinical and biological characteristics have been described as prognostic factors for clinical conversion into clinically definite multiple sclerosis in radiologically isolated syndrome (RIS) population. The aim of this study was to assess signatures of circulating miRNAs in those patients according to their conversion status after 5 years of follow-up. Patients & methods: OpenArray plates assessing 216 miRNA candidates were run in 15 RIS patients, and their relative abundances were analyzed. Results: A specific profile of deregulated circulating miRNAs (miR-144-3p, miR-448 and miR-653-3p in cerebrospinal fluid and miR-142-3p, miR-338-3p, miR-363-3p, miR-374b-5p, miR-424-5p, miR-483-3p in plasma) differentiated individuals who remained as RIS after 5 years of follow-up. Conclusion: Circulating miRNAs might be used as prognostic biomarkers for RIS patients.

scholarly journals Walk Your Talk: Real-World Adherence to Guidelines on the Use of MRI in Multiple Sclerosis

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1310
Author(s):  
Mario Tortora ◽  
Mario Tranfa ◽  
Anna Chiara D’Elia ◽  
Giuseppe Pontillo ◽  
Maria Petracca ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Real World ◽  
University Hospital ◽  
Slice Thickness ◽  
Adequate Quality ◽  
Standardized Reporting ◽  
On Line ◽  
Mri Sequences ◽  
Weighted Sequences

(1) Although guidelines about the use of MRI sequences for Multiple Sclerosis (MS) diagnosis and follow-up are available, variability in acquisition protocols is not uncommon in everyday clinical practice. The aim of this study was to evaluate the real-world application of MS imaging guidelines in different settings to clarify the level of adherence to these guidelines. (2) Via an on-line anonymous survey, neuroradiologists (NR) were asked about MRI protocols and parameters routinely acquired when MS patients are evaluated in their center, both at diagnosis and follow-up. Furthermore, data about report content and personal opinions about emerging neuroimaging markers were also retrieved. (3) A total of 46 participants were included, mostly working in a hospital or university hospital (80.4%) and with more than 10 years of experience (47.9%). We found a relatively good adherence to the suggested MRI protocols regarding the use of T2-weighted sequences, although almost 10% of the participants routinely acquired 2D sequences with a slice thickness superior to 3 mm. On the other hand, a wider degree of heterogeneity was found regarding gadolinium administration, almost routinely performed at follow-up examination (87.0% of cases) in contrast with the current guidelines, as well as a low use of a standardized reporting system (17.4% of cases). (4) Although the MS community is getting closer to a standardization of MRI protocols, there is still a relatively wide heterogeneity among NR, with particular reference to contrast administration, which must be overcome to guarantee an adequate quality of patients’ care in MS.

scholarly journals Telephone-based assessment of multiple sclerosis patients at Ain Shams University Hospital in the coronavirus disease 2019 pandemic

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Mohamed A. Abdel Hafeez ◽  
Dina A. Zamzam ◽  
Mahmoud S. Swelam ◽  
Alaa Abo Steit ◽  
Janet Masoud ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Motor Impairment ◽  
University Hospital ◽  
Healthcare Facilities ◽  
Significant Difference ◽  
Study Population ◽  
Psychological Impairment ◽  
Multiple Sclerosis Patients ◽  
Post Hoc

Abstract Background Assessment of multiple sclerosis (MS) patients during the era of the coronavirus disease 2019 (COVID-19) pandemic was confronted with the overwhelmed healthcare facilities in Egypt and fear of the patients to get infected while attending the follow-up visits. This study aimed to assess the value of telephone-based assessments in the follow-up of MS patients. It includes one hundred and five patients who participated in the study and completed 3 telephone-based assessments which are the Hauser Ambulation index, Multiple Sclerosis Neuropsychology Questionnaire (MSNQ), and Symptoms of Multiple Sclerosis Scale (SMSS). Results The Hauser Ambulation index was significantly correlated with the latest Expanded Disability Status Scale (EDSS) score done within 1 month from the telephone call (r=0.738, P<0.001). The analysis of MSNQ scores showed that one-third of the study population had evidence of cognitive and/or neuropsychological impairment. Post hoc analysis regarding the cognitive and psychological impairment component of SMSS revealed that the patients who answered “Never” had significantly lower MSNQ scores compared to those who answered “Sometimes” (P=0.016), “Often” (P=0.022), and “Always” (P=0.001). The comparison of the EDSS scores of the patients regarding the sensory-motor impairment component of SMSS showed a non-significant difference. Conclusion The Hauser Ambulation index may be a reliable telephone-based tool for the assessment of physical disability. The MSNQ and the cognitive and psychological impairment component of SMSS can be used for the assessment of cognitive and psychological impairment among patients with MS.

scholarly journals Prevalence of radiologically isolated syndrome in a pediatric population-based cohort: A longitudinal description of a rare diagnosis

2021 ◽  
pp. 135245852198922
Author(s):  
CL de Mol ◽  
AL Bruijstens ◽  
PR Jansen ◽  
MHG Dremmen ◽  
YYM Wong ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
General Population ◽  
Confidence Interval ◽  
Pediatric Population ◽  
Population Based ◽  
Radiologically Isolated Syndrome ◽  
Demyelinating Lesions ◽  
Rare Diagnosis

Background: Radiologically isolated syndrome (RIS) is typified by multiple sclerosis (MS)-like lesions on imaging, without clinical MS symptoms. The prevalence of pediatric RIS is largely unknown. Objective: The objective of the study is to provide an estimated RIS prevalence in a population-based cohort of children. Methods: We used data from the Generation R study to identify the childhood RIS prevalence. Results: In 5238 participants, only one RIS case was identified (prevalence: 0.02%; 95% confidence interval (CI): 0.00–0.11). During a 62-month follow-up, imaging examinations showed accrual of new focal demyelinating lesions; however, no clinical MS symptoms occurred. Conclusions: This study shows that the occurrence of RIS in children from the general population is rare.

scholarly journals H3K27me3 loss indicates an increased risk of recurrence in the Tübingen meningioma cohort

2020 ◽  
Author(s):  
Felix Behling ◽  
Christina Fodi ◽  
Irina Gepfner-Tuma ◽  
Kristina Kaltenbach ◽  
Mirjam Renovanz ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Utility ◽  
Univariate Analysis ◽  
University Hospital ◽  
Rank Test ◽  
Subtotal Resection ◽  
Who Grade ◽  
Risk Of Recurrence ◽  
Increased Risk

Abstract Background A loss of the trimethylation of lysine 27 of histone H3 (H3K27me3) in meningioma has been recently suggested as an adjunct to identify subsets of higher risk of recurrence. The aim of the present study was to assess the prognostic value of H3K27 histone trimethylation and its potential clinical utility in the “Tübingen meningioma cohort”. Methods Patients who underwent meningioma resection between 10/2003 and 1/22015 at the University Hospital Tübingen were included. Immunohistochemical stainings for H3K27me3 and the proliferation marker MIB1 were assessed and correlated with clinical parameters using univariate and multivariate cox regressions as well as Pearson’s chi-squared and log-rank test. Results Overall, 1268 meningiomas were analyzed with a female to male ratio of 2.6 and a mean age of 58.7 years (range 8.3 – 91.0). With 163 cases lost to follow up, 1103 cases were available for further analysis with a mean follow-up of 40.3 months (range 1.1 – 186.3). Male gender, younger age, intracranial tumor localization, progressive tumor, subtotal resection, higher WHO grade, increased MIB1 rate and loss of H3K27me3 were significant negative prognostic factors in the univariate analysis. H3K27me3 status and all other prognostic factors, except age and tumor location, remained significant in the multivariate model. Furthermore, adjuvant radiotherapy was an independent positive prognostic factor. Conclusions Loss of H3K27me3 combined with MIB1 labeling index are independent prognostic factors in meningioma. These data from the Tübingen meningioma cohort support the clinical utility of H3K27me3 immunohistochemical staining in meningioma and its integration into the routine histopathological workup.

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