scholarly journals The clinical course of a 79-year-old stroke survivor in the setting of a late-onset COVID-19 infection

2022 ◽  
Vol 10 ◽  
pp. 2050313X2110666
Author(s):  
Salih Ahmeti ◽  
Violeta Lokaj-Berisha ◽  
Besa Gacaferri Lumezi
Keyword(s):  
Clinical Course ◽  
Late Onset ◽  
Clinical Status ◽  
Recovery Period ◽  
Antiviral Drug ◽  
Stroke Survivor ◽  
Therapeutic Agents ◽  
Clinical Activity ◽  
Hospitalization Period ◽  
Old Left

Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (COVID-19), no specific antiviral drug has been proven effective for the treatment of patients with severe complications. However, a nucleoside prodrug remdesivir (GS-5734) was recently approved by the Food and Drug Administration for the treatment of hospitalized patients with COVID-19. Preclinical data in animal models of coronavirus diseases have demonstrated that early treatment with remdesivir leads to improved survival and decreased lung injury. Recent clinical data have demonstrated the clinical activity of remdesivir in terms of shorter recovery period and higher odds of improved clinical status in patients with COVID-19. Here, the story of a 79-year-old patient, with 11-year-old left hemiparesis, concomitant cardiovascular disease, infected with SARS-CoV-2, and the clinical improvement after administration of remdesivir during his second hospitalization period is reported.

scholarly journals Evaluating the Efficacy of Therapies in Patients With Coronavirus Disease 2019

2020 ◽  
Author(s):  
Dan-Yu Lin ◽  
Donglin Zeng ◽  
Joseph J Eron
Keyword(s):  
Clinical Trials ◽  
Clinical Course ◽  
Clinical Status ◽  
Therapeutic Agents ◽  
Simulation Studies ◽  
Specific Change ◽  
Extensive Simulation ◽  
Clinical Events ◽  
Full Picture

Abstract There is a proliferation of clinical trials worldwide to find effective therapies for patients diagnosed with coronavirus disease 2019 (COVID-19). The endpoints that are currently used to evaluate the efficacy of therapeutic agents against COVID-19 are focused on clinical status at a particular day or on time to a specific change of clinical status. To provide a full picture of the clinical course of a patient and make complete use of available data, we consider the trajectory of clinical status over the entire follow-up period. We also show how to combine the evidence of treatment effects on the occurrences of various clinical events. We compare the proposed and existing endpoints through extensive simulation studies. Finally, we provide guidelines on establishing the benefits of treatments.

scholarly journals Remdesivir Treatment for COVID 19 in Pregnant Patients with Moderate to Severe Symptoms: Serial Case Report

2021 ◽  
Vol 13 (2) ◽  
pp. 437-443
Author(s):  
Yudianto Budi Saroyo ◽  
Amanda Rumondang ◽  
Irene Sinta Febriana ◽  
Achmad Kemal Harzif ◽  
Rima Irwinda
Keyword(s):  
Adverse Effects ◽  
Adverse Events ◽  
Pregnant Women ◽  
Clinical Symptoms ◽  
Recovery Period ◽  
Rapid Improvement ◽  
Major Health Problem ◽  
Hospitalization Period ◽  
Duration Of Hospitalization ◽  
Novel Coronavirus

Introduction: Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection that causes novel Coronavirus Disease 2019 (COVID-19) has become a major health problem worldwide and been declared a pandemic since March 2020 by WHO. One special population that poses a challenge is pregnant women with COVID-19. There have not been many studies related to COVID-19 in pregnancy. In this study, we present five serial cases of Remdesivir treatment for COVID-19 in pregnant women with moderate to severe symptoms. Case Illustration: We briefly describe five serial cases being treated with Remdesivir therapy during hospitalization. Four cases were delivered by cesarean section, and one was delivered vaginally in gestation week 37. All cases showed a shortened duration of hospitalization, rapid improvement in clinical symptoms, and no adverse events were observed in mothers, fetuses, and neonates. Discussion: Remdesivir, an inhibitor RNA Polymerase, has been used in COVID-19 treatment and is known to shorten recovery time in nonpregnant women. Some studies have shown no adverse effects on Remdesivir for pregnant women. Based on randomized control trial (RCT) during the Ebola epidemic, Remdesivir was safe to use for pregnant women. All cases showed reduced hospitalization time and better clinical outcomes without maternal, fetal, or neonatal adverse events. Conclusion: Remdesivir protocol for pregnant women with moderate to severe symptoms of COVID-19 has resulted in better clinical improvement with a shorter recovery period and no adverse effects during the hospitalization period. Further studies and RCT are warranted to evaluate the biosafety and effects of Remdesivir in pregnant women.

Mathematical Examination of Dual Individualization Principles (III): Development of a Scoring System for Pneumonia Staging and Quantitation of Response to Antibiotics: Results in Cefmenoxime-Treated Patients

1992 ◽  
Vol 26 (11) ◽  
pp. 1358-1365 ◽  
Author(s):  
Aileen Luzier ◽  
Thomas F. Goss ◽  
Thomas J. Cumbo ◽  
Jerome J. Schentag
Keyword(s):  
Clinical Improvement ◽  
Antimicrobial Therapy ◽  
Scoring System ◽  
Time Course ◽  
Clinical Course ◽  
Clinical Status ◽  
Gram Stain ◽  
Retrospective Data Collection ◽  
The Mean ◽  
Important Time

OBJECTIVE: In order to quantitatively express the important, time-related aspects of response to antimicrobial therapy in patients with pneumonia, we required validated measures of the time course of events during the infection. To quantitate the changes in clinical status in relation to changes in cultures, we developed a scoring system to be used for patient assessment during therapy. DESIGN: Retrospective data collection, prospective analysis of factors. SETTING: Intensive care unit, Millard Fillmore Hospital. PATIENTS: Twenty-eight patients with nosocomial pneumonia. MAIN OUTCOME MEASURES: Clinical parameters were assessed daily for the duration of antimicrobial therapy. Using linear regression, the rate of clinical change in each patient treated was quantified. Eradication of the pathogen was determined by serial cultures of the infection site. RESULTS: Seventeen of the patients demonstrated eradication of the organism, and 11 demonstrated persistence of the pathogen (7 were considered colonization). The system described the patients at baseline in that the mean baseline scores were similar in both groups of patients (p=0.79). Patients in whom the pathogen was eradicated showed a rate of clinical improvement significantly different from those who had persistence of the organism (p=0.04). In patients demonstrating eradication, the time to eradication inversely correlated with the rate of clinical improvement (p<0.05). Of the ten parameters descriptive of the disease, those most sensitive to change after eradication of bacteria were body temperature, bacterial Gram stain, white blood cell Gram stain, and volume of sputum. CONCLUSIONS: In this set of pneumonia patients, the scoring system effectively quantified both baseline and time-related changes in clinical status. The system distinguished between the clinical course of the patient with organism eradication versus organism persistence. A shorter time to eradication was associated with a better clinical response. Prospective study of the system will determine its sensitivity.

Outcome of esophageal atresia: inborn versus outborn patients

2022 ◽  
Author(s):  
Denise Schlee ◽  
Till-Martin Theilen ◽  
Henning Fiegel ◽  
Martin Hutter ◽  
Udo Rolle
Keyword(s):  
Esophageal Atresia ◽  
Primary Anastomosis ◽  
Clinical Status ◽  
Special Focus ◽  
High Morbidity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Hospitalization Period ◽  
Volume Outcome ◽  
Centralized Care

Summary Esophageal atresia (EA) is a rare congenital disease which is usually not of the detected prenatally. Due to the lack of prenatal diagnosis, some newborns with EA are born outside of specialized centers. Nevertheless, centralized care of EA has been proposed, even if a clear volume–outcome association in EA management remains unconfirmed. Furthermore, whether outcomes differ between outborn and inborn patients with EA has not been systematically investigated. Therefore, this single-center, retrospective study aimed to investigate EA management and outcomes with a special focus on inborn versus outborn patients. The following data were extracted from the medical records of infants with EA from 2009 to 2019: EA type, associated anomalies, complications, and long-term outcome. Patients were allocated into inborn and outborn groups. Altogether, 57 patients were included. Five patients were excluded (referral before surgery, loss of data, death before surgery [n = 1], and incorrect diagnosis [diverticulum, n = 1]). Among all patients, the overall survival rate was 96%, with no mortalities among outborn patients. The overall hospitalization period was shorter for outborn patients. The median follow-up durations were 3.8 years and 3.2 years for inborn and outborn patients, respectively. Overall, 15% of patients underwent delayed primary anastomosis (long-gap atresia [n = 4] and other reasons [n = 4]). Early complications included three anastomotic leakages and one post-operative fistula; 28% of patients developed strictures, which required dilatation, and 38% of patients showed relevant gastroesophageal reflux, which required fundoplication, without any differences between the groups. The two groups had comparable low mortality and expected high morbidity with no significant differences in outcome. The outborn group showed nonsignificant trends toward lower morbidity and shorter hospitalization periods, which might be explained by the overall better clinical status.

Late-onset versus early-onset systemic lupus: characteristics and outcome in a national multicentre register (RELESSER)

Rheumatology ◽  
2020 ◽  
Author(s):  
Anne Riveros Frutos ◽  
Susana Holgado ◽  
Arantza Sanvisens Bergé ◽  
Irma Casas ◽  
Alejandro Olivé ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Early Onset ◽  
Clinical Course ◽  
Late Onset ◽  
Immunosuppressive Agents ◽  
Diagnostic Delay ◽  
Clinical Manifestations ◽  
Diagnostic Errors ◽  
Systemic Lupus ◽  
Female Ratio

Abstract Objective The aim of the present study was to describe the demographic, clinical and immunological characteristics of patients with late-onset (≥50 years) SLE vs patients with early-onset SLE (&lt;50 years). Methods We performed a cross-sectional retrospective study of 3619 patients from the RELESSER database (National Register of Patients with Systemic Lupus Erythematosus of the Spanish Society of Rheumatology). Results A total of 565 patients (15.6%) were classified as late-onset SLE and 3054 (84.4%) as early-onset SLE. The male-to-female ratio was 5:1. Mean (s.d.) age at diagnosis in the late-onset group was 57.4 (10.4) years. At diagnosis, patients with late-onset SLE had more comorbid conditions than patients with early-onset SLE; the most frequent was cardiovascular disease (P &lt;0.005). Furthermore, diagnostic delay was longer in patients with late-onset SLE [45.3 (3.1) vs 28.1 (1.0); P &lt;0.001]. Almost all patients with late-onset SLE (98.7%) were Caucasian. Compared with early-onset SLE and after adjustment for time since diagnosis, patients with late-onset SLE more frequently had serositis, major depression, thrombotic events, cardiac involvement and positive lupus anticoagulant values. They were also less frequently prescribed immunosuppressive agents. Mortality was greater in late-onset SLE (14.3% vs 4.7%; P &lt;0.001). Conclusion Late-onset SLE is insidious, with unusual clinical manifestations that can lead to diagnostic errors. Clinical course is generally indolent. Compared with early-onset disease, activity is generally reduced and immunosuppressants are less commonly used. Long-term prospective studies are necessary to determine whether the causes of death are associated with clinical course or with age-associated comorbidities in this population.

scholarly journals The Plasmatic Aldosterone and C-Reactive Protein Levels, and the Severity of Covid-19: The Dyhor-19 Study

2020 ◽  
Vol 9 (7) ◽  
pp. 2315 ◽  
Author(s):  
Orianne Villard ◽  
David Morquin ◽  
Nicolas Molinari ◽  
Isabelle Raingeard ◽  
Nicolas Nagot ◽  
...  
Keyword(s):  
Inflammatory Responses ◽  
Clinical Course ◽  
Clinical Status ◽  
Plasma Renin ◽  
Ordinal Scale ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein

Background. The new coronavirus SARS-CoV-2, responsible for the Covid-19 pandemic, uses the angiotensin converting enzyme type 2 (ACE2), a physiological inhibitor of the renin angiotensin aldosterone system (RAAS), as a cellular receptor to infect cells. Since the RAAS can induce and modulate pro-inflammatory responses, it could play a key role in the pathophysiology of Covid-19. Thus, we aimed to determine the levels of plasma renin and aldosterone as indicators of RAAS activation in a series of consecutively admitted patients for Covid-19 in our clinic. Methods. Plasma renin and aldosterone levels were measured, among the miscellaneous investigations needed for Covid-19 management, early after admission in our clinic. Disease severity was assessed using a seven-category ordinal scale. Primary outcome of interest was the severity of patients’ clinical courses. Results. Forty-four patients were included. At inclusion, 12 patients had mild clinical status, 25 moderate clinical status and 7 severe clinical status. In univariate analyses, aldosterone and C-reactive protein (CRP) levels at inclusion were significantly higher in patients with severe clinical course as compared to those with mild or moderate course (p < 0.01 and p = 0.03, respectively). In multivariate analyses, only aldosterone and CRP levels remained positively associated with severity. We also observed a positive significant correlation between aldosterone and CRP levels among patients with an aldosterone level greater than 102.5 pmol/L. Conclusions. Both plasmatic aldosterone and CRP levels at inclusion are associated with the clinical course of Covid-19. Our findings may open new perspectives in the understanding of the possible role of RAAS for Covid-19 outcome.

Clostridium difficile infection in patients hospitalized in the gastroenterology ward – retrospective analysis

2018 ◽  
Vol 90 (1) ◽  
pp. 7-12
Author(s):  
Kinga Podlaszewska ◽  
Ewa Małecka‑Panas ◽  
Anita Gąsiorowska
Keyword(s):  
Clostridium Difficile ◽  
Retrospective Analysis ◽  
Clostridium Difficile Infection ◽  
Clinical Course ◽  
Significant Risk ◽  
Epidemiological Data ◽  
Significant Risk Factor ◽  
Medical Documentation ◽  
Hospitalization Period ◽  
Future Outbreak

INTRODUCTION. Clostridium difficile associated colitis became over last years a worldwide medical issue. It involves patients of the Polish hospitals too. The aim of the study was the analysis of CDAD incidence and the course of infection in Gastroenterology Ward of Regional Specialist Hospital of Zgierz, 2012-2015. MATERIAL AND METHODS. Retrospective analysis of the medical documentation of 79 patients with CDAD was performed. Demographic and epidemiological data and the clinical course of infection were analyzed. RESULTS. The study group comprised of women in 59,5% and men in 40,5%. The patients’ average age was 70,5 years. The average hospitalization period was 10,3 days. CDAD infection seasonality was proved, with statistically significant peak in springtime. 73% of patients were previously hospitalized and 85% - had co-morbidities. 76% of patients underwent antibiotherapy, whilst 29% - used PPI prior to CDAD diagnosis. 50,6% of patients had severe CDAD diagnosed. The recurrence reached 14%. In 19% of patients CDAD resulted in death. DISCUSSION. The results of the study confirm increase of the incidence of the patients with CDAD in Gastroenterology Ward over 4-years’ observation. The prevalence was higher among 65+ patients, after prior hospitalization and antibiotherapy. The co-morbidities was a significant risk factor, especially common in severe cases. CONCLUSION. The results we obtained confirm substantial importance of Clostridium difficile infection leading to antibiotherapy- associated diarrhea among adults, causing prolonged hospitalization, increased prevalence and mortality of patients. Getting to know and minimizing the risk factors will prevent the future outbreak of the disease.

Acute coronary syndrome without ST segment elevation: possibilities for predicting the clinical course at the posthospital (6 and 12 months) stage

2016 ◽  
Vol 94 (3) ◽  
pp. 205-210
Author(s):  
Zinaida D. Mikhailova ◽  
M. A. Shalenkova ◽  
P. F. Klimkin
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Course ◽  
Regression Equations ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Logistic Analysis ◽  
St Segment ◽  
Increased Risk ◽  
Hospitalization Period ◽  
Sodium And Potassium

Aim. To measure blood IL-6, IL-10, creatinine levels, calcium, sodium and potassium in blood and saliva, melatonin in urine of patients with acute coronary syndrome without ST segment elevation for the prediction of the clinical course at the posthospital stage. Material and methods. The study included 93patients with complicated (n=46) and uncomplicated (n=47) coronary syndrome without ST segment elevation. Blood IL-6, IL-10, creatinine levels, calcium, sodium and potassium in blood and saliva, melatonin in urine were determined on days 1-3 after hospitalization. 6-hydroxymelatonin was measured by HPLC in urine collected between 23 p.m. and 8 a.m., melatonin i in urine collected between 8 a.m. and 23 p.m. Results. Complicated coronary syndrome was associated with increased levels of melatonin (night), blood IL-10 and Na, salivary Na and Ca while the uncomplicated condition with increased blood melatonin (daytime), IL-6, creatinine, Ca, Na, K, and salivary K. 90 patients were followed up within 12 months after discharge. End-points developed in 36 (40%) of Original investigations them. Logistic analysis yielded variables and 2 logistic regression equations The data on night melatonin +5 and +4 were included in ROC analysis. The night melatonin +5 values over 0.7453 were associated with increased risk of complications in the post-hospital period (6 months) and values of0.7453 or lower with the enhanced probability of uncomplicated clinical course. Prognostic sensitivity was estimated at 90%, specificity at -54.39%. The night melatonin +4 values over 0.2903 were associated with increased risk of complications in the post-hospital period (12 months) and values of 0.2903 or lower with the enhanced probability of uncomplicated clinical course. Prognostic sensitivity was estimated at 77.8%, specificity at -59.26%. Conclusion. The night melatonin +5 and +4 models can be used to predict the clinical course of acute coronary syndrome during 6 and 12 months of the post-hospitalization period.

Psychosis and dementia: risk factor, prodrome, or cause?

2017 ◽  
Vol 30 (2) ◽  
pp. 209-219 ◽  
Author(s):  
Corinne E. Fischer ◽  
Luis Agüera-Ortiz
Keyword(s):  
Psychotic Disorders ◽  
Clinical Course ◽  
Late Onset ◽  
Early Recognition ◽  
Neuropsychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Functional Psychosis ◽  
Dementia Risk ◽  
Treatment Considerations ◽  
The Impact

ABSTRACTBackground:Progression of dementia is often associated with the emergence of neuropsychiatric symptoms (NPS), though there is recent evidence that NPS may occur in prodromal dementia (PrD) and impact clinical course. Mood and anxiety symptoms are the NPS that tend to occur most frequently in PrD and thus have been most extensively studied. Comparatively, there has been little focus on psychotic symptoms in PrD.Methods:The authors review the existing literature on psychosis in PrD, including the functional psychosis of early and late onset, with a focus on epidemiology, phenomenology, and clinical course and treatment considerations.Results:Patients with psychotic disorders at baseline such as schizophrenia may be more at risk for developing dementia over time, although this is not completely clear. Psychotic symptoms are likely more common in PrD than previously understood based on factor analysis studies, although they are much more common in established dementia. Variability in findings may reflect the heterogeneous nature of PrD studies to date and the lack of inclusion of patients with late onset psychosis in most clinical studies. The presence of psychosis in patients with PrD may be associated with a worse prognosis in terms of mortality and conversion to dementia.Conclusions:Research to date suggests that psychosis in PrD may be more common than previously thought and impact clinical course negatively. Future studies incorporating patients with late onset psychotic disorders, and focusing on the impact of early recognition and treatment, are required to more fully understand the role of psychosis in PrD.

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