A pooled analysis of 1,546 patients with AIDS-related lymphoma (ARL): An assessment of prognostic factors by treatment era.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 8524-8524
Author(s):  
Stefan K. Barta ◽  
Michael Samuel ◽  
Xiaonan Xue ◽  
Jeanette Y. Lee ◽  
Nicolas Mounier ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Prognostic Significance ◽  
Pooled Analysis ◽  
Cd4 Count ◽  
Significant Prognostic Factor ◽  
Poor Prognostic Factor ◽  
Risk Of Death ◽  
Time Period ◽  
Increased Risk

8524 Background: Management of ARL evolved in the last 2 decades. We previously reported prognostic factors in a pooled analysis of 1,546 patients with ARL, and here present analysis of these factors over time to determine if their prognostic significance has changed. Methods: Following a systematic review, we assembled individual patient data from 19 prospective phase 2/3 clinical trials (published 1993-2010) for ARL (n=1,546). Factors analyzed include age, sex, histology, CD4 count, prior history of (h/o) AIDS, & age-adjusted (aa) IPI. The endpoint was overall survival (OS) expressed as the hazard ratio (HR) for death. We used separate Cox proportional hazard models adjusted for the other covariates to determine the significance of each variable in the following time periods: pre-cART [combination antiretroviral therapy] (<1996; n=388), early cART (‘96-‘00; n=694), modern cART (‘01-‘04; n=282) & current era (‘05-‘10; n=182). We also combined all enrollments in one Cox model to test for difference in association with OS over enrollment periods. Results: Rituximab use was limited in the early cART (20%) compared with the modern cART (83%) and current (93%) eras. Histology & sex were not significantly associated with OS in any time period. Increasing age was associated with worse OS in the pre-cART (HR 1.02; p<0.01) and current (HR 1.05, p=0.04) eras. A prior h/o AIDS increased risk of death during early cART (HR 1.31, p=0.047) but was not significant after 2000. Meanwhile, baseline CD4 count <50 was a poor prognostic factor during early (HR 1.78, p<0.01) and modern cART (HR 2.76, p=0.001) eras, but not in the current era. The aaIPI predicted worse OS in each time period (pre-cART: HR 1.54, p<0.0001; early cART: HR 1.49, p<0.0001; modern cART: HR 1.52, p<0.01; current era: HR 2.34, p<0.0001). No significant interaction between each prognostic factor with enrollment was found. Conclusions: In this pooled analysis of 1,546 patients with ARL, aaIPI was the only consistently significant prognostic factor and its effect was magnified in the current era. HIV-related factors gained prognostic relevance in the early and modern cART era but may not be as relevant with current treatment strategies.

scholarly journals Combination of GP88 Expression in Tumor Cells and Tumor-Infiltrating Immune Cells Is an Independent Prognostic Factor for Bladder Cancer Patients

Cells ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 1796
Author(s):  
Markus Eckstein ◽  
Verena Lieb ◽  
Rudolf Jung ◽  
Danijel Sikic ◽  
Katrin Weigelt ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Prognostic Factor ◽  
Tumor Cells ◽  
Immune Cells ◽  
Potential Candidate ◽  
Poor Prognostic Factor ◽  
Risk Of Death ◽  
Increased Risk ◽  
Muscle Invasive ◽  
Disease Specific

Urothelial bladder cancer (BCa) is the ninth most commonly diagnosed cancer worldwide and accounts for approximately 3% of global cancer diagnoses. We are interested in prognostic markers that may characterize tumor cells (TCs) and immune cells (ICs) and their relationship in BCa. A potential candidate marker that meets these criteria is progranulin (GP88), which is expressed separately in TCs and ICs. We analyzed GP88 expression by immunohistochemistry (IHC) in 196 muscle-invasive BCa samples using a tissue microarray. The immunoreactive score for GP88 staining in TCs and the percentage of GP88-positive ICs was determined. An easy cutoff for the staining status of TCs (positive vs. negative) and ICs (0% vs. >0%) and, more generally, negative vs. positive GP88 staining could be applied. We detected 93 patients (47.4%) and 92 patients (46.9%) with GP88-positive TCs or ICs, respectively. The IHC results were correlated with clinicopathological and survival data. Positive GP88 staining in TCs appeared to be an independent poor prognostic factor for disease-specific survival (DSS) (RR (relative risk) = 1.74; p = 0.009) and recurrence-free survival (RFS) (RR = 1.92; p = 0.002). In contrast, negative GP88 staining in ICs was an independent negative predictor for overall survival (OS) (RR = 2.18; p < 0.001), DSS (RR = 2.84; p < 0.001) and RFS (RR = 2.91; p < 0.001) in multivariate Cox’s regression analysis. When combining GP88 staining in TCs and ICs, a specific combination of GP88-positive TCs and GP88-negative ICs was associated with a 2.54-fold increased risk of death, a 4.21-fold increased risk of disease-specific death and a 4.81-fold increased risk of recurrence compared to GP88-negative TCs and GP88-positive ICs. In summary, GP88 positivity in TCs is a negative prognostic factor for DSS and RFS. In addition, GP88 positivity can mark ICs that are associated with a good prognosis (OS, DSS and RFS). The combination of GP88 staining in TCs and ICs appears to be a significant independent prognostic biomarker in muscle-invasive BCa.

Prognostic impact of chemoradiation-related lymphopenia in patients with gastric and gastroesophageal cancer.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 249-249
Author(s):  
Daniel W Kim ◽  
Grace Lee ◽  
Theodore S. Hong ◽  
Guichao Li ◽  
Eric Roeland ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Cox Model ◽  
Gastroesophageal Junction ◽  
Concurrent Chemotherapy ◽  
Rank Test ◽  
Prognostic Impact ◽  
Poor Prognostic Factor ◽  
Risk Of Death ◽  
Increased Risk ◽  
Ecog Ps

249 Background: Limited data exists on how chemoradiation (CRT)-induced lymphopenia affects survival outcomes in patients with gastric and gastroesophageal junction (GEJ) cancer. We evaluated the association between severe lymphopenia and its association with survival in gastric and GEJ cancer patients treated with CRT. We hypothesized that severe lymphopenia would be a poor prognostic factor. Methods: We performed a retrospective analysis of 154 patients with stage 1-3 gastric or GEJ cancer who underwent CRT at our institution. Patients underwent photon-based radiation therapy (RT) with a median dose of 50.4 Gy (IQR 45.0-50.4 Gy) over 28 fractions and concurrent chemotherapy (CTX) with carboplatin/paclitaxel, 5-fluorouracil based regimen, or capecitabine. 49% received CTX prior to RT. 84% underwent surgical resection, 57% pre-CRT and 26% post-CRT. Absolute lymphocyte count (ALC) at baseline and at 2 months since initiating RT were analyzed. Severe lymphopenia, defined as Grade 3 or worse lymphopenia (ALC < 0.5 k/μl), was analyzed for any association with overall survival (OS). Results: Median time of follow up was 48 months. Median age was 65. 77% were male and 86% were Caucasian. ECOG PS was 0 or 1 in 90% and 2 in 10%. Tumor location was stomach in 38% and GEJ in 62%. Timing of CRT was preoperative among 68% and postoperative among 32%. The median ALC at baseline for the entire cohort was 1.6 k/ul (range 0.3-7.0 k/ul). At 2 months post-CRT, 49 (32%) patients had severe lymphopenia. Patients with severe lymphopenia post-CRT had a slightly lower baseline TLC compared to patients without severe lymphopenia (median TLC 1.4 k/ul vs. 1.6 k/ul; p = 0.005). There were no differences in disease and treatment characteristics between the two groups. On the multivariable Cox model, severe lymphopenia post-CRT was significantly associated with increased risk of death (HR = 3.99 [95% CI 1.55-10.28], p = 0.004). ECOG PS 2 (HR = 34.97 [95% CI 2.08-587.73], p = 0.014) and postoperative CRT (HR = 5.55 [95% CI 1.29-23.86], p = 0.021) also predicted worse OS. The 4-year OS among patients with severe lymphopenia was 41% vs. 61% among patients with vs. without severe lymphopenia (log-rank test p = 0.041). Conclusions: Severe lymphopenia significantly correlated with poorer OS in patients with gastric or GEJ cancer treated with CRT. CRT-induced lymphopenia may be an important prognostic factor for survival in this patient population. Closer observation in high-risk patients and treatment modifications may be potential approaches to mitigating CRT-induced lymphopenia.

Triple negative breast cancer: An institutional review

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22214-e22214
Author(s):  
M. Dioca ◽  
M. Savignano ◽  
L. Gimenez ◽  
L. Marino ◽  
C. Delfino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factor ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Menopausal Status ◽  
Stage I ◽  
Poor Prognostic Factor ◽  
Risk Of Death ◽  
Increased Risk

e22214 Background: Triple negative breast cancer (BC) is a distinct group of tumors that show common but heterogeneous morphologic, genetic, and immunophenotypic features. Despite differences in the definition and prevalence, it comprises 8% to 20% of all breast cancers and is associated with an aggressive clinical course with significant risk of either local or systemic relapse and subsequent increased risk of death on short term follow up (particularly in the first 5 years).We study the pathological characteristics and the clinical outcome of a cohort of 77 triple negative BC patients (pts) diagnosed at our Institution. Methods: Between January 1999 and September 2008, 77 (stage I to III) triple negative BC pts. were retrospectively analyzed. All pts had their receptor status, Her neu, ck-5, ck-6 and staining for EGFR by the same pathologist. Pathological parameters (Pp) analyzed were: status of axilary lymph nodes (LN), nuclear grade, histologic grade, mitotic index and vascular invasion and the use of antraciclins in the adjuvant setting. Univariate and multivariate analysis (proporcional hazard regression Cox model) for the Pp associated with relapse, and the log rank test to compare two curves of each Pp for disease free survival (DFS), and overall survival (OS) were performed. Results: The median age was 57.8 years (range 30–86 years).The median follow up time was 57.7 months (range, 4- 241). From 77 Pts. analized, 65 (84.4%) were basal-like and 43 (64.6%) of those were GH3. Stage at the time of presentation was: 16 (20,7%) stage I; 40 (51,9%) stage II; 21 (27,7%) stage III. Pre-menopausal status was 29,48% (23 pts.), and 61% (47 pts) were LN negative. Overall, relapse rate was 38.5 % (n= 30), 63 Pts (81.8%) are still alive. Median DFS was not reached. Global DFS and OS were 59% and 79% respectively, and status of LN was the only prognostic factor. LN- vs LN+ DFS (p< 00.02) and OS p (< 0.02).All others Pp analyzed were not statistically significative. Conclusions: Despite previous studies have demonstrated that triple negative is an independent marker of poor prognosis in BC as a whole, in the LN-negative, and LN-positive groups, in this basal like population only positive LN was an independent poor prognostic factor for DFS and OS. No significant financial relationships to disclose.

scholarly journals Age Variance in the Survival of United States Pediatric Leukemia Patients (1973–2006)

2012 ◽  
Vol 2012 ◽  
pp. 1-10
Author(s):  
L. Holmes ◽  
F. Opara ◽  
M. Des-Vignes-Kendrick ◽  
J. Hossain
Keyword(s):  
United States ◽  
Prognostic Factors ◽  
Prognostic Factor ◽  
Infants And Children ◽  
Age At Diagnosis ◽  
Age Group ◽  
Pediatric Leukemia ◽  
Risk Of Death ◽  
Significant Variability ◽  
Increased Risk

Background. Age at diagnosis remains an important prognostic factor in pediatric leukemia. However, it is not fully understood which prognostic factors are related to its effect on survival. This study aimed to assess the effect of age at diagnosis on pediatric leukemia survival in the United States (US). Methods. We utilized the Surveillance Epidemiology and End Results (SEER) data of the diagnosed pediatric leukemia patients (n=15215) from 1973–2006. Life table, Kaplan-Meier, log rank test, and Cox proportional hazard methods were used to examine the data. Results. The overall 5-year survival was 67.9%. Infants and children of 18 and 19 years had the highest risk of dying, with a rapid declining risk of death at age of 1 year that continued until age of 3 years and thereafter a steady trend of increased risk of death. The increased risk of dying was associated with boys, T-cell type and more than one primary tumor, P < 0.0001. There was significant variability in survival by the age group at diagnosis. Compared to age group <1 year, children of ages 1–4 years, 5–9 years, 10–14 years, and 15–19 years were 76% (adjusted hazard ratio (AHR) = 0.24, 99% CI = 0.21–0.28), 69% (AHR = 0.31, 99% CI = 0.26–0.36), 46% (AHR = 0.54, 99% CI = 0.46–0.62), and 18% (AHR = 0.82, 99% CI = 0.70–0.95) less likely to die, respectively. Conclusion. The age at tumor diagnosis was a single most potent prognostic factor of childhood leukemia survival, with infants and children of age group 15–19 years experiencing the poorest survival. This significant variability persisted after adjustment for the effect of other covariates. Therefore, there is a need to identify other prognostic factors that are associated with age in order to provide a meaningful explanation of the impact of age on pediatric leukemia survival in the US.

scholarly journals Clinicopathological Characteristics and Survival Outcomes for Pneumonectomy: a Population-Based Study

2020 ◽  
Author(s):  
Linlin Wang ◽  
Lihui Ge ◽  
Yongyu Liu ◽  
Yi Ren
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Forest Plot ◽  
Seer Database ◽  
Term Survival ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background: Prognostic factors in pneumonectomy (PN) are not yet fully defined. This study is to analyze and evaluate long-term survival after PN for non-small cell lung cancer (NSCLC). Methods: We obtained data from the Surveillance, Epidemiology, and End Results (SEER) database for patients who underwent PN between 2004 and 2015. In order to reduce bias and imbalance, propensity score matching (PSM) analysis was performed. We used Kaplan-Meier curves to estimate overall survival (OS), performed univariate and multivariate Cox proportional hazards regression analyses to identify independent prognostic factors for OS, and applied the Cox proportional hazards model to create a forest plot. Results: A total of 1557 PN patients from the SEER database were included. The patients were grouped according to the side of PN. Before matching, OS was worse after right PN (hazard ratio [HR]: 1.303; 95% confidence interval [CI] 1.133-1.498; P<0.001), but survival difference between groups was not significant after matching (HR: 1.061; 95% CI 0.912-1.235; P=0.443). Regression analysis revealed that age, grade, N-stage, radiotherapy, and chemotherapy were independent predictors of OS (P<0.05). Chemotherapy was associated with improved OS (HR: 0.709; 95% CI 0.609-0.825; P<0.001), but radiotherapy was associated with increased risk of death in OS (HR: 1.268; 95% CI 1.061-1.561; P=0.009). On the forest plot, patients with primary overlapping lesions had better OS (HR: 0.684; 95% CI 0.497-0.941; P=0.020) in left, vs right, PN; patients diagnosis during 2004 to 2007 had lower OS (HR: 0.576; 95% CI 0.346-0.960; P=0.034) for left PN vs right PN.Conclusions: Laterality was not a significant prognostic factor for long-term survival after PN for NSCLC. Chemotherapy was a significant independent predictor of improved OS, while radiotherapy appeared to be a negative prognostic factor with increased risk of death in OS.

Prognostic Factors in Children With Extragonadal Malignant Germ Cell Tumors: A Pediatric Intergroup Study

2006 ◽  
Vol 24 (16) ◽  
pp. 2544-2548 ◽  
Author(s):  
Neyssa Marina ◽  
Wendy B. London ◽  
A. Lindsay Frazier ◽  
Stephen Lauer ◽  
Frederick Rescorla ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Germ Cell ◽  
Univariate Analysis ◽  
Germ Cell Tumors ◽  
Primary Site ◽  
Stage I ◽  
Significant Prognostic Factor ◽  
Risk Of Death ◽  
Malignant Germ Cell Tumors

Purpose To investigate prognostic factors for pediatric extragonadal malignant germ cell tumors (PEMGCT). Materials and Methods Between 1990 and 1996, patients with stage I through IV PEMGCT were eligible for a trial of cisplatin dose intensity. We retrospectively investigated prognostic factors for PEMGCT, including age, stage, primary site, treatment, and elevated alfa fetoprotein by univariate and multivariate analysis. Results The 165 patients had a median age of 1.9 years (range, 3 days to 18.5 years); 109 were female; and 99 had alfa fetoprotein ≥ 10,000. There were 30 stage I/II, 61 stage III, and 74 stage IV tumors; primary sites included 88 sacrococcygeal, 39 thoracic, and 38 others. The 5-year overall survival (OS) and event-free survival (EFS) rates with standard deviations were 83.4% ± 3.7% and 79.0% ± 4.1%, respectively. Univariate analysis identified age ≥ 12 years as a highly significant prognostic factor for EFS (5-year EFS, 48.9% ± 15.6% v 84.1% ± 3.9%; P < .0001) and for OS (5-year OS, 53.7% ± 14.9% v 88.5% ± 3.4%; P < .0001), whereas treatment was of borderline significance (P = .0777). Multivariate Cox proportional hazards regression identified only age ≥ 12 years as a significant prognostic factor for EFS (P = .0002). In multivariate Cox regression for OS, the combination of age and primary site was highly significant (P < .0001). Patients ≥ 12 years of age with thoracic tumors had six times the risk of death compared with patients younger than 12 years with other primaries. Conclusion Age is the most predictive factor of EFS in PEMGCT. There is a significant interaction between age and primary site, suggesting that patients ≥ 12 years of age with thoracic tumors are a biologically distinct group.

scholarly journals Influence of lymphocitic thyroiditis on prognostic outcome differentiated thyroid carcinoma

2010 ◽  
Vol 57 (2) ◽  
pp. 85-94
Author(s):  
A. Filipovic ◽  
I. Paunovic ◽  
Lj. Vuckovic
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Thyroid Carcinoma ◽  
B Lymphocytes ◽  
Univariate Analysis ◽  
Lymphocytic Infiltration ◽  
Differentiated Thyroid Carcinoma ◽  
Significant Prognostic Factor ◽  
Poor Prognostic Factor ◽  
Significant Difference

Backgraund/aim. Thyroid carcinoma is rare malignant tumors. They are typically presented with slow progression and clinical course. Lymphocytic infiltration, including fagocytosis of neoplastic cells by macrophage plays an important role in preventing development of distant metastases. This paper sets the following objectives: Establish whether presence or absence of Hashimoto thyroiditis in differentiated thyroid carcinoma (DTC) is a favourable prognostic factor. Methods. The group under examination here are all newly diagnosed patients with differentiated thyroid carcinoma surgically treated at the Surgery Clinic in Podgorica from 2003. to 2010. A total of 125 patients, aged 11 to 79, were included in this research. The patients were divided in two groups, those with and those without lymphocytic infiltration. Both groups were mutually compared for their prognostic factors. For the identification of T and B lymphocytes, anti-CD 3 and anti-CD 20 antibodies were used. Student t-test was used for comparison of clinical and pathological parameters among groups, Hi square test for comparison of frequency, and Coxs regression model for time dependant variables as frequency of recurrence among groups with various stages of disease. Survival curve (Kaplan-Meier) is used for comparison of time dependant variables (survival, recurrence, death). The follow-up time ranges from 10 to 70 months in both groups of patients. Results are as follows: presence of lymphocytic infiltration in thyroid tissue in patients with differentiated thyroid carcinoma is significant prognostic factor (P<0.0001). But, absence of lymphocytic infiltration is a poor prognostic factor in patients with invasive extra thyroid tumours (P<0.0001). Also, absence of lymphocytic infiltration is a poor prognostic factor for development of lymphogenic and hematogenic metastases. The presence of T or B lymphocytes and varying degree of their presence is not a significant prognostic factor (P<0.0046). Patients without lymphocytic infiltration are significantly more numerous in the fourth stage of disease (P<0.0001). There is no statistically significant difference in terms of the presence of T or B lymphocytes in the tissue. Chronic lymphocytic thyroidis hahshimoto is a favourable prognostic factor in our examined group (P<0.0001). Local invasiveness and extrathyroid expansion is significantly smaller in the group of patients with the presence of lymphocytic infiltration (P<0.0001). By means of univariate analysis, we found that factors with a significant impact on survival rate include age (P<0.0001), size of tumour (P<0.018), extrathyroid invasiveness (P<0.0001), hematogenic metastases (P<0.049). Lymphocytic infiltration is present in 81% of patients in their thyroid gland, and in 19% patients there are no lymphocytes in tissue. Limphocitic infiltration has a favourable influence on tumor variables. Conclusion.This research has shown that lymphocytes in tissue as part of Hashimoto thzroiditis have an effect on certain prognostic factors of differentiated thyroid carcinoma as size, smaller invasiveness and extrathyroid tumour growth and incidence of hematogenic metastases.

Prognostic Significance of T-Cell or Cytotoxic Molecules Phenotype in Classical Hodgkin’s Lymphoma: A Clinicopathologic Study

2006 ◽  
Vol 24 (28) ◽  
pp. 4626-4633 ◽  
Author(s):  
Naoko Asano ◽  
Aya Oshiro ◽  
Keitaro Matsuo ◽  
Yoshitoyo Kagami ◽  
Fumihiro Ishida ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
T Cell ◽  
B Cell ◽  
Hodgkin’S Lymphoma ◽  
Prognostic Significance ◽  
Phenotypic Expression ◽  
Hodgkin's Lymphoma ◽  
Null Cell ◽  
Poor Prognostic Factor ◽  
Cytotoxic Molecules

Purpose Classical Hodgkin’s lymphoma (CHL) is characterized by Hodgkin’s and Reed-Sternberg (H-RS) cells, most of which are derived from germinal-center B cells. Nevertheless, one or more markers for T cells and follicular dendritic cells (FDC) may be expressed in a minority of H-RS cells in some CHL patients, although the clinical significance of this remains controversial. The aim of this study was to clarify the association between phenotypic expression and clinical outcome in CHL. Patients and Methods Participants were 324 consecutive CHL patients, comprising 132 patients with nodular sclerosis (NS), 35 patients with NS grade 2 (NS2), and 157 patients with mixed cellularity (MC). We evaluated the presenting features and prognosis of patients on categorization into four phenotypically defined groups: B-cell (CD20+ and/or CD79a+; n = 63), T-cell and/or cytotoxic molecules (CD3+, CD4+, CD8+, CD45RO+, TIA-1+, and/or granzyme B+; n = 27), FDC (CD21+ without B-cell marker; n = 22), and null-cell types (n = 212). Other potential prognostic factors were examined. Results The T-cell and/or cytotoxic molecules group showed a significantly poorer prognosis than the other three groups (P < .0001). This finding was seen consistently in multivariate analyses. Morphologic subtyping (NS/NS2/MC) and Epstein-Barr virus positivity were not identified as independent prognostic factors. Conclusion The presence of T-cell and/or cytotoxic antigens in H-RS cells may represent a poor prognostic factor in CHL, even if their expression is not regarded as lineage specific. Examination of T-cell and/or cytotoxic molecules phenotype in CHL patients is recommended as a routine pathologic practice.

scholarly journals Snake-Eye Myelopathy and Surgical Prognosis: Case Series and Systematic Literature Review

2020 ◽  
Vol 9 (7) ◽  
pp. 2197 ◽  
Author(s):  
Marco Maria Fontanella ◽  
Luca Zanin ◽  
Riccardo Bergomi ◽  
Marco Fazio ◽  
Costanza Maria Zattra ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Literature Review ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Case Series ◽  
Neurological Deficits ◽  
Poor Prognostic Factor ◽  
Surgical Data ◽  
Magnetic Resonance Imaging Mri ◽  
Degenerative Cervical Myelopathy

The prognostic value of “snake-eyes” sign in spinal cord magnetic resonance imaging (MRI) is unclear and the correlation with different pathological conditions has not been completely elucidated. In addition, its influence on surgical outcome has not been investigated in depth. A literature review according to PRISMA (Preferred reporting items for systematic review and meta-analysis protocols) guidelines on the prognostic significance of “snake-eyes” sign in operated patients was performed. Clinical, neuroradiological, and surgical data of three institutional patients, were also retrospectively collected. The three patients, with radiological evidence of “snake-eyes” myelopathy, underwent appropriate surgical treatment for their condition, with no new post-operative neurological deficits and good outcome at follow-up. The literature review, however, reported conflicting results: the presence of “snake-eyes” sign seems a poor prognostic factor in degenerative cervical myelopathy, even if some cases can improve after surgery. “Snake-eyes” myelopathy represents a rare form of myelopathy; pathophysiology is still unclear. The frequency of this myelopathy may be greater than previously thought and according to our literature review it is mostly a negative prognostic factor. However, from our experience, prognosis might not be so dire, especially when tailored surgical intervention is performed; therefore, surgery should always be considered and based on the complete clinical, neurophysiological, and radiological data.

scholarly journals A Retrospective Cross Sectional Study of Clinical Characteristics and Prognostic Factors of Covid 19 Patients Admitted to a Gambian Teaching Hospital

2021 ◽  
Author(s):  
Sheikh Omar Bittaye ◽  
Abubacarr Jagne ◽  
Abdoulie Badjan ◽  
Babakunta Fofana ◽  
Ebrima Barrow ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Prognostic Factors ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Health Facility ◽  
Teaching Hospital ◽  
Clinical Characteristics ◽  
Risk Of Death ◽  
Increased Risk ◽  
Lower Level Health Facility

Abstract Background: The first case of Novel coronavirus disease (COVID 19) was diagnosed in The Gambia on the 17th March 2020. We therefore investigate the clinical characteristics and prognostic factors of COVID 19 patients admitted at a Gambian teaching Hospital. Method: Out of 407 suspected COVID 19 patients, 137 (33.7%) tested positive for COVID 19 and were recruited. Clinical features, treatment and outcomes were recorded. Univariate and multivariate logistic regression analyses were used to assess prognostic factors of survival in our patients. Results: The median age of our patients was 60 years (19-100) and 86 (62.8%) were men. Eighty nine (64.9%) patients had co-morbidities, mostly Hypertension 51 (37.2%) and Diabetes Mellitus 47 (34.3%). The most common symptoms were cough 71 (51.8%) and dyspnea 53 (38.7%) and majority of patients presented with SPO ≤ 93% 75 (54.7%). Patients with SPO2 ≤ 93% were older 63.2 vs. 53.1 years (p=0.001), more likely to present with dyspnea (p=0.002), Cough (0.035), higher respiratory rate (p<0.001) and co-morbidities (p=0.009) compared to patients with SPO2>93%. Non survivors were older 63.2 vs 53.1 years (p=0.001), more likely to present with higher respiratory rate (p=0.014), lower oxygen saturation (p=<0.001), to be referred from lower level health facility (p=0.012) and to have Diabetes mellitus (p=0.007) as compared to survivors. Our cumulative mortality is 49 (35.8%) and mortality rate of patients referred from lower level heath facilities was 46 % as compared to 25 % for self referred patients. Multivariate analysis showed increasing odds of mortality independently associated with Age≥ 60 years (odd ratio, 2.87: 95% CI, 1.21 to 6.83, p=0.012), Diabetes mellitus (odd ratio, 3.47: 95% CI, 1.44 to 8.36, p=0.006), oxygen saturation ≤ 93% (odd ratio, 3.18: 95% CI, 1.27 to 7.99, p=0.014) and referral from lower level health facility (odd ratio, 2.87: 95% CI, 1.11 to 6.82, p=0.017).Conclusion: Older patients, patients with Diabetes Mellitus, hypoxemia or patients referred from lower level health facilities are at increased risk of death. In resource limited countries where critical care/emergency medicine resources are limited, our results may help guide the clinical management of patients with severe COVID-19.

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