Parenchymal lung changes on CT in patients with coronavirus disease 2019 (COVID-19)

INTRODUCTION Infections due to COVID-19 can lead to life threatening pneumonia. Accompanying severe disease are more prominent pulmonary changes on Computed Tomography (CT) scan of the chest. The goal of this study was to describe pulmonary CT changes during acute COVID-19 and at follow up and whether the extent of changes correlate with severity of illness, demographics or other risk factors. MATERIALS AND METHODS Included in this study are all individuals that had confirmed COVID-19 and came for a follow up CT of the chest at Landspitali from May to September 2020. Information regarding medical history was obtained retrospectively from medical charts. All CT scans were reviewed using an international staging system to evaluate the extent of lung changes. RESULTS Eighty-five patients with a mean age of 59 years were included in the study. Sixty patients (71%) were hospitalized during the acute phase and 18 (21%) were admitted to the ICU. During the acute phase more pronounced lung involvement was seen in males and patients admitted to the ICU. At follow-up females had less lung involvement but there was a significant relationship between a higher CT score and age, ICU admissions and days in the ICU. Full recovery was seen at follow-up CT in 31% of patients (median 68,5 days between acute and follow-up imaging). CONCLUSION Patients with severe COVID-19 have more pronounced lung involvement on CT than patients with milder disease during the acute phase and follow-up. Older patients and males are at greater risk of acute and persistent COVID-19 related lung changes.

Download Full-text

A Comparison of 3 Staging Systems for the Outcome Following Autologous Stem Cell Transplantation (ASCT) in Patients with Multiple Myeloma (MM).

Blood ◽

10.1182/blood.v106.11.5479.5479 ◽

2005 ◽

Vol 106 (11) ◽

pp. 5479-5479

Author(s):

Hee-Jung Sohn ◽

Kihyun Kim ◽

Jae-Hoon Lee ◽

Soo-Mee Bang ◽

Dong Hwan Kim ◽

...

Keyword(s):

Overall Survival ◽

Gold Standard ◽

Staging System ◽

Stage I ◽

Event Free Survival ◽

Free Survival ◽

Staging Systems ◽

International Staging System ◽

Beta 2 Microglobulin

Abstract The Durie-Salmon (DS) stage has been the gold standard for stratification of MM patients. However, the system does not contain beta-2 microglobulin (B2M) widely recognized as the single most powerful prognostic parameter. Recently, The Southwest Oncology Group (SWOG) staging system (Jacobson JL, et al. Br J Haematol122:441–50, 2003) and the International Staging System (ISS) (Greipp PR, et al. J Clin Oncol23:3412–20, 2005) utilizing B2M have been proposed. We aimed to evaluate whether the stage assessed at the time of ASCT by DS, SWOG, or ISS predict outcome following ASCT in patients with MM. Between November 1996 and December 2004, a total of 141 patients with MM who were treated with ASCT at 5 institutions in Korea were available for this analysis. The distribution of patients’ stage at ASCT by 3 staging systems was as Table 1. With a median follow-up of 20 months from ASCT, the median event-free survival (EFS) and overall survival (OS) were 16 months (95% confidence interval [CI], 11–21) and 56 months (95% CI, 38–74), respectively. The median survival of each stage group according to 3 staging systems at ASCT was as Table 2. Differences in EFS among the stage groups were not statistically significant. However, OS after ASCT was dependent on the SWOG stage at the time of ASCT and also significantly longer in patients with ISS stage I than others (NR vs. 39 months, P =.001). In this study, OS following ASCT was influenced by the stage according to SWOG or ISS, but not DS. The distribution of patients by 3 staging systems Stage I II III IV DS 32 (23%) 23 (16%) 86 (61%) - SWOG 53 (38%) 66 (47%) 16 (11%) 6 (4%) ISS 85 (60%) 34 (24%) 22 (16%) - Median event-free survial and overall survival by 3 staging systems Stage I II III IV P EFS=evnet-free survival, OS=overall survival, NR=not reached, * in months EFS* DS 27 17 13 - .40 SWOG 22 15 24 4 .21 ISS 17 13 10 - .63 OS* DS NR 58 40 - .17 SWOG NR 41 32 17 .045 ISS NR 32 40 - .0042

Download Full-text

Revised International Staging System (R-ISS) for Transplant-Eligible Multiple Myeloma Patients Risk Stratification

Blood ◽

10.1182/blood-2018-99-117269 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5756-5756

Author(s):

Telma Nascimento ◽

Adriana Roque ◽

Emília Cortesão ◽

Luís Francisco Araújo ◽

Ana Isabel Espadana ◽

...

Keyword(s):

Multiple Myeloma ◽

High Risk ◽

Partial Response ◽

Risk Stratification ◽

Real Life ◽

Staging System ◽

Stage Ii ◽

Novel Agents ◽

International Staging System

Abstract BACKGROUND: In the last decades, multiple myeloma (MM) prognosis has been changing dramatically. Induction with novel agents, followed by high-dose melphalan and autologous hematopoietic stem cell transplantation (aHSCT) is the standard of care for newly diagnosed (ND) and transplant-eligible MM patients (pts). In 2015, a new score was validated [Revised International Staging System (R-ISS)], including data related to high-risk cytogenetic abnormalities (CA) [del(17p) and/or t(4;14) and/or t(14;16)] and serum lactate dehydrogenase (LDH) levels. Few recent studies have supported R-ISS as a reliable prognostic tool for estimating survival in MM pts submitted to aHSCT. AIMS: To determine whether R-ISS is a valid risk model for predicting progression free survival (PFS) and overall survival (OS) among a cohort of real-life aHSCT pts. METHODS: We conducted a single center retrospective study of ND symptomatic MM pts treated with novel agents (bortezomib, thalidomide or lenalidomide) undergoing aHSCT between Jan/2007 and Dec/2017. We excluded all pts with no available information about ISS, LDH and CA [detected by fluorescence in situ hybridization (FISH)]. Response to treatment was evaluated according to the International Myeloma Working Group consensus criteria (2016). Statistical analysis was performed using STATA v.14.2 and significant levels were set at p<0.05. RESULTS: From the total number of 186 pts submitted to aHSCT, only 81 (45%) pts presented criteria to be included in our analysis; 62% were male, with a median age at aHSCT of 60y (28-70). IgG was the most frequent subtype (59%), followed by IgA (20%). At diagnosis, 38% of pts presented anemia, 14% renal impairment (RI), 20% hypercalcemia, 63% bone disease (BD) and 32% extramedullary disease (EMD). According to ISS, 30 (37%) pts presented stage I, 30 (37%) stage II, and 21 (26%) stage III at diagnosis. There were 38% pts with high-risk CA: 24% with del17p; 19% with t(4;14), and 20% with t(14;16). High LDH levels was seen in 48% of pts. Pts were re-staged at diagnosis according to R-ISS, resulting 17% in stage I, 61% in stage II, and 22% in stage III. Thus, 16 (20%) pts previously categorized as ISS I and 3 (4%) pts as ISS III were re-classified as R-ISS II. Median time from diagnosis to aHSCT was 9.7 months. All pts received induction therapy with novel agents (a bortezomib-based therapy in 89% of pts and an IMID-based in 12%), with 81% of pts responding to first line induction; 19% were refractory. At the time of aHSCT, all pts presented at least on partial response (PR) [62% at least very good partial response (VGPR)], with an increase in the proportion of pts in complete response (CR) from 15% to 20% before and after aHSCT, respectively. Maintenance therapy was performed in 31% of pts (79% thalidomide; 21% lenalidomide). At a median follow-up of 33.4 months, median OS had not been reached. Two-years OS was 62%. Median PFS from aHSCT was 67.4%.Neither high-risk CA nor high LDH levels individually predicted lower OS and PFS (p=NS). The 2-year OS for R-ISS I, II and III was 86 %, 61% and 44%, and the 2-year PFS was 79 %, 63% and 39%, respectively. In our cohort we observed statistical significance differences between R-ISS I and III at 2 years in what concerns PFS (p=0.025) and OS (p=0.017) . No differences were seen in between other R-ISS categories. When we stratified R-ISS stage II in two subgroups based on the presence or absence of high-risk CA no differences were found. Pts classified as R-ISS III presented anemia (p<0.001) and RI (p=0.001) more frequently, but no differences concerning hypercalcemia, BD or EMD. CONCLUSIONS: In our real-life cohort, R-ISS at diagnosis was a reliable tool only to predict both OS and PFS between R-ISS I and III and not between other R-ISS subgroups. The main reasons that explain the absence of significance between all R-ISS subgroups were probably the very low number of pts with available cytogenetics compared with the total number of pts submitted to aHSCT in our center and the short follow up of our study. Larger real-life studies with a longer follow up are necessary to determine if R-ISS is a good risk stratification model to applicate to NDMM pts submitted to aHSCT in the era of novel agents. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Multiple myeloma: five-year experience at a University Hospital

Einstein (São Paulo) ◽

10.1590/s1679-45082011ao2006 ◽

2011 ◽

Vol 9 (2) ◽

pp. 145-150

Author(s):

Juliana Todaro ◽

Jandey Bigonha ◽

Davimar Miranda Maciel Borducchi ◽

Leandro Luongo Matos ◽

Damila Cristina Trufelli ◽

...

Keyword(s):

Multiple Myeloma ◽

Statistical Significance ◽

Descriptive Analysis ◽

Staging System ◽

University Hospital ◽

Clinical Staging ◽

Public Healthcare ◽

International Staging System ◽

De Medicina

Objective: To present a descriptive analysis of patients diagnosed with multiple myeloma, correlating it with mortality. Methods: A retrospective study that analyzed consecutive patients diagnosed with multiple myeloma under follow-up at the Faculdade de Medicina do ABC from 2006 to 2010. Results: The median age was 58.5 years. Anemia was observed upon diagnosis in 87% of patients, hypercalcemia in 38%, and creatinine levels higher than 2 mg/dL in 19%. M protein was detected in 85.7%. The five-year survival rate was 74.6%. Multivariate analysis showed statistical significance for Durie-Salmon staging (p = 0.037). The International Staging System and immunoglobulin type did not correlate significantly with survival of the group. Conclusion: This set of cases from a tertiary public healthcare service reflect the approach of multiple myeloma in a predominantly young population with advanced clinical staging, with results comparable to those of the literature.

Download Full-text

The role of 131-I-metaiodobenzylguanidine (13II-MIBG) therapy in irresectable and compromising localized neuroblastoma

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.10053 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 10053-10053

Author(s):

R. A. Schoot ◽

G. Bleeker ◽

H. A. Heij ◽

B. L. van Eck ◽

H. N. Caron ◽

...

Keyword(s):

Partial Response ◽

Primary Tumour ◽

Therapy Response ◽

Progression Free Survival ◽

Staging System ◽

Complete Response ◽

Incomplete Resection ◽

Life Threatening ◽

Localized Neuroblastoma

10053 Background: According to current practice, observation only is justified in patients with localized, irresectable neuroblastoma with favorable biologic features. However, when organ or life threatening symptoms arise, therapy is required. Side effects of treatment should be minimal, since outcome is good. The aim of this study was to evaluate the response and outcome of neuroblastoma under these circumstances, when treated with 131-I-metaiodobenzylguanidine (131I-MIBG). Methods: Between 1989 and 2008, 21 patients (8 boys/13 girls) with localized neuroblastoma were included. Median age was 1.6 years (range of 0–5.5 years). Patients were eligible when the primary tumour was irresectable and organ or life threatening. Diagnosis and staging were performed according to the International Neuroblastoma Staging System (INSS). Fixed dosages of 131I-MIBG (50–200 mCi) were given with an interval of four weeks. The median number of infusions was two (range 1 to 7).131I-MIBG was given according to standard directions for targeted therapy. Response was graded according to the International Neuroblastoma Response Criteria (INRC). Results: Four patients were classified as stage I, three as stage II, and fourteen as stage III. Three tumors were NMYC amplified and two had loss of heterozygosity of 1p. Minimal pretreatment was given to nine patients, because of organ or life threatening symptoms. These patients responded insufficiently or showed return of tumor growth. After 131I-MIBG treatment, 8/21 regressed. Resection became possible in 13/21 patients. In 10/13 patients resection was macroscopically complete. Three other patients had incomplete resection of their tumor. They had longterm progression free survival. At the end of treatment 16/21 patients achieved complete response (CR) and 3/21 had stable disease (2 very good partial response (VGPR), 1 partial response (PR)). Two patients died, one of progressive disease, one due to complications of surgery (CR). One patient was lost to follow-up. Ten years OS was 90.5%, 10 years EFS was 72.4%. Median follow-up was 7.5 years (range 1 to 17.4). Conclusions: 131I-MIBG treatment is an effective treatment modality in irresectable, localized neuroblastoma, in case of organ or life threatening situations. No significant financial relationships to disclose.

Download Full-text

HORIZON (OP-106): An exploratory analysis of time-to-next treatment (TTNT) in patients (pts) with relapsed/refractory multiple myeloma (RRMM) who received melflufen plus dexamethasone (dex).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e20570 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e20570-e20570

Author(s):

Maria-Victoria Mateos ◽

Albert Oriol ◽

Alessandra Larocca ◽

Joan Blade ◽

Michele Cavo ◽

...

Keyword(s):

Disease Progression ◽

Progression Free Survival ◽

Staging System ◽

Median Number ◽

Ocean Study ◽

Disease Stabilization ◽

Heavily Pretreated ◽

Secondary Endpoints ◽

International Staging System

e20570 Background: Melflufen is a novel peptide-drug conjugate that rapidly delivers a cytotoxic payload into tumor cells. Melflufen + dex showed efficacy and a manageable safety profile in pts with poor-risk, heavily pretreated RRMM in the phase 2 HORIZON study (Mateos et al. ASH 2019. Abs. 1883). For pts with RRMM, longer TTNT is indicative of disease stabilization and clinical benefit and is associated with lower costs (Chen et al. J Manag Care Spec Pharm. 2017). This report of TTNT after melflufen + dex from HORIZON is, to our knowledge, the first report from a trial population with such advanced RRMM. Methods: Pts with RRMM who had received ≥2 prior lines of therapy, including an IMiD and a proteasome inhibitor (PI), and were refractory to pomalidomide and/or an anti-CD38 monoclonal antibody (mAb), received melflufen 40 mg (IV on d1 of each 28-d cycle) + dex 40 mg/wk until disease progression or unacceptable toxicity. The primary endpoint was overall response rate. Secondary endpoints included progression-free survival (PFS) and safety. TTNT was defined as the time from start of melflufen + dex to first subsequent therapy. Results: Overall, 154 pts were treated (data cutoff, Oct 1, 2019); median age was 64.5 y (range, 35-86), 32% had International Staging System stage 3 disease, 38% had high-risk cytogenetics, 32% had extramedullary disease (EMD), the median number of prior therapies was 5 (range, 2-12), and 71% had triple-class refractory MM (IMiD + PI + anti-CD38 mAb). Treatment discontinuation occurred in 108 pts (70%), most commonly due to disease progression (47%) and adverse events (14%). Among 125 pts evaluable for response, with a median follow up of 15.3 mo, the median TTNT was 8.0 mo (95% CI, 7.2-8.9) and the median PFS was 4.2 mo (95% CI, 3.7-4.9). TTNT and PFS were similar in subgroups of pts with triple-class refractory MM and EMD (Table). Subsequent therapies after melflufen + dex will be presented. Conclusions: TTNT in HORIZON (median 5 prior lines) was consistent with previous reports of TTNT in pts with RRMM who received melflufen + dex or other therapies (median 2-4 prior lines) (Bringhen et al. J Clin Oncol. 2019. Abs. 8043). Melflufen + dex is being further evaluated in the phase 3 OCEAN study (NCT03151811) in pts with RRMM who are refractory to lenalidomide. Clinical trial information: NCT02963493. [Table: see text]

Download Full-text

Free Light Chain Ratio As a Simple Prognostic Marker in a Single Institution Experience

Blood ◽

10.1182/blood.v126.23.5320.5320 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5320-5320

Author(s):

Camila Pena ◽

Javier Voisin ◽

Alexis Peralta ◽

Manuela Ortiz ◽

Viviana Balboa ◽

...

Keyword(s):

Mortality Rate ◽

Plasma Cell ◽

Light Chain ◽

Staging System ◽

Free Light Chain ◽

Newly Diagnosed ◽

Staging Systems ◽

Study Population ◽

International Staging System

Abstract Multiple myeloma (MM) is a plasma cell dyscrasia characterized by bone marrow plasma cell infiltration and the secretion of monoclonal immunoglobulin (Ig) in the serum or urine. Median survival in MM patients is approximately 5 years and significant morbidity may be experienced. The course is progressive and although, always incurable, the prognosis is highly variable. The two more widely used staging systems in MM are by Durie and Salmon and the International Staging System (ISS). Others have been studied, including serum free light chain (sFLC) concentrations and ratio (sFLCr). Methods: We measured sFLC in 27 newly diagnosed MM (21 Intact Ig MM, 5 light chain MM, 1 non secretory MM) at our center (Hospital del Salvador, Santiago de Chile) from October 2013 until June 2015. The sFLCr was calculated with the involved monoclonal light chain as the numerator. The median sFLCr was 17. Patients were divided into a "low group" (<17 sFLCr) and a "high group" (>17 sFLCr). We also analyzed these patients using the cut off (sFLCr of 50) previously reported by Garcia de Veas Silva et al. [Hematology reports 2015; 7 (s1) p23] The median follow-up was 16 months. Results: During the period of study there were 8 deaths (29,7%). Seven (87,5%) of these deaths presented with an ISS score of 3 (table 1). Mortality rates were lower in the group of patients with "low" sFLCr (15,3%, 2 deaths in a group of 13 patients), as compared to patients with a "high" sFLCr (42,9%, 6 deaths in a group of 14 patients) (table 2). Using the cutoff established by Garcia de Veas Silva et al, the mortality rate for patients with sFLCr >50 was 66,7% vs. 11,1% in for patients in the <50 sFLCr group (table 3). Discussion: Although a short follow up period was available for analysis, we believe these results are promising. sFLCr can be used as an easy prognostic indicator in newly diagnosed, symptomatic MM, especially when high risk patients (>50 sFLCr) are identified. The introduction of biomarkers in the evaluation of MM patients will enable better risk assessment and rational follow up. Table 1. International Staging System. Stratification of our study population. ISS N Patients N Deaths Mortality (%) 1 2 0 0 2 12 1 8,3 3 13 7 53,9 Table 2. Mortality rate in our study population using the median sFLCr as a cut off value. Mortality MM N Patients N Deaths Mortality (%) All 27 8 29,6 sFLCr>17 14 6 42,9 sFLCr<17 13 2 15,4 Table 3. Mortality rate in our population using the published cut off sFLCr value. Mortality MM N Patients N Deaths Mortality (%) All 27 8 29,6 sFLCr>50 9 6 66,7 sFLCr<50 18 2 11,1 Disclosures Delgado: The Binding Site: Employment.

Download Full-text

The Utility of Infectious and Neurodiagnostic Testing in Children With Complex Febrile Seizures Requiring Mechanical Ventilation

Journal of Child Neurology ◽

10.1177/08830738211000507 ◽

2021 ◽

pp. 088307382110005

Author(s):

Jennifer H. Yang ◽

Richard Villegas ◽

Sandeep Khanna ◽

Julie Kaswick ◽

Nicole G. Coufal ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Analysis ◽

Severity Of Illness ◽

Febrile Seizures ◽

Tertiary Hospital ◽

Surgical Interventions ◽

Retrospective Cohort Analysis ◽

Life Threatening

A retrospective cohort analysis was performed on 79 consecutive patients between 6 months and 5 years admitted to a tertiary hospital with a diagnosis of complex febrile seizures requiring mechanical ventilation from 2011 to 2017 to determine the utility of infectious and neurologic diagnostics. Intubation was used as a proxy for severity of illness. The overall intensive care unit stay was short (95% intubated <24 hours, 88% admitted <3 days). No life-threatening infections were identified, and none required surgical interventions. Electroencephalogram (EEG) was obtained on 43%, 26% of which were abnormal. Sixty-six percent of patients were discharged on rescue benzodiazepine and 20% with maintenance antiseizure medications. Duration of follow-up averaged 4 years (range 1 month to 9 years); 8 patients (10%) were subsequently diagnosed with epilepsy. Our findings suggest that extensive diagnostic evaluations may not be necessary for children with complex febrile seizures requiring mechanical ventilation although the role of EEG is less understood.

Download Full-text

Severity of respiratory failure and computed chest tomography in acute COVID-19 correlates with pulmonary function and respiratory symptoms after infection with SARS-CoV-2: an observational longitudinal study over 12 months

10.1101/2021.08.11.21261883 ◽

2021 ◽

Author(s):

Fridolin Steinbeis ◽

Charlotte Thibeault ◽

Felix Doellinger ◽

Raphaela Maria Ring ◽

Mirja Mittermaier ◽

...

Keyword(s):

Quality Of Life ◽

Respiratory Failure ◽

Pulmonary Function ◽

Disease Severity ◽

Acute Phase ◽

Respiratory Symptoms ◽

Lung Involvement ◽

Diffusion Capacity

Background Prospective and longitudinal data on pulmonary injury over one year after acute coronavirus disease 2019 (COVID-19) are sparse. Research question: With this study, we aim to investigate pulmonary outcome following SARS-CoV-2 infection including pulmonary function, computed chest tomography, respiratory symptoms and quality of life over 12 months. Study design and Methods 180 patients after acute COVID-19 were enrolled into a single-centre, prospective observational study and examined 6 weeks, 3, 6 and 12 months after onset of COVID-19 symptoms. Chest CT-scans, pulmonary function and symptoms assessed by St. Georges Respiratory Questionnaire were used to evaluate objective and subjective respiratory limitations. Patients were stratified according to acute COVID-19 disease severity. Results Of 180 patients enrolled, 42/180 were not hospitalized during acute SARS-CoV-2 infection, 29/180 were hospitalized without need for oxygen, 43/180 with need for low-flow and 24/180 with high-flow oxygen, 26/180 required invasive mechanical ventilation and 16/180 were treated with ECMO. After acute COVID-19, pulmonary restriction and reduced carbon monoxide diffusion capacity was associated with disease severity after the acute phase and improved over 12 months except for those requiring ECMO treatment. Patients with milder disease showed a predominant reduction of ventilated area instead of simple restriction. The CT score of lung involvement in the acute phase increased significantly with COVID-19 severity and was associated with restriction and reduction in diffusion capacity in follow-up. Respiratory symptoms improved for patients in higher severity groups during follow-up, but not for patients with mild initially disease. Interpretation Severity of respiratory failure during COVID-19 correlates with the degree of pulmonary function impairment and respiratory quality of life in the year after acute infection. Patients with mild vs. severe disease show different patterns of lung involvement and symptom resolution.

Download Full-text

Impact of Beta Blocker on Clinical Outcomes of Multiple Myeloma (MM) Patients

Blood ◽

10.1182/blood.v124.21.4751.4751 ◽

2014 ◽

Vol 124 (21) ◽

pp. 4751-4751

Author(s):

Yi Lisa Hwa ◽

Martha Q. Lacy ◽

Morie A Gertz ◽

Francis Buadi ◽

S. Vincent Rajkumar ◽

...

Keyword(s):

Beta Blocker ◽

Beta Blockers ◽

Univariate Analysis ◽

Staging System ◽

Preclinical Study ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Apoptotic Effect ◽

International Staging System

Abstract Background: A recent preclinical study revealed an antiproliferative and apoptotic effect of propranolol on MM cell lines. This study was to investigate if propranolol and other beta blocker intake improved survival in MM patients. Methods: Among patients seen at Mayo Clinic, Rochester from 1993 to 2010, we identified those taking propranolol. Age, year of diagnosis, International Staging System (ISS), Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) were used as case-match variables to match propranolol users to two control populations: no beta blocker and other beta-blocker. Cox proportional hazard modeling was utilized to analyze the effect of propranolol and other beta blockers intake on overall survival (OS) and disease-specific survival (DSS). Results: In 3 groups: propranolol (n=52), no beta blocker (n= 136), or other beta blocker (n=84), transplant eligibility was 63.5%, 66.9%, 66.7% respectively (p=0.90). Median age was 63 years. Median follow-up was 86 months. No statistically differences were seen in age, ISS, mSMART or year of diagnosis in 3 groups (p=0.46).In univariate analysis comparing propranolol vs no beta blocker or other beta blocker cohort, 5-year OS rate was 60.2% vs 47% or 64% (p=0.039), and 5-year DSS rate was 71.7% vs 50.3% or 69.1% (p=0.0029). In multivariate analysis adjusted for age, ISS, transplant eligibility, mSMART and year of diagnosis, compared to propranolol intake, no beta blocker group had poorer OS [HR= 2.081; 95% CI (1.353- 3.200); p=0.0008], and DSS [HR=2.833 (1.709-4.697); p<0.0001], but other beta blocker users had no difference in OS [HR =1.145 (0.728-1.803);p=0.56],and DSS [HR= 1.276 (0.745-2.185); p=0.38]. Conclusion: Propranolol and other beta-blocker intake among MM patients were equally associated with a more favorable OS and DSS. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures Lust: Senesco: PI Other.

Download Full-text

Hormonal Defects Are Common during Puumala Hantavirus Infection and Associate with Disease Severity and Biomarkers of Altered Haemostasis

Viruses ◽

10.3390/v13091818 ◽

2021 ◽

Vol 13 (9) ◽

pp. 1818

Author(s):

Marlene Tarvainen ◽

Satu Mäkelä ◽

Outi Laine ◽

Ilkka Pörsti ◽

Sari Risku ◽

...

Keyword(s):

Acute Phase ◽

Severe Disease ◽

Kidney Injury ◽

Hantavirus Infection ◽

Overt Hypothyroidism ◽

Severe Thrombocytopenia ◽

Normal Thyroid Function ◽

Coagulation Abnormalities ◽

The One

Central and peripheral hormone deficiencies have been documented during and after acute hantavirus infection. Thrombocytopenia and coagulation abnormalities are common findings in haemorrhagic fever with renal syndrome (HFRS). The associations between coagulation and hormonal abnormalities in HFRS have not been studied yet. Forty-two patients diagnosed with Puumala virus (PUUV) infection were examined during the acute phase and on a follow-up visit approximately one month later. Hormonal defects were common during acute PUUV infection. Overt (clinical) hypogonadism was identified in 80% of the men and approximately 20% of the patients had overt hypothyroidism. At the one-month follow-up visit, six patients had central hormone deficits. Acute peripheral hormone deficits associated with a more severe acute kidney injury (AKI), longer hospital stay and more severe thrombocytopenia. Half of the patients with bleeding symptoms had also peripheral hormonal deficiencies. Patients with free thyroxine levels below the reference range had higher D-dimer level than patients with normal thyroid function, but no thromboembolic events occurred. Acute phase hormonal abnormalities associate with severe disease and altered haemostasis in PUUV infection.

Download Full-text