scholarly journals Prediction of Hospital Discharge Outcome From Changes in Albumin Quotient and Cerebrospinal Fluid Lactate Dehydrogenase in Patients With Cryptococcal Meningitis

2021 ◽  
Author(s):  
Yue Huang ◽  
Jun Zou ◽  
Ke-ming Zhang ◽  
Hang Li ◽  
Dong-ying Hu ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
Unfavorable Outcome ◽  
Laboratory Findings ◽  
Value Analysis ◽  
Mean Values ◽  
Cell Counts ◽  
Disturbance Of Consciousness

Abstract BackgroundCryptococcal meningitis (CM) is a life-threatening infection of the central nervous system that occurs in healthy individuals and immunocompromised patients, and reliable prognostic parameters are needed urgently. This study analyzed the clinical characteristics and laboratory findings of CM patients from two tertiary care hospitals in China between 2015 and 2019, aiming to provide reliable prognostic factors for patients with CM.MethodsClinical characteristics and laboratory findings of CM patients were retrospectively reviewed. The unfavorable outcome was defined as no improvement or worsening symptoms and signs or persistent positive results for CSF culture or death after starting treatment. The significant differences in clinical characteristics and symptoms between the patients with favorable and unfavorable outcomes were descriptively analyzed. For comparison of mean values of laboratory results between the patients with favorable and unfavorable outcomes, the t test was performed.Results63 patients with CM were enrolled in this study and 67% were men. 38/63 patients were confirmed to be HIV serology positive. The mean onset age of all patients was 49±15 (20– 77) years. For clinical characteristics, headache, nausea and/or vomiting, and fever were the most common symptoms. Older age and disturbance of consciousness tended to poor prognosis. Changes in serum antioxidant parameters were significantly associated with clinical outcome. For CSF parameters, there were significant correlations between changes in leukocyte count, lactate dehydrogenase and chloride, and outcomes in different groups. For HIV-infected patients, increased CD4+ T cell counts suggested good prognosis. Increased CSF/serum albumin quotient (Qalb) was indicative of unfavorable outcome in HIV-negative patients.ConclusionsIn summary, CSF lactate dehydrogenase and albumin quotient may improve prediction of outcome in patients with CM. We recommend incorporation of Qalb value analysis and pay attention to change of CSF LDH during hospitalization.

Prediction of hospital discharge outcome from changes in cerebrospinal fluid/serum albumin quotient and cerebrospinal fluid lactate dehydrogenase in patients with cryptococcal meningitis

2021 ◽  
Author(s):  
Yue Huang ◽  
Jun Zou ◽  
Ke-ming Zhang ◽  
Hang Li ◽  
Dong-ying Hu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Prognostic Factors ◽  
Lactate Dehydrogenase ◽  
Serum Albumin ◽  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Leukocyte Count ◽  
Laboratory Findings ◽  
Csf Lactate ◽  
Hiv Negative

Aim: This study aims to provide reliable prognostic factors for patients with cryptococcal meningitis (CM). Patients & methods: Clinical characteristics and laboratory findings of CM patients were retrospectively reviewed. Results: Sixty-three patients with CM were enrolled and 38/63 were confirmed to be HIV serology positive. Among clinical characteristics, headache, nausea and/or vomiting, and fever were the most common symptoms. Among cerebrospinal fluid (CSF) parameters, changes in leukocyte count, lactate dehydrogenase and chloride were significantly associated with the outcome. An increased CSF/serum albumin quotient (QAlb) was indicative of an unfavorable outcome in HIV-negative patients. Conclusion: CSF lactate dehydrogenase and QAlb may improve the prediction of outcomes in patients with CM.

scholarly journals Pituitary abscess in an HIV-1-infected patient

2017 ◽  
Vol 5 ◽  
pp. 2050313X1770137
Author(s):  
Hiroyuki Yamazaki ◽  
Masayuki Kobayashi ◽  
Anamaria Daniela Sarca ◽  
Akifumi Takaori-Kondo
Keyword(s):  
Central Nervous System Infection ◽  
Clinical Findings ◽  
Endocrine Function ◽  
Visual Field Defects ◽  
Magnetic Resonance Imaging Scan ◽  
Pituitary Abscess ◽  
Laboratory Findings ◽  
Cell Counts ◽  
Disturbance Of Consciousness ◽  
Hiv 1

Objectives: Pituitary abscess is a rare occurrence among pituitary conditions, but one which carries life-threatening potential. An immunocompromised status is a risk factor for the development of a pituitary abscess; however, literature describes only one case among HIV-infected patients. Methods and results: We present here a case of pituitary abscess in an HIV-1-positive patient, who demonstrated a shock status, disturbance of consciousness and generalized skin rash with laboratory findings of hypovolemia, acute inflammatory reaction and blood electrolyte abnormality. We first diagnosed the dermal manifestation as atypical generalized zoster, however, the other clinical findings could not be explained by VZV infection only. Combination with anamnesis, head magnetic resonance imaging scan and endocrine function test helped us to diagnose pituitary abscess. Although the etiology of the pituitary abscess could not be detected, the patient was successfully treated with antibiotics but followed by panhypopituitarism as sequela. Conclusion: A pituitary abscess should be considered in HIV-infected patients with endocrinological abnormalities, visual field defects, and central nervous system infection signs or symptoms, regardless of CD4 T-cell counts.

scholarly journals Pneumothorax in Tertiary Intensive Care With COVID-19 is Associated With Increased Mortality

2021 ◽  
Author(s):  
serife gökbulut bektaş ◽  
Demet Bölükbaşı ◽  
Baha Burak Konak ◽  
Ahmet Gökhan Akdağ ◽  
Aydan Çalışkan ◽  
...  
Keyword(s):  
Intensive Care ◽  
Clinical Characteristics ◽  
Common Ground ◽  
Tertiary Care ◽  
Mortality Rates ◽  
Electronic Records ◽  
Mechanical Ventilator ◽  
Chest Imaging ◽  
Laboratory Findings

Abstract Background: To examine the laboratory findings with clinical characteristics and treatments of patients who were hospitalized in a tertiary intensive care unit with the diagnosis of COVID-19 and developed pneumothorax and to determine epidemiology and risks of pneumothorax.Methods: The study was conducted by retrospectively examining the electronic records of 681 COVID-19 patients who were followed up between 1 April 2020 and 1 January 2021 in 3 tertiary care units (each was 24 beds). Patients demographic and clinical characteristics, laboratory findings, mechanical ventilator parameters and chest imaging were collected retrospectively,.Results: Pneumothorax in 22 (3.2%) of 681 with COVID-19 patients were detected and ARDS in 481 (70.6). All the study patients met ARDS diagnostic criterias. Mortality rates were 43.4% (296/681) in all patients, 52.8% (254/481) in patients with ARDS, and 86.3% (19/22) in patients with pneumothorax. Pneumothorax occurred in the patients within a mean of 17.4 ± 4.8 days. The computed tomographies of patients were observed common ground-glass opacities, heterogenic distribution with patch infiltrates, alveolar exudates, interstitial thickening in the 1st week of their follow-up. Conclusion: We observed that pneumothorax significantly increased mortality in COVID-19 patients with ARDS. We believe that understanding and preventing the characteristics of pneumothorax will make an important contribution to mortality reduction.

scholarly journals 2308. Comparison of Clinical Characteristics Between Laboratory-Confirmed Positive and Negative Patients with Severe Fever with Thrombocytopenia Syndrome

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S791-S791
Author(s):  
Suhyun Oh ◽  
Jeong Rae You ◽  
Sang Taek Heo ◽  
Sujin Jo
Keyword(s):  
South Korea ◽  
Clinical Characteristics ◽  
Close Contact ◽  
Case Fatality ◽  
Oral Intake ◽  
Outdoor Temperature ◽  
Rt Pcr ◽  
Laboratory Findings ◽  
Cell Counts ◽  
Severe Fever

Abstract Background Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne emerging infectious disease caused by SFTS virus (SFTSV). Mortality of SFTS estimated to be 21.8% in South Korea, and this disease is difficult differential diagnosis. Here, we analyzed clinical characteristics between SFTS positive group (SPG) and negative group (SNG) in a primary clinical setting. Methods In this prospective observational study, data were collected on patients with SFTS test performed at the single teaching hospital, in South Korea, between April 2013 and December 2018. The association between each demographic, climatic, clinical, and laboratory variable was assessed. All SFTS was confirmed at the KCDC by detecting the M segment gene of SFTSV RNA using reverse transcription-polymerase chain reaction (RT–PCR), and were confirmed at our laboratory by S segment gene of SFTSV RNA using RT–PCR about patient’s family member and those with close contact. Results Of the 199 patients in the study periods, 61 (31%) were SPG and 138 (69%) were SNG. Mean age was 55.1 ± 20.3 years, and 103 (52%) patients were male. In SPG, the comorbidity score and history of tick bite were significantly higher compared with SNG. SPG and SNG were prevalent in summer and autumn, respectively (60.7% vs. 45.7%, P < 0.05). SPG was associated with mean outdoor temperature, humidity and rainfall compared with SNG (22.9°Cvs. 18.9 ℃; 78.8% vs. 70.6%; 12.6 mm vs. 8.5 mm, all P < 0.01). Dizziness, poor oral intake, nausea, and diarrhea were common in SPG. In laboratory findings, white blood cell counts, absolute neutrophil count, and C-reactive protein were significantly lower in SPG. Lymphocyte fraction, activated partial thromboplastin time, and creatinine phosphokinase were significantly higher in SPG. Case fatality of the SPG and SNG were 9.8% and 1.0%, respectively. In multivariate analysis, mean outdoor temperature, humidity, dizziness, and low CRP were predictive factors in SPG. Conclusion Early prediction of SFTS diagnosis is important because this emerging zoonotic disease was a high fatality in endemic areas. When a physician wants to do SFTS test, they would consider according to this predictive variable for differentiating SFTS in primary care settings. Disclosures All authors: No reported disclosures.

scholarly journals Cryptococcal meningitis in young adults: clinical characteristics and therapeutic outcomes

2019 ◽  
Author(s):  
Che-Wei Hsu ◽  
Chia-Yi Lien ◽  
Jun-Jun Lee ◽  
Wen-Neng Chang ◽  
Wan-Chen Tsai
Keyword(s):  
Young Adults ◽  
Prognostic Factors ◽  
Young Adult ◽  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Laboratory Data ◽  
Adult Group ◽  
Laboratory Findings ◽  
Therapeutic Outcomes

Abstract Background: The clinical characteristics of cryptococcal meningitis (CM) in young adults (≤ 40 years old) have not been reported. The purpose of this study was to delineate the clinical characteristics, laboratory findings and therapeutic outcomes of young adults with CM, and compare them with older adults (> 40 years old) with CM. Methods: Ninety-nine adult patients with CM (64 men, 35 women) were enrolled from 2002-2016, of whom 26 were ≤ 40 years old (young adult group) and 73 were > 40 years old (non-young adult group). The clinical characteristics, laboratory data and therapeutic outcomes of these two groups were compared. The prognostic factors of the young adult CM patients were analyzed, and the clinical characteristics and laboratory data between the young adult CM patients with and without acquired immune-compromised syndrome (AIDS) were compared. The modified Rankin scale (mRS) was used to evaluate the outcomes of the survivors at the time of discharge and at 1 year of follow-up. Results: The young adult CM patients had a significantly higher incidence of headache as the clinical presentation. There were no significant clinical differences between the young adult CM patients with and without AIDS. There were no significant prognostic factors in the young adult CM patients, but the young adult survivors had better outcomes (mRS score 0-2) than the non-young adult group. Conclusion: The young adult CM patients had a higher incidence of headache as the clinical presentation, and the young adult CM survivors had better clinical outcomes.

Clinical Characteristics and Outcomes of Influenza in Hospitalized Pediatric Patients in King Chulalongkorn Memorial Hospital

2020 ◽  
Vol 103 (11) ◽  
pp. 1220-1229
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Associated Factors ◽  
Clinical Characteristics ◽  
Care Center ◽  
Tertiary Care ◽  
Memorial Hospital ◽  
Molecular Testing ◽  
Duration Of Hospitalization ◽  
Severity Of The Disease

Objective: To describe clinical characteristics and outcomes of laboratory-confirmed influenza in hospitalized children in a tertiary care center and to identify factors associated with the severity. Materials and Methods: The present study was a retrospective medical chart review study conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Data were extracted from children aged under 15 years old hospitalized between January 2014 and December 2018. Patients who had laboratory-confirmed influenza by rapid antigen detection or molecular testing were included. Severe influenza was defined as patients who developed influenza complications or duration of hospitalization for more than three days. Multivariate logistic regression was used to identify the associated factors with the severity of the disease. Results: Three hundred fifty-seven influenza patients were included with median age of 43 months (IQR 19 to 81), of which 63.3% were aged under 60 months. There were 174 patients (48.7%) with comorbidities, most common were immunosuppression (18.2%), chronic pulmonary disease (12.2%), and congenital heart disease (11.5%). Fifty-seven out of 183 patients (31.1%) had history of influenza vaccination in the medical records. One hundred sixty-one patients (45.1%) had 212 influenza complications including influenza-related pneumonia (89, 24.9%), secondary bacterial infection (53, 14.8%), and neurologic complications (47, 13.2%), in which 27 cases (7.6%) were transferred to intensive care unit (ICU). Four cases (1.1%) died but not directly related to influenza. Associated factors with complicated influenza were aged less than 24 months [aOR 2.67 (95% CI 1.68 to 4.26)] and presence of chronic lung disease [aOR 4.34 [95% CI 2.01 to 9.35)]. Conclusion: Two-third of the children hospitalized with influenza were younger than 60 months. Nearly half developed complications most associated with the age of less than two years old and patients with chronic lung disease. Low rates of vaccination were demonstrated. Keywords: Influenza, Pediatrics, Complications, Pneumonia, Hospitalization

Homelessness among an inpatient HIV-positive cohort at a tertiary care hospital in central London

2020 ◽  
Vol 31 (7) ◽  
pp. 705-707
Author(s):  
Venkateshwaran Sivaraj ◽  
Rudiger Pittrof ◽  
Olubanke Davies ◽  
Ranjababu Kulasegaram
Keyword(s):  
Bacterial Infections ◽  
Substance Misuse ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Hiv Positive ◽  
Care Hospital ◽  
Hiv Viral Load ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Cd4 Cell

A cohort review was conducted at a central London tertiary care hospital trust on the prevalence of homelessness among human immunodeficiency virus (HIV)-positive inpatients over a year. Data were collected on the duration of inpatient stay, co-morbidities including acquired immune deficiency syndrome (AIDS)-defining illnesses, co-infections, initiation of antiretroviral therapy, CD4 cell count, HIV viral load and substance misuse. Homeless people were found to be at high risk for hepatitis C, mental health illness, substance misuse including injecting drug use, recurrent bacterial infections, AIDS-associated illnesses, lower CD4 cell counts and HIV viremia. They also had more missed HIV outpatient appointments. It was highlighted that a multidisciplinary approach in their care was necessary to address their needs and reduce the morbidity burden in this cohort.

Comparison of phaco time parameters in eyes with and without glaucoma filtration surgery due to pseudoexfoliation glaucoma

2021 ◽  
pp. 112067212110177
Author(s):  
Ayse Gul Kocak Altintas ◽  
Cagri Ilhan
Keyword(s):  
Clinical Characteristics ◽  
Pseudoexfoliation Glaucoma ◽  
Filtration Surgery ◽  
Glaucoma Filtration Surgery ◽  
Mean Values ◽  
Time Parameters ◽  
The Mean ◽  
Group 2 ◽  
Surgical Manipulations ◽  
Phaco Time

Purpose: To compare the phaco time parameters including ultrasound time (UST), effective phaco time (EPT), and average phaco power (APP) in eyes with pseudoexfoliation glaucoma (PEG) and had or had not glaucoma filtration surgery. Methods: In this retrospective comparative study, Group 1 was constructed with 84 PEG patients who had not operated previously, and Group 2 was constructed with 49 PEG patients who had glaucoma filtration surgery. The mean values of UST, EPT, and APP were compared. The preoperative clinical characteristics and surgical manipulations were also compared. Results: The mean ages and male-to-female ratios of the groups were similar ( p > 0.05, for both). There was no difference in the preoperative clinical characteristics, including biometric values between the groups ( p > 0.05, for all). Some surgical manipulations, including pupillary stretching ( p = 0.004), pupillary membrane peeling ( p = 0.021), iris hook using ( p = 0.041), and capsular tension ring implantation ( p = 0.041), were significantly performed more commonly in Group 2. Although the mean UST and EPT values were similar ( p > 0.05, for both), the mean APP value was significantly lower in Group 2 ( p = 0.011). Conclusion: The lower APP parameter was observed in PEG patients having had glaucoma filtration surgery. Needing more surgical manipulation to overcome poor pupillary dilation and weak zonular instability can be a reason for this result.

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