scholarly journals Clinical Manifestations and Prognostic Factors of Fungal Keratitis: Analysis in Patients Over a 20-year Period

2021 ◽  
Vol 62 (7) ◽  
pp. 910-921
Author(s):  
Sang Il Cho ◽  
Young Myoung Park ◽  
Min Ahn ◽  
Nam Chun Cho ◽  
In Cheon You
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Prognostic Factors ◽  
Clinical Outcome ◽  
Clinical Manifestations ◽  
Fungal Keratitis ◽  
Poor Clinical Outcome ◽  
Clinical Prognosis ◽  
Positive Group ◽  
Culture Positive

Purpose: To describe the clinical manifestations, causative organisms, treatment, and prognostic factors of fungal keratitis based on analysis of patients over the past 20 years. Methods: A total of 177 patients (177 eyes) with fungal keratitis, who were diagnosed by smears and cultures, were reviewed retrospectively. Sex, age, predisposing factors, causative organisms, clinical manifestations, treatment, and prognosis were evaluated. The patients were divided into three groups: only potassium hydroxide (KOH)-positive, only culture-positive, and KOH- and culture-positive. Logistic regression was performed to identify the factors associated with a poor clinical outcome. Results: The mean age of the patients was 67.4 ± 11.3 years; 107 (60.5%) patients were men. The most common predisposing factor was ocular trauma (57.6%), especially by plants (29.4%). The most prevalent filamentous fungi were Fusarium species (31.6%, 49 isolates), and the most prevalent yeasts were Candida species (11.0%, 17 isolates). In cases of bacterial and fungal keratitis, filamentous fungus with Gram-positive bacterial infection (70.7%, 29/41) was the most common presentation. Visual improvement after treatment was common in the KOH-positive group (79.2%, 19/24), while visual deterioration after treatment was common in the culture-positive group (40.4%, 36/89). Previous ocular disease (odds ratio [OR]: 3.744, p = 0.010), hypopyon (OR: 2.941, p = 0.030), and surgical treatment (OR: 24.482, p < 0.001) were risk factors for a poor clinical outcome in the multivariate logistic regression model. Conclusions: Clinical prognosis was good in the KOH-positive only group, but poor in the culture-positive group. If fungal keratitis is suspected, diagnostic KOH staining and culture tests should be performed initially. Early intensive antifungal medical treatments are necessary for patients with risk factors for poor clinical outcomes.

scholarly journals Clinical outcome and risk factors of patients with suspected pneumonia in Southwest district of Ethiopia, 2020: A retrospective study

2021 ◽  
Vol 19 ◽  
pp. 205873922110482
Author(s):  
Mengistu A Sebsibe ◽  
Molla A Kebede ◽  
Yosef H Kazintet ◽  
Bizuayehu T Gosaye ◽  
Addisalem M Teferi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Clinical Features ◽  
Respiratory Infections ◽  
Management Strategies ◽  
Childhood Mortality ◽  
Poor Clinical Outcome ◽  
Cross Sectional ◽  
Early Management ◽  
Suspected Pneumonia

Acute respiratory infections (ARIs), especially pneumonia, remain the leading cause of childhood mortality and the most common reason for adult hospitalization in low- and middle-income countries, despite advances in preventative and management strategies. This study was conducted to assess factors associated with poor clinical outcome of suspected pneumonia cases among hospitalized patients at the three public health hospitals in Southwest district of Ethiopia. A cross-sectional study was conducted from May to July, 2020. Those patients admitted with suspected pneumonia were followed up during their hospital stay, and data on outcomes were captured by study nurses. Socio-demographics, clinical features, and follow-up data were gathered, and analyzed using SPSS versions 20.0. The differences in patients’ outcome in relation to their clinical features and epidemiologically linked exposures were described and compared using chi-square tests at 95% confident intervals. In this study, 742 patients with suspected pneumonia were analyzed. Of these, 473 (62.8%) of them were male, and 264 (35.6%) were of age 1–4 years. About 533 (71.8%) patients with suspected pneumonia were presented with irregular respiratory signs/symptoms (more than one symptoms) and 132 (17.9%) had underline illnesses. About 633 (85.4%) of patients were improved after treatment, and 109 (14.7%) of them ended with poor clinical outcome after completion of their treatment. Age of the patients and presence of comorbid conditions such as HIV/AIDS infections and bronchial asthma were identified as the risk factors for poor outcome of patients with suspected pneumonia. The clinical outcome of patients with suspected pneumonia at the three hospitals in Southwest district of Ethiopia was not satisfactory. Our findings highlight that in order to reduce poor clinical outcome related to suspected pneumonia, the efforts should be focused on some factors like management and prevention of chronic comorbidities. Increasing clinicians’ awareness on early management of suspected pneumonia cases is also essential in reducing the burden of the disease .

scholarly journals The significance of C-reactive protein for the prediction of net-adverse clinical outcome in patients with acute pulmonary embolism

2020 ◽  
Vol 77 (1) ◽  
pp. 35-40
Author(s):  
Rade Milic ◽  
Boris Dzudovic ◽  
Bojana Subotic ◽  
Slobodan Obradovic ◽  
Ivan Soldatovic ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Logistic Regression ◽  
Clinical Outcome ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Acute Pulmonary Embolism ◽  
Clinical Manifestations ◽  
Multivariate Logistic Regression Model ◽  
Significant Independent Predictor ◽  
End Point

Background/Aim. Acute pulmonary embolism (APE) may have different clinical manifestations. Also, its outcome can range from complete recovery to early death. Major bleeding (MB) as a due of the therapy also contributes to the overall adverse outcome. So far, it is unknown what the best predictors are for short-term mortality and MB among the several commonly used biomarkers. The aim of this study was to evaluate the significance of Creactive protein (CRP) and other biomarkers for the prediction of adverse clinical outcomes. Methods. This clinical, observational, retrospective-prospective study included 219 consecutive adult patients treated for APE. Results. Among 219 patients, 22 (10%) died within the first month after diagnosis. Twenty seven patients (12.3%) had at least one episode of MB. Composite end-point [netadverse clinical outcome (NACO)] was estimated in 47 (21.5%) of patients. The average values of all biomarkers were higher in the group of patient who died, and differences were statistically significant. Similar results were obtained for composite end-point. In terms of MB, none of biomarkers did not have significance, but CRP had a slight tendency toward significance. Results from univariate logistic regression model showed that troponin was statistically significant predictor of 30-day mortality. However, after adjusting for other variables, in multivariate logistic regression model troponin failed to be significant independent predictor of 30-day mortality. Unlike troponin, CRP and brain natriuretic peptide (BNP) were significant in all models ? uni and multivariate (they were independent predictors of 30-day mortality). Conclusion. CRP has a good predictive value for 30-day mortality and NACO, and potential for MB in patients treated for APE.

scholarly journals The predictive prognostic factors and risk factors of lymph node metastasis in patients with early gastric cancer

2019 ◽  
Author(s):  
hongliang zu ◽  
huiling Wang ◽  
yan MA ◽  
yingwei xue
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Prognostic Factors ◽  
Treatment Strategies ◽  
Multivariate Logistic Regression Analysis ◽  
Clinicopathological Features ◽  
Multivariate Logistic Regression ◽  
Node Metastasis

Abstract Background: Determining the prognosis of early gastric cancer (EGC) is very important for the selection of preoperative treatment strategies. The purpose of this paper was to investigate the clinicopathological features and prognostic factors in EGC and the related risk factors of lymph node metastasis (LNM). Methods: From March 2007 through December 2010, 1004 patients who underwent gastrectomy at Harbin Medical University were retrospectively identified; 120 patients were diagnosed with EGC. The clinicopathological features and prognostic factors were analysed by univariate and multivariate analyses. Multivariate logistic regression analysis was used to discern risk factors for LNM in EGC. Results: The incidence of EGC was 11.96%. A univariate analysis showed that age, preoperative haemoglobin (Hb) level, prealbumin level, tumour size and LNM were significant prognostic factors. A multivariate analysis showed that the preoperative Hb level and LNM were independent prognostic factors. A multivariate logistic regression analysis revealed that age, Ca-199 level and macroscopic tumour type were independent risk factors for LNM in EGC. Conclusions: Preoperative Hb level and LNM were both independent prognostic factors for EGC. These factors may help surgeons implement appropriate treatment strategies during the perioperative period.

scholarly journals Risk Factors, Clinical Outcomes and Prognostic Factors of Bacterial Keratitis: The Nottingham Infectious Keratitis Study

2021 ◽  
Author(s):  
Darren Shu Jeng Ting ◽  
Jessica Cairns ◽  
Bhavesh Gopal ◽  
Charlotte Ho ◽  
Lazar Krstic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Contact Lens ◽  
Visual Outcome ◽  
Bacterial Keratitis ◽  
Contact Lens Wear ◽  
Poor Visual Outcome ◽  
Corrected Distance Visual Acuity ◽  
Culture Positive ◽  
Lens Wear

Background/aim: To examine the risk factors, clinical characteristics, outcomes and prognostic factors of bacterial keratitis (BK) in Nottingham, UK. Methods: This was a retrospective study of patients who presented to the Queens Medical Centre, Nottingham, with suspected BK during 2015-2019. Relevant data, including the demographic factors, risk factors, clinical outcomes, and potential prognostic factors, were analysed. Results: A total of 283 patients (n=283 eyes) were included; mean age was 54.4+/-21.0 years and 50.9% were male. Of 283 cases, 128 (45.2%) cases were culture-positive. Relevant risk factors were identified in 96.5% patients, with ocular surface diseases (47.3%), contact lens wear (35.3%) and systemic immunosuppression (18.4%) being the most common factors. Contact lens wear was most commonly associated with P. aeruginosa whereas Staphylococci spp. were most commonly implicated in non-contact lens-related BK cases (p=0.017). At presentation, culture-positive cases were associated with older age, worse presenting corrected-distance-visual-acuity (CDVA), larger epithelial defect and infiltrate, central location and hypopyon (all p<0.01), when compared to culture-negative cases. Hospitalisation was required in 57.2% patients, with a mean length of stay of 8.0 +/- 8.3 days. Surgical intervention was required in 16.3% patients. Significant complications such as threatened/actual corneal perforation (8.8%), loss of perception of light vision (3.9%), and evisceration/enucleation (1.4%) were noted. Poor visual outcome (final corrected-distance-visual-acuity of <0.6 logMAR) and delayed corneal healing (>30 days from initial presentation) were significantly affected by age >50 years, infiltrate size >3mm, and reduced presenting vision (all p<0.05). Conclusion: BK represents a significant ocular morbidity in the UK. Culture positivity is associated with more severe disease at presentation but has no significant influence on the final outcome. Older age, large infiltrate, and poor presenting vision were predictive of poor visual outcome and delayed corneal healing, highlighting the importance of primary prevention and early intervention for BK.

Quantitative Lesion Water Uptake as Stroke Imaging Biomarker: A Tool for Treatment Selection in the Extended Time Window?

Stroke ◽  
2021 ◽  
Author(s):  
Gabriel Broocks ◽  
Andre Kemmling ◽  
Svenja Teßarek ◽  
Rosalie McDonough ◽  
Lukas Meyer ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Outcome ◽  
Water Uptake ◽  
Odds Ratio ◽  
Mechanical Thrombectomy ◽  
Time Window ◽  
Imaging Biomarker ◽  
Extended Time ◽  
Ischemic Lesion ◽  
Clinical Prognosis

Background and Purpose: Patients presenting in the extended time window may benefit from mechanical thrombectomy. However, selection for mechanical thrombectomy in this patient group has only been performed using specialized image processing platforms, which are not widely available. We hypothesized that quantitative lesion water uptake calculated in acute stroke computed tomography (CT) may serve as imaging biomarker to estimate ischemic lesion progression and predict clinical outcome in patients undergoing mechanical thrombectomy in the extended time window. Methods: All patients with ischemic anterior circulation stroke presenting within 4.5 to 24 hours after symptom onset who received initial multimodal CT between August 2014 and March 2020 and underwent mechanical thrombectomy were analyzed. Quantitative lesion net water uptake was calculated from the admission CT. Prediction of clinical outcome was assessed using univariable receiver operating characteristic curve analysis and logistic regression analyses. Results: One hundred two patients met the inclusion criteria. In the multivariable logistic regression analysis, net water uptake (odds ratio, 0.78 [95% CI, 0.64–0.95], P =0.01), age (odds ratio, 0.94 [95% CI, 0.88–0.99]; P =0.02), and National Institutes of Health Stroke Scale (odds ratio, 0.88 [95% CI, 0.79–0.99], P =0.03) were significantly and independently associated with favorable outcome (modified Rankin Scale score ≤1), adjusted for degree of recanalization and Alberta Stroke Program Early CT Score. A multivariable predictive model including the above parameters yielded the highest diagnostic ability in the classification of functional outcome, with an area under the curve of 0.88 (sensitivity 92.3%, specificity 82.9%). Conclusions: The implementation of quantitative lesion water uptake as imaging biomarker in the diagnosis of patients with ischemic stroke presenting in the extended time window might improve clinical prognosis. Future studies could test this biomarker as complementary or even alternative tool to CT perfusion.

scholarly journals Risk Factors for Development and Severity of COVID-19 in COPD Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Matteo Bonato ◽  
Umberto Semenzato ◽  
Mariaenrica Tinè ◽  
Erica Bazzan ◽  
Marco Damin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Clinical Outcome ◽  
Copd Patients ◽  
Metabolic Conditions ◽  
The Impact ◽  
Metabolic Comorbidities

The impact that COVID-19 could have on patients with COPD is a real concern. In this study we evaluated, in a cohort of longitudinally followed COPD subjects, the incidence of COVID-19, seeking for possible risk factors and prognostic factors predicting the clinical outcome. In our cohort of 370 patients (followed for 5.3 ± 2.7 years), 22 developed COVID-19 (COPD/COVID-19+) between February/November 2020 (5.9%). Cardio-metabolic conditions (hypertension, dyslipidemia, obesity, diabetes) but not respiratory abnormalities (FEV1, DLCO, emphysema and exacerbation history), were risk factors for development of COVID-19 in COPD patients. Out of the 22 COPD/COVID-19+ patients, 10 needed intensive care. Low DLCO and emphysema, but also metabolic comorbidities, were related to the need for intensive care.

scholarly journals Predictive criteria of severe cases in COVID-19 patients of early stage

2020 ◽  
Author(s):  
Jinrui Gao ◽  
Xiu Huang ◽  
Haibo Gu ◽  
Lingyun Lou ◽  
Zhihao Xu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Clinical Symptoms ◽  
Early Stage ◽  
Severe Pneumonia ◽  
Multivariable Logistic Regression Analysis ◽  
Clinical Prognosis ◽  
Logistic Regression Models ◽  
Asymptomatic Patients ◽  
Chronic Comorbidities

Abstract Background: Patients with coronavirus disease 2019 (COVID-19) often suffer sudden deterioration of disease around 1 to 2 weeks after onset. Once the disease progressed to severe phase, clinical prognosis of patients will significantly deteriorate.Methods: This was a multicenter retrospective study on patients of all adult inpatients (≥18 years old) from Tianyou Hospital (Wuhan, China) and the Fourth Affiliated Hospital, Zhejiang University School of Medicine. All 139 patients had laboratory-confirmed COVID-19 in their early stage, which is defined as within 7 days of clinical symptoms or within 7 days of positive viral nucleic acid test for asymptomatic patients. Univariate and multivariate logistic regression models were used to determine the predictive factors in the early detection of patients who may subsequently develop into severe cases.Results: Multivariable logistic regression analysis showed that the higher level of hypersensitivity C-reactive protein (OR=4.77, 95% CI:1.92-11.87, P=0.001), elevated alanine aminotransferase (OR=6.87, 95%CI:1.56-30.21, P=0.011) and chronic comorbidities (OR=11.48, 95% CI:4.44-29.66, P<0.001) are the determining risk factors for the progression into severe pneumonia in COVID-19 patients.Conclusion: Early COVID-19 patients with chronic comorbidities, elevated hs-CRP or elevated ALT are significantly more likely to develop severe pneumonia as the disease progresses. These risk factors may facilitate the early diagnosis of critical patients in clinical practice.

Risk factors for the poor clinical outcome of visually guided temporomandibular joint irrigation in patients with chronic closed lock

2010 ◽  
Vol 22 (3) ◽  
pp. 133-137 ◽  
Author(s):  
Tomoyuki Saito ◽  
Hiroyuki Yamada ◽  
Kazutoshi Nakaoka ◽  
Akihisa Horie ◽  
Akira Mishima ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Temporomandibular Joint ◽  
Visually Guided ◽  
Poor Clinical Outcome ◽  
The Poor ◽  
Closed Lock

scholarly journals Clinical and Angiographic Outcome of Endovascular and Conservative Treatment for Giant Cavernous Carotid Artery Aneurysms

2014 ◽  
Vol 20 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Zhenhai Zhang ◽  
Xianli Lv ◽  
Zhongxue Wu ◽  
Youxiang Li ◽  
Xinjian Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Conservative Treatment ◽  
Clinical Outcome ◽  
Balloon Occlusion ◽  
Parent Artery ◽  
Poor Clinical Outcome ◽  
Parent Artery Occlusion ◽  
Cavernous Carotid Artery

This study evaluated the outcome of endovascular and conservative treatment for giant cavernous carotid artery aneurysms (CCAAs). We retrospectively reviewed a series of 35 consecutive giant CCAAs treated with endovascular and conservative treatment. All patients were evaluated by balloon occlusion test (BOT) before treatment. Patients who could tolerate BOT were treated by parent artery occlusion (PAO), those who could not tolerate BOT were treated by stent/coil or conservative methods. Eight patients were treated conservatively, symptoms were worsened in four patients (50%), unchanged in three, and improved in one at 33.6±19.9 months (6∼65 months) follow-up. In 27 aneurysms treated with endovascular methods, 17 aneurysms were treated by PAO, eight aneurysms were treated with stent-assisted coil embolization, and two aneurysms were embolized with coils. The initial post-procedure angiogram revealed complete occlusion, neck remnant, and incomplete occlusion in 81.5%, 11.1%, and 7.4%, respectively. Procedure-related mortality and morbidity were 0 and 7.4%, respectively. At 33.1±17.4 months (4∼71 months) follow-up, a good clinical outcome (mRS 0–1) was observed in 25 (92.6%) patients, symptoms were resolved or improved in 20 (74.1%). Statistical analysis showed that risk factors for poor clinical outcome included age of 60 years and older (P=0.006), and conservative treatments (P=0.038). Risk factors for poor clinical outcome of giant CCAAs included conservative treatment and age older than 60 years. A symptomatic giant cavernous carotid aneurysm should be treated. The outcome of endovascular treatment of giant CCAAs is promising.

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