scholarly journals Severe West Nile Virus Neuroinvasive Disease: Clinical Characteristics, Short- and Long-Term Outcomes

Pathogens ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. 52
Author(s):  
Marija Santini ◽  
Sara Haberle ◽  
Snježana Židovec-Lepej ◽  
Vladimir Savić ◽  
Marija Kusulja ◽  
...  
Keyword(s):  
Intensive Care ◽  
West Nile Virus ◽  
Functional Status ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
West Nile ◽  
Vital Status ◽  
Neuroinvasive Disease

West Nile Virus Neuroinvasive Disease (WNV NID) requires prolonged intensive care treatment, resulting in high mortality and early disability. Long-term results are lacking. We have conducted an observational retrospective study with a prospective follow-up of WNV NID patients treated at the Intensive Care Unit (ICU), University Hospital for Infectious Diseases, Zagreb, Croatia, 2013–2018. Short-term outcomes were vital status, length of stay (LOS), modified Rankin Scale (mRS), and disposition at discharge. Long-term outcomes were vital status and mRS at follow-up. Twenty-three patients were identified, 78.3% males, median age 72 (range 33–84) years. Two patients (8.7%) died in the ICU, with no lethal outcomes after ICU discharge. The median ICU LOS was 19 days (range 5–73), and the median hospital LOS was 34 days (range 7–97). At discharge, 15 (65.2%) patients had moderate to severe/mRS 3–5, 6 (26.0%) had slight disability/mRS 2–1, no patients were symptom-free/mRS 0. Ten (47.6%) survivors were discharged to rehabilitation facilities. The median time to follow-up was nine months (range 6–69). At follow-up, seven patients died (30.5%), five (21.7%) had moderate to severe/mRS 3–5, one (4.3%) had slight disability/mRS 2–1, six (26.1%) had no symptoms/mRS 0, and four (17.4%) were lost to follow-up. Briefly, ten (43.5%) survivors improved their functional status, one (4.3%) was unaltered, and one (4.3%) aggravated. In patients with severe WNV NID, intensive treatment in the acute phase followed by inpatient rehabilitation resulted in significant recovery of functional status after several months.

scholarly journals Human West Nile Virus Lineage 2 Infection: Epidemiological, Clinical, and Virological Findings

Viruses ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 458 ◽  
Author(s):  
Monia Pacenti ◽  
Alessandro Sinigaglia ◽  
Elisa Franchin ◽  
Silvana Pagni ◽  
Enrico Lavezzo ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Blood Donors ◽  
Case Fatality ◽  
West Nile ◽  
Neuroinvasive Disease ◽  
Human West Nile Virus ◽  
Large Outbreak ◽  
Study Population ◽  
Lineage 2

West Nile virus (WNV) lineage 2 is expanding and causing large outbreaks in Europe. In this study, we analyzed the epidemiological, clinical, and virological features of WNV lineage 2 infection during the large outbreak that occurred in northern Italy in 2018. The study population included 86 patients with neuroinvasive disease (WNND), 307 with fever (WNF), and 34 blood donors. Phylogenetic analysis of WNV full genome sequences from patients’ samples showed that the virus belonged to the widespread central/southern European clade of WNV lineage 2 and was circulating in the area at least since 2014. The incidence of WNND and WNF progressively increased with age and was higher in males than in females. Among WNND patients, the case fatality rate was 22%. About 70% of blood donors reported symptoms during follow-up. Within the first week after symptom onset, WNV RNA was detectable in the blood or urine of 80% of patients, while 20% and 40% of WNND and WNF patients, respectively, were WNV IgM-seronegative. In CSF samples of WNND patients, WNV RNA was typically detectable when WNV IgM antibodies were absent. Blunted or no WNV IgM response and high WNV IgG levels were observed in seven patients with previous flavivirus immunity.

scholarly journals Outcomes of Venous Malformation Sclerotherapy: A Review of Study Methodology and Long-Term Results

2017 ◽  
Vol 34 (03) ◽  
pp. 288-293 ◽  
Author(s):  
Sumera Ali ◽  
Sally Mitchell
Keyword(s):  
Venous Malformation ◽  
Long Term Results ◽  
International Studies ◽  
Venous Malformations ◽  
Long Term Outcomes ◽  
Relative Paucity ◽  
Study Methodology ◽  
Grading Scales

AbstractIt is very important that patients seeking sclerotherapy for the treatment of venous malformations are aware of the expected course of the therapy. They should be thoroughly counseled about the complications, the need for multiple sessions of therapy, and also about the expected clinical outcome. The aim of this review is to discuss the long-term outcomes of sclerotherapy for the treatment of venous malformation. Many studies have discussed their individual center's experiences and short-midterm results, but there is a relative paucity of data on long-term outcomes. We have reviewed the literature and also shared our experience of a large cohort of patients (n = 116) with a relatively longer follow-up period of more than 1 year. Venous malformations are very complex lesions and their treatment is quite variable depending on its extent and complexity. As a result, outcome studies vary considerably in the choice of sclerosant, study methodology, outcome assessment (clinical vs. imaging), and grading scales. This review also highlights this extreme heterogeneity in the literature of the sclerotherapy outcome and summarizes a few national and international studies for comparison.

scholarly journals Initial Gamma Knife Radiosurgery for Large or Documented Growth Asymptomatic Meningiomas: Long-Term Results From a 27-Year Experience

2020 ◽  
Vol 10 ◽  
Author(s):  
Junyi Fu ◽  
Lisha Wu ◽  
Chao Peng ◽  
Xin Yang ◽  
Hongji You ◽  
...  
Keyword(s):  
Median Time ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Long Term Results ◽  
Tumor Control ◽  
Long Term Outcomes ◽  
Radiological Progression ◽  
Design And Methods

ObjectiveThe aims of this study were to investigate the long-term outcomes of initial Gamma Knife radiosurgery (GKRS) for large (≥20 mm) or documented growth asymptomatic meningiomas.Design and MethodsThis was a single-center retrospective study. Fifty-nine patients with large (≥20 mm) or documented growth asymptomatic meningiomas undergoing initial GKRS were enrolled. The median age was 56 (range, 27–83) years. The median time of follow-up was 66.8 (range, 24.6–245.6) months, and the median tumor margin dose was 13.0 Gy (range, 11.6–22.0 Gy).ResultsTumors shrunk in 35 patients (59.3%) and remained stable in 23 (39.0%). One patient (1.7%) experienced radiological progression at 54 months after GKRS. The PFS was 100%, 97%, and 97% at 3, 5, and 10 years, respectively. Nine patients (15.3%) occurred new neurological symptoms or signs at a median time of 8.1 (range, 3.0–81.6) months. The symptom PFS was 90% and 78% at 5 and 10 years, respectively. Fifteen patients (25.4%) occurred peritumoral edema (PTE) at a median time of 7.2 (range, 2.0–81.6) months. One patient underwent surgical resection for severe PTE. In univariate and multivariate analysis, Only tumor size (≥25 mm) and maximum dose (≥34 Gy) were significantly associated with PTE [hazard ratio (HR)= 3.461, 95% confidence interval (CI)=1.157-10.356, p=0.026 and HR=3.067, 95% CI=1.068-8.809, P=0.037, respectively].ConclusionsIn this study, initial GKRS can provide a high tumor control rate as well as an acceptable rate of complications in large or documented growth asymptomatic meningiomas. GKRS may be an alternative initial treatment for asymptomatic meningiomas.

scholarly journals Baseline Functional Status and One-year Mortality After Hospital Admission in Elderly Patients: a prospective cohort study

2020 ◽  
Vol 77 (3) ◽  
pp. 143-148
Author(s):  
Victoria Sáenz ◽  
Nicolas Zuljevic ◽  
Cristina Elizondo ◽  
Iñaki Martin Lesende ◽  
Diego Caruso
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
Hospital Admission ◽  
Functional Status ◽  
Prospective Cohort ◽  
Functional Decline ◽  
Long Term Outcomes ◽  
One Year

Introduction: Hospitalization represents a major factor that may precipitate the loss of functional status and the cascade into dependence. The main objective of our study was to determine the effect of functional status measured before hospital admission on survival at one year after hospitalization in elderly patients. Methods: Prospective cohort study of adult patients (over 65 years of age) admitted to either the general ward or intensive Care units (ICU) of a tertiary teaching hospital in Buenos Aires, Argentina. Main exposure was the pre-admission functional status determined by means of the modified “VIDA” questionnaire, which evaluates the instrumental activities of daily living. We used a multivariate Cox proportional hazards model to estimate the effect of prior functional status on time to all-cause death while controlling for measured confounding. Secondarily, we analyzed the effect of post-discharge functional decline on long-term outcomes. Results: 297 patients were included in the present study. 12.8% died during hospitalization and 86 patients (33.2%) died within one year after hospital discharge. Functional status prior to hospital admission, measured by the VIDA questionnaire (e.g., one point increase), was associated with a lower hazard of all-cause mortality during follow-up (Hazard Ratio [HR]: 0.96; 95% Confidence Interval [CI]: 0.94–0.98). Finally, functional decline measured at 15 days after hospital discharge, was associated with higher risk of all-cause death during follow-up (HR: 2.19, 95% CI: 1.09–4.37) Conclusion: Pre-morbid functional status impacts long term outcomes after unplanned hospitalizations in elderly adults. Future studies should confirm these findings and evaluate the potential impact on clinical decision-making.

scholarly journals The Long-Term Outcomes of Human West Nile Virus Infection

2007 ◽  
Vol 44 (12) ◽  
pp. 1617-1624 ◽  
Author(s):  
J. M. Hughes ◽  
M. E. Wilson ◽  
J. J. Sejvar
Keyword(s):  
West Nile Virus ◽  
Virus Infection ◽  
West Nile Virus Infection ◽  
Long Term Outcomes ◽  
West Nile ◽  
Human West Nile Virus

scholarly journals Long-Term Outcomes in COVID-19 ICU Patients: A Prospective Cohort Study

2021 ◽  
Author(s):  
Nadine Van Veenendaal ◽  
Ingeborg Van der Meulen ◽  
Marisa Onrust ◽  
Wolter Paans ◽  
Willem Dieperink ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Psychological Functioning ◽  
Employment Status ◽  
Family Members ◽  
Well Being ◽  
Long Term Outcomes ◽  
Icu Discharge

Abstract BACKGROUNDThe COVID-19 pandemic causes high rates of intensive care unit (ICU) admissions. After ICU-discharge patients and family members can suffer from persisting impairments known as ‘Post Intensive Care Syndrome’ (PICS) and PICS-family. Since COVID-19 is relatively new, there is barely any knowledge on the long-term outcomes of COVID-19 ICU-survivors and their family members.OBJECTIVESThis study aims to gain insight in the long-term physical, social and psychological functioning of COVID-19 ICU-survivors and their family members at three- and six-months following ICU discharge.METHODSA single-center, prospective cohort study was conducted in COVID-19 ICU-survivors and their family members. Enrolled participants received questionnaires at three and six months after ICU discharge. The MOS Short-Form General Health Survey, Clinical Frailty Scale, spirometry tests, McMaster Family Assessment Device (FAD-GF6+), the Hospital Anxiety and Depression Scale and return to work were used to evaluate physical, social and psychological functioning.RESULTSSixty COVID-19 ICU-survivors and 78 family members participated. Physical functioning was impaired in ICU-survivors as reflected by a score of 33.3 (IQR 16.7-66.7) and 50 (IQR 16.7-83.3) on the physical functioning subscale at 3- and 6-months follow-up respectively. Diffusion lung capacity was reduced in 69% of patients. Ninety percent of the ICU-survivors reported persistent symptoms after 6 months. Social functioning was impaired as 90% of the COVID-19 ICU-survivors did not reach their pre-ICU employment level, 6 months after ICU-discharge. Psychological functioning in ICU-survivors was normal. Family members experienced worse employment status in 35% and 34% including a decrease in employment rate of 18.3% and 7.4% at 3- and 6-months post ICU-discharge, respectively. Psychologically, 63% of the family members reported ongoing impaired well-being due to the COVID-19 related mandatory physical distance to their relatives.CONCLUSIONWe have shown that COVID-19 ICU-survivors suffer from a prolonged burden of disease, prominent in physical- and social functioning, worse employment status and persisting symptoms in 90%. In addition, family members also report long term effects expressed by a reduction in return to work and impaired well-being. Further research needs to extend the follow up and to study the effects of standardized rehabilitation in COVID-19 patients and their family members.

scholarly journals Management of colorectal anastomotic stricture with multidiameter balloon dilation: long-term results

2020 ◽  
Vol 24 (12) ◽  
pp. 1271-1276
Author(s):  
R.-H. Chan ◽  
S.-C. Lin ◽  
P.-C. Chen ◽  
W.-T. Lin ◽  
C.-H. Wu ◽  
...  
Keyword(s):  
Anastomotic Stricture ◽  
Balloon Dilation ◽  
Long Term Results ◽  
Endoscopic Dilation ◽  
Long Term Outcomes ◽  
Recurrence Rates ◽  
Aggressive Management ◽  
Anastomotic Strictures

Abstract Background Postoperative colorectal anastomotic strictures are quite common. As such, many techniques have been available to address such a problem, one of which is endoscopic dilation. The aim of the present study was to evaluate the long-term outcomes following endoscopic dilation using a multidiameter balloon. Methods A retrospective study was conducted on patients with postoperative anastomotic stenosis treated with endoscopic dilation using a multidiameter balloon at our institution, in January 2005–December 2019 were retrospectively reviewed, excluding those with tumor recurrence. Perioperative factors, complications, and recurrence rates were analyzed. Results There were 40 patients, (22 males and 18 females, mean age 64.6 ± 10.7 years, range 33–84 years). The median follow-up period was 56 months (interquartile range 22.5–99 months). Only 1 complication occurred, micro-perforation due to guided wire injury, which was managed conservatively. Five (12.5%) patients developed restenosis and underwent repeat balloon dilation. None of the five recurrences required more aggressive management, such as redo anastomosis. Conclusions Endoscopic multidiameter balloon dilation is a safe and effective method for treating benign colorectal anastomotic strictures.

scholarly journals Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors

2018 ◽  
Author(s):  
Oliver J Schofield-Robinson ◽  
Sharon R Lewis ◽  
Andrew F Smith ◽  
Joanne McPeake ◽  
Phil Alderson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Long Term Outcomes

Outcomes associated with secondary implant removal and arthrolysis in patients with a painful stiff shoulder after proximal humeral fracture fixation

2022 ◽  
Vol 104-B (1) ◽  
pp. 157-167
Author(s):  
Navnit S. Makaram ◽  
Ewan B. Goudie ◽  
C. Michael Robinson
Keyword(s):  
Proximal Humerus ◽  
Plate Fixation ◽  
Multivariable Analysis ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Manual Occupation

Aims Open reduction and plate fixation (ORPF) for displaced proximal humerus fractures can achieve reliably good long-term outcomes. However, a minority of patients have persistent pain and stiffness after surgery and may benefit from open arthrolysis, subacromial decompression, and removal of metalwork (ADROM). The long-term results of ADROM remain unknown; we aimed to assess outcomes of patients undergoing this procedure for stiffness following ORPF, and assess predictors of poor outcome. Methods Between 1998 and 2018, 424 consecutive patients were treated with primary ORPF for proximal humerus fracture. ADROM was offered to symptomatic patients with a healed fracture at six months postoperatively. Patients were followed up retrospectively with demographic data, fracture characteristics, and complications recorded. Active range of motion (aROM), Oxford Shoulder Score (OSS), and EuroQol five-dimension three-level questionnaire (EQ-5D-3L) were recorded preoperatively and postoperatively. Results A total of 138 patients underwent ADROM; 111 patients were available for long-term follow-up at a mean of 10.9 years (range 1 to 20). Mean age was 50.8 years (18 to 75);79 (57.2%) were female. Mean time from primary ORPF to ADROM was 11.9 months (6 to 19). Five patients developed superficial wound infection; ten developed symptomatic osteonecrosis/post-traumatic arthrosis (ON/PTA); four underwent revision arthrolysis. Median OSS improved from 17 (interquartile range (IQR) 12.0 to 22.0) preoperatively to 40.0 (IQR 31.5 to 48.0) postoperatively, and 39.0 (IQR 31.5 to 46.5) at long-term follow-up (p < 0.001). Median EQ-5D-3L improved from 0.079 (IQR -0.057 to 0.215) to 0.691 (IQR 0.441 to 0.941) postoperatively, and 0.701 (IQR 0.570 to 0.832) at long-term follow-up (p < 0.001). We found that aROM improved in all planes (p < 0.001). Among the variables assessed on multivariable analysis, a manual occupation, worsening Charlson Comorbidity Index and increasing socioeconomic deprivation were most consistently predictive of worse patient-reported outcome scores. Patients who subsequently developed ON/PTA reported significantly worse one-year and late OSS. Conclusion ADROM in patients with persistent symptomatic stiffness following ORPF can achieve excellent short- and long-term outcomes. More deprived patients, those in a manual occupation, and those with worsening comorbidities have worse outcomes following ADROM. Cite this article: Bone Joint J 2022;104-B(1):157–167.

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