CLINICAL CHARACTERISTIC, NEUROIMAGING AND NEUROLOGICAL OUTCOME OF TUBERCULOUS MENINGITIS IN PEDIATRIC AGE GROUPAT TERTIARY CARE CENTER OF HAPUR ; “A PROSPECTIVE OBSERVATIONAL STUDY”

2021 ◽  
pp. 13-15
Author(s):  
Nidhi Singh ◽  
Hiru Navaney ◽  
Yogesh Goel
Keyword(s):  
Tuberculous Meningitis ◽  
Neurological Outcome ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Advanced Stage ◽  
Pediatric Age ◽  
Mortality And Morbidity ◽  
Stage Of Disease ◽  
Clinical Characteristic

Background: Early diagnosis and treatment is important in reducing mortality and morbidity. The aim of the study was to describe clinical characteristic, neuroimaging and neurological outcome of TBM in pediatric age group. Methods: A total of 72 patients were included in the study based on inclusion and exclusion criteria. Detailed history and neurological examination, CSF analysis, EEG and CT scan studies done in all patients. Mean age of patient was 59 months (range 6month- 18 year). The majority of these patients were in stage II and III. Results: Among 72 patients included in the study tuberculous meningitis was common in children under 5 years of age (70%). Out of 72 patients 50 patients (70%) were in advanced stage of disease. Most common symptom were fever (90%), altered sensorium (83%), convulsion (80%), th vomiting (75%).7 nerve palsy was most commonly involved (25%), hemiplegia in 15 patients (21%) and papilledema in (14%). CSF culture was positive in 61 patients (85%) with Pleocytosis, lymphocytosis and elevated CSF protein as dominant ndings. Abnormal chest X ray present in 11 patients (50%) in stage I, 9 patients (38) in stage II, and 6 patients (23%) in stage III of disease.: In our study Leptomeningeal enhancement was present in 17 patients (77.27%) in stage I, 16 patients (66.6%) in stage II, 18 patients (69.2%) in stage III of disease. Hydrocephalus was presents in 14 patients (63.63%) in stage I, 15 patients (62.5%) in stage II, 17 patients (65.38%) in stage III of disease. Survival with neurological decit is more in younger age and advanced stage of disease. Conclusion: TBM is an important cause of mortality and morbidity in pediatric patients especially under 5 years of age in countries where tuberculosis is an endemic disease. In our study we found younger the child and more advanced the stage of disease, higher CSF protein value, the greater was mortality and morbidity.

Limited-Stage Mantle Cell Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5330-5330 ◽  
Author(s):  
Ritsuro Suzuki ◽  
Dai Chihara ◽  
Naoko Asano ◽  
Ken Ohmachi ◽  
Tomohiro Kinoshita ◽  
...  
Keyword(s):  
Research Funding ◽  
Cell Lymphoma ◽  
Clinical Stage ◽  
Stage Iv ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Advanced Stage ◽  
Limited Stage ◽  
Stage Disease

Abstract [Background] Mantle cell lymphoma (MCL) is an aggressive B-cell lymphoma, characterized by the overexpression of cyclin D1 derived from t(11;14)(q13;q32) and poor prognosis. Most MCLs show nodal presentation, but also accompany extranodal involvement, such as bone marrow, peripheral blood or gastrointestinal tract. As a result, many MCLs present with advanced stage disease. Since only a small portion of patients show limited-stage disease, minimal data exist on treatment of patients diagnosed with limited stage disease. Nevertheless, the treatment strategy of MCL is recommended according to the clinical stage of limited- (stage I or non-bulky II) vs. advanced-stage, as well as other types of lymphoma. [Patients and methods] We recently collected 633 patient data of MCL (Chihara, et al. Ann Oncol 2015). Information of clinical stage was available in 626 patients. The patient data were retrospectively analyzed the by the clinical stage at initial presentation. [Results] The clinical stage was I in 24 patients (4%), II in 33 (5%), III in 70 (11%), and IV in 499 (80%). Only one patient presented with bulky stage II. Detailed demographic information by the clinical stage are listed in Table. Age and sex were not significantly different by clinical stage. Limited stage patients were associated with better performance status (PS), less B symptoms, no extranodal involvement, and lower lactate dehydrogenase (LDH) level and white blood cell (WBC) count. Most patients in any stage were treated with cytotoxic chemotherapy, but more patients in limited stage received radiotherapy. The proportion of high-dose cytarabine (HDCA)-containing regimen over CHOP/CHOP-like was higher in advanced stage patients. Complete and overall response rates were 92% and 96% in stage I, 58% and 94% in stage II, 66% and 86% in stage III, and 52% and 82% in stage IV, respectively (P = 0.02). However, the higher response rate in limited stage patients did not translate into better prognosis. The median survival was 11.0 years in stage I, 13.4 years in stage II, 11.5 years in stage III, and 5.6 years in stage IV (Figure). The prognosis was not significantly different among patients with stage I, II, and III (P = 0.33). [Conclusion] Prognosis of limited-stage MCL was almost similar to that of stage III MCL. Although the present study includes several limitations including a retrospective nature and limited number of patients, prognosis of patients with limited-stage MCL was not satisfactory. The significance of radiotherapy, as well as the optimal choice of chemotherapy, for limited-stage MCL needs re-evaluation. Table Table. Figure Figure. Disclosures Suzuki: Chugai: Honoraria; Kyowa Hakko kirin: Honoraria; Bristol-Myers Squibb: Honoraria. Asano:Jannsen: Honoraria; Chugai: Honoraria. Kinoshita:Ono: Research Funding; Gilead: Research Funding; Zenyaku: Honoraria, Research Funding; Takeda: Research Funding; Chugai: Honoraria, Research Funding; Eisai: Honoraria, Research Funding; Solasia: Research Funding; Janssen: Honoraria; Kyowa Kirin: Honoraria. Suzumiya:Chugai: Honoraria, Research Funding; Astellas: Research Funding; Eisai: Honoraria, Research Funding; Takeda: Honoraria; Toyama Chemical: Research Funding; Kyowa Hakko kirin: Research Funding. Ogura:SymBio Pharmaceuticals: Consultancy, Honoraria; Celltrion, Inc.: Consultancy, Honoraria.

scholarly journals Tuberculous Meningitis at the Department of Child Health Dr. Pirngadi Hospital, Medan

2019 ◽  
Vol 32 (7-8) ◽  
pp. 190-7
Author(s):  
Margaretha Damanik ◽  
Sri Zamzah ◽  
Mardiana K. Djayusman ◽  
M. D. Marbun ◽  
Bistok Saing
Keyword(s):  
Child Health ◽  
Tuberculous Meningitis ◽  
Case Fatality ◽  
Tuberculin Test ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Severe Malnutrition ◽  
Moderate Malnutrition ◽  
Fluid Cell

Tuberculous meningitis was studied descriptively in 167 cases (1 .19%) of 14082 hospitalized patients at the Department of Child Health Dr. Pirngadi Hospital, Medan in a period of the years 1985 to 1989. The highest incidence was in the age group of under 3 years (46.11%) consisting 20. 78% of the stage I, 54.55% stage II, and 24.67% stage III. The youngest age was five months (2 cases) and the oldest was 14 years old (3 cases). The case fatality rate was 27.54%, they were 2.17% stage I, 32.61% stage II, and 65.22% stage III. Stage III showed higher mortality rate than stage I and II (p <0.001). The most frequent symptom was convulsion (43. 71%) followed by fever (33.53%) . Contact with patients who bad pulmonary tuberculosis were found in 56.28%. Positive tuberculin test was found in 17.96% and pulmonary radiological abnormalities in57.48%. The highest number oj cases (51.50%) was group with cerebrospinal fluid cell count of 101 - 500/mm · Cases which never got BCG immunization comprised 83.83%. The nutritional states on admission to the hospital were mild / moderate malnutrition in 67.07% and severe malnutrition in 32.93%.

Identification of biomarkers and functional modules from genomic data in stage-wise breast cancer

2020 ◽  
Vol 15 ◽  
Author(s):  
Athira K ◽  
Vrinda C ◽  
Sunil Kumar P V ◽  
Gopakumar G
Keyword(s):  
Breast Cancer ◽  
Expression Patterns ◽  
Differential Expression Analysis ◽  
Predictive Biomarkers ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Functional Modules ◽  
Incidence And Mortality ◽  
Multiple Stages

Background: Breast cancer is the most common cancer in women across the world, with high incidence and mortality rates. Being a heterogeneous disease, gene expression profiling based analysis plays a significant role in understanding breast cancer. Since expression patterns of patients belonging to the same stage of breast cancer vary considerably, an integrated stage-wise analysis involving multiple samples is expected to give more comprehensive results and understanding of breast cancer. Objective: The objective of this study is to detect functionally significant modules from gene co-expression network of cancerous tissues and to extract prognostic genes related to multiple stages of breast cancer. Methods: To achieve this, a multiplex framework is modelled to map the multiple stages of breast cancer, which is followed by a modularity optimization method to identify functional modules from it. These functional modules are found to enrich many Gene Ontology terms significantly that are associated with cancer. Result and Discussion: predictive biomarkers are identified based on differential expression analysis of multiple stages of breast cancer. Conclusion: Our analysis identified 13 stage-I specific genes, 12 stage-II specific genes, and 42 stage-III specific genes that are significantly regulated and could be promising targets of breast cancer therapy. That apart, we could identify 29, 18 and 26 lncRNAs specific to stage I, stage II and stage III respectively.

Cardiac transthyretin wild-type amyloidosis (ATTRwt): a prospective study of 400 patients followed at the Italian referral center

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Milani ◽  
L Obici ◽  
R Mussinelli ◽  
M Basset ◽  
G Manfrinato ◽  
...  
Keyword(s):  
Natural History ◽  
Median Survival ◽  
Troponin I ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Wild Type ◽  
Staging Systems ◽  
Significant Difference ◽  
History Of

Abstract Background Cardiac wild type transthyretin (ATTRwt) amyloidosis, formerly known as senile systemic amyloidosis, is an increasingly recognized, progressive, and fatal cardiomyopathy. Two biomarkers staging systems were proposed based on NT-proBNP (in both cases) and troponin or estimated glomerular filtration rate, that are able to predict survival in this population. The availability of novel effective treatments requires large studies to describe the natural history of the disease in different populations. Objective To describe the natural history of the disease in a large, prospective, national series. Methods Starting in 2007, we protocolized data collection in all the patients diagnosed at our center (n=400 up to 7/2019). Results The referrals to our center increased over time: 5 cases (1%) between 2007–2009, 33 (9%) in 2010–2012, 90 (22%) in 2013–2015 and 272 (68%) in 2016–2019. Median age was 76 years [interquartile range (IQR): 71–80 years] and 372 patients (93%) were males. One hundred and seventy-three (43%) had atrial fibrillation, 63 (15%) had a history of ischemic cardiomyopathy and 64 (15%) underwent pacemaker or ICD implantation. NYHA class was I in 58 subjects (16%), II in 225 (63%) and III in 74 (21%). Median NT-proBNP was 3064 ng/L (IQR: 1817–5579 ng/L), troponin I 0.096 ng/mL (IQR: 0.063–0.158 ng/mL), eGFR 62 mL/min (IQR: 50–78 mL/min). Median IVS was 17 mm (IQR: 15–19 mm), PW 16 mm (IQR: 14–18 mm) and EF 53% (IQR: 45–57%). One-hundred and forty-eight subjects (37%) had a concomitant monoclonal component in serum and/or urine and/or an abnormal free light chain ratio. In these patients, the diagnosis was confirmed by immunoelectron microscopy or mass spectrometry. In 252 (63%) the diagnosis was based on bone scintigraphy. DNA analysis for amyloidogenic mutations in transthyretin and apolipoprotein A-I genes was negative in all subjects. The median survival of the whole cohort was 59 months. The Mayo Clinic staging based on NT-proBNP (cutoff: 3000 ng/L) and troponin I (cutoff: 0.1 ng/mL) discriminated 3 different groups [stage I: 131 (35%), stage II: 123 (32%) and stage III: 127 (33%)] with different survival between stage I and II (median 86 vs. 81 months, P=0.04) and between stage II and III (median 81 vs. 62 months, P&lt;0.001). The UK staging system (NT-proBNP 3000 ng/L and eGFR 45 mL/min), discriminated three groups [stage I: 170 (45%), stage II: 165 (43%) and stage III: 45 (12%)] with a significant difference in survival: between stage I and stage II (86 vs. 52 months, P&lt;0.001) and between stage II and stage III (median survival 52 vs. 33 months, P=0.045). Conclusions This is one of the largest series of patients with cardiac ATTRwt reported so far. Referrals and diagnoses increased exponentially in recent years, One-third of patients has a concomitant monoclonal gammopathy and needed tissue typing. Both the current staging systems offered good discrimination of staging and were validated in our independent cohort. Funding Acknowledgement Type of funding source: None

Single Ventricle Palliation in a Developing Sub-Saharan African Country: What Should be Improved?

2019 ◽  
Vol 10 (2) ◽  
pp. 164-170 ◽  
Author(s):  
Valdano Manuel ◽  
Humberto Morais ◽  
Aida L. R. Turquetto ◽  
Gade Miguel ◽  
Leonardo A. Miana ◽  
...  
Keyword(s):  
Confidence Interval ◽  
African Country ◽  
Single Ventricle ◽  
Hazard Ratio ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Lost To Follow Up ◽  
Single Ventricle Palliation

Introduction: Single ventricle physiology management is challenging, especially in low-income countries. Objective: To report the palliation outcomes of single ventricle patients in a developing African country. Methods: We retrospectively studied 83 consecutive patients subjected to single ventricle palliation in a single center between March 2011 and December 2017. Preoperative data, surgical factors, postoperative results, and survival outcomes were analyzed. The patients were divided by palliation stage: I (pulmonary artery banding [PAB] or Blalock–Taussig shunt [BTS]), II (Glenn procedure), or III (Fontan procedure). Results: Of the 83 patients who underwent palliation (stages I-III), 38 deaths were observed (31 after stage I, six after stage II, and one after stage III) for an overall mortality of 45.7%. The main causes of operative mortality were multiple organ dysfunction due to sepsis, shunt occlusion, and cardiogenic shock. Twenty-eight survivors were lost to follow-up (22 after stage I, six after stage II). Thirteen stage II survivors are still waiting for stage III. The mean follow-up was 366 ± 369 days. Five-year survival was 28.4 % for PAB and 30.1% for BTS, while that for stage II and III was 49.8% and 57.1%, respectively. Age (hazard ratio, 0.61; 95% confidence interval: 0.47-0.7; P = .000) and weight at surgery (hazard ratio, 0.45; 95% confidence interval: 0.31-0.64; P = .002) impacted survival. Conclusion: A high-mortality rate was observed in this initial experience, mainly in stage I patients. A large number of patients were lost to follow-up. A task force to improve outcomes is urgently required.

scholarly journals Impact of the Number of Dissected Lymph Nodes on Survival for Gastric Cancer after Distal Subtotal Gastrectomy

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Chang-Ming Huang ◽  
Jian-Xian Lin ◽  
Chao-Hui Zheng ◽  
Ping Li ◽  
Jian-Wei Xie ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Lymph Nodes ◽  
Distal Gastrectomy ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Prognostic Impact ◽  
Term Survival

Objectives. To investigate the prognostic impact of the number of dissected lymph nodes (LNs) in gastric cancer after curative distal gastrectomy.Methods. The survival of 634 patients who underwent curative distal gastrectomy from 1995 to 2004 was retrieved. Long-term surgical outcomes and associations between the number of dissected LNs and the 5-year survival rate were investigated.Results. The number of dissected LNs was one of the most important prognostic indicators. Among patients with comparable T category, the larger the number of dissected LNs was, the better the survival would be (). The linear regression showed that a significant survival improvement based on increasing retrieved LNs for stage II, III and IV (). A cut-point analysis yields the greatest variance of survival rate difference at the levels of 15 LNs (stage I), 25 LNs (stage II) and 30 LNs (stage III).Conclusion. The number of dissected LNs is an independent prognostic factor for gastric cancer. To improve the long-term survival of patients with gastric cancer, removing at least 15 LNs for stage I, 25 LNs for stage II, and 30 LNs for stage III patients during curative distal gastrectomy is recommended.

High Risk Status for Stage I Palliation Increases Mortality Following Stage II But Not Stage III

2021 ◽  
Author(s):  
Garrett N. Coyan ◽  
Carlos Diaz-Castrillon ◽  
Mario Castro-Medina ◽  
Luciana Da Fonseca Da Silva ◽  
Melita Viegas ◽  
...  
Keyword(s):  
High Risk ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Risk Status

Differing from diseased stage in melanoma, the olfactory receptor gene OR56A4 is expressed

2021 ◽  
Author(s):  
Bronte Morse ◽  
Kobi Decker
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Olfactory Receptor ◽  
Receptor Gene ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Olfactory Receptor Gene ◽  
Breast Cancer Patients ◽  
Receptor Family

We have compared the global profiles of 100 tumors in Stage I, II and III with two independently releasedmicroarray datasets in order to understand their transcriptional behaviors accompanying a progression in breastcancer (1, 2). The olfactive receptor, family 56, subfamily A, member 4 OR56A4, was discovered to have beenone of the genes with the most varied expression when comparing initial tumors in stage I, stage II, and stageIII of breast cancer patients. In the stage III tumors, OR56A4 expression in comparison to the stage I tumorswas lower.

scholarly journals PENGARUH REBUSAN DAUN SALAM TERHADAP PENURUNAN TEKANAN DARAH PADA LANSIA DENGAN HIPERTENSI

2018 ◽  
Vol 8 (2) ◽  
pp. 14-21
Author(s):  
Syaifurrahman Hidayat ◽  
Laylatul Hasanah ◽  
Dewi Herlina Susantin
Keyword(s):  
Stage Iv ◽  
T Test ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Test Design ◽  
Post Test

Daun salam (syzygiumpolyanthum) merupakan salah satu dari jenis terapi herbal yang digunakan untuk berbagai penyakit salah satunya yaitu untuk menangani penyakit hipertensi,untuk menurunkan hipertensi dibutuhkan 10 lembar daun salam dan 300 ml air lalu direbus hingga mendidih dan menyusut menjadi 200 ml dan dikonsumsi sebanyak 2 kali sehari pada pagi dan sore hari, masing-masing 100 ml. Penelitian ini bertujuan untuk mengetahui pengaruh air rebusan daun salam dalam menurunkan tekanan darah pada lansia di wilayah kerja UPT Puskesmas Guluk-Guluk. Penelitian ini menggunakan desain penelitian eksperimen Pre post test design, dimana pada rancangan ini berupaya mengungkapkan hubungan sebab akibat dengan cara melibatkan kelompok eksperimental, dengan sampel sebanyak 30 0rang Pengumpulan data menggunakan observasi tekanan darah langsung dan wawancara ke responden.  Hasil penelitian menunjukkan bahwa sebelum diberikan perlakuan pada responden sebagian besar berada pada stage III sebanyak 22 orang (73,3 %), lalu sebagian kecil berada pada stage IV dengan 2 orang (6,7 %). Setelah dilakukan penelitian menunujukkan sesudah diberikan perlakuan pada responden sebagian besar menempati stage II sebanyak 28 orang (93,3 %), sebagian kecil berada pada stage I hanya 2 orang (6,7 %). Hasil uji T test paried dan uji T test didapatkan nilai signifikan 0.000 yang nilainya lebih kecil dari taraf kesalahan α 0.05. sehingga H0 ditolak dan H1 diterima yang berarti ada pengaruh air rebusan daun salam terhadap penurunan tekanan darah pada lansia yang menderita hipertensi di wilayah kerja UPT Puskesmas Guluk-Guluk Kecamatan Guluk-Guluk. Daun salam mempunyai kandungan kimia seperti minyak atsiri, sitrat, euganol, tannin serta flavanoid yang dipercaya mampu untuk menurunkan tekanan darah, mekanisme kerja dari daun salam ini yaitu merangsang sekresi cairan empedu sehingga lemak akan keluar bersamaan dengan usus yang kemudian mengurangi gumpalan lemak yang mengendap dalam pembuluh darah sehingga aliran darah menjadi lancar dan tekanan darah akan normal.

Clinical Staging for Sleep-Disordered Breathing

2002 ◽  
Vol 127 (1) ◽  
pp. 13-21 ◽  
Author(s):  
Michael Friedman ◽  
Hani Ibrahim ◽  
Lee Bass
Keyword(s):  
Body Mass Index ◽  
Success Rate ◽  
Body Mass ◽  
Sleep Disordered Breathing ◽  
Staging System ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Clinical Staging ◽  
Disordered Breathing

OBJECTIVE: The purpose of this study was to identify prognostic indicators that would lead to stratification of patients likely to have successful surgery for sleep-disordered breathing (SDB) versus those destined to fail. STUDY DESIGN: We retrospectively reviewed 134 patients to correlate palate position and tonsil size to the success of the UPPP as based on postoperative polysomnography results. Similar to our previously published data on the Friedman Score as a predictor of the presence and severity of SDB, the palate position was determined on physical examination of the oral cavity and was graded for each patient. This grade combined with tonsil size was used to stage the patients. Stage I was defined as having palate position 1 or 2 combined with tonsil size 3 or 4. Stage II was defined as having palate position 3 or 4 and tonsil size 3 or 4. Stage III patients had palate position 3 or 4 and tonsil size 0, 1, or 2. Any patient with body mass index of greater than 40 was placed in the stage III group. The results of uvulopalatopharyngoplasty (UPPP) were then graded as success or failure and success rates were compared by stage. SETTING: Academically affiliated tertiary care referral center. RESULTS: Stage I patients who underwent UPPP had a success rate of 80.6%, stage II patients had a success rate of 37.9%, and stage III patients had a success rate of 8.1%. CONCLUSION: A clinical staging system for SDB based on palate position, tonsil size, and body mass index is presented. It appears to be a valuable predictor of the success of UPPP. Additional studies and wider use of the staging system will ultimately define its role in the treatment of SDB.

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