scholarly journals Clinical features and prognostic significance of splenic involvement in sarcoidosis

2017 ◽  
Vol 87 (3) ◽  
Author(s):  
Cuneyt Tetikkurt ◽  
Halil Yanardag ◽  
Metin Pehlivan ◽  
Muammer Bilir
Keyword(s):  
Clinical Features ◽  
Systemic Disease ◽  
Prognostic Significance ◽  
Significant Risk ◽  
Organ Involvement ◽  
Laboratory Findings ◽  
Significant Difference ◽  
Splenic Involvement ◽  
Prognostic Outcome ◽  
Splenic Disease

Sarcoidosis is a systemic disease characterized by noncasefied granulomas in various organs. Incidence of splenic disease is variable and is reported to occur in 6.7 to 77 percent of the patients. Firm data establishing the clinical features and the association of splenic involvement with prognosis in sarcoidosis is scant. The aim of our study was to investigate the clinical features and the consequence of splenic involvement on the prognostic outcome of sarcoidosis patients. We evaluated the clinical and laboratory findings in 82 sarcoidosis patients. Forty-two patients with splenic involvement were compared to 48 sarcoidosis patients without splenic disease in regard to laboratory findings, endobronchial disease, extrapulmonary organ involvement, and prognosis. Lung biopsy sample was considered positive if it demonstrated noncaseating granulomas with negative fungal and mycobacterial cultures. Splenic sarcoidosis was identified by ultrasound or computed tomography and was designated as limited, diffuse or without splenic involvement. Extrapulmonary organ sarcoidosis was classified as extensive and limited. Endobronchial disease was categorized as limited or diffuse involvement. The most commonly comprised organ was lung in 95% of the cases followed by lymph nodes, skin, eye, spleen and liver in the order of frequency. Splenic disease was diffuse in 22 patients. Of these patients, 14 had extensive extrapulmonary organ involvement while 16 had diffuse endobronchial disease. There was no significant difference between the three groups for FEV1, FVC, TLC, DLCO/VA, serum and 24h urinary calcium levels. Serum ACE was higher in patients with diffuse splenic involvement (p<0.001). Incidence of persistent chronic disease was significantly higher (p<0.001) in patients with diffuse splenic sarcoidosis. Extensive extrapulmonary organ involvement and diffuse endobronchial disease were more common (p<0.001) in this group. Extensive extrapulmonary organ involvement and diffuse endobronchial disease were more frequent in patients with diffuse splenic sarcoidosis. Patients with diffuse splenic granulomas had a worse prognosis than the patients without splenic involvement or patients with limited splenic disease. Diffuse splenic involvement emerges to be a significant risk factor for persistent chronic sarcoidosis. Extensive granuloma burden in an organ may be the decisive clinical marker for the prognostic outcome of sarcoidosis patients. 

scholarly journals Clinical and prognostic significance of muscle biopsy in sarcoidosis

2018 ◽  
Vol 88 (1) ◽  
Author(s):  
Halil Yanardag ◽  
Cuneyt Tetikkurt ◽  
Muammer Bilir
Keyword(s):  
Clinical Features ◽  
Muscle Biopsy ◽  
Diagnostic Yield ◽  
Prognostic Significance ◽  
Granulomatous Inflammation ◽  
Initial Step ◽  
Muscle Disease ◽  
Organ Involvement ◽  
Muscle Involvement ◽  
Prognostic Outcome

The main objective of this study was to evaluate the influence of muscle involvement on the clinical features, prognostic outcome, extrapulmonary organ, and endobronchial involvement in sarcoidosis patients. The second aim was to assess the diagnostic yield of muscle biopsy for the histopathologic identification of sarcoidosis.  Fifty sarcoidosis patients participated in the study. The patients were classified into two groups according to the histopathologic presence of non-caseating granulomatous inflammatory pattern of the muscle biopsy samples and were evaluated retrospectively in regard to clinical features, prognosis, extrapulmonary, and endobronchial disease involvement. Pathologic examination of the muscle biopsy samples revealed non-caseating granulomas in eighteen and myositis in seven patients compatible with sarcoidosis. The diagnostic yield of muscle biopsy for demonstrating non-caseating granulomatous inflammation was fifty percent. Patients with muscle sarcoidosis showed a worse prognosis and a more severe extrapulmonary organ involvement than the patients without muscle disease. Muscle biopsy was not statistically significant to delineate diffuse endobronchial involvement while it was suggestive for endobronchial disease clinically. The results of our study reveal that muscle biopsy appears to be a useful diagnostic tool along with its safety and easy clinical applicability. It is a rewarding utility to predict the prognostic outcome and extrapulmonary involvement in sarcoidosis patients. Positive biopsy on the other hand confirms the identification of sarcoidosis in patients with single organ involvement carrying an equivocal diagnostic clinical pattern. Muscle biopsy may be considered as the initial step for the final diagnosis of sarcoidosis in such cases.

scholarly journals Clinical Features and Prognostic Significance of Liver Involvement in Sarcoidosis

2016 ◽  
Vol 02 (01) ◽  
pp. 26
Author(s):  
Halil Yanardag ◽  
◽  
Cuneyt Tetikkurt ◽  
Muammer Bilir ◽  
Sabriye Demirci ◽  
...  
Keyword(s):  
Liver Disease ◽  
Clinical Features ◽  
Progressive Disease ◽  
Prognostic Significance ◽  
Organ Involvement ◽  
Liver Involvement ◽  
Diffuse Liver Disease ◽  
Hepatic Involvement ◽  
Significant Difference ◽  
Extra Pulmonary

Background:Sarcoidosis is a systemic disease, characterised by non-caseating granulomas in various organs. Liver involvement is not an uncommon feature of sarcoidosis. However, firm data establishing the clinical features and prognosis in these patients are lacking, although the incidence of liver sarcoidosis is high. In this study, we aimed to investigate the features of liver involvement in patients with sarcoidosis. Another aim was to evaluate the prognostic significance of liver disease by comparing the differences between patients with no liver involvement, limited and diffuse liver involvement.Methods:We conducted a retrospective study to evaluate the clinical and laboratory findings of 271 sarcoidosis patients seen at our institution. Patients with liver sarcoidosis identified by liver biopsy were compared to patients without liver involvement for clinical features and prognosis. The biopsy sample was considered positive if it demonstrated non-caseaiting granulomas with negative fungal and mycobacterial cultures. The patients were classified into three groups according to the radiological and histopathological biopsyresults:no liver involvement; limited liverinvolvement:two sites positive; and diffuse liverinvolvement:three or more sites positive for granulomas.Results:Hepatic involvement was identified by biopsy in 81 (81/271, 29.8%) while 43 (43/271, 15.8%) patients had elevated liver function tests. Most of the patients (94.6%) had lung involvement. Other organs involved, in the order of frequency,were:lymph nodes, skin, eye, spleen and parotid gland. There was no significant difference between the three groups for forced expiratory volume in one second, forced vital capacity, total lung capacity, diffusing capacity of the lungs for carbon monoxide/alveolar volume, serum and 24-hour urinary calcium levels. Serum angiotensin-converting enzyme levels were significantly higher (p<0.01) in patients with diffuse liver involvement than patients with no or limited liver disease. Progressive disease was more frequent (p<0.01) in patients with diffuse liver disease. Extra-pulmonary organ involvement was significantly different between the three groups (p<0.01).Conclusions:Diffuse liver involvement in sarcoidosis is a significant risk factor for progressive disease. Patients with diffuse liver disease have a worse prognosis than patients without or with limited liver involvement. Diffuse hepatic involvement in sarcoidosis is also associated with an increased incidence of extra-pulmonary organ involvement. Presence of diffuse liver disease may reveal a severe prognosis for sarcoidosis patients.

MO294COMPARISON OF TIP AND CELLULAR VARIANT OF PRIMARY FOCAL SEGMENTAL GLOMERULOSCLEROSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Nikola Zagorec ◽  
Ivica Horvatić ◽  
Dino Kasumović ◽  
Petar Šenjug ◽  
Matija Horaček ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Focal Segmental Glomerulosclerosis ◽  
Clinical Features ◽  
Remission Rate ◽  
Prognostic Significance ◽  
European Population ◽  
University Hospital ◽  
Outcome Analysis ◽  
Laboratory Findings ◽  
Segmental Glomerulosclerosis

Abstract Background and Aims After membranous nephropathy, focal segmental glomerulosclerosis (FSGS) is the most common cause of nephrotic syndrome in European population. According to Columbia classification, there are five histological variants of FSGS defined on light microscopy (tip, cellular, perihilar, collapsing and not otherwise specified - NOS) and this classification has a prognostic significance. The aim is to compare features and outcomes of tip and cellular variant of primary FSGS. Method All patients with FSGS were identified by a retrospective review of the Registry of kidney biopsies at the Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, from 2003 until 2020. Each kidney specimen was analyzed by light, immunofluorescent and electron microscopy and Columbia classification was applied by experienced nephropathologist. Patients with primary FSGS met following criteria: full nephrotic syndrome and diffuse podocyte foot process effacement in absence of secondary causes of FSGS. Laboratory findings were obtained for every patient at the time of biopsy and following outpatient visits. Complete remission was defined as proteinuria &lt; 0.3 g/day with normal kidney function and partial remission as proteinuria 0.3 - 3.5 g/day. Variables are expressed as median ± IQR (interquartile range) and frequencies. Statistical comparison between groups of patients with tip and cellular variant of primary FSGS and disease outcome analysis were done. Results Out of 200 patients with FSGS, 59 (29.5 %) had primary form of disease. Tip variant was the most common form of primary FSGS (22 patients, 37 %) followed by NOS (20, 34 %), cellular (13, 22 %), perihilar (2, 3.5 %) and collapsing (2, 3.5 %) variant. Demographic and clinical features with initial laboratory findings are shown in Table 1. There were no significant differences between two groups in all analyzed variables in Figure 1. All patients were treated by anti-RAAS agents and steroids. Median follow-up was 55 months (range 1 – 196 months), and followup data were unavailable for three patients. Figure 2 shows treatment regimens in both patient grouos with treatment outcomes. Remission rate was significantly higher in tip variant (90 % vs. 41 %, p = 0.002). There was no difference in relapse rate between the two groups (p = 0.717). Conclusion There were no significant differences in clinical features and laboratory findings at the time of clinical presentation between tip and cellular variant of primary FSGS. Patients with tip variant had significantly higher remission rate than patients with cellular variant.

Transient Ischemic Attack: Clinical Features and Outcome

2017 ◽  
Vol 10 (1) ◽  
pp. 25-28
Author(s):  
Desislava D. Drenska ◽  
Dimitar B. Maslarov
Keyword(s):  
Clinical Features ◽  
Transient Ischemic Attack ◽  
Social Significance ◽  
State Of Emergency ◽  
Pathogenetic Mechanisms ◽  
The Social ◽  
Significant Difference ◽  
Neurology Clinic ◽  
Prognostic Outcome ◽  
Ischemic Attack

SummaryA Transient Ischemic Attack (TIA) is a state of emergency and an independent risk factor for ischemic stroke. The social significance of the disease is determined, based on the probability of occurrence of subsequent cerebrovascular incidents and their frequency among groups. The purpose of the present study was to perform a comparative analysis of clinical features and outcome in patients with TIA for at least 24 months after onset had been registered, according to the pathogenesis and to ABCD (2) score. Two hundred and fifty-seven patients were monitored at the Neurology Clinic, First MHAT – Sofia after suffering an initial TIA. All subjects were studied using a clinical evaluation of pathogenetic mechanisms and an ABCD (2) algorithm. A diagnosis of TIA was confirmed by neuroimaging. The comparison between specific pathogenetic mechanisms demonstrated a statistically significant difference. Two TIA subgroups were involved – thromboembolic and cryptogenic (p<0.05). Also, according to the ABCD (2) score results, significant differences were found between groups at low (1-3) and high (6-7) risk, and those at intermediate (4-5) and high risk (p<0.01). Detailed investigation and assessment of patients with TIA are important concerning the prognostic outcome.

Risk Factors for the Development of Clostridium difficile-Associated Diarrhea During a Hospital Outbreak

1991 ◽  
Vol 12 (6) ◽  
pp. 345-348 ◽  
Author(s):  
Alain Thibault ◽  
Mark A. Miller ◽  
Christina Gaese
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Systemic Disease ◽  
Gastrointestinal Surgery ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Surgical Patients ◽  
Convenience Sample ◽  
Significant Difference ◽  
Clostridium Difficile Associated Diarrhea

AbstractObjective:To evaluate the risk factors associated with a nosocomial outbreak of Clostridium difficile-associated diarrhea.Design:Case-control study with two control groups.Setting:University-affiliated urban hospital.Patients:A convenience sample of 26 patients was chosen out of a total of 78 hospitalized patients with C difficile-associated diarrhea, defined as the presence of diarrhea and a positive C difficile cytotoxin assay or stool culture. Twenty-six controls were matched for age, gender, ward, and date of admission; 18 additional controls were matched to surgical patients for date and ward of admission, as well as for the type of surgical procedure performed.Results:Significant risk factors for the development of C difficile-associated diarrhea were gastrointestinal surgery (exposure odds ratio [EOR] = 7.9, p= .004, 95% confidence interval [CI]= 1.9, 35), use of neomycin (EOR= 15.6, p=.012, 95% CI=1.7, 92), clindamycin (EOR=15.6, p=.005, 95% CI=1.7, 92), metronidazole (EOR=5.7,p=.02,95%CI= 1.4, 25), and excess antibiotic use (mean number of antibiotics = 4.2 versus 1.4, p<.00005). The presence of systemic disease and the use of antacids or immunosuppressive drugs were similar in cases and controls. In surgical patients, no specific antibiotic could be linked to C difficile-associated diarrhea because of uniform perioperative antibiotic use. There was a significant difference in the number of antibiotics administered to cases and controls (mean = 3.1 versus 1.9, p< .005).Conclusions:The results suggest that control of nosocomial C difficile-associated diarrhea may be attained by minimizing the administration of antibiotics, avoidance of high-risk antibiotics, and having a high index of suspicion of C difficile-associated diarrhea in patients who develop diarrhea after gastrointestinal surgery. Perioperative administration of metronidazole, when given with other antibiotics, failed to protect against the development of C difficile-associated diarrhea.

Clinical Significance of CSF3R, SRSF2 and SETBP1 mutation in Chronic Neutrophilic Leukemia and Chronic Myelomonocytic Leukemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1617-1617
Author(s):  
Chun Qiao ◽  
Yuan Ouyang ◽  
Sujiang Zhang
Keyword(s):  
Molecular Marker ◽  
Clinical Features ◽  
Conflicts Of Interest ◽  
Prognostic Significance ◽  
Chronic Myelomonocytic Leukemia ◽  
Chronic Neutrophilic Leukemia ◽  
Cell Counts ◽  
Significant Difference ◽  
Myelomonocytic Leukemia ◽  
Negative Predictor

Abstract Objective: To investigate the gene mutation and the clinical features of CSF3R, SETBP1 and SRSF2 in chronic neutrophilic leukemia (CNL) and chronic myelomonocytic leukemia (CMML) patients. Method: Sequence analysis of CSF3R, SETBP1 and SRSF2 were performed in 10 CNL and 56 CMML patients whose clinical features were also studied. Result: Among 10 CNL patients, 8(8/10, 80%) patients had CSF3R mutations and 7(7/8, 87.5%) of them were with CSF3R T618I. In 56 cases of patients with CMML, SRSF2 mutations were found in 14(14/56,25%), CSF3R in 4(4/56,7.1%) and SETBP1 in 3(3/56, 5.3%) patients. In CMML, compared to wild-type(wt) SRSF2 patients, SRSF2 mutated patients appeared to be more possible with SETBP1 mutations [1/14(7.1%) vs. 2/42(4.8%), P>0.05], less possible with CSF3R mutation [0/14(0%) vs. 4/42(9.5%), P<0.001]. The clinical characteristics such as age, gender, WHO category, FAB category, karyotype and blood cell counts did not reveal any difference between SRSF2 mutated and wtSRSF2 patients. Either SRSF2 mutated patients or SETBP1 mutated patients both had shorter overall survival (OS) and progression-free survival(PFS) when compared with those with wtSRSF2 (P<0.001 both) and wtSETBP1 (P<0.001 and P=0.02, respectively). No significant difference of OS and PFS between CSF3R mutated and wtCSF3R patients were observed. In multivariate analysis, SRSF2 mutation was an independent negative predictor for OS (HR, 3.307; 95% CI, 1.137 to 9.614; P=0.028) and PFS(HR, 15.431; 95% CI, 3.041 to 78.312; P = 0.001). What's more, SETBP1 mutation was also an independent negative predictor for OS(HR, 9.492; 95% CI, 1.183 to 76.128; P = 0.034). Conclusion: The majority of patients with WHO-defined CNL have oncogenic mutations in CSF3R and the T618I mutation type is a highly sensitive and specific molecular marker of the disease. While mutations of SRSF2 are common in CMML and may be of prognostic significance. As a non-specific molecular marker, SETBP1 was found in CNL, CMML and other blood cancers, which have poor prognosis. Disclosures No relevant conflicts of interest to declare.

scholarly journals Clinical Features in Metastatic Bone Disease with and without Pathological Fractures: A Comparative Study

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Putu Garry ◽  
Mouli Edward ◽  
Rosy Setiawati ◽  
Sjahjenny Mustokoweni ◽  
Ferdiansyah Mahyudin
Keyword(s):  
Medical Treatment ◽  
Clinical Features ◽  
Bone Disease ◽  
Pathological Fracture ◽  
Metastatic Bone Disease ◽  
Pathological Fractures ◽  
Laboratory Findings ◽  
Primary Tumors ◽  
Significant Difference ◽  
History Of

Background: Pathological fracture complications such as impaired clinical features is suspected to increase the mortality in MBD. In Indonesia, the habit of delayed seeking of medical treatment was common and potentially led to pathological fracture. Aim: This study compared the clinical features between MBD with and without pathological fracture. Methods: This was a retrospective study of MBD at Dr. Soetomo General Hospital in 2011-2015. We compared the clinical features by pain in Visual Analog Scale (VAS); general health presentation represented by laboratory findings; and the history of non-medical treatments. Results: 64 patients had MBD were included in this study. 37 (57.8%) of them presented with pathological fractures, and 27 (42.2%) without. Pain was the most common chief complaint (76.5%). No significant difference found between the MBD with and without pathological fracture in all variables (p=0.122; p=0.64; p=0.823; p=0.417, p=1.000 for VAS, hemoglobin, albumin, calcium, and history of non-medical treatment respectively). This probably associated with the therapy and a variety of primary tumors underlying the MBD. However, 6 out of 10 patients with history non-medical treatment presented with fractures. Conclusion: There's no significant difference in clinical features of MBD from both groups, while those with fractures had worse conditions. Keywords: Metastatic bone disease, Pathological fracture, Clinical features

scholarly journals Evaluation of Drug Utilisation Pattern and Clinical Presentation in Covid19 Patients Based on the Disease Severity

2021 ◽  
Vol 11 (2) ◽  
pp. 25-33
Author(s):  
Kamsali Hema ◽  
Peddoju Moulika ◽  
Dinesh Kumar Kukunuri ◽  
Ganta Saidhulu ◽  
Dhivya K ◽  
...  
Keyword(s):  
Clinical Features ◽  
Communicable Disease ◽  
Age Groups ◽  
The Elderly ◽  
Viral Disease ◽  
Severe Illness ◽  
Laboratory Findings ◽  
Clinical Presentations ◽  
Significant Difference ◽  
Study Population

Coronavirus disease of 2019 (COVID-19) is an extremely communicable disease characterized by the serious acute respiratory influenza virus 2, a recently identified novel viral disease (SARS-CoV-2). Hitherto, the quantity of established instances worldwide has reached 135 million, and the number of deaths is 2.9 million. In India, the cases were found to be 20 million and the mortality rate is 3,51,000. This virus was first identified in Wuhan City, Hubei Province in China, at the end of 2019. Until now, it affected more than 200 countries. The treatment pattern and clinical presentations were assessed in COVID 19 patients. A total of 146 patients, severe patients (n = 71) and non-severe patients (n = 75) where included in the study. The mean age of the study population was found to be 58.76±14.32 and the most common symptoms of patients include fever, fatigue, dry cough, and diarrhea there is no statistically significant difference in the clinical features between severe and non-severe patients. There is no significant difference in the laboratory findings except lymphocyte count, CORADS and N/L ratio between severe and non-severe patients. COVID-19 affects all age groups especially the elderly. The risk for severe illness with COVID-19 increases with age. COVID 19 patients were presented with various the risk factors and the clinical features in the severe and non severe conditions patients, our study shows great significance to prevent the patient turning to critical condition during diagnosis and treatment.

scholarly journals Epidemiologic and clinical characteristics of 3334 cases with pre-diagnosis coronavirus disease - 2019 (COVID-19) in Turkey

2021 ◽  
Author(s):  
Nur Simsek Yurt ◽  
Metin Ocak ◽  
Yusuf Can Yurt
Keyword(s):  
Mortality Rate ◽  
Clinical Features ◽  
Age Groups ◽  
Rt Pcr ◽  
Laboratory Findings ◽  
Reactive Protein ◽  
Significant Difference ◽  
Patient Groups ◽  
Post Hoc

Introduction: As COVID-19 disease has rapidly spread across the world, its impact has grown with increasing number of cases and mortality rate in Turkey. Aim: The aim of this study is to examine epidemiologic and clinical features of the patients that admitted to the hospital with the pre-diagnosis of coronavirus disease-2019 (COVID-19) in Turkey. Method: In this retrospective study, epidemiologic and clinical features, laboratory findings, radiologic features, therapeutic approaches and survival conditions of the patients with the pre-diagnosis of COVID-19 from March 11th to June 30th, 2020. The all data of the cases were compared in 4 groups: 1st group for the confirmed cases reverse transcriptase polymerase chain reaction (RT-PCR) +, chest computed tomography (CT) +, 2nd group for the clinically diagnosed cases (RT-PCR- CT +), 3rd group for the mild and asymptomatic cases (RT-PCR + CT-), 4th group for the suspected cases (RT-PCR - CT -). Post-hoc analysis was performed to evaluate the differences among the groups. Results: In total, 3334 patients with the pre-diagnosis of COVID-19 admitted to the emergency department. Based on the post-hoc analyses, significant differences were found among the four groups in terms of their test results of leucocytes, hemoglobin, platelets, neutrophils, urea and C-reactive protein (CRP) (p<0.001). Furthermore, the factors of age groups, hospitalization, intensive care follow-up and mortality rate of the four groups showed a significant difference among the groups (p=0.001). Conclusion: Mean of leucocytes, neutrophile and platelet values of the patients with tested positive for the RT-PCR was found lower compared to the ones with tested negative for the RT-PCR. Mean of CRP values was found higher in patients with lung involvement compared to other patient groups.

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