scholarly journals Epedimiologic, clinical profile and factors affecting the outcome in febrile neutropenia

2017 ◽  
Vol 06 (01) ◽  
pp. 025-027 ◽  
Author(s):  
Kalpathi Krishnamani ◽  
Linga Vijay Gandhi ◽  
Gundeti Sadashivudu ◽  
Digumarti Raghunadharao
Keyword(s):  
Febrile Neutropenia ◽  
Large Scale ◽  
Hematologic Malignancies ◽  
High Serum ◽  
Clinical Profile ◽  
Preemptive Therapy ◽  
Factors Affecting ◽  
Risk Of Death ◽  
Transfusion Requirements ◽  
Mortality Outcome

Abstract Background: Febrile neutropenia (FN) is common in cancer patients particularly hematologic malignancies due to intensive cytotoxic chemotherapy. It is an important cause of morbidity, mortality and treatment delays. The risk is greater in patients with ANC < 500/ mm3 and increases dramatically in those with ANC < 100/ mm3 and duration of neutropenia more than 1 week. Aims and Objectives: The purpose of this study was to evaluate the incidence, demographic characteristics, clinical profile, mortality, outcome and factors affecting the outcome in patients with febrile neutropenia (FN) admitted at our Center between January 2011 and November 2012. Materials and Methods: All cases of FN admitted in our Institute between January 2011 and November 2012 were analyzed. Data was analyzed using IBM statistic SPSS version 19. Results: A total of 333 episodes of FN were reviewed. Hematologic malignancies accounted for 299 (89.7%) episodes and 88% of all the episodes had grade 4 neutropenia. There was a significant association noted between high serum bilirubin, creatinine and outcome. Isolation of an organism from blood culture, positive findings on chest X-ray and fungal infection was associated with higher mortality . Association between transfusion requirements and outcome was analyzed and it was observed that patients who had multiple component transfusions vs single component ones were at a significantly higher risk of death. There were only 7 deaths noted among the patient population. Conclusion: Leukemias are the leading cause of FN at our Institute. Higher bilirubin, creatinine, chest imaging favoring pneumonia, positive isolates and multiple transfusions had significant association with mortality. Large scale prospective studies are needed to determine the association of preemptive therapy with higher mortality. The outcome of high risk FN in this study is favorable.

Factors predicting the outcome in febrile neutropenia: A study from a tertiary cancer center in India.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20684-e20684
Author(s):  
Krishnamani Kalpathi ◽  
Sadashivudu Gundeti ◽  
Rajesh Kota ◽  
Muralidhar Gullipalli ◽  
Vijay Gandhi Linga ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Fungal Infections ◽  
Prognostic Significance ◽  
Hematologic Malignancies ◽  
Cancer Center ◽  
Factors Affecting ◽  
Risk Of Death ◽  
Chest X Ray ◽  
Multiple Component ◽  
Gram Negative Organisms

e20684 Background: Febrile neutropenia (FN) is common in patients undergoing chemotherapy. The risk dramatically increases in those with absolute neutrophil count (ANC) less than 100/ mm3. Methods: In this 2 year studyall FN patients admitted at our center between January 2011 and November 2012 were analyzed for clinical profile, microbiologic isolates, mortality and factors affecting outcome. IBM statistic SPSS version 19 was used to analyze the data. Results: There were 333 episodes of FN during the study period. Majority (89.7%) of FN episodes occurred in patients with hematologic malignancies and 87% of episodes had ANC< 500. Induction, consolidation and maintenance related episodes were 125 (37.5%), 125 (37.5%) and 17 (5.1%) respectively. First line antibiotics (cefipime, Cefaperazone- Sulbactum + aminoglycoside), second line antibiotics (carbapenam) and antifungals were used in 44.4%, 15.6 % and 34% episodes respectively. Gram negative organisms accounted for 51.6% of the isolates. Prognostic significance between mean serum bilirubin, serum creatinine and outcome was noted, with higher deaths in patients with bilirubin > 1.5 mg% (12.2% vs 0.7%) (p= 0.000) and creatinine > 1.2 mg% (16% vs 1%) (p=0.000). Isolation of an organism and infiltrates on chest X-ray had a significant association with outcome(p= 0.017 and 0.002) respectively. Patients who had multiple component transfusions vs single component ones were at a significantly higher risk of death ( 6 deaths vs 1)(p= 0.002). There were 20 (6%) possible,33 (10%) probable and 9 (2.7 %) proven fungal infections, with significant association with outcome (p=0.000). The risk of death in those with fungal infection was 14.323 (95%CI - 2.70-75.952). Preemptiveantifungal use had a higher percentage of prolonged (> 8 days) and profound neutropenia in contrast to the empirical group (77.2% vs 65.2%) and (91% vs 83.8%), resulting in 3 deaths in the preemptive group (6.8% vs 0%) (p=0.02). The overall mortality was 2.1%. Conclusions: Leukemias are the leading cause of FN at our Institute with 2.1% mortality. Higher bilirubin, creatinine, chest imaging favoring pneumonia, positive isolates and multiple transfusions had significant association with mortality.

scholarly journals Assessment of clinical profile and factors affecting outcome of COVID-19 patient in Chhattisgarh state

2021 ◽  
Vol 8 (8) ◽  
pp. 3989
Author(s):  
Nirmal Verma ◽  
Alok Shukla ◽  
Neha Shrivastava ◽  
Swapnil Shinkar
Keyword(s):  
Data Collection ◽  
Treatment Strategies ◽  
Clinical Profile ◽  
Local Context ◽  
Comorbid Condition ◽  
Comorbid Conditions ◽  
Factors Affecting ◽  
Risk Of Death ◽  
Patient Will ◽  
Male Preponderance

Background: India is in the grab of COVID pandemic, understanding the clinical profile, comorbid condition, vaccine status of COVID patient, will help in better prevention, treatment strategies, especially in local context, therefore present study is designed to describe, the clinical profile, comorbid conditions and factors determining the death and recovery of patient both in home and hospital setting.Methods: It is a retrospective record based study of COVID-19 patient from September 2020 to May 2021 who underwent treatment either home or at hospital. Results: Majority 90% patient were hospitalised, with male preponderance, 96.4% patient were non vaccinated at the time of data collection, risk of death about 83% were more >45years age, with associated breathlessness and comorbidity.Conclusions: Higher age, comorbidity, non -vaccinated status was associated with risk of death among COVID-19 patient. 

scholarly journals Evaluation of the nature and etiologies of risk factors for diaphyseal atypical femoral fractures

2021 ◽  
Author(s):  
Hiroyuki Tsuchie ◽  
Naohisa Miyakoshi ◽  
Yuji Kasukawa ◽  
Koji Nozaka ◽  
Kimio Saito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analyses ◽  
Femoral Fractures ◽  
Japanese Patients ◽  
High Serum ◽  
Control Group ◽  
Atypical Femoral Fractures ◽  
Factors Affecting ◽  
Lateral Curvature ◽  
Low Serum

Objectives: Differences in the mechanisms of subtrochanteric and diaphyseal atypical femoral fractures (AFFs) have been speculated in studies that have analyzed differences in the patients’ backgrounds. However, the etiologies of each type of AFF have not been investigated in detail. Therefore, this study aimed to investigate the nature and etiologies of the risk factors for diaphyseal AFFs. Materials and Methods: Eighty consecutive Japanese patients with 91 diaphyseal AFFs (the AFF group) and 110 age-matched female patients with osteoporosis (the non-AFF control group) were included. Their clinical data were compared and the factors affecting AFFs were investigated. Furthermore, the etiologies of the risk factors for diaphyseal AFFs were examined. Results: Multivariate analysis revealed that femoral serrated changes, bisphosphonate or denosumab usage, and lateral and anterior femoral curvatures were the risk factors for diaphyseal AFFs (p<0.0011, p=0.0137, and p<0.0001, respectively). Multivariate analyses also revealed that serrated changes and low serum 25(OH)D levels affected the lateral curvature (p=0.0088 and 0.0205, respectively), while serrated changes affected the anterior curvature (p=0.0006); each significantly affected the femoral curvature. In addition, a high serum calcium (Ca) level, lateral femoral curvature, and anterior femoral curvature were the predictors of serrated changes (p=0.0146, 0.0002, and 0.0098, respectively). Conclusion: The risk factors for diaphyseal AFFs were bone resorption inhibitor usage, a strong femoral curvature, and serrated changes. A low serum 25(OH)D level and serrated changes are the risk factors for lateral curvature, while a high serum Ca level is a risk factor for serrated changes.

scholarly journals On the geophysical processes impacting palaeo-sea-level observations

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Yusuke Yokoyama ◽  
Anthony Purcell
Keyword(s):  
Sea Level ◽  
Large Scale ◽  
Global Climate ◽  
Sea Level Change ◽  
Sea Level Changes ◽  
Factors Affecting ◽  
Ice Volume ◽  
Level Change ◽  
Recent Developments ◽  
Geophysical Processes

AbstractPast sea-level change represents the large-scale state of global climate, reflecting the waxing and waning of global ice sheets and the corresponding effect on ocean volume. Recent developments in sampling and analytical methods enable us to more precisely reconstruct past sea-level changes using geological indicators dated by radiometric methods. However, ice-volume changes alone cannot wholly account for these observations of local, relative sea-level change because of various geophysical factors including glacio-hydro-isostatic adjustments (GIA). The mechanisms behind GIA cannot be ignored when reconstructing global ice volume, yet they remain poorly understood within the general sea-level community. In this paper, various geophysical factors affecting sea-level observations are discussed and the details and impacts of these processes on estimates of past ice volumes are introduced.

scholarly journals Progress in Research on Carbon Nanotubes Reinforced Cementitious Composites

2015 ◽  
Vol 2015 ◽  
pp. 1-16 ◽  
Author(s):  
Qinghua Li ◽  
Jintao Liu ◽  
Shilang Xu
Keyword(s):  
Carbon Nanotubes ◽  
Large Scale ◽  
High Strength ◽  
Cementitious Composites ◽  
Scale Production ◽  
Multiwalled Carbon ◽  
Factors Affecting ◽  
Environment And Health ◽  
Research Activities ◽  
Major Factors

As one-dimensional (1D) nanofiber, carbon nanotubes (CNTs) have been widely used to improve the performance of nanocomposites due to their high strength, small dimensions, and remarkable physical properties. Progress in the field of CNTs presents a potential opportunity to enhance cementitious composites at the nanoscale. In this review, current research activities and key advances on multiwalled carbon nanotubes (MWCNTs) reinforced cementitious composites are summarized, including the effect of MWCNTs on modulus of elasticity, porosity, fracture, and mechanical and microstructure properties of cement-based composites. The issues about the improvement mechanisms, MWCNTs dispersion methods, and the major factors affecting the mechanical properties of composites are discussed. In addition, large-scale production methods of MWCNTs and the effects of CNTs on environment and health are also summarized.

scholarly journals Phenotypic discordance between primary and metastatic breast cancer in the large-scale real-life multicenter French ESME cohort

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Thomas Grinda ◽  
Natacha Joyon ◽  
Amélie Lusque ◽  
Sarah Lefèvre ◽  
Laurent Arnould ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Large Scale ◽  
Tumour Progression ◽  
Primary Tumour ◽  
Multivariable Analysis ◽  
Real Life ◽  
Metastatic Breast ◽  
Her2 Status ◽  
Risk Of Death

AbstractExpression of hormone receptor (HR) for estrogens (ER) and progesterone (PR) and HER2 remains the cornerstone to define the therapeutic strategy for breast cancer patients. We aimed to compare phenotypic profiles between matched primary and metastatic breast cancer (MBC) in the ESME database, a National real-life multicenter cohort of MBC patients. Patients with results available on both primary tumour and metastatic disease within 6 months of MBC diagnosis and before any tumour progression were eligible for the main analysis. Among the 16,703 patients included in the database, 1677 (10.0%) had available biopsy results at MBC diagnosis and on matched primary tumour. The change rate of either HR or HER2 was 27.0%. Global HR status changed (from positive = either ER or PR positive, to negative = both negative; and reverse) in 14.2% of the cases (expression loss in 72.5% and gain in 27.5%). HER2 status changed in 7.8% (amplification loss in 45.2%). The discordance rate appeared similar across different biopsy sites. Metastasis to bone, HER2+ and RH+/HER2- subtypes and previous adjuvant endocrine therapy, but not relapse interval were associated with an HR discordance in multivariable analysis. Loss of HR status was significantly associated with a risk of death (HR adjusted = 1.51, p = 0.002) while gain of HR and HER2 discordance was not. In conclusion, discordance of HR and HER2 expression between primary and metastatic breast cancer cannot be neglected. In addition, HR loss is associated with worse survival. Sampling metastatic sites is essential for treatment adjustment.

Species Responses to Grazing and Environmental-Factors in an Arid Halophytic Shrubland Community

1987 ◽  
Vol 35 (2) ◽  
pp. 135 ◽  
Author(s):  
RB Hacker
Keyword(s):  
Environmental Factors ◽  
Soil Salinity ◽  
Large Scale ◽  
Chemical Properties ◽  
Grazing Pressure ◽  
Aerial Photographs ◽  
Small Scale ◽  
Factors Affecting ◽  
Species Responses

Species responses to grazing and environmental factors were studied in an arid halophytic shrubland community in Western Australia. The grazing responses of major shrub species were defined by using reciprocal averaging ordination of botanical data, interpreted in conjunction with a similar ordination of soil chemical properties and measures of soil erosion derived from large-scale aerial photographs. An apparent small-scale interaction between grazing and soil salinity was also defined. Long-term grazing pressure is apparently reduced on localised areas of high salinity. Environmental factors affecting species distribution are complex and appear to include soil salinity, soil cationic balance, geomorphological variation and the influence of cryptogamic crusts on seedling establishment.

Factors affecting post-fire seedling establishment of selected mallee understorey species

2000 ◽  
Vol 48 (1) ◽  
pp. 59 ◽  
Author(s):  
J. S. Cohn ◽  
R. A. Bradstock
Keyword(s):  
Large Scale ◽  
Prescribed Burning ◽  
New South ◽  
Eucalyptus Species ◽  
Factors Affecting ◽  
Acacia Species ◽  
Introduced Herbivores ◽  
South Wales ◽  
Rabbit Grazing ◽  
Seedling Germination

Factors affecting the survival of post-fire germinants in mallee communities, in central western New South Wales, were examined. Experiments compared the relative effects of native and introduced herbivores (kangaroos, goats, rabbits), after small- and large-scale fires (20–50 and > 10 000 ha, respectively), with particular emphasis on edge effects, seedling clustering, topography and eucalypt canopy presence. The experiments (1985–1997) focused on common understorey species Acacia rigens Cunn. ex Don, A. wilhelmiana F.Muell. and Triodia scariosa N.T.Burb. subsp. scariosa, in mallee dominated by Eucalyptus species. Following a large fire (1985), high spring rainfall and rabbit grazing on A. rigens only, survival of Acacia species and T. scariosa remained relatively high 4 years later (60–70%). After small burns (1987, 1988), low spring rainfall and grazing by rabbits and kangaroos, survival of Acacia species declined to between 0 and 30% of the germinants by the second summer. In most cases, local extinction had occurred within 8 years. After small burns (1988, 1989) and low spring rainfall, the survival of T. scariosa declined to between 0 and 35% of germinants by the second summer (effect of grazing unknown). No consistent effect of edge, topography and eucalypt canopy was found. Survival of clustered Acacia seedlings was between 10 and 20% lower than unclustered seedlings. Given the high frequency of low rainfall and its interaction with grazing, prescribed burning of mallee for wildfire control and nature conservation may require the local elimination of rabbits and a reduction in kangaroo numbers, especially in the first spring and summer following seedling germination.

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