Multicenter Study
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Valentina Duarte ◽  
Carlos Zaror ◽  
Julio Villanueva ◽  
Fabiola Werlinger ◽  
Constanza Vidal ◽  

2021 ◽  
Khalid Mohamed Ali ◽  
Mahmoud Hussien Salih ◽  
Hiba Hassan AbuGabal ◽  
Mohammed Eltahier Abdalla Omer ◽  
Ammar ElTahir Ahmed ◽  

Abstract Background:Patients with neurocritical disorders that require admission to intensive care units (ICUs) constitute about 10–15% of critical care cases.Objectives:To study the outcome of neurocritical disorders in intensive care units.Methodology:This is a prospective observational study which was conducted in neurocritical patients who were admitted in four intensive care units of major hospitals in Khartoum state during the period from November 2020 to March 2021.Results:72 neurocritical patients were included in this study, 40(55.6%) were males and 32(44.4%) were females. 21 (29.2%) patients fully recovered, 35 (48.6%) partially recovered and 16 (22.2%) died. The mortality of the common neurocritical diseases were as follows: Stroke 30.4%, Encephalitis (8.3%), Status epilepticus (11.1%), Guillain-Barre syndrome (GBS) (16.7%) and Myasthenia gravis (MG) (25%).Conclusion:This study identified that near two third of the patients required mechanical ventilation. Delayed admission was observed due to causes distributed between the medical side and patient side. The majority of patients were discharged from ICU with partial recovery.

2021 ◽  
Vol 11 ◽  
Pedro Caruso ◽  
Renato Scarsi Testa ◽  
Isabel Cristina Lima Freitas ◽  
Ana Paula Agnolon Praça ◽  
Valdelis Novis Okamoto ◽  

BackgroundCoexistence of cancer and COVID-19 is associated with worse outcomes. However, the studies on cancer-related characteristics associated with worse COVID-19 outcomes have shown controversial results. The objective of the study was to evaluate cancer-related characteristics associated with invasive mechanical ventilation use or in-hospital mortality in patients with COVID-19 admitted to intensive care unit (ICU).MethodsWe designed a cohort multicenter study including adults with active cancer admitted to ICU due to COVID-19. Seven cancer-related characteristics (cancer status, type of cancer, metastasis occurrence, recent chemotherapy, recent immunotherapy, lung tumor, and performance status) were introduced in a multilevel logistic regression model as first-level variables and hospital was introduced as second-level variable (random effect). Confounders were identified using directed acyclic graphs.ResultsWe included 274 patients. Required to undergo invasive mechanical ventilation were 176 patients (64.2%) and none of the cancer-related characteristics were associated with mechanical ventilation use. Approximately 155 patients died in hospital (56.6%) and poor performance status, measured with the Eastern Cooperative Oncology Group (ECOG) score was associated with increased in-hospital mortality, with odds ratio = 3.54 (1.60–7.88, 95% CI) for ECOG =2 and odds ratio = 3.40 (1.60–7.22, 95% CI) for ECOG = 3 to 4. Cancer status, cancer type, metastatic tumor, lung cancer, and recent chemotherapy or immunotherapy were not associated with in-hospital mortality.ConclusionsIn patients with active cancer and COVID-19 admitted to ICU, poor performance status was associated with in-hospital mortality but not with mechanical ventilation use. Cancer status, cancer type, metastatic tumor, lung cancer, and recent chemotherapy or immunotherapy were not associated with invasive mechanical ventilation use or in-hospital mortality.

2021 ◽  
Tsuyoshi Matsumura ◽  
Hiroya Hashimoto ◽  
Masahiro Sekimizu ◽  
Akiko M Saito ◽  
Yasufumi Motoyoshi ◽  

Abstract Background: The transient receptor potential cation channel subfamily V member 2 (TRPV2) is a stretch-sensitive calcium channel. TRPV2 overexpression in the sarcolemma of skeletal and cardiac myocytes causes calcium influx into the cytoplasm, which triggers myocyte degeneration. In animal models of cardiomyopathy and muscular dystrophy (MD), TRPV2 inhibition was effective against heart failure and motor function. Our previous pilot study showed that tranilast, a TRPV2 inhibitor, reduced brain natriuretic peptide (BNP) levels in two MD patients with advanced heart failure. Thus, this single-arm, open-label, multicenter study aimed to evaluate the safety and efficacy of tranilast for heart failure.Methods: The study enrolled MD patients with advanced heart failure whose serum BNP levels were >100 pg/mL despite receiving standard cardioprotective therapy. Tranilast was administered orally at 100 mg, thrice daily. The primary endpoint was the change in log (BNP) (⊿log [BNP]) at 6 months from baseline. The null hypothesis was determined based on a previous multicenter study of carvedilol results in a mean population ⊿log (BNP) of 0.18. TRPV2 expression on peripheral blood mononuclear cell surface, cardiac events, total mortality, left ventricular fractional shortening, human atrial natriuretic peptide, cardiac troponin T, and creatine kinase, and pinch strength were also assessed.Results: Because of the poor general condition of many patients, only 18 of 34 patients were included and 13 patients could be treated according to the protocol throughout the 6 month period. However, there were no serious adverse events related to tranilast except diarrhea, a known adverse effect, and the drug was administered safely. TRPV2 expression on the mononuclear cell surface was elevated at baseline and reduced after treatment. Cardiac biomarkers such as BNP, human atrial natriuretic peptide, and fractional shortening remained stable, suggesting a protective effect against the progression of heart failure. In the per protocol set group, ⊿log (BNP)was -0.2 and significantly lower than that in the null hypothesis.Conclusions: Tranilast is safe and effective in inhibiting TRPV2 expression, even in MD patients with advanced heart failure. Further trials are needed to evaluate the efficacy of tranilast in preventing myocardial damage, heart failure, motor impairment, and respiratory failure.Clinical Trial Registration Details: The study was registered in the UMIN Clinical Trials Registry (UMIN-CTR: UMIN000031965, URL: [March 30, 2018] and the Japan Registry of Clinical Trials (jRCT, registration number: jRCTs031180038, URL: [November 12, 2021]. Patient registration was started in December 19, 2018.

2021 ◽  
Vol 11 (12) ◽  
pp. 1258
Gil Myeong Seong ◽  
Ae-Rin Baek ◽  
Moon Seong Baek ◽  
Won-Young Kim ◽  
Jin Hyoung Kim ◽  

Old age is associated with disease severity and poor prognosis among coronavirus disease 2019 (COVID-19) cases; however, characteristics of elderly patients with severe COVID-19 are limited. We aimed to assess the clinical characteristics and outcomes of patients hospitalized with severe COVID-19 at tertiary care centers in South Korea. This retrospective multicenter study included patients with severe COVID-19 who were admitted at seven hospitals in South Korea from 2 February 2020 to 28 February 2021. The Cox regression analyses were performed to assess factors associated with the in-hospital mortality. Of 488 patients with severe COVID-19, 318 (65.2%) were elderly (≥65 years). The older patient group had more underlying diseases and a higher severity score than the younger patient group. The older patient group had a higher in-hospital mortality rate than the younger patient group (25.5% versus 4.7%, p-value < 0.001). The in-hospital mortality risk factors among patients with severe COVID-19 included age, acute physiology and chronic health evaluation II score, presence of diabetes and chronic obstructive lung disease, high white blood cell count, low neutrophil-lymphocyte ratio and platelet count, do-not-resuscitate order, and treatment with invasive mechanical ventilation. In addition to old age, disease severity and examination results must be considered in treatment decision-making.

2021 ◽  
Toshihiro Tono ◽  
Hirotoshi Kikuchi ◽  
Tetsuji Sawada ◽  
Mitsuhiro Takeno ◽  
Hiroko Nagafuchi ◽  

Abstract Objectives Approximately 30%–60% of Behçet’s disease patients exhibit joint symptoms. The aim of this study was to determine the clinical characteristics of such patients in Japan. Methods This study retrospectively analyzed 151 Behçet’s disease patients with joint symptoms who had been treated at seven cooperative medical institutions from 2007 to 2017. We investigated their clinical characteristics and treatments. Results The most commonly affected joints were the knee, ankle, and proximal interphalangeal joints. Of the cases with pain and swelling, 18 of 293 joints (11 cases) displayed narrowing of the cleft or deformity by Xray analysis. Improvement in their arthritis was observed in 80% of the patients who received steroids as initial treatment; however, the rate of improvement was lower in patients who had received prednisolone (PSL) at &lt;10 mg/day. The recurrence of joint symptoms was significantly less common in the colchicine group than in the PSL group. Conclusions These results suggest that PSL is effective for remission induction for the treatment of joint symptoms of Behçet’s disease, though it may not be effective at low doses. Additionally, colchicine is effective in preventing the recurrence of joint symptoms in Behçet’s disease. Furthermore, joint damages like joint space narrowing or with any deformity can often be observed in Behçet’s disease patients in Japan.

2021 ◽  
Vol 10 (23) ◽  
pp. 5619
Mineo Kondo ◽  
Hidetaka Noma ◽  
Masahiko Shimura ◽  
Masahiko Sugimoto ◽  
Yoshitsugu Matsui ◽  

Purpose: To determine the baseline characteristics of patients with central retinal vein occlusion (CRVO) that were significantly associated with the best-corrected visual acuity (BCVA) at the initial examination. Methods: This was a retrospective multicenter study using the medical records registered in 17 ophthalmological institutions in Japan. Patients with untreated CRVO (≥20-years-of-age) who were initially examined between January 2013 and December 2017 were studied. The patients’ baseline factors that were significantly associated with the BCVA at the initial examination were determined by univariate and multivariate linear regression analyses. Results: Data from 517 eyes of 517 patients were analyzed. Univariate analyses showed that an older age (r = 0.194, p < 0.001) and the right eye (r = −0.103, p < 0.019) were significantly associated with poorer BCVA at the initial visit. Multivariate analyses also showed that an older age (β = 0.191, p < 0.001) and the right eye (β = −0.089, p = 0.041) were significantly associated with poorer BCVA at the initial visit. Conclusions: The results indicate that an older age, a known strong factor, and the right eye were significantly associated with poorer BCVA at the initial visit to the hospital. These results suggest that functional and/or anatomical differences between the right and left eyes may be involved in these results.

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