Clinical Outcome
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2021 ◽  
Vol 66 ◽  
pp. 138-145
Author(s):  
Frédéric Gonzalez ◽  
Samuel Beschmout ◽  
Laurent Chow-Chine ◽  
Magali Bisbal ◽  
Evelyne d'Incan ◽  
...  

2021 ◽  
Vol 8 ◽  
Author(s):  
Carmen Naranjo-Ruiz ◽  
Alfonso Martínez-Nova ◽  
María de los Ángeles Canel-Pérez ◽  
Miguel López-Vigil ◽  
Javier Ferrer-Torregrosa ◽  
...  

Background and aims: Surgical procedures for central metatarsalgia seek to harmonise the metatarsal parabola with osteotomies that can be performed by minimally invasive techniques. However, the possible relationship of the foot type and the mid-term postoperative outcome is poorly described. The objective of this prospective pilot study was therefore to determine whether the foot type (pronate, neutral, or supinate) conditions the postoperative mid-term functional outcome.Methods: A series of 28 patients (6 men, 22 women) were treated for primary central metatarsalgia by means of minimally invasive distal metaphyseal osteotomy (DMMO).Results: Their functional outcomes at 6 and 12 months were assessed by the self-reporting AOFAS scale. Pre-surgery, the patients' scores were 42.82 ± 15.60. Scores improved at 6 months to 86.50 ± 8.6 and to 92.93 ± 8.6 at 12 months (p < 0.001 in both cases). There were no differences either by sex or by foot type in these overall values, although there was only a slight limitation of interphalangeal mobility in the supinated feet (p = 0.03) at 6-month follow-up as compared to other foot types.Conclusion: Hence, DMMO provides an optimal clinical and functional outcome for the surgical treatment of metatarsalgia, regardless of the patient's foot posture. The occurrence of adverse events was minimal and clinically irrelevant.Trial registration: The study was authorised by the Research Ethics Committee of the Universidad Católica de Valencia San Vicente Mártir, with the registry UCV/2018-2019/019.


2021 ◽  
Vol 3 (9) ◽  
Author(s):  
María Eugenia Soria ◽  
Marta Cortón ◽  
Brenda Martínez-González ◽  
Rebeca Lobo-Vega ◽  
Lucía Vázquez-Sirvent ◽  
...  

COVID-19 severity and progression are determined by several host and virological factors that may influence the final outcome of SARS-CoV-2-infected patients. The objective of this work was to determine a possible association between viral load, obtained from nasopharyngeal swabs, and the severity of the infection in a cohort of 448 SARS-CoV-2-infected patients from a hospital in Madrid during the first outbreak of the pandemic in Spain. To perform this, we clinically classified patients as mild, moderate and severe COVID-19 according to a number of clinical parameters such as hospitalization requirement, need of oxygen therapy, admission to intensive care units and/or death. Also, Ct values were determined using SARS-CoV-2-specific oligonucleotides directed to ORF1ab. Here we report a statistically significant association between viral load and disease severity, a high viral load being associated with worse clinical prognosis, independently of several previously identified risk factors such as age, sex, hypertension, cardiovascular disease, diabetes, obesity and lung disease (asthma and chronic obstructive pulmonary disease). The data presented here reinforce viral load as a potential biomarker for predicting disease severity in SARS-CoV-2-infected patients. It is also an important parameter in viral evolution since it relates to the numbers and types of variant genomes present in a viral population, a potential determinant of disease progression.


Author(s):  
Björn Behr ◽  
Sebastian Lotzien ◽  
Marcel Flecke ◽  
Christoph Wallner ◽  
J. Maximillian Wagner ◽  
...  

2021 ◽  
Vol 10 (18) ◽  
pp. 4266
Author(s):  
Dagmar Krajíčková ◽  
Antonín Krajina ◽  
Roman Herzig ◽  
Oldřich Vyšata ◽  
Libor Šimůnek ◽  
...  

Real-world data report worse 3-month clinical outcomes in elderly patients with acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). The aim was to identify factors influencing clinical outcome in elderly patients with anterior circulation AIS treated with MT (±intravenous thrombolysis (IVT)). In a retrospective, monocentric study, analysis of prospectively collected data of 138 patients (≥80 years) was performed. IVT was an independent negative predictor (OR 0.356; 95% CI: 0.134–0.942) and female sex an independent positive predictor (OR 4.179, 95% CI: 1.300–13.438) of 3-month good clinical outcome (modified Rankin scale 0–2). Female sex was also an independent negative predictor of 3-month mortality (OR 0.244, 95% CI: 0.100–0.599). Other independent negative predictors of 3-month good clinical outcome were older age, lower pre-stroke self-sufficiency, more severe neurological deficit and longer procedural intervals. Mortality was also independently predicted by longer procedural interval and by the occurrence of symptomatic intracerebral hemorrhage (p < 0.05 in all cases). Our results demonstrated, that in patients aged ≥80 years with anterior circulation AIS undergoing MT (±IVT), IVT reduced the chance of 3-month good clinical outcome and female sex was associated with a greater likelihood of 3-month good clinical outcome and lower probability of 3-month mortality.


Stroke ◽  
2021 ◽  
Author(s):  
Gabriel Broocks ◽  
Andre Kemmling ◽  
Svenja Teßarek ◽  
Rosalie McDonough ◽  
Lukas Meyer ◽  
...  

Background and Purpose: Patients presenting in the extended time window may benefit from mechanical thrombectomy. However, selection for mechanical thrombectomy in this patient group has only been performed using specialized image processing platforms, which are not widely available. We hypothesized that quantitative lesion water uptake calculated in acute stroke computed tomography (CT) may serve as imaging biomarker to estimate ischemic lesion progression and predict clinical outcome in patients undergoing mechanical thrombectomy in the extended time window. Methods: All patients with ischemic anterior circulation stroke presenting within 4.5 to 24 hours after symptom onset who received initial multimodal CT between August 2014 and March 2020 and underwent mechanical thrombectomy were analyzed. Quantitative lesion net water uptake was calculated from the admission CT. Prediction of clinical outcome was assessed using univariable receiver operating characteristic curve analysis and logistic regression analyses. Results: One hundred two patients met the inclusion criteria. In the multivariable logistic regression analysis, net water uptake (odds ratio, 0.78 [95% CI, 0.64–0.95], P =0.01), age (odds ratio, 0.94 [95% CI, 0.88–0.99]; P =0.02), and National Institutes of Health Stroke Scale (odds ratio, 0.88 [95% CI, 0.79–0.99], P =0.03) were significantly and independently associated with favorable outcome (modified Rankin Scale score ≤1), adjusted for degree of recanalization and Alberta Stroke Program Early CT Score. A multivariable predictive model including the above parameters yielded the highest diagnostic ability in the classification of functional outcome, with an area under the curve of 0.88 (sensitivity 92.3%, specificity 82.9%). Conclusions: The implementation of quantitative lesion water uptake as imaging biomarker in the diagnosis of patients with ischemic stroke presenting in the extended time window might improve clinical prognosis. Future studies could test this biomarker as complementary or even alternative tool to CT perfusion.


2021 ◽  
Author(s):  
Fedor Shmarov ◽  
Graham R Smith ◽  
Sophie C Weatherhead ◽  
Nick J Reynolds ◽  
Paolo Zuliani

Despite increased understanding about psoriasis pathophysiology, currently there is a lack of predictive computational models. We developed a personalisable ordinary differential equations model of human epidermis that features two stable steady states: healthy skin and psoriasis. In line with experimental data, an immune stimulus initiated transition from healthy skin to psoriasis and apoptosis induced by UVB phototherapy returned the epidermis back to the healthy state. The flexibility of our model permitted the development of a patient-specific "UVB sensitivity" parameter that enabled accurate simulation of individual patients' clinical response trajectory. In a prospective clinical study of 94 patients, serial individual UVB doses and clinical response (Psoriasis Area Severity Index) values collected over the first three weeks of UVB therapy informed estimation of the "UVB sensitivity" parameter and the prediction of patient outcome at the end of phototherapy. Notably, our model was able to distinguish disease flares and offers the potential for clinical application in early assessment of response to UVB therapy outcome, and for individualised optimisation of phototherapy regimes to improve clinical outcome.


2021 ◽  
Author(s):  
Diwakar Shankar ◽  
Deepak Kumar Singh ◽  
Vipin Kumar Chand ◽  
Mohammad Kaif

Abstract Background Primary Intracranial Malignant Melanoma (PIMM) is a very rare neoplasm and account for 1% of all melanomas and 0.1% of all intracranial tumors. It carries a poor prognosis with overall poor survival. Case Presentation: We here present a case of PIMM in a 35-year-old male presenting with sign and symptoms of a left cerebellar hemisphere tumor with leptomeningeal spread. Conclusions Diagnosis on mere imaging findings of an intracranial melanoma is a daunting task. Multimodality treatment with surgery followed by chemotherapy and radiotherapy have proved to be effective in improving clinical outcome in these patients.


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