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2021 ◽  
Vol 11 (12) ◽  
pp. 1258
Author(s):  
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 ◽  
Vol 16 (1) ◽  
Author(s):  
Xiangtian Deng ◽  
Hongzhi Hu ◽  
Zhipeng Ye ◽  
Jian Zhu ◽  
Yiran Zhang ◽  
...  

Abstract Background Acute compartment syndrome (ACS) is an underestimated complication following tibial plateau fractures. Understanding predictors of ACS in the lower leg after a fracture of the tibial plateau may guide earlier diagnosis and promptly decompressed by surgical fasciotomy. To date, however, there are few large-scale sample literatures to investigate the predictors of it. The purpose of our study was to evaluate the prevalence rate of ACS associated with tibial plateau fractures and identified any such predictors with the development of ACS. Materials and methods From January 2015 to January 2020, a total of 1119 consecutive patients (1119 fractures) including 703 males and 416 females with an average age of 40.7 years (18 to 80 years) in tibial plateau fractures who presented to a university-affiliated hospital with level-I trauma center were included. The presence of ACS and associated predictors were collected from patients’ electronic medical records. Associated predictors included gender, age, fracture pattern (open or closed), mechanisms of injury, fracture classification, and underlying disease. Univariate and multivariate logistical regression analyses were performed to identify the predictors of the development of ACS following tibial plateau fractures. Results Of the 1119 fractures of the tibial plateau, 35 (3.1%) developed an acute compartment syndrome. On multivariate analysis, only younger patient age (odds ratio (OR) 2.57; 95% confidence interval (CI), 1.26 to 6.31; P = 0.003), and Schatzker VI type fracture (OR 5.78; 95% confidence interval (CI), 1.78 to 54.34; P = 0.021) were significantly associated with the development of ACS. Other variables did not reach statistical significance. Conclusion Younger patient age and Schatzker VI type fracture were predictors of ACS of the lower leg in adults following tibial plateau fractures. Further studies in the prospective study are still needed to identify the potential risk factors associated with ACS in tibial plateau fractures.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Elena Burgos García ◽  
Andres Villegas ◽  
Fredzzia Graterol ◽  
Jordi Soler Majoral ◽  
Judit Cacho ◽  
...  

Abstract Background and Aims The arteriovenous fistula (AVF) continues to be the first-line vascular access (AV) in the hemodialysis population. However, it is disputed whether the profitability and survival in the elderly patient are the same as in the younger patient. Thus, there are authors who propose the tunnelled catheter as the best option in this group of patients. The objective of this study was to analyze the characteristics of vascular access in incident patients over 80 years of age at our center. Method A retrospective analysis was performed included incident hemodialysis patients &gt;80 years between 2017-2020. Epidemiological and vascular access complications related, as well as first permanent vascular access survival were analysed. A Pearson's correlation coefficients were employed to determine the correlation between the exitus and other variables and Regression models of mixed effects of covariance (ANCOVAs) were created to determine the effect of these with the exitus. Results Demographic characteristics of forty-four patients included are shown in Table 1. Significant differences in sex and comorbidities (diabetes, ischemic heart disease, peripheral vascular disease and hypertension) were found. A total of 26 patients (62%) had a fistula at the time of beginning hemodialysis, all of them with pre-surgical mapping and monitoring, only 15 (34%) of them being working. The most prevalent type of vascular access (VA) was the left humerus-cephalic (21%). 12 (27%) patients were exitus during the 36 months after the beginning of hemodialysis, with significant differences between groups. The variables catheter, male, and type of VA showed a significant correlation with the exitus (-0.345, -0.347, -0.347 and -0.309 respectively). The multivariate analysis showed a significant association between gender and catheter as vascular access at the beginning of hemodialysis with the exitus (p&lt;0.05) even after being adjusted for age and AVF. Conclusion In our population, male sex and catheter at the beginning of hemodialysis have a significant association with exitus. AVF should be considered as the first choice vascular access even in the subgroup of patients over 80 years old


Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Aliza T Brown ◽  
Marzella L Backus ◽  
William C Culp ◽  
Renee Joiner ◽  
krishna Nalleballe ◽  
...  

Introduction: The COVID19 pandemic causes strokes in younger patient populations with higher deficits. We examined recent numbers of stroke consults, their age and deficits in a large telestroke program and compared them to 2019 Hypothesis: Increased younger stroke consults in 2020 would involve higher deficits associated with COVID19. Methods: The Institute for Digital Health & Innovation-Stroke Program provides neurology support to 54 spoke hospitals across Arkansas. Stroke consults who received Alteplase during 01/01/20 to 07/31/20 were compared to the same months in 2019. Retrospective analysis included consult age, geographical region, mechanical thrombectomy (MT), deficits (initial and post NIHSS) and outcomes. Age was listed as < 65 or >/=65 yrs. The state was blocked into seven geographical regions. MT was noted and deficits as improved, worsened, same (no improvement) or unknown. COVID19 positivity was unknown. Results: Consult numbers declined in 2020 vs. 2019, 285 vs. 370, respectively. Both years saw MT in approximately 10%; however, 27% went to hospice or expired in 2020 vs. 7.7% in 2019. In 2020 and 2019, those < 65 consults who received MT were similar at 37 and 41% of total procedures, respectively. Pre-pandemic, there were significant differences in consult numbers among the seven regions (X2=30.1,n=370,p=0.037) in 2020, there were none (p=NS). The number of consults < 65 or >/= 65 years were not different between years(p=0.61); however, age had a similar significant effect on the initial NIHSS in both 2019 and 2020 (X2=13.5,n=370,p=0.0037 and X2=10.8,n=285,p=0.012, respectively). Improvement in initial deficit scores did not change (X2=6.9,n=655,p=0.074). No geographical differences were seen (p=0.66). Monthly initial deficits indicated a significant peak rise in the younger consults (< 65) in April 2020. Conclusion: Stroke consult numbers declined by 13% in 2020 but the proportion of young and old were unchanged. In April 2020, younger consults (< 65) experienced a spike in deficits. Further evaluation throughout 2020 is warranted as COVID19 cases spread.


2021 ◽  
Author(s):  
Miguel Sena-Esteves ◽  
Terence Flotte ◽  
Oguz Cataltepe ◽  
Ajit Puri ◽  
Ana Rita Batista ◽  
...  

Abstract Tay-Sachs Disease (TSD) is an inherited neurological disorder caused by deficiency of hexosaminidase A (HexA). Preclinical work demonstrated safety and efficacy of CNS gene therapy using AAVrh8-HEXA/HEXB. Here we describe an expanded access trial in two patients with infantile TSD (IND 18225). Case TSD-001 demonstrated neurodevelopmental regression by 8 months of age and severe seizures by 1 year was treated at 30 months. An equimolar mix of AAVrh8-HEXA and AAVrh8-HEXB (now AXO-AAV-GM2) was administered intrathecally (IT), with 75% of the dose (1x1014vg) delivered to the cisterna magna and 25% at the thoraco-lumbar junction. The second patient (TSD-002) was treated at 7 months of age with 4.2x1013 vg by a combination of bilateral thalamic (0.18 mL; 1.5x1012vg per thalamus), and IT infusion (3.9x1013vg). Both patients underwent immunosuppression with sirolimus, corticosteroids, and rituximab. Injection procedures were well tolerated and have shown no vector-related adverse events to date. CSF HexA activity nearly doubled from baseline and remained stable. In TSD-002 (now 16 months of age), MRI showed stabilization of disease by 3 months post-injection and appeared to temporarily deviate from the natural history of infantile TSD but declined again 6 months post-treatment. TSD-001 (now 4.5 years of age remains seizure-free on the same anti-convulsant therapy as pre-therapy, but TSD-002 developed seizures between 13 and 17 months posttreatment (by 2 years of age). Administration of AXO-AAV-GM2 by IT and thalamic injections was safe, HexA activity increased in CSF and ongoing myelination was apparent in the younger patient treated at an early symptomatic stage. This study provides early safety and proof-of-concept in humans for treatment of TSD patients by AAV gene therapy.


PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244614
Author(s):  
Kazuya Yamashita ◽  
Saki Sakakura ◽  
Yoshiko Ofuji ◽  
Maho Sato ◽  
Takashi Nagamoto ◽  
...  

Purpose To assess the preoperative characteristics and surgical outcomes of using micro-incision vitrectomy surgery (MIVS) to treat RRD with posterior vitreous detachment (PVD) in an older and a younger patient group. Methods This retrospective cohort study included 407 eyes from 397 patients with primary RRD with PVD who were consecutively treated in our hospital from February 2016 to February 2020. PVD was diagnosed clinically by the presence of a Weiss ring, or was diagnosed morphologically via optical coherence tomography and subsequently confirmed during surgery. The main outcome measures were preoperative RRD characteristics, best-corrected visual acuity (BCVA), and postoperative complications. Results Data were analysed from 55 eyes in the elderly group (age 70 and older), and 352 eyes in the young group (age 69 and younger). There was no significant inter-group difference in the initial reattachment rate. Preoperative characteristics indicated that elderly patients had a significantly lower rate of phakic eyes, shorter mean axial length, lower lattice incidence, and longer time spans from onset to surgery. There were no significant between-group differences in the incidence of the following complications: fibrin formation, intraocular pressure elevation, epi-retinal membrane on the macula, intraocular lens optic capture, proliferative vitreoretinopathy, and vitreous haemorrhage. While the elderly patients had significant postoperative improvements in BCVA, these improvements were significantly lower than those of the younger patients. Conclusions This study highlighted the characteristics and surgical outcomes of MIVS in elderly patients with RRD. Although the time from onset to surgery was longer, MIVS still can be performed safely to improve older patients’ postoperative BCVA.


2020 ◽  
Vol 62 (1) ◽  
Author(s):  
Bá Hải Phan ◽  
Văn Toàn Ngô

Objective: Describing clinical feature, Xray and MRI imaging, and risk factors on avascular necrossis (AVN) of femoral head Patients and method: studied prospectively 120 AVN patients were diagnosed and operated at Vieduc University Hospital Results: Averave age 47,7 ± 10. Male: Female 11:1. Bilateral AVN of the hip patients are 83,33%. Average time between bilateral AVN of the hip is 6,5 months. Risk factors are alcohol (87,5%) and smoking abuse (58,3%). Xray imaging group normaly in lately stage: cresent sign, collapsed. MRI can detech AVN in early stage (I, II) 44,27% patients Conclusion: AVN is a progressive disease, especially in younger patient. Risk factors is alcohol and smoking abuse. Xray and MRI imaging are valuable for avascular necrossis of femoral head diagnosis


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