Predicting and analysing of the unfavourable outcomes of early applicated percutaneous endoscopic interlaminar discectomy for lumbar disc herniation: development and validation based nomogram.

OBJECTIVE: To predict and analyse the unfavourable outcomes of early applicated percutaneous endoscopic interlaminar discectomy for lumbar disc herniation. METHODS: Information of 426 patients treated by early applicated percutaneous endoscopic interlaminar discectomy (PEID) for lumbar disc herniation (LDH) at our hospital from June 2017 to October 2021 in addition to 17 other features was collected. The risk factors were selected by the least absolute shrinkage and selection operator method (LASSO) regression. Then, a prediction model (nomogram) was established to predict the unfavourable outcomes of using the risk factors selected from LASSO regression. Bootstrap (n = 1000) was used to perform the internal validation, and the performance of the model was assessed by the concordance index (C-index), receiver operating characteristic curve, and calibration curve. The decision curve analysis (DCA) and clinical impact curve (CIC) were used to assess the clinical utility of the model, respectively. RESULTS: Finally, 53 of 426 patients showed unfavourable outcomes. Five potential factors, Modic change, Calcification, Lumbar epidural steroid injection preoperative, Articular process hyperplasia and cohesion, and Laminoplasty technique, were selected according to the LASSO regression, that identified the predictors to establish nomogram model. Meanwhile, the C-index of the prediction nomogram was 0.847, the area under the receiver operating characteristic curve value was 0.847, and the interval bootstrapping (n = 1000) validation C-index was 0.809. The model has good practicability for clinics according to the DCA and CIC. CONCLUSION: This nomogram model has good predictive performance and clinical practicability, which could provide a certain basis for predicting unfavourable outcomes of early applicated PEID for LDH.

Severe mental illness is associated with increased mortality and severe course of COVID-19.

OBJECTIVE: Psychiatric disorders have been associated with unfavourable outcome following respiratory infections. Whether this also applies to coronavirus disease 2019 (COVID-19) has been scarcely investigated. METHODS: Using the Danish administrative databases, we identified all patients with a positive real-time reverse transcription-polymerase chain reaction test for COVID-19 in Denmark up to and including 2 January 2021. Multivariable cox regression was used to calculate 30-day absolute risk and average risk ratio (ARR) for the composite end point of death from any cause and severe COVID-19 associated with psychiatric disorders, defined using both hospital diagnoses and redemption of psychotropic drugs. RESULTS: We included 144,321 patients with COVID-19. Compared with patients without psychiatric disorders, the standardized ARR of the composite outcome was significantly increased for patients with severe mental illness including schizophrenia spectrum disorders 2.43 (95% confidence interval [CI], 1.79-3.07), bipolar disorder 2.11 (95% CI, 1.25-2.97), unipolar depression 1.70 (95% CI, 1.38-2.02), and for patients who redeemed psychotropic drugs 1.70 (95% CI, 1.48-1.92). No association was found for patients with other psychiatric disorders 1.13 (95% CI, 0.86-1.38). Similar results were seen with the outcomes of death or severe COVID-19. Among the different psychiatric subgroups, patients with schizophrenia spectrum disorders had the highest 30-day absolute risk for the composite outcome 3.1% (95% CI, 2.3-3.9%), death 1.2% (95% CI, 0.4-2.0%) and severe COVID-19 2.7% (95% CI, 1.9-3.6%). CONCLUSION: Schizophrenia spectrum disorders, bipolar disorder, unipolar depression and psychotropic drug redemption are associated with unfavourable outcomes in patients with COVID-19.

[Forensic medical criteria for the evaluation of the unfavourable outcomes of the roentgeno-endovascular operations on the arteries of the lower extremities]. / Sudebno-meditsinskie kriterii otsenki neblagopriiatnykh iskhodov rentgenéndovaskuliarnykh operatsii na arteriiakh nizhnikh konechnostei.

The objective of the present work was to develop the forensic medical criteria for the evaluation of the unfavourable outcomes of the roentgeno-endovascular operations (REVO) on the arteries of the lower extremities. The study included the analysis of the conclusions based on the results of the commission forensic medical examinations, attorney inquiry reports, query response, medical histories of the hospitalized patients who had undergone the roentgeno-endovascular operations on the arteries of the lower extremities. The criteria for the forensic medical evaluation of the unfavourable outcomes of the roentgeno-vascular operations on the arteries of the lower extremities have been proposed together with the indications for REVO, methods and tools for the performance of these surgical procedures. Particular attention was given to the identification of the signs and prognostics of the unfavourable outcomes of the roentgeno-endovascular operations (both intraoperatively and during the early postoperative period and the subsequent stay in the hospital) and to the risks of the development of the unfavourable outcomes of the surgical interventions following the technically adequate REVO. Special emphasis is placed on the cause-and-effect relationship between the actions or a failure to act on the part of an emergency physician and/or an attending surgeon/cardiovascular surgeon and the possibility of the unfavourable outcomes of the roentgeno-endovascular operations.

Perfusion Abnormalities are Frequently Detected by Early CT Perfusion and Predict Unfavourable Outcome Following Severe Traumatic Brain Injury.

BACKGROUND: In patients with severe traumatic brain injury (TBI), early CT perfusion (CTP) provides additional information beyond the non-contrast CT (NCCT) and may alter clinical management. We hypothesized that this information may prognosticate functional outcome. METHODS: Five-year prospective observational study was performed in a level-1 trauma centre on consecutive severe TBI patients. CTP (obtained in conjunction with first routine NCCT) was interpreted as: abnormal, area of altered perfusion more extensive than on NCCT, and the presence of ischaemia. Six months Glasgow Outcome Scale-Extended of four or less was considered an unfavourable outcome. Logistic regression analysis of CTP findings and core variables [preintubation Glasgow Coma Scale (GCS), Rotterdam score, base deficit, age] was conducted using Bayesian model averaging to identify the best predicting model for unfavourable outcome. RESULTS: Fifty patients were investigated with CTP (one excluded for the absence of TBI) [male: 80%, median age: 35 (23-55), prehospital intubation: 7 (14.2%); median GCS: 5 (3-7); median injury severity score: 29 (20-36); median head and neck abbreviated injury scale: 4 (4-5); median days in ICU: 10 (5-15)]. Thirty (50.8%) patients had an unfavourable outcome. GCS was a moderate predictor of unfavourable outcome (AUC = 0.74), while CTP variables showed greater predictive ability (AUC for abnormal CTP = 0.92; AUC for area of altered perfusion more extensive than NCCT = 0.83; AUC for the presence of ischaemia = 0.81). CONCLUSION: Following severe TBI, CTP performed at the time of the first follow-up NCCT, is a non-invasive and extremely valuable tool for early outcome prediction. The potential impact on management and its cost effectiveness deserves to be evaluated in large-scale studies. LEVEL OF EVIDENCE III: Prospective study.

Developing Prediction Models for COVID-19 Outcomes: A Valuable Tool for Resource-Limited Hospitals.

Purpose: Coronavirus disease is a global pandemic with millions of confirmed cases and hundreds of thousands of deaths worldwide that continues to create a significant burden on the healthcare systems. The aim of this study was to determine the patient clinical and paraclinical profiles that associate with COVID-19 unfavourable outcome and generate a prediction model that could separate between high-risk and low-risk groups. Patients and Methods: The present study is a multivariate observational retrospective study. A total of 483 patients, residents of the municipality of Timișoara, the biggest city in the Western Region of Romania, were included in the study group that was further divided into 3 sub-groups in accordance with the disease severity form. Results: Increased age (cOR=1.09, 95% CI: 1.06-1.11, p<0.001), cardiovascular diseases (cOR=3.37, 95% CI: 1.96-6.08, p<0.001), renal disease (cOR=4.26, 95% CI: 2.13-8.52, p<0.001), and neurological disorder (cOR=5.46, 95% CI: 2.71-11.01, p<0.001) were all independently significantly correlated with an unfavourable outcome in the study group. The severe form increases the risk of an unfavourable outcome 19.59 times (95% CI: 11.57-34.10, p<0.001), while older age remains an independent risk factor even when disease severity is included in the statistical model. An unfavourable outcome was positively associated with increased values for the following paraclinical parameters: white blood count (WBC; cOR=1.10, 95% CI: 1.05-1.15, p<0.001), absolute neutrophil count (ANC; cOR=1.15, 95% CI: 1.09-1.21, p<0.001) and C-reactive protein (CRP; cOR=1.007, 95% CI: 1.004-1.009, p<0.001). The best prediction model including age, ANC and CRP achieved a receiver operating characteristic (ROC) curve with the area under the curve (AUC) = 0.845 (95% CI: 0.813-0.877, p<0.001); cut-off value = 0.12; sensitivity = 72.3%; specificity = 83.9%. Conclusion: This model and risk profiling may contribute to a more precise allocation of limited healthcare resources in a clinical setup and can guide the development of strategies for disease management.

Fovea sparing internal limiting membrane peeling for idiopathic macular holes-Report of unfavourable outcomes of a surgical technique.

PURPOSE: To describe the outcomes of fovea-sparing internal limiting membrane peeling for idiopathic macular holes. METHOD: This was a prospective, interventional case series in patients with idiopathic macular holes. Patients underwent fovea-sparing internal limiting membrane (ILM) peeling with the help of a finesse loop. The primary outcome measure was successful anatomical closure. Secondary outcome measures were postoperative improvement in best corrected visual acuity (BCVA) or any surgical complications. RESULTS: The study included 22 eyes of 22 patients (median age of 61 (IQR 58 to 66) years). The median basal diameter of the holes was 1054 (IQR 961.5 to 1278) microns, while the median minimal linear diameter was 697 (IQR 461.5 to 786) microns. Successful anatomic closure was achieved in nine cases out of 22 (40.9%). BCVA improved from 20/125 preoperatively to 20/80 at the end of the follow-up. There was no difference in baseline parameters between eyes with closure, versus eyes with an open hole. One eye had an iatrogenic break in an attempt to reinitiate peeling and create a fovea-sparing flap. One of the eyes had an ERM formation at end of 3 months. CONCLUSION: Our outcomes of fovea-sparing ILM peeling in idiopathic macular holes were unfavourable. The residual ILM could be causing tangential traction resulting in non-closure.

Characteristics and prognostic factors of bacterial meningitis in the intensive care unit: a prospective nationwide cohort study.

BACKGROUND: Patients with bacterial meningitis can be severely ill necessitating intensive care unit (ICU) treatment. Here, we describe clinical features and prognostic factors of adults with bacterial meningitis admitted to the ICU in a nationwide prospective cohort study. METHODS: We prospectively assessed clinical features and outcome of adults (age > 16 years) with community-acquired bacterial meningitis included in the MeninGene study between March 1, 2006 and July 1, 2022, that were initially admitted to the ICU. We identified independent predictors for initial ICU admission and for unfavourable outcome (Glasgow Outcome Scale score between 1-4) by multivariable logistic regression. RESULTS: A total of 2709 episodes of bacterial meningitis were included, of which 1369 (51%) were initially admitted to the ICU. We observed a decrease in proportion of patients being admitted to the ICU during the Covid-19 pandemic in 2020 (decreased to 39%, p = 0.004). Median age of the 1369 patients initially admitted to the ICU was 61 years (IQR 49-69), and the rates of unfavourable outcome (47%) and mortality (22%) were high. During the Covid-19 pandemic, we observed a trend towards an increase in unfavourable outcome. Prognostic factors predictive for initial ICU admission were younger age, immunocompromised state, male sex, factors associated with pneumococcal meningitis, and those indicative of systemic compromise. Independent predictors for unfavourable outcome in the initial ICU cohort were advanced age, admittance to an academic hospital, cranial nerve palsies or seizures on admission, low leukocyte count in blood, high C-reactive protein in blood, low CSF: blood glucose ratio, listerial meningitis, need for mechanical ventilation, circulatory shock and persistent fever. 204 of 1340 episodes (15%) that were initially not admitted to the ICU were secondarily transferred to the ICU. The rates of unfavourable outcome (66%) and mortality (30%) in this group were high. CONCLUSIONS: The majority of patients with community-acquired bacterial meningitis are admitted to the ICU, and the unfavourable outcome and mortality rates of these patients remain high. Patients that are initially admitted to non-ICU wards but secondarily transferred to the ICU also had very high rates of unfavourable outcome.

Study of treatment outcomes of multidrug-resistant tuberculosis under programmatic conditions and factors influencing the outcomes in Hyderabad District.

BACKGROUND: Treatment outcomes for Multidrug-Resistant Tuberculosis (MDR TB) is generally poor. The study aims to know about the treatment outcomes of MDR-TB under programmatic conditions in Hyderabad District and to analyze the factors influencing the treatment outcomes. METHODS: This is a retrospective study in which 377 patients of Hyderabad district, Telangana state who were diagnosed with MDR TB and registered at Drug Resistance TB Treatment site of Government General & Chest Hospital, Hyderabad from 4th quarter 2008 to 4th quarter 2013 were included in the study. Impact of Demographic factors (age, sex; Nutritional status (BMI); Co-morbid condition (Diabetes, HIV, Hypothyroidism); Programmatic factors (time delay in the initiation of treatment); Initial Resistance pattern on the outcomes were studied and analyzed. RESULTS: The treatment outcomes of Multidrug-Resistant Tuberculosis under Programmatic Conditions were: 57% cured, 21.8% died, 19.6% defaulted, 1.1% failed and 0.5% switched to XDR. Age, Sex, BMI had a statistically significant impact on treatment outcomes. Hypothyroidism and Delay in the initiation of treatment >1 a month had an impact on the outcomes though not statistically significant. NO impact on treatment outcomes was found when Rifampicin resistance & INH sensitive patients were compared with those resistant to both INH and Rifampicin. CONCLUSION: To reduce MDR-TB transmission in the community, improvement of treatment outcomes, via ensuring adherence, paying special attention to elderly patients is required. The Programmatic Management of Drug Resistance Tuberculosis (PMDT) should seriously think of providing Nutritional support to patients with low BMI to improve outcomes. In the programmatic conditions if we could address the problems like delay in initiation of treatment and proper management of comorbidities like HIV, Diabetes, Hypothyroidism would definitely improve the treatment outcomes.

Does Drug-Resistant Extrapulmonary Tuberculosis Hinder TB Elimination Plans? A Case from Delhi, India.

Extrapulmonary drug-resistant tuberculosis (DR-EPTB) poses a formidable diagnostic and therapeutic challenge.Besides associated with high morbidity, it is a major financial burden for the patient and the health system. In spite of this, it has often been neglected as it does not "pose" a visible public health threat. We study clinical profiles, treatment outcomes, and factors associated with unfavourable outcomes among DR-EPTB patients under programmatic settings in New Delhi, India, and evaluate how this could impact TB elimination. A retrospective analysis of all DR-EPTB patients registered at three nodal DR-TB centres in Delhi in 2016 was carried out. Of the 1261 DR-TB patients registered, 203 (16%) were DR-EPTB, with lymph nodes (118, 58%) being the most common site, followed by bone (69, 34%). Nearly 29% (n = 58) experienced adverse drug reactions with severe vomiting (26, 13 %), joint pain (21, 10%) and behavioral disorder (15, 7%). History of previous TB treatment was observed in a majority of the cases (87.7%). Nearly one-third of DR-EPTB cases (33%) had unfavourable treatment outcomes, with loss-to-follow-up (n = 40, 58%) or death (n = 14, 20%) being the most common unfavourable outcomes. In the adjusted analysis, weight band 31-50 kilograms (aRR = 1.8, 1.2-3.4) and h/o previous TB (aRR = 2.1, 1.1-4.8) were mainly associated with unfavourable outcomes. TB elimination efforts need to focus on all forms of TB, including DR-EPTB, leaving no one behind, in order to realise the dream of ending TB.

The long-term outcome of tick-borne encephalitis in Central Europe.

BACKGROUND: Information on the long-term outcome of tick-borne encephalitis (TBE) is limited. OBJECTIVES: To assess the frequency and severity of post-encephalitic syndrome (PES) at different time points after TBE, and to determine the parameters associated with unfavourable outcome. METHODS: Adult patients diagnosed with TBE in Slovenia in the period 2007-2012 were followed-up for 12 months and also examined 2-7 years after TBE. Each patient was asked to refer a person of similar age without a history of TBE to serve as control. RESULTS: A total of 420 patients and 295 control persons participated in the study. The proportion of patients with PES (defined as the presence of ≥ 2 subjective symptoms that newly developed or worsened since the onset of TBE and which had no other known medical explanation, and/or ≥ 1 objective neurological sign) was higher (P < 0.001) at the follow-up visit 6 months after the acute illness (127/304, 42%, 95% CI: 36-47%) than at 12 months (68/207, 33%, 95% CI: 26-40%); the proportion at 12 months was the same as at 2-7 years after TBE (137/420, 33%, 95% CI: 28-37%). However, the proportion of severe PES at the last two time points differed (9.7% vs 4.3%, P = 0.008). Multivariate logistic regression showed that unfavourable outcome at 6 months was associated with CSF leukocyte count (OR = 1.003, 95% CI: 1.001-1.005%, P = 0.017), at 12 months with the disease outcome at 6 months (OR = 115.473, 95% CI: 26.009-512.667%, P < 0.001), and at the final visit with disease outcome at 6 months (OR = 3.808, 95% CI: 1.151-12.593%, P = 0.028) and 12 months (OR = 26.740, 95% CI: 8.648-82.680%, P < 0.001). Unspecific symptoms that occurred within the four weeks before the final examination were more frequent and more constant in patients than in the control group. CONCLUSIONS: The frequency of PES diminished over time and stabilized 12 months after the acute illness, whereas the severity of PES continued to decline. Unfavourable outcomes at 12 months and at the final visit were strongly associated with the presence of PES at previous time points.

Risk factors for unfavourable treatment outcome among new smear-positive pulmonary tuberculosis cases in China.

Setting: Three projects of the Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB. Objectives: To assess unfavourable treatment outcomes (UTOs), including failure, died, loss to follow-up (LTFU), transferred out and unknown outcome, and to identify risk factors associated with UTOs. Design: This was a cross-sectional study using routine programme data. Results: Of 30 277 new smear-positive tuberculosis (TB) patients, 4261 (14.1%) had UTOs: 2048 (6.8%) LTFU, 1418 (4.7%) transferred out, 390 (1.3%) died, 340 (1.1%) failed and 65 (0.2%) had an unknown outcome. Risk factors for LTFU (including LTFU, transfer out and unknown outcome) were residing in Anhui, age > 55 years, service delay > 10 days, patient delay < 30 days, directly observed treatment (DOT) provided by a family member or others and unknown DOT provider. The outcome of 'died' was associated with residing in Shaanxi, age > 55 years, male sex, patient delay > 30 days and unknown DOT provider. 'Failed' was associated with having unlimited access to health services, patient delay of >30 days and unknown DOT provider. Conclusion: This study highlights the predominance of lost patients among UTOs. Patients with family members or other non-medical DOT providers or unknown DOT providers had a high risk of a UTO. There is an urgent need to address these service-related factors.

Contexte : Trois projets du Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB (FIDELIS).Objectifs : Evaluer les résultats défavorables du traitement (UTO) incluant l'échec, le décès, les pertes de vue, les transferts et les résultats inconnus, et identifier les facteurs de risque associés aux UTO.Schéma : Une étude transversale basée sur des données de routine du programme.Résultats : De 30 277 nouveaux patients TB à frottis positif, 4261 (14,1%) ont eu un UTO : perdus de vue (2048 ; 6,8%), transférés (1418 ; 4,7%), décédés (390 ; 1,3%), en échec (340 ; 1,1%) ou inconnus (65 ; 0,2%). Les facteurs de risque de perte d'un patient (incluant les patients perdus de vue, transférés et inconnus) ont été le fait de vivre à Anhui, l'âge > 55 ans, un délai du service > 10 jours, un retard du patient < 30 jours et le traitement directement observé (DOT) fourni par un membre de la famille ou d'autres personnes ou un prestataire de DOT inconnu. Le résultat « décès ¼ a été associé avec le fait de vivre à Shaanxi, l'âge > 55 ans, le sexe masculin, un retard du patient > 30 jours et un prestataire de DOT inconnu. Un « échec ¼ a été associé avec un accès non limité aux services de santé, un retard du patient > 30 jours et un prestataire de DOT inconnu.Conclusion : L'étude a mis en lumière la prédominance de pertes de vue parmi les UTO. Les patients ayant comme prestataire de DOT un membre de la famille ou un autre prestataire non médical ou inconnu ont eu un risque élevé d'UTO. Il y a un besoin urgent d'aborder ces facteurs liés au service.

Marco de referencia: Tres proyectos del Fondo de Estrategias Innovadoras de Ampliación de DOTS mediante Iniciativas Locales para Detener la Tuberculosis (FIDELIS).Objetivos: Evaluar los desenlaces terapéuticos desfavorables (UTO) que incluyen el fracaso terapéutico, la muerte, la pérdida durante el seguimiento, la transferencia a otro centro y el desenlace desconocido y definir los factores de riesgo que se asocian con estos resultados.Método: Un estudio transversal a partir de los datos corrientes del programa.Resultados: Se incluyeron en el estudio 30 277 casos nuevos de tuberculosis (TB) con baciloscopia positiva. De estos pacientes, 4261 tuvieron UTO (14,1%), a saber: perdidos durante el seguimiento (2048; 6,8%), transferidos a otro centro (1418; 4,7%), fallecidos (390; 1,3%), fracasos (340; 1,1%) o desenlaces desconocidos (65; 0,2%). En Anhui, los factores de riesgo de pérdida durante el seguimiento (incluidas las pérdidas, las transferencias a otro centro y los desenlaces desconocidos) fueron la edad > 55 años, un retraso dependiente del servicio > 10 días, un retraso dependiente del paciente < 30 días y el tratamiento bajo observación directa (DOT) suministrado por miembros de la familia u otras personas y un dispensador de DOT desconocido. En Shaanxi, el desenlace 'fallecido' se asoció con la edad > 55 años, el sexo masculino, un retraso dependiente del paciente > 30 días y un dispensador de DOT desconocido. El 'fracaso' se asoció con el hecho de no pertenecer a la categoría de acceso limitado a los servicios de salud, el retraso dependiente del paciente > 30 días y un dispensador de DOT desconocido.Conclusión: El estudio puso de manifiesto el predominio de la pérdida durante el seguimiento en los desenlaces desfavorables del tratamiento antituberculoso. Los pacientes que recibían el DOT por parte de un miembro de la familia o de otra persona diferente a un profesional de salud o cuyo dispensador de DOT se desconocía presentaron un alto riesgo de UTO. Es urgente abordar estos factores que dependen de los servicios de salud.