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1.
BMC Surg ; 21(1): 178, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794850

RESUMEN

BACKGROUND: The inflammation indexes in blood routine play an essential role in evaluating the prognosis of patients with hepatocellular carcinoma, but the effect on early recurrence has not been clarified. The study aimed to investigate the risk factors of early recurrence (within 2 years) and recurrence-free survival after curative hepatectomy and explore the role of inflammatory indexes in predicting early recurrence. METHODS: The baseline data of 161 patients with hepatocellular carcinoma were analyzed retrospectively. The optimal cut-off value of the inflammatory index was determined according to the Youden index. Its predictive performance was compared by the area under the receiver operating characteristic curve. Logistic and Cox regression analyses were used to determine the risk factors of early recurrence and recurrence-free survival. RESULTS: The area under the curve of monocyte to lymphocyte ratio (MLR) for predicting early recurrence was 0.700, which was better than systemic inflammatory response index (SIRI), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and systemic immune-inflammatory index (SII). MLR, tumour size, tumour differentiation and BCLC stage are all risk factors for early recurrence and recurrence-free survival of HCC. Combining the above four risk factors to construct a joint index, the area under the curve for predicting early recurrence was 0.829, which was better than single MLR, tumour size, tumour differentiation and BCLC stage. Furthermore, with the increase of risk factors, the recurrence-free survival of patients is worse. CONCLUSION: The combination of MLR and clinical risk factors is helpful for clinicians to identify high-risk patients with early recurrence and carry out active postoperative adjuvant therapy to improve the prognosis of patients.


Asunto(s)
Carcinoma Hepatocelular , Hepatectomía , Inflamación , Neoplasias Hepáticas , Recurrencia Local de Neoplasia , Carcinoma Hepatocelular/sangre , Carcinoma Hepatocelular/cirugía , Humanos , Inflamación/sangre , Neoplasias Hepáticas/sangre , Neoplasias Hepáticas/cirugía , Recuento de Linfocitos , Monocitos , Recurrencia Local de Neoplasia/sangre , Valor Predictivo de las Pruebas , Periodo Preoperatorio , Pronóstico , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo
2.
Anticancer Res ; 41(4): 2147-2155, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813426

RESUMEN

BACKGROUND/AIM: Inflammation-based prognostic scores are proven prognostic biomarkers in various cancers. This study aimed to identify a useful prognostic score for patients with biliary tract cancer (BTC) after surgical resection. PATIENTS AND METHODS: This retrospective study recruited 115 patients with BTC during 2010-2020. The relationship between clinicopathological variables, including various prognostic scores and overall survival (OS), was investigated using univariate and multivariate analyses. RESULTS: BTC included 58 cholangiocarcinoma, 29 gallbladder carcinoma, 16 ampullary carcinoma, and 12 perihilar cholangiocarcinoma cases. A significant difference was detected in OS of patients with a Japanese modified Glasgow prognostic score (JmGPS) 0 (n=62) and JmGPS 1 or 2 (high JmGPS) (n=53). In the multivariate analysis, tumour differentiation (p=0.014) and a high JmGPS (p=0.047) were independent prognostic factors. CONCLUSION: The high JmGPS was an independent prognostic predictor after surgical resection and was superior to other prognostic scores.


Asunto(s)
Neoplasias del Sistema Biliar/diagnóstico , Neoplasias del Sistema Biliar/cirugía , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/cirugía , Inflamación/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Ampolla Hepatopancreática/metabolismo , Ampolla Hepatopancreática/patología , Ampolla Hepatopancreática/cirugía , Neoplasias de los Conductos Biliares/diagnóstico , Neoplasias de los Conductos Biliares/metabolismo , Neoplasias de los Conductos Biliares/mortalidad , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos/metabolismo , Conductos Biliares Intrahepáticos/patología , Conductos Biliares Intrahepáticos/cirugía , Neoplasias del Sistema Biliar/metabolismo , Neoplasias del Sistema Biliar/mortalidad , Biomarcadores de Tumor/metabolismo , Proteína C-Reactiva/metabolismo , Colangiocarcinoma/metabolismo , Colangiocarcinoma/mortalidad , Neoplasias del Conducto Colédoco/diagnóstico , Neoplasias del Conducto Colédoco/metabolismo , Neoplasias del Conducto Colédoco/mortalidad , Neoplasias del Conducto Colédoco/cirugía , Femenino , Neoplasias de la Vesícula Biliar/diagnóstico , Neoplasias de la Vesícula Biliar/metabolismo , Neoplasias de la Vesícula Biliar/mortalidad , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Inflamación/metabolismo , Japón/epidemiología , Tumor de Klatskin/diagnóstico , Tumor de Klatskin/metabolismo , Tumor de Klatskin/mortalidad , Tumor de Klatskin/cirugía , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Pronóstico , Proyectos de Investigación , Estudios Retrospectivos , Sensibilidad y Especificidad , Análisis de Supervivencia , Resultado del Tratamiento
3.
Anticancer Res ; 41(4): 2183-2186, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813431

RESUMEN

BACKGROUND/AIM: The aim of this study was to identify simple and reliable factors to detect clinically insignificant prostate cancer (PC) for avoiding immediate prostate biopsies using biparametric magnetic resonance imaging (MRI), which consists of T2-weighted and diffusion-weighted imaging. PATIENTS AND METHODS: We retrospectively evaluated 427 men with suspected PC, who underwent biparametric MRI and standard 12-core transrectal prostate biopsy. MRI and prostate specific antigen density (PSAD) were analysed. To evaluate the combination of the two parameters, patients were divided into three groups (Group A: MRI negative and PSAD <0.23, Group B: MRI positive or PSAD ≥0.23, Group C: MRI positive and PSAD ≥0.23). A grade of ≥2 was defined as clinically significant PC. RESULTS: Clinically significant PC was detected in 46.5% of men with positive MRI findings, and 60.0% of men with PSAD ≥0.23. When combining MRI and PSAD, detection rates of clinically significant PC were 10.0%, 28.4% and 65.3% in group A, B and, C, respectively. CONCLUSION: Negative biparametric MRI findings with PSAD <0.23 might be a reliable evidence for avoiding immediate prostate biopsies.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Antígeno Prostático Específico/análisis , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/patología , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Gruesa/métodos , Imagen de Difusión por Resonancia Magnética , Humanos , Biopsia Guiada por Imagen , Pruebas Inmunológicas , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Próstata/patología , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/metabolismo , Estudios Retrospectivos , Carga Tumoral , Ultrasonografía Intervencional
4.
Angiol Sosud Khir ; 27(1): 24-32, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33825725

RESUMEN

AIM: The study was aimed at comparing efficacy of conventional conservative therapy and comprehensive treatment including a plasmid VEGF-165-gene therapy drug in 'no-option' chronic limb-threatening ischaemia with different prevalence of trophic ulcers and infection during a 1-year follow-up period. PATIENTS AND METHODS: A total of 101 patients (54% being men and 46% women, mean age 69 years) with 'no-option' chronic limb-threatening ischaemia underwent comprehensive conservative treatment. They were subdivided into 4 groups according to the WIFI classification: WIFI 130 (n=38), 131 (n=23), 230 (n=16), 231 (n=24). The control group patients (n=58) received standard treatment using a PGE1 analogue (Vasaprostan) and the study group patients (n=43) underwent standard conservative treatment (SCT) in combination with gene therapy. The end points of the study were as follows: major amputation rate, amputation-free survival, total mortality, and ulcer healing rate during a 1-year of follow up. RESULTS: Major amputation rate in the control and study groups amounted to 35 and 28% (p=0.48), respectively, with amputation-free survival of 53 and 63% (p=0.35), total mortality of 21 and 12% (p=0.23), ulcer healing rate of 31 and 51% (p=0.04), respectively. The WIfI classification made it possible to single out a subgroup of patients (WIfI combination 130) yielding other statistically significant results: major amputation rate 27% and 0% (p=0.03), amputation-free survival 59 and 94% (p=0.025), ulcer healing rate 50 and 88% (p=0.016), respectively. CONCLUSION: Using plasmid-based VEGF-165 gene therapy in the subgroup with the WIfI combination 130 decreases the major amputation rate (p=0.03), increases amputation-free survival (p=0.025) and promotes ulcer healing (p=0.016) compared with the standard therapy during 1-year follow up. No significant differences in the compared groups were revealed by all endpoints of the study for other combinations analysed. The total mortality rate in patients with limb-threatening ischaemia does not depend on either the initial severity of ulcer or the selcted methods of conservative treatment.


Asunto(s)
Tratamiento Conservador , Recuperación del Miembro , Anciano , Amputación , Femenino , Humanos , Isquemia/cirugía , Estimación de Kaplan-Meier , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de Heridas
5.
Medicine (Baltimore) ; 100(9): e25007, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655970

RESUMEN

ABSTRACT: Surgical site infection (SSI) is a costly postoperative complication with a decrease in the quality of life. We aimed to probe the predictive role of peripheral blood inflammation markers for SSI following mesh repair of groin hernia (GH).This retrospective study assessed the data of 1177 patients undergoing elective mesh repair of GH (open/laparoscopy) in the absence of antibiotic prophylaxis. The relation between demographics, surgical factors, pre-surgical laboratory results and the occurrence of SSI were investigated by univariate and multivariate analyses. Receiver operating characteristic analysis was performed to determine the optimal threshold of parameters and compare their veracity.The overall SSI rate was 3.2% with 1-year follow-up (38 superficial and 1 deep SSI). Patients with SSI had significant higher pre-surgical neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) than those without (P = .029 and P = .045, respectively); their NLR and PLR correlated positively with postoperative total days of antibiotic treatment for SSI (r = .689, P = .000; r = .493, P = .001; respectively). NLR and PLR had larger areas under the receiver operating characteristics curves than neutrophil (.875 vs. .601; P = .000; .726 vs. .601; P = .017). The combination of PLR and neutrophil/NLR raised the predictive sensitivity of PLR for SSI (sensitivity: PLR: 74.36%; PLR + neutrophil: 82.05%; PLR + NLR: 83.57%). On multivariate analyses, higher preoperative NLR (cut-off 2.44) and PLR (cut-off 125.42) were independent predictors for SSI.Higher pre-surgical NLR and PLR may be valuable predictors for SSI following elective mesh repair of GH.


Asunto(s)
Hernia Inguinal/cirugía , Herniorrafia/efectos adversos , Inflamación/sangre , Linfocitos/patología , Neutrófilos/patología , Mallas Quirúrgicas/efectos adversos , Infección de la Herida Quirúrgica/sangre , Adulto , Anciano , Biomarcadores/sangre , Plaquetas/patología , Femenino , Estudios de Seguimiento , Humanos , Inflamación/etiología , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Valor Predictivo de las Pruebas , Calidad de Vida , Estudios Retrospectivos , Infección de la Herida Quirúrgica/etiología
6.
Vasc Health Risk Manag ; 17: 77-93, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33731998

RESUMEN

Background: In a previous study, the cardio-ankle vascular index (CAVI) was increased significantly in idiopathic pulmonary arterial hypertension (IPAH) patients compared to the healthy group and did not much differ from one in systemic hypertensives. In this study the relations between survival and CAVI was evaluated in patients with IPAH. Patients and Methods: We included 89 patients with new-diagnosed IPAH without concomitant diseases. Standard examinations, including right heart catheterization (RHC) and systemic arterial stiffness evaluation, were performed. All patients were divided according to CAVI value: the group with CAVI ≥ 8 (n = 18) and the group with CAVI < 8 (n = 71). The mean follow-up was 33.8 ± 23.7 months. Kaplan-Meier and Cox regression analysis were performed for the evaluation of our cohort survival and the predictors of death. Results: The group with CAVI≥8 was older and more severe compared to the group with CAVI< 8. Patients with CAVI≥8 had significantly reduced end-diastolic (73.79±18.94 vs 87.35±16.69 mL, P<0.009) and end-systolic (25.71±9.56 vs 33.55±10.33 mL, P<0.01) volumes of the left ventricle, the higher right ventricle thickness (0.77±0.12 vs 0.62±0.20 mm, P < 0.006), and the lower TAPSE (13.38±2.15 vs 15.98±4.4 mm, P<0.018). RHC data did not differ significantly between groups, except the higher level of the right atrial pressure in patients with CAVI≥ 8-11.38±7.1 vs 8.76±4.7 mmHg, P<0.08. The estimated overall survival rate was 61.2%. The CAVI≥8 increased the risk of mortality 2.34 times (CI 1.04-5.28, P = 0.041). The estimated Kaplan-Meier survival in the patients with CAVI ≥ 8 was only 46.7 ± 7.18% compared to patients with CAVI < 8 - 65.6 ± 4.2%, P = 0.035. At multifactorial regression analysis, the CAVI reduced but saved its relevance as death predictor - OR = 1.13, CI 1.001-1.871. Summary: We suggested the CAVI could be a new independent predictor of death in the IPAH population and could be used to better risk stratify this patient population if CAVI is validated as a marker in a larger multicenter trial.


Asunto(s)
Índice Vascular Cardio-Tobillo , Hipertensión Pulmonar Primaria Familiar/diagnóstico , Hemodinámica , Rigidez Vascular , Adulto , Hipertensión Pulmonar Primaria Familiar/mortalidad , Hipertensión Pulmonar Primaria Familiar/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo
7.
Medicine (Baltimore) ; 100(11): e24762, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725942

RESUMEN

ABSTRACT: Chemokines are majorly involved in inflammatory and immune responses. The interferon-γ-inducible chemokines C-X-C motif chemokines 9 and 10 (CXCL9 and CXCL10) are considerably associated with Th1 cells and monocytes, and their expression levels rapidly increase during the early episodes of renal allograft rejection and various infectious diseases. CXCL13 is one of the most potent B-cell and T follicular helper-cell chemoattractants. The expression of CXCL13 in the presence of infection indicates an important chemotactic activity in multiple infectious diseases. C-C motif chemokine ligand 2 (CCL2) can attract monocytes and macrophages during inflammatory responses. However, there are no studies on the role of these chemokines in posttransplant infection in kidney transplant recipients.In this study, CXCL9, CXCL10, CXCL13, and CCL2 were analyzed using the Bio-Plex suspension array system before transplant and 30 days after transplant.The serum levels of CXCL9 and CXCL13 30 days after kidney transplant were associated with infection within 1 year after transplant (P = .021 and P = .002, respectively). The serum levels of CXCL9 and CXCL13 before surgery and those of CCL2 and CXCL10 before and after surgery were not associated with infection within 1 year after transplant (P > .05). The combination of postoperative day (POD) 30 CXCL9 and postoperative day 30 CXCL13 provided the best results with an area under the curve of 0.721 (95% confidence interval, 0.591-0.852), with a sensitivity of 71.4% and specificity of 68.5% at the optimal cutoff value of 52.72 pg/mL.As important chemokines, CXCL9 and CXCL13 could be used to predict the occurrence of infection after kidney transplant.


Asunto(s)
Quimiocina CXCL13/sangre , Quimiocina CXCL9/sangre , Infecciones/etiología , Enfermedades Renales/sangre , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/etiología , Adulto , Biomarcadores/sangre , Quimiocina CCL2/sangre , Quimiocina CXCL10/sangre , Femenino , Humanos , Enfermedades Renales/cirugía , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Periodo Preoperatorio , Estudios Retrospectivos
8.
Medicine (Baltimore) ; 100(11): e24805, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725946

RESUMEN

BACKGROUND: The main purpose of this study is to systematically evaluate the diagnostic value of long-chain non-coding RNA urothelial carcinoembryonic antigen 1 (lncRNA-UCA1) for bladder cancer, and to provide a scientific basis for the diagnosis of bladder cancer. METHODS: By searching PubMed, Web of Science, EMBASE, CNKI, Wanfang, Weipu and other databases, in order to collect relevant literature of lncRNA-UCA1 for diagnosis of bladder cancer. The starting and ending time of the search is from the establishment of the database to December 31, 2019. Screen documents and extract data according to inclusion and exclusion criteria. QUADAS entry tool was used to evaluate the quality of literature. Meta-Disc 1.4 and Stata 12.0 software were used for statistical analysis, and UCA1 was combined for the statistics of bladder cancer diagnosis. RESULTS: A total of 7 articles were included in this study, including 954 cases of bladder cancer patients and 482 cases of non-bladder cancer patients. The receiver operating characteristic curve (ROC) curve AUC of lncRNA-UCA1 used to diagnose bladder cancer was 0.86. The sensitivity was 0.83 (95% CI: 0.80-0.85), and the specificity was 0.86 (95% CI: 0.82-0.89). The positive likelihood ratio is 6.38 (95% CI: 3.01-13.55), and the negative likelihood ratio is 0.20 (95% CI: 0.13-0.31). The diagnostic odds ratio is 33.13 (95% CI: 11.16-98.33). CONCLUSION: lncRNA-UCA1 has a high value of clinical auxiliary diagnosis for bladder cancer, and it can be further promoted and applied clinically.


Asunto(s)
ARN Largo no Codificante/análisis , Neoplasias de la Vejiga Urinaria/diagnóstico , Adulto , Área Bajo la Curva , Biomarcadores de Tumor/análisis , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Valor Predictivo de las Pruebas , Curva ROC , Sensibilidad y Especificidad , Neoplasias de la Vejiga Urinaria/genética
9.
Medicine (Baltimore) ; 100(11): e25081, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725985

RESUMEN

ABSTRACT: This work aims to explore risk factors for ischemic stroke in young adults and analyze the Traditional Vascular Risk Factors Model based on age, hypertension, diabetes, smoking history, and drinking history. Further, the Lipid Metabolism Model was analyzed based on lipoprotein a [LP (a)], high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein AI (apo AI), apolipoprotein B (apo B), and the Early Renal Injury Model based on urinary microalbuminuria/creatinine ratio (UACR). Besides, we estimated glomerular filtration rate (eGFR), cystatin C (Cys-C), homocysteine (Hcy), ß2 microglobulin (ß2m), and validated their predictive efficacy and clinical value for the development of ischemic stroke in young adults.We selected and retrospectively analyzed the clinical data of 565 young inpatients admitted to Zhejiang Provincial Hospital of Chinese Medicine between 2010 and 2020, 187 of whom were young stroke patients. A single-factor analysis was used to analyze the risk factors for stroke in young people and developed a traditional vascular risk factors model, a lipid metabolism model, and an early kidney injury model based on backpropagation (BP) neural networks technology to predict early stroke occurrence. Moreover, the prediction performance by the area under the receiver operating characteristics (ROC) curve (AUC) was assessed to further understand the risk factors for stroke in young people and apply their predictive role in the clinical setting.Single-factor analysis showed that ischemic stroke in young adults was associated with hypertension, diabetes, smoking history, drinking history, LP(a), HDL, LDL, apo AI, apo B, eGFR, Cys-C, and ß2m (P < .05). The BP neural networks technique was used to plot the ROC curves for the Traditional Vascular Risk Factors Model, the Lipid Metabolism Model, and the Early Kidney Injury Model in enrolled patients, and calculated AUC values of 0.7915, 0.8387, and 0.9803, respectively.The early kidney injury model precisely predicted the risk of ischemic stroke in young adults and exhibited a certain clinical value as a reference for morbidity assessment. Whereas the prediction performance of the Traditional Vascular Risk Factors Model and the Lipid Metabolism Model were inferior to that of the early kidney injury model.


Asunto(s)
Reglas de Decisión Clínica , Pruebas de Función Renal/estadística & datos numéricos , Redes Neurales de la Computación , Medición de Riesgo/estadística & datos numéricos , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/diagnóstico , Adolescente , Adulto , Factores de Edad , Consumo de Bebidas Alcohólicas/efectos adversos , Área Bajo la Curva , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Análisis Factorial , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Pruebas de Función Renal/métodos , Lipoproteínas/sangre , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Medición de Riesgo/métodos , Factores de Riesgo , Fumar/efectos adversos , Adulto Joven
10.
Syst Rev ; 10(1): 77, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33726854

RESUMEN

BACKGROUND: Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We summarise the literature on the performance of different rapid tests for exertional desaturation and draw on this evidence base to provide guidance in the context of acute Covid-19. MAIN RESEARCH QUESTIONS: 1. What exercise tests have been used to assess exertional hypoxia at home or in an ambulatory setting in the context of Covid-19 and to what extent have they been validated? 2. What exercise tests have been used to assess exertional hypoxia in other lung conditions, to what extent have they been validated and what is the applicability of these studies to acute Covid-19? METHOD: AMED, CINAHL, EMBASE MEDLINE, Cochrane and PubMed using LitCovid, Scholar and Google databases were searched to September 2020. Studies where participants had Covid-19 or another lung disease and underwent any form of exercise test which was compared to a reference standard were eligible. Risk of bias was assessed using QUADAS 2. A protocol for the review was published on the Medrxiv database. RESULTS: Of 47 relevant papers, 15 were empirical studies, of which 11 described an attempt to validate one or more exercise desaturation tests in lung diseases other than Covid-19. In all but one of these, methodological quality was poor or impossible to fully assess. None had been designed as a formal validation study (most used simple tests of correlation). Only one validation study (comparing a 1-min sit-to-stand test [1MSTST] with reference to the 6-min walk test [6MWT] in 107 patients with interstitial lung disease) contained sufficient raw data for us to calculate the sensitivity (88%), specificity (81%) and positive and negative predictive value (79% and 89% respectively) of the 1MSTST. The other 4 empirical studies included two predictive studies on patients with Covid-19, and two on HIV-positive patients with suspected pneumocystis pneumonia. We found no studies on the 40-step walk test (a less demanding test that is widely used in clinical practice to assess Covid-19 patients). Heterogeneity of study design precluded meta-analysis. DISCUSSION: Exertional desaturation tests have not yet been validated in patients with (or suspected of having) Covid-19. A stronger evidence base exists for the diagnostic accuracy of the 1MSTST in chronic long-term pulmonary disease; the relative intensity of this test may raise safety concerns in remote consultations or unstable patients. The less strenuous 40-step walk test should be urgently evaluated.


Asunto(s)
/sangre , Prueba de Esfuerzo , Ejercicio Físico , Enfermedades Pulmonares/diagnóstico , Oxígeno/sangre , Esfuerzo Físico , /patología , Disnea , Prueba de Esfuerzo/efectos adversos , Humanos , Hipoxia , Enfermedades Pulmonares/sangre , Enfermedades Pulmonares/patología , Enfermedades Pulmonares/virología , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad
11.
Sci Adv ; 7(12)2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33741586

RESUMEN

As no one symptom can predict disease severity or the need for dedicated medical support in coronavirus disease 2019 (COVID-19), we asked whether documenting symptom time series over the first few days informs outcome. Unsupervised time series clustering over symptom presentation was performed on data collected from a training dataset of completed cases enlisted early from the COVID Symptom Study Smartphone application, yielding six distinct symptom presentations. Clustering was validated on an independent replication dataset between 1 and 28 May 2020. Using the first 5 days of symptom logging, the ROC-AUC (receiver operating characteristic - area under the curve) of need for respiratory support was 78.8%, substantially outperforming personal characteristics alone (ROC-AUC 69.5%). Such an approach could be used to monitor at-risk patients and predict medical resource requirements days before they are required.


Asunto(s)
/diagnóstico , Diagnóstico por Computador , Aplicaciones Móviles , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo
12.
Cochrane Database Syst Rev ; 3: CD013705, 2021 03 24.
Artículo en Inglés | MEDLINE | ID: mdl-33760236

RESUMEN

BACKGROUND: Accurate rapid diagnostic tests for SARS-CoV-2 infection could contribute to clinical and public health strategies to manage the COVID-19 pandemic. Point-of-care antigen and molecular tests to detect current infection could increase access to testing and early confirmation of cases, and expediate clinical and public health management decisions that may reduce transmission. OBJECTIVES: To assess the diagnostic accuracy of point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection. We consider accuracy separately in symptomatic and asymptomatic population groups. SEARCH METHODS: Electronic searches of the Cochrane COVID-19 Study Register and the COVID-19 Living Evidence Database from the University of Bern (which includes daily updates from PubMed and Embase and preprints from medRxiv and bioRxiv) were undertaken on 30 Sept 2020. We checked repositories of COVID-19 publications and included independent evaluations from national reference laboratories, the Foundation for Innovative New Diagnostics and the Diagnostics Global Health website to 16 Nov 2020. We did not apply language restrictions. SELECTION CRITERIA: We included studies of people with either suspected SARS-CoV-2 infection, known SARS-CoV-2 infection or known absence of infection, or those who were being screened for infection. We included test accuracy studies of any design that evaluated commercially produced, rapid antigen or molecular tests suitable for a point-of-care setting (minimal equipment, sample preparation, and biosafety requirements, with results within two hours of sample collection). We included all reference standards that define the presence or absence of SARS-CoV-2 (including reverse transcription polymerase chain reaction (RT-PCR) tests and established diagnostic criteria). DATA COLLECTION AND ANALYSIS: Studies were screened independently in duplicate with disagreements resolved by discussion with a third author. Study characteristics were extracted by one author and checked by a second; extraction of study results and assessments of risk of bias and applicability (made using the QUADAS-2 tool) were undertaken independently in duplicate. We present sensitivity and specificity with 95% confidence intervals (CIs) for each test and pooled data using the bivariate model separately for antigen and molecular-based tests. We tabulated results by test manufacturer and compliance with manufacturer instructions for use and according to symptom status. MAIN RESULTS: Seventy-eight study cohorts were included (described in 64 study reports, including 20 pre-prints), reporting results for 24,087 samples (7,415 with confirmed SARS-CoV-2). Studies were mainly from Europe (n = 39) or North America (n = 20), and evaluated 16 antigen and five molecular assays. We considered risk of bias to be high in 29 (50%) studies because of participant selection; in 66 (85%) because of weaknesses in the reference standard for absence of infection; and in 29 (45%) for participant flow and timing. Studies of antigen tests were of a higher methodological quality compared to studies of molecular tests, particularly regarding the risk of bias for participant selection and the index test. Characteristics of participants in 35 (45%) studies differed from those in whom the test was intended to be used and the delivery of the index test in 39 (50%) studies differed from the way in which the test was intended to be used. Nearly all studies (97%) defined the presence or absence of SARS-CoV-2 based on a single RT-PCR result, and none included participants meeting case definitions for probable COVID-19. Antigen tests Forty-eight studies reported 58 evaluations of antigen tests. Estimates of sensitivity varied considerably between studies. There were differences between symptomatic (72.0%, 95% CI 63.7% to 79.0%; 37 evaluations; 15530 samples, 4410 cases) and asymptomatic participants (58.1%, 95% CI 40.2% to 74.1%; 12 evaluations; 1581 samples, 295 cases). Average sensitivity was higher in the first week after symptom onset (78.3%, 95% CI 71.1% to 84.1%; 26 evaluations; 5769 samples, 2320 cases) than in the second week of symptoms (51.0%, 95% CI 40.8% to 61.0%; 22 evaluations; 935 samples, 692 cases). Sensitivity was high in those with cycle threshold (Ct) values on PCR ≤25 (94.5%, 95% CI 91.0% to 96.7%; 36 evaluations; 2613 cases) compared to those with Ct values >25 (40.7%, 95% CI 31.8% to 50.3%; 36 evaluations; 2632 cases). Sensitivity varied between brands. Using data from instructions for use (IFU) compliant evaluations in symptomatic participants, summary sensitivities ranged from 34.1% (95% CI 29.7% to 38.8%; Coris Bioconcept) to 88.1% (95% CI 84.2% to 91.1%; SD Biosensor STANDARD Q). Average specificities were high in symptomatic and asymptomatic participants, and for most brands (overall summary specificity 99.6%, 95% CI 99.0% to 99.8%). At 5% prevalence using data for the most sensitive assays in symptomatic people (SD Biosensor STANDARD Q and Abbott Panbio), positive predictive values (PPVs) of 84% to 90% mean that between 1 in 10 and 1 in 6 positive results will be a false positive, and between 1 in 4 and 1 in 8 cases will be missed. At 0.5% prevalence applying the same tests in asymptomatic people would result in PPVs of 11% to 28% meaning that between 7 in 10 and 9 in 10 positive results will be false positives, and between 1 in 2 and 1 in 3 cases will be missed. No studies assessed the accuracy of repeated lateral flow testing or self-testing. Rapid molecular assays Thirty studies reported 33 evaluations of five different rapid molecular tests. Sensitivities varied according to test brand. Most of the data relate to the ID NOW and Xpert Xpress assays. Using data from evaluations following the manufacturer's instructions for use, the average sensitivity of ID NOW was 73.0% (95% CI 66.8% to 78.4%) and average specificity 99.7% (95% CI 98.7% to 99.9%; 4 evaluations; 812 samples, 222 cases). For Xpert Xpress, the average sensitivity was 100% (95% CI 88.1% to 100%) and average specificity 97.2% (95% CI 89.4% to 99.3%; 2 evaluations; 100 samples, 29 cases). Insufficient data were available to investigate the effect of symptom status or time after symptom onset. AUTHORS' CONCLUSIONS: Antigen tests vary in sensitivity. In people with signs and symptoms of COVID-19, sensitivities are highest in the first week of illness when viral loads are higher. The assays shown to meet appropriate criteria, such as WHO's priority target product profiles for COVID-19 diagnostics ('acceptable' sensitivity ≥ 80% and specificity ≥ 97%), can be considered as a replacement for laboratory-based RT-PCR when immediate decisions about patient care must be made, or where RT-PCR cannot be delivered in a timely manner. Positive predictive values suggest that confirmatory testing of those with positive results may be considered in low prevalence settings. Due to the variable sensitivity of antigen tests, people who test negative may still be infected. Evidence for testing in asymptomatic cohorts was limited. Test accuracy studies cannot adequately assess the ability of antigen tests to differentiate those who are infectious and require isolation from those who pose no risk, as there is no reference standard for infectiousness. A small number of molecular tests showed high accuracy and may be suitable alternatives to RT-PCR. However, further evaluations of the tests in settings as they are intended to be used are required to fully establish performance in practice. Several important studies in asymptomatic individuals have been reported since the close of our search and will be incorporated at the next update of this review. Comparative studies of antigen tests in their intended use settings and according to test operator (including self-testing) are required.


Asunto(s)
Antígenos Virales/análisis , /diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Sistemas de Atención de Punto , /inmunología , Adulto , Infecciones Asintomáticas , Sesgo , Niño , Estudios de Cohortes , Reacciones Falso Negativas , Reacciones Falso Positivas , Humanos , Técnicas de Diagnóstico Molecular/normas , Valor Predictivo de las Pruebas , Estándares de Referencia , Sensibilidad y Especificidad
13.
Orv Hetil ; 162(13): 504-513, 2021 03 28.
Artículo en Húngaro | MEDLINE | ID: mdl-33774601

RESUMEN

Összefoglaló. Bevezetés: A tumorsebészetben a malnutritio független rizikófaktor. A kockázatcsökkentés egyik fontos eleme a perioperatív tápláltsági állapot felmérésén alapuló klinikai táplálás. Az irodalomban jól dokumentált az idoben végzett rizikószurés fontossága, de ennek módja, különösen hazai környezetben, kidolgozatlanabb. Célkituzés: A malnutritio szempontjából esendobb csoportot alkotó onkológiai sebészeti betegek azonosíthatóságának igazolása, a szurési metódus vizsgálata. Módszer: 2016. október és 2018. november között öt kórcsoportban (emlo, máj, pancreas, mellkas, gyomor-bél rendszer) az igazolt vagy gyanított malignitás, illetve gyulladásos bélbetegség miatt mutétre váró betegeket telemedicina-módszerrel kerestük fel. A rizikócsoportokat (nincs rizikó - alultápláltság valószínusítheto - súlyos alultápláltság) a sebész és dietetikus által közösen vezetett 'Nutritional Risk Score 2002' (NRS 2002) szuro pontrendszerrel állapítottuk meg. Az NRS 2002 pontértékeket a posztoperatív lefolyással vetettük össze (kórházi tartózkodás, 30 napon belüli szövodmények Clavien-Dindo szerinti osztályozása). Prospektív vizsgálatunkban 1556 beteg szerepel. Eredmények: Az emlosebészeti betegek (n = 314) 95,2%-a rizikómentes. A májreszekcióra várók (n = 79) 43%-a valószínuleg vagy biztosan alultáplált. A hasnyálmirigymutétre elojegyzett betegek (n = 122) 81,2%-a emelt rizikójú. A kuratív célú pancreasreszekción átesett betegek pontértéke alacsonyabb, mint a palliatív mutétben részesüloké (p>0,05). A tüdoreszekcióra váró (n = 219) betegeknél 40,7% került emelt rizikócsoportba. Az emelkedett NRS 2002 érték magasabb szövodményaránnyal járt (p<0,05). Béltraktust érinto mutétek (n = 822) esetén a betegek 71,2%-a valószínuleg vagy biztosan súlyosan alultáplált. Az elorehaladott tumorok és a szövodmények egyaránt eros összefüggést mutattak az NRS 2002 értékkel (p<0,01). Következtetés: Az NRS 2002 szuromódszer prediktív értékkel bír mind a tumorstádium, mind a szövodmények tekintetében. Módszerünkkel idoben felismerheto a fokozott rizikót jelento betegcsoport, így a pontérték alapján célzott mesterséges táplálás tervezheto. Orv Hetil. 2021; 162(13): 504-513. INTRODUCTION: Malnutrition is an independent risk factor in oncologic surgery. Perioperative screening and aimed clinical nutrition are key elements in risk reduction. The importance of timely screening has been well published, but its method is underdeveloped, especially in Hungary. OBJECTIVE: Evaluation of a malnutrition screening method to identify patients at risk in oncologic surgery. METHOD: Patients were enrolled from October 2016 to November 2018 in five groups (breast, liver, pancreas, thoracic and gastrointestinal surgery). All patients awaiting surgery for suspected or proven malignancy or for inflammatory bowel disease were screened preoperatively via telephone (telemedicine). Probability for malnutrition (no risk - suspicion for malnutrition - severe malnutrition) was jointly assessed by surgeon and dietitian using Nutritional Risk Score 2002 (NRS 2002). Screening results were compared to the postoperative course (including length of stay and 30-day morbidity/mortality using Clavien-Dindo classification). A total of 1556 patients were identified prospectively. RESULTS: 95.2% of breast surgery patients (n = 314) were not at risk. Malnutrition was suspected or detected in 43% of patients awaiting liver resection (n = 79). Increased risk is present in 81.2% of pancreatic surgery cases (n = 122). Pancreas resections with curative intent were associated with lower scores than in palliative operations (p>0.05). 40.7% of the 219 patients scheduled for lung resection had increased malnutrition risk. Higher NRS 2002 resulted in increased morbidity rate (p<0.05). Surgery on the intestines was performed on 822 cases. 71.2% of them had suspected or severe malnutrition. Presence of advanced cancer and complication rate showed strong relations with increased NRS 2002 (p<0.01). CONCLUSION: Screening with NRS 2002 has predictive value on both tumor stage and complications. Our method is sound to identify patients at malnutrition risk in time, and thus an aimed clinical nutrition therapy can be planned. Orv Hetil. 2021; 162(13): 504-513.


Asunto(s)
Desnutrición , Tamizaje Masivo , Neoplasias , Atención Perioperativa , Femenino , Humanos , Hungría , Desnutrición/diagnóstico , Tamizaje Masivo/métodos , Neoplasias/cirugía , Valor Predictivo de las Pruebas , Factores de Riesgo
14.
Medicine (Baltimore) ; 100(12): e25307, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761733

RESUMEN

ABSTRACT: In 2020, the new type of coronal pneumonitis became a pandemic in the world, and has firstly been reported in Wuhan, China. Chest CT is a vital component in the diagnostic algorithm for patients with suspected or confirmed COVID-19 infection. Therefore, it is necessary to conduct automatic and accurate detection of COVID-19 by chest CT.The clinical classification of patients with COVID-19 pneumonia was predicted by Radiomics using chest CT.From the COVID-19 cases in our institution, 136 moderate patients and 83 severe patients were screened, and their clinical and laboratory data on admission were collected for statistical analysis. Initial CT Radiomics were modeled by automatic machine learning, and diagnostic performance was evaluated according to AUC, TPR, TNR, PPV and NPV of the subjects. At the same time, the initial CT main features of the two groups were analyzed semi-quantitatively, and the results were statistically analyzed.There was a statistical difference in age between the moderate group and the severe group. The model cohort showed TPR 96.9%, TNR 99.1%, PPV98.4%, NPV98.2%, and AUC 0.98. The test cohort showed TPR 94.4%, TNR100%, PPV100%, NPV96.2%, and AUC 0.97. There was statistical difference between the two groups with grade 1 score (P = .001), the AUC of grade 1 score, grade 2 score, grade 3 score and CT score were 0.619, 0.519, 0.478 and 0.548, respectively.Radiomics' Auto ML model was built by CT image of initial COVID -19 pneumonia, and it proved to be effectively used to predict the clinical classification of COVID-19 pneumonia. CT features have limited ability to predict the clinical typing of Covid-19 pneumonia.


Asunto(s)
/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Aprendizaje Automático , Tomografía Computarizada por Rayos X/métodos , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Índice de Severidad de la Enfermedad
15.
Biomed Res Int ; 2021: 6696357, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33778081

RESUMEN

Background: Sedentary lifestyle and work from home schedules due to the ongoing COVID-19 pandemic in 2020 have caused a significant rise in obesity across adults. With limited visits to the doctors during this period to avoid possible infections, there is currently no way to measure or track obesity. Methods: We reviewed the literature on relationships between obesity and facial features, in white, black, hispanic-latino, and Korean populations and validated them against a cohort of Indian participants (n = 106). The body mass index (BMI) and waist-to-hip ratio (WHR) were obtained using anthropometric measurements, and body fat mass (BFM), percentage body fat (PBF), and visceral fat area (VFA) were measured using body composition analysis. Facial pictures were also collected and processed to characterize facial geometry. Regression analysis was conducted to determine correlations between body fat parameters and facial model parameters. Results: Lower facial geometry was highly correlated with BMI (R 2 = 0.77) followed by PBF (R 2 = 0.72), VFA (R 2 = 0.65), WHR (R 2 = 0.60), BFM (R 2 = 0.59), and weight (R 2 = 0.54). Conclusions: The ability to predict obesity using facial images through mobile application or telemedicine can help with early diagnosis and timely medical intervention for people with obesity during the pandemic.


Asunto(s)
Antropometría/métodos , /epidemiología , Obesidad/diagnóstico , Adulto , Composición Corporal , Índice de Masa Corporal , Peso Corporal , Reconocimiento Facial/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/metabolismo , Pandemias , Valor Predictivo de las Pruebas , Pronóstico , Factores de Riesgo , Circunferencia de la Cintura , Relación Cintura-Cadera
16.
Medicine (Baltimore) ; 100(11): e24476, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725934

RESUMEN

ABSTRACT: The platelet-albumin-bilirubin (PALBI) grade plays critical role in evaluating liver function. However, the change of PALBI grade from the preoperative to postoperative period in predicting patient outcomes after hepatectomy remains unclear.A total of 489 HCC patients who underwent hepatectomy in West China Hospital between January, 2010 and June, 2016 were analyzed retrospectively.ΔPALBI grade was calculated by PALBI grade at the first postoperative month - preoperative PALBI grade.ΔPALBI >0 was considered as stable; otherwise, worse PALBI grade was considered. Kaplan- Meier method and Cox proportional hazard regression analyses were performed for survival analysis. Prognostic model was constructed by nomogram method.Three hundred forty two patients and 147 patients were classified into training group and validation group, respectively. In the training group, results from Cox model suggested that worse PALBI grade (HR 1.328, 95% CI 1.010-1.746, P = .042), tumor size (HR 1.460, 95% CI 1.058-2.015, P = .021), microvascular invasion (MVI, HR 1.802, 95% CI 1.205-2.695, P < .001), and high alpha-fetoprotein level (AFP, HR 1.364, 95% CI 1.044-1.781, P = .023) negatively influenced postoperative recurrence. Similarly, worse PALBI grade (HR 1.403, 95% CI 1.020-1.930, P = .038), tumor size (HR 1.708, 95% CI 1.157-2.520, P = .007), MVI (HR 1.914, 95% CI 1.375-2.663, P < .001), and presence of cirrhosis (HR 1.773, 95% CI 1.226-2.564, P = .002) had negatively impacts on overall survival. Patients with worse PALBI grade had worse recurrence free (RFS) and overall survival (OS). The prognostic model incorporating the change of PALBI grade constructed in training group and tested in the validation group could perform well in predicting the outcomes.Postoperative change of PALBI grade was independently risk factor related with prognosis. Prognostic model incorporating the change of PALBI grade might be a useful index to predict the prognosis of HCC patients following hepatectomy.


Asunto(s)
Bilirrubina/sangre , Carcinoma Hepatocelular/sangre , Hepatectomía/mortalidad , Pruebas de Función Hepática/métodos , Neoplasias Hepáticas/sangre , Recuento de Plaquetas , Albúmina Sérica/análisis , Adulto , Anciano , Biomarcadores de Tumor , Plaquetas , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/cirugía , Femenino , Humanos , Estimación de Kaplan-Meier , Cirrosis Hepática/sangre , Cirrosis Hepática/etiología , Cirrosis Hepática/mortalidad , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Nomogramas , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Periodo Preoperatorio , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Análisis de Supervivencia
17.
Biomed Environ Sci ; 34(2): 163-169, 2021 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-33685575

RESUMEN

Objective: This study aims to investigate the correlation of an ultrasonic scoring system with intraoperative blood loss (IBL) in placenta accreta spectrum (PAS) disorders. Methods: A retrospective cohort study was conducted between January 2015 and November 2019. Clinical data for patients with PAS have been obtained from medical records. Generalized additive models were used to explore the nonlinear relationships between ultrasonic scores and IBL. Logistic regressions were used to determine the differences in the risk of IBL ≥ 1,500 mL among groups with different ultrasonic scores. Results: A total of 332 patients participated in the analysis. Generalized additive models showed a significant positive correlation between score and blood loss. The amount of IBL was increased due to the rise in the ultrasonic score. All cases were divided into three groups according to the scores (low score group: ≤ 6 points, n = 147; median score group: 7-9 points, n = 126; and high score group: ≥ 10 points, n = 59). Compared with the low score group, the high score group showed a higher risk of IBL ≥ 1,500 mL [odds ratio, 15.09; 95% confidence interval (3.85, 59.19); P ≤ 0.001] after a multivariable adjustment. Conclusions: The risk of blood loss equal to or greater than 1,500 mL increases further when ultrasonic score greater than or equal to 10 points, the preparation for transfusion and referral mechanism should be considered.


Asunto(s)
Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Placenta Accreta/diagnóstico por imagen , Ultrasonografía Prenatal/estadística & datos numéricos , Adulto , Pérdida de Sangre Quirúrgica/prevención & control , Femenino , Edad Gestacional , Humanos , Modelos Logísticos , Placenta Accreta/cirugía , Valor Predictivo de las Pruebas , Embarazo , Estudios Retrospectivos , Riesgo
18.
Isr Med Assoc J ; 23(3): 153-159, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33734627

RESUMEN

BACKGROUND: Immune cell counts in blood in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may be useful prognostic biomarkers of disease severity, mortality, and response to treatment. OBJECTIVES: To analyze sub-populations of lymphocytes at hospital admission in survivors and deceased from severe pneumonia due to coronavirus disease-2019 (COVID-19). METHODS: We conducted a cross-sectional study of healthcare workers confirmed with SARS-CoV-2 in convalescents (control group) and healthy controls (HC) diagnosed with severe COVID-19. Serum samples were taken at hospital admission and after recovery. Serum samples ≥ 25 days after onset of symptoms were analyzed for lymphocyte subpopulations through flow cytometry. Descriptive statistics, Kruskall-Wallis test, receiver operating characteristic curve, calculation of sensitivity, specificity, predictive values, and Kaplan-Meier analysis were performed. RESULTS: We included 337 patients: 120 HC, 127 convalescents, and 90 severe COVID-19 disease patients (50 survivors, 40 deceased). For T cells, total lymphocytes ≥ 800/µL, CD3+ ≥ 400/µL, CD4+ ≥ 180/µL, CD8+ ≥ 150/µL, B cells CD19+ ≥ 80/µL, and NK ≥ 34/µL subsets were associated with survival in severe COVID-19 disease patients. All subtypes of lymphocytes had higher concentrations in survivors than deceased, but similar between HC and convalescents. Leukocytes ≥ 10.150/µL or neutrophils ≥ 10,000/µL were associated with increased mortality. The neutrophil-to-lymphocyte ratio (NLR) ≥ 8.5 increased the probability of death in severe COVID-19 (odds ratio 11.68). CONCLUSIONS: Total lymphocytes; NLR; and levels of CD3+, CD4+, CD8+, and NK cells are useful as biomarkers of survival or mortality in severe COVID-19 disease and commonly reach normal levels in convalescents.


Asunto(s)
Linfocitos T CD4-Positivos/patología , Linfocitos T CD8-positivos/patología , Linfopenia , Neutrófilos/patología , Biomarcadores/sangre , /diagnóstico , /terapia , Correlación de Datos , Estudios Transversales , Femenino , Humanos , Estimación de Kaplan-Meier , Células Asesinas Naturales/patología , Recuento de Leucocitos/métodos , Linfopenia/sangre , Linfopenia/diagnóstico , Linfopenia/etiología , Masculino , México/epidemiología , Persona de Mediana Edad , Mortalidad , Valor Predictivo de las Pruebas , Evaluación de Síntomas/métodos
19.
Medicine (Baltimore) ; 100(12): e25118, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761675

RESUMEN

ABSTRACT: The aim was to examine whether clinical seizures and amplitude-integrated electroencephalogram (aEEG) patterns in infants with hypoxic ischemic encephalopathy (HIE) can predict the extent of brain injury on magnetic resonance images (MRI) and the long-term neurodevelopmental outcomes at 18∼24 months of age.HIE infants who underwent therapeutic hypothermia (TH) between June 2014 and March 2017 were included in this study. Infants with clinical seizure were analyzed for aEEG patterns and the extent of brain injury on MRI findings. Clinical seizure, aEEG, and brain MRI were assessed and compared with neurodevelopmental outcomes at 18∼24 months of age.Among the 97 HIE infants enrolled in this study with brain MRI scans, 78 (73.1%) TH-treated HIE infants exhibited clinical seizures. More abnormalities on a EEGs and more significant use of first and second antiepileptic drugs (AEDs) were significantly higher in the clinical-seizure group with longer hospitalized days. At a corrected 18 to 24 months of age, HIE infants in the clinical-seizure group with more extension of injury lesions on diffusion-weighted MRI scans exhibited significantly more delayed neurodevelopment. A risk factor analysis indicated that male infants who stayed in the hospital for more than 11 days were at a higher risk of having clinical seizures. The lesion size in MRI greater than 37 pixels was a risk factor with an 81.8% accuracy.Seizures in HIE infants may predict abnormal brain MRI scans and abnormal neurodevelopment at 18 to 24 months of age.


Asunto(s)
Hipoxia-Isquemia Encefálica/complicaciones , Hipoxia-Isquemia Encefálica/diagnóstico por imagen , Imagen por Resonancia Magnética , Neuroimagen , Convulsiones/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Encéfalo/crecimiento & desarrollo , Desarrollo Infantil , Preescolar , Electroencefalografía , Análisis Factorial , Femenino , Humanos , Lactante , Recién Nacido , Tiempo de Internación , Masculino , Trastornos del Neurodesarrollo/diagnóstico por imagen , Trastornos del Neurodesarrollo/etiología , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Convulsiones/etiología , Factores Sexuales
20.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 128-132, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33666925

RESUMEN

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is an ongoing global pandemic with over 23 million associated cases and 800,000 associated deaths. There is a surplus of proposed predictive models (n>145) for COVID-19 that have emerged in academic literature; however, many of these predictive models have proven unreliable or biased.1 Several studies have looked at Google Trends data as a possible predictive tool in the last months.2-12 In this retrospective study, we looked at the predictive value of the Google Trends Tool as it applies to COVID-19 Cases and Reported Onset of Symptoms in the US. We looked back at Google Trends data for search interest of common COVID-19 search terms: "coronavirus" and "covid-19" from January 2020 through mid-June 2020 and compared that data to Centers for Disease Control (CDC) data on COVID-19 Cases Reported and Reported Date of Initial Onset of Symptoms.13 Google Trends is a free online tool that allows a user to quantify the search interest for a keyword or phrase over time.14 Significant strong positive correlation was found between CDC Reported Date of Initial Symptoms for Cases data and Search Interest for both terms "covid-19" and "coronavirus." Google Trends is a free and easy to access tool that may have utility as a predictive instrument with regards to the current COVID-19 pandemic. The Google Trends Tool may offer new insight and predictive value for medical decision making during current and future outbreaks in near-real time at a very granular level allowing states, cities and military bases to prepare.


Asunto(s)
/epidemiología , Motor de Búsqueda/estadística & datos numéricos , /diagnóstico , Humanos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Estados Unidos/epidemiología
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