Poor Outcome

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Inflammatory markers and poor outcome after stroke: a prospective cohort study and systematic review of interleukin-6.

Inflammatory markers and poor outcome after stroke: a prospective cohort study and systematic review of interleukin-6.

Why Was This Study Done? Many people are left with permanent disabilities after a stroke. An accurate way to predict the likely long-term outcome (prognosis) for individual patients would help clinicians manage their patients and help relatives and patients come to terms with their changed circumstances. Clinicians can get some idea of their patients’ likely outcomes by assessing six simple clinical variables. These include the ability to lift both arms and awareness of the present situation. But could the inclusion of additional variables improve the predictive power of this simple prognostic model? There is some evidence that high levels in the blood of inflammatory markers (for example, interleukin-6 and C-reactive protein) are associated with poor outcomes after stroke— inflammation is the body’s response to infection and to damage. In this prospective cohort study, the researchers investigate whether inflammatory markers are associated with poor outcome after stroke and whether the addition of these markers to the six-variable prognostic model improves its predictive power. Prospective cohort studies enroll a group of participants and follow their subsequent progress. What Did the Researchers Do and Find? The researchers recruited 844 patients who had had a stroke (mainly mild ischemic strokes) in Edinburgh. Each patient was assessed soon after the stroke by a clinician and blood was taken for the measurement of inflammatory markers. Six months after the stroke, the patient or their relatives completed a postal questionnaire that assessed their progress. Information about patient deaths was obtained from the General Register Office for Scotland. Dependency on others for the activities of daily life or dying was recorded as a poor outcome. In their statistical analysis of these data, the researchers found that raised levels of several inflammatory
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Genomic signatures predict poor outcome in undifferentiated pleomorphic sarcomas and leiomyosarcomas.

Genomic signatures predict poor outcome in undifferentiated pleomorphic sarcomas and leiomyosarcomas.

Undifferentiated high-grade pleomorphic sarcomas (UPSs) display aggressive clinical behavior and frequently develop local recurrence and distant metastasis. Because these sarcomas often share similar morphological patterns with other tumors, particularly leiomyosarcomas (LMSs), classification by exclusion is frequently used. In this study, array-based comparative genomic hybridization (array CGH) was used to analyze 20 UPS and 17 LMS samples from untreated patients. The LMS samples presented a lower frequency of genomic alterations compared with the UPS samples. The most frequently altered UPS regions involved gains at 20q13.33 and 7q22.1 and losses at 3p26.3. Gains at 8q24.3 and 19q13.12 and losses at 9p21.3 were frequently detected in the LMS samples. Of these regions, gains at 1q21.3, 11q12.2-q12.3, 16p11.2, and 19q13.12 were significantly associated with reduced overall survival times in LMS patients. A multivariate analysis revealed that gains at 1q21.3 were an independent prognostic marker of shorter survival times in LMS patients (HR = 13.76; P = 0.019). Although the copy number profiles of the UPS and LMS samples could not be distinguished using unsupervised hierarchical clustering analysis, one of the three clusters presented cases associated with poor prognostic outcome (P = 0.022). A relative copy number analysis for the ARNT, SLC27A3, and PBXIP1 genes was performed using quantitative real-time PCR in 11 LMS and 16 UPS samples. Gains at 1q21-q22 were observed in both tumor types, particularly in the UPS samples. These findings provide strong evidence for the existence of a genomic signature to predict poor outcome in a subset of UPS and LMS patients.
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Prediction of poor outcome in patients with acute liver failure-systematic review of prediction models.

Prediction of poor outcome in patients with acute liver failure-systematic review of prediction models.

This systematic review provides an overview of models for prediction of poor outcome in patients with acute liver failure. These prognostic models were developed to support clinicians’ decisions, but they should be improved before being clinically useful. Future studies could be improved by paying more attention to (internal) validation, the inclusion of model calibration aspects, better consideration of the transplantation patient group, better reporting and handling of missing data, use of absolute risk measures, explicit considerations for considering and selecting predictors, the use of a more extensive set of reference models, and the inclusion of continuous variables without categorizing them, as well as clear reporting on the study design. It is hoped that the results of this review can be useful for developers of future prognostic models for ALF patients.
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Seven-year follow-up of a juvenile female with papillary thyroid carcinoma with poor outcome, BRAF mutation and loss of expression of iodine-metabolizing genes

Seven-year follow-up of a juvenile female with papillary thyroid carcinoma with poor outcome, BRAF mutation and loss of expression of iodine-metabolizing genes

T he activating point mutation V600E in exon 15 of BRAF gene is the most common and specifi c ge- netic event in papillary thyroid carcinomas (PTC) (1,2). It has been suggested that BRAF V600E mutation is a prognostic biomarker that predicts poor outcome, as early recurrences are more frequent, tumors are less di- fferentiated and have a lower survival rate (3-5). Some groups have suggested that its impact on clinical outco- me may be associated with reduced expression of key genes involved in iodine metabolism 6. In fact, high risk

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Early prediction of poor outcome in patients with acute asthma in the emergency room

Early prediction of poor outcome in patients with acute asthma in the emergency room

monary functional factor assessed during the first hour of management in the ER could adequately predict the outcome of acute epi- sodes. Previous studies have suggested that a multifactorial assessment of patients with acute asthma may provide the key to achiev- ing this goal (8). So, we proposed an index score composed of two variables which are commonly and easily measured in the as- sessment of patients with acute asthma. De- spite our efforts, wide overlap between good responders and poor responders was ob- served, with a predictor index score of 1. On the other hand, a predictor index score of 0 suggested that the patient should be consid- ered for discharge, while an index score of 2 suggested that the patient should be consid- ered for prompt hospitalization. The fact that a substantial proportion of our patients had an index score of 1 emphasizes the need for additional evaluation of clinical data and lung function in predicting the post-discharge course and the need for admission to hospital. Previous studies have demonstrated that the failure of initial therapy to improve expi- ratory flow predicts a more severe course and the need for hospitalization (15-17).
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A simplified minimal residual disease polymerase chain reaction method at early treatment points can stratify children with acute lymphoblastic leukemia into good and poor outcome groups

A simplified minimal residual disease polymerase chain reaction method at early treatment points can stratify children with acute lymphoblastic leukemia into good and poor outcome groups

With the technique used, MRD was detected on day 14 and day 28 in 55/210 (26.2%) and 29/220 (13.2%) of cases, respectively. Only one patient with MRD detected on day 28 was negative on day 14. The clinical and bio- logical variables that usually predict a poor response to treatment were significantly associated with the detec- tion of MRD on days 14 and 28 of induction therapy (Table 2). Patient’s age, presence of cerebrospinal fluid infiltrate at diagnosis, or TEL/AML1 positivity were not associated with MRD data on day 14. Likewise age, risk group at diagnosis, immunophenotype, or TEL/AML1 positivity were not associated with MRD on day 28. From 201 non-infant patients analyzed by RT-PCR, five had the translocation t(9;22) and only two the t(4;11). Although these patients had a higher incidence of MRD on day 14 (5/7 patients MRD positive, 71.4%) and on day 28 (4/7 patients MRD positive, 57.1%), the associa- tion of MRD and event-free survival remained statistical- ly significant for all time points in the rest of the cohort after the Philadelphia chromosome-positive and MLL- positive patients were excluded (data not shown) due to the small number of patients.
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Epidemiology and predictors of a poor outcome in elderly patients with candidemia

Epidemiology and predictors of a poor outcome in elderly patients with candidemia

This study has some important limitations, the most significant being its retrospective nature. While all data had been collected prospectively, some variables could not be explored because of missing data. These included clinical manifestations of infection (hypotension and hypo- and hyperthermia, among others), the doses of corticosteroids, the APACHE II score (available for only 220 patients), and the timing of some interventions such as CVC removal, which hampered an analysis of the effect of CVC removal on the outcome. 37

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Maria Vitória Assumpção Mourão

Maria Vitória Assumpção Mourão

The reduction of albumin level, as observed in our study, has been associated with the severity of VL only in a study in Tunisia (Abdelmoula et al. 2003). Oedema and malnutrition, which are related to hypoalbuminae- mia and are associated with higher lethality (Collin et al. 2004, Rey et al. 2005), were not identified as risk fac- tors for poor outcome in this study. Therefore, once the change in albumin levels most likely precedes the clini- cal manifestations of malnutrition and oedema, monitor- ing of albumin levels may be relevant for early identifi- cation of potentially severe cases.
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Role of echocardiography in diagnosis of pulmonary hypertension

Role of echocardiography in diagnosis of pulmonary hypertension

Transthoracic echocardiography can give several para- meters which correlate with right heart haemodynamics, and should be performed in a case of suspected PH. Several parameters are important for estimation of the RV function, which can be reason for poor outcome: right atrial and ventricular dimensions and volumes, functional area changes, tricuspid annular plane systolic excursion (TAPSE), myocardial performance index, infe- rior vena cava size and collapsibility, S velocity estimat- ed by Tissue Doppler Imaging, and additional informa- tion obtained from the advance echocardiograpic tech- niques, like strain, strain rate, three-dimensional echo- cardiography. Estimation of PH based on Doppler echo- cardiography measurements is not suitable for screen- ing of mild, asymptomatic PH. Echocardiography can be recommended as a screening tool for specific diseases, follow up PH, and assessment when right heart catheter- ization is indicated.
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Arq. NeuroPsiquiatr.  vol.72 número11

Arq. NeuroPsiquiatr. vol.72 número11

Aging is a major risk factor for poor outcome in patients with ruptured or unruptured intracranial aneurysms (IA) submitted to treatment. It impairs several physiologic patterns related to cerebrovascular hemodynamics and homeostasis. Objective: Evaluate clinical, radiological patterns and prognostic factors of subarachnoid hemorrhage (SAH) patients according to age. Method: Three hundred and eighty nine patients with aneurismal SAH from a Brazilian tertiary institution (Hospital do Servidor Público Estadual de São Paulo) were consecutively evaluated from 2002 to 2012 according to Fisher and Hunt Hess classifications and Glasgow Outcome Scale. Results: There was statistically significant association of age with impaired clinical, radiological presentation and outcomes in cases of SAH. Conclusion: Natural course of SAH is worse in elderly patients and thus, proper recognition of the profile of such patients and their outcome is necessary to propose standard treatment.
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Braz. j. .  vol.77 número1 en v77n1a10

Braz. j. . vol.77 número1 en v77n1a10

sex predilection. Sinonasal mucosal melanoma tends to have a high rate of locoregional and distant failure and to carry poor outcome after the current treatment and with a median survival of 25.8 months and overall 5-year survival rates of 31%. However, this review shows significant improvement in terms of 5-year survival for recent series compared with previously reported series. Complete surgical excision is the mainstay of definitive therapy for locoregional disease. Postoperative adju- vant radiotherapy improves the locoregional control in patients with sinonasal mucosal melanoma. The impact of adjuvant radiotherapy and chemotherapy on survival remains to be defined.
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LSD1 overexpression is associated with poor prognosis in basal-like breast cancer, and sensitivity to PARP inhibition.

LSD1 overexpression is associated with poor prognosis in basal-like breast cancer, and sensitivity to PARP inhibition.

S1 Fig. High-expression of LSD1 is linked to poor outcome in basal-like breast cancer. Ef- fect of high LSD1 (as defined as values >median) on recurrence free survival (RFS) in all or in specific subtypes of breast cancer are shown (overall breast cancer, n = 3180 (A), basal-like, n = 540 (B), Lumina A, n = 1540 (C), Luminal B, n = 907 (D) and HER2, n = 193 (E)) using pooled data from kmplot.org. High expression of LSD1 transcripts shows significant shorter RFS in all or basal-like breast cancer (p = 0.0015, p = 0.0025, respectively). KMplot divides the data into two groups based on LSD1 expression as compared to the median. P-value was calcu- lated using Gehan-Breslow-Wilcoxon test.
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Arq. NeuroPsiquiatr.  vol.70 número8

Arq. NeuroPsiquiatr. vol.70 número8

Our results show that the evaluation of thumb pain sensation is a valuable prognostic tool in newborns and young infants. Absent thumb pain sensation indicated a poor outcome with good specificity. Lack of specificity is a major concern of Gilbert’s criterion for surgery indica- tion: absent biceps function with three months of age 7,18 .

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Glomerular Immune Deposits Are Predictive of Poor Long-Term Outcome in Patients with Adult Biopsy-Proven Minimal Change Disease: A Cohort Study in Korea.

Glomerular Immune Deposits Are Predictive of Poor Long-Term Outcome in Patients with Adult Biopsy-Proven Minimal Change Disease: A Cohort Study in Korea.

Our study showed the positive rate of glomerular immune deposits in adult MCD patients (23.8%). Consistent with previous studies [1–5], only a few patients progressed to a poor out- come. However, patients with glomerular immune deposits showed a 10 times higher risk for a poor outcome than those who did not have deposits. The reason why glomerular immune deposits are associated with poor outcome in adult MCD patients remains unclear. One possi- ble explanation is the higher rate of non-responders in the positive deposits group than in the negative group. According to Szeto et al., treatment resistance is an independent risk factor for mortality in MCD patients (HR: 5.87, 95% CI: 1.83–18.85, P < 0.001) [27].
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CRITICAL ANALYSIS OF VISUAL OUTCOME IN CLEAR CORNEAL MANUAL SMALL INCISION CATARACT  SURGERY AT EYE CAMPS

CRITICAL ANALYSIS OF VISUAL OUTCOME IN CLEAR CORNEAL MANUAL SMALL INCISION CATARACT SURGERY AT EYE CAMPS

Prospective standardized monitoring of cataract surgical outcomes with regular analysis of the causes of poor outcome is an important tool, which individual ophthalmic surgical teams can use to improve the results of their cataract surgery. The emphasis should be on continuous internal audit over time in order to improve results, rather than on inappropriate comparison of results between canters or surgeons. Routine monitoring of visual outcome of cataract surgery at every hospital will go in a long way to improve both quantity and quality of surgery and thus reduce the substantial amount of burden of blindness on our country.
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Prediction of poor infant growth

Prediction of poor infant growth

Charts showing rates of inadequate weighf gain among 876 members of the study cohort over O-90 days (O-O) and 90-360 days (0-O) relative to three contfnuous variables, these being (A[r]

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A Discourse Touching Provision for the Poor

A Discourse Touching Provision for the Poor

7. By this means the yearly Contributions for the Necessary relief of Poor, that are able to work, and their Families, and those kind of Contributions which in time will be impossible to support the Poor, will be changed into a supply every way more easie for them that are to pay, though at first it may require a more liberal assistance for the raising of the Stocks, and Every way more beneficial and advantageous for the Poor; First, Because they will hereby be educated and inured to a way of Civility and Industry. 2. They will gain a Trade, which will go along with them as the constant support of their lives. 3. The wages that they will gain will be a greater and better support than they can have by any contributions that are able to be assessed for them, for they may be able to gain, Two, Three, Four, Five and Six shillings a Week, for every Person able to work, which is five times more than their weekly or yearly Contributions do or can amount unto, without Exhausting more than the Revenues of the Parishes, wherein these Poor are in many Places: and this shall be demonstrated to the Eye of any that will consider this
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Tradução, adaptação cultural e validação inicial no Brasil da Palliative Outcome...

Tradução, adaptação cultural e validação inicial no Brasil da Palliative Outcome...

Meu nome é Fernanda Ribeiro Correia, sou terapeuta ocupacional e estou realizando uma pesquisa que tem como objetivo fazer a adaptação e validação no Brasil do instrumento de pesquisa Palliative Outcome Scale (POS) (ou “Escala de Resultados de Cuidados Paliativos”), para poder avaliar adequadamente a qualidade de vida da pessoa com doença crônica (câncer ou aids), bem como os resultados do tratamento na visão da própria pessoa e da equipe de saúde. Desta forma, com os resultados deste estudo poderemos identificar quais são as suas necessidades e sofrimentos para conseguir oferecer serviços e intervenções que melhorem a sua qualidade de vida e dos outros pacientes que se encontram na mesma condição. Para isso gostaria de convidá-lo(a) para participar, respondendo a 3 questionários, que não lhe trarão nenhum prejuízo.
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Prevalence of urinary incontinence among the elderly and relationship with physical and mental health indicators

Prevalence of urinary incontinence among the elderly and relationship with physical and mental health indicators

Among the limitations of the present study, we highlight the fact that the association between the types of UI and the health conditions studied was not investigated. There is also the possibility that the individuals of the study were in drug treatment for UI and at the time of data collection did not mention urine leakage. In a cross-sectional study, it is not possible to assess the temporal relationship of UI with functional disability, depression, cognitive deficit and poor/very poor health self-perception. It is suggested that longitudinal surveys are carried out to verify the causal relationship between the variables. It is also worth mentioning that while there is no biological plausibility that UI causes functional disability and cognitive deficit, the relationship of these conditions with incontinence is evident, highlighting the need to evaluate physical and mental health conditions in the practice of care of the elderly with a diagnosis of UI. These are common conditions in primary care and negatively affect the quality of life of the elderly. These findings may support public policies for the elderly population, strategies to prevent UI and its effects on the health of this population and the organization of treatment in primary health care.
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J. Pediatr. (Rio J.)  vol.93 número5

J. Pediatr. (Rio J.) vol.93 número5

In the preterm group, mean time to initiate aEEG monitoring was 5.2 (±1.2) h of life, and pathological trace or DLVP were associated with higher rates of poor early outcome (p = 0.03, PPV 90.9%, NPV 75%, RR = 3.63). Absence of SWC was asso- ciated with poor early outcome (p = 0.019, PPV 75%, NPV 87.5%, RR = 1.53). The results are shown in Table 2. The back- ground activity of patients with poor early outcome changed from normal to pathological aEEG pattern in five patients (38.4%), while in one (7.6%) it changed from pathological to normal aEEG pattern. None of the patients with good early outcome developed pathological aEEG pattern during the period of monitoring. Evolution of aEEG background activity in patients with poor early outcome and good early outcome is shown in Fig. 1.
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